Priscilla Kincaid-SmithBMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4503 (Published 15 September 2015) Cite this as: BMJ 2015;351:h4503
- Ned Stafford, Hamburg
In late 1958, Priscilla Kincaid-Smith arrived in Melbourne, newly married to her Australian husband and eager to resume her medical career. Born and raised in South Africa, she had excelled during the previous six years, training and conducting medical research at Hammersmith Hospital in London. She was in for a shock: married female doctors in Australia could not be employed at a university or a hospital. “To my absolute amazement and dismay, I was jobless,” she recalled a half century later.1
In order to continue her career, she took a position, as a research fellow, far below her impressive qualifications. She worked hard, determined to enter into—and excel in—a system that denied women full and equal employment opportunities. “She was an outstanding role model for women,” says Judith Whitworth, former director of the John Curtin School of Medical Research at the Australian National University. “An abiding characteristic was her determination. If she thought something was important she would go for it relentlessly and never take no for an answer.”
Breaking the mould
Kincaid-Smith eventually became an internationally acclaimed nephrologist, while at the same time opening doors in Australia that previously had been closed to women. She was the first woman appointed professor at the University of Melbourne, the first female president of the Royal Australian College of Physicians, and the first female president of the World Medical Association. She also served as president of the Australasian Society of Nephrology, the International Society of Nephrology, and in leadership positions of other medical societies.
Perhaps the most important of her many medical accomplishments, which include authorship of more than 430 research papers, was the work that helped establish the causal link between the use of compound analgesics and kidney damage, now commonly called analgesic nephropathy. After helping establish the link, she successfully campaigned against their use in Australia, saving perhaps thousands of lives.
“She, simply put, was a giant in our specialty,” says William M Bennett, a past president of the American Society of Nephrology who is now medical director of kidney transplantation at Legacy Health Systems in the United States. “She insisted on excellence and could not abide mediocrity. She was persistent and relentless in pursuing her goals, but I found her warm and genuine.”
Bennett adds that Kincaid-Smith’s “contributions are too numerous to count,” an assessment shared by Whitworth. They say that in addition to describing analgesic associated kidney disease, her contributions include describing the features and treatment of many causes of glomerulonephritis, understanding pre-eclampsia and renal disease of pregnancy, helping establish kidney transplants in Australia, understanding and treatment of malignant hypertension, and work in reflux nephropathy and urinary infection.
“Priscilla, despite her renown as a pathologist, was always first and foremost a clinician,” says Whitworth. “She was astute, with wonderful powers of observation. Her research and advocacy was always patient focused.”
Kincaid-Smith began investigating analgesic nephropathy in early 1959—only weeks after arriving in Melbourne and beginning work as a research fellow at the Baker Institute. She had trained in pathology in London, and each day—out of habit—would visit the autopsy room at Alfred Hospital in Melbourne. She observed what she would later describe as “extraordinary” lesions on the kidneys of recently deceased patients. She was baffled, as she had never seen this form of renal papillary necrosis in her six years in London.
Kincaid-Smith questioned attending pathologists, and they told her that this papillary necrosis was “a very common result of infection” in Australia. Kincaid-Smith was sceptical. “I found it difficult right at the start to accept that it could possibly be the result of infection,” she later said.2
Kincaid-Smith credited her husband and frequent research partner, renal physician Ken Fairley, with helping point her in the right direction. Fairley told her that some of his patients who had developed renal failure had a history of intense use of compound analgesics. She followed that trail and, after years of persistent investigation, helped conclusively identify compound analgesics as the culprit behind the kidney damage.
At the time, compound analgesics in powder form were sold in Australian supermarkets and widely used. They contained the analgesics aspirin and phenacetin, but also caffeine, which helped make them addictive. Often called by the abbreviation APCs (aspirin, phenacetin, caffeine), the two most widely used APCs in Australia were Bex Powders and Vincent’s Powders.
Through the 1960s and into the 1970s Kincaid-Smith was the author of significant papers on analgesic nephropathy in various journals, including The BMJ and the Lancet.3 4 5 6 She also spent years loudly campaigning against the use of compound analgesics, succeeding in 1979 when retail sales were restricted to pharmacies. Cases of analgesic nephropathy in Australia are now rarely seen.
From physical education to medicine
Priscilla Sheath Kincaid-Smith was born on 30 November 1926 in Johannesburg, one of four children. Her father was a dentist and her mother a botanist. A talented swimmer, Priscilla loved sports and had planned to study physical education. But after starting her studies at Witwatersrand University at the age of 16, she found that she enjoyed medical science courses and in 1945 ended up with a bachelor’s degree in science. After an additional honours’ year of science, she began medical studies at Witwatersrand, graduating in 1950.
She trained in medicine and surgery until 1953 at Baragwanath Hospital in Johannesburg. It was a sprawling 2000 bed hospital, and she worked seven days and four nights a week, treating a long list of diseases including malaria, typhoid, and amoebic hepatitis. “We worked very hard to diagnose and then to treat such diseases,” she later said. “I think my label as a therapeutic enthusiast in nephrology probably dates back to those times when I loved making people better.”
In 1953 she moved to London, initially training in pathology under J Henry Dible at the Royal Postgraduate Medical School at the Hammersmith Hospital, but she soon realised she preferred working with patients. After three years of pathology she switched to cardiology and became interested in the kidney. She was mentored by John McMichael.
In May 1958, over an autopsy, she met Ken Fairley, who was training in London at the National Heart Hospital. Kincaid-Smith later said of their whirlwind romance: “Ken and I met in May 1958, got engaged in June, got married in July, and came out to Australia at the end of the year.”
In 1961, after nearly three years in Melbourne, Kincaid-Smith was offered a position at the University of Melbourne, as a senior associate in medicine. She was involved in setting up the renal transplant programme at the Royal Melbourne Hospital, where in 1967 she became director of nephrology. In 1968 she was founding member of the non-profit organisation Kidney Health Australia and in 1975 named professor of medicine at Melbourne University.
“She was an outstanding mentor,” says Whitworth. “Priscilla trained generations of nephrologists in Australia and South-East Asia particularly, but also from all corners of the world.”
In addition to her academic and clinical duties, Kincaid-Smith was highly active in Australian and international medical societies. Her many honours include the Commander of the Order of the British Empire (CBE). Kincaid-Smith was compulsorily retired in 1991 at age 65 from the university and the Royal Melbourne Hospital—a traumatic experience that left her “bitterly disappointed” and in “sort of a vacuum for some time,” she later said. She remained active, however, and in 1994 was named to a one year term as president of the World Medical Association.
In a Q&A with the Lancet in 1999 she spoke of relaxing with her husband at weekends by working—with only one helper—on their 1000 acre beef cattle property. Her advice to young doctors: “Choose an area in which you can wake each day with enthusiasm to get back to work.”7
Kincaid-Smith leaves her husband, and three children.
Cite this as: BMJ 2015;351:h4503
Priscilla Kincaid-Smith (b 1926, q Witwatersrand University, Johannesburg, South Africa, 1950), died from complications after a stroke on 18 July 2015.