Grandes Nomes da Coloproctologia

The life of John Cedric Goligher (1912-1998) revisited

Por: Fábio Guilherme Campos, Sérgio Carlos Nahas, Ivan Cecconello




Early years of a great surgeon

The life of John Cedric Goligher

 

John Cedric Goligher (Figure 1) was born in Londonderry (Northern Ireland) in March 13, 1912. He achieved graduation in 1934 at the University of Edinburgh Medical School, and then served as a house officer at the Royal Infirmary in that city. In 1938, he earned his fellowship in the Royal College of Surgeons in Scotland and England. In 1948, he received his Master of Surgery (CbM) degree from the University of Edinburgh. 1

At the St. Mark's Hospital, he turned to be a first house surgeon and, later, resident surgical officer (RSO) in the early years of the Second World War DCR 1998. Certainly, this period helped him to shape his future career under the influence of famous people in this institution, such as Miles, Naunton-Morgan, Milligan , Lloyd-Davies, Gabriel and Cuthbert Dukes. 2

Later on, Goligher entered the RAMC (Royal Army Medical Corps) in 1941, serving as a surgical specialist in Greece and Italy and achieving the rank of lieutenant colonel. Back to London in 1946, he was appointed honorary assistant surgeon to St Mark's and St Mary's Hospitals from 1947 to 1954. This four decades association with this institution graded him as honorary consultant (later Emeritus) surgeon. 3

Coming to Leeds

For almost two hundred years, Leeds has been considered one of the leading surgical institutions in UK, housing important names such as Fergusson, Mayo and Lord Moynihan. At that time, Leeds had a tremendous reputation for surgical skills, besides little academic activity in surgery (Figure 2). Therefore, on the basis of his distinguished and wealth experience during the War and in London hospitals, Goligher was invited to set up an University Department in 1955, and became Professor of Surgery and Chairman of the University Department of Surgery at the Leeds General Infirmary.

In 1996, he wrote: “since the 1880s there have always been few surgeons who ?devoted special attention to rectal and colonic surgery,?particularly in Britain with exponents such as Salmon, Miles,?Dukes, Lockhart-Mummery, Naunton-Morgan, Milligan and ?Lloyd-Davies. Until lately, the vast bulk of bowel surgery ?remained in the hands of general surgeons, but the past? couple of decades have witnessed a striking change whereby ?colorectal surgery is the chief at traction for many surgeons.4

Within this paper, he commented that in his early years as a consultant at St Mary's and St Mark's Hospitals in London, he was very much a general surgeon, with strong interests not only in colorectal surgery but also in surgery of the stomach and duodenum, and others. He says: However, as my career progressed and I moved to the chair of surgery in Leeds- partly, I may say, in the hope of being better able to maintain my general interests - colorectal surgery came to dominate my practice and I was eventually doing little else. 4

Working in Leeds, he obtained full recognition as a brilliant Professor due to clinical academic career and enormous number of operated patients. During this period, many visitors from all over used to watch him performing live operations through the viewing gallery specially constructed in the operating theater. According to Marvin Corman5, it is no exaggeration to state that his operating theaters have been as Mecca for surgeons from all over the world. The young doctors he trained developed a firm loyalty to his ideas and turned to be leaders in the coloproctology field as they returned home 6 .

He stayed there till 1978 when he became Emeritus Professor, and the Department of Surgery assumed a leading position as a center of academic gastrointestinal surgery 6 .

Scientific contributions

Goligher scientific contributions are unique, and his texts reflect his analytical personality and honesty of reporting. He used to make a critical and methodical evaluation of his clinical data 6. These features helped him conquer a great fame in many countries. He wrote dozens of chapters, scientific papers and books. His main contribution was focused on colorectal surgery, and in this matter he published the Textbook of British Surgery (1956-9), Ulcerative Colitis (1968) and Surgery of the Anus, Rectum and Colon (1961).

One main feature of his books is that Goligher always ensured to present the available modalities of treatment together with his personal advice and the current practice.

