Sir John McMichael’s life was an inspiration to a whole generation of medical teachers and research workers. He was the greatest clinical scientist of his generation. Like so many Scots who have made their way in the world, his origins were relatively humble. He was born in Gatehouse-of-Fleet, in that beautiful southwestern region of Scotland which numbers among its sons the poet Robert Burns and Alexander Fleming. His father was, to use his son’s own words, ‘a gentle God-fearing man of the kindest nature’, who was a penurious butcher and small-time farmer. His parents were committed to the moral precepts of the Church of Scotland and this had a strong influence upon his early life.
His first teacher at Girthon School was William Learmonth, father of Sir James Learmonth, the distinguished Edinburgh surgeon. It was he who recognized McMichael’s intellectual qualities at an early age and convinced his parents that he should go on to Kirkcudbright Academy - where he was dux in 1921 - then, with a scholarship, to Edinburgh University, to become Ettles Scholar in 1927, the year of his graduation in medicine. After a period of house officer posts, he was appointed as first assistant to Stanley Davidson, later Sir Stanley, [Munk's Roll, Vol.VII, p.136] who held the regius chair of medicine m the University of Aberdeen. As McMichael recalled in later years, the first assistant had to write the professor’s inaugural address, which was accomplished by culling the best sentences from similar lectures published in the medical journals and stringing them together.
McMichael came to London in 1932 as Beit Memorial Fellow to work in T R Elliott’s department at University College Hospital [Munk's Roll Vol.V, p.119]. There he met the leading clinical research worker of that era, Sir Thomas Lewis [Munk's Roll, Vol.IV, p.531]. He was helped by a fellow Scot, John W McNee, later Sir John [Munks Roll, Vol.VIII, p.317], who made his remarkable collection of spleens available to him, and McMichael wrote his MD thesis on liver and spleen fibrosis. This won him a gold medal from his Scottish alma mater, to which he returned in 1934. He moved now to the physiology of the heart, a lifelong interest, as a lecturer in human physiology under Ivan de Burgh Daly [Munk's Roll, Vol.VI, p.135], who had succeeded the legendary Sir Edward Sharpey-Schafer as professor of physiology. In 1937 McMichael was awarded the Johnston and Lawrence research fellowship by the Royal Society and this led to his appointment as an extra assistant physician to W T Ritchie, then head of the department of medicine at the Edinburgh Royal Infirmary. Whilst in Edinburgh, and with the aid of a grant from the Medical Research Council, he set about the task of measuring cardiac output in man, using the tedious acetylene method which was the best technique available at that time.
In 1938, Francis Fraser, later Sir Francis [Munks Roll, Vol.V, p.141], a remarkable talent scout who was the first director of the department of medicine at the newly established British Postgraduate Medical School at Hammersmith, had the foresight to appoint him to succeed Robert Aitken as his reader. With the outbreak of war a year later, Fraser left to direct the EMS in London so that McMichael became effectively director of the department. There were to be major contributions to clinical research at Hammersmith during those war years. Crush injuries and the sequelae in air raid casualties were described by E G L Bywaters and his co-workers. McMichael worked with his close colleague, Peter Sharpey-Schafer, grandson of the formidable Edinburgh physiologist who had been McMichael’s teacher, and together they introduced cardiac catheterization in Britain for the study of the circulation and the effects of blood loss directly in man. Using the Fick principle, they were able to obtain accurate measurements of cardiac output, a great advance on the old acetylene method that McMichael had used in Edinburgh. McMichael did not abandon his early interest in liver disease. He used percutaneous liver biopsy, for the first time in Britain, for investigating jaundice in military personnel. In this work he was to be assisted by a new recruit from James Learmonth’s department in Edinburgh, Sheila Sherlock, later Professor Dame Sheila, who thus took her first steps towards a remarkable international career in hepatology.
The introduction of these invasive methods of clinical investigation, soon to become routine procedures, required great courage on McMichael’s part, for they were not welcomed with enthusiasm at that time in the traditional teaching hospitals throughout the country. There was much criticism of experimentation in man as encouraged by McMichael at Hammersmith, and Sir Thomas Lewis himself expressed reservations on the introduction of cardiac catheterization. In those days that preceded the introduction of ethical committees, it was the clinical investigator who made his own ethical judgements and McMichael was not to be deterred.
In 1946 Sir Francis Fraser became director of the British Postgraduate Medical Federation, a new organization within the University of London whose foundation had been recommended by the Goodenough Report on Medical Education and which sought to bring all the postgraduate institutes in London under the university umbrella. That same year, McMichael succeeded Fraser as professor of medicine at Hammersmith.
By now, within little more than a decade of the foundation of the School, his department had achieved an international reputation for its outstanding if controversial research, for its encouragement of dissident views in a world of medical conformity and for the challenging nature of its postgraduate teaching. In those postwar years every aspiring clinical research worker from throughout the Commonwealth and beyond came to Hammersmith, where McMichael built up a department of medicine whose staff were for the most part fulltime university employees who were all committed to research. It was the only department of medicine in this country to emulate the Flexnerian pattern which had proved so successful in the United States. McMichael himself, with Sharpey-Schafer, concentrated on mechanisms of heart failure and the mode of action of digitalis. He effectively revolutionized contemporary views of heart failure, contrasting failure associated with a low cardiac output on the one hand and that with a high output on the other, as might occur in conditions such as Paget’s disease of bone. He brought this work together in his book The Pharmacology of the failing human heart, Oxford, Blackwells, 1951. In later years he specialized in the treatment of hypertension, using the newly developed anti-hypertensive agents, and handed over his physiological studies to J P Shillingford. Clinical cardiology was to be developed by a further recruit, J F Goodwin, in close association with R E Steiner of the department of radiology.
