Lives of the fellows

Ronald Thomson Grant

b.5 November 1892 d.7 November 1989
OBE(1947) MB ChB Glasg(1915) DPH(1920) MD(1921) FRFPS(1921) MRCP(1932) FRS(1934) FRCP(1951) FRCPG(1964)

Ronald Grant was born in Glasgow, where his father was chief of the Glasgow staff of The Scotsman. It was later said that editors never had to correct Grant’s typescripts and he attributed this to the tough training he had when, as a schoolboy making pocket money, he wrote press accounts (at a penny per word) for his father who crossed out every unnecessary word rather than pay an additional penny.

Grant was about to qualify when the first world war started but typically he enlisted at once in the Argyll and Sutherland Highlanders and, although invalidity from a wound enabled him to qualify in 1915, he continued to serve - now in the RAMC - until the end of the war. So he was 27 when he became RMO at a Glasgow hospital in 1919, where he learnt how to use the Mackenzie polygraph. This aroused his interest in heart disease and John McNee, later Sir John [Munks Roll, Vol.VIII, p.317], who was a friend of the hospital’s superintendent, obtained a post for him in Sir Thomas Lewis’ MRC funded cardiographic department at University College Hospital, London [Munk's Roll, Vol.IV, p.531], where he was to stay for 14 years. This appointment, determined by chance and good luck, was the formative and decisive influence of Grant’s long career in medical research.

Lewis put him in charge of a follow-up study of 1000 ex-soldiers with organic heart disease, designed to last for 10 years. This was a demanding task which Grant organized and conducted in an exemplary manner with the loss of only 13 records. His 58-page paper in 1932, with 147 pages of tables, was one of the first large scale statistical clinical studies. It included a pioneer controlled therapeutic trial of three treatment regimes on 175 patients with syphilitic heart disease. Its chief purpose was to evaluate guides to prognosis and Grant found that exercise tolerance and cardiac enlargement were the best.

When Grant joined the department Lewis’ interest, later to change, was still in diseases of the heart (he disliked the word ‘cardiology’) and Grant’s first paper was a comparison of four cinchona alkaloids on the heart rate in atrial fibrillation. In 1923 he and Lewis wrote a 78-page paper on infective endocarditis with especial reference to the role of a bicuspid aortic valve. It included a good histological study for which Grant cut and stained all the sections himself. His interest in cardiac pathology continued with three papers on congenital heart disease and he helped Lewis to re-examine the heart of Sir James Mackenzie [Munk's Roll, Vol.IV, p.533].

By 1923, Lewis had completed his cardiac research and had started work on the vascular reactions of the skin to injury, identifying the ‘triple response’. Grant and he showed that many forms of injury gave this response and after a series of simple and intellectually brilliant experiments they formulated the famous hypothesis that injury releases a histamine-like body, the ‘H substance’, from the tissue cells.

Speaking of the two years it took for Lewis fully to accept him, Grant said ‘You’ve got to make your way’ but that being done he now worked on his own and developed what was to be a life-long interest in the physiology of the peripheral circulation. He found the rabbit's ear to be the ideal preparation for his experimental work and assessed the response to temperature drugs and denervation by direct microscopical measurement of arteriolar diameter.

By 1930, Lewis' campaign to establish clinical science as a discipline in its own right was in full swing and he persuaded the MRC to set up a department of clinical research at Guy s Hospital. Grant became its first director in 1934, the year he was elected a Fellow of the Royal Society, and he was also appointed assistant physician having gained the essential membership of the College just beforehand. He had been happy in his work at UCH although, like others, he found Lewis a difficult person: ‘You were all the time aware of your own deficiencies when you were with Tom. If you could not see things as clearly as he did you were made to feel a fool. But there was a zeal for the truth which appealed to my Presbyterian upbringing and you put up with a hell of a lot from a man who was of that quality.’

The Medical Research Society, so important for the new group of young clinical scientists, was founded by Lewis in 1930 and Grant was appointed its secretary. His circulatory work had now extended, at Guy’s Hospital, to a study of human temperature regulation with measurement of skin and muscle blood flow in response to prolonged heating and cooling. His main subject for this in 1940 was the young Basil Reeve, a doctor, who urged him on to study shock instead but Grant refused to do this until a bomb demolished the temperature laboratory. So again it was chance that led him on to his final phase of research and the formation of a MRC shock unit. The clinical picture of the severely injured patients admitted to Guy’s from the bombing of the London docks was recorded in great detail and, although being only observers, they were accepted because of Grant’s tact and character.

The famous philosopher, L Wittgenstein, became his technician -having first come to Guy’s as dispensary porter to help with the war effort - and it was he who devised a simple way of describing the volume of soft tissue injury by relating it to the size of the patient’s fist. When the air raids ceased there were no more patients to study but Grant then took the remarkable step of persuading the MRC and the Army to set up a traumatic shock research unit, with himself in charge as a lieutenant colonel. The unit went to Italy and worked within ten miles of the battle fronts, such as those around Monte Cassino. They converted a 3-ton truck into a mobile laboratory and soon showed that the blood volume might be only 65% of normal with severe tissue damage, pointing to the value of adequate blood transfusion. But in spite of studying 500 patients he still emphasized the difficulties in using the word ‘shock’. After retiring he continued for several years to work in his laboratory at Guy’s.

Ronald Grant was a typical Scot. Tall, sandy-haired, well built, with a strong rugged face, he was essentially an individualist with a clear, critical and penetrating mind. To the enquiring student he was approachable, warm and friendly, and enjoyed explaining disease in physiological terms. Like Lewis, he was intolerant of sloppy work or statements that could not be supported by evidence. Although he was demanding and could be dour and aloof, he was in essence a very kindly, supportive and generous man, honest, modest and well respected.

Lord Butterfield recollects that Grant once yielded a point during a hot discussion with the revealing remark ‘I’d always thought of myself as "Tiger" Grant, but I suppose even tigers err.’ It must have been almost unique for a teaching hospital consultant to wait 19 years after obtaining his membership of the College before being elected to the Fellowship. Probably Grant was thought to be more of a scientist than a clinician and he was also regarded at Guy’s as a very dour Scot, who took no part in luncheon table talk and who could be critical of colleagues. Perhaps, too, the war years played a part in the delay.

He was a fine pianist, a good gardener and, in his 80s, a student of Gaelic. His first wife was Australian. His second, a gifted Russian pianist, died giving birth to their only child, Diana. His third wife died in 1985.

A Hollman

[Brit.med.J., 1990,300,186;Br Heart J.1990,64,349; The Times, 15 Nov 1989;Guy's Hosp. Gaz., July 1990,Vol.104,104-5; 1991,37,247-262; Biog.Mems.of the Fellows of the Roy.Society, 1991,37,245-262; MRC News, March 1990,46,46]

(Volume IX, page 204)

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