BA Cantab(1930) MRCS LRCP(1933) MB BChir(1936) MA(1937) MRCP(1937) MD(1946)FRCP(1954)FRCPath(1963)
03 October 1906 – 09 February 1989
Michael Darmady trained in pathology after his house appointments and spent most of his career as director of the pathology service of a large National Health Service district. To describe him only as a pathologist would, however, give a quite inadequate picture of this remarkably versatile and inventive man. His contributions included the construction and first clinical use of an artifical kidney machine in the United Kingdom, the introduction of central sterile supply services for hospital equipment and dressings, and the application to renal histopathology of the techniques of microdissection and single nephron autoradiotherapy.
He studied at Emmanuel College, Cambridge, and St Bartholomew’s Hospital, London, where he went on to become house physician to Lord Horder [Munk’s Roll, Vol.V, p.198] and then demonstrator in pathology to professors Kettle [Munk’s Roll, Vol.V, p.229], Hadfield [Munk’s Roll, Vol.VI, p.214] and Garrod [Munk’s Roll, Vol.VII, p.203]. After a period as assistant pathologist to the Salisbury Royal Infirmary and the Wiltshire County, he volunteered for the RAF in 1940. His wartime experiences stimulated his interest in two subjects on which he was to make a great impact, namely renal pathology and the prevention of hospital infection. He was given responsibility for the care of RAF personnel who had contracted hepatitis, including many whose disease followed inoculation or transfusion. His clinical observations and subsequent laboratory studies helped establish the role of needles and syringes in transmitting hepatitis and showed that if they were sterilized by dry heat the reponsible agent could be destroyed. It was this, together with an increasing awareness of other serious hospital infections, which led later to his introduction of a central sterile supply service for the Portsmouth and Isle of Wight district where he became senior pathologist. The service was adopted by the Department of Health as a model and laid the foundations of the sterile supplies industry.
Darmady’s interest in the kidney also grew from his RAF experiences. His observations on renal failure in injured airmen led him to question the current belief that myohaemoglobin (crush syndrome) was principally responsible. He undertook experiments in rabbits that demonstrated the crucial role of renal ischaemia, and they were the subject of his MD thesis in 1946 and of several papers. The first of these papers, in 1944, led a doctor at the Swedish Embassy to draw Darmady’s attention to Kolffs design of an artifical kidney in occupied Holland. Darmady was able to obtain a Medical Research Council grant to build a modified version of Kolffs machine in a garage at Salisbury, using spare parts from his RAF base at Wroughton and cellophane tubing manufactured as substitute sausage skin. He towed this on a trailer to various hospitals in the years immediately after the war and treated 19 civilian cases of renal failure: two survived, and in some others death appeared to be delayed. But the evidence was inconclusive and the beneficial effect of dietary and fluid restriction, which Darmady also helped to promote, led to the shelving of further work on the artifical kidney – which was not to become established in routine treatment for a decade. He was, nevertheless, able to draw attention to its potential in his 1948 Arris and Gale lecture to the Royal College of Surgeons, and in a paper published in the Proceedings of the Royal Society of Medicine.
The artificial kidney was not the only item of pioneering ‘do-it-yourself equipment that stands to his credit. Realizing that more information about blood chemistry, especially the serum potassium concentration, was vital in managing renal failure, he obtained plans for the first flame photometer used at the Mayo Clinic in the USA in 1949 and had one built by a local engineering firm. It was used in his Portsmouth laboratory until commercial models became available some years later. He also designed and built a bed-weighing machine, which provided clinicians treating renal failure with another source of vital information that had hitherto been lacking.
The contribution to nephrology which established Darmady’s international reputation was his use of the technique of renal microdissection, perfected in the USA by the physiologist Jean Oliver, to study disease. Early dissections of kidneys with congenital tubular defects, supplied to him by Charles Dent of University College Hospital [Munk’s Roll, Vol.VII, 148], attracted particular interest, but his later studies of the ageing kidney may prove to be of even greater significance. He was also one of the first to recognize the potential of the electron microscope in renal histopathology and a pioneer of the use of autoradiography to determine the localization of drugs and hormones in the kidney. More than 40 scientific papers and a textbook, Renal Pathology, London, Butterworth, 1980, written with Angus G Maclver, summarize his work in this field.
During his career, Darmady saw pathology change from a service often provided by isolated morbid anatomists with little training in biochemistry, microbiology or haematology, to a discipline employing specialist consultants in each of these fields, backed by equally specialized technicians. He was in the forefront of this change and was highly successful in creating in Portsmouth a unified division of pathology serving a population of over half a million.
His expertise in the organization and design of hospital laboratories was soon to be employed not only in this country but also in Trinidad, Kuwait, Saudi Arabia, Iran and Pakistan. He became increasingly involved in medical politics, chairing committees at local and national level and serving first as councillor and then president of the Association of Clinical Pathologists. He was also one of the founding fathers of the Royal College of Pathologists, of the Wessex region of the National Health Service (which had previously been part of the South West Metropolitan region) and of the Southampton University Medical School. The school later acknowledged his achievements by appointing him to a personal chair in clinical pathology and naming a student prize after him.
Doctors who shoulder the burdens of planning and organization often become unpopular but Michael Darmady was held in affection and respect by almost all his colleagues, of whatever rank, for whom he worked so hard and so effectively. He was a kind and gentle man who loved to be with people and shared their concerns. He was also a happy man, devoted to his wife Mary and their three children, a son and two daughters. One daughter became a consultant paediatrician in the Wessex region her father helped to create.
[Brit.med.J., 1989,299,1095; The Lancet, 1989,2,1111; Times, 28 Sept 1989; The Independent, 26 Sept 1989; The Daily Telegraph, 15 Sept 1989; Bulletin RCPaths.,70, April 1990;Photo]
Courtesy of Royal College of Physicians London, Munk’s Roll, Volume IX, page 114