ISPID - International Society for the Study and Prevention of Perinatal and Infant Death
ISPID - International Society for the Study and Prevention of Perinatal and Infant Death

International Society for the Study and Prevention of Perinatal and Infant Death

Distinguished Researcher Award 1999

During the VIII. ESPID Conference in Jerusalem, the Distinguished Researcher Award was given to Robert Carpenter from London, UK. The diploma was handed over by ESPID Chairman Karl Bentele, who summarized in his speech a few facts about the recipient of the prize.

The history of the study of unexpected death in infancy has been studied with dramatic theories and claims by scientists achieving great fame for a day, some even for two days followed by progressive retreat into near historical oblivion. There is, however, one man whose constant background work has largely been responsible for what progress has been made in the reduction of the number of child deaths. This person is Robert Gordon Carpenter who it is our privilege  to present with the Distinguished Researcher Award today.

Bob Carpenter was born in 1929 into the Baptist church of which he has been an active member all his life and which has regulated his philosophy of live. He went to the City of London School and then on to the Oxford University in 1848. He obtained a first class degree in mathematics in 1950 and then went across to St. John's in Cambridge to do a diploma in Mathematical Statistics at which he obtained the college price in 1951. In 1955 he graduated MA at both Oxford and Cambridge. What a start for anyone!

Meanwhile, he went as a statistician to the Pneumoconiosis Unit in South Wales, at that time under perhaps the most noted statistical physician of this time, Archie Cochrane. From there he went back on to the staff of Cambridge University as a statistician of the Cambridge Medical School and became the Associate Director of Research at the University's Department of Human Ecology in 1961.

It was at that time that Dr. Barrett at Addenbrooke's Hospital in Cambridge was doing his pioneer work on unexpected deaths and first used the term "cot death" and it was with this group that Bob started work on baby deaths. He became the first secretary of the Steering Committee and Secretary of the Scientific Sub-committee on the Ministry of Health Enquiry into sudden deaths in infancy which made an interim report in 1957 and a final report in 1965. Their report on the statistical significance of soft pillows, bedding covering the face and mouth, bed sharing and infections makes almost contemporary reading.

Having completed that report, Bob spent a year as Visiting Associate Professor in the Department of Biostatsitics at the University of California at Berkeley. It was at this time that he became Consultant to the World Health Organisation reporting on the use of computers in medicine. On returning to Cambridge he was largely responsible for setting up the first British conference on cot deaths in 1970 (published 1972, the principal mover of which was Mrs. Hunter-Grey together with Francis Camps). This Conference took place in Cambridge and was the first conference chaired by Sylvia Limerick (Countess of Limerick). As a direct outcome of this meeting, the Foundation for the Study of Infant Deaths was founded in England. Bob was the natural first secretary to the Scientific Advisory Committee of the Foundation and held that post from 1971 to 1985, the period of perhaps the most great activity of the Foundation.

In 1971 he moved to become Senior Lecturer in Medical Statistics to the London School of Hygiene & Tropical Medicine and it is from that position that he continued his work until his recent retirement. It was at the preliminary meetings for the setting of the Foundation for the Study of Infant Deaths that John Emery's active association with Bob commenced. Drinking coffee following one of these meetings (it could not have been in a pub), John mentioned to Bob how frustrating it was to be presented with a dead baby and not having an earlier history. John wanted to know what these children were like before they died. Bob remarked that there had been a statistical tool called stepwise Discriminant Analysis that had been used in borstals and which enabled the prison authorities to identify offenders likely to be re-admitted within a few years. Bob and John wondered if this could be applied to babies likely to experience unexpected death. It was this discussion which led to the association of Bob with Sheffield that has been productive since that day.

Since the details of these early investigations will not be on the Internet, perhaps it would be of interest to the members of this meeting to know what happened. First, a study was made of the information available at the university maternity hospitals in the city of Sheffield, which could only be information recorded before the babies went home. It will be of interest that factors such as maternal smoking were not considered of interest or recorded at that time! Sheffield was a unique place for study at that time as all baby deaths, whether in hospital or unexpectedly at home, were carried out in one department so that the findings of all deaths were available from all children born in the city. The case notes of all babies who had died, together with controls, were surveyed and abstracted and this information was analysed by Bob on the new computers at London University. Bob devised a system whereby, based upon 10 criteria at the time of birth, 60% of child deaths were confined to an identified 15% of the birth population.

