Sir William Liley

KCMG, DSc Vict PhD ANU MBChB BMedSc Otago

Dip Obs FRSNZ FACOG FRCOG

1929 – 1983


Albert William Liley was generally known as Bill and very much wished to be known by his second name in either the full or abbreviated form. He was born in Auckland on 12 March 1929. He was educated at Royal Oak Primary School and Auckland Grammar School before undertaking the first year of his medical course (medical intermediate) at the University of Auckland. He was awarded a University National Scholarship in 1947. From his primary school days onwards his intellectual capacity had been obvious and he distinguished himself in his years at Auckland University and at Otago. He was gold medallist in anatomy in 1950, obtained a Senior Scholarship in medicine and was awarded the Travelling Scholarship in medicine in 1954. He declined to take up that scholarship. Instead he proceeded to the Australian National University at Canberra. At school and during his undergraduate years at medical school, he participated fully in student life, playing rugby and becoming an Otago Blue in fencing. Together with many of that generation he was inspired to enter a career in medical science through the opportunity to undertake a Bachelor of Medical Science under then Professor, later Sir John, Carew Eccles. Together with Ken North, he undertook some pioneering work in neurophysiology and he maintained strong contact with Eccles and the Department of Physiology whilst completing his MBChB degrees.

He undertook the final year of his medical course in Auckland and came under the influence of Professor Harvey Carey who recognised Bill Liley for his intellectual qualities, his capacity for lateral thinking, enthusiam and depth of compassion.

Bill Liley took up a research scholarship in physiology at the Australian National University and worked on various aspects of synaptic transmission. During this period he published four papers in the Journal of Physiology, an outstanding achievement for a recently qualified medical graduate from New Zealand. These were single-author papers, a tribute to Liley and to Eccles and the environment he had created in Canberra.

A considerable tug-of-war ensued between the unit in the John Curtin School at Canberra and Carey’s group in the National Women’s Hospital in Auckland. Auckland won out and Bill Liley returned to Auckland as a Sandoz Research Fellow. He held that position in obstetrics until the end of 1958 when he was awarded a Medical Research Council of New Zealand Research Fellowship in obstetrics. Upon returning to New Zealand he undertook the "seventh year" of his original medical course and thus became a registered medical practitioner for the first time!

From 1958 until the time of his premature death in 1983, he held a series of appointments within the Medical Research Council of New Zealand and the University of Auckland. In 1968 he was appointed to a Personal Chair in Perinatal Physiology at the Postgraduate School of Obstetrics and Gynaecology in the University of Auckland.

In 1965 he took his only extended period of overseas leave when he accepted a position at the Columbia University College of Physicians and Surgeons in New York during the tenure of a US Public Health Service international post-doctoral research fellowship. In 1967 he was awarded CMG and in 1973 was made KCMG.

His bibliography reflects the evolution of his ideas and his major contributions to international medical science generally and to obstetrics in particular. He maintained wide connections within the medical scientific community internationally. In comparison with many colleagues of lesser stature, he was not a prolific publisher and many of his contributions to clinical science and clinical investigation are buried in the publications of others. That was the way he wanted it. Together with Professor G H Green and Professor Graham (Mont), now Sir Graham Liggins, he was one of a powerful triumvirate which built enormously on the foundations prepared by Professor Carey, and continue into the new National Women’s Hospital on the Claude Road site in Greenlane.

Throughout his career Bill Liley asked practical questions concerning the plight of those who were disadvantaged in a medical sense. His experiences as a final year medical student working under Professor Carey influenced him greatly. He was particularly attracted to the problems of unborn and newly born children. Although he did not follow a classical career as a newly qualified doctor, he remained a dedicated and compassionate medical professional. He also recognised the need in all forms of science to select and concentrate his energy on one major issue. He chose what was then (and still is) known as Rh haemolytic disease of the newborn. His approach to the problem typified his ability to stand back at each stage, review scientific progress and assess what issues remained and to put them into perspective. He was a meticulous clinical investigator checking each step carefully as he went. Equally, he had an hypothesis clearly in mind which he was testing at each stage. The problem of Rh haemolytic disease was a major issue in obstetrics, partly because some basic knowledge had been developed in the 1940s and early 50s. At the time he entered the field, perinatal mortality was about 25%, quite clearly an unacceptable situation.

Liley extended spectrophotometry of amniotic fluid to a much wider range of potentially affected pregnancies, thus establishing a sound epidemiological base which he could relate to the erection of hypotheses aimed at improving diagnosis and management. He believed this was one of his main contributions to obstetrics and he certainly rapidly gained an international reputation for this work. In particular, because of his work, it was now possible to identify which baby could be retained safely in utero for a normal gestation period and which should be delivered. This diagnostic precision resulted in a fall of perinatal mortality from haemolytic disease to 8% at the National Women’s Hospital. However, it was clearly not possible on that basis alone to further reduce the mortality.

