Victor Bonney Society
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Victor Bonney
1872-1953 |
History of Victor Bonney
Victor Bonney's eighty years
included the last days of sheltered life of British history; his working life
was from about 1905 to 1945, he was at the top of a conservative profession,
medicine, as a master surgeon, probably the finest of his class in
gynaecology. Surgery has
reduced in scope over the last twenty-five years: hormone therapies have taken
the need away for some, laparoscopically-assisted operations have reduced the extent
of surgery for others and much malignancy is now treated the non-surgical
disciplines of chemotherapy and radiation. Victor Bonney stood at the peak of gynaecological surgery
and showed us how to do it. He
was a determined man and he ensured that his juniors learned from his
principles. Bonney, son and the grandson of
doctors, was brought up in Victorian days in a tall house in Chelsea. It had a well-wooded back garden in
which he and his brothers could play.
His parents were artistic and there was a procession of singers and
musicians coming through the house performing. He was at first educated at home and did not go to Miss
Parker's Day School until he was nine.
Victor Bonney at the age of 8 His main memories of that school
were that he used to make up part of a gang to fight the boys in the
Clockhouse Board School. His
father had not realised the importance of small boys mixing with other
children the same age and so he had had an adult orientated childhood. In consequence he was rather lonely
at school. Later he attended St.
Mark's School where he was thought to have a superiority complex. He did not make friends of his own
age until much later on in adolescence.
He had a good working brain and a fine understanding for mechanical
things. He knew Chelsea before
the great museums were built in Exhibition Road and often used it to walk to
Hyde Park with his nanny, to sail his boat on the Round Pond. Influenced by the careers of his
father and grandfather, Victor Bonney had always wanted to go into
medicine. He took the Cambridge
Local Examination in 1887 and passed with First Class honours. In 1891, he started medicine at St.
Bartholomew's Hospital Medical School; he enjoyed a few months there but
transferred to the Middlesex Hospital Medical School very soon. This was a hospital renowned for a
consultant staff serving the Royal Household and providing Presidents for the
Royal Colleges. He worked his
way through the medical school until the finals where he passed the Conjoint
Examination in Obstetrics and Surgery easily but failed in Medicine. He realised that he had to settle
down and started to work. He
tied facts together logically so that he did not have to remember isolated
events but looked for trends that linked them together. In 1896 he passed Medicine with
Distinction and went on to take the London MB in all parts and again he
gained Distinction. He became a
house physician but fell foul of the great Sir Douglas Powell for two reasons. Firstly, he often saw and treated
patients before his superior had arrived at his weekly visit; secondly, his
notes were brief, containing only the relevant facts. His superiors were also to some
extent unhappy about Bonney's popularity as a teacher of students and so when
he applied to become a Senior House Officer at the Brompton Hospital he was
unsuccessful for his two previous chiefs had blackballed him. He applied back at the Middlesex for
a medical post but again was not supported. It was probably a chance meeting
with the great gynaecologist Sir John Bland Sutton in the corridor of the
Middlesex that led to Bonney taking up a career in gynaecology. Sir John enquired about his old
student's career and, on hearing the story, he is alleged to have said 'We
want a House Surgeon at Chelsea, the job is vacant. I will see you get it if you apply'. This is a little different from the
processes doctors have to go through to get into jobs these days. A resident's post at Chelsea Hospital
was followed by one at Queen Charlotte's and he then returned a year
later to be a Registrar at Chelsea Hospital. He became Outpatient Gynaecologist in 1903 to that
hospital and a Registrar in the subject at the Middlesex. In 1905, he married Annie Appleyard, a Tasmanian nurse who
was a sister at Chelsea Hospital.
He met her, wooed her and married her but sadly within two years of this
marriage Annie had menorrhagia severe enough to drop her haemoglobin
critically. After much
consideration it was agreed that she should have a hysterectomy at the
Middlesex Hospital. This was
done and a single fibroid was found at the fundus. It was the end of the Bonney's hopes of a family and
Victor always remembered this.