This enabled them to set up a prospective study in Sheffield whereby every birth was scored, each child'd risk was worked out and the names of all children having a risk of dying as an unexpected death of higher than 1 in 50 was notified to the health visitors and family doctors. They only notified the health visitor in a random half of the cases. The health visitors were very well aware of the investigation and collaborated enthusiastically. They were anticipating obtaining useful histories from the cot deaths that occurred. However the results of the enquiry were a complete surprise. They found that there was a significant reduction in the number of deaths in those whom they had sensitised to the health visitors, whereas in the control group in which they had not done so, then the death rate remained as previously. It will interest this meeting to realise that the reduction in infant mortality obtained in Sheffield was of the same order as that obtained by the Back to Sleep campaign in recent years. Thus the ojective of the first Sheffield study, that is obtaining good histories, was not attained but a diminuition of death rate was. While this study was taking place in Sheffield, the post perinatal infant mortality rate in Sheffiled became approximately half that of its sister city of Leeds.

To some extent that work was before its day, as there was not at that time general confidence in new statistical methods. The whole enthusisasm in investigations relating to cot deaths was focussed on physiological, virological and chemical studies, there being a sincere belief that through such studies a cause of cot death could be found. That was the period of the search for a "magic bullet"! There are some who still think in that way.

The work in and related to Sheffield continued over 20 years during which Bob refined his methods and later extended them related to child abuse. Bob has been at the forefront in the application of new statistical methods to infant deaths. For example, in 1975 when he used "spline diagrams" to demonstrate how the sociological variables indicated the presence of several independent groupings in unexpected infant deaths. Bob was awarded a PhD of the University of London based upon this work. The findings and results to this statistics have been repeated and confirmed in the United States.

Neither Bob Carpenter nor John Emery were present at the Seattle meetings in 1968/69 when the concept of the Sudden Infant Death Syndrome was launched upon the world. Bob has always maintained a sceptical viewpoint as to the value of this diagnosis, always being aware that the causes of children presenting as unexpected deaths are of multiple and multifocal origin. Thus, while he has spent a large amount of time investigating the validity of hypotheses and devising valid statistical correlates, he has never pronounced a hypothesis himself. Such is the nature of this man.

Bob's concern and interest continued and expanded, later following up families in whom one cot death had occurred. The statistical findings of a study of care given to families who had suffered one cot death resulted in the CONI programme. A recent study that has been carried out with the aid of Bob's assistant Angela McKenzie has indicated that the health visitor input to such families appears to have been associated with a halfing of the likelihood of repeat deaths.

It was only natural that Bob Carpenter would be the co-ordinator of the ECAS (European Concerted Action on SIDS) study which was the first major research programme facilitated by ESPID in which using 20 centers in 17 countries of Europe and 29 collaborators, case control studies were carried out determining so-called risk factors for unexpected child death. The first report of this study came out in Anales Espanoles de Pediatria 1997 and the final major report is expected any day now.

This presentation today has confined itself to Bob Carpenter's contribution to the study of child death – this has been only one aspect of his activities and publications, including such disparate topics as the use of Heaf guns, psoriasis, Q-fever, student suicide and obesity.

Bob Carpenter is a self-effacing and quiet man who does not indulge in historionics or dramatic gestures and, thus, often has a tendency to be overlooked. But those of us who are aware of the background of the work that has been done over the last 30 to 40 years relating to infant deaths fully appreciate his work. This explaines our extreme pleasure in presenting Robert Gordon Carpenter to you as an eminent recipient of the ESPID Award.

Dear Bob, may I - on behalf of the European Society for the Study and Prevention of Infant Death - extend to you this Distinguished Researcher Award and express our sincere thankfulness for your great scientific work, your dedication and your help.

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