Obituary: Sir Melville Arnott

MELVILLE ARNOTT contributed greatly to medicine, medical education and medical research in Britain, and to the development of new medical schools in Zimbabwe and Hong Kong.

Born in 1909 a son of the manse, he qualified at Edinburgh University in 1931. He soon distinguished himself by his work on renal disease and hypertension. This work was interrupted by the Second World War. Arnott had joined the Territorial Army as gunner in 1929 and had been slightly upset when forced in 1931 to transfer to the Royal Army Medical Corps. In 1939 he was a captain and was immediately called up and sent to the Far East. He was the last British officer to leave Shanghai, he just escaped internment by the Japanese in Singapore, he was in the Siege of Tobruk, an experience about which he would never talk, and later he was one of the first medical officers to enter Belsen.

He was appointed to the William Withering Chair in Medicine at Birmingham University in 1946. He had a strong belief that the calibre and reputation of a modern medical school was based on the quality of original work and on the contribution to knowledge made by its staff and from small beginnings he built a department with an international reputation which drew young men from all over the world.

When I joined the department in 1951, it was an exhilarating experience. Arnott was hard, demanding and critical of his staff and he insisted that a physician's paramount concern must always be the best interests of the individual patient. He had no time for anyone who watched the clock. He expected a dedication to the needs of the patient that, like death, knew nothing of free time or weekends off. If at times some felt hard done by, they soon realised that the demands made on them were not as severe as those he made on himself.

It was a time when the recently developed cardiac catheterisation allowed precise information of the nature of both congenital heart disease in children and of the cardiac damage in patients with rheumatic fever. We worked closely with the cardiac surgeons, Alphonse D'Abreu and Leon Abrams, and in the course of this work it was a surprise to find that some patients, with such severe rheumatic heart disease that they were unable to increase their cardiac output at all, were still able to undertake some exercise. This was possible only because the blood flow to the non-exercising parts of the body were being diverted to the exercising muscles and these muscles extracted far more oxygen from the blood than had been previously imagined possible.

Later, in studies in 16 volunteers, all of us either doctors or senior nurses (Dr Roger Bannister had wanted to join us but we knew he was soon to be off to Vancouver, where he ran the first mile in under four minutes), it was shown that the same mechanisms are used by healthy people when they take exceptionally severe exercise. Every time I watch marathon runners or Olympic athletes I remember again that work - for without those physiological adaptations they would not be able to achieve what they do.

Arnott's influence on medicine was threefold: local, national and international. In the West Midlands his work in developing teaching and research in the Birmingham Medical School was helped enormously by the then Vice-Chancellor of the University, Sir Robert Aitken.

And in close co-operation with Christie Gordon, the Senior Administrative Medical Officer, Arnott did much to upgrade the standard of medical care in all hospitals of the West Midlands Regional Health Authority. He took an important part in the appointment of physicians and in planning new services for this authority, which was responsible for the hospital services for some 10 million people. With his colleague, George Whitfield, Arnott also gave much support to the West Midlands Physicians' Association.

Nationally he made his influence felt in many ways. At the Medical Research Council, he sat on many committees and working parties and was much concerned with the allocation of research grants. He served on the General Medical Council for 10 years and here his views and experience in medical education were much valued. He gave freely of his time to the Royal College of Physicians in London where he was Senior Censor to the British Heart Foundation and, late in his life, to the establishment of the British Lung Foundation.

Internationally he played a major role in the Nuffield Foundation's Planning Committee (1957-59) that established the new medical school in Salisbury (now Harare) in Southern Rhodesia (now Zimbabwe). It was in recognition of Arnott's contribution that this school started its life under the auspices of Birmingham University, its students qualifying with the Birmingham MB BCh. I and many of my colleagues were initially "internal examiners" for the medical school and had the interesting experience of becoming "external examiners" for the school when Ian Smith had declared the independence of Southern Rhodesia.

