b.5 October 1928 d.26 June 2010
MB BS Lond(1952) MRCP(1955) MRCPath(1968) MD(1968) FRCP(1970) FRCPath(1976)
Joseph Norman (‘Nat’) Blau was a consultant neurologist at the National Hospital for Neurology and Neurosurgery, London, and a migraine specialist. He was born in Berlin to Polish parents Moses Abraham Blau and Rosa Vogel. In 1938, with the threat of Nazi persecution, the family fled to his parents’ village in Poland. His father put him on the last boat from Gdynia to England, arriving on 29th August 1939, just three days before the German invasion of Poland. He was 10 years old. On reaching London, he was evacuated to live with cousins in Cambridgeshire. His parents and sister Adele went into hiding, but were captured and shot by a Nazi firing squad in 1942.
He was educated at the Jews’ Free School and then at Owens School, both of which had evacuated from London. His determination and intelligence were apparent and in 1947 he secured a place at St Bartholomew’s Hospital Medical School. After house jobs, he began his National Service, serving first as a lieutenant and then as a captain in the Royal Army Medical Corps, including a year at the Army neurological unit at Wheatley Hospital for Head Injuries. During this time he wrote his first research paper, on familial hemiplegic migraine, published in the Lancet (1955 Nov 26;269). He also began researching the vascular supply to the spinal cord, work published in Brain (1958 Sep;81:354-63). In 1962, a Nuffield Medical Scholarship took him to Massachusetts General Hospital, Boston, where he undertook pioneering research on the thymus.
Returning to London, he was appointed as a consultant neurologist at the National Hospital for Nervous Diseases, Queen Square. Similar appointments to the Royal National Throat, Nose and Ear Hospital, and Northwick Park Hospital and Medical Research Centre Harrow, Middlesex, soon followed. An MRC grant enabled him to continue his research on Hassall’s corpuscles at Guy’s Hospital. His experiments demonstrated that these structures, previously thought to have little function in adults, in fact had important immunological activity. This work resulted in publications in the journals Nature (1967 Sep 2;215:1073-5) and Immunology (1967 Sep;13:281-92) and earned him an MD.
In his clinical career, he trained in neurology as a registrar, and later a senior registrar, to Sir Russell (later Lord) Brain [Munk’s Roll, Vol.VI, p.60] at the London Hospital. During this time he met Marcia Wilkinson, with whom he shared a common professional interest and personal affliction with migraine. In 1980, she invited Nat to join her in opening the City of London Migraine Clinic, a registered medical charity. He volunteered a day a week as a consultant neurologist at the clinic, working for 30 years until ill health consequent to prostate cancer forced him to retire just six months before his death. A driving force behind the fundraising – an increasingly difficult task during the latter years – he wrote personal letters to heads of City organisations, highlighting disability from migraine and requesting donations to the charity. More often than not, he received a personal reply accompanied by a cheque. A highlight of each year was the fundraising musical evening held in one of London’s livery halls.
A deep thinker, he had been taught to consider Judaism to be a questioning religion. He believed that if you can question God, you can question anything. He loved to discuss all aspects of migraine, including historical and philosophical aspects. No research escaped critical review, resulting in stimulating debate. Faced with a comment or response with which he disagreed, he would raise his untamed eyebrows and a long pause would be followed by one of ‘Blau’s laws’ – all were peppered with humour, but each held a profound truth. Favourites included: ‘epidemiology is paralysis by analysis’; ‘better to have bad ideas than no ideas’; ‘treat the man not the scan’; and ‘decisive hesitation is better than hesitative decision’.
He eschewed anything that could create a barrier between doctor and patient. This meant that the patient’s chair was placed beside the desk, years before this became the standard recommendation. He used his clinical acumen to further his research, focusing on the patient’s symptoms to help him to understand the pathophysiology. He regularly quoted Sir William Osler’s maxim [Munk’s Roll, Vol.IV, p.295] ‘Listen to the patient, he is telling you the diagnosis’. He would not be swayed by popular medical hypotheses. At a time when animal models for migraine were popular, he stood firm in his belief that we must look to the patient for the answers. The result was seminal papers on migraine precipitants, the phases of migraine attacks and behaviour during cluster headache. He also identified three new headaches. He spent many hours in the Royal Society of Medicine’s library and was a member of the Society of Authors. At home, he enjoyed smoking his pipe while he wrote, leaving a hallmark scent to his work. He published over 120 papers in scientific journals, as well as numerous book chapters, a highly respected textbook on migraine (Migraine: clinical, therapeutic, conceptual and research aspects, London, Chapman and Hall, 1987) and a popular book for the lay reader (The headache and migraine handbook, London, Corgi, 1986).
An eloquent speaker, he received invitations from all parts of the globe. He talked to people, rather than at them, always requesting a tie microphone so that he could wander among the group and question unsuspecting members of the audience. No lecture was ever the same and all were remembered. Active in the lay organisation Migraine Action (formerly the British Migraine Association), he often spoke at their AGM and was their honorary medical adviser from 1980 to 2007. He served on the council of the neurological section of the Royal Society of Medicine and the Anglo Dutch Migraine Association. Between 1994 and 1996 he was chairman of the British Association for the Study of Headache.
Outside medicine, he was an artist and sculptor, attending evening classes and exhibiting his work. He took up the cello when he was 32, joining the London Medical Orchestra and serving for six years as chairman.
He treated and changed the lives of thousands of patients suffering from migraine, cluster and other debilitating headaches. He taught countless medical students and doctors, stimulating interest in headache by encouraging doctors training at the National Hospital for Neurology and Neurosurgery to sit in on his clinics. His questioning approach was polarising, but all admired him for the thorough training that they received. Despite the significant impact he made in the field of headache, he was always modest and unassuming.
Nat Blau married Jill Elise Seligman in 1968. They had two sons (Justin and Adrian) and a daughter (Rosie).
[The Times 9 August 2010, Brit.med.J., 2010 341 4246; Anglo Dutch Migraine Association http://anglodutchmigraine.org/index.php?option=com_content&view=article&id=56&Itemid=11 – accessed 27 February 2012]
(Volume XII, page web)
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