News of Sheilas death on 30 December last year will have come as a shock to many. Although known to be in poor health during the past 12 months, from her retirement in 1983 from the Royal Free Hospital she had continued as a leading light in her beloved specialty, hepatology, to which she contributed so much. Her clarity of presentation made her much in demand as a speaker at postgraduate meetings and similarly, as a chairman, she had a legendary reputation. Many a startled hepatologist has been woken at meetings from his slumbers by Sheilas clarion call for a comment.
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Quite apart from her continued writings, her most famous of liver textbooks, Diseases of the Liver and Biliary System, is now in its 11th edition. Few probably realize, in these days of multi-authored textbooks, that up to 1993 this was written entirely by Sheila a model of concise presentation that has never been equalled.
Sheila had a great love for America, admiring its science and research and always encouraging her fellows to spend their scholarships in America. Possibly some of this stemmed from her formative year at Yale in 1947 as a Rockefeller Travelling Fellow, working on carbohydrate metabolism and liver disease. She was a founder member of the American Association for the Study of Liver Disease never missing a meeting and together with that other legendary figure in hepatology, Hans Popper, she founded the International Association for the Study of the Liver. Sheila had a bolthole in Florida for many years and much enjoyed getting away there from the English winter gloom.
For most of the younger hepatologists around the world, her name will be synonymous with the liver unit she founded at the Royal Free Hospital when she was appointed there as Professor of Medicine in 1959. Initially, the department was housed in a temporary wooden hut on the roof of the old Hospital in Grays Inn Road. I was fortunate enough to have been asked to join the unit as one of her first two Lecturers in Medicine, and what a powerhouse it became. In no time, research groups into different areas of liver disease were set up bilirubin metabolism, headed by Barbara Billing, whom she persuaded to join her; haemochromatosis and iron metabolism; cholestatic liver disease; drug-induced hepatotoxicity; albumin synthesis in liver disease; along with ongoing studies in portal hypertension and ascites. We saw the beginning of an understanding of autoimmune liver disease with the description of the mitochondrial antibody (together with Deborah Doniach at the Middlesex Hospital) and with the controlled trial of corticosteroids in autoimmune hepatitis. Adult liver biopsy interpretation became an art of its own with the work of Peter Scheuer.
In 1974, the Unit moved to the new Royal Free Hospital at Hampstead, where Sheila developed a major academic department immediately adjacent to the clinical wards. Research and papers continued to flow. Viral hepatitis became a major interest and the flow of young doctors from all round the world wanting to be trained in hepatology continued. Although it was some years before Sheila became convinced of the value of liver transplantation, and neither was she a great lover of endoscopy and variceal sclerotherapy, both became important areas of work in her department.
In fact, her more pioneering work was done before the move to the Royal Free Hospital, at the Hammersmith Hospital (or the Royal Postgraduate Medical School as it was then known) where she became a consultant in 1948, at the early age of 30 years. There, under the wise guidance of Professor later Sir John McMichael, she introduced the new techniques of hepatic vein catheterization, intrasplenic pressure and venography into the clinical assessment of patients with portal hypertension. She defined the different patterns of portal hypertension, the sites of the lesion and their consequences. Similarly, in hepatic encephalopathy, she reported the first descriptions of the neuropathological syndromes and their relationship to collateral shunting and impaired liver function. Her studies on ascites led to a better understanding of the pathophysiology on which the use of the new diuretics could be properly based. Liver biopsy in her hands was an everyday tool and it was her studies on the jaundice so common amongst the Allied troops of World War II that laid the foundations of our knowledge of hepatitis histopathology.
Never a great laboratory worker, Sheila nevertheless had an instinctive feel for the essence of research findings and very quickly could get to the core of a problem and how results could be interpreted. Coupled with this was a real empathy for those suffering from liver diseases.
For the young research fellow joining the unit, Sheila was pretty daunting. Her way of working was to allocate to the fellow a particular area of interest that she thought worth exploring, whether or not it was of particular interest to the person concerned. There was always a scientist to oversee the laboratory work and when Sheila judged that the research fellow had had long enough or there was a liver meeting looming ahead, there would be a summons to her office to go over the results. When it came to writing a paper, even a third or fourth draft would be torn up whilst Sheila enumerated her criticisms. Many a young doctor was reduced to despair and woe betide the fellow who did not follow the path set out for them maybe it was time then for a travelling fellowship or an appointment overseas or a more clinical appointment in the National Health Service! To some, the imperious sniff and acerbic comments were frightening, but all respected her prodigious knowledge of liver disease and the energy and determination with which she pursued her goals. We were also aware too of the help and affection that would be there for us if we did give of our best. In working for her, we learned much of other important aspects in academic work how to give presentations clearly, how to write grant applications, raise funds and use our initiative in developing research plans. After a while, we no longer wanted to be spoon-fed, but to fly high, and many did.
Sheilas achievements over the years brought her an amazing number of prizes and medals. She was honoured by the Queen with a DBE in 1978 and, in later life, received honorary degrees of many universities. Just last year, she received the FRS in recognition of her place as one of the outstanding clinical investigators of her generation.
As well as reflecting on Dame Sheilas remarkable career and achievements and all we owe to her in hepatology, at this time we need also to remember and extend our sympathy to her family, to her two daughters and particularly to Gerry James, who, as well as being a distinguished physician and researcher in the world of sarcoidosis, above all and for 50 years was a marvellous other half.
FOOTNOTES
(This article was first published in Liver Transplantation)