Obituaries

David Morley

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b3633 (Published 08 September 2009) Cite this as: BMJ 2009;339:b3633
  1. Andrew Tomkins

    Champion for child health in poor countries

    David Morley saved the lives of many thousands of children in developing countries and made massive contributions to improving their health and development. When David qualified in medicine in 1947 more than one in four children in developing countries died before their fifth birthday. As a young doctor in a mission hospital in Nigeria, David challenged the assumption that children’s main treatment should come from hospitals. He established the basis for primary health care for children, which is now used by governments and agencies worldwide. He set up training courses for senior paediatricians and nurses from all over the world, supported by Unicef and the World Health Organization, reorienting their work. Through the charity he established David sent educational materials to many thousands of frontline workers.

    David was born in 1923 in Northamptonshire, the youngest of seven children. He was schooled at home and later went to school at Haywards Heath and then Marlborough College. David studied natural sciences at Clare College, Cambridge, during which time he published papers on the sensitivity of different bacteria to penicillin. David qualified in medicine at St Thomas’ Hospital, London, and worked at the Sunderland Children’s Hospital, where he met and married Aileen Leyburn, the ward sister. They moved to Newcastle to work with Professor Donald Court on the influential Thousand Family Study, tracking the health of children in poor social and economic settings.

    At the same time, three missionary doctors working in the Wesley Guild Hospital in Ilesha, Nigeria, were painfully aware of the limitations of traditional clinical services. Drs Andrew Pearson, David Cannon, and John Wright obtained a research grant from the West African Medical Research Council, which was matched by the Methodist Missionary Society, although the council was suspicious at first, preferring laboratory based research. They recruited David, and in 1953 he set up an extensive longitudinal study of the health and nutrition of young children in the Imesi-Ile village area, with the nurse Margaret Woodland. David wrote in his papers, “over 400 children were recruited and followed monthly for five years; this was the first of its kind in tropical Africa.”

    Road to health

    But this was not just an observational study. David’s colleagues in Ilesha said that “the Morley revolution introduced and evaluated many innovations in child care, including the under 5s clinic, in which mothers weighed and charted their own infants and kept their children’s ‘road to health cards.’ David started the earliest trials of measles vaccine, including his own children in the cohort.” But they bear no grudge.

    In 1961 David returned to the United Kingdom to work at the London School of Hygiene and Tropical Medicine, but his heart was in child health, and in 1964 Professor Otto Wolff persuaded David to move to the Institute of Child Health, London, where he set up the tropical child health unit and ran courses for senior paediatricians and nurses from developing countries. David, and the team of visionary staff that he recruited, developed extensive collaboration with centres in the UK, Africa, and Asia and produced effective child health workers, who continue to communicate and remember when David visited them with challenging ideas and suggestions about changing their practice.

    David had a “can do” attitude and a great aptitude for developing appropriate technologies that are now standard throughout the developing world. These included a robust scale for weighing infants in the community, “road to health charts” owned by parents, and a simple tape to measure the circumference of the mid-upper arm to detect severe malnutrition. The tropical child health unit at the Institute of Child Health formed the basis for the present Centre for International Health and Development (www.cihd.ich.ucl.ac.uk). He joined with colleagues at the Institute of Education to form Child to Child, the global network for activities by children to improve their own health.

    Identifying malnutrition

    In 1965 David established Teaching Aids at Low Cost (TALC), initially using a network of volunteers in the St Albans area, which has sent abroad nearly 400 000 books, 75 000 CDs, and 270 000 tapes for identifying malnutrition. The resource centre at the tropical child health unit attracted thousands of visitors from all over the world.

    In 1973 David published Paediatric Priorities in Developing Countries. It was radical, challenging the concept of hospitals as “disease palaces,” and not always easy reading for his hospital colleagues. It showed the impact of simple community based technologies and healthcare systems and was the basis for change in healthcare policies by WHO, Unicef, and national governments. Students queued for David’s lectures, and many were captivated by his evidence, messages, and passion.

    David received many honours, including the King Faisal international prize for medicine in 1982, the James Spence medal of the Royal College of Paediatrics and Child Health in 1989, the Maurice Pate award from Unicef in 1978, and the CBE in 1998. He was proud in a humble way of being made a chief by the Owa-Oye of Imesi-Ile in 1987. A film was made of David’s life and work at the time of his festschrift on his 80th birthday, which was distributed on BBC channels. But at all times he maintained a self effacing attitude which made him such an approachable man. It was wonderfully frustrating to try to arrange a time to meet him because he always had so many visitors from abroad. He was working on matters related to TALC until his sudden death. David leaves his wife and three children.

    David’s Christian faith was central to his personality and a motivating force in serving children in difficult circumstances. As one of his African paediatric colleagues said, “David was a giant for improving child health in developing countries, but, unlike most giants, he regarded the task much more important than himself.”

    Notes

    Cite this as: BMJ 2009;339:b3633

    Footnotes

    • David Cornelius Morley, professor of tropical child health at the Institute of Child Health, London (b 1923; q 1947, St Thomas’ Hospital, London), died 2 July 2009 from a heart attack.