Reader, Sydney Ralph

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MB BS 1940 MD honoris causa 2006 DPhil (Oxon) FRCP FRACP

Ralph Reader established the first department of Renal Medicine at Royal Prince Alfred Hospital in 1957 and was the first medical director of the National Heart Foundation of Australia in 1961. Shortly after his return from Oxford in 1951 the RACP appointed Ralph Hon Secretary of the inaugural editorial committee of its newly established Australasian Annals of Medicine, (now the Australian and New Zealand Journal of Medicine). From 1975 to 1982 Ralph was Chairman of the first WHO-ISH Liaison Committee for Mild Hypertension.

Ralph was appointed in 1940, with three of his other colleagues, as students in Residence at Royal Prince Alfred Hospital to relieve the shortage of resident doctors joining the armed services. He graduated in 1940 and in 1941 was appointed Professorial Resident Medical Officer to the clinical professors at the hospital; at that time being Dew, Lambie and Dawson. During that year he enlisted in the Royal Australian Navy Volunteer Reserve and was commissioned Surgeon Lieutenant with seniority 21 July 1941. He was advised, however, to complete his year of residency and to find temporary employment until he was called up for active service. Ralph was mobilised in 1942 and until 1946 he served as a Surgeon Lieutenant and acting Lt Cdr and Medical Specialist with the RANVR.

After World War II he returned to the University of Sydney and took up a research scholarship within the Department of Medicine. During his war service he had developed an interest in the pathogenesis of acute glomerulonephritis and the causes of nephritis and applied to Professor Lambie to develop these interests within his department.

From 1948 to 1950 he was a Nuffield Dominions Fellow within the Department of Medicine at the University of Oxford. Working with Professor Witts at the Radcliffe Infirmary, Ralph had the opportunity to investigate “the popular concept that rheumatism was pathogenetically related to environmental chilling and tissue temperature changes”, receiving his DPhil for this work in 1952.

While still in Oxford, Ralph was appointed Honorary Assistant Physician at Royal Prince Alfred Hospital and on his return, in 1951, began clinical duties, student tutorials, fourth year lectures in nephrology as well as developing his research into the role of complement in immunological diseases such as acute and chronic glomerulonephritis in Professor Lambie’s lab. At the same time, he set up practice in Macquarie Street (and later the Medical Specialist Centre established adjacent to RPAH) and remained active as a consultant for the next ten years.

In his final three years at RPAH he was promoted to acting physician status in charge of one or the six medical units when Harry Maynard Rennie went to the Page Chest Building. Ralph says that “this was symptomatic of a trend to the subspecialties at the hospital and indeed of medicine generally in Australia at that time”. Ralph channeled his own interest in renal disease into the establishment of the ‘Renal Group’ and with his leadership, this voluntary group “sought out interesting cases, consulted when requested and introduced the advances in diagnostic and therapeutic methods that were rapidly evolving”. Dr Hal Selle, General Superintendant in 1957, made a room available for them within the hospital to base their meetings. From these humble beginnings, over ten years “an enthusiastic series of registrars had voluntarily spent time” working with the group: for example Jim Johnson, Don Deller, Colin Johnston, Trefor Morgan and Denis Wade, who later took up clinical chairs and continued their interest in renal disease throughout Australia. When Ralph resigned from Royal Prince Alfred Hospital, John Sands took over the leadership of this unit.

However, Ralph’s flair for leadership in clinical practice and research had been recognised and in 1961 he was invited to join the National Heart Foundation as Medical Director, an appointment he accepted. He was enthused to direct a “community based and funded health organisation promoting research, professional and community education and rehabilitation in cardiac disease”. He also saw this as an opportunity to conduct his own research and further develop his understanding of hypertension within a different context.

Ralph remained Medical Director until 1971, at which time he became Director and CEO, finally retiring from the Foundation in 1980.

His own words reflect upon the necessity for the Foundation and the nature of the early studies he undertook on their behalf:

When I joined the National Heart Foundation in 1961 the over riding consideration was the increasing mortality, in fact an epidemic of coronary heart disease and much was made of this in the promotion of the Foundation. But the crude mortality rates were questioned and it was claimed that the apparent increase was due to increasing age of the population. Age adjusted analysis, however, showed that the increase occurred at all ages and we published a report of those in 1966. I continued monitoring trends in cardiovascular mortality until the practice was taken over by the taken over by the Australian Institute of Health and Welfare.[1]

The increasing mortality rates continued but he reported in 1972 that a reversal of the trend had become apparent. His findings caused a stir because it was two years before this trend was reported in other countries. Under his “breathless stewardship” the Heart Foundation strove to initiate programs that addressed the control of “risk factors like high cholesterol, smoking, hypertension”[1] as well as the educating the community about coronary care, signs of heart attack, heart-lung resuscitation and cardiac rehabilitation.

Ralph states that The Australian National Blood Pressure Study: 1973 to 1979 was the most ambitious and significant project undertaken during his period of service with the Heart Foundation. He says:

Previously hypotensive drugs had been restricted to severe and symptomatic hypertension. This study demonstrated the value of these drugs for the 90% of hypertensives with mild and symptomless level; it was a randomized, blinded, placebo controlled trial in 3427 subjects with mild hypertension with no evidence of cardiac complications. The average length of patient observation was just over four years. As a result of this and similar studies, antihypertensive drugs were quickly adopted world wide for all hypertensive patients. In Australian men aged 20 to 69, deaths from stroke, a measure of the impact of hypertension in the community, have been falling since the drugs were introduced from 80 per 100,000 in 1951 to 22 in 1990.[1]

In recognition of his work in this area the International Society of Hypertension appointed Ralph an Emeritus Fellow which is, in his words, “a rare honour”.

As one of its founding fathers, Dr Reader was widely regarded as the face of the National Heart Foundation and under his stewardship, significant advances were made in the organisation’s research, education and rehabilitation programs. Gaston Bauer acknowledges the impact of Dr Reader’s work in one of his writings on the history of Cardiology in Australia when he says:

Since 1961 research, education and rehabilitation in the field of cardiology have been greatly assisted by the National Heart Foundation of Australia. The impact of the Foundation under the wise guidance of… Dr Ralph Reader has been felt in every cardiac department and unit throughout the Commonwealth.[1]

On his retirement from the Foundation, The Cardiac Society of Australia and New Zealand established The Ralph Reader Young Investigator Prize in recognition of his concern for young Research Fellows fostered by the Foundation. The prize has been awarded annually since 1981.

As well as chairing the WHO-ISH committee on Mild Hypertension Ralph conducted many assignments for WHO, including a tour of South East Asia investigating rheumatic heart disease, 1968, a survey of therapeutic trials in mild hypertension in USA, Europe, England and Australia, 1973, a review of prevalence and control of hypertension in India, 1981, and attended many international WHO conferences on cardiovascular problems, sometimes acting as rapporteur.

In 1976 Ralph was made a companion of the Order of St Michael and St George for his services to medicine. Ralph retired from the Foundation in 1980, but remains to this day one of the Foundation’s honoured National Members-at-Large.

In this our anniversary year, the University of Sydney has awarded Dr Ralph Reader an honorary Medical Doctorate in recognition of his services to clinical practice and medical research, conferred on 16 June 2006 during our anniversary celebrations.

Citation: Mellor, Lise (2008) Reader, Sydney Ralph. Faculty of Medicine Online Museum and Archive, University of Sydney.

An alternate version appears in: Mellor, L. 150 Years, 150 Firsts: The People of the Faculty of Medicine (2006) Sydney, Sydney University Press.