As in many areas of science, major advance results from what is loosely termed serendipity. However, it is not luck which determines these major advances, but rather the presence of a disciplined prepared mind which can capitalise upon an observation, the significance of which would be ignored by others. During one amniocentesis, Liley "accidentally needled the distended fetal abdomen. Instead of getting deep yellow, cloudy, amniotic fluid I got brilliant, golden, clear fluid which was obviously ascitic fluid; this windfall was easily confirmed by injection of contrast medium. .............it occurred to me that if we could needle the fetal peritoneum without even trying then we could perhaps do it deliberately and put it to some good use". (Liley, A, 1965, Paediatrics, Vol. 35: 836-846). The second element in what the world came to regard as his major contribution, occurred when "a young English lady, aged 22, a geneticist who had been working in Nigeria on her favourite topic of sickle cell disease, visited Auckland................with her she had some beautiful blood slides from neonates and infants homozygous HbS, who had been given normal cells intraperitoneally. There were floods of normal cells in their peripheral blood, and this was good enough evidence for us that cells could be taken up from the peritoneum in massive quantity and at a relatively rapid rate". (Liley, A, 1965, Paediatrics, Vol. 35: 836-846). The rest is history.

Liley’s clinical investigation extended well beyond the issues raised by Rh haemolytic disease. He thought hard and worked hard on the very important problems of what was formerly called toxaemia of pregancy, with its frequent tragic outcomes. His sound background in physiology served him well as he explored the relationships between blood volume, weight gain and rising blood pressure in pregnant women. His reading covered an enormous range, he consulted widely and spent much time thinking, in his attempts to produce an embracing hypothesis which could solve these problems, which are still not covered even today, by a unifying hypothesis.

His work with the fetus and with families strengthened the vigour of his advocacy for the unborn child. Although brought up in a Methodist/Anglican tradition, he held no specific religious beliefs. His strong commitment to the unborn child led to close contacts, particularly with the Catholic Church and, as a non-Catholic, he was made a member of the Pontifical Academy of Sciences. His funeral service was conducted jointly by the Catholic and Anglican Bishops of Auckland.

He served the community in many ways. He was the University of Auckland representative on the Auckland Grammar School Board of Governors from 1969 until his death. He was a frequent contributor to public occasions and a major ambassador for science generally and medical science in particular. He was in steady demand for presentations overseas.

He was elected a Fellow of the Royal Society of New Zealand in 1965 and was a Fellows’ Councillor in 1971 and between 1973 and 1978. He was a member of the WHO Expert Advisory Panel on maternal and child health from 1968 until his death.

He became an Honorary Fellow of the American College of Obstetricians and Gynaecologists in 1975 (elected), he was a member of the Medical Research Council of New Zealand between 1972 and 1978 and Chairman of the South Pacific Committee between 1973 and 1978. In 1980 he was appointed a member of the International Association for Advice and Research on Mental Deficiency and was Chairman of the Scientific Council of that association from 1980 until his death. He was elected Honorary Foreign Fellow of the Chicago Gynaecological Society in 1965 and of the New Jersey Obstetrical Society in 1966. In 1972 he was elected to Honorary Life Membership of the Paediatric Society of New Zealand and in 1977 elected to Honorary Membership of the Neonatal Society of the United Kingdom.

Bill Liley lived life to the full. He married Helen Margaret Hunt in 1953. She became an antenatal care physician at National Women’s Hospital. They had two sons and three daughters and an adopted daughter. Professor G H Green referred to the adoption in an obituary published in the New Zealand Medical Journal August 10 1983, pp 631-632, "a little known response to the criticism often heaped on him for his uncompromising pro-life attitudes was his and the family’s adoption of a daughter with Down’s Syndrome who might in different circumstances never have achieved birth, but who in the Liley environment developed a wonderful vocabulary".

Sir William was devoted to his children and was ahead of his time as a health professional and scientist in ensuring that he shared adequate time with them, as their attentive father and guide. He shared baby and child sitting duties to enable Margaret to develop her career. He enjoyed manual skills and made toys and furniture for his children.

Together with colleagues and friends within and outside medicine, Bill and Margaret Liley spent much time farming an 88 hectare property near Bennydale in the King Country. Here also the children and their involvement was a primary commitment. Children from other families shared in this unique experience.

