Ian McDonald changed the study of multiple sclerosis from a system based on exploratory but disjointed approaches into a highly productive discipline grounded in first class clinical science. The contributions to experimental neurology were creative and sustained over a period of nearly 50 years. McDonald was an ambassador for all that is valued most in British neurology.
Renowned as a lecturer and sought after as a clinician, he taught a generation of students at the National Hospital for Neurology and Neurosurgery ("Queen Square") in London. His methods were loyalty and a commitment to the institution; meticulous preparation and attention to detail in his writings and lectures, with the ability to synthesise a complex story; a humble perspective on his own achievements set in the context of illustrious predecessors; and easy performance concealing much personal modesty. McDonald was the quintessential "safe pair of hands" on any professional, academic or social occasion, and he revelled in them all.
For a young New Zealander arriving in the UK in 1963, the National Hospital was an inspiring yet intimidating place to work. Yet, this was a pivotal period in the evolution of an institution that needed to move on from 100 years of descriptive neurology.
McDonald was one of very few neurologists active in experimental work. His contributions were crucial and understood, at least by the more forward-looking of his senior colleagues and contemporaries. In the 1960s, with Professor Tom Sears, McDonald characterised the physiology and morphology of demyelination and remyelination in the central nervous system. These physiological experiments rarely lasted less than 18 hours and McDonald would watch the dawn breaking as he drove home, before returning to the hospital for a clinic starting at 9am.
In the 1970s, with Dr Martin Halliday, he pioneered laboratory methods for supplementing the clinical diagnosis of multiple sclerosis. At first, this work on evoked potentials met with scepticism, even from close colleagues. But the observations brought objectivity to the diagnostic process in multiple sclerosis, and the techniques survive as the definitive markers of what happens physiologically when the myelin sheath is lost from nerve fibres in the brain and spinal cord.
In the 1980s, McDonald realised that magnetic resonance imaging and spectroscopy could be used to illuminate the nature of inflammatory brain disease. Professor Alan Davison had suggested that, as a senior investigator who had never held a grant from the Multiple Sclerosis Society, Ian McDonald would be the ideal person to develop a research unit funded by the society. Resources were quickly mobilised by John Walford, general secretary of the society. The chairman, Dr Reginald Kelly, was worried that the unit would not be dedicated to multiple sclerosis research, and felt vindicated when the first paper was a letter to The Lancet on stroke. But the programme was nurtured through its infancy to a state of lasting success.
Each of these achievements was substantial: together, the work on multiple sclerosis represents a major and lasting contribution to neurological medicine.
Ian McDonald trained in clinical and experimental neurology at the University of New Zealand, where he was taught, at Otago, by Professor Archie Macintyre and Dr Keith McLeod. In London, he became close to Sir Charles Symonds, then in retirement, saw something of Sir Francis Walshe, and was influenced, amongst others, by Dr Denis Brinton, Dr Macdonald Critchley and Dr M.J. (Sean) McArdle. At that time, the brightest neurologists training at Queen Square went to Dr Derek Denny Brown, another New Zealander who had worked in England from 1925, initially with Sir Charles Sherrington, before moving to Boston in 1939. McDonald was enraptured by the experience; and the admiration was mutual.
Already appointed as consultant neurologist to the National Hospital, Queen Square, in 1966, and to Moorfields Eye Hospital on his return from Boston in 1969, McDonald held a personal professorship at London University from 1974 to 1995. He understood better than others the contributions of his close friend Professor Roger Gilliatt, foundation professor of neurology at London University and chairman of the department at Queen Square from 1962. Many expected the established professorship of neurology at the Institute of Neurology to transfer "down the corridor" to McDonald on Gilliatt's retirement in 1987, but not until 1995 - and after the deaths of Gilliatt's two immediate successors, Professors David Marsden and Anita Harding - was McDonald appointed, and then for only a short period before his own retirement.
Although the interests of the institute may have been well served by this sequence, the perceived delay in recognising his suitability as chairman hurt, for a while; and whereas his friends were also surprised at the lack of public recognition for his contributions in the form of a civil honour, and other indicators of professional achievement in the sciences, these omissions soon became matters of lofty indifference to McDonald, who well understood the hits and misses of accolades in professional life.
For he had been striding an international stage for several decades and needed no reassurance that his work matched the high standards of those who had shaped his own professional development. At heart he was a romantic, steeped in history, who absorbed the legacies of those that came before, sought to carry the banner for a while himself, and hoped that the attitudes and style he espoused would survive in the activities of the school he created.
McDonald received recognition from many neurological societies and organisations; and he delivered many named lectures throughout the world. He edited Brain from 1991 to 1997, having earlier brokered the financially successful move of that journal, established in 1879, from Macmillan to Oxford University Press, achieving substantial financial security in the process, and thereby allowing the Guarantors subsequently to distribute significant resources annually in support of education for young people working in the neurosciences.
In retirement, McDonald served as Harveian Librarian at the Royal College of Physicians of London. In this he was happy, and resolute in the determination to see off proposals to part with the valuable Wilton Psalter, part of the original bequest that formed the Dorchester Library at the college. For McDonald had a deep appreciation of the aesthetic quality of "things"; and the opportunity to curate an important collection of books, portraits and medical ephemera brought much pleasure.
Throughout his life, Ian McDonald set aside time to engage with the arts, and his wide circle of friends included many individuals professionally active in music, dance, the visual arts, literature and history. These friendships outside medicine cultivated by McDonald and his partner, Stanley Hamilton, were important. Several revolved around the Garrick, membership of which he cherished. They provided a reference point for his professional work and a rich source of information and anecdote that he used in conversation, and to decorate his own writings and lectures.
A man of striking physical appearance, who always cut a dashing figure, McDonald attracted people because his conversation was interesting: he was assiduous in sending handwritten notes expressing gratitude or appreciation, often attaching items that he considered wry or amusing, culled from the many sources he accessed on a regular basis, and which revealed his affection - occasionally waspish - for the foibles and witticisms of social intercourse in public and private life; and he did not forget the more frail and retiring of those friends with whom he had engaged in medicine and the arts down the years.
He was particularly pleased to be elected Foreign Member of the Venetian Institute of Science, Arts and Letters; and the connection with Venice was evident in the enthusiastic review he wrote of the most recent case of Commissario Brunetti (Through a Glass Darkly) by a thriller writer he much admired, Donna Leon, in the Times Literary Supplement.
But his greatest passion was music. Taught piano by Ernest Empson in New Zealand and by Gigi Wild in London, McDonald considered himself to be "of average competence, being a useful accompanist in lieder and chamber music from the baroque classical and easier romantic repertories". Others would go further: "as a member of a trio he was exceptional: certain in rhythm, intensely musical in his ability to see a long phrase within a theme, and with the fingers led by the ear". Therefore, it was poignant that a small stroke in 2004 removed, for a while, his ability to understand music, read a score and play the piano. Recently, he published, in Brain, a characteristically erudite account of this intensely personal episode.
Ian McDonald's lasting contribution is to have illuminated the clinical science of multiple sclerosis. For nearly half a century, people with that difficult disease had no better a professional friend.
Alastair Compston
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