Professor James AR Friend

 James Anthony Ritson Friend was the third of three sons of Greville, an academic zoologist at Edinburgh University, and his wife Mary, an English graduate. He attended Edinburgh Academy and won an exhibition to Gonville and Caius College in Cambridge to study medicine. His main influence in choosing medicine had been the sad death of his mother from leukaemia when he was 13, he having been one of her carers. At that time in Cambridge, after graduating with a BA in Natural Sciences, medical students usually transferred to a London Hospital for their three subsequent clinical years, but because his father was alone in Edinburgh he decided to move there to do his clinical training. Unusually, he did not return to Cambridge for his medical degree, taking instead the Edinburgh examinations, winning the Wightman prize and the Murchison scholarship in medicine; he was also a senior president of the Royal Medical Society. Even as a final year student, his dedication to medicine became apparent and, after a day spent on the wards without eating, the ward sister took pity on him, asking a staff nurse to make him scrambled eggs. That nurse, Elizabeth Sim, was in 1964 to become his wife.

His house posts were with Sir Michael Woodruff and Professor Girdwood, followed by SHO posts with Professor Strong and Dr Robson. He passed the Edinburgh MRCP in 1964 and in the lottery of the times was interviewed for two registrar posts on the same day. Fate decided that he was to become a chest physician as he was offered the registrar appointment to Sir John Crofton and Andrew Douglas. This post often turned out to resemble a life-long appointment, as Crofton continued to mentor his protégés throughout their careers. James was no exception and he moved to Oxford in 1968 as senior registrar and later lecturer, during which post he spent a year in Seattle on an MRC fellowship. In 1973 he was appointed consultant and honorary senior lecturer in Thoracic Medicine in Aberdeen.

The 1970s were a period of remarkable change in respiratory medicine. The work of Crofton and his colleagues had shown that tuberculosis could be cured by meticulous use of triple therapy and the need for patients to spend years in sanatoria was being eliminated by successful trials of shorter-term therapy. The physicians who had spent their lives treating TB were being replaced on retirement by a generation trained in internal medicine who started to confront the issues of asthma, which appeared to be on the rise, and the smoking-related diseases, lung cancer and chronic obstructive pulmonary disease, which were definitely increasing in incidence. From being a single disease specialty, chest medicine was about to move into the mainstream of acute medicine, with advances in bronchoscopy, imaging and lung pathology and physiology.

In the 1970s and early 80s the Aberdeen Respiratory Unit was split between inpatient beds at an old sanatorium, Tor-Na-Dee Hospital, and the City Hospital where there were inpatient beds and a chest clinic. Under James’ leadership the beds at Tor-Na-Dee were closed in 1986 and acute respiratory beds shared with general medicine were opened at Aberdeen Royal Infirmary (ARI). The beds and outpatient facility at the City Hospital were closed in the 1990s, and designated acute respiratory wards and a chest clinic were then opened at ARI. He also established a clinic dedicated to management of the increasing numbers of patients with cystic fibrosis who were surviving into adulthood. Throughout his consultancy in Aberdeen, James also held a twice-monthly clinic in Banff, 46 miles to the north.

James inspired a series of young colleagues to enter the developing specialty, He was always approachable and welcoming of all his colleagues and had great empathy with his patients. As a result, the Respiratory Unit became a happy and supportive working environment and there was always competition to work there. James also encouraged clinical research. In 1987, after finding notes from a 1964 study of children in Aberdeen with wheeze, he set up a cohort study to determine the lifelong consequences of early asthma that continued until after his retirement. With his colleagues, he published on the natural history of asthma and its causation by work in local industries. But aside from his dedication to the clinical care of his patients, his major lifetime activity related to prevention of smoking in conjunction with Action of Smoking and Health (ASH). At a national level, he became President of both the British and Scottish Thoracic Societies and chaired the UK Government’s Scientific Committee on Tobacco and Health, leading to a report on the effects of passive smoking and to important legislation to prohibit smoking indoors in public places, a major public health advance. He also set up a club in Grampian called Smokebusters, aimed at smoking prevention for children in their last years of primary school and first year of secondary school. Its main impact proved to be delaying the average onset of smoking.

James was a most modest and generous man, an exemplar of the caring physician, including his role as teacher and supporter of his younger colleagues. In 2000 this was recognised by his appointment to an honorary chair in medicine at Aberdeen University. He retired in 2003 and in retirement continued to improve his piano playing, reaching grade 7. His hobbies also included hill walking, skiing and bee keeping.  His marriage to Elizabeth was long and very happy, and they had three children. In 2005 Elizabeth sadly died of cancer and in 2017 James married Ann, whom he had met through his continued work on tobacco control. Four years later he developed early signs of the motor neurone disease that was cruelly to rob him of his muscle function. To the end he had nothing but praise for the care he received from his family and the NHS.

Anthony Seaton