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Biographical entry Belsey, Ronald Herbert Robert (1910 - 2007)

MRCS 1934; FRCS 1935; MB BS London 1934; MS 1942; LRCP 1934.

Born
2 April 1910
London, UK
Died
22 May 2007
Occupation
Thoracic surgeon

Details

Ronnie Belsey was a consultant thoracic surgeon, known worldwide for his innovative techniques in oesophageal surgery. He was born on 2 April 1910 in London, the son of Herbert Robert Belsey, a dental surgeon, and Marie Martha Annie née Moller. He was educated at Woodbridge School, Suffolk. There he excelled, not only in his studies but also in a variety of sports, and was made head prefect in 1926. From Woodbridge he won an entrance scholarship to St Thomas’ Hospital where, in addition to medical studies, he played rugby and ice hockey. Among his memories of this period he recounted the two London hospitals cup finals against St Mary’s, both of which Tommy’s won.

After qualifying with the conjoint diploma in 1934, he went on to sit the London MB BS examination, winning the coveted Beaney prize for surgery (with honours). During his training he was house surgeon on the surgical unit to Max Page, Hugo Romanis and Norman (Pasty) Barrett. In later years he could concede that Barrett had a major influence in moulding his interests in oesophageal surgery.

In 1936 he moved to the Brompton Hospital as a resident surgical officer, working with the doyens of thoracic surgery - Tudor Edwards, J E H Roberts and Clement Price Thomas, not to mention the up and coming Russell Claude Brock. With Roberts he was closely involved in developing extrapleural pneumonolysis and artificial pneumothorax in the treatment of pulmonary tuberculosis. At the same time Brock was breaking new ground in our College in defining the anatomy of the bronchial tree. These influences by the giants of thoracic surgery kindled in Belsey a lasting interest in that field.

In 1937 he was awarded the Dorothy Temple Cross scholarship, which enabled him to go to the USA as a research fellow at the Harvard Medical School, acting as clinical assistant to Edward (Pete) Churchill. The outcome of this collaboration was the outstanding contribution which they jointly made to pulmonary surgery: ‘Segmental pneumonectomy in bronchiectasis’ (Annals of Surgery, Vol.109, 1939, No.4, pp.481-499). He rounded this year off with a paper presented in Atlanta to the American Association of Thoracic Surgeons on extrapleural pneumothorax.

On returning to England, he was appointed as a resident assistant surgeon at St Thomas’ Hospital, in time to witness the outbreak of the Second World War. With the evacuation of the medical school to locations outside London, Belsey was left with a skeleton surgical staff to cope with war casualties, an experience he cherished. In 1941 he was sent down to the West Country to establish a thoracic surgical service for the south west region. Having initially worked at a tuberculosis sanatorium in Kew Stoke, outside Weston-super-Mare, in 1944 he moved to Frenchay Hospital, which until then had been a Nissen-hutted evacuation hospital run by the US Army Medical Corps for war casualties. Here he established the south west regional thoracic centre, training surgeons to man units in Tehidi (for Cornwall and south Devon) and Bovey Tracey (for north Devon).

From the outset he worked on the principle (to put it in his own words): “you cannot make friends and at the same time get things done”. True to his word, he went ahead and made several enemies. The result was an excellent thoracic surgical centre manned by two consultants, well known all over the world, training surgeons who went on to lead some of the best centres in Europe and North America. He received a constant stream of trainees from the USA and Canada, initially from the Massachusetts General Hospital, Boston, and later from the Johns Hopkins Hospital, Baltimore. In reciprocation he made a visit each year to the USA to attend the annual meeting of the American Association of Thoracic Surgeons. It was on one such visit in 1966 that he delivered the honoured guest lecture to that association on the surgical treatment of functional diseases of the oesophagus, which to this day remains the authoritative paper on the subject. He will however be remembered for the Mark IV operation for control of gastro-oesophageal reflux. His interest in hiatal herniation was initiated during the year he spent in Boston, when Harrington presented his paper on the anatomical repair of hiatus hernia.

Whilst working in Frenchay, Belsey made several attempts at a physiological repair constructing an anti-reflux valve mechanism. Having designated these attempts as Marks I to III, he came to the conclusion that a 270 degree partial inversion wrap produced the best result. This he called the Mark IV repair, the description and results of which were only communicated to the surgical world, not by himself but by his senior registrar, after a ten year follow-up of his patients.

