Lives of the fellows

Leonard Birnie Strang

b.13 May 1925 d.24 June 1997
MB BS Durh(1949) MRCP(1952) MD(1961) FRCP(1967)

Leonard Strang was an important figure in European paediatrics for more than three decades. His hallmark was an understanding of the relationship between science and clinical services, essential if children and their families are to benefit fully from medical care. This was coupled with an ability to enthuse younger collaborators, many of whom subsequently filled important positions in child health and developmental physiology across the world.

The formative influence in Leonards early life was Sir James Spence [Munk’s Roll, Vol.V, p.386]. His example of how the mixture of science and humanity applied to the common problems of health became central to Strang’s vision when, following his brother and sister into medicine, he qualified and worked with Spence and his group of young doctors. The influence was perhaps the greater because Strang had been Spence’s patient when, at the age of ten (in pre-antibiotic days), he permanently lost the free use of his legs from septicaemia following mastoiditis. Recurrent surgery left him with a profound understanding of both sides of the doctor/patient divide. Nevertheless, such was the power of Leonard’s personality that his closest colleagues forgot his disability completely. It was only, for example, when he would produce one of his sticks to provide visiting lecturers with a pointer to their slides that the cost of his gallant triumph over adversity would be noted. As one patient later put it "he was such a person that you didn’t forget his sticks, rather it seemed the normal way to walk."

It was during clinical postgraduate training in paediatrics at Newcastle that Strang’s research talent began to emerge. He was an outstanding clinical observer, contributing to the first accounts of harlequinism and of catecholamine secretion in neuroblastoma. However he gradually became dissatisfied with the limited scientific infrastructure in such existing departments of child health and took a research fellowship at Harvard. While there he contributed to identifying the right to left shunt in infants with respiratory distress. He was, importantly for his future work, also introduced to the study of animal foetal physiology.

After a period at the Hammersmith, he went in 1963 to University College Hospital as reader and was soon promoted to occupy the first chair in paediatrics at a London undergraduate medical school. He promptly established a research group which continued to elucidate the processes of change in the lungs at birth with increasing precision and clarity over the next 30 years.

We owe to this work much of our understanding of the changes in pulmonary vasculature in the perinatal period and even more the central role that secretion of lungs containing fluid plays in lung formation and preparation for birth. Elegant methods to study the process of lung liquid secretion and absorption at all levels of complexity, from the molecule to the whole animal, were developed in his laboratory. The work was summarized and its implications teased out in his classic book Neonatal respiration: physiological and clinical studies, Oxford, Blackwell Scientific Publications, 1977. Several groups world-wide have continued unravelling the molecular and clinical basis of his findings which are central to the process of birth.

The team he recruited at UCH under his leadership and with his support became a dominant force in British academic paediatrics. Its neonatal unit, headed by Osmond Reynolds, whom he recruited from Yale, took the lead in the development of ventilatory support for pre-term infants. Strang was convinced that long-term follow up of these infants was essential and many of the most important publications in this field have also come from UCH. They underpin subsequently developed techniques helping to protect the brain of a new-born baby in order to prevent cerebral palsy and other handicaps.

Other areas of important work were pursued in his department: nutrition and blood clotting in the new-born, thalassaemia, urinary tract infections and many more. The number of those who went on to chairs after working with him runs well into double figures.

At the bedside he was a superb clinician and teacher; attentive, thoughtful, caring and thorough. He made himself available by day or night, always ready to deal with a difficult problem, whether a clinical conundrum or a difficult parent. All were supported at times of stress or difficulty, junior or senior. He was a truly rounded doctor’s doctor.

Honours and official duties naturally came his way. As censor and secretary of the paediatric committee, he was mainly responsible for the introduction for the first time of a paediatric examination for the membership. He was president of the Neonatal Society, and was an honorary fellow of the British Paediatric Association and it’s James Spence medallist (particularly apposite both to him and posthumously to Spence). He was well known in the USA for his contributions to foetal physiology and in Europe he was one of the founding fathers of a club which later evolved into the European Society for Paediatric Research.

A passionate Francophile he found time, while a professor in London, to have regular French lessons. As a result of his friendship with Alex Minkowski, the renowned French neonatologist and left-wing activist, he spent a year's sabbatical in Paris which fully confirmed his love affair with that country. His first wife, Madeleine, who died prematurely herself, contributed a central element to the warm family atmosphere so characteristic of Leonards department. By her he had four children of whom he was intensely proud. He was fortunate to find happiness a second time with Susan and their extended family of children and step-children. They retired to Volx, off the Rhone valley, where former colleagues and pupils were made welcome, introduced to the village and taken to eat at Leonards favourite restaurants. He was a fine doctor, a fine scientist, a fine friend and a fine human being.

Robert Boyd

[The Guardian, 7 July 1997]

(Volume X, page 472)

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