As with all other activities, Bill Liley made a careful study of silviculture and he took much pleasure in mastering the various manual techniques. He was a prime mover in new directions for forestry development. His enthusiasm and eagerness to share ideas excited many New Zealand farmers and people with small land holdings. These interests inspired the future national and international career of Bill Liley Jnr. Sir William Liley embodied many characteristics which have typified the leaders and giants of scientific endeavour in New Zealand. He combined top-flight intellectual ability with practical skills, humanity and humility. His accomplishments indicated to his generation and those coming after that achievement on a world scale was very much within the grasp of dedicated scientists who chose to return to or remain in New Zealand.

From early on, Bill Liley’s view on life caused him to take counsel mainly from himself. While deeply immersed in his family, he did not seek, and rarely accepted, guidance from others in relation to many aspects of his life. This was a strength but also, in the Shakespearean sense, had within it the seeds of tragedy.

Sir John Scott

Bibliography

Liley A.W. and North K.A.K. (1952) Post-tetanic potentiation at the neuromuscular junction. Proc. Univ. Otago Med. School, 30, 6-7.

Liley A.W. and North K.A.K. (1953) An electrical investigation of effects of repetitive stimulation on mammalian neuromuscular junction. J. Physiol. 16, 509-527.

Liley A.W. (1956) An investigation of spontaneous activity at the neuromuscular junction of the rat. J. Physiol.(Lond.) 132, 650-666.

Liley A.W. (1956) The quantal components of the mammalian endplate potential. J. Physiol. (Lond.) 133, 571-587.

Liley A.W. (1957) The effects of presynaptic polarisation on the spontaneous activity at the mammalian neuromuscular junction. J. Physiol. (Lond.) 134, 427-443.

Liley A.W. (1957) ?Spontaneous release of transmitter substance in multiquantal units. J. Physiol. (Lond.) 136, 595-605.

Carey H.M. and Liley A.W. (1959) The assessment of the risk of intrauterine death in pre-eclampsia. New Zealand Med. J. 58, 450-460.

Carey H.M. and Liley A.W. (1959) The optimal time for induction in pre-eclampsia. New Zealand Med. J. 58, 460-466.

Eccles J.C. and Liley A.W. (1959) Factors controlling the liberation of acetylcholine at the neuromuscular junction. Amer. J. Phys. Med. 38, 96-103.

Liley A.W. (1960) The technique and complications of amniocentesis. New Zealand Med. J. 59, 581-586.

Liley A.W. (1961) ?Liquor amnii analysis in the management of the Pregnancy complicated by Rhesus sensitisation. Am. J. Obstet & Gynec. 82, 1359 - 1370.

Liley A.W. (1963) Errors in the assessment of haemolytic disease from amniotic fluid. Am. J. Obstet. & Gynec. 86, 485 - 494.

Liley A.W. (1963) Amniotic fluid. In: Modern Trends in Human Reproductive Physiology. H.M Carey (ed). Butterworths, London. Pp 227-244.

Liley A.W. (1963) Intrauterine transfusion of foetus in haemolytic disease. B.M.J, ii, 1107 - 1109.

Liley A.W. (1964) Amniocentesis and amniography in haemolytic disease. In: Year Book of Obstetrics & Gynecology, 1964-65. J.P. Greenhill (ed). Pp. 256-263.

Liley A.W. (1964) The technique of foetal transfusion in the treatment of severe haemolytic ?Disease. Aust. & N.Z. Obstet. & Gynaec. 4, 145-148.

Liley A.W. (1965) Amniocentesis. New Eng. J. Med. 272, 731.

Green G.H., Liggins G.C. and Liley A.W. The place of foetal transfusion in haemolytic disease. Aust. & N.Z. Obstet. & Gynaec. 4, 53-59.

Liley A.W. (1965) Physiological observations in foetal transfusion. In: Studies in Physiology. D.R. Curtis and A.K. MacIntyre (eds). Springer-Verlag, Berlin. Pp. 165-169.

Liley A.W. (1965) Foetal transfusion. Proc. Xth Congr. Int. Soc. Blood Transf., Stockholm.
Pp. 929-932.

Liley A.W. (1965) The use of amniocentesis and fetal transfusion in erythroblastosis fetalis. Pediatrics. 35, 836-847.

Liley A.W. (1965) Spectrophotometry aids ‘Rh baby’ therapy. The Analyzer (Beckman) July 1965.

Liley A.W. (1965) What the Rh factor is and what can be done about it. Redbook Magazine, U.S.A. November 1965. (A.C.O.G.)

Liley A.W. (1966) Intrauterine transfusion. Jewish Memorial Hospital Bulletin 10, 70-76.

