75th stories: From Greece to Kenya – Henry Foy, the Wellcome Trust’s first scientific employee
To mark the 75th anniversary of the death of Henry Wellcome and the founding of the Wellcome Trust, we are publishing a series of 14 features on people who have been significant in the Trust’s history. In our fifth piece, writer Henry Nicholls looks at Henry Foy, the Trust’s first scientific employee.
On the East coast of Africa, in Kenya’s Kilifi district, are the hospital and research laboratories of the KEMRI-Wellcome Trust Research Programme. Renowned internationally for its work tackling malaria and other infectious diseases, the Programme was established formally in 1989. But its history goes back to Greece, the earliest days of the Wellcome Trust and the Trust’s first scientific employee – Henry Foy.
When the newly formed Wellcome Trust agreed to take on responsibility for a small research laboratory in a Greek hospital in 1937, it marked the start of a long-running support of Henry Foy’s research into malaria and nutritional disorders. Displaced by World War II, Foy and long-term collaborator Athena Kondi eventually settled in Kenya. Their success there – research full of “energy, enterprise and scientific imagination”, as the Trust commended them on their retirement in 1970 – also paved the way for the Trust’s support of similarly small, independent teams around the world with a clearly defined programme of research.
The League of Nations had appointed Foy (1900-1991) to investigate malaria and its control in Greece in 1932. His qualifications for the job are uncertain. He was born in 1900 and went to the University of Oxford at the age of 18, where he studied physiology under Julian Huxley. Upon graduation, he taught biology at Gresham’s School in Holt, Norfolk and at Malvern College, Worcestershire before emigrating to the West Indies to take up a teaching post at the Imperial College of Tropical Agriculture in Trinidad. From here, Foy became involved in a leper colony in Manaus on the Upper Amazon, sparking his interest in tropical medicine.
In spite of his lack of formal medical training, when the League of Nations posted him to Greece in 1932, Foy showed characteristic confidence. He moved construction of the laboratory, which was to be based in Athens, to Thessaloniki, where the incidence of malaria and other conditions was far higher. The upheavals in the region during World War I, the Graeco-Turkish War and the proximity to the malaria-infested Struma Valley guaranteed Foy a steady stream of interesting cases. And with money provided by a wealthy American, Mrs David Simmons, he established a small laboratory in the grounds of Thessaloniki’s Refugee Hospital, an institution that catered for Greeks displaced from Turkey following the breakup of the Ottoman Empire a decade earlier. For the renowned Australian physician Sir Neil Hamilton Fairley, who visited the laboratory during this early period, Foy had a perfect set-up, a judgement that influenced the Wellcome Trust’s decision to support the laboratory.
For Foy, this support was crucial because by 1937, the League of Nations funding was running out. The British Medical Research Council (MRC) was keen to see Foy’s work continue but as a part of the British government it was itself not able to take on responsibility for a laboratory in a foreign country. So members of the MRC’s Tropical Medical Research Committee approached Henry Dale, one of the Wellcome Trust’s first Trustees. Would this nascent charitable foundation be in a position to provide support to Foy?
Following Henry Wellcome’s death less than a year earlier, Dale and the other Trustees had a lot to deal with. For a start, the terms of Wellcome’s will had not drawn an adequate line between his business and philanthropic interests. In addition, it took time to value Wellcome’s significant estate and calculate the considerable death duties that needed to be paid. However, the amount that Foy needed to keep his laboratory running was not significant and the Trustees were able to agree to cover expenses of £2000 a year. The League of Nations Malaria Laboratory was renamed the Wellcome Trust Research Laboratory at Thessaloniki.
Foy followed up this new source of funding with a proposal to expand the laboratory by adding a new wing and an upper floor, which would make room for a small clinic that could admit ten patients for special study. The low cost of materials and labour made this an easy decision: and the Trustees approved Foy’s plans and left him to oversee them. But though Dale had Foy pegged as “a real Quaker Enthusiast!”, he was also aware of Foy’s “unusual and irregular training”; the new clinic would require someone with formal medical qualifications. The answer was Dr Athena Kondi, a Greek national then working at the Refugee Hospital, with whom Foy had already worked on the epidemiology and treatment of malaria and associated blackwater fever in the surrounding region.
