Browse Fellows

Google

www Lives

Biographical entry Horsley, Sir Victor Alexander Haden (1857 - 1916)

Knight Bachelor 1902; CB 1916; MRCS Nov 17th 1880; FRCS June 14th 1883; 1st MB Lond (Gold Medal in Anatomy and 1st Class in Physiology) 1878; MB BS (Scholar and Gold Medal in Surgery) 1881; FRS 1886; MD Halle 1894; DCL Aberdeen 1914.

Born
14 April 1857
London
Died
16 July 1916
Amerah
Occupation
Neurosurgeon, Pathologist and Politician

Details

Born at 128 Church Street, Kensington, on April 14th, 1857. His grandfather was William Horsley, musician; his father, John Callcott Horsley (1817-1903), RA, and Treasurer 1882-1897, author of Recollections of a RA, an opponent of the Pre-Raphaelites, of the Paris Salon, and of the nude model of his day, a persona grata to Queen Victoria - hence the name Victor. His mother was Rosamund, sister of Sir Francis Seymour Haden (qv), etcher and surgeon, second wife of Victor's father, Victor being the third child. The sister of his father, Miss Sophy Horsley, was a distinguished pianist and a friend of Mendelssohn, who dedicated to her some of his pieces. One of the grandfather's daughters married Isambard Brunel, the engineer, who by inhaling a half-sovereign became a remarkable surgical case.

Horsley inherited from his father a fine figure and face, had a rather dolichocephalic head, and the hands of an artist, musician, and surgeon. He was brought up largely at his father's country house, Willesby, near Cranbrook, Kent, where he had the opportunities afforded by country life which early drew him towards natural history. He began to learn French from his governess, and then from 1866-1873 attended as a day-boy the Elizabethan school at Cranbrook. But Cranbrook made no impression on him, nor he on Cranbrook. "He ought to have gone to some great public school far from home" (see Paget's biography, p14). But Horsley's peculiar intellect would have rebelled against being drilled into uniformity, and he went on to University College, into the atmosphere which distinguished the University of London from Oxford and Cambridge. He learnt enough of the classics at Cranbrook to excite the strong love of archaeology he exhibited throughout life. His genius as a reformer was early exhibited in his sketch of a reformed dress for women which his sister pronounced hideous. He saw something of the local medical practice of Dr T Joyce. He matriculated in 1874 after being coached by Mr (later Sir) Philip Magnus, later MP for the University. He attended University College for the Preliminary Scientific MB course, the Professor of Physics being Sir Carey Foster, who had (Sir) Oliver Lodge acting as a Student Assistant for the Junior Physics Course. From 1875-1878 he worked at anatomy and physiology under Viner Ellis, Dancer Thane, Burdon-Sanderson, and Schafer. Burdon-Sanderson combined experimental physiology and experimental pathology in their bearings on medicine and surgery. He thus became the model which directed Horsley's future.

Horsley started hospital work in October, 1878; he acted as Physician's Clerk to Charlton Bastian, who influenced him in opposite directions; he was attracted over aphasia and the sensorimotor functions of the cortex; repelled by spontaneous generation based on imperfect bacteriological methods. His first publication was with Bastian on the combination of arrested development in the right ascending parietal convolution and in the left upper limb. With F W Mott in 1882 he proved the absence of micro-organisms in healthy tissues. He was taught surgery by Marcus Beck (qv), the greatest teacher of students of his day, combining the pathology based on Pasteur with the practice of Lister. The strict adherence to Lister's methods, together with general anaesthesia and some addition of morphia, underlay the whole of Horsley's surgery and of his experiments on animals as well, although through von Bergmann (qv) and Arthur Barker (qv) in later years he made some use of sterilizing methods and of topical anaesthetics. He was Resident House Surgeon for six months under John Marshall, who in 1883 gave the Bradshaw Lecture at the College of Surgeons, "On the Operation of Nerve Stretching", at the production of which Horsley assisted, and clinched Marshall's argument by demonstrating nervi nervorum.

Horsley's delicate nervous mechanism rejected poisons even in infinitesimal doses; he made fifty hazardous self-administrations of anaesthesia, noting the stages of disappearance and vagaries of consciousness, and of the patellar tendon reflex. He made a slashing attack on tobacco in the Students' Club when clay pipes and coarse quids were thought to be causing cancer in the mouth; cigarette-smoking had just come in and was causing amblyopia. He did not live to see women take to mild cigarettes, but found plenty of evidence that nicotine is a cardiac poison.

