Dr. Joseph Milic-Emili, Professor Emeritus at McGill University and a true giant in respiratory physiology whose work had a major impact on clinical care, passed away on January 8, 2022. Professor Milic-Emili (“Milic” to his friends and colleagues) was Chair of the Department of Physiology (1973-1978) and then served as Director of the Meakins-Christie Labs (1979-1994) at McGill. During his career he received many honors and distinctions, including being elected Fellow of the Royal Society of Canada and receiving the Order of Canada. He was also granted honorary degrees by the Université Catholique de Louvain (1987), the University of Kunming (1988), Université de Montpellier (1994), the University of Athens (1999), and the University of Ljubljana (1999).
He was born in 1931 in the village of Sezana, then part of Italy but now in Slovenia. After obtaining his medical degree from the University of Milan in 1955, he was appointed Assistant Professor in the Department of Physiology in that institution, where he carried out research on exercise physiology with Professor Rodolfo Margaria. He was enticed to move to the University of Liège in 1958 by the Belgian physiologist Jean-Marie Petit, with whom he developed methods to measure pleural pressure with the esophageal balloon catheter as well as the electrical activity of the diaphragm using esophageal electrodes, techniques still applied in patients to this day. In 1960 Milic moved to Boston to work at the Harvard School of Public Health. Then in 1963, Milic moved to McGill University where he would spend the remainder of his professional life.
Over the course of his storied career, Milic made myriad foundational contributions to our understanding of respiratory physiology in both health and disease. A very incomplete list of his accomplishments includes: 1) description of the cardinal features of ventilation-perfusion relationships in the lung;Citation1,Citation2 2) development of novel tools and concepts in the analysis of control of breathing and lung mechanics;Citation3 and 3) dissection of the dynamic mechanical properties of the respiratory system that determine the work of breathing and flow limitation.Citation4,Citation5 These basic discoveries carried over into the clinical realm, helping to explain the basis of hypercapnia during treatment with high levels of oxygen, why proning improves gas exchange in intensive care unit patients, and how intrinsic PEEP increases the work of breathing along with strategies to mitigate its adverse effects in patients during spontaneous breathing or mechanical ventilation.
Milic trained countless students and fellows from all over the world, many of whom went on to become international academic and scientific leaders in their own right. In addition, many of his trainees pursued careers in nonacademic clinical medicine but remained greatly influenced by his way of thinking about a problem. Indeed, Milic felt that one of the most important functions of the Meakins-Christie Labs was to serve as a school of respiratory physiology. He maintained close relationships with his former trainees, exerting a profound and lasting impact on their attitudes not only toward science but toward life in general. He was a teacher, mentor, friend and confidante. He was also a merciless critic of research he judged to be methodologically or conceptually unsound, to the point that Milic often shocked outside speakers who were unused to such rigorous cross-examination.
Meakins-Christie reception at the American Thoracic Society Conference in 1995. Joseph Milic-Emili is 3rd from left in the front row.
In addition to his tremendous scientific achievements, Milic was, as they say, “a character.” Among the many notable testimonials received after his passing were the following:
“I remember him explaining the pleural pressure gradient and the resultant gravity dependent variation in lung expansion using a Slinky (toy)! What a showman! What an inspiration!”
“Once we were attending a meeting and during an oral presentation session a speaker did not show up. The person chairing the session asked the audience what we should do and immediately someone said: “Let’s have Milic telling us jokes during these 15 minutes!” There he went, a tremendous success! Sometimes I slept in and found a message by Milic on my desk: “Are you awake enough to go over the manuscript?” or he would phone me up saying: “This is Meakins-Christie wake up service, Sir, it is ten o’clock” and hung up!”
“He was able to have such an impact because of his enormous expertise and knowledge, but also because of his extraordinary charisma. Milic could make you laugh just by the way he told a joke, regardless of its intrinsic merit. Thinking of him still makes me laugh, but most of all reminds me how lucky I was to know him.”
The legacy of Joseph Milic-Emili is enormous in terms of his scientific contributions and their translation to clinical care. Many of the concepts he pioneered have reached “textbook status”, and are now simply taken for granted by today’s pulmonary physicians and physiologists. His impact on colleagues, collaborators and friends at a human level was equally profound. Milic was one of a kind and there will never be another like him. We were indeed lucky to know him!
Meakins-Christie Laboratories, Faculty of Medicine, McGill University, Montreal, Quebec, Canada;
Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
[email protected]
Funding
The author(s) reported there is no funding associated with the work featured in this article.
References
- Milic-Emili J, Henderson JAM, Dolovich MB, Trop D, Kaneko K. Regional distribution of inspired gas in the lung. J Appl Physiol. 1966;21(3):749–759. doi:10.1152/jappl.1966.21.3.749.
- McCarthy DS, Spencer R, Greene R, Milic-Emili J. Measurement of “closing volume” as a simple and sensitive test for early detection of small airway disease. Am J Med. 1972;52(6):747–753. doi:10.1016/0002-9343(72)90080-0.
- Whitelaw WA, Derenne JP, Milic-Emili J. Occlusion pressure as a measure of respiratory center output in conscious man. Respir Physiol. 1975;23(2):181–199. doi:10.1016/0034-5687(75)90059-6.
- Coussa ML, Guerin C, Eissa NT, et al. Partitioning of work of breathing in mechanically ventilated COPD patients. J Appl Physiol (1985). 1993;75(4):1711–1719. doi:10.1152/jappl.1993.75.4.1711.
- Petrof BJ, Legare M, Goldberg P, Milic-Emili J, Gottfried SB. Continuous positive airway pressure reduces work of breathing and dyspnea during weaning from mechanical ventilation in severe chronic obstructive pulmonary disease. Am Rev Respir Dis. 1990;141(2):281–289. doi:10.1164/ajrccm/141.2.281.