BGS Presidents - Biographical Sketches: Mike Denham

Memories of Michael John Denham\President British Geriatrics Society 1992 - 1994

I was born on 17/03/1935 at Urmston, Manchester.  I was educated at Sale High School, Manchester and then, after my parents moved to Norwich, at King Edward VI School (now known as Norwich School) and the City of Norwich School until 1953, when I went to Downing College, Cambridge to read Natural Sciences.  I married Shiela Ann Rodger on 30/10/1965 at Auchingramont Church in Hamilton, South Lanarkshire, Scotland.  I have three children (two daughters and one son) and two grandchildren (boys).

After I qualified from Cambridge University and Westminster Medical School I decided to enter general practice and passed a series of what were then considered to be appropriate diploma examinations: DRCOG, DCH and DA.  However, after putting my toe in the water, I decided this was not what I wanted to do, which was general medicine.  I now faced two problems: firstly deciding which branch of medicine to enter, remembering that I was now several years behind my contemporaries who were well on their career in general medicine and secondly to start taking more exams.  I talked to many people, including Dennis Hyams at Addenbrookes, and decided that geriatric medicine fitted the bill.  I studied for the MRCP at the West Middlesex Hospital, where I met Jimmy Andrews, and at St. Stephen’s Hospital in Chelsea where later I started work on my MD thesis.  In 1970 I successfully applied for the post of senior geriatric registrar at newly opened Northwick Park Hospital/Clinical Research Centre (NPH/CRC) where I trained under the excellent leadership of Malcolm Hodkinson.

In 1973 I was appointed consultant at the hospital.  The presence of the CRC gave the campus considerable kudos and it became a thriving centre for research with eminent clinicians/scientists such as Sir Graham Bull, Sir Christopher Booth, Sir Peter Medawar, David Tyrell and John Nunn on the staff.  I found several members of the staff of St. Stephen’s Hospital were appointed to prominent positions at NPH.  The senior administrator of the hospital in the early years was Graham Millard, who was dynamic and forward-looking.  The 1970s were a happy time because the campus was relatively small, everybody knew everybody and money was not a problem.  The medical staff at the nearby Edgware General Hospital, which had an enviable reputation for MRCP teaching, realised that the opening of NPH would bring about the demise of their hospital, which indeed closed in 1997 before being reopened in 2005 as a community hospital.  The whole set up at NPH/CRC was conducive to research and I managed, with Malcolm’s help, to write papers and complete my MD in 1976.  Because I was a new boy I was made a member of numerous hospital committees, which helped me to understand how hospitals work. The NPH/CRC Ethical Committee was particularly instructive and I became its chairman in 1975.

Domiciliary visits. One of the pleasures of the consultant post was the privilege of visiting elderly patients in their own home. The influence of the Poor Law was still evident in the 1970s because some patients were reluctant to be admitted because they feared the hospital was the old workhouse.

Many and varied were the situations I saw and I doff my hat to the difficulties experienced by GPs.  I observed examples of the Diogenes Syndrome, so well described by Tony Clark of Brighton in 1975.  Other visits revealed a 1920s time warp, unsanitary conditions, lack of adequate heating, curious personal relationships within households and once I had to invoke the Section 47 of the National Assistance Act, which did not prove a happy occasion.  After one incident you can imagine my embarrassment when I entered a house by the open back door, as directed by the GP’s instructions, to find I had come to the wrong address.  Another visit was to a very scruffy, smelly house where I learnt to feel the dryness or otherwise of the carpet before kneeling down beside the bed.  This avoided wet knees!

I am reminded of a visit to an elderly couple who were both in bed when I arrived.  Unfortunately the bed was in an alcove close to wall and so I had to clamber over the wife to get at her husband: all very tricky.  One memorable occasion happened when I was asked to see an elderly gentleman lodger whose health had been deteriorating.  His landlord was burning his clothes in the garden when I arrived.  I soon found the reason: the patient was covered with fleas.  I fear I did not examine him then but the history was strongly suggestive of carcinoma of the lung so admission to hospital was arranged and he was cleaned.  His clothing was all removed and destroyed.  Later examination added little to the presumptive diagnosis.  The following day he died.  Post mortem revealed no obvious cause of death and I was left with the feeling that he had been killed by our ‘kindness’.  Another visit, which was carried out in a snowstorm, was filmed as the basis of instructional material for the Open University.

Every now and then visits could be embarrassing. A visit to an elderly couple proved illuminating in more ways than one.  The landlord told me that the husband tore off wood panelling from neighbouring fences for firewood and thus did not need to buy coal.  The wife also adopted an unusual method of keeping warm.  She did not wear underclothing, would turn on the gas cooker, open its door and standing with her back to it would raise the back of her dress.  I was given a demonstration!  Another embarrassing visit was to an old people’s home on a particularly hot day.  I had to find the matron, who proved to be a nubile young lady, for information about the patient.  She called me into her bedroom where she lay on the bed with minimal clothing!  Since she showed no signs of getting up or dressed, I addressed my questions to the wall to avoid looking at her.

Involvement with the BGS. My work with the BGS began when I was elected North West Thames regional secretary in 1974-8.  In 1977 Gordon Mills who was consultant geriatrician at the Central Middlesex Hospital and deputy secretary of the BGS, was appointed to the Chair at Liverpool and so relinquished both posts.  I was ‘shoe horned’ in to fill the BGS gap.  Fortunately I did not have to undertake the organisation of the Spring meetings because Peter Horrocks was already ably doing this when I arrived.

