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And ladies and gentlemen, may I have your attention, please? A very warm welcome to Bristol. A very warm welcome to this very special event, the 75th anniversary of the formal founding of the Department of Neurological Surgery in, in Bristol at French, a hospital. Um Also a very warm welcome to everyone who's joining us literally from across the world on the live stream. Uh Just a very few housekeeping points um because we are live. Um If you are Barrack ing interrupting or making a useful comment from the floor, please, would you use a microphone? So uh everyone overseas can, can hear us. Um There's gonna be lots of photography at this meeting. The formal photograph will be on the steps of ST George's just before lunch, but the photographer is roving and if any one of you would like group shots, portraits, whatever. Um just just tap him on the shoulder and assemble your group and uh you'll get some lovely professional photography. Um We, it's a very, very full program as you can see, but we are hoping to have a short break mid morning as well as the lunch break. Um Do remember to sign the departmental book. If you've had a look at it, you'll notice that the first signatures in that book are from the formal opening of the neurosurgical theaters in 1953. And we've got meetings ever since then up to date. Um So when I came to French, a hospital which was uh just over 33 years ago, I was greeted by four remarkable characters. Um Hugh Griffith, Brian Cummins, Mike Torrance and Hugh Coke. Um um of course, uh Hugh and Brian long since departed. Um And I'm very sorry to have to say that Annie Cummins who was due to join us uh for this meeting has been detained by medical problems. Um Anne, when you watch this, you might be watching it on the live stream, but you may watch the video later. Um I hope you will not mind me referring to you as the matriarch of Bristol neurosurgery. We're very sorry to miss you and I think we all send our very best wishes for a speedy recovery. Um So, on the other hand, I'm very pleased to say that there are two of those characters here uh this morning. Um And the first of those is Professor Michael Torrance, uh Mikes come to join us from Athens. Um Whereas, you know, uh he set up his practice after leaving French shortly after I joined. And so it's a very great pleasure to ask uh Mike if he would just say a few uh introductory marks as we get this meeting underway, Mike Torrance. Well, thank you for inviting me. It's great to be back. It's only been 33 years. I didn't leave because he came. Um but uh I suppose, excuse me, I am the senior living neurosurgeon from Bristol, which is rather dubious position to hold because if you're the senior living, you will also be most likely to be the first to depart. But I would like at that point to quote Brian Cummins something he said, I think it was when he came back from Kilimanjaro, he said, I don't care what happens. I've lived two lives and I'm happy with it and I have done the same. I'm pleased to say I've lived two lives too and I'm very happy with it. But the first part of my life with French and we're celebrating Bristol neurosurgery and it's anniversary 75 60 75 years. I'm sorry. So I thought, you know, I must say something profound. So uh the only profound thing that I could think of was my profound. Thanks for the opportunity to work at French for the enormous experience that I got from this environment in the two decades, 23 years. Actually, I was associated with French neurosurgery. Now, Bristol neurosurgery, the question is, or one question why was Frenchy then so special? Um And there are three things that came to my mind, particularly. The first was the physical layout which I'll tell you one or two short words about. The second of course, was the people uh in any environment, people make the difference. But the third was the Burden Institute which seems to have become neglected. The burden was internationally recognized and famous and some of the glow that the burden had internationally, I think rubbed off on French over the years. The layer topography of the department was the legacy of George Alexander. And there are let copies of letters between him and Norman Dato. I hope the name is familiar to you in Edinburgh in relationship to the foundation of an Institute of Neurosurgical Sciences. And although it never had that name, that is in fact what George Alexander left when he retired in 1968. And Hugh Griffith took his place from the Central Neuro Theatre at French A which was designed in fact or not designed as an architect that designed in concept by George Alexander. Everything was within about 50 m of the coffee room in the theater and this was before there were pages even for communication. So everybody was there, everybody was nearby, you could go out of the door and somebody would be there that you wanted to tell something to. This was an extraordinary family environment that worked very dedicated nurses in the theater. You didn't have to speak to them, even if you don't want to put your hand out, the right instrument was put in it slap that and you went on and I knew exactly what was going to happen. And I must mention the boys, those of you remember the boys, they were operation theater assistants who knew exactly how everything worked, everything around, everything