McMichael’s most important achievement, however, was to create a clinical research environment unique in Britain at that time, of free discussion and debate in which all, whatever position they held, might join. But it was a freedom that was never allowed to degenerate into licence. Those who attended the outspoken staff rounds and clinico-pathological conferences that he chaired with such genial authority on Wednesday mornings will recall particularly his encouragement of the young. The future Dame Sheila Sherlock was given beds and her own unit at the age of 28; and when McMichael was president of the Association of Physicians of Great Britain and Ireland m 1965, he made the memorable comment that ‘ ... we must have the young upon our shoulders, not trample them under our feet.’ His influence lived on in the work of those many physicians and clinical investigators who were so greatly inspired by him and who went on to academic leadership not just m this country, but throughout the Commonwealth and the wider world.
There are those who have argued that the Postgraduate Medical School itself was John McMichael’s life and his creation. He himself would not have been so immodest as to make that claim, nor would such an assessment do justice to his many contributions to medicine outside the portals of Hammersmith. He always paid generous tribute to his predecessor, Sir Francis Fraser, and to the many distinguished colleagues who were his contemporaries at the School. Several - Sir John Dacie, M D Milner, William Hayes - became, like himself, fellows of the Royal Society. Yet it was McMichael who most contributed to the success of what became, in 1967, the Royal Postgraduate Medical School.
He had a very high regard for Sir Henry Dale, Nobel Laureate and president of the Royal Society [Munk’s Roll, Vol.VI, p.130], who supported him during the catheterization controversy. Within his own department he was a fearless leader, with an instinct for recognizing outstanding talent. He was never afraid of the unconventional in medicine and at an early stage took the unfashionable view that anticoagulants should not necessarily be used in the treatment of acute coronary occlusion. A dissident to the end, McMichael did not share the conviction that blood cholesterol was important in the pathogenesis of ischaemic heart disease, then widely held by the cognoscenti on both sides of the Atlantic.
He retired from the Postgraduate Medical School in 1966, by which time he had become a towering figure not only in the School but also as one of the most influential individuals in international cardiology and medicine. He received many honours and distinctions, and was elected a foreign member of many associations and academies in other countries. In particular, he was a foreign associate of the National Academy of Sciences of the USA. He was Harveian Orator in 1975, examining the relationship between Sir James Mackenzie [Munk's Roll, Vol. IV, p.533] and Sir Thomas Lewis, and in 1970 he was president of the World Congress of Cardiology when it was held in London. He was awarded the Moxon medal in 1970, the Gairdner award (Toronto) the same year, the Wihuri prize (Finland) in 1968 and the Krug award for excellence in 1980.
At the time of his retirement The Lancet saw fit to publish a leading article entitled ‘McMichael of Hammersmith’. Like Francis Fraser before him, he left Hammersmith to become director of the Postgraduate Medical Federation. During those later years he did so much more. He was an influential Wellcome Trustee from 1960-1977, in succession to Sir Henry Dale, and he ensured that clinical research would be effectively supported. It was McMichael who initiated the foundation by the Wellcome Trust of their clinical research fellowships which provided new and challenging opportunities for aspiring clinical research workers during a whole generation.
He could be ruthless when necessary but he always retained a Churchillian magnanimity in his dealings with his colleagues. He did not encourage familiarity. He revealed little of his inner thoughts and emotions to his associates, yet his toughness was tempered with compassion and he always felt that his department and the medical school that he served with such devotion was an extended family. His support for those who had worked with him was legendary. He had great determination, a characteristic that extended to his home life. When faced with an inordinate growth of weeds in a corner of his garden in Richmond, he did not resort to either spade or weedkiller but purchased for himself a flamethrower.
John McMichael remained a Scot throughout his life, always faithful to his Scottish origins and upbringing. It was at Gatehouse-of-Fleet that he suffered the stroke that left him hemiplegic, dysphasic and dyslexic, during his last years. He faced with courage and fortitude the afflictions of those years and in all his vicissitudes he retained that twinkle of the eye that was one of his most endearing characteristics.
He married Joan McPherson in 1932 (marriage dissolved) by whom he had two sons, one of whom, Hugh, is a Fellow of the College; he then married Sybil Blake in 1942 (who died in 1965) and had two more sons, one of whom, Andrew, is both a Fellow of the College and of the Royal Society. In 1965, he married Sheila Howarth FRCP, widow of his old friend and colleague, Peter Sharpey-Schafer.
Sir Christopher Booth
[Brit.med.J.1993,306,713; The Lancet, 1993,341,686; The Times, 25 Mar 1993;The Independent, 13 Mar 1993; The Guardian, 11 Mar 1993; The Daily Telegraph, 5 Mar 1993; The Scotsman 10 Mar 1993;Proc.Roy.Coll.Phycns.Edin., v.23,no.3(July 1993); Clin.Cardiol, 16,453-455(1993); The Wellcome Trust, Twenty-first Report, Sept 1992,pp.14-15 The Times, 31 Dec 1991; Postgrad.med.J.,1968,v.44,pp.6-8; Heart, Mar 1965,p.13; The Lancet, 29 Oct 1960, The Scotsman, 7 Jan 1952; Daily Record, 7 Jan l952; Christchurch Press NZ, 12 Sept 1953]