William Stanley Peart: MB BS (London) 1943, FRCP 1974, FRS 1969, KBE 1985, Clinician, Scientist, and Teacher (Born 31 Mar 1922, Died 14 Mar 2019)
2019; Lippincott Williams & Wilkins; Volume: 74; Issue: 6 Linguagem: Inglês
10.1161/hypertensionaha.119.13230
ISSN1524-4563
Autores ResumoHomeHypertensionVol. 74, No. 6William Stanley Peart: MB BS (London) 1943, FRCP 1974, FRS 1969, KBE 1985, Clinician, Scientist, and Teacher (Born 31 Mar 1922, Died 14 Mar 2019) Free AccessObituaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessObituaryPDF/EPUBWilliam Stanley Peart: MB BS (London) 1943, FRCP 1974, FRS 1969, KBE 1985, Clinician, Scientist, and Teacher (Born 31 Mar 1922, Died 14 Mar 2019) Peter Sever Peter SeverPeter Sever Imperial College London, National Heart and Lung Institute, London, United Kingdom Originally published4 Nov 2019https://doi.org/10.1161/HYPERTENSIONAHA.119.13230Hypertension. 2019;74:1226–1228Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: November 4, 2019: Ahead of Print Among the great British clinician scientists of the 20th century, Stanley Peart was a giant. His international fame was based on a remarkable scientific contribution for research on the autonomic nervous system and the renin-angiotensin system—2 systems that play a vital role in the regulation of the circulation and the kidney. He was responsible for demonstrating that noradrenaline was the sympathetic neurotransmitter—the nature of which had eluded scientists for >3 decades and, subsequently, the nature of angiotensin, the key effector peptide hormone of the renin-angiotensin aldosterone system, and its isolation, purification, and sequencing—an outstanding achievement given the limitations imposed by the technologies of the time.Download figureDownload PowerPointHe was a Fellow of the Royal Society and, in 1985, Knighted for his contribution to medicine.Apart from science, as a teacher he was unique. His teaching sessions were command performances and if Oscars could have been be awarded, he would have been a winner. Last (and by no means least), he was one of the finest clinicians I have ever encountered.Born in South Shields, County Durham, he was a Tynesider, whose father was a talented footballer. The family moved several times during his childhood following the career of his father, eventually to London where his father managed Fulham Football Club. Peart transferred to Kings College School Wimbledon, where he excelled in sciences. He was offered a place at the University of Oxford but, because his parents could not afford the fees, he was unable to take up the offer. Serendipity, however, dictated a different career option. He had seen some pamphlets advertising the Moran Scholarship to St Mary's Hospital Medical School. 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. He replied that he could run 100 yards in some fractions of a second faster than his actual performance—an answer which guaranteed him the scholarship, which he accepted.He entered St Mary's in 1938, where medical education revolutionized his life. In the preclinical School, he benefited from a number of excellent teachers, many of whom were active in research—the anatomist Grey, the physiologists Huggett, Greenfield and Fraser and the pharmacologist Stewart. In 1939, with the outbreak of war he was persuaded to continue his medical studies. In 1941, during his clinical course, there were few supervisors, as most had been commissioned for the war effort. This was the time he first came into contact with George Pickering, who had arrived at Mary's in 1939 as Professor of Medicine.In 1943, Pickering chose Peart as his House Physician and, after a period of time on the wards,Pickering advised him to spend a short time in the laboratory with Alexander Fleming, which was Peart's first exposure to research.At the end of his house jobs, Peart was advised to apply for an Medical Research Council studentship, which enabled him to work with Gaddum in Edinburgh in 1946. Gaddum was a shy, gangling figure, awkward in conversation, but a superb mentor. In the department was Martha Vogt, another well known pharmacologist. Challenged to work on sympathin, a substance putatively released from sympathetic nerves, there was uncertainty as to whether this was adrenaline or some other mediator. The question was what actually is released from nerve endings, how could you measure it, and how could you distinguish between adrenaline and other substances released from sympathetic nerve endings, including noradrenaline? The experimental model was a ewe's liver, and the effluent collected used to investigate its effect on various smooth muscle preparations by bioassay. However, Peart realized that a much better experimental model was the perfused spleen, with a rabbit ear as the bioassay for the vasoconstrictor effects of the effluent from the spleen. After a series of painstaking experiments, he realized that this substance could not be adrenaline but was noradrenaline—the nature of splenic sympathin—published in the Journal of Physiology in 1949.During his time in