b.7 April 1920 d.12 July 2001
BM BCh Oxon(1943) DM(1949) MRCP(1948) FRCP(1963)
W B Matthews was one of the most respected neurologists of the 20th century. In 1963 he published a medical classic - Practical neurology (Oxford, Blackwell Scientific). He filled his little book with the wisdom that came from having seen thousands of patients and the clinical common sense that was pure WBM. In those days neurology was regarded as an elitist and stuffy subject, indulged in by eggheads with little interest in human beings. Not so Bryan Matthews, a modest and humane physician, who wrote “The best test of a physician’s suitability for the specialised practice of neurology is not his ability to memorise improbable syndromes but whether he can continue to support a case of motor neurone disease and keep the patient, his relatives and himself in a reasonably cheerful frame of mind.” And because he saw everything neurological there was to see he was sometimes worn down like the rest of us by the same old recurring problems. How else could he have had the wit to write: “There can be few physicians so dedicated to their art that they do not experience a slight decline in spirits on learning that their patient’s complaint is dizziness.” Much later, just before he died, he wrote about Practical neurology - “A reviewer, who approved of the content, described the title as ‘banal’. The derivation of this word is surprisingly complex, but is now taken to mean common or everyday and was, I felt, not too far removed from what I was hoping to achieve on chapters on such mundane but important matters as headache and dizziness.”
Walter Bryan Matthews was born in London, the son of Walter Robert Matthews, later dean of St Paul’s, and was educated at Marlborough College and University College, Oxford, where he read medicine. He spent three years in the Royal Army Medical Corps and then, after general medical experience in Oxford, he trained in neurology in Manchester and King’s College Hospital, London. At the age of 34 he was appointed consultant physician with a special interest in neurology to the Derbyshire Royal Infirmary, the first and for several years the only doctor in the East Midlands with any training in neurology.
The clinical burden was enormous. Not only did he see hundreds of new patients every year, but he reported all the electro-encephalograms and did his own nerve conduction. He even had to turn his hand to neuroradiology – direct puncture of the carotid artery in the neck to produce images of the blood supply to the brain, air encephalograms to show crude shadows of the brain, and myelograms to outline the structure of the spinal cord (now all superseded by less invasive techniques). But he was doing what fascinated him and what he enjoyed, and he found time to write about it and to do the research that led to his national and international reputation as a master physician, wonderful writer and outstanding clinical researcher.
His research was not the factory work of molecular biology, nor based on the shifting sands of animal models of human disease, but always focused on his patients. He wrote about the symptoms of multiple sclerosis, described the unusual neurological manifestations of sarcoidosis, told us about the good outlook for middle-aged women who drop to their knees in the street, and memorably accused the emerging specialty of clinical neurophysiology of relying far too much on the electro-encephalogram in the diagnosis of epilepsy.
His master-stroke came from a discussion with Peter Daniel, a neuropathologist in London, who showed Matthews that the brains at post-mortem patients with Kuru looked very similar under the microscope as those with Creutzfeld Jakob disease (CJD). Kuru was an obscure fatal brain disorder in Papua New Guinea tribesmen, transmitted by cannibalism, which had recently been transmitted to monkeys by Carleton Gajdusek in the United States. CJD was a little-known but rapidly dementing and fatal disorder in man, occurring only once in every million people a year. But might it too be transmissible? Back in Derby, Matthews soon found a patient with CJD. When the patient died he sent his registrar down to the post-mortem room to collect the brain and made sure one half was sent to Daniel and the other to Gajdusek, who injected it into a chimpanzee. Nine months later Matthews phoned the registrar to say, “He’s got it.” At a stroke, an arcane and so-called degenerative disease of the brain had become – astonishingly – an infective disease. No one then could have realised that this same disease, or something very similar, would be transmitted to man from cattle with the related disease of bovine spongiform encephalopathy (BSE).
Derby was not in the end the right place for Bryan Matthews. To flourish more as a researcher and teacher he moved in 1968 to Manchester, and then in 1970 to Oxford, where he was professor of clinical neurology. Here he concentrated as much on developing the clinical service as research and teaching. Indeed, he started and ran a neurology clinic in Banbury to demonstrate that neurologists should work in district general hospitals close to where patients live, even if they are Oxford professors.
He was at his spoken best in small groups around the bedside, in the corridor, or – delightfully – after work on a Friday, in the Royal Oak opposite the Radcliffe Infirmary. Informative asides were his style, not set piece lectures – “if you want to know if a patient’s thigh muscles are wasted on one side, then pull up their pyjama legs to see which one can be pulled up furthest, on the assumption that Marks and Spencers make their pyjamas with legs the same size” - and so on.
He continued his research into the epidemiology of CJD and the diagnosis of multiple sclerosis, wrote a book about multiple sclerosis for patients (Multiple sclerosis: the facts, Oxford, Oxford University Press, 1978), as well as editing and co-authoring the standard text on MS (McAlpine’s multiple sclerosis, Edinburgh, Churchill Livingstone, 1985 and 1991), carried out one of the first decent trials of treatment in acute stroke, and – crucially – greatly influenced the next generation of neurologists. He didn’t dominate. He was unselfish, with a word of encouragement here and some advice there. We were allowed to do our own thing and when it went well he was as pleased as anyone. When it didn’t he would commiserate and tell of his own professional failures, usually with some amusing anecdote to lighten the mood. There are now professors in Cambridge, Sheffield, Edinburgh, Derby and Nottingham who are his proteges and NHS consultants up and down the land who he helped to train. In our turn, I hope we are carrying his wisdom and humanity to the next generation of neurologists, even though the content knowledge of the subject has changed vastly. But we are small in number, certainly compared to the number of people who must have read Practical neurology and his other books and papers, texts which will survive us to be read by future generations.
Bryan Matthews retired in 1987, but continued to write and maintain a lively interest in all things neurological. Sadly his last years were spent in declining health and looking after his wife, Margaret. But he was always ready for a pint and a chat in some favourite Oxford pub, and his advice was as welcome as ever. I last saw him in the Churchill Hospital looking rather morose as he contemplated the possibility of a leg amputation. But his ironic sense of humour was all there as he suggested he might have to buy a parrot. In the event he decided to keep his foot and go home to die, supported by his son and daughter. No parrot for Bryan. He had decided it was not worth going on, and I am pleased that his doctors did not try to dissuade him.
[The Guardian 26 July 2001; The Times 31 July 2001]
(Volume XI, page 383)
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