Obituary: Sir John Nabarro

IT WAS John Nabarro's broad concern for "the whole patient" in his or her family and social setting that drew him into diabetes, and through the British Diabetic Association made him such a tireless champion for the diabetes cause.

He led the clinicians and scientists as Chairman of the Medical and Scientific Section of the association, indeed was one of its founder members; later, as Chairman of the association's Executive Committee, he argued and won the patients' case for NHS provision of blood glucose strips and modern syringes and insulins. He fostered the evolution of Diabetes Centres which have so greatly raised the quality of diabetes care in Britain and he promoted the recognition of diabetes as a major national public health problem as well as a personal medical predicament.

Diabetes with its complications of blindness, amputations, kidney failure and heart attacks consumes about 10 per cent of the NHS budget. Nabarro contributed powerfully to the ongoing case that, with modern knowledge, much of the misery of diabetes can be prevented and its long-term costs greatly reduced, given the will and some shorter-term wherewithal to tackle it.

Nabarro was a perfectionist in all he did, making great demands upon himself and expecting a like performance from those working with him. His credentials were excellent and his purposes uncompromising - to do the best for the patients and the issues for which he had responsibility.

In today's jargon, he gave everything he did his "best shot". In the line of duty, he was no easy colleague. The words were few, but the flesh sizzled. To his patients he was a model physician, one who listened, supported and sympathised, encouraged and exhorted, inspired confidence, affection and sometimes awe.

His intelligence, integrity and immense capacity for hard and sometimes defiant work were recognised by his colleagues in many ways. As a leading clinical endocrinologist, he attracted referrals of difficult and unusual problems from all over the country. His personal knowledge and experience were wide and unusually well organised, his coverage of the medical literature quite prodigious.

As a teacher, a role he relished, he was meticulous and accurate with an impish humour and apposite anecdote that made his lessons memorable. The Royal College of Phys-icians and the Royal Society of Medicine elected him to high professional office. For the Department of Health, he undertook the near impossible task of fashioning a scheme to balance better the number of junior training posts and the number of consultant appointments ultimately available to accommodate them - and made a remarkably good job of it.

It was in his "diabetes life" I knew him best, first as a highly focused clinical scientist, one of the group of bright young persons back from the Army and laying the foundations of sound, science-based medicine in the university departments which lived then in such productive symbiosis with the new NHS.

His concern was with how best to correct the severe disturbance in the body's content of water and salts that occurs when diabetes gets out of control, later with methods for measuring the tiny quantities of insulin in the blood. He was above all a clinician and, despite his high specialism, a generalist doctor at heart.

He was also a collector. As he demitted the Chair of the British Diabetic Association I had the pleasant duty of presenting him with a token of our esteem, a postage stamp for his collection. It was not difficult to discover which one to get, a rare "Dutch cover" which all the informed philatelic agencies knew he was after. He was surprised and delighted and proceeded to deliver a crisp, highly informed disquisition on the stamp and its provenance.

He collected and analysed the case records of all of his diabetic patients and produced a masterly summary of almost 7,000 of them after he retired. He was so authoritative as sometimes to seem authoritarian. A senior consultant friend asked me why it was that, when "Nab" talked to him, he still felt like a junior house physician. When he first addressed me by my first name, I really felt that I had arrived.

It was entirely in character that the weekend before his death John Nabarro was in North Yorkshire to deliver a philatelic discourse of high quality for which he had been preparing for some weeks. Though increasingly hard of hearing, he was also able to enjoy his grandson's singing in Ripon Cathedral choir. Soon after he returned home, a massive stroke rendered him unconscious and he died a few hours later in the arms of Joan, his wife, with his family around him.

John David Nunes Nabarro, physician and endocrinologist: born London 21 December 1915; Consultant Physician, Middlesex Hospital 1954- 81 (Emeritus); Kt 1983; married 1948 Joan Cockrell (two sons, two daughters); died London 28 April 1998.