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Biographical entry Monro, James Lawrence (1939 - 2013)

MRCS LRCP 1964; MB BS London 1964, FRCS 1969; FETCS 1997.

17 November 1939
29 August 2013
Cardiac surgeon


James Lawrence 'Jim' Monro was a cardiac surgeon at Southampton General Hospital, where he successfully developed the service for infants and children. Jim's medical lineage could hardly have been stronger. He was born in Singapore on 17 November 1939, at the start of the Second World War, the son of Jack Monro, professor of surgery in Singapore, and Landon Carter Monro née Reed. His father's Scottish antecedents, a branch of clan Monro of Fyrish, Easter Ross, included, in the 18th and 19th centuries, four medical directors of Bethlem Hospital, commonly known as 'Bedlam'. Jim's American mother was the granddaughter of Major Walter Reed of the US Army Medical Corps, who had identified the aedes aegypti mosquito as the vector for yellow fever. The Walter Reed Medical Center in Washington is named in his honour.

Following the bombing of Pearl Harbour in December 1941 and the entry of Japan into the war, Jim's father managed to get his wife, Jim and his baby sister Mary on to the evacuation ship SS Ulysses. He stayed behind to care for the injured civilians and, with the fall of Singapore, was interned in Changi prison. His family managed to reach Perth, Australia, and then went on, six months later, to San Francisco by sea and eventually to Landon's family in Virginia.

On VE Day, Jim, his sister and mother sailed back to the UK on the Queen Mary, zig-zagging across the Atlantic at 30 knots to avoid any remaining U-boats. They returned to witness bombed-out buildings and the devastation of post-war London. Initially they stayed with relatives near Richmond, and Jim started to go to school in Putney. After VJ Day, the family were reunited with an emaciated Jack Monro. He was given extra rations and was soon able to attend a refresher course at his alma mater, the London Hospital. Six months later, his recovery was sufficient for the whole family to return to a comfortable government house in Singapore.

At the age of nine Jim went back to the UK for his schooling, first in Barnstaple and then at Sherborne. His parents also eventually returned to the UK, and Jack Monro was a consultant general surgeon at the Princess Margaret Hospital in Swindon. Jim spent time with his father in the operating theatre, and even removed an appendix before ever becoming a medical student. Jim's poor A level grades prevented him from taking up an offer at Pembroke College, Cambridge, but he gained a place at this father's old medical school with the help of a 'crammer'.

At the London his attitude to exams improved and he soon won a scholarship and several prizes. He was not alone, however, in enjoying, and fully participating in, medical student activities, both on and off the pitch. Cars and stuffed monkeys featured; a Bentley-owning Robert Winston, the future IVF innovator, was one of his contemporaries. Jim passed the conjoint exam in January 1964 and gained his MB BS in May 1964. He was also awarded the Frederick Treves prize in surgery.

Directly after qualifying, he held two house posts at the London, under Clifford Wilson and Jack Ledingham in medicine and David Ritchie in surgery. Suitably inspired by this lively Scottish surgeon, Jim soon headed for the primary FRCS course. He passed this in January 1966, and then worked at Birmingham Accident Hospital as a casualty officer. He then moved south again, and arrived at St James' Hospital, Balham, to work under Dan Desmond and Norman Tanner. In March 1967 he returned as a registrar to David Ritchie at the London Hospital, and worked on the vascular surgery unit with Douglas Eadie, and also on a nascent cardiac surgical unit with John Weaver, who had studied open heart surgery with Brian Barratt-Boyes in Auckland, New Zealand. Barratt-Boyes had pioneered the use of human aortic valves (homografts) with good results, and John Weaver's team was now replicating this success. Around this time, Christiaan Barnard was also starting cardiac transplantation in South Africa.

With the blessing of John Weaver, Jim then went to work with Brian Barratt-Boyes at the Greenlane Hospital. These years were adventurous, with a particularly fruitful extension of his stay for a second year of training. By this time, Brian Barratt-Boyes had started using a cooling technique in small babies. He had performed this with success in 200 patients by the end of Jim's second year and this experience proved particularly valuable for Jim in later years. Barratt-Boyes subsequently described Jim as one of the best three young cardiac surgeons he had helped train.

Jim returned to the cardiac unit at the London in 1972. Having been interviewed unsuccessfully for a consultant post in Edinburgh, Jim was tempted by an invitation from Keith Ross to apply to join him in Southampton. On 11 May 1973 he was duly appointed and his outstanding career as a cardiac surgeon took wing. Keith operated on relatively few children, so Jim was asked to develop the paediatric cardiac surgery. Over the years, the number of these patients treated grew rapidly. Jim, meanwhile, also played a full part in the treatment of adults, so that over 300 cases of open heart surgery were performed annually.