It turned his mind towards conservative surgery for benign conditions
of the uterus and ovary and influenced his whole career. In 1907 he became
an Assistant Gynaecological Surgeon but still did not have any inpatient beds - but
two years later Bonney became a full gynaecologist at the Middlesex Hospital
and in 1913 filled the same post at Chelsea Hospital for Women. The great professional achievement
was surgery for carcinoma of the cervix. He, along with Comyns Berkeley pioneered this operation in
Britain and the Empire. The
Wertheim hysterectomy was not popular in this country for it was a very
difficult operation but Bonney mastered it. He by now was in the full flood of his work, rising early
in the day, writing before breakfast sometimes walking across the park from
his home in Harley Street to Chelsea Hospital. He would consult in the hospital all day and in the later
afternoon see private patients.
In the early evening he would do research and write. Bonney was not however a dull
man, He was a very sharp dresser, always in dark suits with a fresh carnation
in his buttonhole each day of the year.
He and Annie always dressed and dined formally in their home even
though they were alone and afterwards would often go out to a night club to
dance for a few hours for they were both extremely good sleek dancers. He had the habit of calling everyone
(male and female) 'Darling' which was endearing to some but irritated others
and was frankly astonishing when some six foot Australian gynaecologist met
him for the first time and was addressed as 'Darling'. Bonney drove smart cars around London
and as his practice grew, he acquired two chauffeurs; his total staff was
thirteen at home including his secretaries and he worked them all hard. When the First World War started,
Bonney went to the War Office to volunteer but was told rather briskly that
gynaecologists were not required, and rather rudely reminded that 'the days
of Amazons had passed'. He and
Comyns Berkeley spent the war running the convalescent home of the Middlesex
Hospital down at Clacton-on-Sea. They would go there turn and turn about, three days each
working in London or down at Clacton.
Whilst at Clacton they were the only Medical Officers so performed all
sorts of duties from taking X-rays to doing major abdominal and thoracic
surgery.
Bonney working the x-ray machine at Clacton In addition they treated trench
fever, gassed soldiers, burns and over four thousand cases of gunshot
wounds. The journey was done
after dark, trains were irregular and cold. This journey, twice a week through four long years, must
have taxed Bonney. He still kept his work going on
the other three days at the Middlesex and Chelsea Hospitals both in cancer
and in conservative surgery. It
must be remembered that when Bonney was at his height there were no antibiotics
so antisepsis had to be strict, hence the invention of Bonney Blue. Further, there was little organised
blood transfusion available and so blood had to be conserved even on the
major Wertheim operations.
Anaesthesia
was not as developed as it is now and Bonney got through an
enormous load, much of it in private in the homes of the rich in London. He would have two operating teams and
two motor cars, leapfrogging from one to another allowing him to arrive and
depart promptly so performing up to four major operations in a morning in
four different sites.
Bonney Operating. Note the steep tilt of the table As mentioned previously, his work
on conservative gynaecological surgery is one of his memorials. He believed strongly that fibroids
should be removed, shelled out from the uterus of the women who were of
childbearing age, leaving the organ behind. The old arguments that the uterus would be useless after
such surgery he proved wrong and by the invention of his myomectory clamp,
the symbol of the Victor Bonney Society, he was able to control blood flow to
and from the uterus. This gave
him a bloodless field and he would remove many fibroids with a single
incision, always in the anterior wall of the uterus.
Bonney's myomectomy clamp to cut off the uterine blood supply while he performed a myomectomy (Left).
Application of myomectomy
clamp (Right). . By the same token, ovarian
surgery was influenced by Bonney's conservative attitude. Benign tumours of the ovaries were
displaced from the organ leaving a shell of active ovarian tissue, which he
would restore, by buckling up the cavity with a continuous suture and another
is used to bring the edges together.
