Professor Anthony David Milner (1951-1957)
Died on 28th September 2021, aged 83
The following obituary was published by the Royal College of Paediatric and Child Health in November 2021. It is followed by a personal tribute from Tony Randall, who was his contemporary at school. The two tributes give an excellent all-round perspective of a world-leading medic.
Professor Warren Lenney remembers his mentor Professor Anthony David Milner, ‘The father of modern respiratory paediatric research’.
To be well-respected by our colleagues is something to which we all aspire. To be known as a leader in one’s profession is only for the few. To be labelled as ‘The father of modern respiratory paediatric research’ is something else. Over the last 50 years, Tony has had an extraordinary influence on many young doctors, nurses and researchers in the UK and beyond; an influence which will be remembered for many decades. We owe him so much for his leadership and guidance, his friendship and for his enthusiasm in improving the care of children with respiratory disease wherever they live in the world.
Tony was a humble man. He initially planned to read Classics at university. He ultimately decided, however, to progress a career in medicine by attending St John’s College, Cambridge followed by Guys Hospital, London. From 1963 to 1972 he remained in London, primarily at Guys and at Great Ormond Street Hospitals specialising in children’s chest disorders and beginning his extensive research career. He spent six months learning about neonates at the Hammersmith.
In 1972 his friend and colleague from Great Ormond Street Hospital, Professor David Hull invited Tony to join him as Senior Lecturer in the newly developed School of Medicine at Nottingham University. It was there that Tony’s respiratory research took off to great acclaim. There were two main strands, the first was a neonatal theme, establishing the mechanics of how a baby takes its first breath (as before birth the lung is a completely fluid-filled space), developing novel neonatal lung function techniques, improving resuscitation at birth and measuring an infant’s work of breathing. He was the first researcher to show that lung volumes following the first breath were less in babies born by Caesarean section than in those born by spontaneous vaginal delivery. He elegantly demonstrated that during neonatal resuscitation, prolongation of the first inflation to two - three seconds led to volume changes similar to those in babies with spontaneous onset of breathing. His World Health Organisation grant studying the use of simple face mask resuscitation at birth benefitted babies in developing countries struggling to breathe. His measurement of lung function in babies requiring mechanical ventilatory support gained world recognition particularly in relation to high-frequency and patient-triggered ventilation.
The second strand investigated which lung function technique best suited the preschool child with obstructive airway diseases, particularly assessing how young children responded to specific medications in common respiratory disorders. Tony undertook many clinical studies to better understand whether any medicine was useful in the treatment of acute viral bronchiolitis or in acute viral croup. He was a world leader in lung function measurement in children who wheezed in the first 5 years of life. He re-developed the forced oscillation technique in this age group and built his own body plethysmograph to assess young children’s response to bronchodilator medications. His many research workers presented his exciting results at national and European research meetings putting the UK on the world stage as a leader in children’s respiratory research. Tony was rapidly promoted to Reader and then to Professor of Paediatric Respiratory Medicine in 1981. He co-founded the British Paediatric Respiratory Group, the forerunner of the British Paediatric Respiratory Society (BPRS) and was Chair of the BSI committee on incubators and radiant heaters. He was a committee member of the RCPCH and of the research committee of the RCOG as well as a committee member of the Foundation for the Study of Infant Deaths. Tony was Chair of the Specialist Advisory Committee for Paediatrics, was on the editorial committee for many journals including Archives of Disease in Childhood, the European Journal of Paediatrics and Pediatric Pulmonology. He was also an expert referee for the Medical Research Council (MRC) and the Wellcome Foundation. He lectured worldwide with Nottingham becoming the place that many of the world’s leading paediatric respiratory professors visited. This resulted in the setting up of exchange programmes for eager young researchers, particularly with Australia.
In 1990 Tony became Professor of Neonatal Medicine at King’s College London and consultant paediatrician at Guys and St Thomas’ Hospital London (UMDS). It was here he further developed his neonatal research alongside his wife Anne. Their partnership flourished in more ways than one and by the turn of the century his research papers numbered well over 250. He investigated further the mechanisms of the Hering-Breuer Reflex, the effect that smoking tobacco had on the growing lungs of the infant, the sleeping positions of babies, Proportional Assist Ventilation (PAV) and many other aspects of neonatal respiratory care.
It is difficult to count the number of his researchers, many of whom went on to become consultant respiratory paediatricians, professors, paediatricians with an interest in chest diseases or specialist paediatric nurses in their own right. Tony has greatly enriched the pool of experts dedicated to the care of children with chest diseases, more perhaps than almost anyone else in the last half century.
In 2000 he was made Emeritus Professor and Honorary Senior Research Fellow at King’s College London, lecturing worldwide almost up to his untimely death. His many books, book chapters, papers and learned articles are there for posterity to read but his greatest achievement is the memory we all share of him as a kind and delightful person, someone who never lost his temper, was always supportive if anyone needed help or advice, was an excellent teacher and at heart his main wish was to help all children with chest conditions to lead a healthier life. His clinical acumen was astute and invariably accurate from which many of us benefitted when a diagnosis was unclear and a second opinion was required. He will be sorely missed by all who knew or worked with him.
