Henry J M BarnettBMJ 2016; 355 doi: http://dx.doi.org/10.1136/bmj.i6293 (Published 22 November 2016) Cite this as: BMJ 2016;355:i6293
In 1983 a young doctor in the UK who was planning to train in neurology picked up a copy of the first ever issue of Neurologic Clinic, which focused on cerebrovascular disease.1 Henry J M Barnett was guest editor of the issue and also wrote the foreword, which had a profound effect not only on the young doctor, but on the entire specialty of neurology.
“It was immediately clear from reading his foreword that Barnett was changing the world of neurology as we knew it,” recalls Alastair Buchan, who was the young doctor in 1983 and is now dean of medicine and professor of stroke medicine at the University of Oxford. “His hypothesis was that stroke is preventable.”
Buchan was so impressed with the foreword that he moved to Canada to train in neurology under Barnett, who was chair of the department of clinical neurological sciences at Western University in London, Ontario.
Buchan told The BMJ that Barnett was “the neurologist who turned stroke from being an ‘act of God’ into something that physicians could prevent.”
Indeed, in 2008 Barnett—after decades of groundbreaking work—travelled to Stockholm to receive the Karolinska Stroke Award for Excellence in Stroke Research, for his contributions to research that “changed the management of millions of stroke patients” and “prevented innumerable attacks.”
Barnett, known as “Barney” or “HJMB” by friends and colleagues, is most widely recognised for his leadership in three groundbreaking research trials. J David Spence, who trained under Barnett and is now director of the stroke prevention and atherosclerosis research centre at Robarts Research Institute at Western University, says that Barnett always recruited “the best collaborators available” and “then set about to conduct extremely exacting and rigorous clinical trials.”
His second key trial studied whether extracranial-intracranial bypass surgery, a common procedure at that time, was effective in stroke prevention. The results, published in 1985, showed that rather than decreasing the risk of stroke, the procedure increased the risk.5
The study became the target of “ferocious attacks by enraged surgeons,” says Spence, prompting Barnett and colleagues to respond two years later. “His masterful response,” Spence says, “explaining the need for clinical trials of surgical procedures should be required reading by all surgeons, interventionalists, and students of epidemiology.”6
Barnett’s third major trial was the two phase North American Symptomatic Carotid Endarterectomy Trial, known as NASCET. The trial looked at whether carotid endarterectomy—a procedure to unblock a clogged carotid artery in the neck—reduced a patient’s risk of stroke. “No one knew who needed surgery and who didn’t,” Barnett later recalled. NASCET provided scientific evidence that showed which patients were most likely to benefit from the procedure.7 8
Canada and the UK
Henry Joseph Macaulay Barnett was born on 10 February 1922 in Newcastle upon Tyne, the son of a clergyman. His family emigrated to Canada when he was 3 years old. He began studying medicine at the University of Toronto in 1939.
After graduating he trained in internal medicine and subsequently at Toronto General Hospital; he completed his training in 1950. He then spent two years on a Nuffield fellowship at the National Hospital for Neurology and Neurosurgery at Queen Square, London, and the University of Oxford. While in England, Barnett struck up a lifelong friendship with fellow neurologist John Walton, who would go on to found Muscular Dystrophy UK and become a crossbench peer.9
Barnett returned to Toronto in 1952 to practise neurology at Toronto General Hospital. In 1966 he moved to Sunnybrook Hospital as chief of neurology. “One of the interesting things about Barney,” says Spence, “was that he really only became a researcher after about 25 years in a very busy clinical practice.”
In 1969 Barnett was appointed chief of the division of neurology at Western University and Victoria Hospital in London, Ontario, where he would spend the rest of his career. In 1974 he was named chair of Western’s department of clinical neurological sciences, and in 1986 he co-founded Western’s Robarts Research Institute, serving as its first scientific director.
Fame, friends, heroes
“Barnett was above all an accomplished and skilled practitioner,” says Buchan, who adds that as a teacher Barnett was inspiring. “HJMB’s mentees have gone on to leadership positions all over the medical world.”
Barnett was editor of the journal Stroke from 1982 to 1986, served as president of the International Stroke Society, and, with Charles Drake,10 was co-author of the authoritative textbook Stroke: Pathophysiology, Diagnosis, and Management. In 1995 he was inducted into the Canadian Medical Hall of Fame.
In 2012 Barnett—frail at 90 years of age and confined to a wheelchair—travelled with his “two sturdy sons” to England to receive an honorary degree from the University of Oxford.11 He later described the event as a “remarkable day,” comparable to no others “in my first 90 years.” At an afternoon garden party, he had the chance to meet up with his old friend and colleague Lord Walton.
“Walton and Barney had promised that the last one standing would deliver the eulogy at the other’s funeral,” says Spence, noting that Walton died in April 2016. “Unfortunately Barney was not well enough to make the trip to the UK for that purpose.”
Barnett’s “three heroes” were Mahatma Gandhi, Martin Luther King Jr, and Nelson Mandela. He was a lifelong naturist and conservationist, his interest being sparked on a Sunday in 1934 when he met ornithologist James L Baillie birdwatching in Ashbridge’s Marsh in Toronto.
Barnett was predeceased by Kathleen, his wife of 60 years. He leaves their two sons and two daughters; grandchildren, and great grandchildren.
Henry J M Barnett (b 1922; q University of Toronto 1944), died peacefully in the company of his family and care givers on 20 October 2016.