Hugh William Bell Cairns

Hugh William Bell Cairns was the only son of William Cairns, a timber contractor who had immigrated from Scotland, and Amy Florence, née Bell, an Australian music teacher. He first went to the local government school in Riverton and from 1909 to 1912 attended Adelaide High School, where he was dux and editor of the journal in 1911. He then proceeded to the university with an exhibition.

A student goes to war
At the age of only fifteen and a half years cairns entered the faculty of medicine at Adelaide University. But in 1915 his studies were interrupted when, on May 11, he joined the Australian Medical Corps as a private. From July 30 he served with the X-ray department of the 3rd Australian General Hospital on the Greek island of Lemnos. After Gallipoli had been evacuated his unit was posted to Egypt in January 1916.

In February that year he left for Sydney, where he was discharged to continue his medical training in Adelaide. He completed his medical course at the University of Adelaide and graduated Bachelor of Medicin in 1917. On August 7 he was commissioned as captain, and elected to the South Australian Rhodes scholarship. This enabled him to apply for a place at Balliol College, Oxford.

In 1917 he was commissioned as a medical officer in the Australian Army Medical Corps. He reached England and visited Oxford, where he introduced himself to Arthur Lionel Smith (1850-1924), the Master of Balliol College, and met Sir William Osler (1849-1919) who was the Regius Professor of Medicine at that time. From March 29, 1918 Cairns was posted in France as a General Duty Officer, serving with Australian and British Units.

Peace and love
In January 1919 he obtained leave from the army in order to begin studies at Oxford. He entered Balliol College but also found time for another serious occupation, rowing. He was president of the Balliol Boat Club and distinguished himself by representing Oxford as a bow in the University boat race of 1920. The race was won by Cambridge.

After six months in the Radcliffe Infirmary as house surgeon, he utilized his Rhodes scholarship to begin his long connexion with the London Hospital, first in the pathology institute, then in the surgical unit, becoming F.R.C.S. in 1921.

He was greatly admired by the family of A. L. Smith, the Master of Balliol, and by Lady Sherrington and Lady Osler, through whom he first med Harvey Williams Cushing (1869-1939). While staying with the Smiths at their house in Northumberland he became engaged to their youngest daughter Barbara, a graduate in history from Girton College, Cambridge. They were married in Oxford in November 1921, the day after Cairns passed the first FRCS examination.

Beginning of a career
In March 1921, with the help of his future father-in-law, cairns took up the appointment of House Surgeon to Sir Henry Souttar (1875-1964) at the London Hospital while still being financed by his Rhodes Scholarship. After working for several months in the pathology department he became assistant to the Surgical Unit, and then first assistant to various consultants, notably in urology.

In October 1925 he met Cushing once more. Cairns now planned to work for a year in Boston and to devote his life to neurosurgery. He achieved consultant status in June 1926 by being appointed Honorary Assistant Surgeon to the London Hospital. However, this was unpaid under the voluntary hospital system then existing and, in order to go to America, he needed finance. So he applied to the Rockefeller Foundation for a Fellowship.

Into neuro surgery
Cairns now found that time was ripe for the development of neurosurgery at the London Hospital, and in September 1926 he went to Boston to work for Cushing as Assistant Resident at the Peter Brigham Young Institute in Boston, Massachusetts. Under Cushing's abiding inspiration, he learned the surgical technique, the organisation of a clinic and the system of record collection with which he was to endow generations of his pupils.

On his return to London Hospital towards the end of 1927, Cairns had an assured appointment at the London Hospital but life was not at first financially easy. He determined to adopt the specialist approach to neurosurgery which he had seen in Boston. But his beds were scattered, theatres not easily made available, and nurses and especially radiologists were untrained in the new kind of surgery which was, moreover, unpopular with anaesthetists.

He put forward the principle that private patients, who were the source of income for the staff of voluntary hospitals, should be treated in private wards within the hospital. Both ideas were rejected. However, he did not give up, and in order to promote further specialization, he managed to get help from the Rockefeller Foundation to obtain his own full-time anaesthetist. She was Olive Jones, who later accompanied Cairns to Oxford and worked with him for the rest of his life.

In 1931, he obtained his own First Assistant, with the help of Rockefeller money, enabling him to visit Otfrid Förster (1873-1941) in Breslau, an experience that he greatly valued. In 1835 he revisited Boston and other centres in America, using the occasion to follow up Cushing's tumour patients whom he had known in 1926. These cases formed the basis of several papers on the results of neurosurgery which were published in 1936.

