Most physicians, looking back on their careers, will reflect that their job was one of lifelong learning and that much of this came from their pathology colleagues. For chest physicians particularly, David Lamb was the best of educators, always ready to share his microscope to discuss a biopsy and to contribute as the voice of reason to sometimes fractious discussions with his clinical colleagues at weekly case meetings. It was one at one of these at Edinburgh’s City Hospital in 1978 that I first met David, but shortly afterwards found that he was supervising PhD students at my other workplace, the Coal Board’s Institute of Occupational Medicine (IOM).
David graduated from University College London with a BSc in Physiology and MB BS in 1959. After house appointments in London and Newcastle he spent a year as anatomy demonstrator before starting his career as a pathologist In Bristol, where he met his wife Joan, a fellow doctor. He then moved to the Brompton, where he worked with Prof Lynn Reid, gaining his MRCPath and PhD. In 1970 he was appointed Senior Lecturer at St George’s Hospital in London and in 1974 moved to his definitive post in Edinburgh University as Senior Lecturer and later Reader in Pathology.
His time at the Brompton marked the start of his interest in pulmonary pathology, occurring at a period of great change in the specialty as tuberculosis declined and was replaced by increasing interest in chronic obstructive lung disease and lung cancer. His early research fitted well with the new developments in understanding of emphysema and the small airways and in lung radiology as the CT scanner became available. He made notable contributions to research in relation to the classification of lung tumours but his work with scientists at the IOM on occupational lung diseases was also of great significance.
In the 1980s and 1990s two particularly important issues were under investigation at IOM. The first was the relationship between work as a coal miner and development of emphysema, something of great importance in relation of compensation of miners. He was a key contributor to the studies that showed the risks of development of clinical COPD and pathological centriacinar emphysema to be increased in relation to the amount of coal dust to which miners had been exposed. This led eventually to coal miners being able to claim compensation if they developed the disease. The second issue related to the causation of asbestos-related diseases, particularly asbestosis and mesothelioma. Asbestos itself was already known to be deadly and was on the way to being banned, but new substitute fibres were being introduced into industry. How safe were they? This was being investigated in rat models and involved physicists as well as pathologists. A succession of young scientists obtained their PhDs for this work, with David providing supervision. The outcome was clarification of the physical factors of fibres, their length, diameter, and durability in tissue, that led to inflammatory responses and thus toxicity; from this work, criteria were developed for assessing the likely pathogenicity of new fibres intended for use in industry.
Aside from his research supervision, David was an enthusiastic teacher and central to the growth of interest in pulmonary pathology in the UK, being a founder member of the Association of Pulmonary Pathologists and a regular contributor to the meetings of the British Thoracic Society. His interests ranged widely, from fishing to photography (he was a member of the Royal Photographic Society). Notably, he was an expert on English pewter and Scottish snuff boxes, and acted as a guide to these at the National Museum of Scotland. His humanity is epitomised by the notice that his colleagues felt able to put on the door of his office in the Pathology Department, “Beware, garlic eater inside!” He did indeed like garlic and would sometimes fry a clove as a snack.
David’s latter days were clouded by failing vision but despite this he came regularly to the meetings and lectures of the Senior Fellows’ Club of the Royal College of Physicians of Edinburgh, accompanied by his wife Joan. Their son and daughter followed them into the profession and we, their colleagues, extend our sympathies to the family. His legacy lives on in those pathologists whom he trained and in all of us who learnt from him.
