Obituary: Professor David Ritchie

Horace David Ritchie, surgeon: born Falkirk 24 September 1920; Professor of Surgery, London University 1964-85 (Emeritus); Director, Surgical Unit, London Hospital 1964-85; Dean, London Hospital Medical College and Dental School 1982-83; married 1953 Jennifer Prentice (three sons; marriage dissolved), 1990 Elizabeth (Peggy) Thompson; died Tenterden, Kent 21 December 1993.

DAVID RITCHIE was perhaps the most brilliant of an outstanding generation of Edinburgh surgeons who were raised under the tutelage of Sir James Learmonth, and who dominated British surgery for the third quarter of this century. He was a complex person, whose true qualities were not apparent at first sight, and whose achievements are still imperfectly perceived by many of his contemporaries and successors.

One of four children of a Falkirk grocer, Ritchie intended to be a Presbyterian minister, and to that end graduated MA with honours in Latin, Greek, and Theology from Glasgow University, but his vocation then changed to medicine, which he studied at Magdalene College, Cambridge, and Edinburgh University, where he qualified in 1947. Four years later, he obtained his fellowship of the Edinburgh College of Surgeons, and then, as a Crichton Research Scholar of the university, began his career in surgical research. With a Medical Research Council Training Scholarship in 1953, he moved to Liverpool, where he married. In 1955, he joined the Department of Surgical Research at the Mayo Clinic, working with John Grindlay, and with two outstanding physiologists, Jesse Bollman and Charles Code. The work that Ritchie did there provided a thesis that later won him a Gold Medal from his Edinburgh Alma Mater. He would have been welcomed on the Mayo staff, but the cash nexus of American medicine was anathema to him, and he returned to

Britain.

Nevertheless, the contact with Charles Code, which ripened into an enduring friendship, was a key event in his life. A mutual interest in the relation of gastric acid secretion to peptic ulcer disease led Ritchie to believe that peptic ulcer surgery, at that time dominated by contradictory surgical dogmas, could be rationalised by attention to, and measurement of, the underlying secretory state. He was also convinced that physiology was an essential part of the training of an academic surgeon, and, in later years, a steady flow of young surgeons travelled from Whitechapel to Code's laboratory in Rochester, Minnesota. Indeed, at the symposium held at Mayo on Code's retirement in 1975, there were more alumni from the London Hospital Medical College than any other institution except the Mayo Clinic

itself.

In 1958, after lectureships at St Andrews and Glasgow, Ritchie entered his final university, joining the London Hospital Medical College, one of the constituent independent medical schools of the federal University of London; in 1964, he was appointed Professor of Surgery and Director of the Surgical Unit. His Department of Experimental Surgery became a hive of activity, where he developed unique expertise in the study of isolated abdominal organs. This was used for the study of gastric acid, and it was his technology that attracted Code, in one of his very rare working excursions away from Mayo, to bring his team for a brief spell of research in Whitechapel in 1971. Ritchie encouraged a succession of able young surgeons in this work, arranging symposia that attracted audiences from all parts of Britain, in which they could display their achievements.

In the early years, he accompanied them to scientific meetings in Britain and abroad as a combination of father figure and congenial host. He travelled widely for a time, and was much in demand as a distinguished guest in France with his ability to lecture and argue in fluent French, albeit modulated by a strong Scots accent.

Increasingly, however, Ritchie's time and energy was devoted to strengthening the medical college and the London (now Royal London) Hospital with which it was intertwined. He was the driving force behind the creation of academic departments of urology, neurosurgery, anaesthesia, transplantation immunology, and gastroenterology in the college, as well as encouraging the development of cardiac and ENT surgery in the hospital. He was a key figure in establishing academic and clinical links with the new nucleus hospital in Newham, bringing the medical culture of Whitechapel to an area of half a million inhabitants. He shared with Sir John Ellis, then Dean of the medical college, a strong belief in extending the influence of academe in a teaching hospital, and when Ellis retired Ritchie seemed to be the logical successor; his nomination as Dean was unopposed. He hesitated before accepting; with the perfect vision of hindsight it might be argued that he made the wrong decision, but he felt that he should respond positively to the strong encouragement from many colleagues.

