Professor Richard Welbourn

Pioneer and historian of endocrine surgery
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The Independent Online

Richard Welbourn led one of the biggest departments of surgery in the UK and established a reputation internationally for endocrine surgery and postgraduate courses at the Royal Postgraduate Medical School of London University. He was the first President of the British Association of Endocrine Surgery and took a prominent role in the teaching of medical ethics, co-editing and writing two editions of The Dictionary of Medical Ethics (in 1977 and 1980). On his retirement, in 1983, 25 professors of surgery worldwide (12 in the British Isles), many of them endocrine surgeons, were former members of staff of the RPMS.

Welbourn was born in 1919, the youngest of five. His father was an engineer, but at Rugby School Dick became inspired instead by biological sciences and followed two brothers to Cambridge, winning a scholarship to read Natural Sciences at Emmanuel College; he also joined the chapel choir. After Addenbrooke's he planned to continue his clinical studies at the London Hospital but the Blitz interrupted and instead he went on to Liverpool University. The bombing there was just as devastating, and the shortage of doctors meant that at one time, just before he qualified, he was in sole charge of a ward at the children's hospital.

The day after his house jobs finished, Welbourn was called up by the RAMC and joined the 28th Field Dressing Station. Landing in Normandy with a forward medical unit in 1944, he saw unspeakable carnage. Caen was in flames. Patchwork surgery, triage of major casualties and TLC had to be learned on the spot. He decided to pursue a career in surgery and, on one short leave, he took the primary fellowship of the Royal College of Surgeons. On another he married Rachel Haighton, whom he had met in the Student Christian Movement in Liverpool.

His de-mob number came up, but, with a desperate requirement for surgeons in Europe, he worked for nearly two more years in fire-torn Hamburg. He said: "Even after the war ended, the casualties kept coming in: compound fractures, open chests and bellies, skulls - everything."

Returning to Liverpool in 1947, he became registrar and then senior registrar at the Royal Infirmary and took his final FRCS exams. He enthusiastically welcomed the coming of the National Health Service in 1948, hoping for equal chances for all. Encouraged in research by his surgical mentor, Professor Charles Wells, he was awarded his MD for his thesis on "the nutritional effects of gastric resection" in 400 patients in Liverpool.

In 1951 he gained a Fulbright Scholarship for a year in basic research at the Mayo Clinic in Rochester, Minnesota. There he learned the techniques of surgical research that became the foundation of his career as an academic surgeon and surgical teacher. The steroid hormone cortisone had been purified there by the biochemist Dr Edward Kendall and was used to treat patients with rheumatoid arthritis by Dr Philip Hench, work for which they both won the Nobel Prize in 1950.

The Mayo surgeon Dr James Priestley and others then started performing adrenal surgery under cortisone cover with astonishing success for patients with Cushing's syndrome. Dick Welbourn remembered "riding the crest of the cortisone wave". Mayo was where he got interested in endocrinology. He moved to Queen's University, Belfast, as consultant and lecturer in surgery and, in 1952, began himself to perform adrenalectomy, surgical removal of the adrenal gland, for patients with Cushing's syndrome. He published in 1954 the first results for this operation outside the United States and later, in 1971, published the long-term follow-up.

At Queen's, where he stayed for 11 years with his growing family, he met Professor Desmond Montgomery, physician in charge of the Metabolic Unit at the Royal Victoria Hospital. With him he published the textbook Clinical Endocrinology for Surgeons (1963), the first major book on the subject; a revised edition followed, Medical and Surgical Endocrinology (1975).

In 1963 Welbourn was invited to the Chair and Directorship of the Department of Surgery at the Postgraduate Medical School (later RPMS) in Hammersmith Hospital, London. He set about restructuring the department with Ivan Johnston, his former Senior Registrar at Queen's. Over the next two decades, he and the department became known for endocrine surgery particularly relating to the adrenal glands and hormonal diseases of the gut.

He established close research collaborations with colleagues across the disciplines. Students at Hammersmith were all postgraduate doctors, many from the Commonwealth. Consultants both locally and from all over the world referred patients to Hammersmith and the doctors were especially encouraged to communicate well with patients and their relatives, luckily very often in their own languages. Welbourn managed to gear the whole department to teamwork and there were good facilities for research and able assistants. Altogether he wrote and co-authored over 230 research publications, book chapters and books on endocrine and gastrointestinal topics, and also on surgical philosophy and education.

At Hammersmith, with the distinguished scientists Professor (now Dame) Julia Polak, Professor Stephen Bloom and others, he organised many courses in surgical endocrinology. He felt that the courses were not merely for teaching but that the RPMS itself was enriched by the calibre of doctors from all over Europe and further afield. Attendance was high and the meetings were held in great esteem. At one time the Scandinavian contingent, staying in a yacht on the Thames, joked that no one should be allowed to practise surgery unless they had attended a course at the Hammersmith.

In 1969, Dr William Longmire, Chairman of the Department of Surgery in the University of California, Los Angeles, visited Hammersmith and proposed an association between the surgical departments. Clinical visits for up to a year would be funded by UCLA. Such travel was not common at this time and many clinicians on each side of the Atlantic enthusiastically took up this opportunity. They were able to compare and contrast the research in their laboratories and the treatment in their respective hospitals. It was a valuable development, widening horizons and broadening perspectives.

Welbourn was invited to lecture widely and did so in five continents. He founded British and international societies of endocrine surgery, he was President of the Surgical Research Society and held office in many professional associations and served on the editorial board of several journals.

At Queen's, in the 1950s, he had tried to start discussions in the medical school about death and dying, but the subjects were taboo. By 1963, Professor Charles Fletcher's television programme Your Life in Their Hands was provoking enormous interest, while Cicely Saunders's work with her hospice movement was proceeding apace. At this time, the Rev Ted Shotter, of the Student Christian Movement (now Dean Emeritus of Rochester Cathedral), started the London Medical Group to discuss such problems.

Dick Welbourn became one of the first members, later writing and editing, with Professors Archie Duncan (physician) and Gordon Dunstan (moral theologian), The Dictionary of Medical Ethics (1977). He lectured widely on ethical subjects and arranged meetings on eagerly debated subjects such as life before birth and euthanasia. The London Medical Group evolved into the Institute of Medical Ethics and Welbourn became first Chairman of the Council and later continued as Vice-President.

His relationship with UCLA did not end with retirement. In 1983, as Visiting Scholar, he started writing The History of Endocrine Surgery, enjoying writing it almost as much as he had enjoyed surgery. This scholarly labour of love took seven years of meticulous study of original source material before he felt ready to publish.

Welbourn was very influenced by the writings of the great John Hunter, the founder of scientific surgery, who recognised that all operations were inevitably a traumatic assault on the human body. Much later, in retirement, he followed enthusiastically the new laparoscopic techniques resulting in speedy recovery and relative comfort for patients - a huge contrast to the big, painful incisions and thus long stay in hospital needed previously.

His chief interests outside medicine and ethics - and writing - were gardening, which became impossible in later years, and classical music, which he keenly enjoyed to the end of his life.

M. J. Peters

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