Sir John de David Nunes Nabarro

Obituary: Sir John Nabarro

HARRY KEEN Thursday 14 May 1998

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.

Source: http://www.independent.co.uk/news/obituaries/obituary-sir-john-naba...

http://nabarro.info/getperson.php?personID=I812&tree=Nabarro1

http://nabarro.info/showmedia.php?mediaID=15

http://books.google.com.au/books?id=hJc8afOZV0QC&pg=PA708&lpg=PA708...

Father of David Nabarro:

http://en.wikipedia.org/wiki/David_Nabarro

http://www.davidnabarro.com/?PageID=20

GEDCOM Note

Sir John Nabarro’s career spanned the time when general physicians began to give way to system specialists - he excelled both as a general physician and an endocrinologist. He was at one time chairman of the executive council of the British Diabetic Association, a senior vice-president of the College and chairman of the Joint Consultants Committee, being knighted for this last appointment when he retired.

John’s father was born into a strict Sephardic Jewish family, but his activity in the affairs of the synagogue lapsed and he married a Christian nursing sister whom he met after being appointed as a bacteriologist at the Hospital for Sick Children in Great Ormond Street in 1912. John was a committed Christian and served at one time as the lay vice-chairman of the parochial church council of Christchurch, Lancaster Gate.

Educated at University College School and Oundle, and then University College Medical School, John passed the primary FRCS in 1935, since it could at that time be taken between the second and final MB, and qualified towards the end of 1938, having won most of the scholarships and prizes available, but not the medal for medicine. He started as a house physician to Sir Thomas Lewis [Munk%E2%80%99s Roll, Vol.IV, p.531] at University College Hospital in February 1939 and was about to start a house surgeon’s post when he was called up with the rest of the Territorial Army on 1 September 1939. The brigade to which he was attached remained in and around the City of London in order to set up a reception station for minor injuries (of which there were frustratingly few for him) and then moved to Sussex and Kent, where the threat of invasion was ever present. The resulting tension made morale hard to maintain.

It had been intended to send John’s division directly to Egypt, but plans changed and they ended up in Kirkuk north of Baghdad in the cold and wet winter of 1942. In March 1943, they drove 3,400 miles in 34 days to join the Eighth Army on the road from Tunis to Tripoli, where they stayed until the German surrender on 12 May 1943. John was present at the Salerno landings, Monte Cassino and Anzio, but he was frustrated by working in a divisional headquarters and was worried that he was “forgetting” his medicine, so he applied to transfer to a general hospital in Cairo as a trainee physician under Neville Oswald from Bart’s. Here he saw tuberculosis, malaria, amoebiasis, tropical eosinophilia and an outbreak of infective hepatitis and was struck by the low erythrocyte sedimentation rate (ESR) of hepatitis patients compared to those with malaria. “I was able to show that it was due to a factor in the plasma and that the high ESR of malaria could be reduced to a subnormal level by the addition of bile salts (obtained from the pathology department) in amounts that would be expected in patients with infective hepatitis.”

In January 1945 the then ‘graded’ physician was posted to a general hospital in Haifa, where he remained until December. Lieutenant Colonel Nabarro returned to University College Hospital as an assistant medical registrar in February 1946; he passed the MRCP in May and the MD in July and was appointed resident assistant physician, a post he occupied for two years from 1947. Neither notoriously riotous parties in the mess (one involved dropping a defunct grand piano down three storeys), nor being resident prevented him from marrying Joan Cockrell, a house physician, in 1948.

In 1954 (“after about eight fruitless applications”), John was appointed physician to the Middlesex Hospital. The board of governors there had instituted an Institute of Clinical Research and Experimental Medicine for part-time staff to have facilities for laboratory research, the infrastructure of which the board and its successors (special trustees) supported until 2000. John worked at the Middlesex until he retired from the NHS in 1981 and at the institute in an honorary capacity for another 15 years. The list of those who worked with him constitutes a roll call of endocrinologists worldwide, in whose subsequent careers he took great pride. He actively supported Debra Doniach [Munk%E2%80%99s Roll, Vol.XI, p.160] and Franco Botazzo in their investigations of the auto-immune basis of type-one diabetes and Roger Ekins, who was making important contributions to the development of hormone assay by saturation analysis (more widely known as radio-immunoassay).

John was a caring and conscientious physician. His meticulous record keeping enabled him to document a huge series of patients. He was the author of 160 papers in the peer-reviewed literature. His research contributions were largely in the area of clinical practice, especially the understanding and management of diabetes mellitus. For example, after carefully assessing the electrolyte and fluid deficit that developed in patients with diabetic ketoacidotic coma, John and his colleagues devised a dynamic regimen of replacement that greatly simplified management and later introduced the low dose schedule of intravenous administration of insulin. John was a pioneer in the management of pituitary disease, fostering the development of trans-sphenoidal selective pituitary adenectomy at the Middlesex. He made important contributions to the study of hyperandrogenism in women.

His research expertise attracted many distinguished lectureships and visiting professorial appointments in the UK and Australasia. He was successively Oliver Sharpey and Croonian lecturers at the College, which awarded him its Moxon medal, the John Matheson Shaw lecturer at the Royal College of Physicians in Edinburgh, the 29th Banting memorial lecturer at the British Diabetic association and the first clinical endocrinology lecturer at the Royal Society of Medicine.

John was expert in committees. He chaired all the important ones in the Middlesex Hospital and Medical School and, in 1977, was appointed a representative of the College on the Joint Consultants Committee, of which he was the chairman for five years from 1979. He was knighted for this work. He was prominent in the medical and scientific work of the British Diabetic Association over many years.

As in his clinical practice, John was meticulous in his hobbies, especially in his garden (keeping notes of every plant in its proper place) and philately, being a keen attendee and knowledgeable buyer of stamps (especially 17th century Dutch postmarks) at auctions.

Although not a social person, John had a twinkle in his eye and knew how to switch off on holiday in Scotland where, as in London, he walked for miles with his family. His trademark pipe always close to hand, his sense of humour was sparing but all the more effective for being so. He inspired tremendous respect, but also loyalty and affection.

John’s wife Joan was a physician and they had two sons and two daughters, of whom three became doctors. It would be as a superlative clinician, teacher, researcher and a founder of the specialty of endocrinology for which he would most have liked to be remembered, the true physician-scientist.

C G D Brook

[Brit.med.J.1998,317,1391; The Times 21 May 1998]

(Volume XII, page web)

GEDCOM Source

Ancestry.com Public Member Trees Name: The Generations Network, Inc.; Location: Provo, UT, USA; Date: 2006; @R1@ Database online.

GEDCOM Source

Ancestry.com Public Member Trees Name: The Generations Network, Inc.; Location: Provo, UT, USA; Date: 2006; @R1@ Database online.

GEDCOM Source

Ancestry.com Public Member Trees Name: The Generations Network, Inc.; Location: Provo, UT, USA; Date: 2006; @R1@ Database online.