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- W2023840102 abstract "InIn a long career—he lived to 106 and worked until he was 102—Philip D'Arcy Hart showed that pneumoconiosis was an industrial disease for which sufferers should receive compensation. In a landmark controlled clinical trial with Sir Austin Bradford Hill, Hart showed that streptomycin, then newly discovered, cured tuberculosis. In 1965 he was made a CBE for this work. He did other major epidemiology, retired at 65, and spent the next 37 years making fundamental advances on the pathogenesis of tubercle bacilli.Figure 1Credit: NICK SINCLAIRPhilip Montagu D'Arcy Hart was born in London in 1900 to a wealthy, cultivated, and philanthropic family. His father trained as a barrister but abandoned the bar to become a successful painter; his mother was the daughter of Samuel Montagu, first Baron Swaythling, Liberal MP and founder of a merchant bank. Philip was educated at Clifton College, Bristol, and Gonville and Caius College, Cambridge; he had entered medicine because of his mother's regard for a surgeon who had operated on him in childhood.His clinical training was at University College Hospital, London, where he won scholarships, and where he recalled being taught by Sir John Rose Bradford that there was only one disease, scurvy, that could be cured medically. He served as house officer to the neuroanatomist Wilfred Trotter, and was inspired to do research. He joined the medical unit at University College Hospital. Even before he became a consultant, he was the author of a 1932 Medical Research Council report showing that the von Pirquet test for tuberculosis was not reliable but the Mantoux test was: when positive it was 100% reliable; when negative, 98% reliable.Hart became a consultant physician at University College Hospital in 1934, spending his first year on a research fellowship in New York. The celebrated cardiologist Sir Thomas Lewis, a member of the Medical Research Council, suggested to the council that Hart be invited to study miners' diseases. Miners who quarried mine shafts developed silicosis and received compensation; those who worked at the coal face developed chronic lung disease and did not.In 1937 Hart was put in charge of a large scale clinical examination of miners, showed that their disease was occupational, and successfully recommended that they received compensation. He did this work from 1937 to 1948, living in lodgings in Cardiff and travelling up and down the valleys with a portable x ray van. His colleagues at University College Hospital regarded him as a traitor for leaving his potentially lucrative consultant post there, and never invited him back to lecture.From 1948 until he “retired” in 1965, Hart was director of the MRC tuberculosis research unit. Here he carried out various studies, ranging from the streptomycin trial (1948) to in vitro and animal work, and reviewing the applicability of BCG vaccination to humans. The French had developed BCG in 1921, and in a trial on 50 000 teenagers in England Hart showed that it was 80% effective as a vaccine. Throughout this period he also served on the World Health Organization's expert committee on tuberculosis.From 1965 until 2002 he continued to work for the MRC at Mill Hill, mainly on the cellular interactions of tubercle bacilli with macrophages; his last research paper, on antituberculosis agents in mice, was published in 2004.Hart had a lifelong interest in social medicine. He belonged to the Socialist Medical Association for decades, and during the Spanish civil war was an active member of the British-Spanish Medical Aid Committee, which supported the republican government. When he went to the United States as a member of an official MRC mission to speak about the council's streptomycin trial, as the guest of the New York state health department, he had refused to sign the political disclaimer required of anyone applying for a US visa during the McCarthy era.He was elected to fellowship of the Royal College of Physicians in 1936 and gave three of their named lectures: the Milroy, Mitchell, and Marc Daniels. He was an excellent speaker—dry, concise, and witty. In 1998 he spoke at a BMJ conference to mark the 50th anniversary of the streptomycin trial. Richard Smith, the BMJ's then editor, said of him: “Although pretty deaf, he spoke brilliantly. He had a very old fashioned voice and spoke as if from ancient history. It was like hearing Napoleon speak.” When he was over 100 he rang Smith with suggestions on how to improve the BMJ.Except for his deafness Hart remained clear minded, in good health, and living in his own home until shortly before his death. He leaves a wife Ruth, a retired gynaecologist 13 years his junior, and a son.Philip Montagu D'Arcy Hart, epidemiologist and cell biologist (b 1900; q Cambridge/University College Hospital, London, 1925; CBE, MD, FRCP), d 30 July 2006." @default.
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