Obituary featured in The Telegraph on 17 September 2023
Ronald Bradley, intensive-care pioneer who invented an important arterial catheter.
He built a mobile intensive-care unit, and he and his colleague were known as the ‘deathwatch beetles’ as they took it from bed to bed.
Ronald Bradley, who has died aged 93, was a pioneer of intensive care medicine in Britain; he made his mark as a young research fellow at St Thomas’ Hospital in London by designing and equipping an ingenious diagnostic contraption on wheels to help junior doctors on the night shift understand how best to deal with gravely ill patients. It was the first mobile intensive-care unit.
When a purpose-built intensive care unit opened at St Thomas’ in 1966 – the first in the country – Bradley was the obvious choice to run it. There, he invented his own pulmonary artery catheter which revolutionised the treatment of acute cases.
In 1989 he was made Britain’s first professor of intensive care. As his reputation grew, there was competition among physicians from different disciplines to be part of his team on Mead Ward. Of the 170 who worked as his senior house officer (SHO), more than 20 went on to become professors in their chosen field.
A modest, courteous man with a sense of mischief and a hatred of pomposity, Bradley trained at St Thomas’, graduated in 1955 and remained there until his reluctant retirement in 1994. He was known as “Uncle Ron” because of his kindness and solicitude. His first question when arriving on the unit was usually: “Have you had breakfast yet?”
Uniquely for a professor, he kept a bed in his office because he did not want to leave the unit in times of crisis or in the hands of a newly arrived SHO. “He built a team who would do anything for him”, said David Treacher, his successor as head of intensive care at St Thomas’, “and that in itself was a work of genius.”
Ron Bradley claimed he “fell into” the business of intensive care in the early 1960s “out of terror” at being responsible for sick patients overnight when cardiologists were hard to get hold of. “I designed a logic system for myself to sort out these acute messes.” His boss, Professor Edward Peter Sharpey-Schafer gave him three years to figure out what improvements could be made.
A man of practical skill and inventiveness, Bradley set about sawing up lengths of steel tubes, making scaffolding and mounting it on wheels so that equipment for catheterisation and the measurement of heart function could be taken from bedside to bedside. He and his senior registrar and collaborator, Margaret Branthwaite, became known as “the deathwatch beetles” as they trundled the vast trolley at speed to wherever in the hospital there was a crisis.
Driven by his quest for mathematical certainties and his fascination with the circulatory system, especially in sick patients, Bradley went on to invent the pulmonary artery catheter, a means of measuring pressures within the heart and also cardiac output. It was significant, recalled Margaret Branthwaite, because until then the only way of doing cardiac catheterisation involved a major procedure under X-ray control and many patients were too ill to be moved. “To do this at the bedside of the acutely ill was 100 per cent novel.”
Novel, too, was the manner of Bradley’s research. Unhampered by ethics committees, and working alone in a medical school laboratory, he conducted experiments on himself, passing hand-made float catheters into his own pulmonary artery – at some risk.
Two visiting cardiologists, William Ganz and Jeremy Swan, who worked together in America, marketed a remarkably similar device called the Swan-Ganz catheter not long after observing Bradley’s work. It was used around the world. Margaret Branthwaite recalled that after a meeting between Bradley and Swan in London, Swan had asked for details of the technique. She duly typed them out in immense detail but there was no acknowledgement of the letter. “It was with some sorrow,” she told an audience at the Wellcome Trust Centre in 2010, “that shortly afterwards we saw the publication of a notice of this spectacular new device, the Swan-Ganz catheter. Sadly, credit was not given where credit was due: that is, to Ron.”
Colleagues were indignant on his behalf but Bradley himself, unconcerned about self-advancement, ignored the whole thing.
The catheter eventually fell out of use in favour of non-invasive monitoring and Bradley became so adept at assessing patients by what he called “the knowing eye” and a stethoscope, that he ceased to use it. Contrary to specialist practice today, his success was founded on a careful bedside assessment of the whole patient.
Bradley’s findings using the catheter and his cumulative wisdom led to the publication of his seminal work Studies in Acute Heart Failure. David Treacher describes it as “a book of just over 100 pages of absolutely brilliant circulatory pathophysiology which became a bible to all those who worked on Mead and to many others”.
Bradley was not just a brilliant cardiac physiologist who saved thousands of lives; his creativity extended to other areas. He developed techniques for renal support and for obtaining liver biopsies intravenously, so that if the patient bled they did so into their own circulation. He reprogrammed the earliest BBC computers for use as bedside monitors, saving the unit thousands of pounds.
In 1993 he was awarded the Moxon Medal for his outstanding contribution to medical physiology by the Royal College of Physicians, and the Fothergillian Medal of the Medical Society of London in 2017. Hearing of the latter award, he said, wrongly: “I was a pretty ordinary physician who happened to be in the right place at the right time.” He explained: “I spent my time in ICU trying to discover how the whole circulation, rather than just the heart, behaved when serious spanners were thrown into the works.”
Bradley’s great love was teaching, not meetings, and he had a healthy disregard for bureaucracy. He created a fictional patient called Eustace Cocklecarrot with a false hospital number and would send prescriptions to the pharmacy in that name if he needed drugs urgently. Eustace was the longest-stay patient on Mead, one of his colleagues observed, as it took more than five years for the pharmacy to rumble him.
His nicknames and circumlocutions became known as “Ronisms” and his old-fashioned way of scrutinising patients before consulting measurements and charts was called “Ronometry”. He would describe a long-winded, incompetent historian as having “malignant prattleopathy.” A self-important person would be due a “pompousectomy”. For a patient for whom no more could be done, he would say the Nunc Dimittis had been sounded.
Bradley was much loved by his SHOs and respected by his consultant colleagues, as well as nurses, physiotherapists and pharmacists. He told one nervous junior doctor to feel free to call him at any time of the night if he was troubled and – unusual advice from a consultant – always to ask the advice of nurses as they were very experienced. He was on call at nights until he retired. He never felt threatened by the expertise of others and encouraged juniors to put forward ideas. Humility rather than hubris was a guiding principle.
Outside work, there was a reckless side to him: he loved to drive fast, was a fearless equestrian and was still using a chainsaw into his late eighties. An inveterate problem-solver, he made a subtle modification to the fuel system of his Jaguar. “The car would appear easy to steal,” his son Giles recalled, “but within a few hundred yards the engine would stop, causing the villain to panic and flee.”
Ronald Duncan Bradley was born on July 8 1929, the only son of a chartered accountant. He grew up mainly in Kent where, as a schoolboy of 13, he met his future wife, Betty Gibbon, when she kept turning up to watch him play rugby.
They married in 1951, were a devoted couple, and died within six weeks of one another, Betty in June at aged 94. Their home for 55 years was a 16th-century farmhouse at Toys Hill, near Sevenoaks, which Ron had seen when he was picking hops as a teenager and vowed one day to own. Ronald and Betty Bradley are survived by their three children, Amanda, Vanessa and Giles.
Ronald Bradley, born July 8 1929, died April 26 2023