IOIBD
INTERNATIONAL ORGANIZATION FOR THE STUDY OF INFLAMMATORY BOWEL DISEASE
Sidney Truelove, a great gastroenterologist and great friend of Spain, has passed away
On April 19, 2002, at the age of 89, Dr. Sidney Charles Truelove passed away in his beloved Oxford. We are certain that Spanish gastroenterologists, as a whole, will feel this loss, since it is impossible to work in this specialty without having read his name in a multitude of articles and books. Not one among the experts in Digestive Diseases is unaware of the fact that the work of Truelove in the 1960s radically changed our vision of ulcerative colitis and what later was to be called “Inflammatory Bowel Disease”. We must also remember that it was Truelove’s meticulous and well-designed clinical studies that showed, among other things, the utility of glucocorticoids in those suffering from acute ulcerative colitis — a treatment plan that has been unaltered since then.
He and Professor Leslie Witts, who brought him to Oxford in 1937, carried out the first clinical trial in the history of gastroenterology. They demonstrated that cortisone was more effective than placebo in ulcerative colitis (Br Med J 1955;2:1041). The relevance of this article is proved just by looking in the Citation Index, which shows more than 520 citations up to April 2002. A short time later in a placebo-controlled study, he showed the value of hydrocortisone locally in distal ulcerative colitis (Br Med J 1958;2:1072). The intravenous treatment of a severe attack of ulcerative colitis with glucocorticosteroids which he introduced, and which in many countries is known as the “Truelove regimen”, constituted another of his classic observations of this disease (Lancet 1978;2:1086). He introduced the practice of collaborating from the beginning with surgeons in order to optimize therapy and indications for surgery in the treatment of severe ulcerative colitis patients (World J Surg 1980;4:195).
Not any less important was his conclusive demonstration that Salazopyrin, taken regularly, greatly reduced the risk of relapse of the disease (Gut 1973;14:923). His interest in this field kept him from settling with Salazopyrin as maintenance treatment, as he deemed the eventual pharmacological side effects to be unacceptable. With elegant methodology, he proved that the active part of the drug was the salicylic radical and that the Sulfamide only served to allow that the former would arrive to the colon intact, where the latter’s therapeutic effect took place, while Sulfamide was responsible for the side effects (Lancet 1977;2:892). From this observation new drugs and new galenic forms of the salicylates were derived which allowed the drug to arrive to the colon without having to suffer from the toxic effects of the sulfa (Scand J Gastroenterol Suppl 1988;148:3 and Z Gastroenterol Verh 1989;24:12).
Only these findings, fruit of the effort, diligence and creative spirit, would be enough for Sidney – as he himself asked to be called, even by those of us who were young and left nearly speechless when we met him – to pass in his own right into the history of 20th Century Gastroenterology.
All of the experts know that he had many more contributions to the field of digestive diseases, but believe that this is not the place to reiterate them. Nonetheless, we must remember that it was the classic study of Chaudhary and Truelove that opened new guidelines in the diagnosis and classification of irritable bowel syndrome (Q J Med 1962: 307). We would also like to highlight his very complete training as an internist, a little known fact demonstrating that Dr. Truelove was not only able to contribute in the field of gastroenterology. He always had a broad vision of medicine; before settling in Oxford he had already published a very rigorous study showing that, in general terms, patients with myocardial infarction did not benefit from oral anticoagulant treatment in the first months. The rigor of his work in this field is the reason this observation is still valid after so many years.
