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Thomas Bothwell (1926–2016)


Thomas Hamilton Bothwell, Emeritus Professor of Medicine and an Honorary Professorial Research Fellow at the University of the Witwatersrand, died in Bergvliet.

An internationally acclaimed scientist, outstanding clinician, natural leader and inspiring teacher, Professor Bothwell was the Head of Wits’ Department of Internal Medicine from 1967 to 1991. At the same time he was Chief Physician at the Johannesburg Hospital (now Charlotte Maxeke). He was Dean of the University’s Medical Faculty from 1992 to 1993 and a member of Wits’ Council.

“His contribution to iron biology was prodigious and far-reaching,” said Wits Professor Emeritus Patrick MacPhail, who studied under and worked with Bothwell and considered him a mentor and friend. “It was probably the insight that he brought to the movement of iron through the body, and the effects of substances in the diet on iron absorption, that are his greatest legacy.”

But in addition to his achievements as a scientist, “he was the doctor we all aspired to be. He had a remarkable bedside manner and, although he appeared to be aloof, he was a compassionate and empathetic man. All who worked with him will remember the mixture of encouragement and advice, spiced with wit and not a little sarcasm. We soon found that the sarcasm was greater the more he liked, and respected, his victim. He often addressed his junior staff, ironically, as ‘Maestro’ and tempered their enthusiasm with ‘down, boy’ – no doubt a reference to his beloved dogs. But it was the way he spoke to his patients that impressed us most. Never the overbearing professor, he would draw up a chair so as to be on the same level as his patient and quietly explain what was going on.”

MacPhail said: “Much of our understanding of how food interacts with iron and the basic principles of iron fortification follow from his work. The foundation of our understanding of iron overload and the havoc that it causes belong to him. Even the basic methods of measuring iron in tissues and organs are his. All this is documented in over 300 publications written in his inimitable style. There are no better examples of clear, concise and unambiguous scientific writing.”

Bothwell attended St John’s College and obtained his Wits MBBCh degree in 1948. He received the Bronze Medal of the Southern Transvaal Branch of the Medical Association of South Africa for the most distinguished medical graduate of the year, as well as the Medical Graduates Association Prize for the best final-year student in Medicine.

Professor Bothwell’s first interest was cardiology, but it was the havoc wrought by iron overload on the heart that that started his journey, while still an intern, into iron biology and haematology.  He pioneered the use of radioactivity as a tool to investigate iron metabolism and was among the first in the world to describe radioiron kinetics in haemochromatosis and in normal iron metabolism.

From 1954 to 1957, he furthered his research career abroad at Oxford, as a Nuffield Fellow, and at the University of Washington. In this period he made contacts which became long-lasting research partnerships. One such collaboration was with another great iron pioneer – Clem Finch, in Seattle. Their seminal contribution to iron metabolism was the demonstration that iron absorption is related inversely to the size of iron stores and directly to the rate of erythropoiesis (the production of red blood cells). How this is managed was a mystery that eluded them for the next 50 years. The recent discovery of the iron-regulating hormone, hepcidin, at last provided an explanation. Indeed an example of seeing further “by standing on the shoulders of giants”.  Bothwell and Finch together with Bob Charlton and Jim Cook produced a comprehensive textbook, Iron Metabolism in Man, which remains essential reading for anyone wanting to make their mark in this field.

Bothwell himself highlighted his major contributions as being the demonstration of certain consequences of iron deficiency, such as disturbances of muscle metabolism, brain function, immunity and temperature regulation, as well as investigating the factors affecting the absorption of dietary iron. His work in this latter field brought him international recoginition with appointment to the WHO Expert Committee on Nutritional Anaemia and to the International Nutritional Anaemia Consultative Group. Perhaps his greatest insight was the realisation that it is the mix of promotors and inhibitors of iron absorption in the diet that determines the iron nutritional status of different populations. To this list must be added Bothwell’s contribution to our understanding of iron overload, both haemochromatosis and African dietary siderosis; how they differ and how iron overload disrupts organ function, ascorbic acid (vitamin C) metabolism and bone formation.

He wrote two books, hundreds of articles and many chapters and reviews on these subjects. His outstanding contribution to science earned him an honorary doctorate in medicine from Wits in 1994 and many other honours and awards, including a Gold Award from the SA Medical Research Council, the South Africa Medal (Gold) from the South African Association for the Advancement of Science, the Science-For-Society Gold Medal from the Academy of Science of South Africa and the Royal Society of South Africa’s John FW Herschel Medal. He was made the first honorary member of the International BioIron Society for “pioneering contributions to iron research” and received the South African Order of Meritorious Service (Silver).

His PV Tobias Award for Excellence in Clinical Teaching speaks to his ability to pass on his learning. In training thousands of doctors over the years, he led by example.

“Despite his prodigious academic output and his participation in many University and international committees, I never saw Tom take work home,” said Prof MacPhail. “I asked him about this and his reply has become one of our family sayings. He simply said: ‘Home is for dogs’. He taught me that you can have a highly successful career without ruining your family life.”

Bothwell was also an activist for social justice. He was instrumental in leading the integration of the Rahima Moosa and Helen Joseph Hospitals (as they are now named).  He also took a personal interest in and advocated for interns, ensuring their placement in the health system.

He was a proud Witsie, a generous Wits donor and an active alumnus participating in many Health Graduates Association reunions.

Loved and respected by a wide circle of friends and colleagues, he is survived by his wife Alix, three children and four grandchildren.