George Grey Turner, 1877-195 1 time he had been-doing the right thing even. for the wrong reason-and possibly helping his patients to survive. Malignant epithelial tumours rarely develop in ectopic bladders, which themselves are uncommon. Grey Turner himself saw only one such malignant case. He was never in a hurry to excise the bladder after transplanting the ureters and was prepared to wait months or even years. One of his patients, the last whose ureters he transplanted and whose bladder I subsequently excised, developed a fatal malignant tumour at the site of the ureterocolic anastomnoses about i8 years later at the age of 20. The growth extended up into one of
307
the kidneys, both of which were atrophic and infected. Although Grey Turner's ureteric transplantations were conceived for congenital abnormalities, in the last decade of his life he recognised that the operation had a place in the management of some patients with acquired conditions and he never failed to encourage his successors to accept the challenges which they evoked6. I consider it was a great privilege to have known Professor George Grey Turner and to have been with you today to pay tribute to that distinguished master surgeon.
THE MIDDLE YEARS H G Hanley CBE
MD
FRCS
House Surgeon to Grey Turner at Hammersmith, I937-38; subsequently Consultant Urologist to St Peter's and St Paul's Hospitals, Dean of the Institute of Urology, and Dean of the Institute of Basic Medical Sciences, Royal College of Surgeons of England
It is a privilege for me to talk about George Grey Turner because he made a great impression on me as a young man. I was one of his first house surgeons here and I quickly recognised in him the absolute master surgeon. I had actually seen two ureterocolic anastomoses before I came here, but my interest in the problem was really aroused by Grey Turner and I saw him perform the operation three times. He was a pioneer par excellence and it took considerable courage to persevere for over 20 years, in the face of considerable opposition, with an operation which he thought was good. Although he was no physiologist, he repeatedly stressed three very important principles. First, he said that the eventual treatment of most diseases would be by some form of 'haemotherapy'-not by X-rays and not by the surgeon's knife. And he was, of course, much impressed by the development of Prontosil in Germany and later by penicillin. Previously we had had nothing that would sterilise the urine. Second, he was very keen on giving intravenous infusions of glucose-'a little sugar, doctor'-to patients undergoing major operations. Third, he told us repeatedly that the postoperative toxicity after ureterocolic anasto-
mosis was due to some alteration in the blood chemistry caused by the absorption of urine from the bowel. He was nearly there, wasn't he? I have stressed these three pints because they are relevant to our approach to urinary diversions in the years 1938-56. Until then the operations were hazardous, with a high operative mortality and a relatively toxic existence afterwards. Only a minority of the patients felt really well. Nevertheless, Grey Turner pinpointed the problems and the changes which were to corne, and these have since made the operation safe. These were: (i) the appreciation of some disturbance in blood chemistry (the term 'hyperchloraemic acidosis' had not been invented); (2) the value of an effective urinary antiseptic; (3) properly balanced administration of fluid; (4) the avoidance of paralytic ileus, with a tube in the stomach if necessary; and (5) the admission that the Coffey-Stiles-Grey Turner operation was imperfect because it leaked and tendeed to stenose. He was very conscious of its defects, but, as he said, it was the best that he had tried. The beginning of the new era in urinary diversion came in I948 with the introduction
308
George Grey Turner, i877-I95I
of the mucosa-to-mucosa anastomosis of bowel and ureter by Reed Nesbit7*. This was modified by Cordonnier in I 9508 and by Leadbetter in 195I9. These technical advances coincided with two majoir developments in medicine. and surgery in general, the introduction of drugs which would kill bacteria in the kidney and the understanding and control of hyperchloraemic acidosis. Despite these real advances in ureterocolic anastomosis we were told at a meeting of the British Association of Urological Surgeons (BAUS) that the operation was finished and that the construction of ileal and colonic loops and rectal bladders were the operations of the future. The advocates of these procedures were eminent and persuasive surgeons, and Charles Wells'0 in particular reported excellent results with the ileal loop. The BAUS then requested Arthur Jacobs and Barr Stirling to review the results of ureterocolic anastomoses performed by British surgeons, and in I952 they published a collective review of I637 patients". These were largely of the Coffey or Grey Turner type and few of them had been done by urologists. The overall operative mortality was 2i
307
the kidneys, both of which were atrophic and infected. Although Grey Turner's ureteric transplantations were conceived for congenital abnormalities, in the last decade of his life he recognised that the operation had a place in the management of some patients with acquired conditions and he never failed to encourage his successors to accept the challenges which they evoked6. I consider it was a great privilege to have known Professor George Grey Turner and to have been with you today to pay tribute to that distinguished master surgeon.
