South Australian Medical Heritage Society Inc

ACKNOWLEDGEMENT:
We are most grateful to Dr. Brian Barraclough for his article about Sir Aubrey Lewis. It is presented unchanged. Dr. Barraclough, an Otago medical graduate, trained in psychiatry under Sir Aubrey Lewis at the Maudsley Hospital London 1962-5. He then worked in psychiatry for the UK Medical Research Council and then Southampton University Medical School. In 2000 he saw the light and returned to his native Auckland.

AUBREY JULIAN LEWIS Kt MD FRCP

Aubrey Lewis (1900–1975), the leading psychiatrist of his day, was born in Rundle Street, Kent Town, Adelaide, the only child of George Solomon Lewis, a watchmaker and watch repairer from England, and his Adelaide born wife Rachel (Ré) Isaacs, an elocution teacher. Although Jewish, Lewis was educated at the Christian Brothers' College (1911-1917) where he showed remarkable literary ability. His pass subjects were Latin, Greek, French, German, English Literature, History and Mathematics. No science, yet he entered the Faculty of Medicine at Adelaide University graduating in medicine in 1923 with distinction. After graduation he was for two years, successively, resident medical officer, medical registrar and surgical registrar at Adelaide Hospital, providing a good clinical grounding. While an undergraduate he contributed to the Adelaide Medical Students Society's 'Review' and succeeded HW Florey as Editor. In the Review he published an essay on the value of literature, both reading and writing, as a diversion from an exacting career.

F Wood Jones FRS, anatomist, anthropologist and naturalist became Professor of Anatomy in 1919 and undertook anthropological research among Aborigines in the Outback. In 1925, as part of Wood Jones programme, Lewis took part in a study of Aborigines living at Ooldea, working with TD Campbell. Ooldea was, and is, a small, remote settlement on the eastern edge of the Nullarbor Plain, a stopping place on the Trans Australian Railway. Papers on Aboriginal dental health and physical measurements and psychology were published jointly in 1926, Lewis' first scientific publications.
Following this work Lewis was in 1926 awarded a two year Rockefeller medical research travelling fellowship to train as a psychiatrist with the ultimate object of studying the mental traits of the Aborigine. The fellowship allowed him to visit Macfie Campbell, a pupil of Kraepelin and of Adolf Meyer, at the Boston Psychopathic Hospital; Adolf Meyer himself, at the Phipps Clinic, Johns Hopkins Hospital; Gordon Holmes at the National Hospital for Nervous Diseases; Karl Beringer in Heidelberg and Karl Bonhoeffer at the Charité in Berlin. Lewis adopted the Meyerian outlook.

He returned to Australia in 1928 but could not find suitable employment. Wood Jones had moved to a Chair in Honolulu in 1927. Lewis, now drawn to a career in psychiatry, joined the Maudsley Hospital, London. This was first as a research fellow and from 1929 as a member of the medical staff - there were five full-time doctors. He remained at the Maudsley until he retired in 1966.
The Maudsley had opened in 1923 as a hospital with the dual purpose of treating voluntary adult psychiatric patients with recent onset illness, and for postgraduate teaching. Under the first superintendent, Edward Mapother (1881-1940), a postgraduate school of psychiatry was recognised by London University in 1936 with Mapother as Professor of Clinical Psychiatry and Frederick Golla as Professor of the Pathology of Mental Diseases.

London provided Lewis with the stimulus and opportunity to write. From the late 1920s onward he wrote several hundred book reviews, mostly unsigned, for many journals, among them The Times Literary Supplement and The New York Review of Books. For The Lancet he contributed unsigned Editorials and Annotations. For instance in 1933 he published a reasoned rejection and condemnation of the German Government's plans to compulsorily sterilise, on eugenic grounds, the mentally handicapped, the mentally ill, chronic alcoholics and criminals. Subsequent Editorials considered Hitler's mental state (1940) and the correct diagnosis for Hess (1945).

Lewis became Clinical Director of the Maudsley in 1936 an appointment which continued in the part of the Maudsley evacuated to Mill Hill School during World War Two, 1939-45.
Mapother died in 1940. The Chair was vacant for six years, Lewis succeeding in 1946. Lewis' professorial appointment coincided with the Maudsley becoming the centre for psychiatry in London University's British Postgraduate Medical Federation, housing the Institute of Psychiatry. The Federation, established in 1944 with Francis Fraser as Director, co-ordinated the work of London's teaching hospitals which had postgraduate institutes. Lewis and Fraser had met and become friends during WW2 while working in London's Emergency Medical Service set up to cope with the medical effects of the blitz. Their friendship, it is said, assisted the birth of the Institute of Psychiatry.
Lewis had been planning an Institute for 15 years so its development was rapid. The Institute had no Director although Lewis was the acknowledged leader, primus inter pares, according to Michael Shepherd.
The inception of the National Health Service in 1947 provided the opportunity for the Maudsley, with its academic responsibilities, to merge with the Bethlem Royal Hospital, with its ancient prestige and endowments, to form a joint hospital, the Bethlem Royal and Maudsley Hospital. Lewis became Director of the Professorial Unit at the Maudsley.

