Obituary: Professor John Malins

John Melville Malins, physician, born Birmingham 28 January 1915, FRCP 1957, MD 1960, Assistant Physician United Birmingham Hospitals 1946-55, Physician 1955-79, Physician Kidderminster General Hospital 1947- 79, Admissions Tutor to Birmingham University Medical School 1957-74, personal chair in Medicine Birmingham University 1971-79, Chairman Medical and Scientific Section British Diabetic Association 1972-75, Councillor Royal College of Physicians 1973-76, Linacre Fellow Royal College of Physicians 1978-85, married 1941 Joanna Middlemore (died 1987; three sons, three daughters; marriage dissolved), 1983 Penelope Hobhouse (nee Chichester-Clark), died Tintinhull Somerset 6 August 1992.

JOHN MALINS was a superb physician whose breadth of humanity and learning were remarkable. He was also an author, gardener and sportsman. During more than 30 years as physician at the General Hospital, Birmingham, he advanced the care of diabetic patients with an unequalled understanding of their needs, published one of the very best clinical accounts of diabetes in his textbook Clinical Diabetes Mellitus (1968) and will be remembered by most of the Birmingham medical students for 17 years as their Admissions Tutor.

He was born in Birmingham in 1915. His father, Wyndham Howard Malins, was a lawyer, and his grandfather Sir Edward Malins an obstetrician. He was educated at Shrewsbury and at Birmingham University, qualifying in medicine in 1939. He played hockey for Worcester (1937-39) and Midland (1947-50). After a brief spell in general practice which influenced his whole approach to medicine he was appointed assistant (later full) physician at the General Hospital, Birmingham, where he practised until his retirement in 1979.

Diabetes as a medical specialty developed only after the discovery of insulin in 1921, and was still primitive when John Malins was appointed physician in 1946. He established probably the largest diabetic clinic in Britain. In his open-plan clinic there was a time when he knew almost every one of his numerous patients and commanded their respect and confidence, often recalling their individual circumstances, and instantly able to locate their homes by the nuances of their speech and accents. His work at the 'pit face', as he described his clinic, enabled him to gain a vast clinical experience of diabetes, so that by the time he published his textbook in 1968 he had examined more than 12,000 newly diagnosed cases.

This huge experience, tempered by his 'chance to enjoy some of the pleasures of general practice which arise from long acquaintance with many of the patients', gave him marvellous clinical insight. His junior staff were inspired by his clinical example, and most of his senior registrars became diabetes specialists (and one a professor of medicine) throughout Britain and Ireland.

Malins was therefore keen to keep 'the flag of clinical diabetes flying' and this philosophy was reflected in his extensive clinical research. He elucidated many of the problems of diabetes, especially those complications affecting kidneys and nerves. Above all, by careful treatment and collaboration with obstetricians, he set new standards of care for pregnant diabetic patients, substantially reducing the fetal mortality which in the 1940s was about 30 per cent and is now just 1-2 per cent.

In 1960, together with his colleague Dr Michael FitzGerald and the College of General Practitioners, he conducted one of the earlier population surveys to discover the prevalence of diabetes in the community: he reached the conclusion, often confirmed since then, that for every known diabetic patient, another previously undiagnosed patient could be discovered.

His academic achievements resulted in the honour of a personal chair in medicine at Birmingham University. John Malins was also amongst those who were instrumental in the formation of the Medical and Scientific Section of the British Diabetic Association (1960) in the teeth of opposition from the great Dr RD Lawrence himself, founder of the association and the pre-eminent physician in the field, and later (1972-75) acted as its chairman.

His appointment as Admissions Tutor to the Birmingham Medical School (1957-74) influenced the selection of medical students over 17 years and gained him substantial respect. Somebody described him as a 'humanely shrewd person accepting ultimate responsibility for maintaining the quality of student entrants to the school', which sums him up admirably. This experience must have paved the way for his subsequent appointment as Linacre Fellow of the Royal College of Physicians (1978-85), which gave him responsibility for maintaining standards of training in the medical specialities throughout Britain.

Gardening and trees were lifelong hobbies and he was for years a member of the International Dendrology Society. At his retirement in 1979, he gave up medical practice at once. Shortly afterwards and until his death he and his second wife Penelope Hobhouse took responsibility for the superb garden owned by the National Trust at Tintinhull House in Somerset. His energy and interest never failed and it is characteristic of the man that he both planted an arboretum and published a book on pruning (The Essential Pruning Companion, 1992).

He married Dr Joanna Middlemore in 1941: they had six children, including two doctors and a nurse. Joanna's protracted illness was a source of much sadness; John Malins staunchly supported her over many years, uncomplainingly and with great courage. His second wife, Penelope Hobhouse, the garden designer and author, led to a happy marriage of interests in gardening and their joint pride in the garden at Tintinhull.

Malins described one of his medical ancestors, Samuel Malins of Liverpool, as a man 'with integrity and good sense, accompanied by gentle modesty' - exactly the qualities which John Malins himself must surely have inherited.

(Photograph omitted)

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