Home of Fred the Snake (and Dr. Peter)

PeterBCottonThe Early Days

Peter Cotton was born in Herefordshire, England, where his father was a country physician. He was educated at Leighton Park Quaker school in Reading, Cambridge University and then at St. Thomas Hospital Medical School in London, and graduated in 1963. After a series of post-graduate training posts around Britain in general medicine and pediatrics, he returned to St Thomas’s in 1967, and was fortunate to come under the influence and guidance of Brian Creamer, an internist with an interest in gastroenterology.

Brian’s research in the “Gut Hut” was focused on small bowel physiology and pathology, especially Celiac disease. Peter was put to work on thin-layer chromatography of small bowel lipids which generated a Thesis MD, but also clearly demonstrated that basic science should not be his career track. There was a gastroscope in the closet, a so-called semi-flexible Schindler era instrument. Brian said that the procedure was uncomfortable and hazardous, and that no one believed what you said you saw. An avid enthusiast for the jejunal biopsy capsule (for Celiac diagnosis) he said “tell me when there is a gastroscope with which you can take tissue samples; that may make it useful”.

In that same year (1968) an article appeared in the British Medical Journal, from Oxford, describing the flexible fiberoptic Olympus (side-viewing) gastroscope with a biopsy capability. An instrument was purchased, and Peter’s career was born. Within 2 years, while still officially a trainee (“senior registrar” in English parlance), he was running a primitive endoscopy service, initially with a chemistry tech as assistant. Soon the first endoscopy nurse (Sue Wright) was appointed and a forward-viewing ACMI instrument was added to allow “panendoscopy”.

Peter’s next stepping stone was also provided by Brian Creamer, who returned from an international meeting in 1970 saying that a Japanese had shown pictures of the pancreatic duct obtained with a duodenoscope. Brain persuaded the British Cancer Campaign to support purchase of the instrument, and to send Peter to Japan to learn how to use it (saying that this procedure would eliminate pancreatic cancer). But, Brian suggested that Peter should visit Iran on the way to Japan, since the British Council had been asked to provide staff for the public hospital in Shiraz. He spent 6 eventful months there in 1971 before studying with Kazuei Ogoshi in Niigata, Japan.

He returned to Britain where he introduced and named “ERCP” (Endoscopic Retrograde CholangioPancreatography). His first paper on ERCP was published in the Lancet in January 1972. Now, 9 years out of Medical School, he was still looking for a “Consultant” (Faculty) position. In those days the number of positions was strictly limited, and advancement often had to wait for someone to die or retire. After unsuccessful interviews at four Hospitals in and out of London, Peter was eventually appointed to the staff of The Middlesex Hospital in 1973, albeit on a part-time basis. It seemed that most of the Consultant staff were based in nearby Harley Street, the focus of London private practice, and only attended ward rounds at The Middlesex twice a week.

Fortunately the Chair of Surgery (Professor Leslie LeQuesne) was supportive, and provided the facilities for Peter to establish a small endoscopy unit, which grew in stature (if not in size) over the next few years, with the help of post-graduates from many countries. The group pioneered and evaluated many diagnostic and therapeutic procedures, held numerous teaching courses, and introduced live CCTV workshops. The late 70s and early 80s were exciting times for endoscopy, with rapid technical development, formation of the British Society for Digestive Endoscopy, and increasing involvement with companies making instruments and accessories. It was also a tough time to be trying to work and expand within the National Health Service framework, with severe financial constraints.

A Second Career in USA

Lack of resources in Britain forced Peter to re-evaluate his career. After taking a 6 month leave of absence from Middlesex in 1986 to consider alternatives, he was recruited by Dr Ian Taylor and appointed as Professor of Medicine and Chief of Endoscopy at Duke University in North Carolina, USA. He developed a state of the art endoscopy center. He maintained his interests in developing and teaching new techniques, and careful outcome evaluation.

In 1994, he moved again, to the Medical University of South Carolina in Charleston to initiate and lead the Digestive Disease Center, dedicated to multi-disciplinary patient care, and the research and education needed to enhance it. Dr Cotton focused his practice, teaching and research on patients with complex pancreatic and biliary problems, and became more involved in quality issues in endoscopy, including objective assessment of performance and benchmarking. He stepped down as Director of the Center in 2007, and stopped seeing patients and doing procedures in May 2011. He continues to work part-time, with NIH research funding.

Another recent focus has been on writing books for children. There are now 5 books about Fred the Snake. Rhyming stories beautifully illustreated by Bonne Lemaire.

Dr Cotton is deeply fortunate to live with his wonderful wife, Marion, in the special community on Dewees Island outside Charleston ( They are blessed with an awesome family, including 8 grandchildren, and two great-grandchildren.

Dr Cotton’s full curriculum vitae is available.

Highlights include:

Dr Cotton has multiple degrees, by examination: MA (Cambridge University Natural Sciences, 1960), MB BChir (Medical Graduation, 1963), DCH (Diploma of Child Health, 1966), MD (Cambridge University by Thesis, 1970), MRCP (Member, Royal College of Physicians of London, 1967), and by election: Fellow of the Royal College of Physicians (1978), Fellow of the Royal College of Physicians and Surgeons of Glasgow (1998), and Fellow of the Royal College of Surgeons, (2002).
He has been active in many National and International organizations, and has given invited lectures and demonstrations in more than 50 countries. He helped form the British Society for Digestive Endoscopy, became its president, and served the British Society of Gastroenterology as its vice president and treasurer. He was secretary of the European Society for Gastrointestinal Endoscopy, and president of the Pancreatic Society of Great Britain. Dr Cotton was awarded the Rudolph Schindler award of the American Society for Gastrointestinal Endoscopy in 2004.
His bibliography includes over 900 publications, with more than 300 original contributions in peer reviewed journals, and 10 books. “Practical Gastrointestinal Endoscopy” (co-authored by Christopher Williams) is the standard teaching text going into its 8th edition since 1980. He also has a book on “Fundamentals of ERCP” with Joseph Leung. Dr Cotton recently published his “endoscopic memoirs”, entitled “The tunnel at the end of the light; my endoscopic journey in six decades” (available at

Medical publications: