Sir Stanley Peart (usually known as ‘Stan’), professor of medicine at St Mary’s Hospital, London, was amongst the great British clinician scientists of the 20th century. He made remarkable scientific contributions to the understanding of the autonomic nervous system and the renin-angiotensin system, which both play a vital role in the regulation of the circulation and the kidney. He showed that noradrenaline was the sympathetic neurotransmitter. He then isolated, purified and sequenced angiotensin, the key effector peptide hormone of the renin-angiotensin-aldosterone system, an outstanding achievement given the available technologies of the time. He was a fellow of the Royal Society and was knighted for his contribution to medicine. Apart from science, he was a remarkable teacher, and one of the finest clinicians I have ever encountered.
Born in South Shields, County Durham, his father, John George (‘Jack’) Peart, was a talented footballer. His mother was Margaret Joan Peart née Fraser. The family moved several times during his childhood following the career of his father, eventually to London, where his father managed Fulham Football Club. At King’s College School, Wimbledon Peart excelled in sciences. He had seen advertisements for scholarships to St Mary’s Hospital Medical School and, although never having considered a career in medicine, he went for interview with the dean, Charles Wilson, later to become Lord Moran. Moran’s view, widely known at the time, was that a man who excelled at sport would make a good doctor. Did Peart play rugby? On being told he played on the wing, Moran asked him how fast he could run 100 yards. Peart replied that he could run 100 yards in some fractions of a second faster than his actual performance – an answer which won him a scholarship.
<p>He entered St Mary’s and, despite the outbreak of war, continued his medical studies. During his clinical course, he first came into contact with George Pickering, who had arrived at St Mary’s in 1939 as professor of medicine. In 1943, Pickering chose Peart as his house physician and soon advised him to spend a short time in the laboratory with Sir Alexander Fleming, which was Peart’s first exposure to research.
At the end of his house jobs in 1946 Peart obtained a Medical Research Council studentship to work with the pharmacologists John Gaddum and Marthe Vogt in Edinburgh. The challenge was to identify the sympathetic neurotransmitter, thought by some to be adrenaline. Peart’s experimental model was a perfused spleen, and the vasoconstrictor effects of the effluent were studied in a rabbit ear bioassay. After a series of painstaking experiments, he realised that this substance could not be adrenaline but was noradrenaline, reported in the Journal of Physiology in 1949 (‘The estimation of adrenaline and allied substances in blood.’ J Physiol. 1949 Jun 15;108:467-81).
During his time in Edinburgh, he married Peggy Parkes, a St Mary’s nurse. He also had time to continue his rugby; he played for the university at Murrayfield and subsequently moved to Edinburgh Wanderers, where he played seven-a-side rugby until he sustained an accident in which his jaw was broken.
Peart returned to London and from 1948 carried out his National Service in the RAF for two years. Stationed at Ely, he was exposed to an enormous amount of general medicine among the RAF personnel and the local civilian population.
In 1952, Pickering was convinced that the future of hypertension research involved the identification of components of the renin-angiotensin aldosterone system (RAAS). Pickering sent Peart to the Medical Research Council laboratories at Mill Hill, where, under the direction of Sir Charles Harington, the challenge was the nature of the blood pressure raising substance, angiotensin, and its purification. Peart achieved this (mainly in collaboration with Don Elliott) by reverse phase chromatography followed by electrophoresis and spectrophotometry of the amino acid sequence of the decapeptide angiotensin 1, reported in Nature in 1956 (‘Amino-acid sequence in a hypertensin.’ Nature. 1956 Mar 17;177:527-8).
He left Mill Hill in 1954 to return to the medical unit at St Mary’s, where he was promoted rapidly to senior lecturer. Pickering was planning to move to Oxford with Peart to accompany him, but Peart was invited to apply for Pickering’s chair. Although the youngest applicant by far (and other renowned applicants included Douglas Black and Hugh de Wardener), he was appointed to the post.
