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Diagosing smallpox


Debating whether to work in paediatrics or in adult medicine
Harold Lambert Physician
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When I left the Central I had... I was havering between doing paediatrics and adult medicine, and I went to the Sheffield Children's Hospital. Again, a very famous man called Ronald Illingworth who wrote lots of books about the normal child and development. Very stiff, stern man but, you know, a good chap, and I worked with him for one job and I realised first of all I was totally lost, I didn't know what was going on at all. I thought I knew everything, that I'd got membership and I was a typical, arrogant, young doctor. I started seeing these sick children and also were neonates then, before neonatology became a specialty and I hadn't the slightest idea what was going on. It took me, oh, I suppose six weeks or two months before I felt I had the slightest notion, but I also felt it was too veterinary. I even knew less what was going on than I did with the adults and I felt I couldn't do this as my speciality. It's really too vague. But we had enormous...

[Q] You had thought of doing paediatrics?

Yeah. Yeah, I had seriously thought of it. Yeah, yeah. It was the other thing, adult medicine or... I knew I couldn't do surgery. I wasn't gifted enough with my hands and... I... well anyway, there were a lot of things I knew I wouldn't or couldn't do and the analytical side of medicine, trying to work out a difficult problem with the patient's rights being respected, it was those things together, really. But we had, it was the last phase of tuberculous meningitis and we had a lot of it in Sheffield. It was quite a poor place, and we had a number of patients, it was the last phase of it and, would, you believe this, I used to give intrathecal injections of streptomycin six times a week for six weeks. I mean... I mean it shivers your timbers, doesn't it, to think of it? But that's what we did and actually, to be fair, at that point it was uncertain whether intrathecal treatment was essential to get the good results and the reason for that was the MRC trials had shown before isoniazid had come in that as you know, tuberculosis and meningitis are lethal diseases, everybody dies they'd shown that intrathecal plus intramuscular was better than intramuscular. So the people in the trade at that time had natural fear about whether they would give complete treatment without intrathecal because, as you know, strep doesn't get across into CSF very well, not at all well. So this is what we... we did, and the results were good because by that time we had isoniazid so maybe you didn't need to give intrathecal, but people didn't know so they gradually gave less and less and less trying it out and seeing if they could get away meaning the patient surviving a good neurological state without it. Actually, to tell you the truth I'm still a bit uncertain whether you wouldn't do better with a few intrathecal injections and it's still a little bit unsettled like most things, but nobody would believe me if I said that.

British doctor Harold Lambert (1926-2017) spent his career tackling infectious diseases, helping in the development of pyrazinamide as an effective treatment for tuberculosis. He also published work on the rational use of antibiotics and was a trustee and medical advisor for the Meningitis Research Foundation.

Listeners: Roger Higgs

Roger Higgs was an inner city GP for 30 years in south London, UK, and is Emeritus Professor of General Practice at Kings College London, where he set up the department.

He gained scholarships in classics at Cambridge but changed to medicine after a period of voluntary work in Kenya in 1962. He was Harold Lambert's registrar for 18 months in the early 1970s, the most influential and exciting episode in his hospital training. He set up his own practice in 1975. He helped to establish medical ethics as a practical and academic subject through teaching, writing and broadcasting, and jointly set up the 'Journal of Medical Ethics' in 1975.

His other work included studies in whole person assessment and narrative in general practice and development work in primary medical care: innovations here included intermediate care centres, primary care assessment in accident and emergency departments, teaching internal medicine in general practice and establishing counselling services in medicine.

He was made MBE in 1987 for this development work and now combines bioethics governance, teaching and writing with an arts based retirement.

Tags: Sheffield Children's Hospital, Ronald Illingworth

Duration: 3 minutes, 8 seconds

Date story recorded: October 2004

Date story went live: 24 January 2008