Lives of the fellows

William Ian McDonald

b.15 March 1933 d.13 December 2006
BMedSc New Zealand(1955) MB ChB(1962) PhD(1962) MRACP(1963) MRCP(1964) FRACP(1968) FRCP(1972) FRCOphth(1989) Hon FRCOphth(1999) FMedSci(1999) Hon DSc Otago(2000) Hon PhD Thessaloniki(2003)

Ian McDonald was the leading authority on multiple sclerosis during the latter part of the twentieth century. In work that was creative and sustained over a period of nearly 50 years, he brought first class clinical science to a subject where research had previously been exploratory and somewhat disjointed. His main professional appointments were consultant neurologist to the National Hospital for Neurology and Neurosurgery in London and Moorfields Eye Hospital, and professor of neurology at the Institute of Neurology, London University.

William Ian McDonald was born in Wellington, New Zealand, graduating from the University of Otago. He trained in experimental neurology with A D ('Archie') Macintyre and clinically with Keith McLeod, amongst others. In London from 1963, he captured the attention of an older generation, themselves linked by personal contact with physicians who had established modern neurology in the late nineteenth and early twentieth centuries. These were important links for someone who was sensitive to the historical record, absorbed the legacies of those that came before, sought to carry the banner of academic neurology for a while himself, and hoped that the attitudes and style he espoused would survive in activities of the school he himself created. In the 1960s, the brightest neurologists training at Queen Square went to Derek Denny Brown, another New Zealander who had worked in England from 1925, initially with Sir Charles Sherrington [Munk's Roll, Vol.IV, p.523], before moving to Boston in 1939. This was a critical period for Ian McDonald's own development as an experimental neurologist, and also a pivotal period in the evolution of an institution that needed to move on from 100 years of descriptive neurology. Ian McDonald was one of relatively few trainees who remained active in experimental neurology; and his contributions were appreciated by his more forward-looking senior colleagues and contemporaries.

In the 1960s, with Tom Sears, he characterised the physiology and morphology of demyelination and remyelination in the central nervous system. These physiological experiments rarely lasted less than 18 hours and McDonald would watch the dawn breaking as he drove home, before returning to the hospital for a clinic starting at 9am. In the 1970s, with Martin Halliday, he pioneered laboratory methods for supplementing the clinical diagnosis of multiple sclerosis. The observations brought objectivity to the diagnostic process in multiple sclerosis, and the techniques survive as markers of what happens physiologically when the myelin sheath is lost from nerve fibres in the brain and spinal cord. In the 1980s, Ian McDonald pioneered brain imaging as a method for studying the pathogenesis of human and experimental demyelinating disease. Each achievement was important and, together, the work represents a lasting contribution to neurological medicine.

Throughout his career, Ian McDonald encouraged younger neurologists, trained by example, lifted less gifted colleagues, and reflected with generosity and uncomplicated pride on their achievements. He was sought-after as a clinician and renowned as a lecturer and writer. His methods were meticulous preparation and attention to detail, the ability to synthesise a complex story, perspective concerning his own achievements set in the context of illustrious predecessors, and apparently easy performance concealing much personal modesty.

Ian McDonald received recognition from neurological societies and organisations; and he delivered many named lectures throughout the world. He edited Brain from 1991 to 1997, having earlier brokered the move of that journal, established in 1879, from Macmillan to Oxford University Press, achieving financial security in the process, and thereafter allowing the guarantors to distribute significant resources annually in support of education for young people working in the neurosciences.

Ian McDonald delivered the Bradshaw Lecture (1986), taking as his subject 'The pathogenesis of multiple sclerosis'. In a characteristically wide-ranging and scholarly account, he analysed all that was then known about the aetiology and pathogenesis of that difficult disease, leaning heavily on the contributions of his group in the (then) emerging field of nuclear magnetic resonance imaging. He received the Jean Hunter Prize (1993). His Fitzpatrick Lecture on 'Deficit, recovery and the vis nervosa' (2004) was a blend of historical scholarship and scientific authority on the physiology of normal and altered nerve conduction. He served as a member of council from 1989 to 1992 and, in retirement, was appointed (13th) Harveian Librarian at the College (1997 to 2004). The opportunity to curate an important collection of books, portraits and medical ephemera brought much pleasure.

