JOHN McMICHAEL's pioneering research into the cause of heart failure formed the basis of British success in the treatment of cardiac disease. McMichael's vision, achieved at Hammersmith by the development of the Royal Post Graduate Medical School, was of a profession increasingly led by scientifically trained medical academics cascading their knowledge throughout clinical practice in the UK and abroad.
An Edinburgh medical graduate with a brilliant academic record, McMichael made his name in London. In 1939, then aged 35, he was offered the post of Reader in Medicine at the Postgraduate Medical School at Hammersmith Hospital by the Foundation Professor, Francis Fraser. The medical school was only four years old at the time, but Fraser had already made two critical decisions: that it should be an academic hospital, unlike any other in Britain, and that it should stake its reputation on research and not become the medical crammer that many critics expected.
The war broke out shortly afterwards and Fraser left to organise the emergency bed service, leaving McMichael in charge of the Department of Medicine. For the next 27 years McMichael was at Hammersmith, although he only formally became chairman of the department in 1946.
The pattern that Fraser had set, and McMichael carried through, of a hospital staffed at consultant level almost entirely by medical academics, with the chairman as Chief of Service, was regarded with outrage by many in the London medical establishment. To a Scot it was less unusual because Scottish academic medicine was organised along German lines, with the chairman in nominal charge of all the beds.
However, if all McMichael had done was to create a little Edinburgh in west London, we should not now mourn him so deeply. Where he departed from the German tradition was his policy of recruiting and rapidly promoting young academic physicians of promise. That policy was remarkably successful over a wide range of disciplines. In 1968, Sir Harold Hinsworth, the Secretary of the Medical Research Council, speaking at the opening of a new laboratory block, said of Hammersmith: 'Within the last quarter-century a miracle has happened here. Twenty-three years ago you had here a Poor Law Hospital. Today you have a centre of medical knowledge which is in the foremost rank of such institutions anywhere in the world.' McMichael was the driving force of that achievement.
McMichael's own research interests were in the heart and lung and his most important work was undoubtedly the study of the haemodynamic changes in heart failure carried out with Peter Sharpey-Shafer using the newly discovered technique of cardiac catheterisation. At the time there was much head-shaking about the ethics of introducing tubes into patients' hearts to measure pressures and blood flow for the purpose of research, yet within a few years it had become a standard diagnostic technique practised by cardiologists throughout the world.
In 1966 he left Hammersmith to become Director of the British Postgraduate Medical Federation which embraced the University Postgraduate Medical Institutes associated with the single-speciality hospitals in London. He found the job less congenial because it involved less direct contact with researchers and much more medical politics along the interface with the National Health Service.
John McMichael was a man of power and determination who revealed little of his inner thoughts and emotions to his associates. He was strong and critical in argument (and could be inflexible), as in his attacks on the validity of the clinical trials of anticoagulants in patients who had suffered a heart attack. Yet his toughness was tempered by compassion and he had a very genuine feeling that his department was an extended family for which he was responsible. His real monument is not so much his science but the department and medical school which he shaped. Hammersmith broke the conventional, conservative, mould of British academic medicine at a time when pressures to conform were strong. To achieve that required not just tenacity and determination but vision.