At that time, 'The London' was still slowly emerging from two centuries of inbreeding, with most staff appointments going to those who had not only trained there, but spent almost all of their working lives within that institution. Ritchie broke the mould by recruiting talent where he could find it. His predecessors as dean had encouraged the preservation of the traditions of a London undergraduate medical school, but, while Ritchie had a deep reverence for universities (as befitted a man who had been trained in three of them), this was expressed as the pursuit and encouragement of excellence in the academic activities of research and teaching, with little time or patience for nostalgia. He wanted the London to be known for what it is, not what it was.

A strong supporter of the Flowers recommendation that the London, St Bartholomew's, and Queen Mary College should merge, he established cordial working relations with the heads of the other two colleges. This aroused the resentment of some 'Old Londoners' who felt that he was destroying traditional values, and they found common cause with the lay governors of the medical college, at that time - but no longer - a cautious and undistinguished group dedicated to the preservation of the status quo. This led to direct confrontation between the Dean and the chairman of the governors, and the development of factions supporting each side.

Ritchie was at a disadvantage here; his political skills lay in covert manipulation, not in open warfare. Moreover, he was both disconcerted and deeply wounded by what he regarded as attacks on his personal integrity. His defence of his position was uncharacteristically lacklustre; he could not believe that old friends seemed to have turned against him. He resigned, and devoted the three years that remained until his retirement to tending his department, shunning contact with those whose behaviour he could neither forget nor forgive.

A decade later, an objective appraisal of Ritchie's achievements is possible. He canvassed many innovations. Sometimes these failed; his ambition for a satellite medical school in continental Europe involved protracted negotiation in, successively, Spain, France and Switzerland, but came to nothing. Of his many successful schemes, two in particular serve as a memorial. He was responsible for setting up a Diploma Course in Sports Medicine, the first of its kind in Britain, which has trained doctors from many countries in the specific skills required to tend sports injuries. The Gastrointestinal Science Research Unit sprang from his ability to dissuade a potential donor from endowing a chair at another college and to deflect the benefaction into building and maintaining a unit in Whitechapel that is now internationally recognised for interdisciplinary research.

But his contribution is wider than this. His advocacy of fusion with Queen Mary College has been vindicated by events. The clinical strength of the Royal London Hospital, recognised by the Tomlinson report, and its research record, reflected in the latest rankings, spring directly from Ritchie's efforts to build an outstanding medical school. For 20 years, he was the driving force for change and improvement, often in the face of much opposition; many of the present staff are not fully aware of the debt that he is owed for transforming an introspective traditional London hospital into a

forward-looking and achieving institution.

As a person, Ritchie seemed to be a mass of contradictions. An apparently extrovert facade concealed a shy, sensitive, and vulnerable individual. Yet, although facets of his Presbyterian upbringing persisted, he greatly enjoyed his contacts, engineered by his friend and colleague Sidney Watkins, with the glitzy world of Formula One racing. He wore his learning lightly, concealing a wide knowledge of music and a love of the classics behind casual Gaelic bonhomie. He was an emotional man, but his approach to problems was analytical and objective. He valued friendship, and demanded - and gave - total commitment; consequently he was sometimes hurt when friends opposed his schemes. To his patients, he mas not only a skilful surgeon but a deeply caring physician. Among undergraduates and postgraduates, he was widely known as one of the editors of 'Bailey and Love' (Bailey and Love's A Short Practice of Surgery), the best-selling of all surgical textbooks. He was liked and respected by London medical students, even though his contact with them progressively diminished; much as he valued and respected teaching, he found little time for it.

Ritchie was intensely proud of his three sons, helping them through difficult phases in their education with personal tuition, and encouraging them in their chosen occupations. He even learnt to ski in middle life so that he could be with them on Alpine holidays. The early years of his retirement, fortified by the piano and the golf course, were marred by two serious illnesses. The second of these seemed likely to prove fatal, but, to the astonishment of his medical attendants, he made a complete recovery. Following this he remarried, and enjoyed three years of rural contentment in Kent before his brief final illness.

(Photograph omitted)