Obituary: Lionel Cosin

Lionel Zelick Cosin, surgeon, geriatrician: born London 8 November 1910; Medical Superintendent, Orsett Emergency Hospital 1940-48; Medical Officer, Orsett Geriatric Unit 1944-48; member, BMA Geriatric Unit 1948- 49; Clinical Director, Geriatric Unit, United Oxford Hospitals 1950-76, Emeritus Consultant Geriatrician, Oxfordshire Area Health Authority 1976-94; University Lecturer, Geriatric Medicine, Magdalen College, Oxford University 1960-79; married 1941 Pamela Headlam (one son, one daughter); died London 21 March 1994.

LIONEL COSIN was a pioneer of geriatric medicine and one of the eight founder members of the British Geriatrics Society. Physically small, he had big ideas and the persuasiveness to get them implemented. He established a worldwide reputation and his department in Oxford trained many of today's leading geriatricians.

The son of an estate agent, Cosin was educated at Westminster City School and Guy's Hospital, and wanted to be a surgeon. To further his career after qualification in 1933 he needed to pass the exams for the Fellowship of the Royal College of Surgeons. So he looked for work which would give him time to read. He took a job at Littlemore mental hospital, bringing with him copies of the British Journal of Surgery for the past 20 years. By the time he had read them he had passed the exam. In 1939 he was about to take up a post in the neurosurgical department of the London Hospital when the war intervened. The London teaching hospitals were dispersed and Cosin found himself at Orsett, in Essex, as a general surgeon dealing with war casualties.

Orsett Hospital, run by Essex County Council, also contained 300 beds for the chronic sick. It was directed by a medical superintendent. In 1940 the superintendent retired and Cosin succeeded him, finding himself, aged 30, responsible for 300 chronic sick beds in addition to his surgical commitment. Although a surgeon, he was always known thereafter as Dr Cosin.

The chronic patients were well cared for by the standards of the time. They were kept in bed and kindly treated, but there was no expectation of improvement and no attempt at rehabilitation. After 1944 the wounded no longer came to Orsett and Cosin was free to turn his attention to his chronic sick patients. He found himself with two empty wards. This enabled him to take at short notice patients referred for permanent care. Among them were people with broken hips, and considered too old for any form of treatment; but Cosin operated, offered them rehabilitation and got them home, at the time a revolutionary achievement.

By taking people at once instead of from a waiting list Cosin found that his patients, a1though referred for permanent care, were not untreatable. Only one in five was still in hospital after six months. The traditional candidates for these wards were, he claimed, suffering not from chronic sickness but from chronic neglect. This message did not endear him to everybody but he presented his results at the Royal Society of Medicine and his reputation spread.

Cosin became a member of the Ministry of Health's Committee on the Chronic Sick in 1947 and helped persuade the Chief Medical Officer to aim for active geriatric units in general hospitals rather than to multiply institutions for the chronic sick. Cosin was also a member of a BMA Committee whose report in 1949 gave guidelines for a comprehensive geriatric service which set the pattern in a field where Britain still leads the world.

In 1950 Cosin was invited to develop a geriatric service in Oxford based at Cowley Road Hospital. He inherited a waiting list of over 300 but had the courage to refuse an offer of additional beds. He applied the principles established at Orsett and soon had the bed problem under control. He at once attracted able people to work for him.

His most original idea was the Day Hospital for the Elderly. The Cowley Road Day Hospital, opened in 1957, was the first in the world. Once Cosin had shown the way a day hospital was recognised as essential to any effective geriatric service. The world flocked to Oxford and there were regular seminars. Cosin was widely honoured abroad, lecturing at over 90 universities and holding several visiting professorships. In the United States he advised on the establishment of a Community Health Care programme in Chinatown, in San Francisco, and presented a paper to a Senate committee on ageing. He also worked for Jewish charities in North Africa and in Czechoslovakia. A ward at the Radcliffe Infirmary, in Oxford, was named after him.

Cosin's principal interest was rehabilitation, which he defined as the measurement of the rate of return to competence. His belief in rehabilitation and, perhaps, his surgical training unfortunately blinded him to the role of the geriatrician in acute illness and in later life he distanced himself from the British Geriatrics Society preferring to work through the Royal Association for Disability and Rehabilitation (RADAR). But he will be remembered as one of the greatest innovators in his field with everyday hospital for the elderly as his memorial.

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