Lives of the fellows

Peter Wilfred Nathan

b.1 February 1914 d.5 December 2002
MB BS Lond(1939) MRCP(1940) MD(1952) FRCP(1964)

Peter Nathan was a familiar presence at Queen Square for more than 50 years. His achievement was that his work was central to the thinking and practice of neurologists, neurosurgeons and those concerned with the management of severe pain in the second half of the twentieth century. Many organisations concerned with medicine, culture and the environment, and many talented young people entering these fields too have cause to be grateful for his support. The remarkable range of his influence reflects a remarkable man with an unusual background.

Peter's grandfather founded the firm of Glaxo some 100 miles north of Wellington, New Zealand. His father, Alec, came to London early in the 20th century to market their new product, dried milk, and promote it as a baby food safe from infection. The company later diversified and by 1944 was producing about 80 per cent of the penicillin used in the Normandy landings. These circumstances gave Peter the financial independence to pursue his interests without conforming to the orthodox lines of professional development.

Peter Nathan was educated at Marlborough, but so detested it that his parents sent him in his last year to a private school in Switzerland where his gift for languages flourished. His first intention was to study psychology, and after a short spell in Paris he went to Munich where he was influenced by the work of Adler. In Munich he witnessed the growth of Fascism (he had a discussion in a Bierstube with the rising Adolf Hitler), and his later observation of its terrible consequences led to his first book, The Psychology of Fascism (London, Faber & Faber, 1943) which was much admired.

But the psychology of the 1930s lacked the precision he sought and he turned to neurology, first qualifying in medicine at the Middlesex Hospital in 1939. During the war he served in the UK (at the head injury unit at Oxford), Italy and Palestine.

In 1946 he joined the Medical Research Council's neurological research unit at the National Hospital, Queen Square. The director, Arnold Carmichael [Munk's Roll, Vol.VII, p.91], suggested that he and the pathologist Marion (Mai) Smith [Munk's Roll, Vol.VIII, p.476] should study the intrinsic pathways of the human spinal cord; knowledge about them at that time was imprecise, being an amalgam of observations in man and animals. There was a unique opportunity to do so because of the large number of patients at that time who had spinal tractotomies at Queen Square for intractable pain.

Their method was to correlate Peter's meticulous pre- and post-operative clinical findings in the patients with Mai Smith's equally meticulously documented anatomical findings at post mortem. The first report in what came to be a classical series of some 20 papers appeared in 1951, and the last, in Brain in 2001. They defined the pathways in the spinal cord sub-serving movement, pain, other forms of sensation and bladder function. Their contribution was definitive.

Peter's orientation was physiological and he was ever alert to opportunities to elucidate normal and pathological mechanisms related to the function of the pathways he and Mai Smith were studying. Amongst his many contributions were the demonstration (with the neurosurgeon John Andrew) of the importance of the frontal lobes of the brain in the control of the bladder. A practical consequence of his work in this field was the introduction of a simple non-invasive method for stimulating emptying of the bladder when voluntary control was lost. Nathan and Smith's work on the pathways sub-serving movement (which was controversial in the 1950s and precipitated a colleague at Queen Square, Sir Francis Walshe [Munk's Roll, Vol.VI, p.448], into one of his characteristic polemics in Brain in 1956) is recognised now as providing the indispensable basis for assessing the effectiveness of current attempts to repair the human spinal cord in paraplegia.

But Peter's best-known achievement was in relation to the control of pain. In the course of his early work he became increasingly convinced that better methods were needed and he set about developing them, drawing on his own experience and that of others. As his work became known, increasing numbers of patients were referred from a wide area, and his clinic at Queen Square gradually emerged as one of the first pain clinics in the UK. Neurologists, anaesthetists and palliative care physicians from around the world came to learn his approach. Physiologists too came to discuss the theoretical implications of his work. His critical review of the gate theory of pain was a landmark. Those on the staff at Queen Square - and elsewhere - who were fortunate enough to collaborate with him were enriched scientifically, culturally, and personally too. After Peter and Mai Smith retired they continued their work, together with Pat Deacon, in the department of neuropathology at Oxford, Mai dying in 1988 and Peter continuing into the last year of his life.

Peter's approach to everything he was interested in was marked by freshness and an almost child-like enthusiasm which he often translated into financial support (usually anonymous). A good example is provided by the internationally successful musical, Canterbury Tales. It was originally devised by his life-long friend Martin Starkie for the 650th anniversary of Exeter College, Oxford. Its success led to the suggestion that it might be put on in London. No theatrical backer was interested, so Peter put up the entire production costs. The huge profit from it went to charitable purposes.

Peter maintained his wider intellectual interests. His second book, Retreat from Reason: An essay on the intellectual life of our time (London, William Heinemann) appeared in 1955. The Nervous System (London, Harmondsworth Penguin), a hugely popular introductory text, came in 1969 and is still in print after four editions.

Peter lived modestly. He was a generous and amusing friend and a delightful colleague. He could be alarmingly direct, but his comments, delivered in his puckish way, were never hurtful. He was always ready with praise, and he was unfailingly encouraging to the young. When he saw a new publication he liked he would often send the author a short note on a scrappy piece of papers (headed notepaper was not to be wasted) using an ancient typewriter, which he referred to as his 'tripewriter'. The text was sprinkled irregularly with upper and lower case letters and numerous spelling mistakes. He would comment that since people knew what he meant, there was no point in wasting time with corrections.

Peter Nathan must have been one of the last private scholars of medicine. He used his personal wealth to further his work and to support a remarkable range of causes and individuals in medicine and the arts. His scientific contribution, made at Queen Square, is part of the fabric of neurology.

Ian McDonald

[The Times, 14 March 2003; The Guardian, 17 March 2003;, 2003,326,604]

(Volume XI, page 415)

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