In 1972 Arnott and Professor David Greenfield, the Dean of Medicine at Nottingham University, were asked by the Nigerian Government to visit Ibadan University College and they made a comprehensive and useful report on the facilities needed for postgraduate medical education.

In 1975 Arnott was a member of a small Academic Advisory Committee led by Sir William Trethowen, Dean of the Birmingham Medical School, with Greenfield and Dr Gerard Choa, who held in Hong Kong a position similar to that of Christie Gordon in the West Midlands. Their task was to give guidance on the development of the new medical school in the Chinese University of Hong Kong.

In 1971 Arnott resigned from the Chair of Medicine at Birmingham - his place was taken by Professor Raymond Hoffenberg, later the President of the Royal College of Physicians - so that he could help the British Heart Foundation by taking the Headship of the Department of Cardiology that the foundation had created in Birmingham. He held this Chair until he retired from academic life in 1974.

After retirement he found he could not give up clinical medicine and he continued for many years to do locum posts in hospitals in the West Midlands. He worked mainly in geriatric units. Here he developed a special iconoclastic mission to reduce unnecessary medication in the elderly, and to destroy the conviction of patients - and only too often of their doctors - that there is "a pill for every ill".

He had already begun to cut down the locum work he so much enjoyed when in 1990 his wife Dorothy became bed-ridden after a stroke. After that Melville devoted himself to looking after her. But he never lost his great interest in medicine. When he became frail and had difficulty in moving around, he used to spread his medical journals out around his armchair - the New England Journal of Medicine, The Lancet, The British Journal of Cardiology, The British Medical Journal (of which he was increasingly critical - "Too much on all these social problems!") and various journals of pathology. Towards the end of his life, although he welcomed visitors, he tired easily and his characteristic way of hinting that he wanted his visitor to depart was to pick up one of these journals and say "I must finish this interesting article!" It was the time to leave.

Arnott was deeply concerned for the interests of all who worked with him, although this might not be apparent for he had a severe manner. Although always ready to criticise their work, he was too shy to show his staff directly that he approved of them or their work. But outside his unit, when he talked of his staff, he talked in such a way that those who worked in other medical schools envied us. Within the unit there was a tremendous esprit de corps which was not confined to the medical staff. Ward sisters did not leave the unit except for important things like marriage. Secretaries and technicians gave combined years of service that totted up to three score and ten.

He had one major interest outside medicine - railways and model trains. In the middle of a ward round, if a train went past the hospital, he might pause, look out of the window, glance at his watch and mutter "The Newcastle to Penzance is three minutes late again." When I first knew him, he always insisted on getting down to the railway station, if we had to go to London for a meeting, long, long before it was necessary - and then he would look at his watch and find that we had time to drop in at the model shop where they had the Basset-Lowke models that he admired. He shared his interest with his brother-in-law and his son and it must have made him a most acceptable grandfather for his two grandchildren.

He was a great physician. What he did, what he said and what he decided were always for the sake of the discipline of clinical medicine, for the medical school, for the hospital or for patients. That is how he saw his work. That is how he will be remembered.

William Melville Arnott, cardiologist: born Edinburgh 14 January 1909; Assistant Physician, Edinburgh Municipal Hospitals 1934-36; Honorary Assistant Physician, Church of Scotland Deaconess Hospital, Edinburgh 1938-46; Director of Postgraduate Studies, Edinburgh University 1945-46; Honorary Assistant Physician, Edinburgh Royal Infirmary 1946; Consultant Physician, United Birmingham Hospitals 1946-74; William Withering Professor of Medicine, Birmingham University 1946-71 (Emeritus), British Heart Foundation Professor of Cardiology 1971-74; Kt 1971; Honorary Consulting Physician, Queen Elizabeth Hospital, Birmingham 1974-99; married 1938 Dorothy Hill (died 1999; one son); died Birmingham 17 September 1999.