Fred Miller was a skilled paediatrician who made a distinctive and important contribution in describing the manifestations of tuberculosis in childhood and the principles of its treatment and control. He was born, the son of a dentist, in Newbiggin-by-the-Sea, Northumberland, and educated at the King Edward VI Grammar School in Morpeth. Here he performed highly as both a scholar and sportsman, playing junior representative rugby for Northumberland as a schoolboy. He went on to the University of Durham Medical School and as a student first encountered Sir James Spence [Munk's Roll, Vol.V, p.386]. He was bewitched from the outset and would spend every available afternoon in the childrens out-patient clinic. Sir James, the first holder of a chair in child health, was to be one of the principal influences on Fred’s life and one which he was always pleased to acknowledge and celebrate.
After qualification his junior appointments included a post as house surgeon to George Grey Turner, the most illustrious surgeon of his day. He placed great value on a period spent as assistant in general practice at Barton, Humberside. He later held posts at Great Ormond Street and at the Brompton Hospital, where he had intensive exposure to chest manifestations of tuberculosis. During his time in London he met Sheila Franklin, later to become his wife. Fred always spoke warmly of his training in London, but his roots were firmly in the North East. There was never any real doubt he would eventually return to work amongst the people he knew, almost invariably in medicine related to children. With this in mind he took up a post as a maternal and child health officer under Sir John Charles [Munk’s Roll, Vol.VI, p.98], the medical officer of health for Newcastle and later chief medical officer for England and Wales. In the years that followed, Charles, Spence and Miller carried out some important studies of mortality and morbidity in the population of Newcastle, work which was key preparation for some of Fred Miller’s later work and which undoubtedly shaped the thinking of Charles at the inception of the NHS.
During the Second World War he became medical officer to a field ambulance and later saw service in Shetland, North Africa and eventually Italy. At the end of hostilities in Europe he expected to be posted to the Far East but, immediately on disembarkation from his troop-ship in early 1945, he was summoned by Charles, then chief medical officer, and told that Spence needed him in Newcastle and that he would be leaving the Army.
Back in Newcastle he worked closely with Spence on a number of problems related to children’s health. This work and earlier studies drew increasing attention to the importance of infections and the relationship which was emerging between the impact of disease and social deprivation. Out of this grew the idea of the thousand families study. This was originally set up to examine the effect of infection, social circumstances and other factors associated with outcome in the first year of life. The sample upon which the research was based comprised all babies born in Newcastle in May and June 1947. The pioneering study was enormously successful and continued well beyond the neonatal period - it is now in the process of a fifty year follow up. The results of the study have been published in a series of four books which embody the work of a team effort but which bear testimony to Fred Miller’s own powers of organization and literary skill.
When Fred started his medical career in 1934 tuberculosis was a grim threat to children growing up in the North of England and the mere mention of it terrified parents. His working life spanned the years of dramatic success with firstly streptomycin and later other agents which, coupled with changes in nutrition and general health of the population, resulted in tuberculosis becoming a clinical rarity in the UK. Fred’s meticulous studies were captured in what still remains a standard text Tuberculosis in children: evolution, epidemiology, treatment, prevention, Edinburgh, Churchill Livingstone, 1982. The resurgence of tuberculosis in the 1980s highlighted the need for an authoritative updated book and resulted in collaboration with Sir John Crofton and Norman Horne and the publication of Clinical tuberculosis, London, Macmillan, 1992. This book was written with doctors and health workers in the Third World in mind and was produced at low cost and distributed very widely by a variety of organizations. Fred was justifiably proud of the venture and delighted in the plans continuing at the time of his death to extend its distribution to all parts of the globe.
The decline in tuberculosis in Britain was mirrored by his increasing involvement in developing countries where his skills and experience were highly prized. Acting as a consultant for WHO, he was closely concerned with the development of maternal and child services in India where he had many friends, many of whom visited Newcastle and were received with warm hospitality.
Fred was appointed as a consultant at the Royal Victoria Infirmary and Newcastle General Hospital in 1948 at the inception of the NHS and he held this post until his retirement in 1974. In 1987 he was honoured by the British Paediatric Association with the award of their highest honour, the Spence medal. He took a particular pride in this given his long term admiration for Sir James.
Fred was also a strong supporter of the academic department of child health in Newcastle and was disappointed that he was not appointed to the chair in 1954 after the untimely death of Sir James. It went instead to Donald Court [q.v.] and they enjoyed an uneasy partnership over the next twenty years and, although they worked together on the thousand families study, the tension was always apparent to the informed outsider. It wasn’t until after Court’s death in 1994 that he began to talk openly about what his real ambitions had been.
He delighted in a long retirement in which he appeared to relax considerably the slightly austere discipline he imposed on himself in his professional life. He was a widely read man with a love of medical and local history. He relished historical research and for some years after retirement held an honorary lectureship in medical history at the University of Newcastle upon Tyne. Shortly before his death he completed a biography of Henry Armstrong who was Newcastle’s first medical officer of health. He wrote clear simple English which was much admired and he was characteristically precise in thought and speech - the vowels carrying a light Northumbrian intonation and the consonants relics of a conquered stammer.
He was a true bibliophile. He read avidly, collected widely (both antiquarian and new), wrote and, in his later years, bound books. He was also a great letter writer continuing correspondence over many years with old friends and colleagues. His letters would often contain a hidden message, so hidden that the real message was sometimes missed. He held the family to be of central importance in his professional work with children, and so it was in his own life. He took enormous pride in his four children and found profound comfort over more than fifty years in his marriage with Sheila.
A W Craft
[Brit.med.J., 1996,312,1414]