Few did more to help doctors recognise and treat severe lung disease than the American clinical researcher John F Murray, who has died, aged 92, of respiratory complications arising from Covid-19. For much of his career Murray provided international leadership in efforts to contain the scourge of tuberculosis, the leading cause of death from infection globally, at 1.5 million people every year.
One of Murray’s major research contributions was to expand the definition of acute respiratory distress syndrome (ARDS), the condition that eventually killed him, to include a wider range of signs and symptoms.
Using the battery of diagnostic tests he proposed, doctors are able to work out how severely a patient’s lungs are affected. The group of tests gives a “Murray score”, which helps the doctor to decide whether the patient can cope with conventional ventilation (via a tube inserted into their windpipe), or needs to have their blood oxygenated artificially outside the body (extracorporeal membrane oxygenation). This research is highly relevant to the current situation, with the massively increased demand for ventilation in Covid-19 patients.
Murray never went into private practice. For most of his career as a clinician, he chose to work at the San Francisco general hospital, a public hospital that treated people from the poorest and most deprived neighbourhoods in the city, where he was chief of the pulmonary division from 1966 to 1989 and set up the first intensive care unit.
The hospital has an excellent TB clinic, and although Murray himself was not a TB specialist, many of those that he trained have gone on to be leading figures in the fight against the disease.
During the early 1980s, the hospital saw many of the first cases of Aids, and in response Murray convened the first of several workshops, under the auspices of the US National Heart, Lung and Blood Institute, to develop an understanding of how Aids affects the lungs. He also warned that HIV was leading to an increase in cases of TB. “The major place of tuberculosis should not be forgotten – as it is,” he told the Union World Conference on Lung Health in 1990, “and TB should be considered when allocating health care resources – as it isn’t.”
Murray was instrumental in establishing respiratory medicine as a discipline separate from cardiovascular medicine, helping to raise the profile of the lungs in a world where heart and brain steal most of the limelight. On the international stage, he was involved for more than 40 years in the work of the International Union Against Tuberculosis and Lung Disease (the Union), based in Paris. As its secretary general, he extended the scope of the organisation to diseases other than TB, and made its membership much less exclusive. In his clinical practice he had always made a point of including nurses and other health professionals, patients and their relatives in discussions about the best approach in any individual case.
Born in Mineola, a village on Long Island in New York state, John was the son of Frederick “Feg” Murray, the cartoonist and former Olympic hurdler, and his wife, Dorothy (nee Hanna). The family moved early in John’s childhood to Los Angeles, where they lived in some style thanks to the success of Feg’s nationally syndicated comic strips.
John attended Los Angeles high school and after a period of wartime national service in the US navy as a radar engineer entered Stanford University, where he graduated in medicine in 1953. He completed his training in San Francisco, New York and London, before embarking on his long career as a senior clinician at San Francisco general hospital and professor at the University of California, San Francisco (UCSF).
Paula Fujiwara, who trained under him as a junior doctor in intensive care and later became his colleague in the Union, vividly remembers the experience of presenting cases to him, an immensely tall and hawk-like figure in a bow tie, and the fountain of expertise he would produce in response. While most clinical professors might prefer to teach young doctors at the end of their first clinical year, Murray always opted to take the first month, July, with newly graduated medical students who had no idea what they were doing.
Committed as much to communication as to research, in 1976 Murray published The Normal Lung, a detailed account of lung development and function from birth to death. He went on to co-edit (with a fellow UCSF chest specialist, Jay Nadel) the classic two-volume textbook Murray and Nadel’s Textbook of Respiratory Medicine, first published in 1988 and currently in its sixth edition. He was working on a seventh when he died. Anticipating the current trend for memoirs from the medical front line, he also published Intensive Care: A Doctor’s Journal in 2000.
His first marriage, to Sarah Sherman, ended in divorce in 1966. Three years later Murray married the novelist and screenwriter Diane Johnson. He moved as easily in literary circles as medical ones. A workaholic, in his rare off-duty moments Murray enjoyed fly-fishing. Since he retired from San Francisco general in 1994, he and Diane had lived for much of each year in Paris, where he retained a small office in the headquarters of the Union to work on his books and journal editing.
Diane survives him, as do his children, Douglas and Elizabeth, from his first marriage, and his stepchildren, Kevin, Simon, Darcy and Amanda, and 14 grandchildren. His eldest son, James, predeceased him.
• John Frederick Murray, consultant in respiratory medicine, born 8 June 1927; died 24 March 2020