THE MIDDLE YEARS H G Hanley CBE
MD
FRCS
House Surgeon to Grey Turner at Hammersmith, I937-38; subsequently Consultant Urologist to St Peter's and St Paul's Hospitals, Dean of the Institute of Urology, and Dean of the Institute of Basic Medical Sciences, Royal College of Surgeons of England
It is a privilege for me to talk about George Grey Turner because he made a great impression on me as a young man. I was one of his first house surgeons here and I quickly recognised in him the absolute master surgeon. I had actually seen two ureterocolic anastomoses before I came here, but my interest in the problem was really aroused by Grey Turner and I saw him perform the operation three times. He was a pioneer par excellence and it took considerable courage to persevere for over 20 years, in the face of considerable opposition, with an operation which he thought was good. Although he was no physiologist, he repeatedly stressed three very important principles. First, he said that the eventual treatment of most diseases would be by some form of 'haemotherapy'-not by X-rays and not by the surgeon's knife. And he was, of course, much impressed by the development of Prontosil in Germany and later by penicillin. Previously we had had nothing that would sterilise the urine. Second, he was very keen on giving intravenous infusions of glucose-'a little sugar, doctor'-to patients undergoing major operations. Third, he told us repeatedly that the postoperative toxicity after ureterocolic anasto-
mosis was due to some alteration in the blood chemistry caused by the absorption of urine from the bowel. He was nearly there, wasn't he? I have stressed these three pints because they are relevant to our approach to urinary diversions in the years 1938-56. Until then the operations were hazardous, with a high operative mortality and a relatively toxic existence afterwards. Only a minority of the patients felt really well. Nevertheless, Grey Turner pinpointed the problems and the changes which were to corne, and these have since made the operation safe. These were: (i) the appreciation of some disturbance in blood chemistry (the term 'hyperchloraemic acidosis' had not been invented); (2) the value of an effective urinary antiseptic; (3) properly balanced administration of fluid; (4) the avoidance of paralytic ileus, with a tube in the stomach if necessary; and (5) the admission that the Coffey-Stiles-Grey Turner operation was imperfect because it leaked and tendeed to stenose. He was very conscious of its defects, but, as he said, it was the best that he had tried. The beginning of the new era in urinary diversion came in I948 with the introduction
308
George Grey Turner, i877-I95I
of the mucosa-to-mucosa anastomosis of bowel and ureter by Reed Nesbit7*. This was modified by Cordonnier in I 9508 and by Leadbetter in 195I9. These technical advances coincided with two majoir developments in medicine. and surgery in general, the introduction of drugs which would kill bacteria in the kidney and the understanding and control of hyperchloraemic acidosis. Despite these real advances in ureterocolic anastomosis we were told at a meeting of the British Association of Urological Surgeons (BAUS) that the operation was finished and that the construction of ileal and colonic loops and rectal bladders were the operations of the future. The advocates of these procedures were eminent and persuasive surgeons, and Charles Wells'0 in particular reported excellent results with the ileal loop. The BAUS then requested Arthur Jacobs and Barr Stirling to review the results of ureterocolic anastomoses performed by British surgeons, and in I952 they published a collective review of I637 patients". These were largely of the Coffey or Grey Turner type and few of them had been done by urologists. The overall operative mortality was 2i