The time as Secretary proved very busy and involved much travelling to the BGS base, which was then in the Age Concern premises in Tooting.  The committee meeting were held in the chapel at St. Pancras hospital which was where Norman Exton-Smith was based.  I remember being a ‘Young Turk’ and trying to persuade him to achieve more in the College by tackling problems head on.  No, he said, I’ll do it my way using a softly, softly approach via the back door.  Needless to say he was successful.  When Norman died the College held a celebration of his life at which we learnt of aspects of his life which were unknown to us, such as his interest in model aircraft flying.  He was a gentle man and a gentleman

I started a system of ‘father figures’ to ensure that geriatricians were helped to obtain merit awards, which I think did have some positive effects especially on morale.  Between 1985-7 I was organising secretary for the European IAG conference in Brighton and was chairman of the Society’s training committee.  Between 1992-4 I was BGS President, which proved to be a hectic time because I was also the RCP senior censor.  By 2011 I had became the Society’s unofficial honorary archivist and historian.

Teaching and management. I became very interested in teaching senior registrars about management and how to be an effective consultant.  I visited several RAF hospitals to see how their management differed from the NHS. My goodness how proud the commanding officers were of their units!  This led to holding intensive weekend courses at the King Edward’s Fund premises then based in Bayswater and which ran for several years until the costs made it impractical.  Eminent doctors agreed to speak including Stephen Lock, then editor of the BMJ.   Amusing moments occurred during the mock interview sessions.  I lectured on balancing hospital commitments with family life with examples from my own experience of what not to do.  I was appointed lecturer/examiner for District Nurses and Health Visitors at Stevenage College, later at the University of Hertfordshire, where I became Visiting Professor.

The Royal College of Physicians. My BGS work brought me into contact with Norman Exton-Smith, who I strongly believe helped me in appointments within the Royal College of Physicians.  I served on several working parties including the first on Medication in the Elderly, which was chaired by the President of the RCP, Sir Douglas Black.  I remember him commenting on a Department of Health publication which he greeted with ‘negative enthusiasm’.  He had a wonderful gift of producing clarity: the working party had produced many recommendations which he felt lacked ‘punch’ and, after a few moments thought, reduced them to a few eye catching proposals.  I served on other College committees and learned how the ‘system’ worked.

I started examining for the MRCP examination in 1985 and the DGM in 1989.  By 1992 I was a pro-Censor and senior Censor in 1993.  Examinations and the duties of the censors were under the tight control of the then College Registrar, David Pyke.  I hosted the exam on several occasions at Northwick Park ably assisted by David Lubel.  The College sent me overseas of a number of occasions to represent it and to invigilate.  On one occasion I carried the examination papers with me to the Oman.  I had to ensure that they were not opened by customs, especially as there were explicit photographs of clinical conditions, which might have seen me having to answer awkward questions.

I served on the higher awards committee as the North West Thames representative as a physician between 1992-6.  This proved a salutary experience and showed the difficulty in trying to equate the achievements of different specialties.   Everyone tried to be fair knowing there were many more potential consultants than there were awards.  I also attended meetings of the National Institute for Health and Clinical Excellence (NICE), which demonstrated to me how very fair Committee members tried to be.

Writing and publishing. I was editor of Care of the Elderly Journal 1988-1996, was a committee member of other journals and acted as a referee for other journals.  I have written 88 papers, 22 editorials for Care of the Elderly journal, 30 chapters in books and co- edited 11 books.

Health Advisory Service For many years I was seconded annually to the NHS Health Advisory Service, then under the direction of Donald Dick and Peter Horrocks.  As a member of the visiting team I was sometimes able to assist in producing solutions to local problems.

Other Commitments. I was medical advisor to Research into Ageing 1980-1990.[1] I was a trustee of the Royal Surgical Aid Society, a committee member of Lady Avebury’s advisory group, which produced A Better Home Life in 1996, a member of the Department of Health/Centre for Policy on Ageing Committee on the National Care Standards for Nursing Homes and served on several second opinion complaint procedures.  In 2005 I became a benefactor of Downing College, Cambridge.

In 1992 I was elected a Fellow of the Royal Society of Arts, in 1997 elected to the Worshipful Society of Apothecaries, became a Freeman of City of London, and in 2005 was elected to the Athenaeum club. In 2000 I was asked by Sir Liam Donaldson, the Chief Medical Officer, to join the team to assess General Pinochet at Northwick Park Hospital.

Retirement.  My challenge to myself on retirement was, to ‘Strive to Achieve’.  I learnt to type, use a PC and Reference Manager and with these skills successfully completed my PhD thesis in 2004 on The History of Geriatric Medicine and the Hospital Care of the Elderly in England between 1929 and the 1970s.  The work was based at the Wellcome Trust Centre for the History of Medicine at the University College London.  This has proved a fruitful source of papers.

I continue my interest in military and medical history, go on battlefield and architectural tours, keeping fit by swimming several times a week, attending various air-shows and gardening.  I still lecture from time to time and help with mock PACES examinations at NPH.  I am now a retired blood donor having donated 84 pints.

[1] Research into Ageing was asked to provide several members to take part in a parade into Horse Guards before Queen Elizabeth the Queen Mother on the occasion of her 80th and 90th birthday celebrations.  I was one of them. There were rehearsals to try to get the hundreds who were there into some sort of order.  On the second occasion our large group came into Horse Guards in ‘echelon’ rather than ‘broadside’.  We were strongly criticised by the military man in charge as being ‘a shower’ – just like Terry Thomas used to say.  He was probably swearing about having to train civilians!  We did arrive correctly when the time came.