went together. And they certainly knew more sometimes than some of the young doctors. Me, for example, when I was there, uh the boys would, for, they would anesthetize a neonate with a pillow stuffed with the cotton ball soaked in whiskey while I took with localized that it closed a Meningomyelocele things probably don't do very much now. I don't know they were an enormous part of the character of the Neuro Theatre. And within that 50 m from the Neuro Theatre was Betty Brown, Els New neuropathology department, all the secretaries, all the records, the outpatients department, ct scan er isotopes, Kanner neuroradiology, all awards with sisters like Rose ironical in charge who again knew more than the shos and guided them gently through the process of learning neurosurgery. And this continuity was I think fundamental of the way French it worked in the late 19 sixties. The organization of that contiguity became rather like the Oxford style Pennybacker style because quite a proportion of the doctors who came including Betty Brownell and Gordon Thompson in neuro radiology. And in the decades of the seventies and eighties, half of the neurosurgeon know surgical dance came through Oxford. But we had the advantage of Oxford of continuity and space and mm, well, we had joint meetings and slowly, slowly we came to their level and even maybe above neurology also was nearby. The burden had an influence through the unit that has medical physics. It's always useful to have medical physics in your department because they begin or began then to run things. Neurophysiology was there as well. The ICP recording lab that started in the 19 sixties all together. But I suppose I should also say the people, the neurosurgeons were before me were remarkable. Doug Phillips, New Zealander had enormous, tremendous intuition. He, he knew how things would go. He always got it right? Uh It was almost miraculous, right? When I observed how he went about things, he did lose his temper sometimes. But anyway, he was an intuitive neurosurgeon. Then Alan Hume uh Scott, intellectual scientific Scott. He was the one who started the integration monitoring projects and he had an analytical approach to his patient's rather than an intuitive approach. So he was intellectual, Hugh Griffith was the ideas man. He had vision and inspiration. He was my patron, my mentor and my friend and I'm sure people will talk about him a lot because he came at the turning point of French able and uh the beginning of changing from being average neurosurgical department to becoming, I think, I hope you will agree became and remains world class. So Brian Cummins, Brian had ingenuity. He was a very practical person who always found solutions to the problem. He would make a spinal prosthesis in his garage at the weekend and planted on Monday and the patient. These four pillars of neurosurgery, intuition, intellect, inspiration and ingenuity based obviously on uh very good training, immense experience, dexterity of of manual and intellectual. This I believe is what made the difference at that time to French. And it became a place where people seem to want to work and want to train and want to visit. And by the end of the two decades that I worked there, it was indeed very different place. I was very, very grateful that I was able to join this team and we did do it our way. Perhaps this was creatives and progressive and uh perhaps also it was arrogant and arrogance can be dangerous. Perhaps it was all of those things. If we had a new problem, then we designed a new operation. If we wanted some new equipment and the state would provide it. We found the way of providing it. If we wanted somebody to work with us, we said we want that person to work with us and we appointed them. Some people get rather annoyed about that, but it seemed to work and we had a healthy disrespect for uh study, leave, regulations and restrictions and all travel the world extensively, not friends, all around the world. Um In fact, we almost had a part of the world that we were connected with, which brought people in. I was particularly connected with Scandinavia. I don't claim that this was the best possible way of practice, but I do feel it was appropriate for that particular time. And as I said, it may be the reason why there was a change between just doing the work and becoming uh internationally recognized center. And lastly, very briefly, maybe that was one of the reasons that I decided to leave. I saw a future that would be different and when, which I would not be able to work happily. So I went somewhere and as in the script of life, I tried to reproduce French a in a foreign climb. I thought it would take five years or so. No problem. It took 15. But after 15, we were, I think equipped both by experience and by certainly equipment with virtually any other center in Europe. Uh For example, we had both spinal and cerebral radio surgery, DBS unit, skull base unit, uh designated design, not designed, designated vascular surgeon who did all the embolization himself. It was not done by a neuro radiologists. So maybe I succeeded. Well, I would have to say I succeeded, wouldn't I? Otherwise it would have been inappropriate? But I do now look forward to learning what happened after I left because I did not for deliberate reasons. I did not return very often to Britain and I will continue to live in