Lives of the fellows

Kenneth Shirley Smith

b.23 January 1900 d.29 January 1987
BSc Lond(1923) MB BS(1927) MRCP(1927) MD(1929) FRCP(1933)

Kenneth Shirley Smith was born in Hendon. His father, Edward Shirley Smith, was a hotelier. His mother, Gertrude Water, came from a medical family; her father and two brothers were doctors. Kenneth was educated at Haberdashers Aske’s. He obtained a senior scholarship to the Middlesex Hospital medical school and graduated BSc with first class honours. In 1925 he married Alice Hoogewerf, the daughter of a Dutch lawyer. He qualified in medicine in 1927, proceeding MRCP in the same year, and was awarded a doctorate in 1929. He became medical registrar at the Middlesex after his house appointment there, and then resident medical officer at the National Heart Hospital. He was appointed assistant physician to Charing Cross Hospital in April 1930, becoming full physician in 1935. At that time, consultant physicians combined general medicine with their specialty, as had done the great physicians of the past such as Sir Gordon Holmes [Munk's Roll, Vol.V, p.195] and W J Adie [Munk's Roll, Vol.IV, p.596] at Charing Cross Hospital. His contemporaries were also superb general physicians, and yet made lasting contributions to their subjects of special interest, such as Anderson Hickling’s work on myelosclerosis which is still quoted today.

He served with the First Army in North Africa during the war, and was also with the Central Mediterranean Force in Italy, Greece and Austria, rising to the rank of lieutenant colonel RAMC.

Kenneth Shirley Smith made many advances in cardiology, but his work was mainly done before the explosion of knowledge produced by cardiac catheterization. Much of his earlier published work was concerned with the interface of cardiology and other specialties such as diabetes. He coined the term ‘linked angina’ to describe angina precipitated by other disease. He was particularly concerned with the prevention of impending myocardial infarction and the treatment of cardiogenic shock. His recogniton of minor episodes of myocardial infarction with their good prognosis enabled many patients to return early to a normal life at a time when prolonged bed-rest, and permanent entailment of subsequent activity, was the advice so often given to a patient. His work led to the widespread recognition of the relatively benign nature of right bundle branch block. He published many of the early papers on the treatment of hypertension with ganglion blocking drugs and their more specific successors. He was a pioneer in the study and radiological appearances of pulmonary infarction. He studied the application of kymography in the radiological diagnosis of patent ductus arteriosus at the London Chest Hospital. He provided a very active service in cardiology, both at Charing Cross Hospital and the London Chest Hospital. He was also consultant physician to the Samaritan Hospital for Women. He was such a good teacher, his outpatient clinic so active and his inpatient rounds so interesting, that each year he tended to attract the best house physicians.

At a time when academic departments in medicine were being set up in London there was some conflict between the academic units, rapidly increasing in size, and the part-time London teaching hospital consultants. It was claimed that teaching, NHS patient care, and research must suffer if time was spent on private practice. Kenneth Shirley Smith fulfilled all his commitments as generations of students, research associates, and all his patients can testify. There was never any conflict between his private practice and his NHS commitments. Reports on all his patients, to their general practitioners, were full and detailed. If a patient with an obscure heart disease had a small, reducible, indirect inguinal hernia, this would be included in the report. He hated slovenly speech and writing, believing that they denoted slovenly thinking. No student could say ‘fast atrial fibrillation’ when he meant ‘atrial fibrillation with a fast ventricular response’. This abbreviation, repeated continuously at the bicentenary celebration of William Withering in Birmingham recently by members of his beloved British Cardiac Society, would have saddened him greatly.

He was secretary of the first European Congress of Cardiology held in London in 1952. He had already become associate editor of the British Heart Journal, to Maurice Campbell [Munk's Roll, Vol.VI, p.86], and editor in 1959. The cardiologists had made a wise choice; papers were rejected for ambiguity, but not for lack of literary style. He was very critical of clichés and pointless padding, and swept out jargon, giving the Journal a high international reputation. He was elected president of the British Cardiac Society in 1964. It was the same year that his brother, Sir Hubert Shirley Smith, became president of the Institute of Civil Engineers.

Kenneth Shirley Smith was so modest that many of his colleagues at Charing Cross Hospital were unaware of his standing in the world of cardiology. At the same time, some in the hospital considered him autocratic; he used to state that democracy did not work in hospitals. The consultant was in total charge and responsible for the patients under his care. He uncannily anticipated many of our present day NHS problems. The multidisciplinary teams and the prolonged case conferences held on individual patients, so common now, would have been anathema to him. Yet there was no person too unimportant for their opinion to be disregarded, and he treated all people with great courtesy. His kindness and reticence prevented many from realizing that he had an underlying will of steel. A man of strong convictions, he overcame his shyness to take a very active part in the medical world. He was prominent in the Assurance Medical Society of Great Britain, and became president 1955-56. His diffidence allowed him to be overshadowed to some extent by those on the other side of the watershed produced by the introduction of cardiac catheterization. He gave tremendous support to his successor, who had been trained in the modern techniques. His own work was not always appreciated by those who came after him. He was a very different type of cardiologist from Paul Wood [Munk's Roll, Vol.V, p.456], whose daughter married Shirley Smith’s son.

Kenneth Shirley Smith was a gifted, sensitive, artistic man and it is no surprise that his son became a famous artist. His daughter obtained a degree in physiology, and his grand-daughter is reading physiology at Cambridge.

Kenneth Shirley Smith was stricken low by the death of his beautiful, warm-hearted wife, but his self-discipline and courage did not allow his grief to affect his work. He had a subtle sense of humour, complete integrity, a sensitivity and loyalty that made those who worked with him love him and feel privileged to have known him.

PBS Fowler

[Brit.med.J., 1987,295,338-9; Charing X Hosp.Gaz., Summer 1966,64(2)86-87]

(Volume VIII, page 473)

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