Edinburgh, he married Peggy, a St Mary's nurse, and they lived together in a number of rented apartments in Scotland, including a flat in George Square which, interestingly, sported a portrait of Harvey Cushing on the drawing room wall. During this period of intense research, he also had time to continue his rugby. He played for the University at Murrayfield, and subsequently moved to Edinburgh Wanderers, where he played 7-aside rugby until he sustained an accident in which his jaw was broken.Peart returned to London, and in 1947, following service deferment, he was seconded to the RAF for 2 years. He spent this time at Ely Hospital on the Medical Service, where he was exposed to an enormous amount of general medicine, not only among the RAF personnel, but also in the referrals from local practitioners.In 1952, Pickering was convinced that the future of hypertension research involved the identification of components of the renin-angiotensin aldosterone system which, based on experimental work conducted mainly in the Unites States, appeared to be a major candidate for the pathogenesis of hypertension. The technology involved in investigating the renin-angiotensin aldosterone system was not available in the laboratories at Mary's and Pickering suggested that Peart went to the Medical Research Council laboratories at Mill Hill, where, under the direction of Charles Harington, he was exposed to the future Nobel Laureates, Rodney Porter, and Martin Archer. The challenge was the nature of the blood pressure raising substance, angiotensin, and its purification. His early work involved the developmental of reverse phase chromatography and the ultimate identification by electrophoresis and spectrophotometry of the amino acid sequence of the decapepide angiotensin 1. Much of this work was conducted in collaboration with Don Elliott. The final, now classic paper, was published in Nature in 1956, with a more detailed account in the Biochemical Journal.He left Mill Hill in 1954 to return to the Medical Unit at St Mary's, where he was promoted rapidly by Pickering, to the role of Senior Lecturer. Like many others, he was confronted with the dilemma of whether one should do research or clinical medicine or, indeed, whether it was possible to do both.At about this time, Pickering was planning to move to Oxford with Peart to accompany him; however, he was invited to apply for Pickering's Chair. Although the youngest applicant by far, with co-applicants including Douglas Black and Hugh de Wardener, he was appointed to the post.The Unit had evolved in the direction of Pickering's research in the field of hypertension. When Peart was appointed, he attracted 2 clinicians to the team—Bob Robertson and Jehoyda Brown, both of whom pursued his interest in hypertension, with a continuing focus on how the renin-angiotensin aldosterone system actually worked. The Swiss pharma company, Ciba, had synthesized angiotensin and this was used for exploratory studies in the laboratory to establish its actions. The next challenge was the isolation of renin, the rate limiting step in the activation of the renin-angiotensin aldosterone system. The team traveled regularly to Northumberland, to obtain the kidneys of >1000 rabbits that had been trapped locally. These were brought back to London where they were used to extract the enzyme renin.The Unit attracted visitors from around the world, particularly Australia, Italy and Greece, and the United States. Most of these workers, despite spending much time in the laboratory, would take part in the clinical team on the wards.The interests of the team widened, influenced no less by, Roy Calne, Registrar on the Surgical Unit, and a future internationally renowned transplant surgeon. Ken Porter, a renal histopathologist and James Mowbray, an immunologist, shared a collective view that the team had the experience and wherewithal to start renal transplantation. This was no doubt stimulated by the recent availability of the immunosuppressive agent, azathioprine. The team was also fortunate to have the surgical expertise of Ken Owen and Ian Kenyon. During 1959 and 1960, renal transplantation was established at St Mary's and subsequently, one of the first series of cadaveric renal transplants, was published by the Mary's team.Work on the renin-angiotensin system continued. The similarity of the experimental hypertension reported by Goldblatt, following occlusion of the renal artery, and the genesis of hypertension in the clinic in patients with renal artery stenosis, was obvious. New radiological techniques had been developed for the diagnosis of renal artery stenosis, and the triumvirate of Robertson, Brown, and Lever, together with Peart, were in pursuit of the mediator of the hypertension and, more specifically, the identification of an assay for renin, the rate-limiting enzyme in the activation of the renin-angiotensin system.Hypertension in the early 1960s was considered the poor relation of cardiology—it probably still is—and, in contrast to the enormous national and international cardiology meetings, a small