From Greece to Kenya
With the outbreak of World War II, Foy and Kondi’s research in Thessalonika became increasingly difficult and, when Germany invaded Greece in April 1941, the scientists fled to Istanbul, taking much of their lab equipment with them. From there, they sailed for Cairo, but found it equally inhospitable. So, boxing up their equipment and leaving it in the care of the British GHQ Middle East, they boarded a ship to take them to South Africa, where they worked out the War for the South African Institute for Medical Research in Johannesburg. The Wellcome Trust, which continued to support them throughout this troubled period, found Foy’s proposals “eminently satisfactory” and he and Kondi made the most of their new location, travelling to Swaziland, Lesotho, Botswana and Mozambique to collect data on the incidence of malaria and blood disorders across the wider southern African region.
With the liberation of Greece in 1944, Foy and Kondi embarked on a 4000-mile road trip from Johannesburg to Cairo in a Ford V8. Picking up a steamer on the Nile, they made their way to the Egyptian capital to collect their laboratory equipment from storage. Once back in Greece, they found that the German occupation and looting had left the laboratory and clinic in Thessaloniki in a state of disrepair, but they were soon back at work.
Then, in 1946, Greece fell into a state of civil war. For Foy, writing in 1950, it was this single reason – “the chaos that was reigning in Northern Greece at the time” – that led him to head back to South Africa in 1948. It seems likely, however, that a dramatic decline in the incidence of malaria and other conditions that interested Foy also had an impact on his research ambitions.
Perhaps most notably, the War had seen the Allies investing heavily in pesticides in the ongoing battle against malaria. While efforts to drain the swampy Struma Valley during World War I had failed miserably, the widespread application of DDT across the region in the early 1940s had been a triumph. “This had been so effective that the prevalence of malaria had been reduced to small proportions – a result most heartily to be acclaimed from every point of view, apart from the exceptional opportunities, previously offered by the locality, for a concentrated study of the different aspects and complications of that disease,” wrote Dale in the Trust’s first ‘Report’, published in 1957.
On their way to South Africa, Foy and Kondi’s ship stopped off in Mombasa on the Kenyan coast and the pair made what they imagined was to be a brief foray inland to Nairobi, to visit the National Hospital (now the Kenyatta National Hospital). But the wealth of interesting cases on its wards – patients with malaria, nutritional anaemias, kwashiorkor, splenomegaly and hepataomegaly – was to keep them there for the rest of their working lives. “Malaria is abundant here,” Foy eagerly wrote back to Dale. Furthermore, he noted, “There is a wide spread sickle-cell trait that varies in degree” – a condition that Foy had observed in Greece just after the War. In short, there was an “abundance of material for all kinds of work” and it was “just the place” to build a new programme of research.
Research in Kenya
The Trustees agreed, and so began the Wellcome Trust’s involvement with biomedical research in Kenya. It was a shrewd move, with a steady flow of research papers. One early research focus was on megaloblastic anaemia, a condition characterised by the failure of red blood cell division. Foy and Kondi found that it could be treated successfully with penicillin, which through its influence on gut bacteria increased the availability of crucial metabolites – notably vitamin B12 – to the patient. “The high incidence of megaloblastic anaemias in many backward countries may be connected with a high carbohydrate low protein diet that produces an intestinal environment inimical to the synthesis and utilization of B12,” they concluded in ‘Transactions of the Royal Society of Tropical Medicine and Hygiene’ in 1954.
With Foy and Kondi’s professional partnership firmly established, the pair became one in the eyes of those they dealt with, referred to quite simply as ‘Foyandkondi’. Their relationship privately is less clear. Foy had been married and was the father of two, though it seems likely he left his wife for Kondi. “We were never quite sure of their relationship,” says his granddaughter Nicola Foy. “But they did live and work together for decades.”
They travelled widely in Africa – to Tanganyika, the Belgian Congo, Sudan, Ethiopia and Somalia – all the while collecting epidemiological data on the incidence of megaoloblastic and other anaemias. Their work in Kenya and Sudan, for example, revealed surprising variation in the incidence of sickle-cell trait between and even within different tribes.