Peart attracted excellent researchers to the medical unit – including Ian ‘Bob’ Robertson, Jehoiada Brown and Tony Lever – who pursued his interest in hypertension, investigating how the RAAS actually worked. The next challenge was the isolation of renin, the rate limiting step in RAAS activation. The team travelled regularly to Northumberland, to obtain the kidneys of more than 1,000 rabbits that had been trapped locally. These were brought back to London, where they were used to extract renin and develop an assay for it. In 1965, Brown, Robertson and Lever left the medical unit to establish the first Medical Research Council unit of hypertension in Glasgow.
The interests of the medical unit widened. In 1959, St Mary’s was among the first to establish cadaveric renal transplantation with a notable team including Ken Owen, Richard John ‘Ian’ Kenyon and Roy Calne (surgeons), Ken Porter (a renal histopathologist) and James Mowbray (an immunologist). To support the transplant work a peritoneal dialysis programme was also established, one of the first in the UK.
Clinical medicine continued to be a major interest of Peart’s. He was absorbed by the diagnostic challenges, and there were many similarities in his approaches to clinical medicine and research. For every patient he would generate a hypothesis, largely based on an immaculate history; he regarded talking to the patient as the most important part of the clinical evaluation. Examination of the patient and clinical investigation would follow, enabling him to reach a diagnosis and solve the problem. He was also one of the first to insist upon the importance of clinical audit, which took place during a weekly meeting, and at which each and every patient who had been managed by the medical unit’s team was presented. Management was discussed and emphasis always placed on where mistakes might have been made. As a clinical teacher, Peart was a unique showman. He held two formal teaching sessions a week, in addition to which the students allocated to his firm would be expected to actively participate in his clinical ward rounds.
Successfully combining research, clinical medicine and teaching was Peart’s forte, a challenge now taken up by few others.
During the 1970s and 1980s, Peart increasingly took roles beyond St Mary’s. He was president of the Renal Association from 1971 to 1974. He chaired the Medical Research Society, which played a key role in the development of academic medicine in Britain. He chaired several Medical Research Council working parties, including one responsible for two famous MRC trials, on the treatment of mild hypertension and on the treatment of hypertension in older adults, both of which have influenced clinical practice and guidelines to the present day. He became a Wellcome trustee at a time when it had a limited budget, and in an era when patronage was the rule and individual trustees could largely dictate the way in which funds were dispersed.
Peart retired in 1987. He had a remarkable festschrift held in his favourite place on Lake Como. Looking back on his retirement, Peart said one of the most memorable occasions was a party given to him in 1987 by a group of surviving renal transplant patients.
Retirement at last gave him time to pursue his other interests, including the history of medicine, particularly in the 19th century, and romantic opera. He always followed sport with interest and remained very active, playing tennis and still skiing in his late eighties.
As a family man, he owed an enormous amount to his wife, Peggy. Stan always referred to his own rather selfish existence and the compromises that Peggy must have made throughout his life, and he was enormously indebted to her devotion. He spent many years of his retirement looking after Peggy when she suffered from dementia.
Sir Stanley Peart died age 96, after a long illness. He was one of the last real professors of medicine – a scientist, a teacher and always a clinician. Many believe his legacy is unrivalled in British medicine. Those who followed and were fortunate to have worked with him remember the brilliant mind, the charisma, the sense of humour and, perhaps, the bow tie and the red socks.
[RADAR Institutional repository of Oxford Brookes University Sir Stanley Peart FRS in interview with Dr Max Blythe https://radar.brookes.ac.uk/radar/items/4c192d38-d375-4f61-a932-c6083dd2d8e0/1/ – accessed 12 September 2019; Ham & High 15 March 2019 www.hamhigh.co.uk/news/sir-william-stanley-peart-of-highgate-dies-at-96-1-5956471 – accessed 12 September 2019; The Times 10 April 2019 www.thetimes.co.uk/article/sir-stanley-peart-obituary-03ztx6bb6 – accessed 12 September 2019; The Renal Association William Stanley Peart https://renal.org/history/obituaries/stan-peart/ – accessed 12 September 2019]