Lives of the fellows

Christopher William Burke

b.20 December 1934 d.22 December 2016
BM BCh Oxon(1961) MRCP(1964) DM(1971) FRCP(1975)

Christopher Burke was a consultant physician and endocrinologist in Oxford. He was born in Sheffield, the son of Francis James Burke, an assistant school medical officer of health, and Dora Burke née Siddle. He was from a family of naval doctors; his grandfather, Richard Francis Burke, was a deputy inspector general in the Navy, while his father was a surgeon lieutenant commander. Chris attended Ratcliffe College in Leicester and then went on to Oriel College, Oxford, as an entrance scholar in chemistry (a background which probably determined his interest in endocrinology). He changed to medicine after two years, and managed to compress the 11-term pre-clinical course into nine, went on to Bart’s for his clinical studies and qualified in 1961.

As well as the standard house jobs, he was a neurology houseman at Bart’s, and then a houseman at Brompton Hospital, so he was well-rounded when, after a few weeks in general practice, he became a senior house officer in the casualty department at Middlesex Hospital in 1963. He gained his MRCP in 1964.

It was his two-year registrar post at Hammersmith Hospital with Cuthbert Cope [Munk’s Roll, Vol.VI, p.118] that settled him into endocrinology, and he followed it with two years mainly in research for his DM, awarded in 1971, on the problems of assaying bound and unbound cortisol in blood. He developed a steady-state gel filtration assay, which won the Postgraduate Medical School of London’s Kiely prize for registrars in 1969, and he extended this method to measure free thyroxine concentrations in urine. He continued with clinical endocrinology at Hammersmith Hospital with Russell Fraser [Munk’s Roll, Vol.XI, p.149] and Graham Joplin [Munk’s Roll, Vol.XII, web].

In 1973, he was appointed to the Oxford hospitals, providing the clinical service for non-diabetic endocrinology, as well as working as one of the three consultants of firm D for on-take medicine, which meant an evening and next morning round on admission days, and the subsequent care of the admitted patients. His colleagues admired his diagnostic skills. He retired in 1994, with just two interruptions – six months in Melbourne as locum director of the metabolic unit at the Alfred Hospital and the visit to Boston, Massachusetts, described below.

When Chris determined what should be done, usually correctly, he felt he must do it, whatever the difficulties, and that it must be done to a very high standard – which sometimes caused frustration and disappointment. This emerged most clearly in his travails rewiring his first Oxford home in the months after appointment, and then in the ultimately successful work he did installing medical audit in Oxford and by helping to organise the formation of a department of diabetes, endocrinology and metabolism during 1991 and 1992.

He served on the Royal College Physicians’ working party on medical audit and then set up an audit group in Oxford, but he was disappointed that, though all the four medical firms in Oxford clinically audited individual cases, this had little obvious effect on the quality of care. So, with the help of the King’s Fund, he obtained a place on Don Berwick’s course on clinical quality improvement in Boston. He was heavily influenced by that experience and on his return obtained the funding for an Oxford district clinical quality and audit group. He was helped in all of this by the contacts he made as the RCP’s regional adviser for the Oxford region, and went on to set up a clinical audit services group comprising 10.5 whole time equivalents of professionals, which interacted with nearly all the county’s 70 or so clinical directorates. This work was taken up by both the Oxford providers’ group and the purchasing authority, and continued with improvements in information technology in over 40 of the clinical directorates. Not surprisingly, this led to him teaching for three years on the Templeton College management development course for consultants and on the Oxford region’s equivalent course for senior registrars.

But his greatest service to Oxford was in non-diabetic endocrinology, where he provided a widely-based clinical service and was much appreciated for his clear and practical teaching of junior staff, all helped by the manual he wrote. His collaboration with the specialist pituitary neurosurgeon Christopher Adams was particularly outstanding; their patients operated on for pituitary tumours showed success rates comparable to the best international centres. They were a couple of plain-speaking perfectionists, who appreciated one another’s directness.

He also supervised John Bevan, later professor of endocrinology at Aberdeen, in ground-breaking research on dopamine agonist-dopamine receptor interactions in prolactinomas and non-hormonally functioning pituitary tumour cells. The group was amongst the first to show that nearly all prolactinomas regress during primary dopamine agonist therapy, unlike non-functioning pituitary tumours, even though these possess membrane-bound dopamine receptors that bind bromocriptine. For many years their 1992 contribution to Endocrine Reviews was frequently cited (‘Dopamine agonists and pituitary tumor shrinkage’ Endocr Rev 1992 May;13[2]:220-40).

Chris published 90 papers and 12 chapters in books: the 1993 assessment of the current modes of treatment of pituitary tumours, co-authored with Chris Adams, epitomised their hugely successful experience (‘Current models of treatment of pituitary tumours’ Br J Neurosurg 1993;7[2]:123-7), described more variously in 12 of his other papers, with Margaret Esiri and John Bevan frequent co-authors. More generally, his wide interests were reflected in topics ranging from nose bleeds via career choices to merit awards. And he left his clinical records in such good order, partly through an ingenious and personally designed card index system, that his successor, John Wass, was able to quickly write a notable account of pituitary apoplexy.

His wide horizons, combined with a close focus on his prime current interest, didn’t always fit well with everyday affairs when things didn’t run as his perfectionist streak desired. This was shown when his retirement plans to grow biomass for use as non-fossil fuel energy, sometimes discussed on ward rounds, were thwarted as he realised that he had bought unsuitable land in Devon. So he and his second wife, Jilly, established a pedigree herd of Devon Ruby cattle. He went on to lay 29 hedges and plant 40,000 hedge plants and well over 1,000 trees, and consequentially looked notably fitter than his contemporaries. In 2001 the farm was only 800 metres from the second outbreak of foot-and-mouth disease in Devon. By scrupulous care, the herd survived to win the medium herd competition of the Devon Cattle Breeders’ Society the next year. He made furniture from the trees he had felled on the farm, and supported Jilly in raising goslings for Christmas. On his second retirement, he moved south, first on to Dartmoor, where he restored a rectory, and then to Sidmouth, where he both improved his culinary skill and lectured to a science, technology and engineering group, who greatly valued his broad scientific knowledge.

He died from an aggressive cancer after a six-month illness, and was survived by his wife, the two children of his first marriage (to Frances Mary née Bridgstocke) and five grandchildren.

Derek Hockaday

(Volume XII, page web)

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