Professor Anthony David Milner obituary

Professor Warren Lenney remembers his mentor Professor Anthony David Milner, ‘The father of modern respiratory paediatric research’.
 Professor Anthony David Milner
Professor Anthony David Milner

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 Kings 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.