International Hypertension Group of no more than 50 participants, held its first meeting in Northern Italy. Here, such names as Pickering, Page, Manger, Goldblatt, Steggs, and Peart discussed and debated the key issues of the day in hypertension. This embryonic hypertension club has now evolved into an International Society with over 4000 members.In 1965, Brown, Robertson, and Lever left the Medical Unit to establish the first Medical Research Council Unit of Hypertension in Glasgow. Back at St. Mary's, clinical medicine was a major interest of Peart's. He was absorbed by the diagnostic challenges, and there were many similarities in his approach to clinical medicine with those he had formulated from his early days in the laboratory with Gaddum. For every patient, he would generate an hypothesis, largely based on an immaculate history. Examination of the patient and clinical investigation would follow, as part of the process enabling him to reach a diagnosis and solve the problem. More than any other clinician I have ever come across, he regarded talking to the patient as being the most important part of the clinical evaluation. The patient's history, taken over some considerable time, would prompt his first question—what ails this patient? He regarded this, rather than the tentative diagnosis offered by the referring physician, as the fundamental basis from which his initial hypothesis would be generated.He was also one of the first to insist on 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 unique. He held 2 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.Combining research, clinical medicine, and teaching was Peart's forte and an enormous challenge which few will take up.During the 1970s and 1980s, and resulting from his extraordinary achievements, he was invited to Chair the Medical Research Society, a society which was probably responsible for the development of academic medicine in Britain. It was a society of critically minded, senior academics, who met monthly to discuss a broad range of topics. He was appointed to membership of the Medical Research Council, where he chaired several working parties, one of which was responsible for the conduct of the 2 famous Medical Research Council Trials of Mild Hypertension and Hypertension in the Elderly, the outcomes of which have influenced clinical practice and guidelines to the present day.He established joint positions with the London School of Hygiene and Tropical Medicine in collaboration with Geoffrey Rose, a man of enormous talent and integrity—a quiet and unassuming man, deeply religious—in striking contrast to the Director of the Medical Unit! In the 1970s, he became a Wellcome Trustee. The Trust by today's standards was extremely small. It was governed by a few decision makers with rather limited budgets—around £1.5million per year, compared with over £500 million today. The Trustees had considerable influence over the spending in an era when patronage was the rule, and individual trustees could largely dictate the way in which the funds were dispersed.Peart retired in 1987. The members of the unit, arranged a Festschrift for him in his favourite place on the banks of Lake Como. It was a memorable occasion attended by over 100 of his former friends and colleagues. Looking back on his retirement, Peart said one of the most memorable occasions was a party given to him in 1987 on his retirement by a group of surviving renal transplant patients.During his professional lifetime, he had little time for anything outside of the hospital and laboratory. He was fascinated by the history of medicine, particularly in the 19th century. He loved opera, but his indulgence in this activity followed on during his retirement when he had more time. He loved the blood and thunder operas—those with manifestly aggressive actors and singers—Don Giovanni and Tosca were his favourites. He followed sport with interest and was active playing tennis at the weekends and skiing whenever possible.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, throughout his life, must have made, but he was enormously indebted to her devotion. He spent many years of his retirement looking after Peggy as she sadly suffered from the problems of dementia.Stanley Peart died at the age 96, after a long illness, on March 14, 2019. He was one of the last real professors of medicine—a scientist, a teacher and always a clinician. Many think his legacy is unrivaled in British medicine. Those who followed and were fortunate to have worked with him, remember the brilliant mind, the charisma, the sense of humor and, perhaps, the bow tie and the red socks.Peter SeverJune 2019Peter SeverImperial College LondonNational Heart and Lung InstituteLondon, United Kingdom Previous Back to top Next FiguresReferencesRelatedDetails December 2019Vol 74, Issue 6 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.119.13230PMID: 31680562 Originally publishedNovember 4, 2019 PDF download Advertisement SubjectsACE/Angiotensin Receptors/Renin Angiotensin System
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