Conor Ward has been one of Ireland’s most distinguished paediatric cardiologists. His legacy to the development of paediatric services at Our Lady’s Hospital in Crumlin, to paediatric cardiology and to academic medicine at UCD from the 1950s to the 1980s has been immense.
He is one of a handful of Irish doctors who is eponymous, credited with the first description with a medical condition: Ward - Romano syndrome, a disorder of cardiac rhythm he co-discovered in the 1960s.
He has also carried out important work in the area of intellectual disability; in particular, Down’s Syndrome. But like James Joyce and many Irish people before him, he chose exile, and moved to London on his retirement in 1990.
A kindly and quietly spoken man, he would certainly not be described as a liberal firebrand, yet his difficulties with Catholic authority as it applied to medical and hospital practice over the years highlight the tensions which Irish society endured as it tried to come to terms with the late 20th century.
He now, however, looks back more in sorrow than in anger.
Prof Ward’s relocation to London has, he points out, been personally fulfilling and professionally active. He has lived very happily in the metropolis with his wife Pauline for the past 20 years. They celebrated their 50th and 60th wedding anniversaries there and they enjoy the company and social support of three London-based families, including eight grandchildren.
They still visit Ireland regularly and meet up with the five grandchildren in Waterford and Dublin.
In an interview with irishhealth.com, Prof Ward, now 87 and in good health, looks back on a varied and fascinating career.
Prof Ward is one of the handful of Irish doctors who is eponymous in view of his being the first to publish a report on an unrecognised medical condition: the Ward-Romano Syndrome. This is a genetically-inherited cardiac arrhythmia. Its discovery led to an advance in the understanding and the effective treatment of one of the major causes of sudden cardiac death.
“In 1962 I saw a girl of eight years of age who was suffering from loss of consciousness of unexplained origin. In hospital, she collapsed, pulseless, after she was taken on a run around the ward. Her brother was later affected. Their resting ECGs showed a prolonged QT interval and the attacks were caused by a serious form of ventricular arrhythmia."
"The textbooks proved of no help to me in trying to find an explanation for this and consultations with cardiologist colleagues worldwide initially proved fruitless until Anton Jervell told me about his finding deaf patients with the same condition in Norway. Sir Peter Froggatt's Belfast based research in this area led to a long-lasting friendship between us."
"When we pursued the possibility of a genetic inheritance in our family we found there had been no history of sudden cardiac death on the father’s side but the mother had an abnormal ECG and there was a history of SCD in her family." He subsequently presented a paper on the family at the Royal Academy of Medicine in Ireland and then in 1964 published this in the Journal of the Irish Medical Association.
"Expert opinion on postmortem findings indicated that the condition was due to an abnormality of function rather than an abnormality of structure, and some years later the actual gene defect involved was identified. An editorial in the Lancet described it as a new discovery."
"Around the same time as the Lancet report on the case was published, an Italian cardiologist, Cesare Romano, independently noted the same arrhythmia and also published his findings in the Lancet. Around 1970 the syndrome became associated with both our names and hence the joint eponym. We remained good friends until his death in 2007.”
Later developments, suggesting that the Romano-Ward abnormality may account for 15% of sudden infant deaths now make it necessary to ensure that genetic testing is included in the postmortem examination, Prof Ward says.
"I would see the recognition of this syndrome as delivering an important message for medical students and doctors in terms of assessing patients' symptoms. The message is that they should always listen to what parents say about child patients, and that they should fully investigate the history that parents give them. Parents, you will find, always do try to tell the truth.”
Sudden Infant Death
Prof Ward also played another important role in the area of sudden infant death. “In 1986, I felt the support systems within Our Lady's Hospital, Crumlin, for parents whose baby had been the victim of a sudden death syndrome were inadequate. We carried out a survey of 100 families. This showed that almost half of the families who had experienced such tragedies said that the doctors and hospital chaplains they dealt with had actually aggravated, rather than helped their grieving."
"It was clear that the hospitals needed to change the way they handled such situations. A broadly based back-up system was set up to help support families who had suffered a sudden infant death. The system ensured that such deaths were treated as medical emergencies and nursing, social service and chaplaincy support were co-ordinated."
"The new system ensured that a senior paediatrician would always talk to the parents at the time of the death."
"He would explain, for example, the need for the Guards to be involved and for a post-mortem, then visit the postmortem to get the findings immediately and have them for the family at the time of the removal of the remains from the hospital mortuary. The family came back six weeks later when the detailed laboratory examination had been completed, and if anything further had come to light from the post-mortem this was explained to them. A further appointment was offered later."