During the six months as Assistant he was able to prepare for the MB BS and to gain the Gold Medal in Surgery in the summer of 1881. In the autumn of 1881 he went to Berlin with introductions from his aunt, Miss Sophy Horsley, as well as to Leipzig. He thus learnt German and formed his German connection. He was inspired by Cohnheim as regards his future lectures on pathology; had a long controversy with Munk over the prefrontal convolutions, and translated Koch's Investigation of Pathogenic Micro-organisms for the New Sydenham Society in 1886. From 1882-1884 he was Surgical Registrar, and Assistant Professor of Pathology, 1884-1887; during this period he did most of his elementary clinical teaching to residents, students, and nurses at University College Hospital.

EXPERIMENTAL PATHOLOGY - Burdon-Sanderson had been the first Superintendent of the Brown Institute, and especially through him Horsley was appointed, in succession to Roy, Superintendent for the six years 1884-1890. He was thus put into the peculiar position of head of the laboratory of a hospital for the treatment of diseased animals. In the laboratory there were already workers engaged independently in experimental pathology, both human and animal, whilst a first-class veterinary surgeon treated domestic animals, both as in-patients and out-patients, in accordance with progress already made in medicine, by the use of antiseptics and anaesthetics. It brought Horsley into the public arena over questions of health, and at the same time exposed him to malignant attacks concerning animal experiments. Experiments on animals had been properly regulated by Act of Parliament, and Horsley conformed, and saw to it that co-workers did the same, in respect to the licences and supervision under the Act.

No sufficient comprehension of Horsley's achievements at the Brown Institution can be formed except after a thorough study of his Annual Reports, preserved in the University of London. In those Reports are placed on record researches made by a number of independent workers and the important results at which they arrived. One example may be given, "The Chemistry of the Blood, and other Scientific Papers by the late L C Wooldridge", edited by Horsley and Starling. Wooldridge, Assistant Physician to Guy's Hospital, died in the midst of his work, bitterly lamented by Horsley, who attributed his death to cigarette-smoking in excess.

In 1879 Claude Bernard said that there was nothing known of the thyroid and suprarenal glands; Kocher and Reverdin drew attention to the cachexia strumipriva which followed upon total excision of the thyroid gland for goitre. Schiff confirmed this experimentally on dogs and rodents. Myxoedema had been described clinically by physicians in London, but it was connected with an antiquated pathology until Felix Semon drew the attention of the Clinical Society to the Swiss observations. A committee of investigation was formed, and Horsley was asked to study the matter experimentally in monkeys. His results were most striking; they opened the way to a conservative surgery, and further, after grafting had been tried, to the administration of thyroid gland preparations begun by George Murray, of Newcastle, student and then House Physician at University College Hospital from 1886-1889. Less generally recognized were Horsley's concurrent experiments on the pituitary body, some twenty in number, in dogs; he used a small trephine with a long shank for the approach through the palate. The temporal route which he adopted for human patients, he returned to in 1911 with Handelsmann, making fifty-four further experiments.

Rabies was being repeatedly revived in this country by dogs imported from the Continent. Besides cats, deer in Richmond Park were affected, a mare bitten on the muzzle battered to pieces her stall at the Brown Institute, and was covered with blood before she could be got at and killed. A boy bitten behind the knee, after a latent period of two years and four months from the date of the bite, proved at the time to have been caused by a dog affected by rabies, started symptoms in the persisting scar, and there followed death from hydrophobia, completely confirmed by post-mortem examination. Horsley went over to Pasteur, taking with him the laboratory attendant who was accidentally infected with and died in Paris from the variety of hydrophobia known in the dog as 'dumb rabies'. Horsley became the authority through whom Walter Long (later Lord Long of Wraxall), to his eternal credit, was enabled to withstand the opposition which included his own fox-hunting friends. He introduced the universal muzzling order, and the quarantine at the ports, which stamped out both rabies and hydrophobia. Incidentally the order caused a marked diminution in canine distemper and chorea, and Horsley declared in his Report of 1889 that it was an absurd and cruel fallacy that a dog must have distemper.

