Horace Smirk, a major figure in hypertension research, was born in Lancashire and he remained proud of his Lancashire origins to the end of his life. A brilliant undergraduate career launched him into a series of research scholarships and grants, culminating in 1932 in a Beit memorial fellowship which he used for a three-year period of research at University College Hospital, London, under T R Elliott [Munk’s Rollf Vol. V, p.119] and Sir Thomas Lewis [Munk's Roll Vol.IV, p.531]. With colleagues such as McMichael, later Sir John; Pickering, later Sir George [Munk’s Roll Vol.VII, p.464]; Wayne, later Sir Edward, and Harold Himsworth, later Sir Harold, this was a stimulating experience and it showed him what could be done by a combination of clinical and laboratory research. In 1936 he took up the chair of pharmacology in Cairo, in succession to J H Gaddum. This post included care of patients and it was during this period that he became interested in hypertension and the variability of blood pressure.
In 1939 he was appointed to the chair of medicine at the University of Otago, Dunedin, New Zealand, arriving there in 1940 with his wife Aileen two small children (two more were born later), a mass of blood pressure data and samples of many different drugs among which he hoped to find some that would be clinically useful in lowering blood pressure. In spite of a heavy teaching load, wartime shortages and very few staff, he continued his research and developed his multifactorial hypothesis of hypertension, delivering a paper on it to the College in 1946. This hypothesis was that early elevations of blood pressure are physiological rather than pathological, that a raised blood pressure is followed in time by pathological changes in the blood vessels and that these lead, in a vicious circle, to further rises in pressure. At this stage he was convinced that high blood pressure itself is damaging, he was very knowledgeable concerning the behaviour of the blood pressure in different situations and he was actively searching for drugs that would lower high blood pressure.
During a period of sabbatical leave in London in 1949 he became interested in the discovery of the effects of hexamethonium and he brought supplies of the drug with him on his return to Dunedin. Like others, he quickly confirmed the hypotensive effects but, unlike many, he was not put off by the side effects. By a combination of meticulous attention to detail of dosage and advice to patients, and by his enthusiasm and confidence, he made the regimen work and obtained very good results. His use of technicians to record blood pressure throughout the day played a big part in this.
Smirk’s work with the improved ganglion blocker pentolinium was fundamental in overcoming much of the widely held early suspicion of antihypertensive therapy. In a series of papers in the early 1950s he reported that left ventricular failure could be relieved by lowering the blood pressure without the use of digitalis or diuretics, and that severe retinopathy could be made to regress. He became a world authority on antihypertensive treatment and was much in demand as a speaker. In 1957 his book High arterial pressure, Springfield,Ill.,Thomas, was published; according to his wife, in order to write the book he used to set the alarm for 4 am each morning for a year. He was a man of tremendous energy and drive.
Horace Smirk was particularly interested in neurogenic and vascular aspects of hypertension and was keen to find an animal model of hypertension that was neither renal nor endocrine. By 1958 he was successful in developing, by selection and in-breeding, the first strain of genetically hypertensive rats, later to be emulated by others. These rat strains have contributed enormously to our knowledge of hypertension.
He also took a lively interest in arrhythmias. His efforts to discover a new antihypertensive agent did not bear fruit but did turn up an iminazole, amarin, which sensitized the heart of an anaesthetized experimental animal to the effects of adrenalin or electrical stimulation, leading to the ‘R-on-T’ phenomenon and ventricular fibrillation. He went on to show that the ‘R-on-T’ phenomenon occurred also in man and could lead to sudden death. He was ahead of his time in this work.
In 1958 he was knighted. In 1962 the Wellcome Foundation recognized his contributions by granting £120,000 to the University of Otago to build the Wellcome Medical Research Institute with Smirk (now professor of experimental medicine) as its first director. He ended his career with a flourish when - at the age of nearly 70 - he presented five papers at a large symposium in Philadelphia, USA.
Horace Smirk was a tall man, always on the move, shrewd, bold, determined and hugely enthusiastic. He had an infinite capacity for work, a restless and enquiring mind, and a certain panache and style. He was a founder member of the group which subsequently grew into the International Society of Hypertension and he enjoyed his many international contacts. He liked to read the writings of philosophers, Montaigne being his favourite. He had a long and happy marriage and the Smirks were a close knit family. Sadly, cerebrovascular complications set in, an irony of fate in view of his life’s work to prevent vascular problems. During this long period of ill health he was devotedly cared for by his wife, who predeceased him, and by his family.
F O Simpson
[Brit.med.J..1991,303,49-50; The Lancet, 1991,337,1405-6; J.Hypertension,1991,9,887-891; Hypertension, 1991,17:247-250; The Times, 2 Mar 1961; RACP Fellowship Affairs, Sept 1991,10,40]