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James Spence Medallist 1997: Dr Barbara Mary Ansell

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At the first Annual Meeting of the Royal College of Paediatrics and Child Health, in April at the University of York, the President, Professor Sir Roy Meadow, presented the James Spence Medal to Dr Barbara Ansell, with this citation.

1997 is the 100th Anniversary of George Frederic Still’s description of chronic joint disease in children. At least seven different forms of idiopathic arthritis that commence in childhood are now recognised, and no-one has done more than today’s James Spence Medallist in defining these disorders and improving their management. Dr Barbara Ansell fulfils to the limit the criteria by which our premier award, the James Spence Medal, is awarded—for outstanding contributions to the advancement or clarification of paediatric knowledge.

Barbara Ansell was educated at King’s High School for Girls in Warwick before entering, as a medical student, Birmingham University, from which she qualified in 1946. Thus, she has experienced the first 50 years of the National Health Service, and in many ways she exemplifies all that has been best about our health service in its first 50 years—the development of specialty services and, in particular, specialty services for children, the development of child and family centred services, the advent of clinical trials, the delivery of care for chronic disorders by multidisciplinary teams, and the availability of expert care on an equitable basis, and (though I hope it does not sound patronising) one of the most important aspects of today’s health service, the stature and role of women doctors, for whom opportunities previously were so limited. Dr Ansell has participated in, and led, all these developments, and we congratulate and thank her.

Dr Ansell’s early work and interests were in general medicine and particularly cardiology. Of immense importance was her appointment in 1951 as registrar to Dr Eric Bywaters at the Special Unit for Juvenile Rheumatism at the Canadian Red Cross Memorial Hospital, Taplow, in Buckinghamshire. For the next 10 years of training she had continued links with that unit and wrote many of her early papers with Professor Bywaters. She was appointed consultant physician in rheumatology at Taplow in 1962, with half her sessions in the Medical Research Council Rheumatism Unit. Dr Ansell made her name at Taplow, and even though she was appointed to head the Division of Rheumatology at the Clinical Research Centre at Northwick Park Hospital in 1976, she kept her attachment to Taplow until its closure 12 years ago.

Most people will have difficulty imagining the sort of disability and the sort of life that children with rheumatic disorders, and other chronic disorders, experienced in the early years of the National Health Service. Dr Ansell encountered wards full of severely disabled young people, in bed or in wheelchairs, sitting or lying with fixed deformity, many of them suffering additional ills from the consequences of amyloidosis. The children were cared for kindly, but their families were often far away and parents could visit for, perhaps, two hours a week.

Dr Ansell was one of those who foresaw the need for new treatments and for clinical trials. From the days of relying on aspirin there came, in the 1950s, the use of steroids and then chlorambucil. She has been in the forefront of most of the clinical trials of drugs that may be used for childhood arthritis and has clarified their safe and effective use. But always she has recognised the immense importance of other treatments and the fact that physical treatment could reduce the need for large doses of drugs. In the late 1960s she led the way with her orthopaedic colleagues in exploring the use of synovectomy and of joint replacement for children, and has continued introducing and assessing new treatments. As a careful observer and assessor of the complications of arthritic disease, her papers, in the early 1970s concerning uveitis and cataract, were of immense importance and have influenced the way in which such children are managed.

Her great capacity for work, and her organisational skills established her as a pioneer of the multidisciplinary team care that is needed for children with chronic disease or disability. She has always been supportive of those who worked with her, and made it her business to care about them and their families, with so many of whom she remains in contact.

She is a leader and someone who expresses her views vividly and with force. She has managed to combine the necessary sympathy and support for a group of children and their families who are often extremely difficult to encourage, and to give them optimism and determination to participate in full education and normal activities.

She has been, and is, a prolific writer of clinical research papers and of review articles and books. She has well over 300 publications to her name. As a lecturer she is renowned throughout the world, and has been honoured by countless medical societies and associations. Among her British honours is that of Commander of the Most Excellent Order of the British Empire, which she received in 1982.

In addition to delivering prestigious guest lectures (she delivered our own George Frederic Memorial Lecture in 1981), she always has been willing to teach in less glamorous settings and to small groups who seek her help. She is a committed teacher, and the way in which she has continued to attend specialist paediatric rheumatology clinics in different parts of the country has been of immense value, not just to those children and their families, but as a teaching experience for the paediatricians and other staff at those clinics. There are many in today’s audience who would wish to express their personal thanks for this valuable service.

When I wrote to Dr Ansell, informing her that it was the decision of our Council that she should be awarded the James Spence Medal, she said in her reply that she couldn’t really regard herself as a paediatrician ‘having never done much neonatology’. Dr Ansell, you have been a member of the British Paediatric Association for a long time and, in more recent years, a distinguished Honorary Member, and therefore a founding Honorary Fellow of our College. It is irrelevant to us that your last official appointment was entitled consultant rheumatologist; because we know a paediatrician when we see one. Paediatricians are not only people who have done a formal attachment in a neonatal unit, or in a child development centre. Paediatricians are doctors who are skilled and experienced in the health and ill health of children, and who care about the needs of children and their families. And the best paediatricians are those who create better services for them.

George Frederic Still never did much neonatology, but he became the first President of the British Paediatric Association and would be delighted that today we should be honouring you as a most distinguished paediatrician. Dr Barbara Mary Ansell, I invite you to accept the James Spence Medal of the Royal College of Paediatrics and Child Health. James Spence Medallists 1960 Professor A A Moncrieff 1961 Professor R A McCance 1962 Sir F Macfarlane Burnet 1964 Professor L S Penrose 1965 Dr Cicely D Williams 1967 Professor R R A Coombs 1968 Dr Mary D Sheridan Dr D W Winnicott 1969 Dr G S Dawes 1970 Professor D V Hubble 1971 Dr W W Payne 1972 Dr R C MacKeith 1973 Professor C A Clarke 1974 Dr J Bowlby 1976 Dr D M T Gairdner 1977 Professor R S Illingworth 1978 Professor S D M Court 1979 Professor K W Cross 1980 Professor J M Tanner 1981 Dr Elsie M Widdowson 1982 Dr D MacCarthy 1983 Professor J O Forfar 1984 Dr J W B Douglas 1985 Dr N S Gordon 1986 Sir Peter Tizard 1987 Professor J L Emery Dr F J Miller 1988 Professor O H Wolff 1989 Professor D C Morley 1990 Professor L B Strang 1991 Professor John A Davis 1992 Professor Richard W Smithells 1993 Professor Dame June Lloyd 1994 Professor E O R Reynolds 1995 Professor R H R White 1996 Sir David Hull