b.21 April 1920 d.12 November 2012
BM BChir Oxon(1942) MRCP(1948) DM(1954) FRCP(1972)
Christopher Silver was a geriatrician in the East End of London. He was born in Exeter, the son of Clifford Marking Silver, a dentist, and Gladys Lucy Silver née Acott. He was educated at King’s School, Bruton, and then Hertford College, Oxford, where he qualified in 1942.
He was a house officer in Sheffield, where it is reported that, when not tending patients, he was tending vegetables in the hospital garden. He then served with the RAMC in North Africa, Italy and India, being demobilised in 1946 with the rank of temporary major. He had arrived in Italy soon after the Anzio landings, but his active service there came to an end when he broke a leg in an accident caused by the blackout. He did gain the dramatic consolation of witnessing the great eruption of Mount Vesuvius from his hospital bed.
After demobilisation he worked at the Radcliffe Infirmary, Edgware General, the London Chest, Mount Vernon and Papworth. In 1952 he became an assistant tuberculosis officer at the London Chest Hospital. There he wrote his doctorate on the use of tuberculin jelly in the diagnosis of TB. When it became apparent that respiratory medicine was oversubscribed for a career, Max Caplin [Munk’s Roll, Vol.XII, web], who had helped him with his doctorate, suggested he might look at geriatric medicine and so, in 1961, Silver became a consultant in this specialty at St Matthew’s Hospital in Shoreditch, London.
St Matthew’s was a place which hardly seemed to have moved on since the Victorian era, when it was built. With ward names like Dickens and Copperfield, the rows of patients, many confined to primitive beds with high cot sides, would have been a familiar sight in many of the old poor law institutions. With the support of the local hospital management committee, Silver was gradually able to introduce a more modern and rehabilitative approach. He continued to have patients at St Matthew’s until the late 1970s, but his locus of work moved east, taking on patients in what became Tower Hamlets.
By 1972 he had in excess of 200 inpatients scattered across the four hospitals, St Matthew’s, Bethnal Green, the London (Mile End) and St Andrew’s. He managed to give them steadily improving care with the help of a remarkable but rather motley crew of doctors and a highly organised secretary. Together they made sure that no patient got lost – a significant risk with such a widely dispersed service and referrals coming in from so many different sources. His close association with the London Hospital was recognised by his formal appointment there as a consultant in 1968.
Home visits were frequent to assess need and priority for admission. Some of these were formally requested by GPs and paid for as domiciliary consultations. But he was unusual in often visiting in response to requests for admission, even if the GP had not asked for a visit. These informal and unpaid home visits saved many old people from the risks of admission, preserved the scarce resource of hospital beds or ensured that, for those who had to be admitted, there was a consultant opinion and plan even before the patient reached hospital.
He rapidly realised the close overlap between physical and psychiatric disease in older people, and sought to bring the two specialties together. He suggested broadening patient admission criteria for the new ward at the London Hospital (Mile End), so that patients would be under the joint care of himself and a psychiatrist. His proposal was strongly supported by Brice Pitt, then recently appointed as a psychogeriatrician at the London, and so this tolerant and effective assessment ward was set up. It was probably a surprise to both men that the concept was so rarely tried elsewhere.
Despite all the work pressures, he and his indomitable secretary steadily amassed data on all the patients who had been admitted, using a simple punch card system. This was then analysed with the advanced technology of a knitting needle, enabling them to produce papers demonstrating the age, frailty and prognosis of this fairly typical population of patients reaching an inner city hospital geriatric department. He invented a practical test of cognitive ability, ‘Silver’s test’, which was useful in demonstrating the functional losses associated with brain disease and ageing.
In 1978 it was finally possible to appoint a colleague to share the clinical and teaching load. To have the care of about 250 hospital patients cut overnight to 120 must have been a considerable relief for him. Although many consultants in the teaching hospitals viewed geriatric medicine with suspicion and disdain, attitudes at the London steadily warmed, and he, with his colleagues, became important contributors to the medical family, clinical care and teaching at Whitechapel and Mile End.
Christopher was a quiet, thoughtful man. Though shy, he had a welcoming, reassuring face and a wonderful head of hair, never too long, but not well-disciplined either. So it was unsurprising that his family gave him the appropriate name of ‘Fluffy’. He put up with the early disparagement of geriatric medicine without rancour, but with the quiet conviction that good medical care for the elderly would come to be seen as important, not only morally, but also for the effective functioning of modern hospitals. That the second ward to be inherited by his department had been named after one of the physicians who had opposed the arrival of geriatrics caused him wry pleasure. He was held in warm affection by those who worked with him and, using his considerable photographic skills, he gathered a gallery of pictures of all his medical teams. To the amusement of those who saw the picture, he arranged a photo montage of one group so that, with him, they were seen to be examining a massive black cat in bed on a ward round. His secretary from his later time at Mile End wrote: ‘He was a lovely man and I have very fond memories of working with him and the little things he did. He did so much for the elderly people in Tower Hamlets, and I remember clearly the first day that I met him with his shy little smile. He was a true gentleman.’
In retirement he gave wise advice for several years, in his usual quiet, self-effacing way, to the charity Research into Ageing. He continued to do so until, in his judgement, he risked being too out of touch with medicine.
His wife, Nancy (née Pym), had been a successful classicist and headmistress. On a trip together to visit classical sites in Asia Minor, he had come across the story of Brunel’s prefabricated Crimean war hospital at Renkioi. He researched this with his usual patience and thoroughness, and eventually published the results of his enquiries as a book dedicated to Nancy, who had sadly died ten years earlier (Renkioi: Brunel’s forgotten Crimean war hospital Sevenoaks, Valonia Press, 2007). Her death had left an understandable hole in his life, but did not detract from his activities. His macular degeneration had improved somewhat with ranibizumab treatment, but reduced vision, atrial fibrillation and, in the summer of 2012, a pelvic fracture, took their toll. He was survived by a son (Paul), three daughters (Eleanor, Angela and Susannah), seven grandchildren and one great grandchild.
[Brit.med.J., 2013 346 895; The Times 3 January 2013]
(Volume XII, page web)
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