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John O'Connell—Man of Barts
270
Surg Neurol 1990;34:269-70
disease. The place of anticoagulation is also reviewed from this perspective. Also unique to this volume and the perspective of the authors is the emphasis on the importance of neurovascular evaluation of the patient with manifest coronary artery disease, and of cardiovascular evaluation of the patient with transient ischemic attack or stroke in both the outpatient setting and in the setting of acute symptomatic events leading to hospitalization. The text is well written, the illustrations are clear, and each chapter is followed by a summary and thorough bibliography. The only weakness of the book proceeds from its strength: because the topic chosen is so broad, some subjects must be covered in an abbreviated form to accommodate a volume of this size. For example, anatomy of stroke and localization of stroke are covered in only four pages, and clinical evaluation of cerebral vascular disease, including physical examination, is covered in three pages. On the other hand, it may be assumed that persons reading this book will have expertise in clinical examination, and the book is not meant as a substitute for a textbook of cardiology or neurology. It is likely that the new discipline represented by this text will grow exponentially in importance over the next several years. Very recently Professor Geoffrey Rose has estimated that, paradoxically, the lifetime probability of death from coronary heart disease may actually increase even as risk factor reduction reduces age-specific death rates (Lancet 1990;335:275). As the age of onset of initial clinical manifestations of coronary artery disease increases, the likelihood of coexistent vascular disease of several arterial beds will certainly increase as well. The magnitude of the problem will be compounded by the aging of the population. These problems are likely to become of growing importance for outpatient management of the elderly, but in-hospital care is also likely to be influenced. Since age is one of the most potent risk factors for in-hospital stroke and since the average age of individuals undergoing open heart surgery is increasing by about 5 - 1 0 years every decade (at least at our institution), we may well see a marked increase in the consequences of panatherosclerosis in hospitalized patients in the decades to come. For clinicians interested in a glimpse of this world of the future, this textbook should make interesting reading; its messages are also of great importance to those practicing in the here and now. J O H N R. CROUSE III, M.D. Winston-Salem, North Carolina John O'Connell--Man of Barts. By Peter Upton. Published privately by the author, Winchester, Hampshire, England. Printed by BAS Printers Limited, Over Wallop, Hampshire. Paperback 129 pages. £8 sterling equivalent.
In 1971, John E. A. O'Connell, fondly known as J. O'C., retired from his life's work as the neurosurgeon at the St. Bartholomew's Hospital in London. Without fanfare or pretense, he moved to the Itchen Valley, an area loved by naturalists and fisherfolk, to a home named Fishing Cottage. After
retirement, he married a lady whom he had known since their student days; they enjoyed together their rural life, fishing, visits from old and new friends, and traveling until her lingering illness and death in 1986. In 1985, Peter Upton, a friend and neighbor in Itchen Abbas, learned quite by accident ofJ. O'C.'s remarkable past, and found that his ignorance was shared by all of their neighbors. Upton, a retired military officer, the Regimental Secretary of The Royal Hussars, and the founder of The Royal Hussars Museum, set about learning about his neighbor. H e shares his findings with us in a delightfully perceptive and readable short biography. The story briefly cites the history of St. Bartholomew's Hospital, founded in 1123, and of the family O'ConneU, transplanted from Ireland to England; their stories merge with the entry of young J. O'C. to the clinical courses as a student in 1929. H e excelled in anatomy, became a demonstrator, and was particularly interested in the nervous system. The story touches on the history of neurology and neurosurgery in Britain and in the United States;J.O.' C's decision to pursue further training in the United States was made possible by a Rockefeller Foundation Travelling Fellowship of 15 months' duration. H e then returned to Barts in 1937 as chief assistant to the senior surgeon of the hospital and was soon encouraged by the allotment of two beds "for the investigation and treatment of any patients with neurological problems, that might be referred to him." In that same year he became an associate member of the Society of British Neurological Surgeons, which society then numbered 45. The story intertwines with that of other pioneers in Britain, and then, with the onset of World War II, J. O'C. was transferred to Hill End as a part of the wartime plan of dispersal to auxiliary hospitals in the suburbs to meet normal demands for care and to absorb war casualties treated and triaged from inner city hospitals; for the first time there was a dedicated unit for neurosurgery. H e volunteered for active military duty but was ruled essential at his post. In 1944 he was called on to form the Barts neurosurgical unit at Cosham to manage the casualties returning from the invasion of Normandy. The years after portray scenes familiar to many older neurosurgeons, the slow uphill development of a program, teams, equipment, techniques; the joys of teaching and clinical research, and of close contact with patients and colleagues; the triumphs and the heartaches. Through it all the character of J. O'C. shines; near monastic in his dedication to his patients and his profession; preferring to work in a charitable hospital "designed to succour the poor"; pioneering and developing surgical and conservative treatment for disorders of the intervertebral disk; and developing the technique for the separation of craniopagus twins; teaching, caring, serving; quietly, firmly, and persistently striving for those things that he perceived to be right. This book is a tribute that will be enjoyed by his many friends and acquaintances, and by other older neurosurgeons who will experience a sense of d~j~ vu. It shares with other journals some historical interest, but above all the life portrayed is a refreshing reminder that dreams of dedication and service need not succumb to mammon. C O U R T L A N D H. DAVIS, Jr. Winston-Salem, North Carolina
