Kenneth William Donald was an expert on underwater physiology. His work extended from research into the welfare of divers to the care of patients with respiratory and heart disease, with the linking thread of the safe practical use of oxygen. He was born into a military family; his father was a colonel of artillery. He was educated at Emmanuel College, Cambridge, and St Bartholomew’s Hospital, qualifying just before the war. After house appointments he joined the Royal Navy and served from 1939 until 1945. He worked on destroyers and took part in the first Battle of Narvik, but later rarely spoke of these events. The London Gazette records that five British destroyers attacked at dawn in a heavy snowstorm and surprised the enemy. When withdrawing from the fjord they encountered five enemy ships with superior gunpower. Donald was in HMS Hotspur which was hit and lost control and had to be escorted by the others. Later he took part in combined operations raids on the Lofoten islands and liked to recall that by bringing back a large supply of cod liver oil he made a contribution to the health of children in Britain during the war years. He was awarded the DSC in 1940.
In 1942 he was transferred to work on underwater physiology, an event which was to shape much of his subsequent career. Naval divers had only recently begun to use pure oxygen and suffered from oxygen poisoning, the cause and mechanism of which was little understood. In the Admiralty diving unit, which he helped to establish, research was conducted which led to safe diving procedures, using oxygen-nitrogen mixtures under controlled conditions. This allowed the crews of midget submarines and especially divers involved in the clearance of mines in captured ports to carry out their hazardous work. His expertise in underwater physiology and medicine became widely recognized and after leaving the Navy and during the period of the cold war he continued as a naval adviser. This work was covered by official secrets regulations, and at times it was evident to those who worked with him that knowledge gained in this way could be relevant to improving the care of patients with respiratory disease, particularly when they were being treated with oxygen, and he was troubled by the requirement for secrecy. Later his knowledge and experience was valuable for the development of the North Sea oilfields and he chaired the government advisory committee which investigated the health aspects of diving.
After the war he returned to Bart’s as chief assistant to Ronald Christie [Munk’s Roll, Vol.VIII, p.86] and started research on the physiological disturbances of chronic lung disease. From 1948 to 1949 he was a Rockefeller fellow at the Bellvue Hospital, New York, working with the Nobel prize winner Andre Cournand. He collaborated with Richard Riley and helped to develop new concepts concerning ventilation-perfusion relationships and gas diffusion at the alveolo-capillary membrane of the lungs. He also became familiar with the procedures of right heart catheterization which had then been recently developed in Cournand’s unit. On his return, after a short stay at the Brompton Hospital, he was appointed senior lecturer in medicine at the University of Birmingham, Queen Elizabeth Hospital. He was appointed a reader in medicine in 1953.
At Birmingham he turned his attention to the study of pulmonary circulation, gathering a team which included John Bishop, Gordon Cumming, Archie Pincock and Owen Wade. Over the next seven years substantial advances were made in the understanding of circulatory changes at rest and during exercise. This was the time when early operations for closed mitral valvotomy were being performed. What little was known of the physiological changes accompanying the disease and its treatment related to the resting state. Since the major symptoms occurred during exercise it seemed important to make measurements during this stress. Intravascular pressures were recorded, frequent blood samples were taken and the Fick principle applied to calculate cardiac output. For the first time it was possible to make these measurements during the rapidly changing state which occurs at the onset and conclusion of exercise, and to demonstrate how soon a steady state was established. In order to interpret the findings in disease states it was necessary to know how normal subjects behaved under the same conditions. A group of sixteen normal subjects underwent the same procedure, most of them being members of the research team or close associates, Donald himself being the first. The rapid changes and the steady state values at different levels of exercise were defined and have since been widely used as reference values. A striking finding was that in rheumatic heart disease the cardiac output did not increase much with exercise and sometimes not at all, although this could be reversed after successful valvotomy. In compensation a greater proportion of the available oxygen was removed from the blood flowing though the exercising muscles and sometimes the femoral venous blood might contain no oxygen at all. Even more startling was the observation that the oxygen content of blood from other regions - the superior vena cava, renal and hepatic veins - also fell during exercise of the legs. This indicated that blood flow was redistributed away from these regions towards the exercising muscles and detailed studies were made of the time course of these changes and the factors influencing them. For these and other studies Donald was awarded the doctorate of science and thereafter the rather rare conjunction of DSC and DSc was cause for comment and sometimes mystification.
In 1959 Donald was appointed to the chair of medicine at the University of Edinburgh, in succession to Sir Stanley Davidson [Munk’s Roll, Vol.VII, p. 136]. An early achievement was to establish a new department in the Royal Infirmary, jointly funded by the University and the NHS, equipped with laboratories for cardiorespiratory research. Newly appointed consultants were offered sessions within the department as part of Donald’s efforts to promote close cooperation between the University and NHS staff. Major fields of research included studies on physiological changes following myocardial infarction and the controlled use of oxygen in acute and chronic respiratory disease.
The responsibilities of the chair towards the NHS were heavy and he undertook these together with many other commitments. He was dean of the faculty of medicine for three years, during which time major revision of the curriculum took place. He continued to advise the Admiralty on underwater physiology and was chairman of the MRC’s Royal Naval Personel Research Committee. He was appointed physician to the Queen in Scotland, and in 1976 was president of the Association of Physicians of Great Britain and Ireland.
He was approachable and a good chairman. Although some thought that he ran his department with more than a tinge of naval discipline, this was always tempered by his sense of humour. At times he could be outspokenly critical, particularly when hospitality had been generous, and it may be that this contributed to what many would regard as insufficient formal recognition of his outstanding contributions to several fields of medicine.
He retired in 1976 to the Welsh borders where he and his wife Rethê had built a house. He continued to advise on underwater medicine, and he recorded his long experience in this field in a book he published himself in 1992 entitled Oxygen and the diver. He shared his wife’s lifelong enthusiasm for the theatre and he was a keen and skilful fly fisherman.
J M Bishop
[Proc.Roy.Coll.Phycns.Edin., 1995,25,1; The Times, 6 Aug 1994; Brit.med.J., 1994,309,1296]