Lives of the fellows

John Ellis Middleton

b.22 August 1924 d.23 December 2013
BM BCh Oxon(1948) MRCP(1954) MRCPath(1963) FRCPath(1974) FRCP(1983)

John Middleton was a consultant pathologist in Southampton. As a physician and a pathologist, he recognised the fundamental importance of strong laboratory support for good medicine. John was a Yorkshire man. Born in Sheffield, he was educated at King Edward VII School, where he excelled not only academically, but also in athletics and football. Dissuaded from pursuing a career in geology, and not wanting to be an accountant like his father, Harold William Middleton, he won a Hastings scholarship to Queen’s College, Oxford, to read medicine. He did his clinical training and first pre-registration jobs at St Thomas’ Hospital, London, and then carried out his National Service in the Army.

From 1950 to 1955 he held a variety of junior posts, which gave him a broad experience in general medicine. After achieving his membership of the Royal College of Physicians, he returned to St Thomas’, but now as a lecturer in clinical pathology. Initially he worked in all the pathology disciplines, but from 1959 specialised in chemical pathology, combining duties in the laboratory with work on the metabolic ward.

In 1962 he was appointed to the first consultant post in chemical pathology at Southampton General Hospital, which he held until 1989. After his retirement, he was awarded the title of consultant emeritus to the Southampton and South West Hampshire Health Authority, in appreciation of the great respect held for him by his colleagues. He taught undergraduate and postgraduate students throughout his career, and from 1971 was an honorary clinical teacher of the newly-founded Southampton University Medical School.

Working at the interface between science and medicine, John’s research interests were clinically based, driven either by a need to improve the management of patients or by an insatiable curiosity to explain unusual or unexpected biochemical abnormalities in samples from patients. His early publications were largely concerned with optimising antibiotic treatments, and later studies with the development and application of laboratory methods. Amongst his achievements was the identification of a previously unreported histidine metabolite in urine of folate deficient patients. However, probably because of his modesty, his most important, and very significant, contribution to medical care has been forgotten and does not receive the recognition it deserves. Working with W J Griffiths at St Thomas’ Hospital, he was the first to develop a new and rapid specific enzyme test to measure glucose accurately in blood and cerebrospinal fluid, published in 1957 (‘Rapid colorimetric micro-method for estimating glucose in blood and CSF using glucose oxidase’. Br Med J. 1957 Dec 28;2[5060]:1525-7). Until then it was only possible to get approximate glucose levels by using lengthy chemical tests to measure ‘blood sugar’. These values were too high because they included compounds in blood other than glucose. With the new test, glucose could be analysed reliably within ten minutes in blood samples collected in outpatient clinics. The enzyme method, which became known as the ‘while you wait test’, was widely adopted and improved, and was subsequently adapted for use in portable glucose monitors. These have revolutionised diabetic care.

The new post in Southampton was challenging. John had to expand the chemical pathology service to meet the needs of a large hospital with many specialist units, which became a teaching hospital in 1971. Worldwide, the demand for biochemical tests of ever-increasing diversity was escalating at an alarming rate. He increased staff numbers, introduced new automated instrumentation, and a wide range of assays, and provided a service which satisfied even his own high standards. He also set up an outpatient clinic to investigate metabolic disorders, but with particular emphasis on prevention of urolithiasis (perhaps a reflection of his geological leanings!). This excellent stone clinic is one of very few in the United Kingdom, and has continued since he retired.

John was always keen to protect the interests of clinical pathologists and to ensure that their status was not denigrated by colleagues working in more frontline clinical disciplines. He was strongly supportive of his laboratory staff, and quick to admonish junior doctors who were discourteous to them. He also believed strongly that the disciplines of clinical pathology should function in unison, and was a keen and active member of the Association of Clinical Pathologists. For their diamond jubilee in 1987 he designed a rather colourful tie and umbrella with broad stripes: red for blood (haematology), violet for haematoxylin and eosin stain (histopathology), blue for Gram stain (microbiology) and yellow for jaundice (chemical pathology). He was awarded the Association’s Marshall medal in 1988 for his service over the years. From 1978 to 1982, he organised the Wessex general pathology training course for the primary examination of the Royal College of Pathologists. This rotated through all the pathology disciplines across the region in order to provide a vantage of differing practices and viewpoints. He wanted the trainees to have a broad vision of the discipline.

John was a thoughtful, highly intelligent, modest and private man. He had great integrity, a keen sense of right and wrong, and was suspicious of pretension. He was a strong family man, who seldom talked about work at home. He met his wife Rita (née Wallis) at St Thomas’, where she was a nurse, and they enjoyed a very happy marriage. Their home was a refuge for numerous animals in want of tender loving care, which were accumulated by their three children, Cherry, Nicholas and Margot. All John’s medical skills were needed to resuscitate a very sick baby squirrel. He and the family loved exploring the English countryside, although not all were convinced by his need to go armed with a rucksack of library books.

Valerie Walker

[The Queen’s College Newsletter issue 17 03/11]

(Volume XII, page web)

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