Robert Edgar Hope-Simpson

Robert Edgar Hope-Simpson (1908 – 5 July 2003) OBE FRCGP Hon FFPHM was a general practitioner. He showed that shingles was caused by reactivation of the chickenpox virus.

Early life

Hope-Simpson was born in 1908, the fourth of five children. His father, Sir John Hope Simpson was in the Indian Civil Service, in 1916 the family returned to England to farm in Somerset. Sir John later became a diplomatic troubleshooter sent out by the government to solve disputes around the world including Greece (to solve the refugee problems of Turks and Greece), Palestine (he wrote The Hope-Simpson Report in 1930 which examined the economic conditions and to suggested solutions to the territorial dispute between Jews and Arabs), Canada (1934–36) (he was a Natural Commissioner and there is an area of Newfoundland called Port Hope Simpson named after him.^[1])

Hope-Simpson went to prep school at Heddon Court in Hertfordshire (1913–1919) and then Gresham's in Norfolk (1919–1925) where he won a prize for natural history - an interest which he carried on his entire life. He spent a year at the Faculte des Sciences, Grenoble, (1925–26) before starting his medical studies at St Thomas' Hospital. His career choice of medicine at St Thomas' Hospital disappointed his father who wanted Hope-Simpson to farm. But Edgar was committed to medicine, He intercollated in physiology before getting his MRCS/LRCP in 1932. It was in the laboratory that he met Eleanor Dale (daughter of Sir Henry Dale), his future wife.

Working life

His first post was in the Dorset County Hospital in Dorchester in Dorset as a Resident Medical Officer. He had heard that the hospital was friendly but busy. In those days he could expect one afternoon off in an otherwise seven-day working week. He would be on call for the other 156 hours. And do everything. He would live in a hospital room, and a major perk of the job was the slate outside his door on which he could chalk up his morning request for tea. And his shoes would be cleaned. A year later, in 1933, he answered an advertisement for "an assistant with a view" to help in Beaminster in the practice of Dr. Herbert Lake. Hope-Simpson was prepared for questions about his Quaker views, especially as he’d discussed them with his disapproving father the year before. However Hope-Simpson was very surprised at the brevity of his interview with Dr Lake. And Dr Lake didn’t care whether his clever young assistant was a vegetarian teetotalling pacifist providing he didn’t hunt on Tuesdays, Wednesdays and Saturdays. Edgar and Eleanor settled down at Gable End on Hogshill Street in Beaminster. In 1939 the war started. Edgar maintained his pacifist views. He was in a reserved occupation, so probably would not have been called up but insisted on registering as a conscientious objector. By the end of the war Edgar was getting restless, and so was his practice. He had established a pioneering home nursing service amongst his rural patients, as well as outside surgeries in the Marshwood Vale, Salway Ash, Toller Porcorum, West Milton and Powerstock. And he had developed a fledgling note keeping system linking patients, where they lived and their diseases. So Hope-Simpson left Beaminster in 1945 for Cirencester. Four years earlier his wife had given him Wensleydale general practitioner William Pickles' then new book Epidemiology in Country Practice, detailing the epidemiological research of common diseases which could be carried out by a general practitioner. Hope-Simpson modelled his approach on this, and he exchanged visits with Pickles. Only a year after starting at Cirencester, he transformed his practice (housed in an eighteenth-century cottage in the high street) into Cirencester Research Unit which was funded by the Public Health Laboratory Service 1947–1973 and the Department of Health and Social Security 1973-1981. His research activities, as well as a post as pathologist at the Cirencester Memorial Hospital (1946–1961) never stopped him practising as a popular general practitioner [1946–1976]. The bulk of his interest was in infectious diseases. He was self-taught and without any formal epidemiological or research training, but he learnt fast. He started to write papers, particularly on chickenpox and herpes zoster, in the 1940s and 1950s, which were published in the Lancet and the BMJ, overall he produced a series of publications (while being a GP) of which many professors would be proud.

Work on chickenpox and shingles

At that time it was known that Chickenpox and shingles were related, but how? Experts at the time were suggesting that two different viruses existed. Edgar Hope-Simpson increasingly believed there was only one, but how to prove it? In the end, he took his small team of research colleagues to the Island of Yell in Shetland in 1953 and literally followed up every known case in a much closed community. He was empowered by local islanders' memories for occurrences and dates. By 1962, new microbiological techniques enabled him to prove his point. Edgar believed that a virus could commonly lie dormant in the human body, for years, indeed decades, and then reappear in another form. Only an unusually determined researcher could have pursued the idea through fieldwork in the natural history tradition. He delivered his conclusion in the Albert Wander lecture on 10 June 1964, very properly and modestly describing it as his "hypothesis." His report became one of the most cited general practitioner publications. This was world class research in clinical medicine and Hope-Simpson made probably the most important clinical discovery in general practice in the 20th century. Later the virus, now known as the varicella zoster virus (VZV), was identified and isolated, and the researcher responsible (Thomas Huckle Weller) received a Nobel prize, although for his work on Polio. Later still, a therapy for herpes zoster was developed (Aciclovir) and one of the researchers, Gertrude B. Elion, too, received a Nobel prize.

Work on influenza

His career-long interest in the manner of transmission of the influenza virus was first stirred by the great epidemic of 1932–33, the year in which he entered general practice. It culminated in a book, published in 1992 that questioned the theory of person-to-person transmission being enough to explain the simultaneous appearance of influenza in places far apart. His initial hypothesis proposed that the cause of influenza epidemics during winter may be connected to a seasonal influence.^[2] His later research suggested that the correlation may be due in part to a lack of vitamin D during the wintertime.^[3][4] His findings were based not only on observation in his practice, but also on extensive historical research into past epidemics.

Honours and final days

He received the Order of the British Empire, the Stuart prize from the British Medical Association, the Kuenssberg prize from the Royal College of General Practitioners, and an award from the International Society of Biometeorology. The VZV Foundation in the United States gave him its gold medal in 1999. The then president of the Royal College of General Practitioners presented him with the George Abercrombie award, for outstanding contributions to the literature. He also spend a semester as Visiting Professor in Community Health, Case Western Reserve University, Cleveland, Ohio in 1974. Hope-Simpson's practice was used as a model in 1994 when the RCGP introduced research practices, which later became NHS research and development general practices. His first wife, Eleanor died in 1997 after a long illness, during which he was an exemplary carer. He remarried, when over 90, and leaves his second wife, Julia; a daughter; and four grandchildren. Edgar never stopped thinking and reading, made many observations, he retained his faculties until just before he died, saying how much he loved life, even in his final week.

References

• This article is based on the bibliographic notes as hold by the Royal College of General Practitioners. The notes, and more information can be found here