Testimonial by Professor Christopher Mathias
Emeritus Professor of Neurovascular Medicine, Queen Square Institute of Neurology, University College London
I wish to focus on some of Sir Roger Bannister's many major contributions to the clinical science of the autonomic nervous system. He chose a complex system, the involuntary/automated part of the nervous system that innervates every organ in the body. It controls integrative systems essential for our survival such as blood pressure, heart rate and body temperature. He was one of the pioneers in clinical autonomic medicine.
After his consultant appointments in London at St Mary's and Queen Square he studied orthostatic (postural) hypotension in patients with autonomic failure, rarely diagnosed before the 60s. This is when blood pressure falls on standing, often far below 120/80, because the autonomic nerves fail to constrict blood vessels in response to gravity. Human evolution from quadrupeds to bipeds is disadvantageous when this occurs, with diminished oxygen and nutrients to organs above the heart, such as the brain. This can cause fainting and, in some, serious injury. He studied the mechanisms responsible and treatments to reverse it. He followed this with neuropathological studies in Oxford, documenting cell loss in autonomic areas in the brain and spinal cord. This research, with key publications between 1967 and 1972, was crucial in understanding the different forms of autonomic failure, such as multiple system atrophy.
Sir Roger and I'm first met for a short period in 1976 when he was the external examiner for my DPhil thesis. I then was unaware of the severity of his car accident in 1975. This clearly did not deter him, and he pursued autonomic research with even greater vigour, at Queen Square where he started the Autonomic Investigation Unit, and in the Medical Unit at St Mary's which I joined in 1979. I was fortunate to begin working alongside him from 1981, in what was to be a lifelong collaboration. The two Units became national referral centres for autonomic disorders, with referrals from the UK and abroad. They advanced the recognition, diagnosis and treatment of common autonomic conditions, and also rare disorders such as with enzyme deficiencies that cause a low noradrenaline level and severe orthostatic hypotension. This resulted in successful use of a novel drug to replace this key autonomic neuro-transmitter. He was most interested in the postural tachycardia syndrome (PoTS), a new millennium autonomic disorder, and its link with the joint hypermobile form of Ehlers-Danlos syndrome. He undoubtedly would have contributed to autonomic implications in Long COVID-19.
Sir Roger led the autonomic field nationally and internationally. In 1983 he edited Autonomic Failure, a textbook with 29 chapters and 31 authors, and in the further volumes that we co-edited this rose to 72 chapters and 112 authors, as in the 5th edition in 2013. It is used worldwide. The autonomic field, as we reflected, had grown substantially over the previous three decades, almost exponentially. As Chairman of the Editorial Board he strongly supported my founding and editing Clinical Autonomic research in 1991, the first and now leading journal in our field. He was a Founder Trustee of the Autonomic Charitable Trust. In 2019 the Royal Society of Medicine instituted an annual Memorial Lecture in recognition of his numerous autonomic and neurological achievements.
I've only touched on a few of Sir Roger’s multiple accomplishments in the autonomic field. He was instrumental in the development of clinical autonomic medicine that will continue to benefit many, and which now is an established speciality.
Testimonial by D J Thomas
Professor Emeritus of Clinical Neuroscience, Imperial College London
Sir Roger Bannister was one of the outstanding British neurologists of the 20th century. In his autobiography, ‘Twin Tracks’, he surprised some people, who didn't know him, that although athletics had made him famous, medicine in general, and neurology in particular, were more important to him. In his early medical years he had to work especially hard to convince the medical establishment that he was a talented physician and not just an athlete. This extra effort and commitment may have helped him make the neurological star he turned out to be.
I really appreciated being his close neurological colleague St Mary’s, benefitting from his advice and support, and witnessing his diagnostic, patient management, and teaching skills, first hand. His neurological textbook became the ‘bible’ for junior doctors working for higher qualifications. He attracted the best young doctors to work and train with us, many going on to have great careers.
To be a fully rounded physician, in addition to being a superb generalist, one needs a special interest. With his strong background in physiology, he was attracted by those patients, then poorly understood, who had failure of the autonomic nervous system: the system controlling our internal organs, performing vital functions that we don't need to think about, like keeping blood flowing to the brain when we stand up!
Autonomic patients are a real challenge. They have multiple problems that can be difficult to treat to, requiring clinical and pharmacological skills, compassion and dedication, often for years. His patients adored him and soon he was attracting referrals from all over the country. But Sir Roger’s reputation was not just national. It was international. For example, in 2005 the American Academy of Neurology made Roger their first ever recipient of their ‘Lifetime Achievement’ award.
Sadly, memories of one’s clinical skills may not be long lasting. What may persist are our contributions to medical science. When negotiating his move to become Master of Pembroke College, Oxford, Roger insisted on being able to continue his autonomic work. It was so important to him. The college wisely agreed to this.
It is truly remarkable that he was able to contribute so much to our understanding of failures of the autonomic nervous system and how to attempt to treat them. It is for this work that the medical community and of course, our patients, should be grateful. He should be long remembered and we all agree that his memorial here is eminently appropriate.