As money and talented people became available Lewis lead the development of research and of clinical departments. By his retirement these included groups for laboratory based neuro-sciences, epidemiology, genetics, metabolic disorder in mental illness, neuro-psychiatry, neuro-surgery, psychology, social psychiatry and substance abuse. And to general adult psychiatry, which had been the core inpatient clinical service, were added child and adolescent psychiatry, forensic psychiatry, mental handicap, old age psychiatry and group and individual psychotherapy.
The London University Postgraduate Academic Diploma in Psychological Medicine had comprised a six month course of lectures since the 1920s. Lewis in 1952 reformed the curriculum and the Academic DPM became the premier post-graduate qualification in psychiatry and the insignia of a Maudsley student until the Royal College of Psychiatrists' Membership examination superseded it in the 1970s. His aim was to train "all-purpose psychiatrists" with clinical teaching as the core. Candidates, recruited on ability, came primarily from the UK but from any country and notably from the Commonwealth. Candidates spent up to three years in clinical training as junior doctors at the Maudsley while attending lectures and seminars on neuro-science and psychiatry. A thesis based on original research was required. A two part examination assessed competence.
Lewis' intention was to educate and to train those who in due course would fill the academic and research posts in the UK and also in the Commonwealth, posts which he believed would be created with the expansion of the health services and the universities and the growth of scientific knowledge.
Australian professors of psychiatry who took the Maudsley course in the Lewis era include Davies (Melbourne), German (UWA), Trethowan (Sydney) and Whitlock (UQ). Since Lewis retired those who have spent periods at the Maudsley and subsequently become Professors in Australia include Almeida (UWA), Ames (Melbourne), Everall (Melbourne), Foerstl (UWA), Jablensky (UWA) and Mullen (Monash). Dawson (Sydney) was at the Maudsley in the early 1920s before Lewis arrived there.

Lewis' tutorial style required evidence and reasoning expressed lucidly and economically. Failure to reach his standard resulted in memorably uncomfortable moments for his post-graduate students which induced improvement. In private he was warm and a relaxed witty conversationalist, amused by gossip.
Lewis' interest in social and economic influences on mental illness lead the Medical Research Council to set up in 1948 the Occupational Psychiatry Research Unit, with Lewis as Honorary Director. This became better known under John Wing as the Social Psychiatry Research Unit. The MRC also established a Psychiatric Genetics Unit at the Maudsley with Eliot Slater as Director.
By Lewis' retirement in 1966 the Maudsley led the world in psychiatric research and post-graduate teaching. The Maudsley today (2014) is a large successful institution and still leading the world, a monument to Lewis' vision, scholarship, leadership and administrative ability.

Lewis' standing in medicine resulted in his becoming the first psychiatrist to be a member of the UK Medical Research Council. He gave many eponymous lectures; among them the Maudsley (Royal Medico-Psychological Association 1951), the Bradshaw (Royal College of Physicians 1957), the Galton (Eugenics Society 1958), the Bertram Roberts (Yale 1960), the Harveian (Royal College of Physicians 1963) and the Linacre (Cambridge 1967). In 1959 he was knighted, an honour said to have mellowed him.
His collected papers on psychiatric topics were published in two volumes, edited by the 1966 Junior Common Room at the Maudsley Hospital. Lewis published no books telling Michael Shepherd he hadn't the time.

Lewis died in 1975 his final years blighted by Parkinson's Disease and the loss of his wife Hilda Stoessiger MD FRCP (1900-66), a noted child psychiatrist, who died in 1966. They had married in 1934 in London at the Liberal Jewish Synagogue, Marylebone, where his Memorial Service was held in 1975.
Lewis is survived by two sons and two daughters. His daughter Naomi qualified in medicine and married a doctor, Jeffrey Cream. His son Gilbert became a medical anthropologist whose studied indigenous peoples in New Guinea.

Aubrey Lewis three years.

Brian Barraclough.
brian.barraclough [at] xtra.co.nz
May 2014

Sources for the above include an entry in the Australian Dictionary of Biography.

Brian Barraclough, author of this essay, trained at the Maudsley Hospital 1962-5.

-o0o-