Greece. And I also, I'm very interested and this is in absolutely no way at all. Criticism. I'm interested in learning and why it needs 20 neurosurgeons now to do what we did with four, of course, demographics change, of course, the disease profiles of change. Of course, you've invested new disease treat, but I'm interested to know how neurosurgery works and I will spend the rest of the day listening to all of you with great pleasure because I don't have anything else to say. Thank you very much indeed. Uh Mike, thank you very much indeed. And and now to uh the fourth member of that quartet who uh greeted me uh French a 33 years ago, Professor Hugh Coke. Um Thank, thank you, Richard. Thank you Michel for a very clear picture of the, of the feeling which was engendered in the old French hospital. Uh I had some of the happiest years of my professional life there. Now, just a quick uh he reminded me with a quote from our dear friend, the late Brian Cummins when he was really quite ill. Towards the end, I went to see him in hospital and he looked over my shoulder and said either that wallpaper goes or I do so, that was Brian. He joked, joked until the very end. Now, I'm delighted to be associated with hospital that internationally has become a brand name. I think there's no doubt about that if I went to any meeting anywhere in the world people would round on me, they wouldn't notice my name on my badge. They would say French hospital to me. So, French French French and I would, I would, I would be interested if it would be possible for the present team to take the name French in some way to South, made the French Institute of whatever you want to call it. They've done exactly the same in, um, Atkinson Morley taken to ST George's and they've done exactly the same in the Walton taken to physically in Liverpool. So you wouldn't want to call anything for exactly neurosurgery, would you anyway. But, so there we go. Just a thought. Just a thought. Now I'm going to limit my talk entirely to French a hospital, I'm afraid because I, I retired weight well, before the date of salad need, but I have an absolutely splendid time there. And, um, just to review the history, it was originally French a park in North Bristol with, with a rather fine ancient mansion there which still is still standing. It's great to listed. And, um, soon after that in the 19 twenties, the first medical input took place which was, uh, sort of tuberculous children's pediatric hospital with a little bit of orthopedics thrown in, partly based in the old house and partly in, in a few new wards that had been built. So that, that was the medical beginnings. Then there was fear of a war in 1938 39. And at that stage, the are dear friends from America. But we're, we have quite a few here. So welcome Americans, but we welcome them, actually cry. Sorry. We, we, we welcome them in the early days in 38 39. And they came to have a look at the site and they began to plan a military hospital for the American Forces, which was actually designed by the Americans, but built by the Brits. And it was completed in 1943. And I can show you what is probably the earliest, the earliest photograph. No, that's the second, that, that is actually the second one. Sorry. Hold on there. We are the, the, the earliest photograph there. Not, not a great picture taken from the air. I hope they had the bomb doors closed. But you can see it's a typical military hospital and it's pretty much remained like that. Oh, sorry. Um, I want to go back one please. Where do I point this? Yeah. No address. It's going to back. Yeah, just one. Yeah. Ok. Anyway, now this is actually from, from the cover of a book, but this is 1983 which is pretty much what it was like when I arrived in 1980. And it's, it's quite a good book if anybody's interested in researching the history a bit more. Um, by James James Briggs who was a histopathologist in French. Uh, the, yeah, the, the neurosurgery section was, you've you've heard Michael Torrance describe how integrated neurosurgery was. It was beautifully preplanned and it was, it was all down here, neuro radiology laboratories, etcetera, etcetera. And then here quite close by were three neurosurgical adult boards. And at that time, there was a pediatric ward which was a little bit further away, which is unsatisfactory and we put that write a bit later on and made it all more integrated. So that's how it looked. Where do I point this anywhere towards you? I want to change the slide. I'm pressing the right one. Okay. There we go. So Michael has mentioned the characters and uh so here, here are the faces. Um First of all, our founding father who was George Alexander came from training under a famous man in Edinburgh called Norman dot And guess what Norman dot was a pupil of Harvey Cushing. So we're only about 22 generations away. Uh He, he did a lot of the, a lot of the planning of the geography of neurosurgery. Thank, thank goodness for him, Douglas Phillips from New Zealand, who you've heard about and Alan Hume, who's a Scott. And then, um then there was myself later on following Brian Cummins, Hugh Griffiths and Michael Torrance, looking handsome and younger. And then I was followed by another important young man that I think you've recognized, which is Richard Nelson, David Sanderman, Stephen Gill and Ian Poeple, who's, who's with us today? Thank goodness. So, uh so