Horsley co-operated with others in his researches on the brain and spinal cord. He began the minute localization of the cortical function of the brain with Schafer, confirming Ferrier's results on monkeys; then with Beevor, who at the same time made an extraordinary collection of the cerebral tumours observed at the National Hospital. The observations were extended to an orang-utan in 1890, and subsequently by Sherrington and Grunbaum to the chimpanzee and gorilla - all serving as a guide to Horsley in his operations on the brain. F W Mott and Howard Tooth with Horsley experimented upon the spinal cord, its posterior columns and posterior roots; with Schafer, Risien Russell, and R H Clarke, Horsley experimented on the cerebellum. At Oxford, with Burdon-Sanderson and Francis Gotch, his brother-in-law, using a special apparatus, there was electrically demonstrated a current in the spinal cord descending when the cerebral cortex was excited. The current was demonstrated in the spinal cord below the upper limb segment, and above the lower limb segment, when the cortical area for the leg was stimulated. The muscular contractions in the lower limb were first persistent, then rhythmic, corresponding to clinical tonic and clonic convulsions - a demonstration included in the Croonian Lecture in 1891 with Gotch, by which Horsley reached the apogee of his genius.

With Felix Semon and Risien Russell were carried through experiments connecting the cortex cerebri with the larynx, and with R H Clarke studies directed to relieve roaring in horses. With W G Spencer were made experiments on intracranial tension, on the connection of the cortex of the brain with the respiratory rhythm, and with the circulation through the carotids. This led to an elaborate research with R H Clarke, and with Kramer, of Cincinnati, on gunshot wounds of the head, and the explosive effect of the modern rifle bullet, due to its velocity. At the outbreak of the War Horsley was the one surgeon in the country who might possibly have saved some among early cases of head injuries before other surgeons had gained experience. Thirty years later there appeared disturbances of the respiratory rhythm caused by scattered lesions of the cerebrum in the course of encephalitis lethargica.

There was one subject to which Horsley devoted an enormous amount of work in early days without success - general epilepsy - subsequent to experiments by Brown-Séquard, Franc, and Pitres. Horsley was optimistic, hoping for discovery developing out of Hughlings Jackson's focal epilepsy; he studied convulsions produced by poisons and by infective agents, by intracranial pressure, by disturbances of the cerebral circulation, by gunshot injury. Kocher was at that time equally hopeful, believing in a cortical congestion rather than in a cortical anaemia as the immediate forerunner of the fit.

After 1890 all the above work was continued at University College. In 1887, from Assistant Professor, Horsley became Professor of Pathology, compiled a syllabus of lectures, following Claude Bernard and Cohnheim, to be accompanied as far as possible by practical demonstrations. He had a most brilliant assistant in Rubert Boyce, who later established the School of Tropical Medicine at Liverpool. Vaughan Harley started the teaching of pathological chemistry in the face of much opposition. Horsley held the post until 1896. He made some general statements at the Nottingham Meeting of the British Medical Association as President of the Pathological Section. He was also a leader in the Pathological Club in bringing to a standstill the London Pathological Society because of its limitation of attention to pathological anatomy. The Section of the Royal Society of Medicine was the successor.

MARRIAGE AND FAMILY - The families had long been friends when in October, 1883, Horsley became engaged to Miss Eldred Bramwell, daughter of the engineer Sir Frederick Bramwell, and niece of the judge, George, Baron Bramwell, and they were married in October, 1887. She became in the fullest sense his helpmate. There were three children - two sons and a daughter. Shortly afterwards his sister Rosamund married Francis Gotch, his partner in the most important of his experiments, and later Professor of Physiology at Oxford. His wife supported him in directing his future to include surgery. For a few years they lived in Park Street, Grosvenor Square; from 1891 at 25 Cavendish Square. During the War the eldest son became a Captain in the Gordon Highlanders and was wounded three times. Joining the Royal Flying Corps, he was promoted Flight Commander and was killed while flying on Aug 19th, 1918. His second son was wounded in 1914 whilst in charge of bombers; his injuries during the War precipitated his death subsequently. His daughter accompanied her father and mother to Egypt, where she was severely attacked by dysentery. She later married Stanley Robinson.