Above all, however, Tony was a family man. He was devoted to his wife Anne. Their daughter Antonia, his children Sharon, David and Katie and all his grandchildren will miss him greatly. Tony died on Tuesday 28 September 2021 after a short illness. Not only have we lost one of the ‘greats’ of children’s respiratory care in the UK, the families have lost a wonderful husband, father and grandfather.
Tony Milner (1951-1957): a personal tribute from Tony Randall
Tony was one of a tiny handful of my oldest and closest friends. Despite my living away from England for over 50 years, combining intermittent telephone calls with occasional visits to London not only kept us in touch, but as is often the way with long distance relationships, absence brought us closer together. Our meeting places in London did not conform to a set pattern; occasionally at his home in South London, not far from King’s College, London and St Thomas’s and Guy’s Hospitals, where he worked. More often, an old London pub - his favourite being the 19th century coaching inn, The George - less than 10 minutes from St Thomas’s and Guy’s Hospital.
Tony, as he was known to his school friends (later in life, Anthony to his wife and close colleagues, and Professor Anthony Milner to the medical world in general) entered the Manor in 1951, the School’s boarding house, long since closed. I started the same year and it wasn’t long before we became firm friends. Tony spent many of his holidays in Egypt, where his father worked as a senior official of the British Foreign Office. This was a period of great upheaval in Egypt; the toppling of King Farouk, the military coups of the army officers Neguib and Nasser, and in 1956 the invasion of the British and French forces and the Suez Canal Crisis. Tony never seemed to talk much about any of these events. Instead he was preoccupied with the School’s least known club, The Manor Rabbit Club, which was so low profile, it didn’t even get a mention in the Taylorian’s list of the School’s societies and clubs, of which there were 15 in total.
The news of Tony’s death in September 2021 was a devastating shock to me, even more to his wife and colleague, Anne, as I had no idea that he was or had been ill. I learnt that he had had a stroke at home, fell unconscious to the floor and never woke up. Tony’s passing has left a huge hole that cannot be filled in the lives of his family, friends, colleagues and the world of paediatricians specialising in respiratory diseases of babies and preschool children, the medical field of which Tony was considered to be the father of modern research.
There were few clues during his time at MTS that Tony’s career on leaving school was going to be anything out of the ordinary. Apart from one event, his progression through the school was unremarkable. He detested the CCF parades, but he was not alone in that, and became a House Prefect, a Monitor and played for the 1956 1st XV Rugby team as a highly effective wing forward (flanker in today’s language).
The one notable event was at the age of 15, he announced to the “powers that be” that he wanted to study medicine at university because he wanted to be a paediatrician, so he needed to stop studying classics and start studying science subjects. At this point, neither the School nor Tony would give way. “Not possible,” Tony was told, “you should have thought of that earlier. It’s too late now; no one has ever done this before”. Tony stuck his feet in and got the support of Teddy Rider, the Manor Housemaster. Eventually, Tony prevailed and started studying science with much younger boys, finally obtaining a place at St John’s College, Cambridge, to study medicine.
After graduating, his first appointment was at the world famous Great Ormond Street Hospital for Children, the largest paediatric centre in the UK, admitting 250,000 patients per year. Tony’s time at Great Ormond Street was the springboard for his career as a specialist in researching respiratory diseases in Neonatal Medicine, new born babies, and in preschool children. His subsequent appointments were at Nottingham University, where he was appointed Professor of Paediatric Medicine and where he co-founded the British Paediatric Respiratory Society. He went on to chair numerous other specialist Paediatrics Committees and lectured worldwide on results of research into respiratory diseases of children. Nottingham became a world centre for knowledge about children’s respiratory diseases and Professors from around the world came to visit Tony in Nottingham.
In 1990, Tony was appointed Professor of Neonatal Medicine at King’s College, London and Consultant Paediatrician at Guy’s and St Thomas’s Hospital. Here he developed his research studies alongside his wife, Anne, also a distinguished specialist in Neonatal Medicine. Together they jointly published many research papers. In 2000,Tony was made Professor Emeritus and Senior Research Fellow at King’s College, London. Ignoring the idea of retirement, he continued to lecture worldwide almost until his death.
These are the facts of a life lived well and lived to the full. But the facts do not convey the essence of Tony Milner. As is often the case of people of real stature who have reached the very top of their chosen profession, Tony was the ultimate in modesty, kindness and simplicity. He had no interest in extravagance and like so many outstanding people, he was humble. He touched the lives of thousands of children, students, medical specialists and more than anybody his wife, Anne, and his children Antonia, Sharon, David and Katie and his grandchildren. Not only was a wonderful researcher, teacher and mentor, he was a terrific family man, a loving husband, father and grandfather. An old Italian saying ‘Ricorda sola I giorni felici’ has over the centuries given comfort to those who have lost loved ones. The English translation is ‘Remember only the happy days’. Let us hope these words will also bring comfort to those who loved Anthony and all those who were touched by him.
Tony Randall (1951-1957)