Lives of the fellows

Timothy John McElwain

b.22 April 1937 d.26 November 1990
MB BS Lond(1965) MRCP(1968) FRCP(1977)

Timothy McElwain was born in New Zealand in 1937 and educated at St Peter’s College, Adelaide, and Haileybury College, Melbourne. He left Australia to come to polytechnic in London, to pursue studies in biology, but he soon decided to transfer to medicine. Among the many prestigious medical schools in London the one that proved most receptive to an application from someone starting relatively late in medicine, and from an unusual academic background, was St Bartholomew’s and throughout his life Tim McElwain retained a great affection for Bart's which he referred to, with only partly humorous intent, as ‘the mother hospital of the empire’. He had a distinguished record at Bart’s, achieving honours in pharmacology in 1965. He was also a prominent member of the student community, playing a large part in sporting and social events and winning the Hayward prize for student activities in 1964. After qualification, he took up his house physician job at Bart’s with Neville Oswald and Gordon Hamilton-Fairley [Munk’s Roll, Vol.VI, p.215] and was also introduced to medical oncology, his future great interest, which was then a very new specialty. As a house surgeon, he worked with Oswald Tubbs and after extending his medical experience he moved on to paediatrics at the Hammersmith in 1967. He returned to Bart’s late that year as a registrar on his old firm, with Hamilton-Fairley and Oswald, and was already showing an interest in the management of malignant disease. In 1968 he moved up rapidly to become a lecturer in haematology, funded by the Leukaemia Research Fund at the Institute of Child Health, working with Roger Hardesty, and was introduced to laboratory science and the management of children with malignant disease. He remained in his lectureship at Great Ormond Street but also became a part-time clinical assistant in the department of medicine at Bart’s where he developed his interest in adult oncology.

In 1970 he took up his first posts in medical oncology as a lecturer in medicine at the Institute of Cancer Research and as an honorary senior registrar in his discipline at the Royal Marsden Hospital in Sutton, working in the firm being established by Hamilton-Fairley, John Mathias and Thompson Hancock. This was a time of great excitement and rapid growth in medical oncology, with the introduction of combination chemotherapy in Hodgkin’s disease, and he was associated with Sir David Smithers and Michael Peckham in work on the medical and chemotherapeutic management of cancer patients, particularly with lymphomas. Rapid promotion to senior lecturer came in 1972 when Gordon Hamilton-Fairley returned to Bart’s as professor of medical oncology. In 1973 McElwain moved across to become a consultant physician at the Royal Marsden Hospital but, in reality, did not alter his clinical practice which remained academic throughout his career. In 1977 he was appointed acting head of the division of medicine at the Institute for Cancer Research and was confirmed as head in 1980, taking up the chair of medicine in 1982. He remained in the chair until his sudden death, by his own hand, in November 1990 at the age of 53.

Tim McElwain’s contributions and achievements in the field of medical oncology were outstanding by any standards. His early work in paediatric oncology, germ cell tumours and leukaemia, placed him at the forefront of development in that field. His modifications of chemotherapy for Hodgkin’s disease were responsible for the great strides that made those treatments more acceptable and tolerable for patients in the later 1970s. Regimens designed by Tim McElwain remain the standards by which all others must now be judged. In the late ’70s and throughout the ’80s he explored innovations in cancer chemotherapy including the use of high dose treatments, in which field he was the leading exponent. He pioneered the use of high dose chemotherapy in autologous bone marrow transplanation for Hodgkin’s disease and developed high dose chemotherapy for myeloma. Through his work and the work of others, both treatments have achieved a place in the management of these diseases and are now generating long term disease free survival for patients, which was not possible by other methods and would not have been possible without the innovative drive, energy and imagination of Tim McElwain.

He was primarily a clinical academic and his innovations evolved from his imaginative approach to clinical practice and his intense caring for his patients. But his interests extended far beyond therapeutic innovation. His common sense helped to keep the feet of British medical oncologists firmly on the ground at a time when there was a risk of excessive enthusiasm for therapy. His critical and incisive judgement always revealed the fallacies of an over-enthusiastic approach to cancer treatments. His concern for improvement in the quality of life for patients, and his careful consultation with them before embarking on complex therapies, have established the standards of practice for those he trained and will continue in the standards held by the next generation of British clinical oncologists. His commitment to the support of his patients was clearly illustrated by his efforts to aid the establishment of the patient support group BACUP, with Vicky Clement-Jones [Munk’s Roll, Vol.VIII, p.93], in the late 1980s.

Outside his academic work he was undoubtedly one of the leading physicians in oncology of his generation, not only in the United Kingdom but throughout the world. He established Cancer Chemotherapy in Pharmacology, which grew to be the leading journal in its field, and was its editor for 10 years. He was also on the editorial board of the British Journal of Cancer, and of Clinical Oncology, and a reviewer for a wide range of cancer journals. He established the Association of Cancer Physicians, of which he was the first chairman, and he either chaired, supported, or significantly influenced all of the committees governing the specialty. His influence in the College, in recent years, has always been directed towards more integration and amalgamation among the fragmented specialties of clinical oncology in the UK. This surprised many who had seen him as one of the leading forces developing medical oncology as a separate specialty, but his long term view and common sense compelled him to the conclusion that greater integration had to be achieved despite the obvious difficulties. He was a member of the United Kingdom Coordinating Committee on Cancer Research and a member of Council at the MRC, and his advice was widely sought, formally and informally, in this country and abroad.

Such a catalogue of achievements speaks for his powerful personality but in many ways he was more remarkable and memorable than even this long list suggests. His tremendous physical and personal presence was felt wherever he went. His ability to recognise the essence of any subject was perhaps his greatest strength. He painted his conceptual pictures with a broad brush, allowing others to contribute the details. He was renowned for his fierce temper but those who knew him well realized that it was short-lived and invariably followed by kindness. He was always prepared to offer help and advice to colleagues or juniors. As his career developed more and more demands were placed on him. He carried a vast clinical workload. He ran personally four large outpatient clinics which he attended conscientiously, providing individual and personal care. In addition, his inpatient practice reflected a huge referral from across the whole of the UK. It also incorporated a very extensive medical practice using bone marrow transplantation and a range of support techniques for sick patients undergoing complex therapies. His personal involvement, his knowledge of his patients, and his recall of their problems was quite extraordinary. A practice which continued despite his commitments to major national bodies and the demands of his academic and administrative work. This undoubtedly generated huge pressure and many problems, most of which he overcame.

Tim McElwain, often known to friends as ‘Mac’, had great ability and humanity. No one meeting him could fail to realise that under his convivial manner lay a fund of knowledge - of music, literature, politics, and a serious and unpretentious interest in wines. Conversation with Tim McElwain was never dull and could be challenging, not least because he could be as good a listener as he was a talker.

He left an indelible mark on the development of medical oncology in the United Kingdom. Almost all the senior academics in this field either worked with him or for him at some time in their careers and medical oncologists trained by him have populated the UK and many other parts of the English speaking world. He was survived by his wife, Sheila Glennis née Haworth, a physician working at the Institute of Child Health, Great Ormond Street.

P Selby

[Brit.med.J., 1991,302,46;The Lancet, 1990,336,1436; The Times, 1 & 3 Dec 1990;The Independent, 30 Nov,13 Dec 1990; The Guardian, 13 & 14 Dec 1990; The Daily Telegraph, 1 Dec 1990;MRC News, Mar 1991]

(Volume IX, page 337)

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