I was lucky enough to be followed by what I can. What identical? The younger neurosurgeons. Welcome. You're welcome younger neurosurgeons. I can see them all on the table here. Um Nitin Nitin Patel Crispin Whitfield, Richard Edwards. Uh now Madison. Oh, in poeple again. Medicine Michael from Memphis, Tennessee. Uh We had a fantastic relationship with Memphis Tennessee, which began many years ago before I arrived. Thanks to the friendship between Hugh Griffiths and gosh, just forgotten his name. Yeah. JJT Professor JT Robertson. That's right. That's right. Um And uh we subsequently, we, we exchanged registrars, which was absolutely great. We did an awful lot of learning in both directions up that way and uh we were so lucky. Um Then up here, up here we have Nik Patel and um sorry, Richard. That's right, sir, Richard. Um And sorry. Yeah. Yeah. And these, these two guys, they were, they were, they, they're holding certificates presented to them for the best presentations at the A NS meeting in America, I think in New Orleans it doesn't seem to change. Okay, thanks. Thanks, thanks. Well, I was, I was taken on in 1980 largely because I had a research background and as some of, you know, that was in, in basically neuroimmunology. And um I was lucky enough to do my medical initial medical training at um UCH in London. Um and I, I managed to spend a year in a laboratory and he started tinkering around with tissue cultured glial cells and glioma cells and all that sort of thing and, and making antibodies. This was well before monoclonal antibodies have been developed, this was we were using rabbit antiserum by immunizing rabbits. And during, during using this method, I was lucky enough to discover that human astrocytoma has had a specific tumor antigen on their surfaces. And luckily, I was able to publish this in in nature in 1970 for um I was subsequently invited to the States to the in 1970 for to to North Carolina to the first world meeting of brain tumor immunology. For goodness sake. And I was, I was asked to give the key address for goodness sake. So, and when I stepped off the airplane, I was, I had a welcome committee and shook hands and introduced ourselves. And one of them said, geez, you're so young. So I was, I was lucky indeed this lead eventually to a fellowship at Harvard based in the Massachusetts General. And um that went extremely well and we, we did, we did more work on brain tumor immunology and by that time monoclonal antibodies, thank goodness, we're just about coming in. So by the time I got to French, eh I teamed up with a London scientist from the Imperial Cancer Research Fund, which is now Cancer Research UK. He called John came shed and he eventually came up to join me in Bristol where the Imperial Cancer Research Fund of the day actually built a laboratory for about 25 scientists and other workers. Um, we had great difficulty planning, planning. It, we had very little help from the senior management of French. Eh, eh, in building what should have been, you know, a supreme advance and eventually it was dear dear Annie Cummins, Brian Cummings wife, who, who we hope would have been here today, who helped. She was on the board of the hospital and she actually said, look for Christ's sake, let's put it on the junior doctors, tennis court's which, which didn't go down very well with the junior doctors. And I think I was asked by the, by the senior management of the day to pay the junior doctors 1000 lbs from my research fund. So that's not, not quite what research is for. Anyway, the lab got built and we all started working away and we trained a lot of fellows and many of them are consultants all around the country now. So, um these are my early days of French A. Um as I mentioned, I was lucky enough to, to have 11 paper in nature. And this is the second paper we found quite fortuitously that a monoclonal antibody which had been made against human t lymphocytes. We were, we were just tinkering around one day and found that it specifically stained one cell of the mammalian nervous system, which was the park in the cell and not only did it stay in the park in the cells. But, but the, the journal nature actually put us on the front cover, which is a bit like ending up in on the front cover of Playboy or something in, in scientific terms. Right. Um, now I always used to tell the registrar's whenever possible, try to travel to another, another country, trying to use a good department and go and see some good surgery and then you can bring the, bring the technical tricks back home again, which is what I did. And I was lucky enough quite early on to bump into uh a man who became a good friend who some of you already know uh Taka Fukushima, who that initially was in Tokyo. And in fact, I used to go and visit him, don't tell the management, but I used to take sabbaticals, but about twice a year and I used to, I used to be his first assistant and he was so good. He would travel around the whole of Japan doing difficult cases for his friends. They weren't obviously emergencies, they were, you know, meningioma skull base and all that sort of thing. And so I learned a hell of a lot from Taka uh particularly microvascular decompression, which I brought back home to Bristol. And um we had quite a good business eventually in that. Now, one more thing to say before we go on to the final slide that is um dear