Dame Margaret Turner-Warwick obituary
When Margaret Turner-Warwick, who has died aged 92, entered the field of respiratory medicine in the 1950s, it was a time of great change. Effective treatment for tuberculosis had recently been introduced, and the adverse effects of cigarette smoking on the lung were beginning to be appreciated.
The focus of academic research had been limited to understanding and measuring lung function, but with her colleagues Jack Pepys and Deborah Doniach, Margaret expanded it to include the immunology of the lung, and particularly of the fibrosing lung diseases. She showed that they were associated with autoimmune diseases, rheumatoid arthritis, systemic sclerosis and the severe form of lupus known as systemic lupus erythematosus, and she demonstrated the presence of relevant auto-antibodies in the blood.
Anticipating modern “personalised medicine”, she distinguished between different patterns of fibrosing lung disease, to identify the minority of patients who would respond well to steroids and the majority who would not, and for whom modern biological treatments are now being introduced.
Similarly, in her other major area of interest, asthma, she recognised different clinical patterns, based on differences in the patterns of peak flow records – rates of forceful exhalation – requiring different treatments. She was also responsible for several early clinical trials, most notably with inhaled corticosteroids, that have formed the mainstay of modern treatment. Her recognition of the importance of immunological mechanisms in lung disease led to the publication of many research papers and of her book Immunology of the Lung (1978).
Margaret combined a formidable scientific intellect with the humanity of an exceptional physician, and played a fundamental role in the development of modern respiratory medicine.
Born in London, she was the daughter of William Harvey Moore, QC, and his wife, Maud (nee BadenPowell). She decided on a career in medicine from an early age, and in 1943 went from St Paul’s girls’ school, west London, on an open scholarship to Lady Margaret Hall, Oxford, one of a quota of 7% of female medical students admitted to the university in her year.
After completing her clinical training and early posts at University College and Brompton hospitals in London, in 1961 she was appointed a consultant physician at Elizabeth Garrett Anderson hospital, and six years later to a part-time consultant post at Brompton and London Chest hospitals and a senior lecturership at the Institute of Diseases of the Chest. When, in 1972, she became professor of medicine (thoracic medicine) at what had now become the Cardiothoracic Institute, University of London, she was, with Sheila Sherlock at the Royal Free hospital, one of only two female professors of medicine in London. She served as dean of the institute (1984-87), which is now part of the faculty of medicine of Imperial College London, and in 1991 was made a dame.
Margaret’s understanding of patients’ concerns was informed by her own time as a patient. During her final year at Oxford in 1946, before the advent of effective antibiotic treatment, she was diagnosed with pulmonary tuberculosis and treated for a year in a TB sanatorium. The year she spent there brought her into close contact with fellow patients, whose hopes and fears she came to understand.
Her growing reputation as a physician led to patients with uncommon and, on occasion, unrecognised respiratory diseases being referred to her from throughout the UK. Physicians from around the world visited Brompton hospital to learn from her clinical insights and experience and she was invited to lecture widely in the UK and abroad, particularly in the US and Australia.
She recognised that the future sustainability of respiratory medicine, which she described as a “Cinderella subject” when she started, depended on attracting academic clinicians into the speciality who would develop the sub-specialities to which she had contributed, such as asthma, fibrosing lung disease, cancer and occupational lung disease. From the mid-70s she recruited a number of talented clinicians to the Brompton hospital and scientists to the institute, insisting that communication between clinicians and scientists should flow in both directions – from “bed to bench” as well as from “bench to bed”.
She believed strongly in partnership and collaboration, in academic work, between universities and hospitals, between academics and clinicians and between clinicians and hospital managers. During her period as professor she ensured a close and synergetic working relationship between the institute and the Brompton hospital, succeeding in persuading a reluctant University of London to appoint a joint chair, to reflect their shared mission.
Margaret was notable for her great generosity, intellectually and personally. She gave many of her junior clinical staff ideas which formed the basis of publications, which provided a foundation for their future careers. She lent her home on the Dorset coast to colleagues and their families.
Margaret combined her career with a very happy family life. In 1950 she married Richard TurnerWarwick, a surgeon who specialised in the reconstruction and functional restoration of the urinary tract, and they had two daughters, Lynne and Gillian. She took particular pride in Lynne and her granddaughter Tabitha following her into medicine. A keen artist, she painted watercolours, often of the Dorset coast, for her Christmas cards.
Her period as the first female president of the Royal College of Physicians (RCP), from 1989 to 1992, coincided with the introduction by Kenneth Clarke as health secretary of the internal market into the NHS. Margaret was typically constructive. While not opposing the proposed reforms, she pointed out to the government her concerns about the implications for research and education and for continuity of clinical care. She persuaded her colleagues in other royal colleges that to be effective they had to present their views as a single voice: in 1996 the existing conference organisation was renamed the Academy of Medical Royal Colleges.
After leaving the RCP Margaret served as chairman of the Royal Devon and Exeter Hospital Trust (1992-95). She continued to play an active role in the life of Lady Margaret Hall and as a trustee of the Rayne Foundation, focusing on young people’s mental health, the arts as a tool for social change and improving the quality of life for carers and older people.
Asked about how she had coped with a professional world dominated by men, Margaret said that being in a small minority at Oxford had taught her to take no notice. She nonetheless became a role model for the many women who entered medicine in the subsequent generation.
She is survived by Richard, her daughters, four granddaughters and two grandsons, and four greatgrandchildren.
• Margaret Elizabeth Harvey Turner-Warwick, thoracic physician, born 19 November 1924; died 21 August 2017