Dame Margaret Elizabeth Harvey Turner-Warwick

Abstract

Architect of modern UK respiratory medicine. Born in London on Nov 19, 1924, she died there of pneumonia on Aug 21, 2017, aged 92 years. Margaret Turner-Warwick enrolled at Oxford University's Lady Margaret Hall in 1943 to study medicine, and continued her undergraduate and subsequent specialist training in respiratory medicine at University College Hospital and Royal Brompton Hospital, both in London, UK. The early part of her career, in the 1950s, coincided with a time of rapid development in her specialty. This was when the damaging effects of cigarette smoking were beginning to be understood, drugs for tuberculosis had arrived, corticosteroids were in their infancy, and the use of controlled clinical trials was still a novelty. “There was real change going on”, says Sir Anthony Newman Taylor, Professor of Occupational and Environmental Medicine at Imperial College London and a close colleague and friend of Turner-Warwick. “Until that time, chest physicians had really been concerned with the treatment of tuberculosis. Academic endeavours were mostly about the nature of lung function. When Margaret entered the field she recognised that a much broader range of ill health related to the respiratory system—asthma, chronic emphysema, lung cancer, fibrosing lung diseases—needed clinical attention and research.” As Turner-Warwick acquired seniority in her discipline, she not only presided over a great expansion of respiratory disease medicine, but also helped to mould the field. “I think she was the great shaper of this change in terms of what underpinning academic work was needed,” says Newman Taylor. Turner-Warwick's decision to specialise in respiratory medicine was almost certainly influenced by her experience of tuberculosis while a student in her final year at Oxford. Treated with a standard therapy of the time, phrenic nerve crush, she had to take a year out of her studies. Her first consultant post was in London's then Elizabeth Garrett Anderson Hospital. From here she moved to the Royal Brompton Hospital and took up a senior lectureship at the then Institute of Diseases of the Chest. In 1972, she was appointed Professor of Medicine at the Cardiothoracic Institute, now Imperial's National Heart and Lung Institute. It was here that she began broadening the scope of her discipline. She employed people with a knowledge of the pharmacology of asthma, the biochemistry of collagen, immunology, and much else. She herself did key studies of inhaled steroids. “The Institute became a focus of research into many different areas important for respiratory disease”, says Newman Taylor. Turner-Warwick retired emeritus from medical practice in 1987. 2 years later she was elected to the Presidency of the Royal College of Physicians (RCP). She proved to be a reformer and an innovator. Spurred on by the then staff shortages in many subspecialties, she created what is now the RCP's Medical Workforce Unit. Reliable data on numbers employed and hours worked allowed the RCP to argue more forcefully in disagreements with the Department of Health. She improved the RCP's management structure and tried to bring more transparency to its decision making. Above all, she found herself having to deal with Prime Minister Margaret Thatcher's reforms to the National Health Service (NHS), including the split between NHS purchasers and providers, and the introduction of the much disliked internal market. In a tribute the current RCP President Professor Jane Dacre described Turner-Warwick as not only a reforming President but also “a challenging president and a collaborative president”. Lord Leslie Turnberg, some time Dean of Medicine at Manchester University and President of the RCP in direct succession to Turner-Warwick, first met her when he was elected to the RCP Council in the late 1980s. He found her impressive. “She was a terrific President, and a terrific chair of the Council”, he recalls. “She was very charming, but also very imposing—so smart and so intellectual. She was very impressive in the way she handled everything, and was on top of everything.” When she entered medicine, Turner-Warwick joined a male-dominated world. Although she was the RCP's first female President, she does not seem to have found this intimidating. According to Turnberg, “she simply regarded herself as a President of the College who happened to be a woman”. Dacre, commenting on Turner-Warwick's thoughtfulness and wisdom, agrees that while she didn't set out to be a feminist pioneer, “she did undoubtedly inspire many of us to aim higher and become involved in medical politics. I benefited personally from her understanding, accurate and honest insights about issues like junior doctors, women in medicine, and dealing effectively with other Colleges, and government ministers”. Turner-Warwick leaves her husband Richard, a surgeon, and daughters Lynne and Gillian.