Milestones in European Thyroidology (MET)

Reginald Hall (1931-1994)

Reg Hall was born on 1st October 1931 at Belmont in County Durham in the northeast of England where his father (also Reginald Hall) worked for the Post Office. He was educated at the Alderman Wraith Grammar School in nearby Spennymoor (a school which has provided a number of distinguished members of the medical profession) and Berwick Upon Tweed Grammar School. He proceeded to King’s College, Newcastle in 1950 and graduated BSc. with First Class Honours in 1953 and MB, BS in 1956 (also with First Class Honours). It was as a student that he first developed an interest in the thyroid. His undergraduate project was a study of the metabolic rate in the rat which was stimulated by the discovery of triiodothyronine by Rosalind Pitt-Rivers and Jack Gross. Reg was a distinguished member of a very talented cohort of Durham students who graduated in 1956 – and his achievements are underlined by the fact that he was awarded a number of the undergraduate prizes within his year group against very stiff competition. His activities during his student years were not, however, limited to his academic pursuits. He was a champion sprinter as a schoolboy, he represented the medical faculty at hockey and he developed a number of botanical interests – particularly in the bryophytes. Reg married Joan Patterson, a student teacher, towards the end of his student career. She tragically died of a brain tumour in 1959 shortly after the birth of their daughter Susan. Reg married a fellow physician, Molly Hill, in 1960 and they had four children, two girls (Amanda and Stephanie) both of whom are doctors and twin sons (John and Andrew).

Reg received much of his postgraduate training in the Professorial Medical Unit in Newcastle which was headed by Professor (later Sir) George Smart. It was here that he further developed his endocrine interests with a particular focus on the thyroid. He did, however, spend an important year as a Harkness fellow with Professor John Stanbury at the Thyroid Clinic at the Massachusetts General Hospital. John Stanbury’s clinic at that time was regarded as the mecca for thyroid research and it attracted many of the best clinical scientists of that generation to Boston. A high proportion of these subsequently made considerable contributions to the development of clinical endocrinology and the annual meetings of the European and American Thyroid Associations provided the focus for the renewal of friendships and collaborations amongst this group. The intellectual excitement which was generated within that group has been well characterised by the title of John Stanbury’s own book - “A constant ferment”.

The 1960’s were also an exciting time in Newcastle as a specialist endocrine service was being established by Dr C N (Nat) Armstrong and George Smart. At the same time new approaches to medical education were being developed within the Faculty and Reg played a prominent role in both of these. He also established a laboratory and clinical research interest in the immunology of thyroid disease which was to continue throughout his professional life. Reg was appointed a Senior Lecturer and Consultant Physician in 1966 and was awarded a personal chair in 1970. He was also elected a Fellow of the Royal College of Physicians of London in the same year.

The 1970’s saw a considerable expansion of the endocrine group and the Newcastle Endocrine Unit was formally established in 1974. It was during this decade that the group established a major international reputation. The authors of this memoir joined the group in 1970 (DE) and 1972 (MT) and subsequently many clinical scientists who were to establish independent international reputations joined the Newcastle Unit. This group included Bernard Rees Smith, Terry Davies, Maurice Scanlon, Alan McGregor, Tony Weetman and Antonio Gomez-Pan. The Unit also attracted talented young physicians and scientists to Newcastle from the United Kingdom and 20 other countries around the world. This group was encouraged, enthused and befriended by Reg who would take immense trouble to assist them in developing their scientific and medical careers and would also provide a helping hand for anyone with personal problems.

The development of thyroid research during the 1960’s, 1970’s and 1980’s was driven by scientific and technical advances – the groundwork for some of these being laid in the previous decade. A number of major advances proved critical to the development of research in thyroidology and these led to an explosion of activity in both laboratory and clinical research throughout Europe and also on the other side of the Atlantic. These included:

1. the ready availability of radioisotopes of iodine for use in clinical and laboratory studies;
2. the development of competitive binding assays, particularly radioimmunoassay following the pioneering work of Berson and Yalow in the US and Ekins and Hunter in Europe. The subsequent recognition that these techniques were not limited to the assay of proteins and polypeptides but that they could also be utilised for the measurement of small molecular weight compounds of biological importance;
3. the development of the concept of organ specific auto-immunity through the pioneering work on Hashimoto’s disease of Deborah Doniach and Ivan Roitt in London and Witebsky and Rose in the United States;
4. the isolation. Purification and synthesis of the hypothalamic releasing hormones – the first of which, TRH, became available in 1969 and
5. improved methods for the isolation and determination of the structure of proteins of biological importance.