Bryan Cummins, was, I believe the first person to devise a well functioning cervical joint. And, and this is it, and guess what it was, it was made, it was actually actually made by the engineering department which we created in French, a hospital. So it was local, made stainless steel and later on it was, it was perfected and re engineered by Steve Gill Rick Nelson, various other people and it became the prestige joint, which is obviously sold by Medtronic all around the world. Oh Bugger. Here we go. Uh Can we get the next? Is it not okay? Oh, great, great, great, great, good. So this is, this is the penultimate slide and I sort of created this, I think when we had our clothes closure of French A in 2014, I made this poster and as we can see here, um This was a quote from the American Journal Neurosurgery. And there's the reference we were described as a world renowned center. And that was a paper actually written about Brian Cummings by two consultants from the Royal London Hospital. By that time, dear Brian had had passed, passed away from his, from his cancer. And at that time before then in 4000 and something I've just forgotten a day. But he, he was the first person in the world to measure human intracranial pressure in ambulance people. And he did it while they were climbing up a mountain in the, in the Himalayas extraordinarily, this is probably not quite aware of this, but in 19 Patel's book, he's got some, some plates taken from the original paper that these chaps wrote of our Brian after Brian had deceased. Of course, Brian was always too busy to put pen to paper, I'm afraid, but this was written, this was written about his work. Um Finally, you're going to hear from Katie Gilkes about MS Diana Beck, who was the possibly, possibly capable Librate this but possibly one of the first female neurosurgeons in the modern world. And she, she practiced before neurosurgery was set up under the NHS at French. Where was she, she was at the Burden Neurological Institute, I think in the late late thirties. Um And that was the other side of what is now the N 32 in Stoke place called Stoke Park. It was built to support and research into mental illness because there were thousands of mental patients' incarcerated in the Stoke Park colony, which has now become a, which then became a stately home and is now a block of flats and they weren't, they weren't actually put there to do any neurosurgery, but there was a neuro theater there apparently just in case and it was there. I believe that um that um Diana Beck started to operate, but you'll be hearing about that a bit later. Um You'll be hearing from Mick Powell about the Hugh Griffiths neuro neuro endoscopy work. So I won't go into the details of that. Um I arrived in 19 eighties and in February 1980 I actually did I have to blow my own trumpet and say I did the first trans natal nasal pituitary operation. Where did I, how did I come across this? I learned it in Boston when I was doing a fellowship, I was taken by a fellow resident Bob March Tusa. I think some of you Americans will know Bob Marchesa. He said come over to Beth, come over to Beth Israel, Hugh. They're doing trans nasals over there. So that's what I did. And I saw a youngest neurosurgeon called Richard Berglund do the first trans nasal. Who was, it was a fantastic experience. And I thought cranky, this is quite easy. In fact, it was so easy. I slightly, slightly lost interest and Hugh dear Hugh Griffith took over because he had the big pituitary practice of the time. So, um I won't go into this too much more because I've already told you a little about this. We published a paper with Betty Brownell, the neuropathologist too to prove that we could improve the diagnosis of um human brain tumor's and CSF malignant cells. We can, we can improve the diagnosis of solid humans by 20% and CSF diagnosis by 80%. And this is what this is all been published. Um We mentioned Brian Dear Brian's joint and we mustn't forget, image guided neurosurgery, Hugh Griffiths and I saw this in a double A Ns New Orleans meeting. Uh There was a huge crowd of people around this display and we've pushed ourself, pushed our way through, you know, rugby fashion, through the, through the crowd and saw and saw the first thing called a viewing wand, which has now been adapted obviously in sophisticated in many ways. But we had the first, the first viewing wand um outside of, of North America, I think they had three or four in North America at the time. So we were possibly number five. And um David Sanderman took over and it became a teaching center for the rest of the world. Basically that is outside of America. Of course, Hugh Griffith set up the British Journal of neurosurgery, um uh edited by Michael Torrance and finally, in the eighties, um Steve Gill did his wonderful work on Parkins disease disease and got a uh at least at least another one nature application out of this. Thank, thank you, Stephen. Uh Not to mention the neurosurgical robot. Um He might tell you later if, how this is still going and, and if it still exists. So I think I've probably said enough and it's doing this talk is, is brought back so many happy memories. It's, it's actually lightened by spirit because prior to having my, my ethos lightened like this, I used to be a little bit. My friends used to describe me as statistics broken down by Asian sex. Thank you.