Surg Neurol 1990;34:269-70
disease. The place of anticoagulation is also reviewed from this perspective. Also unique to this volume and the perspective of the authors is the emphasis on the importance of neurovascular evaluation of the patient with manifest coronary artery disease, and of cardiovascular evaluation of the patient with transient ischemic attack or stroke in both the outpatient setting and in the setting of acute symptomatic events leading to hospitalization. The text is well written, the illustrations are clear, and each chapter is followed by a summary and thorough bibliography. The only weakness of the book proceeds from its strength: because the topic chosen is so broad, some subjects must be covered in an abbreviated form to accommodate a volume of this size. For example, anatomy of stroke and localization of stroke are covered in only four pages, and clinical evaluation of cerebral vascular disease, including physical examination, is covered in three pages. On the other hand, it may be assumed that persons reading this book will have expertise in clinical examination, and the book is not meant as a substitute for a textbook of cardiology or neurology. It is likely that the new discipline represented by this text will grow exponentially in importance over the next several years. Very recently Professor Geoffrey Rose has estimated that, paradoxically, the lifetime probability of death from coronary heart disease may actually increase even as risk factor reduction reduces age-specific death rates (Lancet 1990;335:275). As the age of onset of initial clinical manifestations of coronary artery disease increases, the likelihood of coexistent vascular disease of several arterial beds will certainly increase as well. The magnitude of the problem will be compounded by the aging of the population. These problems are likely to become of growing importance for outpatient management of the elderly, but in-hospital care is also likely to be influenced. Since age is one of the most potent risk factors for in-hospital stroke and since the average age of individuals undergoing open heart surgery is increasing by about 5 - 1 0 years every decade (at least at our institution), we may well see a marked increase in the consequences of panatherosclerosis in hospitalized patients in the decades to come. For clinicians interested in a glimpse of this world of the future, this textbook should make interesting reading; its messages are also of great importance to those practicing in the here and now. J O H N R. CROUSE III, M.D. Winston-Salem, North Carolina John O'Connell--Man of Barts. By Peter Upton. Published privately by the author, Winchester, Hampshire, England. Printed by BAS Printers Limited, Over Wallop, Hampshire. Paperback 129 pages. £8 sterling equivalent.
In 1971, John E. A. O'Connell, fondly known as J. O'C., retired from his life's work as the neurosurgeon at the St. Bartholomew's Hospital in London. Without fanfare or pretense, he moved to the Itchen Valley, an area loved by naturalists and fisherfolk, to a home named Fishing Cottage. After
retirement, he married a lady whom he had known since their student days; they enjoyed together their rural life, fishing, visits from old and new friends, and traveling until her lingering illness and death in 1986. In 1985, Peter Upton, a friend and neighbor in Itchen Abbas, learned quite by accident ofJ. O'C.'s remarkable past, and found that his ignorance was shared by all of their neighbors. Upton, a retired military officer, the Regimental Secretary of The Royal Hussars, and the founder of The Royal Hussars Museum, set about learning about his neighbor. H e shares his findings with us in a delightfully perceptive and readable short biography. The story briefly cites the history of St. Bartholomew's Hospital, founded in 1123, and of the family O'ConneU, transplanted from Ireland to England; their stories merge with the entry of young J. O'C. to the clinical courses as a student in 1929. H e excelled in anatomy, became a demonstrator, and was particularly interested in the nervous system. The story touches on the history of neurology and neurosurgery in Britain and in the United States;J.O.' C's decision to pursue further training in the United States was made possible by a Rockefeller Foundation Travelling Fellowship of 15 months' duration. H e then returned to Barts in 1937 as chief assistant to the senior surgeon of the hospital and was soon encouraged by the allotment of two beds "for the investigation and treatment of any patients with neurological problems, that might be referred to him." In that same year he became an associate member of the Society of British Neurological Surgeons, which society then numbered 45. The story intertwines with that of other pioneers in Britain, and then, with the onset of World War II, J. O'C. was transferred to Hill End as a part of the wartime plan of dispersal to auxiliary hospitals in the suburbs to meet normal demands for care and to absorb war casualties treated and triaged from inner city hospitals; for the first time there was a dedicated unit for neurosurgery. H e volunteered for active military duty but was ruled essential at his post. In 1944 he was called on to form the Barts neurosurgical unit at Cosham to manage the casualties returning from the invasion of Normandy. The years after portray scenes familiar to many older neurosurgeons, the slow uphill development of a program, teams, equipment, techniques; the joys of teaching and clinical research, and of close contact with patients and colleagues; the triumphs and the heartaches. Through it all the character of J. O'C. shines; near monastic in his dedication to his patients and his profession; preferring to work in a charitable hospital "designed to succour the poor"; pioneering and developing surgical and conservative treatment for disorders of the intervertebral disk; and developing the technique for the separation of craniopagus twins; teaching, caring, serving; quietly, firmly, and persistently striving for those things that he perceived to be right. This book is a tribute that will be enjoyed by his many friends and acquaintances, and by other older neurosurgeons who will experience a sense of d~j~ vu. It shares with other journals some historical interest, but above all the life portrayed is a refreshing reminder that dreams of dedication and service need not succumb to mammon. C O U R T L A N D H. DAVIS, Jr. Winston-Salem, North Carolina