These advances offered opportunities to explore the physiology and pathophysiology of the thyroid in ways which had not been possible a few years previously. Reg led and encouraged a wide range of endocrine interests during this time. These included the development of assays for thyrotrophin and the thyroid hormones, the study of autoimmune disease, clinical physiological studies of the releasing hormones, the epidemiology of thyroid disease and the control of thyrotrophin secretion.

Reg moved to Cardiff in 1980 as Professor and Head of the Department of Medicine and a number of his colleagues and collaborators moved with him. The 1980’s proved to be as productive as the 1970’s. Units of endocrine immunology, cellular immunology and neuroendocrinology were established and each of these gained an independent international reputation.

There were many scientific highlights over these two decades. These included the first clinical studies with synthetic TRH and other hypothalamic hormones, a radio-receptor assay for thyroid stimulating immunoglobulins, the isolation and characterisation of the thyrotrophin receptor, the regulation of thyroid antibody synthesis, the control of thyrotrophin secretion in vivo, the regulation of lymphocyte function in autoimmune thyroid disease, the study of thyroid disease in pregnancy and post-partum and the Whickham Survey (a large scale epidemiological study examining the prevalence of thyroid disease and cardiovascular disease in the community).

Reg Hall published widely (more than 400 original papers), was the senior author of Fundamentals of Clinical Endocrinology and edited and contributed to many other books. His contributions to endocrinology and medicine extended nationally and internationally far beyond his own institution and his own discipline. He was an early member of the European Thyroid Association and served on the Executive Committee from 1968 to 1973. He was awarded the ETA Prize for his major contributions to thyroid research over many years in 1987. He was a strong supporter of the ETA and was a lively presence at many of the annual meetings. He was a longstanding member of the London Thyroid Club (of which he was the President) and the Society for Endocrinology which awarded him the Dale Medal in 1987. He gave many named lectures including the Jacobaeus (Helsinki), Leo Oliner (Washington), Samuel Haines (Mayo Clinic), Watson Smith (Royal College of Physicians of London) and Transatlantic (American Endocrine Society). He served with distinction on a number of national bodies including both the Systems and Cell Boards of the Medical Research Council and was Chairman of the Specialist Advisory Committee for Endocrinology and Diabetes. He, above all, made major contributions to endocrinology and medicine through the many postgraduates whom he trained and supported and who now hold senior positions in the UK and elsewhere. His contributions to medicine were publicly honoured in 1989 by the award of a CBE and an honorary MD from the University of Wales in 1994.

All this is a matter of public record. All who worked with Reg and many others around the world whom he supported, encouraged and befriended know that this public record, outstanding though it is, only provides part of the picture of the man. Reg achieved much with a style which was uniquely his own. He accepted every challenge with enthusiasm, vigour and commitment. He succeeded in establishing research groups of people with disparate skills and varying backgrounds and created highly successful and productive teams. He was the guide, mentor and, above all, the friend of all who worked with him at senior and junior level. Reg and Molly Hall were generous and hospitable to all and the transition to the United Kingdom for many from overseas was made much happier by the warm welcome and practical support which they received. It was a pleasure to visit their home which always appeared to be full with their five children and their friends, interesting people from overseas and experts on a wide range of subjects.

This record is all the more remarkable in that Reg battled with illness for the last twelve years of his life. He developed primary amyloidosis with infiltration of the myocardium. The first effects of this became apparent in 1982 and he had a cardiac transplant in 1984. His long illness was borne with characteristic spirit, supported by a strong Christian faith and an absolute determination that his activities should not be curtailed unnecessarily. He was able to give an extraordinarily objective account of his illness in the British Medical Journal. He continued to work full time until 1989 when he retired from the Chair of Medicine in Cardiff. Following his retirement he continued his research in thyroid disease in pregnancy and to lecture in the United Kingdom and overseas. He was engaged in the preparation of a book on major eponyms in clinical medicine during the last year of his life.Reg regarded his early retirement as an opportunity to spend more time with his enlarging family (all five married during the years following his retirement) and with his friends. He also had more time to develop his passion for reading, re-establish his botanical interests and to become an accomplished cook. The strength and warmth of the bonds which united the family were a great source of pleasure to Reg and they, particularly Molly, were an unfailing support throughout his long illness and particularly during the last few weeks before his death on 20 July 1994. A tribute to Reg by Professor David London (a fellow endocrinologist) captures the essence of the man: “He was one of the seminal endocrinologists of his generation. A force in medicine and a towering intellect, reason enough to mourn his passing but more importantly we grieve because of the loss of the living example that stood before us of the true and good doctor.” To all who knew him well he was a good friend, an enthusiastic and inspiring leader and a very special human being.

David Evered and Michael Tunbridge