A surgeon’s life

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Professional medical historians are often caustic about yet another ‘life’ of a distinguished doctor. All too often it is written, by a doctor, not as a critical biography but as hagiography in which, after a carefree boyhood, the popular student is rapidly promoted to registrar, then manoeuvred by appreciative chiefs into a consultant post at a leading hospital where affability, equanimity and a happy family earn him civil, academic and/or professional distinction, a mellow retirement, a peaceful death, glowing obituaries and a splendid memorial service.

Adrian Marston’s Hamilton Bailey is an exception. Marston, who himself rose to the top of his profession, provides a warts-and-all story of a world famous surgeon. Bailey’s father was a dour medical missionary, then an unsociable family doctor. His mother, a nurse, lost her first child at two days followed by puerperal fever, lifelong depression, alcoholism and institutionalization. Bailey’s younger sister was schizophrenic, hospitalized, leucotomized and hidden for ever. Hamilton Bailey was an antisocial, argumentative schoolboy, but an industrious student and house surgeon at the London with war service with a Red Cross unit in Belgium, and then at 20 in the Battle of Jutland in 1916.

When resident surgical officer at Wolverhampton he quarrelled with the senior surgeon. As surgical registrar at Liverpool he became a superb teacher. He remained asocial and friendless, and his appointment as registrar back at the London was strongly opposed. In 1925 he failed to win even one vote for the post of assistant surgeon at the London, but he did achieve that post at Liverpool.

There he met and married happily Veta, a photographer, but disagreed with colleagues and after a few months moved to Dudley Road Hospital, Birmingham, where he performed 3642 operations in four years and published in 1927 Demonstrations of Physical Signs in Clinical Surgery with a hundred photographs by Veta. It became a world classic and is now in its twenty-sixth edition. He left Birmingham under a cloud and worked in Bristol for a year at the Homoeopathic Hospital but failed to be appointed to the Royal Infirmary.

However, in 1930 he brought out his second masterpiece Emergency Surgery, and then both he and McNeill Love (with whom he co-authored his third classic A Short Practice of Surgery) were appointed to the Royal Northern Hospital, which became one of the greatest non-university voluntary hospital in the country. Marston praises Bailey’s incisiveness, industry, obsessionality and self-confidence as he was chauffered in his Rolls between home, seven hospitals, two private clinics and Harley Street, all the while dictating on to a wax cylinder of a Dictaphone, and accompanied by one or two secretaries.

Thus GPs and colleagues received typed letters the next day, and Veta had material for a chapter in a new book or edition. Marston describes how my GP father sent all his surgical patients to Bailey, and how this demigod came to our home for my abdominal pain-prod,’acute appendicitis’, immediate appendicectomy. My father also entrusted Bailey with four operations on my right hallux and a hysterectomy on my mother. Above all, Bailey was a legendary clinical diagnostician and postgraduate teacher, both in his ultra-efficient clinic and in his publications.

Marston never knew Bailey but cites many witnesses that he was a rapid. but poor, sometimes careless and heavyhanded technician, abrupt with his patients, absent from hospital committees and medical organizations apart from the International College of Surgeons. In 1943 his son was killed in an accident, after which he deteriorated into manic depressive psychosis. He was hospitalized in 1948 and proved resistant to electroconvulsive and insulin therapy but in 1953 he made a remarkable recovery with lithium and retired to the country and then to Spain.

He died in1961 after operations for intestinal obstruction, worsened by his interference with his doctors’ decision-making. His name lives on in his books and his royalties-endowed trust for medical education and libraries in the third world. I have three disagreements with Marston. I do not accept that ‘Famous surgeons are an extinct species’, nor that Bailey as ‘a supreme observer… was, essentially a scientist. ‘ There was little science at the Royal Northern in 1943 when I spent 14 days at complete bed-rest after an uncomplicated appendicectomy.

As a house surgeon there in 1955 patients after a subarachnoid haemorrhage spent six weeks in complete bed-rest: those on one side of the ward had their bedhead raised to reduce the pressure in the brain; those in the beds of the other surgeon had the bedhead lowered to improve the blood flow to the brain. And one physician’s routine placebo was daily injections of B12 1000mg which the pharmacist secretly supplied as 1000 micrograms. And why is this excellent history unreferenced? I do hope that Marston will deposit his source material at the Royal London Archives to join the Bailey material there which he rescued.

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