In 1936 the idea came to cairns of establishing a neurosurgical unit at the Radcliffe Infirmary in Oxford, in close association with the University, whose scientific departments offered the possibility of collaborative research. Most noteworthy at this time was the work on the pathology of Menière's syndrome. Cairns had obtained the temporal bones of two patients who had died following surgery and saved them until they could be examined by the otologist Charles Skinner Hallpike (190-1979). This paper has become a classic.

Negotiations and arguments eventually led to the establishment of a Medical School and its Nuffield professorial Department in Oxford. Departments with associated wards and necessary facilities were founded in surgery, medicine, obstetrics and gynaecology, anaesthetics and orthopaedics. Cairns was appointed to the first Nuffield Chair of surgery, with 21 beds and an operating theatre, opened at the Radcliffe Infirmary in 1938.

World War II
By the latter part of 1938, when war seemed inevitable, Cairns, who had been consultant neurosurgeon to the army for several years, was called to the War Office to discuss the provision of neurosurgical services. He arranged for the purchase of neurosurgical instruments for the future needs of the Royal Army Medical Corps (RAMC) and eventually rose to the rank of brigadier. With the cooperation of Sir Edward Farquhar Buzzard (1871-1945), Charles Symonds (1890-1977), consultant neurologist to the Royal Air Force, and George Riddoch (1888-1947), consultant neurologist to the army, created the Combined Services Hospital for Head Injuries at St. Hugh's College, Oxford. Here 'The Nutcrackers Suite' became a neurological unit of first importance. Plans were complete when war was declared in September 1939, and the Hospital opened in February 1940. It became the training school for a generation of neurologists and neurosurgeons and treated no less than 13,000 service men and women in the five years of its existence.

Seven pillars of wisdom and a motor cycle
When Colonel Thomas Edward Lawrence (1888-1935) – Lawrence of Arabia – was fatally injured in a motorcycle accident in May 1935, Cairns was one of the doctors attending him. He was moved by the tragedy in a way that was to have far-reaching consequences. At the beginning of the Second World War there was a devastating number of deaths from head injury among army motorcycle dispatch riders. This caused Cairns to give his attention to providing some means of protection for them. He devised a helmed with a smooth outer shell supported by a lining consisting of a number of webbing slings attached to the base. This was introduced to the armed forces by Cairns in 1941 and brought about an immediate reduction in the mortality and morbidity from head injury.

Cairns realized that, in order to save the lives of the greatest number of soldiers suffering from head wounds, they should be treated in the field by specialist neurosurgical teams. He devised and brought about the formation of eight mobile neurosurgical units. These units treated more than 20,000 patients in North Africa, Italy and the other European theatres of was as well as in India, and their formation was one of Cairn's greatest contributions in the field of military medical care.

In 1943 Cairns began collaboration with his friend Sir Howard Walter Florey (1898-1968) – his successor as Rhodes Scholar from Adelaide, on the use of penicillin. Penicillin had been given preliminary trials and was now to be used in the field. So Cairns and Florey went to Sicily and North Africa to set up a programme for its use by the mobile neurosurgical units. Despite the impurity of the early samples of the drug, the results wee dramatic and were meticulously recorded in the battle zone, even to the extent of measuring concentrations in the blood and cerebrospinal fluid.

In 1945 Florey shared the Nobel Prize in Physiology or Medicine with Sir Alexander Fleming (1881-1955) and Sir Ernst Boris Chain (1906-1979) "for the discovery of penicillin and its curative effect in various infectious diseases".

Peace
Cairns was demobilized in September 1945 and appointed Knight Commander of the Order of the British Empire (KBE) in the following year, but he continued to supervise the patients in the Military Hospital for Head Injuries, which was moved to the Churchill Hospital, Oxford, and then to Wheatley.

Cairns, again working in the Radcliffe Infirmary, developed an interest in the treatment of mental illness. He carried out a series of psychosurgical operations designed to compare the results of different methods, since he was already aware of the need to refine the standard leucotomy operation and supported research into the effects of leucotomy on the personality.

In 1947 he was elected the first Sims Commonwealth professor appointed by the Royal College and given the honorary M.D. of Adelaide. He was an enthusiastic supporter of the medical research soon to begin in the Australian National University.