As part of the new system, it was agreed that the Guards attending the hospital would be plainclothes officers.
“The system of having a single senior paediatrician involved with the family from the start, providing information and answering questions proved to be of great help to parents in the grieving process. Subsequent research by Dr Maria Powell confirmed the value of the co-ordinated system. Abnormally prolonged grieving was cut by 75%.”
On the retention of organs issue, while Prof Ward accepts that problems did emerge with protocols and consent he believes that organ retention was never more than a philanthropic effort to try to advance research into the specific causes of death and disease and to provide answers for the future, especially with regard to successful cardiac surgery.
Prof Ward was recently in Dublin as guest of honour at a symposium on sudden cardiac death, organised by the Irish Heart Foundation
Born in Monaghan, Conor Ward was the son of a GP and politician who was parliamentary secretary to the Minister for Local Government and Public Health in the 1940s. Starting with an honours degree from UCD in 1947, his ambition initially was to go into general practice with his father. However, his interest in paediatrics was ignited when he went to Alder Hey Hospital in Liverpool for six months paediatric training as part of the preparation for general practice.
Instead he found himself selected for specialist training and stayed on in Liverpool for eight years to complete the training programme. “The National Health Service had just been introduced and there was great enthusiasm for developing hospital services. My mentors were life-long role models. They unselfishly shared their knowledge and experience with their new trainee."
"It was a time when there were fascinating new developments in diagnosing and treating cardiac disease, including angiocardiography, moving on to cine-angiography, and the development of micro methods for blood examination, so important in intensive care. Liverpool was to the fore in these developments."
"The comprehensive training I had in Liverpool would not have been possible without the NHS. I was one of the few specialists at the time who did their entire training in the one academic centre."
"The general expectation was that I would stay in England. Things changed when Our Lady’s Hospital for Sick Children opened in 1956 and I applied instead for an appointment there. Ultimately I was offered the post of assistant paediatrician. This was a challenge. The hospital was to start from scratch. The aim was to provide a high-class tertiary referral centre for paediatrics."
This new children’s hospital had in fact been planned since the early 1930s and had been spearheaded by the Catholic Archbishop of Dublin, John Charles McQuaid.
"When the initial plans were drawn up for the hospital, there was a great deal of serious poverty and an associated high child mortality and morbidity in Dublin. By the time the hospital was eventually built however, the social conditions which had been the background to the hospital development had improved. Antibiotics had come on the scene in the 1940s and 1950s. The deficiency disorders, rickets and scurvy, had become uncommon with improvements in nutrition and diet."
"In the event, when Crumlin opened there was a new emphasis on treating illness rather than on managing the consequences of social deprivation. Paediatrics had rapidly developed into a sophisticated specialty”
One difficulty, Conor Ward says, was that the Sisters of St Vincent de Paul had brought with them an enhanced anxiety about the risks of cross-infection.
"Cross-infection had caused serious epidemics in their hospital in Paris. For this reason visiting hours were initially very limited. The importance of the adverse emotional effects of deprivation of family contact were not at first fully appreciated. The case for daily visiting was finally accepted in 1958. For the same reason the length of hospital stay was cut by accelerating the rate at which investigations were done and bed stay fell from an average of 15 days to five over a period of time." Prof Ward had been trained in paediatrics and paediatric cardiology, and over 30 years helped develop the cardiology service in Crumlin to world-class levels.
It was certainly a very busy time. “In addition to the work in Crumlin, I also did outlying clinics in Cavan, Longford, Meath, Monaghan and Westmeath. I found this work very satisfying. It was often not easy for patients to get in to the county cllinics from where they lived. They often came in by horse and cart or on the back of a tractor. The area was blessed with high standards of general practice and relationships with the local practitioners were warm and supportive. I did the county clinics until I was appointed Professor of Paediatrics in 1973."
New children’s hospital
Prof Ward dismisses the suggestion that the current opposition to the Mater site for the national children’s hospital is merely a manifestation of age-old rivalries between the three children’s hospitals in Dublin. Two of the hospitals had previously come very close to amalgamating, he points out. The extent of these rivalries, he says, was greatly exaggerated and there was always a good deal of agreement among consultants at the three hospitals that the paediatric hospitals should work together.
