John Trounce, the first Professor of Clinical Pharmacology at Guy's Hospital Medical School, died on 16 April 2007 aged 86 years.
During a busy oncology clinic at Guy's Hospital in the mid 1960s, a woman (a philosopher of distinction) arrived whose recent tissue biopsy had revealed an unusual form of lymphoma. When her turn came to see the consultant, who was John Trounce, he told her that he had just seen a revue article assessing the results of existing treatments on her type of lymphoma. As there was no time to discuss the article at that moment, he found her a place to sit and read the article. At the end of the clinic, he asked her for her view of the article. She had decided on a particular regime, which Trounce also thought was the treatment of choice. The treatment was successful.
This episode illustrates aspects of Trounce's personality which will be recognizable to those who knew him, but difficult to capture in a few words: his dealings with fellow professors, patients and students were all in the same level and unaffected manner. He was a master clinician who practised ‘evidence-based medicine’ long before the term was made fashionable, and whose bedside skills presaged issues of optimization of adherence to medication that were formalized decades later. He was also good at spotting exceptional ability in others.
John Trounce qualified at Guy's Hospital Medical School in 1943. Shortly after that he joined the Royal Army Medical Corps. He was in the army for 4 years, during which time he was mentioned in dispatches. If you asked him about this, he said it was recognition that he had successfully rescued several hundred cases of champagne from the Wehrmacht.
He worked in the Medical School at Johns Hopkins Hospital in Baltimore from 1960 until 1961. The experience was not wasted on the young physician. On returning to Guy's he initiated three developments.
He started a renal dialysis programme which he did not direct himself but involved a team of enthusiastic and energetic physicians led by Stewart Cameron and Chisholm Ogg (at the time known as the Starsky and Hutch of renal medicine). The unit rapidly became established and is now one of the major nephrology centres in Europe.
Trounce also started a lymphoma clinic, which was the first Oncology Department at Guy's Hospital, andworked in this clinic until his retirement. As well as attracting distinguished oncologists to Guy's, Trounce forged links with the Radiotherapy Department to facilitate the designing of integrated treatment for individual patients.
In 1964 Trounce became the first Professor of Clinical Pharmacology at Guy's Medical School (later United Medical and Dental School). From the start, the department had a strong research component, initially dealing with problems arising in anticancer treatment such as oral infections following radiotherapy. Teaching was another important activity in the department, and Trounce organized a fresh and relevant course in therapeutics, and coauthored the Textbook of Clinical Pharmacology on which the course was based. He considered it important to have a separate examination in the final MB in Clinical Pharmacology and Therapeutics to follow on from the course he had designed. Also, he helped to form a section of clinical pharmacology in the British Pharmacological Society (BPS).
It is surprising that some of these changes proposed by such a quiet person aroused such resistance. The reactions were fierce and often angry. The medical examiners in final MB said there was no need for a separate examination in pharmacology (as they called it) – they could examine students in therapeutics perfectly well in the medicine exam; some members of the BPS said there should not be a section in clinical pharmacology because no experimental work is done in this subject; the government said there were too many expensive departments in London teaching hospitals and moved the major part of Guy's radiotherapy to the St Thomas' Hospital campus.
In his retirement he was disappointed to see the removal of clinical pharmacology and therapeutics from the final MB as a separate examination. He would have been delighted (if dryly amused) to witness its current rebirth in the School of Medicine of Guy's St Thomas' and Kings at King's College London, with educational support from Professor John Rees, another of his distinguished protégées. He would also have been delighted to see the way in which the clinical pharmacology section is now welcomed and recognized by the BPS, now recognized as the specialist professional society for clinical pharmacologists.
The philosopher whose lymphoma was treated in Trounce's clinic dedicated her next book to him: his patients, at least, appreciated his talents.