That a resident assistant physician at St Thomas’s Hospital should leave London for the provinces was thought astonishing in 1927. If Cole was setting a precedent then, he set two others later. In 1957 he became the first dean of the Cambridge postgraduate medical school, and in 1964 the first of our College’s vice-presidents under new Bye-Laws.
His father, Samuel Barrett Cole, was a Swindon clothier who retired early and sent his two sons to Leighton Park, the Quaker school near Reading. Leslie, the elder, spent his twentieth birthday as a Gunner officer at Hyderabad (Sind). Transferred to Mesopotamia for active service, he was recalled to England in June 1918 to go on with his medical studies. The coming shortage of doctors was causing anxiety.
At King’s College, Cambridge, he was given an exhibition, and at St Thomas’s he won the Mead medal and the Toller prize. The return to Cambridge was a venture; for Addenbrooke’s Hospital was below London standards, though the university connection gave it potential. Cole did much to revitalize it, working for a day when it should be the clinical centre for the Cambridge medical school.
Meanwhile he had to earn fees, by convincing general practitioners that his opinion was worth getting. And this he soon did. Besides a steadily increasing knowlege, especially of diabetes and diseases of the heart, he had instinct and judgement, and his advice was clear and practical. Though deeply interested in diseases, he cared even more about the people who had them, and about the situation of those people. He was very kind, and his views on such subjects as diet and rest in bed were refreshingly sensible.
In due course he joined the staffs of the West Suffolk Hospital and Papworth.
As a young consultant he sometimes felt that ‘clinical observation has about reached its limit’, and wondered whether he had come to a dead end. But these thoughts were the prelude to his becoming for a time the foremost British authority - indeed, a world authority - on the treatment of tetanus.
This infection, rare though it was, kept turning up in East Anglia, and he was all too often confronted with patients, in distress and danger, whose best treatment was uncertain. His early hopes of curare were dashed, but in time his experience of many methods enabled him to write with confidence on what should and should not be done. His summary in Robert Hutchison’s Index of Treatment (1948) was a model.
In 1939 Addenbrooke’s supplied most of the senior staff of the 20th General Hospital, and Cole became lieutenant colonel in charge of the medical division. A tented hospital was set up at Dannes-Camiers in January 1940, but it was little used, and on the night of 21 May he had to march his men to Boulogne, with some walking wounded, to take ship for England. When the hospital was re-established in Northern Ireland he still felt almost useless, and he was thankful to be sent back to Addenbrooke’s, which had doubled its beds and needed him badly. On 18 June 1941 he wrote: T have more than fifty beds and terrific outpatients, a moderate amount of private work and a number of odd things as well. I hope that the work will get heavier and heavier as it probably will. I don’t ever really get tired of clinical work’.
But he also enjoyed writing - a substitute for the teaching he would have liked to do more often. Three short postwar papers — significantly entitled ‘Diagnosis and the Patient’, Treatment and the Patient’, ‘Prognosis and the Patient’ — contain more useful advice than most textbooks, and much of it is still timely.
Seeing the doctor as responsible for the entire patient, he had always practised ‘holistic’ medicine. Concern over a cardiac infarct should not, he felt, mean lack of concern for a corn that is also causing pain. Repeatedly he drew attention to the noxious anxieties that can be aroused by investigation, by treatment, and by silence; and to the care needed to prevent them.
‘The more thorough an examination ... the greater can be the influence of the final summing up. There is perhaps no part of treatment in which serious mistakes are more commonly made or harder to set right …’
‘With reservations, the aim should be to tell the truth or at least as much of it as is compatible with comfort and hope. This should be done with conviction and without hesitation, and to do this the physician must have confidence in himself ... Lack of confidence in a doctor is communicated to his patient in the same way as nervousness in a rider is communicated to his horse. The results in both cases are often disastrous …’
‘The second aim should be to tell a patient nothing that is likely to frighten him either directly or by evasion. Very little is ever gained by doing this, and yet it is perhaps the cause of more distress and illness than all the other mistakes in medicine and surgery put together’.
Cole insisted that whatever is said should be said in words the particular patient can understand. Communication matters so much that ‘the ability to say things clearly should be recognized as one good reason for going in for medicine’. Those in charge of medical education should realize that ‘the study of the English language is as important as the study of anatomy and physiology, because it is the vehicle which makes or mars all the rest of diagnosis and treatment and indeed can often make or mar research’.
With vigour of mind went vigour of body. The strenuous tennis he played at St Thomas’s continued till his late seventies; and in his eighties he was still taking the daily cold bath of his schooldays. He loved riding, and before the war he hunted regularly with the Cambridgeshire foxhounds. But the occupation that fitted his personality best was cruising at sea in small boats, for he liked both decisive action and tranquil contemplation, as well as the danger and beauty of the sea. Only in his fifties did he discover his considerable talent for painting. Here too he was an enthusiast, and his enthusiasms were lasting - whether they were for butterflies, for Vermeer, Picasso, and his Japanese prints, for his colleges in Cambridge and Regent’s Park, or for his friends.
Taught at Addenbrooke’s by Sir Clifford Allbutt, Cole never wavered in his wish to see it a major academic centre. The National Health Service made it a teaching hospital, and in 1957 when the university created the school of clinical research and postgraduate medical training, he appropriately became its dean. In this post till 1965, he did much to arrange the courses, for specialists and for general practitioners, which set a national example at a time when the expansion of postgraduate training had scarcely begun.
For many years the undergraduate medical students at Peterhouse had his tutorial help, and from 1958 to 1965 he was an assessor for the Cambridge MD degree. By this time he was an examiner of long and varied experience: for Cambridge in pharmacology and medicine; for Oxford and Bristol in medicine; for the Conjoint Board in medicine and pathology; and for the MRCP. In this role as in others, he was well informed, thorough, sagacious, and reliable. At the College he became a councillor in 1950 and a censor in 1960, and in 1964 and 1965 he was senior censor and senior vice-president.
Cole’s mother was Annie, daughter of Ebenezer Gammon. He married in 1927 Mary, daughter of the late Surgeon Captain HW Finlayson DSO. They had three sons, two of whom followed him to King’s College and all three into the medical profession. They are RHL Cole of Barnstaple, RB Cole FRCP of Newcastle-under-Lyme, and PH Cole of Northampton. He died at his last home, at Flore, near Northampton.
Sir Theodore Fox
J Wedgewood
ND Compston
[Brit.med.J., 1983, 2, 436; Lancet, 1983, 2, 115]