Lives of the fellows

Archibald David Mant Greenfield

b.31 May 1917 d.17 November 2005
BSc Lond(1937) MRCS LRCP(1940) MB BS Lond(1940) MSc(1947) DSc(1953) MRCP(1968) FRCP(1973)

Professor David Greenfield was the foundation dean of the faculty of medicine and professor of physiology at the University of Nottingham for 15 years from 1966 to1981. He was dean of the first new British medical school of the 20th century. Greenfield was also a distinguished physiologist. He had held the Dunville chair of physiology at Queen’s University Belfast (from 1948 to 1964) and the chair of physiology at St Mary’s Hospital Medical School. He is remembered for his gentle but firm determination, generous open-mindedness and rigorous attention to detail.

Born in Wallingford, the son of A W M Greenfield and Winifred Greenfield, Archibald David Mant Greenfield was educated at Poo!e Grammar School and proceeded, on an entrance scholarship, to St Mary's Hospital Medical School in 1934. He was among the first students at St Mary's to take an intercalated BSc honours degree. During his undergraduate years Greenfield collected a host of prizes and certificates, and on registration he became house physician to George Pickering [Munk’s Roll, Vol.VII, p.464]. Following this appointment on the medical unit he joined Sir Alexander Fleming's [Munk’s Roll, Vol.V, p.132] pathology trainee scheme for the Emergency Medical Services. It was at Harefield Hospital that he met Margaret (Peggy) Duane, Tom Holmes Sellors’ ward sister. He married Peggy Duane in 1943, she remained a constant support until her death in 1999. They had a son, Peter, and a daughter, Catherine. In 1941 Alastair Frazer [Munk’s Roll, Vol.VI, p.186] left St Mary’s to take the chair of pharmacology at Birmingham, David was the obvious person to succeed him in the department of physiology as a junior lecturer.

David’s career and research interests were influenced significantly by the work which he undertook during the Second World War. He set himself the task of solving the cause of ‘black-out’ in the pilots of Spitfires flying tight turns. This was proving an all too frequent cause of lost aircraft. He wanted to understand, and if possible prevent, gravity-induced loss of consciousness (G-LOC). Although the problems that exposure to increased gravitational force might cause to aircrew were observed within a few short years of the Wright Brothers' first flight in the early 1900s, the cause of these observations was not fully understood in 1940 and there had been limited attempts to protect pilots against the effects. This experimental research on the effects of acceleration and of enhanced gravity on the circulation led to an association with the Institute of Aviation Medicine at Farnborough. During his first appointments at St Mary’s Medical School he was greatly influenced by A St G Huggett and G W Pickering. He developed his interest in the circulation in human limbs, and collaborated in work on the haemodynamics of the foetal circulation.

In 1948, at the age of 31, Greenfield was appointed to the Dunville chair of physiology at the Queen's University of Belfast in succession to Henry Barcroft [Munk’s Roll, Vol.XI, p.37], who had pioneered research into the human peripheral circulation. The department attracted many brilliant young medical scientists. Greenfield was always able to get the best out of staff and to inspire great loyalty. Of those whose science he nurtured during the 16 years of his tenure of the chair, eight subsequently occupied chairs, and of these six became deans of medical schools and one was twice a vice-chancellor. One became president of the American Heart Association. An intercalated honours degree in physiology was started, and the graduates have held important posts. Greenfield and his colleagues laid the foundations for our understanding of the neural control of the peripheral circulation. Modern treatments of vascular diseases are derived from this fundamental work. It is a measure of his own and his staff’s enthusiasm that they were constantly presenting papers building and demolishing hypotheses at meetings of the Physiological Society in London when the journey entailed a sea crossing and long train journey.

From 1963 to 1963 he spent a sabbatical year working in Julius Comroe's [Munk’s Roll, Vol.VII, p.105] department in the San Francisco Medical Center, University of California. He probably invented, but certainly developed, a technique for testing cardiovascular reflex function (lower body negative pressure – LBNP), which became used extensively by NASA. This work was of great importance for our understanding of how the human circulation can withstand, first the acceleration, then the weightlessness of space travel and finally the return to earth suffering the effects of whatever degree of de-conditioning has occurred. Indeed it was considered as one of the counter measures that could be adapted to in-flight use in the prevention of de-conditioning of the circulation. For certain LBNP triggered much immediate excitement in US Air Force Research Centre. NASA was between the Mercury and Gemini programs and space flights of longer duration were in immediate prospect. Some consider that David received far less credit for his contribution than he deserved.

In 1964 Greenfield returned to St Mary's as professor, but plans were developing to start a new medical school in Nottingham. Sir George Pickering became the chairman of the University's medical school advisory committee. In 1966 David was appointed to be dean of the new school. It was a unique opportunity. It was the first new medical school of the 20th century in the UK. There were of course, problems. Nottingham had been chosen partly because it was in a seriously under-doctored part of the country and was in urgent need of a large new hospital, which would serve as the main teaching hospital for the school. Unfortunately legal problems over site acquisition delayed the start of the building of the hospital until 1971, and integral with it the accommodation for the medical school. However the school was committed to accept students in 1970, so temporary accommodation had to be used, and in the early years all clinical teaching was in existing hospitals with inadequate space and facilities. It needed enthusiasm, commitment, confidence and improvisation to start the school in such circumstances. Fortunately, these qualities were to be found among the doctors already in Nottingham and a team of young enthusiastic foundation professors who would develop a medical school with a different approach. The students when they arrived in 1970 were exposed to patients from the first week of training and an intercalated degree was established for all. Greenfield was re-elected dean for a succession of three-year terms until he retired in 1981. The new school was by then firmly established with an annual entry of 130, and the university hospital and medical school buildings were complete, though not yet fully commissioned.

When he retired the medical school was firmly established in its permanent accommodation and the dream of 1966 had become the Queen's Medical Centre, which was opened by the Queen in 1977. This was his outstanding achievement: it proved to be a notable international success, both clinically and academicaly. To mark his involvement, the medical library was named the Greenfield Library. Three hundred and eighty five Nottingham doctors had qualified, the local clinical services had improved out of all recognition and a new medical curriculum, copied by several other medical schools, established.

Greenfield was a member of the editorial boards of most of the cardiovascular journals, a member of the MRC until 1977, then medical member of the University Grants Committee and chairman of its medical sub-committee. He was also a member of the General Medical Council.

He travelled widely, even well into retirement, advising many universities planning new medical schools, most notably the Chinese University of Hong Kong, the University of Kuwait and the Sultan Qaboos University, Oman. In 1987 he was elected an honorary member of the Physiological Society.

David left an important legacy to cardiovascular research and to medical eduation. He made a fundamental contribution to aviation physiology, aviation medicine and the basic physiology of manned space flight. He laid the foundations of cardiovascular research in Belfast, St Mary’s and Nottingham. He manifested a deep interest in human beings – patients, students and doctors and their sensitivities.

Peter Fentem

[The Guardian 15 Dec 2005; The Times 6 Jan 2006; Lancet2006 367 22;Brit.med.J.,2006 332 239]

(Volume XII, page web)

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