Cairns was one of the first to be able to spare the facial nerve after complete removal of an acoustic neuroma, a considerable achievement before the advent of microsurgery.

The man and the surgeon
Cairns was aware of his limitations as a surgeon and delegated certain operations to Joseph Buford Pennybacker (1907-1983), while retaining a special interest in pituitary tumours and the removal of meningiomas and acoustic neuromas. He only operated on one aneurysm, and that with some hesitation. He was extremely concentrated when operating and would not tolerate any relaxation during a procedure, which often went on for many hours. Any slackening of attention, real or imagined, would be followed by a firm rebuke, However, Cairns always made up for any harsh words by a well-chosen compliment or other gesture. Nevertheless, if anyone fell short of his criteria, he had no hesitation in dismissing them.

He travelled widely and in his later years administrative and ambassadorial duties stole time from his clinical work, but he remained to the end first and foremost the 'good doctor'. Every patient became Cairns's personal friend for life.

Cairns had an attractive personality combined with infinite drive and dedication. He allowed nothing to stand in his way if he felt that what he was doing was right. He was a man who inspired his colleagues with respect and devotion and who served his patients and the institutions with which he worked with incredible energy and determination. Hugh William Bell Cairns died of cancer in 1952, aged only 56. He left a widow and four children, sons John and David, and daughters Margaret and Elizabeth.

«How does one learn to devote oneself unsparingly to one’s patients? You cannot get this from books or from formal clinical instruction. It is something which is passed on from one generation of doctors to the next, and the easiest way to acquire it is to work with a doctor who already has it in his blood. Lister, for example, was a good doctor: he used to visit his patients in King’s every day, including Sundays, and his eminence and his preoccupation with research did not prevent him from showing great understanding and consideration of their feelings.»
Lancet, 1949; 2: 665.

«Your patients . . . . do not come to you to be cured; they come to be relieved of their pains and other symptoms and to be comforted. Forced to choose, they would usually prefer a kind doctor to an efficient one. Never forget that the patient and his relations are usually frightened and anxious – upset in the normal life to such an extent that they are prepared to call you into their lives and to tell you the most intimate facts about themselves, though you may be unknown to them except as a member of an honourable profession.
Lancet, 1949; 2: 665.

«How does one become a good doctor? When one doctor says of another, "He is a good doctor," the words have a particular meaning. You will hear the expression used not only about some general practitioners, but also about some specialists. As I understand it a good doctor is one who is shrewd in diagnosis and wise treatment; but, more than that, he is a person who never spares himself in the interest of his patients; and in addition he is a man who studies the patient not only as a case but also as an individual. . . . . The good doctor, whether general practitioner or specialist, is also a man who studies the patient’s personality as well as his disease.»
Lancet, 1949; 2: 665.