This restores a working ovary, producing both oocytes and
hormones. His work on cancer of the
cervix has probably overshadowed much of the conservative surgery for he
performed over seven hundred Wertheim hysterectomies in his life with very
low death rates bearing in mind the conditions under which he was operating. He was a meticulous surgeon for he
had learned his anatomy well and he always searched the area for nodes,
dissecting boldly but carefully. Between the Wars, Bonney's reputation rose
and he was invited to lecture in other parts of the world, he enjoyed this
for he was a gregarious man.
However, he did not like operating in strange operating theatres for
on one occasion this was associated with a death in New Zealand, which
haunted him.
In the late 1920s London only had two Royal Colleges in
medicine, that of Physicians then in Trafalgar Square and the second of
Surgeons in Lincoln's Inn Fields.
Blair Bell, an obstetrician from Liverpool and Fletcher Shaw from
Manchester conceived the idea of starting a college for obstetricians and gynaecologists. All the eminent were asked to become
Founder Members. Bonney, who by
this time was on the Council of the Royal College of Surgeons, refused. He was sure that such a college would
be neither fish nor fowl and would dilute the effort of gynaecology in
surgery. He felt that the right
place for gynaecologists was in the Royal College of Surgeons. After much internicene college
bickering, the College of Obstetricians and Gynaecologists was founded in
1929. Bonney, to his eternal
credit, never spoke out publicly against his colleagues of the new
college. After the WWII he
accepted an Honorary Fellowship of the, by then, Royal College of
Obstetricians and Gynaecologists.
He had fought a long fight to keep gynaecology as a sub-speciality of
surgery but the bond with obstetrics was too strong and since then the main
subject of obstetrics and gynaecology has blossomed. It is interesting that since Bonney's
time sub-specialities have developed in the RCOG and it may be that
gynaecology will separate from obstetrics in the future.
Bonney and his wife, Annie, at a wedding in 1926 As the years passed, Bonney did
not seem to age. He still had
enormously long operating lists, travelling round London performing dexterous
surgery. He retired from his two
teaching hospitals in London in the late 1930s aiming to live quietly in his
home, Seabournes, on the River Wye.
The Second World War however intervened and he came back to do a locum
at Hereford Hospital for the whole of the War to release a younger man to go
to the armed services.
Bonney's last home, overlooking the River Wye After the Second World War Bonney
recognised that his operating skills were diminishing. He led a quiet life in Wye with many
visitors from all around the world.
In 1949 he was fêted at Guest of Honour at a conference on malignancy
in Newcastle and gave his last scientific paper there. He had a coronary thrombosis in 1953
at his home after developing a chest infection, and was transferred to the
Middlesex Hospital where, after a cerebrovascular accident, he died on July 4th
of that year. He was buried at
Putney Vale Cemetery next to his father.
RECOMMENDED READING (1) Bonney V (1911) A TEXTBOOK OF GYNAECOLOGICAL SURGERY.
Cassell & Company Ltd, London.
(2) Bonney V
(1946) EXTENDED MYOMECTOMY AND OVARIAN CYSTECTOMY Bonney's fuller account of his views and experience of conservative
surgery. (3) Bonney V
(1949) WERTHIEM'S OPERATION IN RETROSPECT
Lancet I 637-639 A brief review of Bonney's defence of the operation and his lifetime
results. (4) Chamberlain
G (2000) VICTOR BONNEY. THE
GYNAECOLOGICAL SURGEON OF THE TWENTIETH CENTURY.
Parthenon Publishing Group, Carnford Modesty prevents my commenting on this volume but it is the only biography written about the master's life. I have set it in the context of the changes in the medical world and in national events over eighty years.
It is on sale at the RCOG Bookshop. Kindly written by: Geoffrey
Chamberlain MD FRCS FRCOG Professor Emeritus and Past President
of the Victor Bonney Society |