In Southampton, the old tuberculosis sanatorium at the Western Hospital had become the cardiothoracic hospital but, by 1981, the cardiac unit had split off and relocated to the General Hospital. Cardiologists Alan Johnson and Neville Conway were soon providing a stream of patients requiring coronary artery bypass grafts. A major advance in angiography for childhood congenital defects occurred with the arrival of Barry Keeton, who had trained at the Mayo Clinic around the same time as the advent of echocardiography. Vast improvements in post-operative and, particularly, intensive anaesthetic care were likewise provided by John Manners and John Edwards.

The cooling technique that Jim had learnt in New Zealand soon proved highly beneficial, with, for example, a successful repair by Jim in 1974 of a seven-week-old baby with persistent truncus arteriosis (a previously rapidly fatal cardiac deformity). Complete repairs of Fallot's tetralogy in babies likewise now replaced the temporary Blalock or Waterstone 'shunts', which needed full repair at a later date.

The advent of therapy with prostaglandin, which opened the ductus arteriosis and thereby increased lung perfusion, proved another significant advance in the treatment of 'blue babies', producing dramatic post-operative benefit. Among the large number of tiny babies that he operated on was one weighing less than a bag of sugar.

Jim was one of the most technically accomplished cardiac surgeons of his generation and his international reputation attracted many junior colleagues to work with him in Southampton. He was a genuine team player, always courteous and polite. Junior staff were inspired by his unflagging enthusiasm and keenness to teach anyone who wished to learn. They found he was, moreover, always helpful and supportive.

His determination to develop and improve the treatment of his young charges led to a large number (over 150) of peer-viewed papers, as well as two influential textbooks (written with Gerald Shore) - A colour atlas of cardiac surgery. Acquired heart disease (London, Wolfe Medical, 1982) and A colour atlas of cardiac surgery. Congenital heart disease (London, Wolfe Medical, 1984).

Even towards the end of his career, he continued to operate on the most complex and difficult problems in these babies (with a seven-hour procedure being undertaken on his last list), whilst actively and enthusiastically training his junior staff in less complicated procedures. By the time of his retirement, he had operated on the full range of cardiac abnormalities in 2,000 babies with outstanding results. This was all in addition to operating on some 10,000 adult patients.

In 2001, in response to the Bristol inquiry into high death rates among babies who had undergone heart surgery, Jim was asked to chair a committee to review paediatric heart surgery across the UK. The Monro report called for a decrease in the number of units performing children's heart surgery. To Jim's immense disappointment, the committee's recommendations were not acted upon.

Jim's standing with his surgical colleagues was reflected in his appointment first as a council member, vice president and then president in 2003 of the European Association for Cardio-thoracic Surgery. He was also president of the Society for Cardiothoracic Surgery in Great Britain and Ireland from 2000 to 2002.

All of these achievements, however, were only part of the man. The parents and families of his young patients speak in glowing terms of his kindness and the support shown to them through such desperate times. Although his great charm earned him the sobriquet of 'Gentleman Jim', his real qualities were much deeper. He was a true leader.

In 1973 Jim met Jane Dunlop. Within three weeks, he had the good sense to propose, and, after a week of diligent enquiries by Jane in relevant quarters, their engagement was duly achieved. Marriage ensued on 29 September 1973, four weeks after he started his clinical commitments at Southampton. They had three children - Charles, Rosie and Andrew. Despite the pressures of work, Jim managed to enjoy a full family life, with tennis, golf, skiing and horse riding playing prominent roles.

Earlier in his life Jim had played rugby (breaking his jaw twice), and had represented Scotland at rifle shooting. He had a decent golfing handicap. He was also a brave and accomplished skier, winning slalom races against Continental colleagues at European surgical gatherings. His ability in a dinghy was less apparent, however, with his drenching providing considerable amusement for 300 spectators during an island trip. Following his retirement he also became a fine draughtsman and water-colourist.

In 1997, Jim developed colonic carcinoma. This was treated successfully by his old friend, Bill Heald, in Basingstoke. He was able to resume working after this, however, in 2006, two years after his retirement, prostate cancer was also diagnosed and treatment commenced.

Jim died on 29 August 2013, aged 73, and was survived by his wife and family. At a commemoration of his life at Romsey Abbey, tributes of admiration, respect and love were paid to him, not only by colleagues from far and wide, but by many of his former patients, whose lives he had not only saved but had otherwise transformed by his continuing care and support.

Steve Karran

Sources used to compile this entry: [The Telegraph 13 October 2013].

The Royal College of Surgeons of England