SURGERY - In 1885 Horsley was appointed Assistant Surgeon to University College Hospital, and in 1886 Surgeon to the National Hospital for Paralysis and Epilepsy, Queen Square. At University College from 1893 he was styled Surgeon to Out-patients without allotted beds. It was only in 1900 that he came into charge of in-patients as Professor of Clinical Surgery. On the one hand his attention had been drawn to novel and special departments of surgery, and he was temperamentally and by circumstances a teacher not of students but rather of post-graduates. His practice of surgery was dictated by the patients of the National Hospital, which included thyroid gland cases. He began operations there, as Spencer Wells had started ovariotomy at the Samaritan Hospital, without an operating theatre, but it was rendered possible by Listerism. Before him, the surgical treatment had been mainly limited to the subcutaneous tenotomy initiated by Stromeyer and Dieffenbach. (See ADAMS, WILLIAM.)

In 1884 Alexander Hughes Bennett (son of J Hughes Bennett, the Professor of Medicine in Edinburgh), Physician to the Hospital for Paralysis and Epilepsy, Regent's Park, and Assistant Physician at Westminster Hospital, had, in the light of Hughlings Jackson's clinical observations and the experiments of Ferrier, diagnosed a case of localized lesion in the ascending parietal convolutions giving rise to focal epilepsy. At the Regent's Park Hospital Godlee, later Sir Rickman Godlee (qv), trephined at the spot upon which Bennett put his finger, and scooped out a subcortical tumour the size of a pigeon's egg. The actual cautery was applied to the interior of the cavity to arrest haemorrhage, and to this is attributable the hernia cerebri with inflammation which caused the death of the patient on the twenty-third day. Horsley in the discussion mentioned the preliminary use of morphia. His first operation at the National Hospital was for Jacksonian epilepsy on May 15th, 1886; on May 28th at the Clinical Society he mentioned the ligature of the jugular vein for lateral sinus thrombosis, later developed by Arbuthnot Lane and Charles Ballance. The short paper he read at the Brighton Meeting of the British Medical Association in July concerned three cases of Jacksonian epilepsy set up by a scar, a tuberculoma in the thumb area, and a splinter surrounded by a cyst. He made a semilunar flap, replacing the crucial incision handed down from Hippocrates, liable to be followed by a hernia cerebri. More famous still was the case, with Gowers, of spinal-cord tumour. Horsley had prepared himself by experiments on animals and cadavers. Assisted by Charles Ballance, after exposure of the cord, it was necessary to extend the wound upwards two vertebrae. The patient was exhibited at the Medico-Chirurgical Society (Med-Chir Trans,1888, lxxi, 377 (paper); discussion in Proc Med-Chir Soc, NS ii, 407). In no operation did Horsley exhibit such marvellous skill as in exposing the spinal cord. To him is due the discovery and relief of varieties of circumscribed pachymeningitis and cystic meningitis. Twenty-one cases were described at Queen Square on Feb 27th, 1909. All the laminectomies done during the War originated with Horsley; there were a few successes, although the injury rendered the majority of cases hopeless.

For trigeminal neuralgia there was the avulsion of the third or second branches. Horsley's experiments, in which posterior roots were divided, led him to undertake the division of the main root of the fifth nerve, at first behind a screen in a ward. He prepared himself by animal experiments and dissection of the dead body. The operation had to be interrupted owing to haemorrhage from a petrosal sinus. He tried the zygomatic approach used by Rose, then adopted the temporal Hartley-Krause route. He later reserved the division of the main root, which he did better than anyone else, for recurring cases. In 1905 he reported a series of cases with a mortality of 7 per cent among 149 removals of the Gasserian ganglion: all the deaths were in patients over 50 years of age.

In his Linacre Lecture in 1909, after twenty-three years' experience, he ascribed the following functions to the gyrus precentralis of man: (1) slight tactility, (2) topognosis, (3) muscular sense, (4) arthritic sense, (5) stereognosis, (6) pain, (7) movement. At the International Medical Congress in London, 1913, he presided over the surgical division. Howard Tooth had analysed 500 cases of cerebral tumour at Queen Square between 1902 and 1911, in connection largely with which Horsley analysed 265 operations. Speaking generally, decompression was preferable to removal; an alternative to removal was not then under consideration, for radiology was still in embryo.

POLITICS - Three opinions extracted from obituary notices:
"What demon drove a man of this type into the muddy pool of politics? A born reformer, once in a contest, no manna-dropping words come from his tongue, A hard hitter, and always with a fanatical conviction of the justice of his cause. What wonder that the world's coarse thumb and finger could not always plumb the sincerity of his motives? Let us, as dear old Fuller says of Caius, 'leave the heat of his faith to God's sole judgement and the light of his good works to men's imitation'." (OSLER, Brit Med Jour.)

