The celebration of his hundredth birthday gave added resplendence to the name of Charles Nathaniel Armstrong, a legendary figure in the north east of England where he was loved and respected by generations of students, friends and colleagues. If strength of arm was the badge of his unruly forebears, strength of character more fittingly defined his personality. Gentle and courtly of manner, he was resolute of purpose and did not hesitate to reprove impropriety or any decline from the standards he steadfastly upheld. ‘Natty’, by which he was familiarly known, was not just an abbreviation of his middle name, but a reflection also of his sense of neatness and precision both in matters of dress and in the ordering of thought and speech.
Born and bred in Newcastle upon Tyne, the young Armstrong was educated at the Royal Grammar School and the Newcastle Medical School, then part of Durham University. After passing his second MB examination, he volunteered as a surgeon-probationer (later surgeon sub-lieutenant) in the Royal Naval Volunteer Reserve. Armed with his knowledge of anatomy and physiology, a one month course of instruction at Haslar Naval Hospital and a booklet on abdominal emergencies, he served for eighteen months as medical officer in His Majesty’s ships of war. "I was fortunate", he later recorded, "no member of the crew was seriously ill or had a serious accident."
Towards the end of the war he returned to his studies and qualified in 1920 having already served whilst a student as house physician to David Drummond. He took a course in public health and hygiene but then, attracted to the specialty of neurology, he obtained an appointment as clinical assistant to Gordon Holmes [Munk's Roll, Vol.V, p.195] at the National Hospital, Queen Square. Here he wrote his first paper, published in Brain, on supra-pituitary tumours presenting as Frolich’s syndrome.
Back in Newcastle, Armstrong was employed for three years as a neurologist to the Medical Pensions Board whilst awaiting a registrar vacancy at the Royal Victoria Infirmary. This materialised in 1928 and three years later he was appointed honorary assistant physician. He practised as a general physician with an interest in neurology and in 1939 he became honorary physician. At the same time he was appointed clinical sub-dean to the medical school. He brought order to the hitherto ill-organized undergraduate clinical teaching and a conspicuous achievement was to persuade the University and the board of governors jointly to provide the Royal Victoria Infirmary with an excellent lecture theatre, later to be named after him.
In the early forties Armstrong’s interests moved from neurology to endocrinology, a specialty which had early associations with Newcastle through George Murray’s [Munk's Roll, Vol.IV, p.403] demonstration in 1891 of the successful treatment of myxodema with extract of sheep’s thyroid. Armstrong was a founder member, and later president, of the section of endocrinology of the Royal Society of Medicine. Within the specialty he developed a particular interest in what was to become known as intersex. His opinion was widely sought both as clinician and expert witness and his contributions to the subject won international recognition. He gave evidence in several celebrated legal cases and his criteria for the determination of gender were generally accepted. A man of fastidious taste and a stickler for accuracy he objected to the liberties taken by some contemporary artists in the representation and disposition of various features of the human form. This prompted a letter to Picasso, but without noticeable effect.
Armstrong retired from the National Health Service in 1962 and was then appointed regional director of postgraduate medical education, a new post created with wisdom and foresight by the then Regional Hospital Board. He set about establishing postgraduate centres in all the major district hospitals, organising training for junior hospital staff and involving general practitioners in educational activities. He thus very successfully laid the foundations of the future postgraduate institute.
In 1970 he relinquished his postgraduate role, but for a further quarter century he maintained an active interest in medical affairs in Newcastle, attending meetings, giving lectures and continuing to contribute on the subject of intersex. He valued particularly his involvement with the Durham and Newcastle Medical Graduates Association of which he was president from its inception until the time of his death.
Over his long years of joy and fulfilment Armstrong was grateful above all for the happiness of his family life.
David Shaw
[Brit.med.J.,,1999,318,607]