Arthur Norman Exton-Smith (1920–1990)

Smith, Arthur Norman Exton- (1920–1990), geriatrician, was born on 7 January 1920 in Graham Street, Ilkeston, Derbyshire, the elder of the two sons of Arthur Smith (1881–1975), and his wife, Ethel Mary (1887–1960), daughter of Robert and Augusta Robertson of Nottingham; both the Smith parents were teachers and both sons became medical professors. Born Arthur Norman Exton Smith, he assumed the surname Exton-Smith in 1943, perhaps to distinguish himself from his brother, David Robertson Smith. He was educated at Nottingham high school, Pembroke College, Cambridge, and University College Hospital (UCH), London. He qualified in 1943 and in the following year joined the Royal Army Medical Corps, landing in Normandy the day after D-day.

Demobilized in 1947, Exton-Smith returned to UCH for specialist training. His professor, Max Rosenheim, suggested that he should assist Lord Amulree in a new department of geriatric medicine at St Pancras Hospital, which with the advent of the National Health Service in 1948 had been taken over by UCH from the London county council. The inheritance was bleak: the wards were overcrowded; there were no bed curtains, few chairs, and only primitive bedside lockers. The patients were mostly confined to bed—none had been properly examined; they had simply been labelled ‘senile’. It was enough to drive away any ambitious doctor. But Exton-Smith, impressed by Amulree's enthusiasm, stayed. Within a year he published a paper showing what could be achieved even in such a medical backwater. He stressed the interest, the job satisfaction, and the vast field for research—concerns which were to occupy him for the rest of his life. In 1951 he was appointed consultant geriatrician to the Whittington Hospital, and on 29 August of that year he married Jean Barbara Belcher (1924–1990), a nurse; they were to have two children. In 1959 he added to his post at the Whittington that of physician to the Hospital of St John and St Elizabeth. In 1966 he returned to UCH as Lord Amulree's successor, and in 1973 UCH created a chair and he became the first professor of geriatric medicine in London.

In 1955 Exton-Smith published Medical Problems of Old Age, a pioneer textbook of geriatric medicine. But he preferred to write in collaboration with colleagues and was an excellent editor. His greatest interests were in nutrition and metabolism, the ageing of the autonomic system, and the regulation of body temperature. In 1964 he chaired the BMA committee which first drew attention to hypothermia and wrote its report. His research also covered many other fields, including organization, nursing, bone disease, pressure sores, and terminal care. Latterly he used computerized testing to study dementia. In every field he made fundamental contributions. Elected a fellow of the Royal College of Physicians in 1964, he became the first geriatrician on the college council and the secretary of its first geriatrics committee, and he persuaded the college to recognize geriatrics as a speciality. He was for sixteen years a member of a government committee on food policy and for fifteen years a consultant adviser on geriatric medicine to the Department of Health. He was also a governor of the Centre for Policy on Ageing.

Exton-Smith became assistant secretary of the British Geriatrics Society in 1952 when it had 100 members, and subsequently became secretary, editorial secretary, and president. When he retired the membership was 1500 and a small medical club had become an influential professional society. He was the first editor of the society's journal (1959–85). He wrote or edited four textbooks of geriatric medicine, four books on nutrition and metabolism, a report on geriatric nursing, the proceedings of several international conferences, and 135 papers. He knew everybody in his field and was an enthusiastic organizer of meetings both nationally and internationally. Through the British Council he arranged courses for physicians from abroad; he set up joint meetings in the USA, Belgium, the Netherlands, Germany, and Italy; and, an immensely hard worker, he even found time to be secretary to a dining club for Cambridge medical graduates.

Exton-Smith received many honours including the appointment as CBE in 1981, the Henderson medal of the American Geriatrics Society, the Moxon medal of the Royal College of Physicians, the Founder's medal of the British Geriatrics Society, the Sandoz prize for research in gerontology, and an honorary DM at Nottingham. He retired in 1985, but returned to the Whittington to conduct research. For the last eight years of his life he suffered from cancer but between operations continued to research, to write, and to lecture. His courage and determination were beyond praise. He died on 29 March 1990 at the Edenhall Marie Curie Home, London, and was cremated at Golders Green. During his life he did more than any other person to bring geriatric medicine from the professional backwater in which it originated to the position of a major speciality of medicine.

Munk, Roll, 9.160–66 • private information (2004) • m. cert.
British Geriatrics Society, London • Royal Society of Medicine, London 

R. E. Irvine, ‘Smith, Arthur Norman Exton- (1920–1990)’, Oxford Dictionary of National Biography, Oxford University Press, 2004; online edn, May 2010 [, accessed ]
Arthur Norman Exton-Smith (1920–1990): doi:10.1093/ref:odnb/57334