"Had he lived, he would have seen many of the reforms he was pressing already adopted, and this only shows how inestimable a benefit to others it is that some men should think differently, and act differently, to accepted customs and traditions." (F W MOTT, Proc Roy Soc.)

"The day will assuredly come when the crowded and eventful life of Sir Victor Horsley will form one of the brightest and most moving pages in the whole history of British Medicine." (ARTHUR KEITH, Times Lit Supp.)

At the Church Congress in October, 1892, at Folkestone the subject under discussion was, "Do the interests of mankind require experiments on living animals?" Miss Frances Power Cobbe had published, under her own name, a book entitled The Nine Circles. This, after exposure, was excused as having been compiled not by her, but for her. Horsley, then as afterwards in many other instances, demonstrated a suppressio veri which silenced antagonists. But there continued a repetition of statements proved over and again to be untrue against him and his work. It embittered his manner on the platform, for the natural Horsley was the ideal captain of a team, helpful, encouraging, abounding in praise of those working under him, perhaps sometimes impatient about progress and choleric, yet over tea there would be expostulations, explanations, extenuations, ending in frank accord. He concocted a rebus, a flying horse with V in position on the saddle. He would begin by bald dogmatic assertion of his case along with depreciation of opposite views, so that within five minutes his opponents were upstanding and interrupting. He would not begin with generalities and soothing clearance of objections. But after things had quieted down he would then develop reasons which appealed to his audience. What if he did use the art of rhetoric - which is the art of speaking in language designed to persuade and impress - even the vituperation of Cicero (tritium paro, I disparage), and censure seniors of the General Medical Council or of the Council of the British Medical Association who were forgetting the origin in a Provincial Association governed by a Representative Meeting! If he miscalled the Home Secretary (Mr McKenna) Viscount Holloway (the prison in which the Suffragettes were confined), was it not only by sheer luck that the Minister escaped the responsibility of causing the death of women imprisoned there, in the course of being forcibly fed? His attack on tobacco, already mentioned, gained support during the War, by the 'disorderly heart' which caused so much invaliding of young soldiers. The battle about alcohol continued after him, particularly in the United States; he had produced on himself by inhaling ether the temporary loss of control which occurs when a young person with a full circulation takes a minute dose of alcohol on an empty stomach. The Registrar-General continued to report a high death-rate among doctors from alcoholism and cirrhosis. Even in Egypt Horsley sought to collect evidence against alcohol and the rum ration.

He began attending the Metropolitan and Marylebone Branches, also the Annual Representative Meetings, of the British Medical Association. He was Chairman of the Representative Meeting from 1902-1906 and continued a member until 1912. Reforms desired by the representatives, advocated by him, have led to an increase of the Association to include more than two-thirds of the whole profession. There was a temporary resignation of consultants over so-called trade-union methods which did not concern consultants personally. Horsley suffered their opposition, but many of them drifted back quietly into the Association after his death.

He was elected President of the Medical Defence Union at a critical juncture in 1892, and occupied the Chair until in 1897 he was elected upon the General Medical Council as one of three direct representatives of the profession. He went to it, as he said, to stir it up. He was re-elected for a second term, at the end of which he did not seek re-election, as he deemed that his objectives had been reached. The one lack of success in relation to the Medical Act of 1858 concerned unqualified practice to which the public accorded support. Improved death registration, medical inspection and treatment of school-children, a Ministry of Health, general improvement in the scientific side of medical education, sick medical insurance and an improved contract practice, State registration of nurses referred to in one of his last letters from Mesopotamia - on all these matters Horsley was in the forefront of the battle, and the subsequent victories enhance his fame. The seat in Parliament for which he was most fitted as an independent Member was that at the University of London, but at the general election in 1910 he had to oppose the sitting Member, Sir Philip Magnus, who had coached him for the Matriculation, and the consultants who had seceded from the British Medical Association voted against him. He was adopted by the North Islington Liberals and Radicals and might have been helped by the University College connection and by the women, including the nurses who canvassed for Sir Richard Barnet when he got in for St Pancras. But Horsley retired when adopted by Market Harborough in January, 1913. Unfortunately the apple of discord was thrown by the Suffragettes, then militant, damaging property and getting themselves forcibly fed in prisons. Between January, 1914, and May, 1915, he was approached by four other constituencies, the last being Gateshead, which he declined on May 17th, 1915, as "certainly anxious to get into Parliament" but just leaving for Egypt.

