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140 pp Price £19.95 (US$29.95) ISBN 1-85070712-X (h/b)
Carnforth: Parthenon, 2000 .
Fifty years ago every one of London's teaching hospitals had on its staff a consultant gynaecologist trained by Victor Bonney, so great was his influence and so successful his methods of training gynaecological surgeons. How did this small, dapper man do it? In a beautifully written biography Geoffrey Chamberlain explains much about Bonney's special style and skills.
Bonney was born in West London in 1872: both his father and his paternal grandfather were family doctors. In describing Bonney's life Chamberlain has seamlessly linked his chronology with the events of the late 19th and of the 20th century during which two world wars were fought and many great political and social changes occurred.
Bonney's professional achievements and his fame among colleagues were firstly for his extraordinary performance of 500 Wertheim radical extended hysterectomy operations for cancer of the cervix and, secondly, for his development of the conservative operations of myomectomy and ovarian cystectomy. His radical hysterectomy saved the lives of many women who would otherwise have died from painful and debilitating cancer of the cervix; and his conservative operations preserved the fertility of many women who would otherwise have been childless. His motivation for the development of the second type of operation was the experience of his wife Annie, who became grossly anaemic from heavy menstrual periods and underwent a hysterectomy, the only treatment then known. So within two years of marriage she was made sterile. Ten days after the operation Annie's bowel obstructed. A great surgeon Bland Sutton dealt with that. Bonney inevitably became interested in conservative surgery and in bowel function after major surgery; so in the end he developed not only the operation of myomectomy to remove fibroids and conserve the uterus, but also ovarian cystectomy to remove non-malignant cysts while conserving ovaries.
Chamberlain has managed to detail the events of Bonney's professional and social life in context with the very dramatic world events that occurred in his life. In the First World War Bonney and his consultant colleague Comyns Berkeley were, because of the work they were doing, prevented from joining the forces, which Bonney would very much have liked to do. They continued practising, each for half a week in London and half a week in Clacton, Essex. In London they continued working at the Middlesex Hospital and at the Chelsea Hospital for Women, as well as maintaining some private practice. In Clacton they operated on many thousands of wounded soldiers, removing bullets, shrapnel and damaged tissues from every part of the body. Chamberlain details in a table all these operations performed on soldiers who arrived in convoys of 130 by train. In total they operated on over 9000 wounded soldiers, saving the lives of many.
Chamberlain details Bonney's particular contributions made by designing surgical instruments such as the special clamp sometimes still used for diminishing the blood loss at myomectomy. Another instrument was for lessening the blood loss at lower-segment caesarean operations. Bonney was one of the first to insist on delivering babies by caesarean section through the lower segment when necessary.
A very important part of the book concerns Bonney's reaction to the establishment of a College of Obstetricians and Gynaecologists, which is now the Royal College. He was very much against the College, holding that both gynaecology and (somewhat illogically) obstetrics were branches of surgery. He was on the Council of the Royal College of Surgeons of England for a long time and, because he attended most of the council meetings, was very important there. But despite achieving high office he never became President of the Royal College of Surgeons, which he probably hoped he might. In his early opposition to the College of Obstetricians and Gynaecologists he refused to join, but later in life he was persuaded to accept their Honorary Fellowship. Outside medicine Bonney's great hero was Rudyard Kipling, who was his friend. Chamberlain has headed each chapter of the book with a quotation from Kipling.
Bonney's skills were not limited to the operating theatre. He wrote many books, some together with Comyns Berkeley. The most important of these were their textbook of gynaecological surgery, which went to six editions, and Bonney's very notable Extended Myomectomy and Ovarian Cystectomy. Both books had illustrations by Bonney. He wrote hundreds of articles for a host of journals including the JRSM (then the Proceedings). His hobbies were dancing, in which he and his wife excelled, painting water-colours and fishing which he managed to do in rivers all over the world but in particular at Seabournes, his country home on the beautiful River Wye in Hereford.
Fifty-three years ago, I had the honour to assist Bonney at one of his last myomectomies and then to drive him around the haunts of his childhood in West London, when he recounted some of the things that Chamberlain now records in a work notable for its sympathy, accuracy and fairness.