Those of us who had the chance and the privilege of enjoying his teaching and friendship, in varied periods of time, can tell a multitude of anecdotes that are not just limited to the field of medicine. This demonstrates his incredible humanity and knowledge of people. That is how he had Diego, on his first day of his stay, see the most bad-tempered, cryptic patient with the hardest imaginable English to understand, in his consultation. What turned out to be a test of the capabilities of the doctor, was so favorable, that from then on he entrusted him with full freedom one of the regular consultations. For Julio, one night in Madrid when he dropped him off at his hotel, before accepting to spend a year in Oxford, he invited him to have a few drinks in his room until the wee hours of the morning; they had Carlos I brandy, which Sidney loved. As he accurately indicated, the following day he did not have any obligations, and Julio was very young and could survive such a late night and work normally the next day. Martin Roca, who is unfortunately no longer with us and whom Sidney called “the most German of his disciples”, because of his vigorous methodology, defended his doctoral thesis in Oxford, as did Salvador a few years beforehand. Both, after 5 years of training in what should be called “The School of Sydney Truelove”, and just like Diego and Julio, established undying ties of friendship and a professional relationship with Sidney, which was a source of a constant urge for improvement in professional and human aspects. If we have improved in these aspects since our first arrival at Oxford, undoubtedly Sidney Truelove had an important hand in it.
Sidney was definitely drawn by contact with young foreigners, not just Spaniards and other Latin Americans, but also people from Italy, Sweden, Greece, India, Bangladesh, Japan, Arabic countries, etc. We swarmed for years around him under his careful and paternal aegis at the Radcliffe Infirmary in Oxford, and enriched him by bringing him close to diverse cultures and realities. All of us who were with him learned, together with his colleagues, the radiologists Lumsden and Nolan and the pathologists Whitehead and Piris, that gastroenterology is a multidisciplinary specialty.
What can be said about his evening visits to patients, an inexhaustible source of better knowledge of “ars medica” and of the doctor-patient relationship; of the intimate dinners at his cozy cottage in Kirlington, always accompanied by Joan, the perfect woman for such a great man; of the walks through the gardens and colleges of Oxford at sunset, if time permitted, talking about the divine and the human always with his characteristic and British good humor.
He came numerous times to Spain to give conferences. He enjoyed our hospitality, he endlessly praised our chorizo; once, after eating despite having a slight enteritis, he affirmed that it helped his case and ironically he suggested we do a controlled study on its curative effects. We will also always remember the day when, upon feeling a bit dizzy, he decided to lie down on the pavement of the porticos of the Plaza Mayor in Segovia, with the consequent commotion.
His last trip to our country took place, already having reached 80 years of age, when he was awarded with a Doctor Honoris Causa by the Universidad Autonoma de Madrid.
We remember his speech well. He began by saying, more or less, the following: “To receive an honorary doctoral degree is always an honor, to receive it from a country other than one’s own is a great honor, to receive it from a country that one truly loves is on top of that a great pleasure.” He spoke little of gastroenterology or of medicine, rather he spent the large part of his time talking about his experiences in Spain and of his Spanish friends. In the reception that followed, he felt great relief watching the Rector Magnificus light a cigarette and thus allowed himself to do the same with one of his unmistakable “Players.” That night in the home of Mari Luz and José María Pajares, he told entertaining jokes in English while enjoying our cuisine and our wines—an experience that will be hard to forget.
Many gastroenterologists followed his example of forming monographic consultations on IBD, including Irene Weterman and Salvador Peña in Leiden (Holland), Martin Roca in Barcelona, and Julio García Paredes in Madrid since the 1970s.
This Spring of 2002 a great man has left us, a man whose life was truly complete. We sincerely believe that Spanish gastroenterology will always be in debt to him. By cordially receiving Spanish disciples and teaching them his way of practicing medicine, he undoubtedly collaborated in the present development of this specialty in our country.
If we were asked to write his epitaph, we would plagiarize the subtitle of the memoirs of Pablo Neruda: “Confieso que he vivido” (“I confess I have lived”).
Diego Reverte-Cejudo
(Hospital General de Segovia, Segovia, Spain)
Julio García-Paredes
(Hospital Clínico de San Carlos, Madrid, Spain)
A. Salvador Peña
(VU University medical center, Amsterdam, The Netherlands)
The authors wish to thank Prous Science in Barcelona for the English translation of this contribution and in particular Michelle Tracy.