His last political service was rendered between January and August 1914 on the Royal Commission on Venereal Diseases which eventuated in the Government subsidy of hospital treatment.

Concerning the religion of such a man, the chapter headed "Brotherhood Addresses" in Paget's book is to be noted.

At the outbreak of the War in August, 1914, Horsley ranked as Captain RAMC (T), with previous non-commissioned rank in the Artist Volunteers. He was the one surgeon competent, as an experimental pathologist and surgeon, to have saved lives in those suffering from head injuries or tetanus - an attainment which had to await acquirement of knowledge by others before it could take effect - nor later had he opportunity given him of treating head injuries at an early stage, except after one minor affair against the Senussi on the western border of Egypt. In May, 1915, he was appointed Surgeon to the Mediterranean Expeditionary Force with the rank of Colonel AMS. He served at the base in Egypt, and visited Gallipoli and Mudros. Learning of conditions in Mesopotamia, he volunteered and proceeded there in May, 1916. On June 7th he wrote noting the absence of infusion apparatus for the treatment of cholera, having found a medical officer using a teapot as a substitute. He was not foolhardy; he was not boastful of his resistance as a teetotaller and non-smoker; it was his duty to make a round of hospital visits, and as there was no available conveyance he had to walk across sand with a moist temperature above 110° F in the shade. He was taken ill on July 15th at Amerah, with headache and a temperature of 104° F; no malaria organisms were found in the blood, no enteric organisms. The next day he was unconscious, with a temperature of 108° F. After his death there developed the treatment of heat-stroke by venesection and infusion, based on the experiments by Wooldridge which Horsley had watched in the Brown Laboratory twenty-seven years before - namely, the bleeding of a dog and the immediate infusion of an equivalent amount of fluid. He died at 8.30 pm on July 16th, 1916, at the Rawal Pindi Hospital, and was buried in the Amerah Cemetery, some 80 to 100 of the medical staff attending the funeral.

Many honours came to Horsley in the course of his life. He was awarded the Cameron Prize by the University of Edinburgh in 1893; a Royal Medal of the Royal Society in 1904; the Fothergillian Gold Medal of the Medical Society of London in 1896; and the Lannelongue Prize and Gold Medal at Paris in 1911. He was elected a Foreign Associate of the French Academy of Medicine in 1910, and a member of the Society of Upsala in succession to Lord Lister in 1912.

The Victor Horsley Memorial Lecture was instituted in his memory. The first lecture was delivered at the Royal Society of Medicine on Oct 23rd, 1923, by Sir Edward Sharpey-Schafer, FRS, Professor of Physiology in the University of Edinburgh, and previously Professor of Physiology and a colleague of Horsley at University College, London. This lecture, on "The Relations of Physiology and Surgery", was published in the British Medical Journal (1923, ii, 739). The second lecture, by Wilfred Trotter, MS, FRCS, Surgeon to University College Hospital, assistant to and colleague of Horsley, was delivered at the British Medical Association on July 9th, 1926, the title being, "On the Insulation of the Nervous System"; it may be read in the British Medical Journal (1926, ii, 103). The third lecture was delivered by Sir Thomas Lewis on July 16th, 1929, on "Observations relating to the Mechanism of Raynaud's Disease" (Brit Med Jour, 1929, ii, 111)

Sources used to compile this entry: [Sir Victor Horsley: A Study of his Life and Work, by Stephen Paget, London, 1918, with a Prefatory Note by Lady Horsley, and portrait, and a list of published writings numbering 129; there are additional references in the Obituary Notices and by the Memorial lecturers; reviewed by Sir Arthur Keith in The Times Literary Supplement, 1919, Nov 27. Brit Med Jour, 1916, ii, 162, with portrait, including a note by Sir William Osler; also p510. Ibid, 1920, i, 260, 262. Lancet, 1916, ii, 200, 207, 498, 734, his will, also with portrait. Brit Jour Surg, 1916, iv, 327, with portrait. Proc Roy Soc, by "F W M" (Sir Frederick Mott), ser. B, 1920, xci, obituary notice, p. xliv. Sharpey-Schafer's History of the Physiological Society, Cambridge, 1927, 74, with a portrait of Horsley as a very young man. Rawlings' A Hospital in the Making, 1913].

The Royal College of Surgeons of England