In the Trust’s 1957 ‘Report’, covering the first 20 years of the organisation, Foy’s publication record was paraded in a lengthy appendix. The author of the ‘Report’, most likely Dale, boasted that “the trustees have every reason to be gratified by the importance and the distinction of the results which have accrued from this, the first medical research enterprise to which they agreed to give financial support in any form”. He went on: “This enterprise had an exceptional history in many respects – in the manner of its origin, in the successive interruptions and displacements to which it has been subjected, and in the repeated re-establishment in distant centres and with appropriate realignments of its research objectives.” Foy, he acknowledged, had “faced all these unusual difficulties” with “unfailing courage, determination and resourcefulness”.
For his part, Foy attributed his success to his relaxed approach to management, giving his staff the freedom to carry out their work “on an individualistic basis with close and informal contact between workers in the field and London”. He took pride in the “minimal administration”, with activities “not hindered and handicapped by red tape”.
“Such an organisation,” he wrote, “is in sharp contrast to the vast, impersonal machines that seem to be gaining control in almost every scientific field and whose operation requires armies of clerks, large sums of money and in which the top-heavy administrative machinery results in a rigidity that is frustrating to the field worker and penalises him in favour of the administrator.”
It seems likely that the success of Foy’s operation inspired the Trustees to invest in other small, independent teams with a focus on tropical medicine. For example, Wellcome labs with clearly defined research programmes sprung up in Vellore, India in 1957; in Belém, Brazil in 1964; and in Bangkok, Thailand in 1979.
Foy and Kondi continued to travel, and often farther afield – to India and Mauritius in 1959 and to the Seychelles in 1961 – collecting data all the while. Their survey work in the Seychelles identified the main cause of anaemia as iron deficiency exacerbated by the prevailing hookwork infection. Once back in Africa, the duo began to conduct simple experiments to explore this link in more detail. A colony of some 150 baboons established in Nairobi gave them further experimental opportunities, probing the causes and treatment of nutritional disorders such as kwashiorkor, marasmus and liver diseases. In a ‘Nature’ paper published in 1966, for example, they reported the biochemical and histological effects of depriving baboons of riboflavin and pyridoxine. A deficiency in these B vitamins, they speculated, might contribute to the high incidence of liver disease and cancer on the African continent.
By the 1960s, the Trust’s interests and influence had broadened to such a degree that there were plenty of opportunities for research collaboration within the Wellcome network. In 1961, the Trust announced its decision to establish the Wellcome Laboratory of Tropical Haematology at the Postgraduate School of Medicine in Hammersmith, London under the leadership of the UK’s first professor of haematology, John Vivian Dacie. While some £45 000 was to be spent setting up this lab, £14 000 was put aside to promote co-operation between Dacie’s unit and the Trust-funded labs in Singapore, Vellore and Nairobi, with their overlapping interests in megaloblastic anaemia and sprue, a diarrhoeal condition common in Asia and less so in East Africa.
Throughout his long association with the Trust – for more than half of its 75-year history – Foy showed great dedication to his work. On one occasion in the 1930s, the London School of Tropical Medicine and Hygiene had asked Foy for fresh samples of the Plasmodium falciparum parasite then endemic in Greece. Dutifully, Foy ventured out into “a remote district in search of appropriately infected mosquitoes”, only to be captured by bandits. He could be frequently found in the lab on a Sunday. “Now,” he grumbled to a friend in 1977, “everybody seems to be in the category of 9 to 5 research workers, but of course if you have the washing up, the lawns and the hedges to cut naturally you have to go home in time to get these things done.”
By then, Foy was in his late 70s and although he and Athena Kondi had formally retired in 1970 he was still working away as hard as ever. For he believed in “the skills, experience and integrity of the aged compared with the generation brought up in an atmosphere of over tolerance and in a world peopled by people who don’t know that they don’t know”. Youth, he wrote, “is an improving fault”. This might explain why he continued to turn up for work at the Nairobi lab right up until his death in 1991.
Find out more about activities marking the Wellcome Trust’s 75th anniversary, including links to other features as they are published.
Henry Nicholls is a freelance science writer based in London.