C Miller Fisher, MD, Leading Stroke Neurologist, Dies at 98
C. Miller Fisher, MD, a giant in the field of stroke neurology, died on April 14 in Albany, NY, at the age of 98. A professor emeritus of neurology at Harvard Medical School, Dr. Fisher worked at the Massachusetts General Hospital (MGH) for more than 50 years — though officially retiring in 1983, he continued to go on rounds residents into his 90s.
He was the most meticulous observer of human behavior I had ever met, Lee Schwamm, MD, professor of neurology at Harvard Medical School, and vice chairman of neurology at the MGH, told Neurology Today. He had “an extraordinary capacity to deduce, from those observations, general principles of the human nervous system and its blood supply.”
Louis R. Caplan, MD, senior neurologist at Beth Israel Deaconess Medical Center, and Dr. Fisher's last fellow at MGH, recalled the extensive manila folders Dr. Fisher kept in his office, detailing any behaviors or symptoms he found odd or unexplained. “After a long time — maybe years — something would come up which would inform him of what those patients may have had, and he would go back and try to make some sense of the collection or symptom.”
Despite his legendary accomplishments in the field of vascular neurology, and his towering physical presence, Dr. Fisher was the kindest and gentlest physician when interacting with patients, said Dr. Schwamm.
“It was common to see him spend several minutes replacing the socks of a patient whose feet he had examined. He practiced truly patient-centered care, frequently spending an entire night at the bedside of a patient having a stroke, trying to deduce how he might intervene to rescue that patient from the brink of permanent disability,” he added.
Dr. Fisher was a remarkable individual, Dr. Caplan said, but really impractical: “He wouldn't pay any attention to time. If he had a patient and there was something happening there, he would just stay there and follow it. The secretary might call and say, 'Dr. Fisher, there are seven patients in the office,' and he'd say, ‘No, no, history is here.’” But his patients all knew that; he would spend as much time as needed with each of them, and they wouldn't mind waiting. The lesser known fact is that Dr. Fisher really thought of himself first and foremost as a doctor, rather than a scientist, Dr. Caplan told Neurology Today.
When Dr. Caplan first arrived at MGH for his fellowship, salary had not been previously discussed. Dr. Fisher handed him a long form to fill out and send to NIH. “I have to fill one out, too,” Dr. Fisher said. “This was in 1969 before the computer. So I stayed up all night handwriting it, and brought it in the next day,” Dr. Caplan said. But when Dr. Fisher pulled out his own copy, it was blank. On the top, he then wrote: “I guarantee his time will be well spent” with his signature. In a week we heard that we got the money, Dr. Caplan remembered.
Dr. Fisher taught and led by example, and also by the Socratic method, Dr. Schwamm said. “He communicated as much by what he did not say as what he did. He had infinite patience to nurture the curious mind.” Over the years, Dr. Schwamm spent countless hours in “Fisher Rounds” and later sought his mentor's advice about difficult cases or controversial topics in Dr. Fisher's 9th floor office, and then over the phone after his retirement.
Born in Waterloo, Ontario, Dr. Fisher graduated from the University of Toronto Medical School in 1938. During World War II, he served as a Surgical Lieutenant Commander on board a British Naval ship that was sunk by the Germans in 1941. He was found by enemy soldiers after surviving nine hours in the water, and spent the next three years as a prisoner of war in a German camp.
Dr. Fisher safely returned home in 1944, and completed his neurology training at the Montreal Neurologic Institute. His colleague at the time, Roy Swank, MD, PhD, in a step that proved to be life-changing, arranged for Dr. Fisher to enroll in a year on the Neurology Service of the Boston City Hospital under the direction of Raymond D. Adams, MD, studying acute hypertensive encephalopathy.
In 1954, Harvard University invited Dr. Fisher to start the first stroke service at Massachusetts General Hospital, under the direction of Dr. Adams. Thus would begin Dr. Fisher's career in stroke neurology — he went on to make discoveries in the field of aspirin and anticoagulant use for the prevention of stroke, introduced the term TIA, as well as other terms (“one-and-a-half syndrome,” “string sign,” “lipohyalinosis,” “ocular bobbing,” and “wrong way eyes”).
In 2011, Dr. Schwamm was honored as the first recipient of the C. Miller Fisher Chair in Neurology at MGH. Dr. Fisher's spirit still lives on in the MGH Stroke Service, where every year residents and fellows are trained in the grand tradition he started, Dr. Schwamm said.
Dr. Fisher is survived by three children, Elizabeth, Peter and Hugh; and four grandchildren, Ben, Alex, Hugh and Taylor. Contributions in his memory can be made to the Massachusetts General Hospital for stroke research and clinical activities.
The MGH Neurology Service will be organizing a memorial service in the fall for Dr. Fisher, and invites Neurology Today readers to share memories, old photos or other remembrances as part of that effort. Please send any material by email to [email protected] or by regular mail to Lee H. Schwamm, MD, Department of Neurology-ACC 720, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114.