Jack Pepys: A personal recollection

A brief biography of Jack Pepys, written by his son, Mark B. Pepys, MD, PhD, FRS, FMedSci, Centre for Amyloidosis and Acute Phase Proteins Division of Medicine, University College London, United Kingdom.

Prof Jack Pepys
Jack Pepys was not only a wonderful father and family man but was also my lifelong mentor in medicine and research, and for 52 years, we were also best friends. He had many talents and interests; for example he was a superb cook, loved to socialize, was a brilliant raconteur and wit with a great sense of humour, knew more good jokes than anyone I have ever met (he never told a bad one), and loved many sports, but he had no hobbies. Apart from his family, his work was his life. Until the day he died, he was devoted to being a physician and a scientist, uncovering the secrets of nature for the benefit of patients.   

He decided to become a doctor at the age of 3, when he had an appendectomy for acute appendicitis. He was an extremely intelligent child, and when it was discovered that he could skip a year at high school by matriculating 6 weeks after the end of the previous school year, his family engaged a tutor, he worked hard, and he passed. Thus he entered the then newly opened Witwatersrand Medical School in Johannesburg at the age of 15. He was about to leave for the first day at university when his mother realized that he did not have any long trousers and rushed out to buy his first pair. When he studied obstetrics at age 17, he grew a moustache to look acceptably mature for the mothers he was examining and whose babies he was delivering. He kept that moustache for the rest of his life. His research career started when he qualified as a doctor at the age of 21. He was not allowed by law to practice until he was 22 and therefore spent 6 months working for the professor of pharmacology, who by chance was interested in allergy. Jack was enthusiastic about the subject because he was himself highly atopic and suffered greatly from eczema throughout his childhood, often with large areas of raw, weeping skin, which his mother used to dress with bandages soaked in starch paste. During this critical period, before he started his internship, he learned about food allergy as a cause of eczema, eliminated fish from his own diet, and dramatically ‘‘cured’’ his eczema. That was it: he had become an allergist!

There were no formal opportunities for postgraduate medical education or clinical research in South Africa at that time, and he went directly into general practice, where he worked extremely hard for the next 12 years. From childhood, he had been appalled by the discriminatory treatment of the Africans, and in his practice he treated patients of all races according to their need, often without payment. He and his wife Rhoda, who he had married when they were both aged 23, also worked politically to improve the lot of the Africans, so that when the National Party with its apartheid policy was elected to power, they decided to leave the country. Jack was determined to further his medical education and had learned from Professor Frankie Foreman, a legendary clinician in Cape Town, to appreciate high-quality internal medicine, although Jack himself always aspired to become an allergist and to do research, as well as practice.   

We arrived in Great Britain in 1948, when I was 3 years old, and lived initially in Edinburgh, where there was a training course for candidates for membership in the Royal Colleges of Physicians, the equivalent of the Boards in Internal Medicine. The freezing weather and rationing of food and sweets (candies) still in place after the war were a severe culture shock for the family after the climate and comfortable lifestyle of South Africa, but Jack worked characteristically hard and effectively. When the time came for the examinations, he entered in both the London and Edinburgh Colleges and travelled back and forth on the overnight sleeper train on a series of consecutive days. He passed in both places, a considerable achievement in an era when the pass rate was very low, and he was always an excellent general physician who knew much about all aspects of medicine.

After his late start in academic medicine, his career and achievements were remarkable, especially as ‘‘allergy’’ was a dirty word in British medicine in the 1950s, tarnished by much charlatanry in the field in previous years. It took him a very long time to almost single handedly establish the subject in Britain as a valid specialty with a rigorous scientific basis. Even when he was finally appointed in 1967 to a Professorial Chair at the Institute for Diseases of the Chest in London University, the first in the United Kingdom in this subject, the title was Clinical Immunology rather than Allergy. Early on he had struggled greatly to find posts in which he could pursue his research aspirations, but he still managed to do beautiful work. His analysis of specific and nonspecific factors in the tuberculin reaction is a seminal contribution to understanding of the delayed hypersensitivity reaction and is an exquisite example of rigorous clinical experimentation producing robust conclusions. For several years, he worked for the Medical Research Council, running chemotherapy trials for tuberculosis in Africa, and made a substantial contribution to establishment of the optimal treatment regimens. 