One of his greatest works was developed in the field of peptic ulcer disease. He pioneered randomized controlled trials concerning the surgical treatment of peptic ulcer, focusing on the long-term outcome after vagotomy and gastric resections. The Leeds-York series has become the classic controlled trial in ulcer surgery. This and other studies were all accompanied by data produced in his unit. In this context, he wrote about rectal cancer surgery, IBD, anorectal diseases and so on.

Goligher also studied the substitution of pharynx and esophagus in attempts of resection and reconstruction, using the left colon placed in the ante thoracic position. This appears to have replaced most of the methods where anastomosis to the pharynx is required, though others preferred the stomach 7 .

Within the field of inflammatory bowel diseases (IBD), Goligher preferred to perform primary colectomies and proctocolectomies simultaneously with ileostomy instead of three stage operations for chronic cases. He thought this  “procedure could be accomplished without increasing the dangers, contrary to the general believes at that time. 8

With no doubt, his masterpiece is the book Surgery of the Anus, Rectum, and Colon, released in five editions from 1961 to 1984. Having almost all text written by him (except one chapter), the first edition turned to be a world reference for students and young doctors, and deserved translations to Spanish and Italian. Thus, since the beginning, this reference book turned to be the most comprehensive and influential text in the field of coloproctology. 9

The third edition inspired the following words: Professor Goligher textbook is unquestionably the ?most authoritative account of the surgery of the?distal bowel. The third edition, in spite of contributions by others, remains predominantly the?monumental achievement of one man. The author frequently describes his own actions in difficult circumstances while modestly forbearing to claim superior knowledge. It is truly an encyclopedia and has many virtues that stamp it as the outstanding volume in its field. Nearly all such texts in these days are multi-authored. It is a relief to discover an authority that, because of his personal experience, has written 25 of the 27 chapters 10.

Referring to the 4th edition, someone said that it is a pity that every surgical specialty does not have a writer of Professor Goligher experience and authority. 11

In another text concerning the 4th edition, it was written that  anyone who has had the experience of writing a surgical textbook will feel humble when he reads through Professor Goligher classical magnum opus on surgery of the large bowel. Magnificently written, profusely and beautifully illustrated and with extensive and up-to-date bibliographic reviews, it represents undoubtedly the standard source book of information in this field in the English language. Having made these comments, one can only salute an outstanding example of British surgical writing and illustration: this book is the standard by which all other contributions on colorectal surgery must be judged. 12

The last edition also deserved so many compliments. Someone wrote that Professor Goligher textbook was always excellent but this new edition can only be described as superb. It is a "must" for all colorectal surgeons and general surgeons who operate in this area. Even those who already own a copy of an earlier edition should invest in this fifth edition. 13

Emeritus Professor John Goligher has been a leading authority on surgical diseases of the intestine, and his editions of the textbook Surgery of the Anus, Rectum and Colon have been the most lucid, comprehensive, and authoritative expositions of our specialty practice during the past three decades. 14

During his life, he became largely recognized for his numerous contributions to the literature, as he wrote more than 200 papers as sole or first author, what granted him an enormous reputation as a honest investigator. He probably was the most active promulgator of prospective controlled and randomized trials in surgical research 15, dealing with issues such as high ligation of the inferior mesenteric artery, sphincterotomy for anal fissure, single vs. two-layer anastomosis, drainage vs. primary closure of pelvic abscess and other.

Contributions to medical societies and world recognition

Professor JC Goligher participated on the council of The Royal College of England from 1968 to 1980. He was President of the Royal Society of Medicine Section of Proctology, where he was elected to the Roll of Honorary Fellows in 198616 . According to Gordon Robson (President in 1986), he add distinction to the Society 2.

He was also elected President of the Association of Surgeons of Great Britain & Ireland, as well as the British Society of Gastroenterology (1975-76). Moreover, he received many fellowships and doctorates from around the world, including the American College of Surgeons and The American Society of Colon & Rectal Surgeons.2 . All this homages reflected the esteem in which he was held by his professional peers. 6

All this activities put him in great demand as a visiting professor and lecturer in Europe, North America, and UK. He used to manifest a great enthusiasm during his lectures, and his encyclopedic knowledge of the literature made him a formidable participant in scientific meetings.