He points out that the senior retired professors of paediatric surgery from all three hospitals recently co-signed a letter to the Irish Times opposing the choice of the Mater site for tertiary services. He says he regrets that previous plans to amalgamate Crumlin with the then National Children’s Hospital in Harcourt Street in the 1970s never came to pass, largely due to the opposition of the then Catholic Archbishop of Dublin and chair of Crumlin Hospital, Dermot Ryan. "Had the project gone ahead, the present discussion on the location of tertiary services would have been unnecessary."
Prof Ward says there is widespread opposition among the paediatric community to the Mater site and feels the recent stance of the Faculty of Paediatrics in favour of the Mater location did not properly reflect this. He believes that the sole option of having a tertiary paediatric hospital co-located with an adult hospital has been pushed through against expert advice, allowing of no consideration being given to the possibility of developing a free-standing tertiary paediatric referral unit.
"The external advisory group opted for co-location on the Mater site in spite of this not having the specific support of Sir Alan Craft, the sole paediatrician whose advice had been asked."
"In addition, we have very good examples of outstandingly successful free-standing paediatric hospitals elsewhere, such as Alder Hey in Liverpool, now to be rebuilt on site, Great Ormond Street in London and the Glasgow Hospital for Sick Children, which opened as recently as 1971." Prof Ward says he is particularly concerned about access issues with the Mater site. He would reject the view that, despite the opposition, now that the plans have been made, it should be accepted that the Mater project should be allowed go ahead. He feels the plans can be put to good use in another location. He publicly supported the efforts of the late Maurice Neligan to have the Mater location decision reversed.
'Not always a bed of roses’
Conor Ward left behind a considerable healthcare legacy in Ireland. In London, he has kept up a very active involvement in medical and voluntary work, particularly in relation to Down's Syndrome.
However, looking back he reflects: "Crumlin was not always a bed of roses for me, and I think most people who know me will know that.” He believes future historians will pass judgement on the roles of successive Catholic Archbishops of Dublin in the management Our Lady's Hospital, Crumlin and the medical and administrative decisions which led to his ultimate relocation to London. The chairmanship of the hospital's management board still rests with the Catholic Archbishop.
But Prof Ward feels times have now changed and says the current Archbishop Diarmuid Martin has ushered in a new era of open communication.
He was given access to the hospital archives held by the Archdiocese of Dublin. The records suggest that the long-standing "kitchen cabinet" on which Archbishop McQuaid depended for advice appears to have been responsible for some of his errors of judgement, he believes. Prof Ward does not dwell too much on his clashes with Archbishops, but what is known about them demonstrates that, belying his quiet and courteous demeanour, he showed considerable moral courage.
He regards his problems with the archbishops as personal rather than institutional. He describes a face-to face confrontation in a room in St Patrick’s Training College with the formidable John Charles McQuaid, to whom he protested about the treatment of a consultant colleague by Crumlin's Committee of Management, chaired by the Archbishop. This was not an exchange to be undertaken lightly.
Dr McQuaid was not accustomed to being confronted about his authoritarian ways. Following Prof Ward’s protest, having delivered a suitably withering response, His Grace turned on his heel and stormed out of the room.
Another incident involved Dr McQuaid’s later successor, Archbishop Dermot Ryan.
Prof Ward had inquired about the possibility of a mother, whose child had been born with gargoylism, having a genetic test, (amniocentesis) carried out in the UK should she become pregnant again. This test was not available in Ireland at the time on religious grounds.
His inquiries came to the notice of Archbishop Ryan and in consequence Prof Ward's UCD Professorship came under threat. Prof Tom Murphy, then President of UCD, and himself a conservative Catholic, resisted the pressure from the Archbishop's Palace and Prof Ward's post remained secure.
An irony is, perhaps, that despite his brushes with the authoritarianism of the hierarchy, Prof Ward remains a committed Catholic, as does his wife Pauline.
"My firmly-held belief is that religion is a private matter for the individual. As Cardinal Newman said, conscience should prevail.”
On the case of the family coping with the problems of the progressive downhill course of their child with gargoylism, he points out they wished not to be responsible for the inevitable fate of any future similarly affected child. He would, he says, still support their search for an antenatal assurance that another newly-conceived child was not also to endure similar hardships.
"I would be at one with the Thomist perception that ensoulment occurs only when the foetus has reached about the fourth month of development.” He does not see the termination of such a pregnancy at such a time as the taking away of an integrated human life. The same considerations apply to anencephaly, in which the absence of a developed brain results in certain neonatal death. These are both special cases”.
He does not, however, support the termination of pregnancy when Down's Syndrome and similar conditions are diagnosed antenatally. He and his wife at one time contemplated the adoption of an abandoned Down's Syndrome child.