Eventually he established himself at the Brompton Hospital with a laboratory funded by the Medical Research Council and ran the research program and clinics in which he made his many seminal contributions to allergy, especially respiratory allergy and occupational lung disease. At the same time, he trained a whole generation of British chest physicians and allergists, as well as many others from all around the world, in both research and clinical allergy. His personal work with experimental models was limited early on by development of exquisite allergic sensitivity to guinea pigs and other animals, but his focus was always on clinical research and clinically relevant observations. His achievements included discovery of the cause of farmer’s lung; description of the syndrome of extrinsic allergic alveolitis (hypersensitivity pneumonitis); identification of many of its forms, including bird fanciers’ lung, and their causes; the detailed description of allergic bronchopulmonary aspergillosis and its diagnosis and management; the development and extensive use of bronchial challenge testing for elucidation of allergic mechanisms of asthma and respiratory disease in general; identification of many of the causes of occupational asthma; major contributions to the development and use of cromoglycate; and standardization and expert exploitation of skin prick testing.

His work was generally characterized by straightforward methods and techniques, usually deployed in human subjects, meticulous clinical observation, and perceptive protocols that revealed, in an unprecedented manner, fundamental immunologic mechanisms of direct clinical relevance. Few others have made such wideranging contributions that so immediately affected clinical practice for the benefit of patients with a broad range of both very common and rare diseases. The use of agar gel precipitin tests to detect precipitating antibodies, of provocation testing in conditions that closely reflected real-life occupational exposure to inhalational allergens, and of simple skin prick testing did not attract the attention of basic scientists, but the benefits for patients were universally recognized and very warmly appreciated by clinicians worldwide.

Jack Pepys’s central credo was that discovery in biomedicine only achieves its full potential when it is translated into clinical benefit. I was exposed to this all my life and never contemplated any career other than medicine and medical research. On the one occasion, when I was in high school, that I suggested to my father that I might become a physiologist rather than a physician, it only took him a few minutes to convince me that I should study medicine first and then decide what to do. He was utterly compelling but always through reasoned and articulate argument, never dictatorial or bombastic.

He was an outstandingly good lecturer and accepted happily almost all invitations from anywhere in the world, regardless of the size or importance of the venue. His work had direct clinical relevance with immediate implications for patient management, so that his message was always useful. He therefore travelled extremely widely and was known and very fondly remembered by physicians worldwide. Although he was obliged by British law to retire from his chair and department at the age of 65, he continued to work as a visiting professor in my department at the Royal Postgraduate Medical School, Hammersmith Hospital, until a few weeks before he died. Toward the end of his life, I had the privilege of accompanying him to major international allergy meetings in the United States and in Europe and saw how almost everybody knew him and came to pay their respects and remind him of his visits and talks in their particular centers, hospitals, or parts of the world.

I received hundreds of letters and messages of condolence after his death on 9 September 1996, and many of them mentioned that one of his most notable characteristics was that he never gossiped about people. It had struck all these individuals that my father was one of the very few persons they had met who was never heard to criticize others behind their backs or to participate in such character assassination. Of course, he was appropriately critical in professional reviewing, but at a personal and social level, he was truly a model person. He was modest, kind, thoughtful, and considerate to everyone and always visited when anyone he knew was sick. He was always optimistic and equable and extremely brave and stoic when it was necessary. He was respected, loved, and appreciated by all who knew him, worked with him, or were taught by him. His given name was Jacob and the inscription on his tombstone includes the biblical verse ‘‘And Jacob was a perfect man,’’ a description that genuinely fits him well.

Jack Pepys, Royal Brompton Hospital Jack Pepys


It looks like Joan Longbottom seated at the far bench, who is standing?

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