As Harveian Librarian, McDonald was responsible for volumes X (1999, the first to be accessible through the Internet) and (with his successor) XI (2006) of Munk's Roll, writing several notices himself and always knowing from whom to charm biographies - no easy matter as the size and longevity of the fellowship increased, making informed notices less easy to conjure. He helped see through to publication Lord Asa Briggs's History of the Royal College of Physicians of London: volume four (Oxford, Oxford University Press, 2005). In 2001, with Geoffrey Davenport and Caroline Moss-Gibbons, Ian McDonald edited The Royal College of Physicians and its collections: an illustrated history (London, Royal College of Physicians), describing the heritage accumulated since the Marquis of Dorchester bequeathed his library to replace that lost by fire in 1666. He persuaded council to invest not only in archiving and conservation but also physical preservation of printed material through the provision of climate controls. Ian McDonald was a staunch defendant of the responsibility the College has to those of its Fellows who built up the heritage collection, thereby honouring one of the two principles that led Thomas Linacre [Munk's Roll, Vol.I, p.12] to provide premises (in Knightrider Street) for a College of Physicians - a meeting room and a library. When the sale of important items such as the Wilton Psalter was mooted, McDonald was quick to impress upon colleagues that future generations would not trust a College that failed to honour the terms of its legacies. And he argued that the library, eclectic in its holdings, illustrates how physicians learned and were educated down the centuries. The item that gave him most pleasure - for professional and historical reasons - was the manuscript casebook of Augustus d'Este; and this informed the College Lecture Ian McDonald delivered on 'A problematic grandson of the mad King George' (1997).

Ian McDonald contributed much to the social life of the College. Through his obvious interest in themselves as people, the staff held him in high esteem. When representing the College regionally and abroad, and when dining with the College Club, conversation was lively and informed, revealing the warmth and wisdom of someone who enjoyed the company of others, knew a great deal about medicine, history, literature and the arts: received and gave much in friendship; and assumed the best in everyone (until proved otherwise). Friendships outside medicine cultivated by Ian McDonald and his partner, Stanley Hamilton, provided a reference point for his professional work and a rich source of information and anecdote that he frequently used to decorate his writings and lectures. He was assiduous in sending handwritten notes expressing gratitude or appreciation, often attaching items that he considered wry or amusing, culled from the many sources he accessed on a regular basis, and which revealed his affection for the foibles and witticisms of social intercourse in public and private life; and he did not forget the more frail and retiring of those friends with whom he had engaged in medicine and the arts down the years.

His passion was music. Ian McDonald considered himself to be 'of average competence, being a useful accompanist in lieder and chamber music from the baroque classical and easier romantic repertories'. Others went further: 'as a member of a trio he was exceptional: certain in rhythm, intensely musical in his ability to see a long phrase within a theme, and with the fingers led by the ear'. Therefore, it was poignant that a small stroke in 2004 removed, for a while, his ability to read a score and play the piano. In 2006 he published, in Brain, a characteristically erudite neurological account of this intensely personal episode.

The professional contribution is to have illuminated the clinical science of demyelinating disease. For almost half a century, people with multiple sclerosis did not have a better professional friend. Sensitive to the history of his subject, knowledgeable in the arts, of striking physical appearance and always impeccably dressed, an accomplished musician, and with a wide circle of friends, Ian McDonald was an ambassador for all that is valued most in British neurology. He died suddenly in London.

Alastair Compston

[J Roy Coll Phys Lond 1987: 21; 287-294; Clinical Medicine 2006: 6; 294-301; Brain 2006: 129; 2554-2561; The Independent 19 Dec 2006; College commentary Feb 2007]

(Volume XII, page web)

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