Leslie Ernest HughesBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7367 (Published 25 November 2011) Cite this as: BMJ 2011;343:d7367
- Bronwyn R Hughes,
- David Webster
Leslie Ernest Hughes (“Les”) was a quiet, self effacing man, whose integrity and deep Christian belief informed his work. He made an indelible impression on those who worked with and for him. His modesty sometimes led to a lack of appreciation of his talents by his colleagues. His wide influence is apparent in the many other professors, both in the United Kingdom and abroad—especially in Australia and India—who owe much to his guidance during their time in his department.
Les was the fifth of eight children born to Charles and Dorothy Hughes in Parramatta, New South Wales. His father was a tailor and always told his children what a tough childhood he’d had. After finishing at Parramatta high school Les gained a place to study agricultural science at Sydney University as his wish was to farm. However, his older brother Walter, a medical student, persuaded him that medicine was a better option and he transferred in his second year. He graduated in 1954 and married Marian Castle, a fellow medical graduate.
After a surgical registrar post at Concorde Hospital, Sydney, he moved to the UK and worked initially at Derby City Hospital and then West Middlesex Hospital. During these clinical posts he gained his love of surgery—and was never more happy than when taking responsibility for all the surgical cases in the hospital and operating through the night. During the holidays he explored Europe and particularly enjoyed travelling extensively through eastern Europe in a campervan with Marian. In 1962 he was appointed cancer research fellow at King’s College Hospital and developed his research interest. By chance he met Dame Cicely Saunders, the founder of the hospice movement, and helped her with some studies. It was fitting that he was able to benefit from hospice care at the end of his life.
He then returned to Australia as a reader in surgery (1964-71), working with Professor Burnett. As well as doing his clinical work he became involved in the Queensland melanoma project. As a consequence he was aware of the danger of the sun before it was public knowledge and was strict about his families’ sun exposure. He caused great embarrassment by forbidding swimming in the local pools before 4.30 pm. His children were later grateful.
As the Eleanor Roosevelt cancer research fellow he studied for a year with Tom Dao at the Roswell Park Memorial Institute in Buffalo, USA. This enabled the family to travel around the world with him—all were then infected by his love of travelling.
He returned to Brisbane but soon was appointed as professor of surgery at the Welsh National School of Medicine in Cardiff in 1971, in succession to A P M Forrest.
He was professor of surgery and head of department from 1971 until his retirement in 1992. A university clinical department has three roles: provision of clinical services, education (both undergraduate and postgraduate), and research. He was an able administrator, a task to which he brought his ability to assimilate the detail while identifying and focusing on the important issue. He served on the medical school’s senate and later became vice provost. He did not always speak, but when he did, his lucid development of his argument usually ensured that he won his point. He made major contributions to clinical surgery, research, and teaching both in Wales and beyond.
He was an outstanding general surgeon with a wide repertoire, but more than that he was an innovator. He was accomplished in head and neck surgery, using plastic surgery techniques that he later adapted to reconstructive breast surgery long before this became fashionable. He had a wide knowledge and experience of abdominal surgery and produced seminal works on diverticular disease and perianal Crohn’s disease. He had a formidable knowledge and experience of the management of skin cancer and, in particular, malignant melanoma. He also developed interests in rather neglected topics, enhancing our understanding of and the treatment of hidradenitis suppurativa and granulating wounds. He set up the first wound care clinic. He developed a new generation of dressings for chronic wounds.
As an operating surgeon he was technically meticulous and careful; attributes that stood him in good stead as many of his cases were complex secondary or tertiary referrals. When the clinical situation arose he could be extremely quick, but, as he once wryly remarked, “When you have trainees they have to see you doing it properly.” His clinical skills were not confined to operative technique: he was widely knowledgeable in the wider range of medicine and many patients had cause to be grateful for his kind and thoughtful approach to their problems.
Les Hughes brought a formidable intellect and ability to recall facts to research. Although his time in the laboratory was limited, his grasp of the essentials of technique made him a formidable team leader. His early work in Cardiff revolved around clinical immunology. Later he was interested in the development of molecular biology as it applied to surgical problems. He developed a research team that contributed major advances in the management of benign breast disease, wound healing and the immunological responses to cancer. No paper was allowed out of the department until it had been scrutinised and written to his exacting standards.
As a clinical researcher he was interested in, and published papers on, a wide range of topics: wound healing, incisional hernia, diverticular disease, malignant melanoma, prophylaxis of deep vein thrombosis, Crohn’s disease, and benign as well as malignant breast disease were all the subjects of original contributions. He was a founder member of the national melanoma study group and was responsible for setting up one of the early national databases for melanoma. Of these his book on benign breast disease (now in its third edition) is widely regarded as the definite work on this topic, and remains the principal textbook on this topic in the English language.1
The esteem in which his research was held, at national level, was reflected in the invitation to give a Hunterian lecture at the Royal College of Surgeons and from the Surgical Research Society to become its president.
Les Hughes believed in the importance of education as a core component of the work of his department. He ensured that undergraduates got their share of his time, but it was as a surgical educator of junior staff that he excelled. Always demanding but never unfair, he might be critical to your face but would then defend you against others. He espoused the idea of mentorship throughout his working life, and there are many surgeons with reason to be grateful for his teaching and the example that he set. He would quietly bring his own mentors to teach in the department on Friday mornings that were dedicated to education, the mortality and morbidity meeting, research meeting, and practice presentations. These could be intimidating but made the Surgical Research Society seem like a cakewalk.
As an internal undergraduate examiner in Cardiff and as an external undergraduate examiner elsewhere, and on the court of examiners at the Royal College of Surgeons, he sought to find out what the candidates knew rather than what they did not.
He had four children. The youngest had Down’s syndrome. He was supportive and fiercely protective of him. He always told his children he felt he had missed out on their childhood, but his grandchildren benefited as he spent so much time with them and took real pleasure in all their achievements.
After retirement he continued to be interested in developments not only in surgery but in the wider world of medicine. He expanded and shared his knowledge of medical history and wrote several illuminating pieces. While his health allowed it he travelled widely . He would spend two to three months each year in his and his wife’s beloved Sydney, spending time with family and exploring new places in the country. Not only did he travel for holidays, but he was often invited to lecture by many of the surgeons overseas he had trained or with whom he collaborated. He was asked to plant many mango trees in India. He loved his garden and his vegetables and constantly helped his children with theirs. He extensively researched his family to find some roots in Wales, although his family had travelled to Australia in the late 1800s.
He had a great love of music, particularly choral music, and was at home at the Welsh National Opera and St David’s Hall, listening to male voice choirs, and singing in the church choir. His favourite opera singer was the Australian soprano Joan Southerland.
He developed myelodysplasia at the end of his life but continued to strive to improve lives of others, organising residents committees even near the end of his life.
He is survived by his wife, Marian; two daughters; a son; and five grandchildren.
Cite this as: BMJ 2011;343:d7367
Former professor of surgery Cardiff (b 1932; q Sydney 1954), died from acute myeloid leukaemia on 3 March 2011.