In the early fifties, with declining tuberculosis and bronchiectasis, and an increasing potential for cardiac surgery, the regional thoracic centre became the regional cardio-thoracic centre. Closed heart surgery flourished and with the advent of open heart surgery ‘the B’ (as Belsey came to be known) was invited to move the open-heart unit to the Bristol Royal Infirmary. Like the true researcher that he was, he set off to study cardiopulmonary bypass on animals at the Bristol University Veterinary School in Langford. He then took himself off to join his friend Charles Drew at the Westminster Hospital to learn the technique of profound hypothermia using quadruple cannulation.

He returned to set up the cardiac unit at the Infirmary, devoting his time to the Children’s Hospital, Bristol Royal Infirmary and Frenchay. Despite his commitment to paediatric cardiac surgery, his main interest was in congenital tracheo-oesophageal fistula, atresia and other non-cardiac conditions in the newborn.

He was a pioneer in the use of the left hemicolon in oesophageal replacement surgery and a firm believer in the place of stainless steel wire sutures in thoracic surgery, a conclusion arrived at in the tuberculosis era. Belsey was a meticulous technical surgeon, handling tissues with the utmost gentleness, and working with dexterity and complete economy of hand movement. “Doctor, remember you are dealing with human flesh, handle it with care, not macerate it,” he would tell his assistant if the latter was caught manhandling the organs. Even when confronted with a complex situation in the operating room ‘the B’ was in total command, and his assistants knew that he was.

In 1973 he was awarded the Colles medal by the Royal College of Surgeons in Ireland, and a year later the Sir Clement Price Thomas medal of our College. In 1983 he delivered the Tudor Edwards memorial lecture under the auspices of our College. He also collected medals from the universities of Leiden and Padua for services to thoracic surgery.

Belsey retired from the National Health Service in 1975 and in the following year was invited to join the department of surgery at the University of Chicago, where he spent six months of each year participating in teaching postgraduates until 1988. He published extensively and co-edited a book on Gastroesophageal reflux and hiatal hernia (Little Brown, 1972) and in 1988 (with David Skinner) the monumental textbook Management of esophageal disease (Philadelphia, Saunders). He travelled worldwide, and held visiting professorships in several universities in Europe and America. He took great delight in spending short sojurns in Cairo, operating on children with corrosive strictures of the gullet. He was awarded honorary memberships and fellowships of several surgical societies both in Europe and America. He was an early member of Brown’s Club and a founder-member of the Esophageal Club in the United States. He was a past president of the Society of Cardiovascular and Thoracic Surgeons of Great Britain and Ireland. In 1996 during the presidency of the European Association for Cardio-Thoracic Surgery of his last registrar in Bristol, he was made an honorary member, the citation being presented by his last senior registrar and successor at Frenchay.

Early in his surgical career, Belsey started planning for his retirement. He was an excellent shot, an aptitude he attributed to the genes he acquired from his father who had won several prizes at Bisley. He was a member of the Bristol Gun Club and was a collector both of long and short firearms. He was a keen fly fisherman and belonged to the Frenchay Fly Fishing Club, which met regularly on the Usk in Monmouthshire. When time permitted he would disappear into the depths of the Devon countryside with a local group of fly fishermen, delicately designing his own flies, and fishing on the Dart. In 1969 he acquired Combestone, an old farmhouse with a stretch of the river below Dartmeet. This was the family weekend retreat.

Belsey married Pauline May Tilbury in October 1941, a graduate of the Florence Nightingale School of Nursing at St Thomas’. Pauline, who loved the farm and nursed many a delicate and feeble lamb into healthy adulthood, died in 2000. They had three daughters, one of whom, Gay, died in infancy. Annabelle trained as a nurse at St Thomas’, where she became a theatre sister and is married to an anaesthetist, Stuart Ingram: they have two sons. Gillian followed her father into medicine, became a senior partner in a general practice in north Devon and predeceased Ronald in 2002.

With increasing inability to walk down to his beloved Dart, Belsey took to carving handles for walking sticks out of wood and bone, which he would give away to friends and visitors. Despite his reluctance to move out of his farmhouse, and the dedicated support of his nursing carer, Dorothy Steele, it became clear that a remote dwelling on Dartmoor was not the best place for a 94 year old. In March 2004 he agreed to move to a nursing home in Denbury, near Newton Abbot, where he remained with excellent mental facilities, able to converse intelligently until his last days.

Ronald Belsey died on 22 May 2007. His funeral service at the church of St Mary the Virgin, Holne, was attended by members of his family, fishing and local friends, and several of his medical and surgical colleagues and former trainees, who later retired next door to the Church House Inn, a popular old haunt of his.

Sources used to compile this entry: [Information from Mrs Annabelle Ingram, Kumarasingham Jayasingham; J Irish Colleges of Physicians and Surgeons 9: 1979 35-6; The Times 25 July 2007; Western Morning News 7 June 2007].

The Royal College of Surgeons of England