Lives of the fellows

Donald Emslie-Smith

b.12 April 1922 d.30 June 2016
MB ChB Aberd(1945) MRCP(1952) MD(1957) MRCP Edin(1962) FRCP Edin(1965) FRCP(1968)

Donald Emslie-Smith was a reader in medicine at the University of Dundee and a consultant physician at the Royal Infirmary and Ninewells Hospital, Dundee. His father, Harry Emslie-Smith, was a lieutenant colonel in the Indian Medical Service; his mother was Mary Isabella Emslie-Smith née Milne. Emslie-Smith was educated at Trinity College, Glenalmond. In 1945 he graduated from Aberdeen University, winning the Munday prize in pharmacology.

He was a house physician at Aberdeen Royal Infirmary and then served as a flight lieutenant in Egypt, Sudan and Eritrea. He returned to civilian life in 1948. His MD thesis ‘The electrical activity of the heart in hypothermia’ was awarded with honours. He held medical registrar posts in Aberdeen and Poole General Hospital. Next, he became a registrar in cardiology to Ian Hill [Munk’s Roll, Vol.VII, p.262] in Dundee. Hill was a world authority on electrocardiography, having done research with Frank Wilson in Ann Arbor, USA and with Wenckebach [Munk’s Roll, Vol.V, p.440] in Vienna before the Second World War. Carrying on with this tradition, Emslie-Smith set his long-term research goal of mapping the electro-mechanical conduction pathways of the heart using specially designed electrode-tipped cardiac catheters in routine preoperative work-up. This led to a series of publications in the British Heart Journal, the first of which was cited as a ‘landmark paper’ by H B Burchall, the senior cardiologist at the Mayo Clinic, and provoked widespread interest in the USA. It pioneered the way for the introduction of intracardiac electrocardiology to the UK.

When it was envisaged that open-heart surgery could be introduced in Dundee, Hill arranged for Emslie-Smith to spend a year in Melbourne, Australia doing basic research. There he investigated the effects of induced hypothermia in humans, experimental animals and the isolated toad atrium. He was able to record the cardiac electrical activity during these procedures and described the unfamiliar deflection added to the QRS wave, which in 1956 he named the ‘J’ wave.

On his return to Dundee, while routinely reporting ECGs he recognised his J wave in some elderly patients and in a younger one with severe myxoedema. No low-reading clinical thermometers existed, so he hastened to record their low rectal temperatures with a long mercury-in-glass laboratory thermometer. This led him to appreciate that severe, undiagnosed hypothermia was not uncommon and led to increased morbidity and mortality. His 1958 Lancet paper showing that in the UK hypothermia was common in the elderly became a classic (‘Accidental hypotherimia; a common condition with a pathognomic electrocardiogram’ Lancet. 1958 Sep 6;2[7045]:492-5), eventually leading on to such things as improved house insulation and, more recently, the winter fuel allowance for pensioners.

Between 1958 and 1961, by invitation, he served on the staff of the Postgraduate Medical School of London and Hammersmith Hospital as a senior registrar in medicine to John McMichael [Munk’s Roll, Vol.IX, p.341] and a tutor in general medicine. His work there included the applied pharmacology of various antihypertensive drugs such as pempidine, bretylium, guanethidine and chlorothiazide.

In 1961 he returned to Dundee as a senior lecturer in medicine, University of St Andrews and honorary consultant physician, Dundee Royal infirmary. In 1967 he co-authored a paper in the American Heart Journal on the recording of the intracardiac ECG deflection of human atrioventricular conducting tissue, which attracted widespread international attention (‘The intracardiac electrocardiogram of human atrioventricular conducting tissue.’ Am Heart J. 1967 Jul;74[1]:66-70). Later (1967), in a prestigious report on research in biomedical science inspired by President Lyndon Johnson, this article was cited as an important advance in electrocardiography. It led, ultimately, to much better understanding of cardiac arrhythmias and heart block, and, in due course, to therapeutic ablation techniques and improved cardiac pacemakers.

In 1965 Emslie-Smith was seconded to the department of medicine, Mulago Hospital, Kampala, Uganda as a British Council adviser, where he studied the intracardiac ECG in patients with endomyocardial fibrosis. These intracardiac ECGs proved to be essential for the accurate investigation of the haemodynamics of severe endomyocardial fibrosis.

He was co-author of the definitive monograph Accidental hypothermia (Oxford, Blackwell Scientific, 1977) and co-editor of four editions of the Textbook of physiology and biochemistry (Edinburgh, Churchill Livingstone).

Donald was a founder member of the Society for Low Temperature Biology and of the British Hypertension Society, as well as a member of the International Society of Internal Medicine, the Association of Physicians of Great Britain and Ireland, and the British Cardiac Society. From 1986 to 1987 he was president and orator of the Harveian Society of Edinburgh. He was a serving brother of the Order of the Hospital of St John of Jerusalem (1988) and an officer from 1992.

He was a fellow of the Society of Antiquaries of Scotland and a member of the Scottish Society of the History of Medicine and of the Heraldry Society of Scotland. His other interests were wide-ranging, including fly fishing, bird watching, wild flowers (especially Scottish alpines), Greek, Roman (especially Scottish Roman) and Byzantine classics, music and family history.

He will be remembered as a lucid clinical teacher and was unflinching in his tutoring and support for the well-being of junior staff.

Predeceased by his wife Ann Elizabeth née Milne (always known as Judy), he leaves a son Alistair (also a doctor) and daughter Sophie and four grandchildren (Tom, Matthew, Finlay and Sarah).

Derek Maclean

(Volume XII, page web)

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