Lives of the fellows

Archibald Leman Cochrane

b.12 January 1909 d.18 June 1988
CBE(1969) MBE(1946) MA MB Chir Cantab(1938) MRCP(1961) FRCP(1964) FFCM(1972) Hon Dr York Univ(1975) Hon DSc Rochester USA(1977)

All fellows are unique, but none (in his generation) was as unique as Archie Cochrane. Born at Galashiels into a family that had become moderately wealthy by manufacturing textiles, his early life was traditional enough, taking him via Uppingham to King’s College, Cambridge, where he obtained first class honours in both parts of the natural sciences tripos and nurtured the ambition of becoming a don. Fortunately for medicine, the problem he began to tackle proved to be a sterile aspect of tissue culture and he soon became dissatisfied with its triviality and his own technical incompetence. When, therefore, he developed a functional symptom, which no English physician could cure, he abandoned his project and sought advice at the Kaiser Wilhelm Institute in Berlin, then the fount of academic medicine. Again obtaining no relief and becoming intrigued, like so many other young people at the time, with the ideas of Freud, he turned to psychoanalysis. The next two years in Berlin, Vienna and Amsterdam, following his Jewish analyst as he fled from Hitler, gave him a hatred of fascism, fluent German, and a sceptical attitude to all theories not validated by experiment.

In 1935 Archie returned to Britain and started clinical medicine at University College Hospital, where he was greatly influenced by the enthusiasm and scientific rigour of Sir Thomas Lewis [Munk's Roll, Vol.VI, p.531] and George Pickering, later Sir George [Munk's Roll, Vol.VII,p.464] and by the social concern of Philip D’Arcy Hart. It was four years, however, before he qualified, as the outbreak of the Spanish Civil War led him to join an ambulance unit in support of the Republic, in which he must have been the only member with neither political nor religious affiliation. He returned to Britain after a year, in which he had gained experience of triage on the Madrid front, and qualified just in time to complete a house job at the West London Hospital and to obtain a research appointment at UCH - before resigning to join the Army. Eighteen months later he found himself a prisoner of war, having been captured with an ill-starred commando unit in Crete. For most of the rest of the war he was the British officer in charge of prison hospitals, in which he had first hand experience of Nazi brutality, carried out his first controlled experiment to find a cure for famine oedema, became an expert on tuberculosis, and exposed himself to such a large dose of x-rays that he developed, 20 years later, a squamous carcinoma on the back of his hand.

On demobilization, Archie obtained a Rockefeller fellowship in preventive medicine, which involved a course at the London School of Hygiene and Tropical Medicine, where he fell under the influence of Austin Bradford Hill, later Sir Austin, and then a year at the Henry Phipps clinic in Philadelphia. At the latter, he came across the problem of inter- and intra-personal variation in the reading of x-rays and developed his interest in the scientific study of diagnostic and prognostic error.

Back in Britain, Archie joined the MRC’s pneumoconiosis research unit under Charles Fletcher and worked steadily for the next 40 years, first as a member of the unit, then from 1960 as David Davies professor of tuberculosis and diseases of the chest and director of the MRC’s new epidemiology unit in Cardiff, and finally, after official retirement, as the first president of the Faculty of Community Medicine, 1972-75, and an honorary member of the unit he had previously directed. Employed, at first, to study the factors that determined the development and progression of pneumoconiosis in coal mines, Archie imaginatively sought to test the hypothesis that progressive massive fibrosis was determined by tuberculous infection, by making intensive efforts to eliminate tuberculosis from one valley while leaving another to standard practice. His plan was thwarted however by the introduction of streptomycin, which almost eliminated tuberculosis from both. Turning to investigate the role of dust, he demonstrated for the first time a quantitative correlation between the development of the disease and exposure to dust (rather than silica) by studying ‘random colliers’ whose exposure was measured by members of his team who ‘shadowed’ them at work.

When the National Coal Board took over the work on pneumoconiosis, Archie began to use the technique of population surveys that he had developed in the study of coal miners, to study the natural history and causes of a wide range of common diseases from anaemia to glaucoma. In the course of this work, he helped to set new standards for the burgeoning science of epidemiology by refusing to accept lapse rates of more than five per cent in surveys and follow-up studies and by checking the reproducibility of any measurement or item of the subject’s history.

Just as important were his efforts to establish medical and social practice on a sound basis by persuading clinicians, medical administrators, and members of other professions (including magistrates and schoolteachers) to base their practice on the results of randomized controlled trials rather than on personal impression, precept, theory or tradition. These were epitomized in his short book on Effectiveness and efficiency: random reflections on health services, London, Nuffield Provincial Hospitals Trust, 1972, which was based on his own experience in testing the value of domiciliary, outpatient and inpatient treatment in the National Health Service, and won him international acclaim.

Despite frequently working a 12-hour day, Archie somehow found time to create a garden at his home at Rhoose Farm that came to be included in the national garden scheme, to collect with discrimination modern paintings and sculpture, and to offer hospitality to friends and students on a scale more reminiscent of Edwardian than Elizabethan times. Unusually for someone with so much concern for communal welfare, he was equally concerned for the welfare of his family, his staff and his friends. When his sister was admitted to a psychiatric hospital, he refused to accept the diagnosis of dementia and sought a fresh opinion in Edinburgh, which led to the discovery that she, and he, were both porphyriacs. Concerned that relatives might, unknown, endanger their lives by exposing themselves to barbiturates or sulphonamides, he sought urinary and faecal specimens from 153 of them scattered as far afield as New Zealand and obtained specimens from 152.

To talk with Archie might occasionally be tiresome, if one was not immersed in the topic, as he found small talk difficult and preferred to discourse at length on his current enthusiasm. To work with Archie was to obtain a lifelong friend, on whom one could rely for unfailing support in times of need.

Sir Richard Doll

[Brit.med.J., 1988,297,63,355,419,614,1704,1989,298,454; Lancet, 1988,2,57-58; The Times, 22 June 1988; Video]

(Volume VIII, page 95)

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