Frank Dudley Hart

Leading specialist in the classification and treatment of rheumatic disease

Anyone who has a rheumatic disease has reason to be grateful to Frank Dudley Hart, who classified the diseases (proper diagnosis is a forerunner to proper treatment), introduced most of the modern therapies, and collected the evidence that was needed to discard treatments that did more harm than good.

Francis Dudley Hart, rheumatologist: born Glossop, Derbyshire 4 October 1909; House Physician/House Surgeon, Sick Children's Hospital Edinburgh, Paddington Green Children's Hospital, Royal Northern Hospital and Brompton hospitals 1933-38; Registrar/Senior Registrar, Westminster, Royal Northern and Brompton hospitals 1937-40; Assistant Physician, then Consultant Physician, Westminster Hospital 1946-74; married 1944 Mary Tully (died 2002; one son, two daughters); died London 10 April 2004.

Anyone who has a rheumatic disease has reason to be grateful to Frank Dudley Hart, who classified the diseases (proper diagnosis is a forerunner to proper treatment), introduced most of the modern therapies, and collected the evidence that was needed to discard treatments that did more harm than good.

He founded the first rheumatology clinic in Britain, at the Westminster Hospital in London: before that, the speciality was known as physical medicine, and the change in name represented a sea-change in the way joint diseases were perceived. Later he helped persuade the Royal College of Physicians to recognise that rheumatology was a speciality in its own right.

Until 1951, there was only one non-steroidal anti-inflammatory drug, and that was aspirin; Hart did the clinical trials that introduced many others, including indomethacin and phenylbutazone, and also of new classes of drugs including gold and penicillamine. He was the first to recognise that ankylosing spondylitis, an inflammatory disease affecting the spine and often other joints, was a different disease from rheumatoid arthritis.

The son and grandson of Anglican clergymen, Hart was educated at Grosvenor School and spent two years studying Divinity before switching to Medicine at Edinburgh University. After a variety of hospital jobs in Edinburgh and London he went, in 1939, to the Westminster Hospital. Apart from his Second World War service he spent the rest of his career there.

In 1939 the patients, students and most of the staff at the Westminster were evacuated and he was left with three surgeons to run the Westminster as a casualty clearing station in preparation for the bombing of London. In 1942 he joined the RAMC, serving in Iraq, Italy and North Africa and was mentioned in dispatches. He soon became interested in the prevalence of ankylosing spondylitis. This affects at least one person in 200, mainly male, and was surprisingly common in young recruits.

In 1946 he was demobbed and went back to the Westminster as a general physician. He stayed there until his retirement in 1974. Hart not only introduced all the modern treatments that work; he was responsible for the abolition of two standard but harmful treatments for ankylosing spondylitis.

First, he liberated patients from the useless plaster casts that they hated, and got them exercising instead. Many of the patients were young men sent over from the army hospital in nearby Millbank. The casts were applied because it was argued that their spine would become rigid anyway, and it was better that it was rigid and straight than rigid and bent. Hart reasoned that with the right exercises, done frequently enough, the rigidity could be reduced or prevented. This was successful and he published a paper on it. Later in his career, he collected the evidence that put paid to another harmful treatment, spinal radiotherapy.

It was at the Westminster Hospital, in 1973, that the genetics of ankylosing spondylitis was discovered: a colleague, Dr Derrick Brewerton, asked Hart if any rheumatic diseases ran in families, and Hart replied that ankylosing spondylitis did. Another colleague, the transplant immunologist David James, did leading work on the leukocyte antigens that form our tissue type, and Brewerton was able to demonstrate that 95 per cent of patients with ankylosing spondylitis had an antigen called B27.

Hart advised the Department of Health on painkilling and anti-inflammatory diseases. He was nice to everyone and was universally popular. He was an outstanding teacher, both in the lecture room and at the bedside, and a high proportion of the current generation of leading rheumatologists trained under him. He backed the idea of a specialist research institute, which was funded by a gift from Mathilde Kennedy (neé Marks, and heir to Sir Simon Marks of Marks and Spencer). Thus in 1965 arose the Kennedy Institute of Rheumatology, affiliated to Charing Cross Hospital.

He published 200 clinical papers in learned journals, contributed to several textbooks, and in his latter days wrote on the history of rheumatology and other aspects of medical history and biography. Hart wrote and broadcast for a lay audience, was the author of Overcoming Arthritis (1981) and for many years - until 1998, when he was nearly 90 - wrote a regular column in Arthritis Today, the Arthritis Research Campaign's quarterly magazine, answering readers' questions.

Several of the important annual medical lectures in the UK and abroad were delivered by Hart, and he served for many years on the executive committee of the Arthritis and Rheumatism Council (later the Arthritis Research Campaign), advising on how best to split the funding of clinical and laboratory research.

Hart was a large, happy, friendly, expansive, sociable man, with a natural and uncontrived charm. He played a dozen musical instruments and loved jazz and swing.

When he developed an intestinal cancer, loyal to the last he went to his old hospital, now the Chelsea and Westminster, for treatment.

Caroline Richmond



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