7 January 1924 – 29 September 2017
Margaret Platts was a Reader in Medicine at the Sheffield University Medical School and Consultant Renal Physician at Sheffield Teaching Hospitals.
Margaret was the first to publish in a European journal the association of high aluminium content in the water for haemodialysis and the increased incidence of fractures and encephalopathy, a serious complication in patients on chronic haemodialysis for end-stage renal failure (BMJ 1977 2(6088):657-660). She concluded that all patients undergoing chronic dialysis in areas where water contains high aluminium concentrations should be supplied with deionisers. This seminal and significant observation influenced the future management of patients on dialysis throughout the United Kingdom and abroad.
Margaret was born in Sheffield and at the age of 11 won a scholarship to Sheffield High School for Girls. During the War the school was evacuated to Cliff College in Calver, Derbyshire. As Sheffield was heavily bombed the young Margaret would have seen the glow of the fires, fearful for her family’s safety.
Her interest in science at school led her to enter Sheffield Medical School in 1942 where she may have been the only female medical student doing an intercalated BSc in Physiology. After qualifying in 1948 and house appointments in Sheffield she joined the Department of Medicine under Sir Charles Stuart-Harris, the Professor of Medicine, as a lecturer.
Initially her research work and publications where related to aspects of acid/base and blood gas metabolism in pulmonary and cardiac disease. Her MD thesis was entitled ‘The significance of the composition of the arterial blood in pulmonary heart failure’.
Margaret was appointed as a Senior Lecturer and Consultant General and Respiratory Physician in Sheffield. However her professional life was to take a very different course. In the mid-1960’s the NHS undertook to fund chronic haemodialysis for end-stage renal failure in Departments of Medicine. Sir Charles recommended Margaret to start this program given her interest in metabolic aspects of disease. Indeed she had published previously papers related to kidney function in the BMJ 1952, Clin. Sc. 1964, 1966, J.Appl. Phsiol. 1956 and the J. of Physiol. 1959. So it was understandable why Sir Charles turned to Margaret for this undertaking.
A period spent at the Hammersmith Hospital in London taught her the techniques then available to establish a haemodialysis programme. This included the insertion arterio-venous silicone ‘shunts’ in the wrist (a-v fistulae where yet to be developed), the way to declot them, which was a common problem, and to set up the machine for dialysis; this was a major undertaking. Returning to Sheffield she established the chronic dialysis program which served a population of 2 million.
Margaret never married and devoted the rest of her professional life to running almost single handed the acute and chronic haemodialysis/peritoneal dialysis programme and the management of patients with renal disease until she retired in 1984. At one time there were over 150 patients on home dialysis (necessitated by the absence of hospital facilities and the huge geographical area served) as well as over 50 patients on hospital-based dialysis in Sheffield; at that time one of the largest dialysis programs in the United Kingdom. In 1968 she was involved with the management of the first kidney transplant in Sheffield carried out by Mr John Williams, Consultant Urologist.
A major problem for patients on long-term chronic dialysis is metabolic bone disease due to abnormal calcium and phosphate metabolism associated with Vitamin D deficiency and secondary hypoparathyroidism, termed renal osteodystrophy. However Margaret made the unique and significant observation that in some of her patients there was a different pattern of bone fracturing and in some associated with encephalopathy. The study of 202 patients described in British Med. J in 1977 demonstrated that water supplied to the dialysis machines of these patients contained significantly less calcium and fluorine and more aluminium and manganese than that supplied to patients without these major complications. The high aluminium concentrations in the bone of patients with encephalopathy were confirmed. The paper concluded that ‘Patents who undergo dialysis in areas where water contains high aluminium concentrations should be supplied with deionisers’. As the water supply is often changed coming from different sources deionisers were soon indicated for all patients on dialysis. This paper by Margaret and her co-authors G C Goode and J H Hislop had a major impact on the understanding of this not uncommon serious clinical complication of chronic haemodialysis and the method of preventing it which was soon incorporated in all dialysis units in the United Kingdom.
In the Lancet Letters section April 3 1976 Margaret and her colleague Dr Peter Moorhead published a letter entitled ‘The Sheffield Protest’ in which they pointed out that they provided acute nephrological services for patients coming from seven different health authorities with a population of 2 million in four separate hospitals with only half the facilities provided for London units. Acute services where not funded like chronic dialysis from central funding and so were ignored. Despite numerous meetings and plans to develop a single site for renal services and appropriate funding nothing was achieved. The author’s conclusion was:
‘Thus, it seems that there is no-one at any level in the N.H.S. administration who has the authority to tackle a problem whose nature is fundamentally administrative, whose solution is obvious, and which will at best result in the continued and increasing waste of resources, and at worst in tragedy for some of our patients’.
Writing this entry for Munk’s Roll in 2018, 31 years later, one might say ‘plus ça change, plus c’est la même chose’
With the parents of one her patients, Margaret started the Sheffield Area Kidney Association which has raised tens of thousands of pounds over the years to both support patient needs and research by the Sheffield Kidney Institute.
After retiring in 1984 Margaret undertook a 6 year course at Sheffield University in French literature in which she had an abiding interest. Part of her thesis was published in the BMJ (Med Humanit 2001 27(2):82-88) ‘Some medical syndromes encountered in nineteenth-century French literature’. Margaret also set up the ‘Cercle Francaise’ with The University of The Third Age which met regularly until her death at her home in Sheffield.
She was a remarkable person and self-effacing considering her significant achievements. However she had a sharp and dry sense of humour well illustrated by a student friend recalling her renaming Rimsky Korsakov as ‘Rips His Corset Off’’. An excellent clinician Margaret was loyal and supportive to her colleagues, and much loved and respected by her patients.
C B. Brown