"At a political level I thought the efforts to introduce the Mother and Child scheme in Ireland in the early 1950s were a step in the right direction and the opposition of the Catholic church was misguided.”
Prof Ward was, in the 1960s, secretary of the Catholic doctors' group, the Guild of St Luke, Sts. Cosmas and Damien.
He recalls that the Guild adjourned sine die when members considered Pope Paul VI’s Humanae Vitae encyclical, banning contraception. The group was unable to issue a statement of support for the encyclical. The Guild adjourned and did not arrange to meet to meet again. He says he shared the disappointment of many Catholics with the then Pope’s refusal to allow artificial contraception in some shape or form and also the failure to address concerns that reliance on the “safe period” might, in the light of contemporary research, increase the incidence of congenital malformation.
Prof Ward was a member of the Doctors Against the Amendment group in the divisive abortion referendum of 1983, in which he supported access for Irish women to termination of pregnancy in cases of life-threatening malformation.
Views on our health service
Prof Ward confesses to being ill at ease with the way in which Ireland has moved in recent years. He believes the Irish health system, in particular, has become even more two-tiered than it has been in the past. "There was a time when up to 90% of the child population had public care as there was a way in which the County Medical Officer could request a specialist consultation, so there was little need for private insurance.”
"When Crumlin opened St Peter's ward was a designated private ward. Following discussion the designation was dropped in the expectation that every ward in the hospital would be so well run that private accommodation was unnecessary."
It was his view that parents should not feel the need to go privately in order to get the best care for their children. Prof Ward says that, in post in UCD, he was required to limit his private practice, and compliance was verified annually by an official visit by the Dean of Medicine. Changes in the operation of the health service later made it necessary to re-open a private ward in Our Lady's, but he feels private practice was a by-product rather than the end-product of medicine.
Conor Ward also believes it is better to have the Department of Health as the central agency running the health service, rather than hiving it off to a state agency like the HSE. He remembers in particular the pioneering work of Dr James Deeny the Department's Chief Mecdical Officer at the time that Our Lady's Hospital opened.
He believes cardiology in terms of what it can do for patients has expanded in leaps and bounds in recent decades.
"The specialty has developed rapidly in terms of the range of investigations and treatments made available. It has certainly become very labour intensive in terms of the time it takes to complete the complex investigations which are now possible, and indeed necessary. Cardiac physiology has become recognised as a special entity. Medicine keeps moving ahead, but that often makes it very difficult to operate within a fixed budget."
Prof Ward’s decision to move to London with his wife in 1990 provided him with a new academic forum. At that time, three of Prof Ward’s family were already working in the UK and family backup was assured. There were eight grandchildren in London and their company was a great source of pleasure. Frequent visits to Ireland kept the contact with the Waterford and Dublin families and their five children.
"New medical horizons opened up for me. I have always liked England and I particularly admire the NHS.” I was delighted to be asked to join the St George’s Medical School teaching programme at Kingston Hospital. I did weekly unpaid outpatient teaching clinics there until I was 75 and was doing teaching sessions for undergraduates until I was 85 - only two years ago. The wide-ranging activities of the academic programme were a great source of pleasure."
"I found myself among colleagues who also shared my interest in medical history.”
Prof Ward, who had previously been Medical Adviser to the Irish Down's Syndrome Association, became heavily involved with the Downs Syndrome Association in the UK, and served as Chairman of the Board of Trustees of the Langdon Down Centre in London from 2003 to 2009.
Having always been interested in the doctor who gave his name to Down’s Syndrome, Conor Ward’s decision to live in Teddington in Middlesex proved serendipitous. "I knocked on the door of the house where John Langdon Down had lived. It was very near to us. I was invited in. In the basement I discovered all his clinical notes and his clinical photographs from 1868 on. It was a treasure trove.”
A four-year labour of love ensued resulting in the book John Langdon Down, A Caring Pioneer, which was published by the Royal Society of Medicine and which led to an award from the British Society of Authors. The book has been translated into Japanese.
Prof Ward has also written another two books on Langdon Down to be marketed by the Down's Syndrome Association. The royalties go to the Association. He undertook further historical research on Down's syndrome and he was awarded a PhD in medical history by UCD in the year 2000. "One of the pleasures of living in London is access to the libraries - the Royal Society of Medicine, the British Library and the Wellcome Foundation, for example. They really are fantastic.”
He is a Reader in the chaplaincy of St. Mary's University College in London and on the occasion of the recent Papal visit to the College, he and his wife were among those invited to the special service for Charisma in Education.
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