b.17 April 1946 d.22 September 1990
BSc Rhodesia(1969) MB ChB Birm(1971) MRCP(1975) MD(1983) FRCP(1989)
Brian Macdougall was born in Scotland but brought up in Rhodesia (now Zimbabwe) and used his medical school’s connection with Birmingham well, achieving a first in his intercalated BSc degree and graduating MB ChB with honours. After house jobs in Harare Hospital, Salisbury, and a brief spell of military service in the Rhodesian Air Force and the SAS as a medical officer, Brian left for England where he made his home.
He started with a SHO appointment at Hertford Hill, near Warwick, and then became medical registrar at Warwick Hospital, 1974-75. His chief there was S R F Whittaker, that legendary physician and senior figure of Midland’s medicine [Munk’s Roll, VoL VII, p.595] who was such a help to many aspiring young physicians. Not surprisingly, with Brian’s natural abilities and intelligence, during that year he obtained his membership of the College at first attempt. I remember S R F Whittaker ringing me one day, at King’s, asking me to take on this young doctor of whom he had formed such a high opinion; speaking particularly of his very human qualities. How right he was. Brian came to King’s as a clinical research fellow in June of 1975 and was shortly afterwards awarded the Mackenzie Mackinnon Streatfield Research joint fellowship of the Royal Colleges of Surgeons and Physicians, which he held for three years.
His initial investigative work was in the condition of extrahepatic portal hypertension due to portal vein thrombosis. It had been thought that the development of an erosive oesophagitis might underlie the repeated occurrence of bleeding in this condition and he carried out a controlled clinical trial of H2 antagonists along with measurements of oesophageal pH. No benefit was shown, but the careful documentation of one of the largest series in the literature led to important new knowledge on the natural history of the repeated episodes of variceal bleeding in this condition and the long-term outcome. He was also interested in the pathophysiology of acute gastric erosions in fulminant hepatic failure, and in another carefully controlled clinical trial the demonstration of the benefits of H2 antagonists in preventing upper GI haemorrhage from erosions marked a major advance in the treatment of this condition [Gastroenterology, 1978;74, 464-465].
At that time, results of treatment for bleeding varices - particularly in the cirrhotic subject - were poor despite the variety of surgical techniques in use. We had become aware of the use of endoscopic sclerotherapy by R Macbeth at Oxford and I invited Harold Rodgers to visit the unit in 1973 to demonstrate the technique he had used in a considerable number of patients in Belfast with apparently remarkable results. Subsequent excellent development work by Ken Williams, senior registrar to J L Dawson, led us to switch from rigid to fibreoptic methods with the development of the overtube and considerable improvement in safety. Brian was one of the first physicians to take up variceal injection personally, removing the activity from the theatre to the endoscopy room. Thus the way was opened for appropriate clinical trials. A controlled clinical trial of long-term endoscopic therapy had been started by Keith Mitchell, an Australian clinical fellow, but Brian was the mainstay for keeping the trial running for the number of years it required to achieve statistically significant results. Scrupulous honesty in assessing the results of this treatment, with the random allocation of patients to a no-treatment group and all the difficulties that that entailed, was followed eventually by the final analysis of which Brian was the first author [The Lancet, 1982, 1, 124-127]. This paper attracted very considerable attention worldwide. It was the first properly controlled trial of endoscopic therapy and the improvement in long-term survival that was shown, as well as the decrease of frequency in subsequent bleeding, was the basis on which endoscopic therapy became so rapidly and widely accepted throughout the world. On the basis of his work in portal hypertension Brian was successful with his doctoral thesis ‘Pathogenesis and management of upper gastrointestinal haemorrhage in acute and chronic liver disease’.
After Brian became senior registrar to the liver unit in 1979 he played a major part in the development of the liver transplantation programme and a series of papers followed on various clinical aspects. This post included a one-year rotation to Brighton where he worked for Tony Trafford (q.v.) and Joanna Sheldon (Munk's Roll, Vol.VIII, p.458] and in a very short time he became as popular there as he was at King’s. When a consultant post became available there in 1983 - the first appointment for which he had applied - he was sucessful. Andrew Clark, the consultant surgeon there, with whom he had formed a close link having previously worked with him at King’s, said ‘At Brighton, as a consultant physician, almost from the first day of his appointment he set out single-handedly to improve the lot of patients with GI bleeding.’ He rapidly established his position as the leading young gastroenterologist on the south coast and this led to his being asked by the British Society of Gastroenterologists, of which he was always an active member, to organize the Spring meeting of the Society in Brighton in 1985, This he did with his usual unassuming efficiency.
Brian had a natural friendliness and ability to get on with his colleagues, and his advice was often sought on management matters in the Brighton hospital. He gave freely of his energies and at the time of his death he was chairman of the division of medicine in addition to being chairman of the district ethical committee and of the drugs and therapeutics committee. He was also an active member of the regional scientific advisory council in gastroenterology and it was there that I last saw him some two months before he died, then full of life. We talked of plans to celebrate in 1991 the 25th anniversary of the liver unit at King’s and he was keen to play an active role, which he most certainly would have done.
While Brian’s work always came first he did find some time for non-medical pursuits. He loved collecting antiques for his home, where he delighted in entertaining his friends to champagne and smoked salmon, followed by his favourite Rhodesian barbecue. He took the early failure of his first marriage to heart and only after several years of bachelor life did he remarry in 1987. His marriage to Jane was extremely happy and in 1990 they bought a house in France - typically, loaned with pleasure to all their friends. He also enjoyed sailing and I enjoyed his company and whole-hearted input on various yachts when I campaigned actively in the Royal Ocean Racing Club's races and Solent regattas. On one occasion he was the first to volunteer to be hoisted up the mast at the end of a Round the Island race when the tattered remains of a spinnaker had to be brought down.
His last illness was sudden and certain and a short while in hospital led to a month at home, beautifully cared for by his wife, with time for a talk and a joke with friends before he died.
R S Williams
(Volume IX, page 332)
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