• H. Cairns:
  Heredity in polycystic disease of the kidneys.
  The Quarterly Journal of Medicine, Oxford, 1925, 18: 359-392.
• H. Cairns:
  A Study of Intracranial Surgery.
  Medical Research Council Special Report No. 125. London: HMSO, 1929.
• H. Cairns:
  Acoustic neurinoma of right cerebello-pontine angle. Complete removal. Spontaneous recovery from post-operative facial palsy.
  Proceedings of the Royal Society of Medicine, London, 1931, 25: 35-40
• H. Cairns:
  Surgical aspects of meningitis. British Medical Journal, London, 1: 969-976.
• C. S. Hallpike and Hugh Cairns.
  Observations on the pathology of Menière's syndrome.
  Proceedings of the Royal Society of Medicine, 1938, 31: 1317-1336.
  Also published in The Journal of Laryngology and Otology, 1938, 53: 625-655.
  Hallpike and Cairns were the first to describe the characteristic histological changes in Menière's disease.
• Richard Charles Oldfield (1909-1972), J. B. Pennybacker and Dacid Whitteridge (1912-1994):
  Akinetic mutism with an epidermoid cyst of the third ventricle.
  Brain, 1941, 64: 273.
• H. Cairns:
  Neurosurgery in the british Army, 1939-1945.
  The British Journal of Surgery, 1947. War Supplement No. 1. Wounds of the Head: 9-26.
• H. Cairns:
  Tuberculous meningitis treated with streptomycin.
  Transactions of the American Neurological Association, New York, 1950: 110-119.
• H. Cairns:
  Mental disorders with tumours of the pons. Folia psychiatrica, neurologica et neurochirurgica Neerlandica, April 1950, 53 (2): 193-203.
• P. Glees, C. W. Whitty, H. Cairns:
  The effects of lesions in the cingular gyrus and adjacent areas in monkeys.
  Journal of Neurology, Neurosurgery and Psychiatry, London, August 1950, 13 (3): 178-190.
• H. Cairns, H. V. Smith, R. L. Vollum:
  Tuberculous meningitis. The Journal of the American Medical Association, Chicago, eptrember 9, 1950, 144 (2): 92-96.
• J. B. Pennybacker, H. Cairns:
  Results in 130 cases of acoustic neurinoma. Journal of Neurology, Neurosurgery and Psychiatry, November 1950, 13 (4): 272-277.
• W. Lewin, H. Cairns:
  Fractures of the sphenoidal sinus with cerebrospinal rhinorrhoea.
  British Medical Journal, January 6, 1951, 1 (4696): 1-6.
• H. Cairns, W. H. Mosberg Jr:
  Colloid cyst of the third ventricle.
  Surgery, Gynecology & Obstetrics, Chicago, May 1951, 92 (5): 545-570.
• H. Cairns, M. A. Davidson:
  Hemispherectomy in the treatment of infantile hemiplegia.
  The Lancet, September 8, 1951, 2 (10): 411-415.
• H. Cairns:
  Neurosurgical methods in the treatment of tuberculous meningitis with a note on some unusual manifestations of the disease.
  Archives of Disease in Childhood, London, October 1951, 26: 373-386.
• H. Cairns:
  [Progress in surgery.] Undetermined Language.
  Deutsches medizinisches Journal, Berlin, February 15, 1952, 3 (3-4): 53-38.
• C. W. Whitty, J. E. Duffield, P. M. Tow, H. Cairns:
  Anterior cingulectomy in the treatment of mental disease.
  The Lancet, March 8, 1952, 1 (10): 475-481.
• H. Cairns:
  Disturbances of consciousness with lesions of the brain stem and diencephalon.
  Brain, June 1952, 75: 109-146.
• H. Cairns, J. Cole, H. G. Epstein, M. Gardner, P. Gleese:
  Temporary depression of cortical function by local anaesthetic and cooling.
  The Journal of Physiology, March 1953, 119 (4): 44P-45P. Biographical:
• Hugh William Bell Cairns.
  The Lancet, July 26, 1952, 2 (4): 202-203. [No authors listed]
• L. C. Lindon:
  Hugh William Bell Cairns.
  The Medical Journal of Australia, August 30, 1952, 2 (9): 325-326.
• E. T. Williams:
  Cairns, Sir Hugh William Bell (1896-1952).
  Australian Dictionary of Biography. Melbourne University Press, 1979, volume 7: 524-525. Information was taken from the online edition.
• Geoffrey. Jefferson:
  Memories of Sir Hugh Cairns (1st Sir Hugh Cairns Memorial Lecture).
  Journal of Neurology, Neurosurgery and Psychiatry, London, 1959, 22: 155-166.
• J. B. Pennybacker:
  Sur Hugh William Bell Cairns, 1896-1952. Surgical Neurology, 1975, 4: 347-350.
• G. J. Fraenkel:
  Hugh Cairns. The First Nuffield professor of Surgery. University of Oxford.
  Oxford, Oxford University Press, 1991.
• Peter H. Schurr:
  The contribution ot neurosurgery of the Combined Services Hospital for Head Injuries at St. Hugh's College Oxford, 1940-1945.
  Journal of the Royal Army Medical Corps, London, 1988, 134: 146-148.
• Peter H. Schurr:
  The Cairns Tradition (12th Sir Hugh Cairns Memorial Lecture).
  Journal of Neurology, Neurosurgery and Psychiatry, 1990, 53: 188-193.
• Peter H. Schurr:
  Sir Hugh Cairns KBE MD FRCS (1896-1952).
  Journal of Medical Biography, 1993, 1 (4): 202-206.
• Nicholas F. Maartens, Andrew D. Wills, Christopher B. T. Adams:
  Lawrence of Arabia, Sir Hugh Cairns, and the Origin of Motorcycle Helmets.
  Neurosurgery, January 2002, 50 (1): 176-180.