Personality , death and legacy

John Goligher has received many definitions during his life. Technically,  he was defined as a master surgeon by Marvin Corman, for whom he had “clarity of thinking and expression” 5. He was meticulous, bloodless, anatomic, gentle, efficient, and organized, a master at his work. Personally, he was slim and austere, with a dry humor, insatiable energy (at one time he had five secretaries), erudition and expertise, is a master craftsman, renowned worldwide as an ambassador for Britain in gastroenterological surgery. A shy and somewhat self-effacing man, he was held in affection both by his staff and by his patients 6.

His interests outside medicine included reading, classical music, gastronomy and oenology. He loved cars and loved the sun, and use to go to the south of France and Italy to relax and write 17. Many times he manifested his personal admiration to the persons of Dr Cuthbert Dukes and William Gabriel, who he considered dear friends and ideals of researcher and surgeon.

He has always been considered a great surgeon and a great scientist. Some of his texts revealed his thoughts about ideas that were truly representing himself. In 1984, he wrote: You are all familiar with the often- repeated phrases 'the art and science of surgery' or 'the principles and practice of surgery'. Both these terms imply that there are two sides to surgery on the one hand the operative act (or the skill with which it is performed) and on the other hand, the body of knowledge that underlies or surrounds that act. 18

And he continued: It follows from this definition that a scientific surgeon is, not just a particularly erudite or scholarly surgeon, but one with an enquiring or sceptical turn of mind, who is prepared - nay anxious - to challenge accepted doctrines and formulate original concepts, and to submit both old and new ideas to the test of really stringent scrutiny.

After retirement he established a considerable private practice for many years. He was married with Nancy Williams since 1952, an Australian whom he met when she was an Almoner on his ward at St Mary's. He died of carcinomatosis on January 18, 1998, leaving two daughters, a son and three grandchildren 19 .

Those who have lived with him wrote: he always had something important or at least meaning-full to say. For all of this, he certainly has been greatly missed by his family, friends, and colleagues at home and abroad. Nonetheless, his influence on surgery, and colon and rectal surgery in particular, will remain. 6

References

1. Lives - Goligher, Watkinson, Sircus. Gut. 1987; 28 (Suppl): 32.
2. Robson G. Society News. JRSM 1986; 79: 556-557.
3. Medical News. Brit Med J 1954, p 529.
4. Goligher J. Colorectal surgery as a specialty. JRSM 1996; 89(11): 601–603.
5. Corman, Marvin L. John Cedric Goligher March 13, 1912-January 18, 1998. Dis Colon Rectum 1998; 41(4):522-524.
6. John Cedric Goligher. The Times, 16th February 1998.
7. Goligher JC, Robin IG. Use of the left colon for reconstruction of the pharynx and oesophagus after pharyngectomy. Br J Surg 1954;42:283-90.
8. JC Goligher. Proceedings of the Royal Society of Medicine 1953; 46: 25.
9. Surgery of the Anus, Rectum and Colon. Postgrad Med J. 1980; 56(659): 683.
10. Welch CE. Boston, Massachusetts. Book Reviews , p. 793.
11. Hill GL. Arch Surg 2000; 135: 239.
12. Jones PF. First-class four. Brit Med J 1980; 9: 447.
13. Surgery of the Anus, Rectum and Colon. Ulster Med J. 1984; 53(1): 102.
14. Fazio V. Comments from the editor. Dis Colon Rectum 1997; 40: 735.
15. Evans M, Pollock AV. The inadequacy of published random control trials of antibacterial prophylaxis in colorectal surgery. Dis Colon Rectum 1987; 30: 743-6.
16. Devlin HB. News from the President. JRSM 1979; 79: 556.
17. Badham G. BMJ 1998; 20; 316(7148): 1908.
18. Goligher J. The skeptical chirurgeon. Ann R Coll Surg Engl. 1984; 66(3): 207–210.
19. Losowsky MS. Obituaries: John Cedric Goligher. BMJ 1998; 316: 1909.



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