Lives of the fellows

Neil Harrison Cox

b.21 July 1956 d.8 December 2009
BSc Liverpool(1978) MB ChB(1980) MRCP(1983) FRCP(1994) FRCP Edin(1994)

British dermatology has lost one of its most able and likeable individuals with the untimely death of Neil Cox, at the age of 53 years. He was Consultant Dermatologist to North Cumbria University Hospitals NHS Trust, past Editor of the British Journal of Dermatology, coeditor of Rook’s Textbook of Dermatology, and a major contributor to so many other dermatological activities in the UK.

Neil was born in Leeds, and after attending Leeds Grammar School, chose Liverpool University. He obtained a first class honours BSc in Cell Biology as well as his MB ChB, and after graduation stayed in Liverpool for his basic medical training. His interest in dermatology was initiated by Paul Dufton and Chris Vickers, and he fitted in a surprising amount of dermatology around general medicine while working towards his MRCP.

Neil joined us in Glasgow in 1984 as a registrar. At this time there were several gifted trainees in the department, and Neil stood out because of his palpable enthusiasm and commitment to dermatology. I remember his standing in the dermatology ward on his first day in Glasgow radiating energy. His clinical knowledge as a first year registrar was remarkable. He had already read a large proportion of the then current edition of Rook and showed his outstanding ability to retain what he read and apply it to clinical situations. If a challenging patient were admitted for diagnosis, Neil within 24 hours would have reviewed the relevant literature, come up with an intelligent suggested diagnosis, which was usually proven correct, and possibly drafted a case report. All this before the easy availability of Google and search engines. His publication list during his two and a half years with us as a registrar was impressive with 10 refereed clinical papers and 11 case reports, as well as numerous letters and commissioned articles.

Even at this early stage in his training, it was clear that Neil wanted to specialize in the whole of dermatology, not just a subsection. Thus, while he showed promise as an excellent medical dermatologist, making strong links with diabetologists and neurologists, he also became an extremely competent dermatological surgeon, read widely and published in contact dermatitis, enjoyed attachments to paediatric dermatology clinics, and gave a sound dermatopathological opinion.

Neil moved to Newcastle upon Tyne to a senior registrar post where he continued his energetic apprenticeship, and steady expansion of his publication list. His CV and reputation were such that he would have been a welcome applicant for a consultant post in any teaching hospital in the UK. However, he had set his sights on Carlisle, where he was appointed as a consultant in a nonteaching district general hospital. Neil was a countryman at heart and was drawn to the salmon in the River Eden and the Cumbrian wildlife. He had clearly decided that this was the part of the world where he wanted to put down roots with his wife and young family.

For many people this appointment would have resulted in a change of pace, with a solid NHS contribution in working hours and then enjoyment of country pursuits at the weekend. Not so for Neil, who continued his remarkable and energetic workload with a steady output of publications and service on national committees, clinical research and thoughtful and productive improvements to patient services in Cumbria.

Neil’s facility with words, wide clinical knowledge and publication record made him a natural as assistant editor and then coeditor of the British Journal of Dermatology, posts which he held from 1997 to 2001. He liked to communicate with authors verbally, and frequently would telephone about a submitted manuscript offering perceptive and constructive suggestions which were much appreciated. His editorship of the Journal led to his becoming one of the four editors responsible for the 7th and 8th editions of Rook’s Textbook of Dermatology. In this role again he demonstrated both his remarkable breadth of dermatological knowledge and his ability to negotiate with authors in a friendly and productive manner. He was also coauthor of four beautifully produced and illustrated textbooks, two with Cliff Lawrence and two in collaboration with Gary White. Two of these texts earned him the Society of Authors’ Medical Atlas prize and the 2006 British Medical Association prize for Dermatology Book of the Year.

Serious health problems developed which led to a need for renal dialysis and eventually a kidney transplant. For most patients, such problems lead to a very clear slowing down due to chronic tiredness, but Neil’s workload appeared to change very little, and he coped with great courage and fortitude with this cruel blow.

Neil enjoyed helping others organize and deliver dermatological knowledge and services in the same logical and productive manner that he personally practised. He led the prizewinning Hospital Doctor Dermatology Team of the Year in 1999, and was a very effective chair of the British Association of Dermatologists (BAD) Therapy and Guidelines Subcommittee from 1999 to 2003. He had the skill and tact to gently guide colleagues with differing views to a sensible compromise. My last personal contacts with him were in late 2009 over a revision of the BAD guidelines for the treatment of melanoma. While some members of the group were quibbling over trivia, Neil was concentrating on the bigger picture: whether or not the guidelines would be of real value to the nonexpert and checking if any significant references had been omitted. He was on the UK Dermatology Clinical Trials Executive from 2003 to the time of his death, and led the PATCH study, the first large multicentre study planned by the UK Dermatology Clinical Trials Network. This double-blind controlled trial concerning cellulitis reached its challenging recruitment target only a few weeks before his death and is the largest ever study of this subject worldwide. It is good to know that a fellowship in this Network for specialist registrars will be named in his memory.

The high quality of Neil’s clinical research was twice recognised by the BAD with the award of the Wycombe Prize for dermatological research from a district general hospital. He would have been a superb teaching hospital consultant or member of an academic unit. His skills in teaching young trainees and stimulating them to write papers were not lost: he was a frequent and very able speaker on courses and study days for dermatologists, nurses and others in primary care. He enjoyed contact with fellow dermatologists and was President of the Dermatology Section of the Royal Society of Medicine in 1995. He then became Dermatological Assistant Editor of the Journal of the Royal Society of Medicine.

Neil’s academic skills were recognized by the University of Cumbria who appointed him a visiting Professor in 2009. In accepting this post, Neil talked of expanding and strengthening the research and teaching he had developed in the North Cumbria dermatology department with colleagues at the University. This would have been a very valuable contribution and it is very sad that he did not live long enough to see this collaboration flourish.

In view of all these contributions to dermatology, it is entirely fitting that in April 2010, the BAD executive agreed unanimously that Neil should posthumously receive the Sir Archibald Gray medal, the highest award given in the UK for services to dermatology.

Neil married Fiona (Fi), a veterinary surgeon, in 1980 and was very proud of their two children, David and Kathy, both now undergraduates. He enjoyed the outdoor life, particularly salmon fishing. When he left Glasgow, he asked for the classic and beautifully written texts by Hugh Falkus on fishing as a parting gift and I hope they were well used in his rare moments of relaxation. We all miss him and offer Fi, David and Kathy our deep sympathy, and also happy and admiring memories.

Rona Mackie

[Reproduced, with permission, from the British Journal of Dermatology 2010 162, pp1414-5]

(Volume XII, page web)

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