Liley A.W. (1966) Foetal transfusion in haemolytic disease. Bibl. Gynaec. Fasc. 38, 146-157.

Liley A.W. (1967) Diagnosis and treatment of erythroblastosis in the fetus. In: Advance in Pediatrics. Levine S.Z. (ed). Vol. XV, Year Book Medical Publishers, Inc., Chicago.
Pp. 29-63.

Liley A.W. (1967) Amniotic fluid pigmentation and haemolytic disease. Proc. XIth Congr. Int. Soc. Blood Transf., Sydney. Bibl. haemat. No. 29, Part 1, 237-340.

Liley A.W. (1967) Physiological problems in foetal transfusion. Proc. 2a Reunion Asociacion Latinoamericana de Investigaciones en Reproduccion Humana, Santiago de Chile, 1966. Pp. 151-152.

Liley A.W. (1968) The beginning of communication - the unborn child. N.Z. Speech Therapists’ Journal (1967) 22, No. 2. 13.

Liley A.W. (1968) The diagnosis of foetal condition in the isoimmunised pregnancy. Proceedings of the XII International Congress of Pediatrics. Mexico-City. 1. Pp. 245-253.

Liley A.W. (1969) Prenatal Treatment of Haemolytic Disease. Sociomedical Aspects. Fondazione Carlo Erba, Milano.

Liley A.W. (1970) Intrauterine Transfusion. Chapter in ‘The Rh Problem’. J.G. Robertson and F. Dambrosio (eds). Ann. Ostet. Ginec. Milano. Pp. 130-133.

Kinnock S. and Liley A.W. (1970) The epidemiology of severe haemolytic disease of the newborn. N.Z. med. J. 17, 76-84.

Liley A.W. (1970) ‘Gaining on the Rh Problem’. Medical World News Symposium ‘Obstetrics & Gynecology 1970’ J.T. Queenan (ed). McGraw Hill, New York.

Liley A.W. (1970) The clinical and laboratory significance of variations in maternal plasma volume in pregnancy. Int. J. Gynaec. Obstet. 8, 358-362.

Liley A.W. (1970) A new look at old ways to damage a baby’s brain. The New Zealand Speech Therapists’ Journal 25, 19-24.

Liley A.W. (1971) Transfusion of the foetus. In: Documenta Geigy. ‘The foetus as a patient’ Ciba-Geigy Limited, Basle, Switzerland. P. 5.

Liley A.W. (1971) The development of the idea of fetal transfusion. Am. J. Obstet. & Gynec. 111 No. 2, 302-304.

Liley A W (1972) Aspects of Rh maternofetal incompatibility. Tribuna Medica, Madrid. Feb. 11.

Liley A.W. (1972) Disorders of amniotic fluid. Chapter 3. In: Pathophysiology of Gestation, Vol. 2 (Fetal Placental disorders). N.S. Assali (ed). Academic Press Inc., New York and London. Pp. l54-207.

Liley A.W. (1972) The foetus as a personality. Aust. N.Z. J. Psychiatry 6, 99-105.

Kinnock S and Liley A.W. (1974) The performance of an anti D immunoprophylaxis scheme. New Zealand Med. J. 80, 337-343.

Liley A.W. (1976) Experiences with uterine and fetal instrumentation. In: Intrauterine Fetal Visualisation : A Multidisciplinary Approach. Kaback M. M. and Valenti C. (eds). Excerpta Medica, Amsterdam, Oxford and American Elsevier Publishing Co. Inc., New York. Pp. 70-77.

Liley A W (1976) A perspective of Rh haemolytic Disease. Modern Medicine of New Zealand 9, No. 16, 23-32, and reprinted Modern Medicine 45, No. 3, 33-48.

Liley A.W. (1977)

?Management of the Rh sensitised pregnancy. In: Progress in Perinatology. Kaminatzky H.A. and Iffy L. Stickley (eds). Philadelphia. Pp. 209-218.

Liley A.W. (1979) Transfusion of the fetus. Patient Management 8, No. 7, 37-45.

Liley A.W. (1981) Acquired mental retardation of fetal and perinatal origin. Pontificiae Academiae Scientiarum Scripta Varia, 47, 21-28.

Coleman R.J., Liley A.W., Pinder L. and Woodfield D.G. (1982) Free antibody after low dose Rh immunoprophylaxis. New Zealand Med. J. 95, 449-451.

Liley A.W. (1983) Estudio sobre las clasificaciones del Retraso Mental/ Classifications of Mental Retardation. IAMER publication series. Egrafia SA, Madrid.