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Biographical entry Taylor, Hermon (1905 - 2001)

MRCS 1929; FRCS 1930; MB BCh Cambridge 1930; MChir 1932; MD 1934; LRCP 1929.

Born
11 May 1905
Workington, Cumbria
Died
10 January 2001
Occupation
General surgeon

Details

Hermon Taylor was born in Workington on the Cumbrian coast on 11 May 1905. His father, Enoch Oliver Taylor, was a schoolmaster and his mother, Louise née Harrison, a schoolmistress. His father came to London to become Director of Education for Edmonton and Hermon was educated at Latymer School, from which he won a scholarship to St John's College, Cambridge. There he gained the Horton Smith prize, and an entrance scholarship to St Bartholomew's Hospital in 1925. He qualified MRCS LRCP in 1929 and the following year passed the Cambridge MB ChB and the FRCS.

At St Bartholomew's he was house surgeon to Louis Bathe ('Jumpy') Rawling, J E H Roberts and R C Elmslie, and became a demonstrator in pathology while studying for the FRCS. After experience in regional hospitals, at Hertford, Lincoln and Tottenham, he returned to St Bartholomew's with the Luther Holden research scholarship in 1932. Then he went to Heidelberg, where Rudolph Schindler and Georg Wolf had developed a gastroscope with a slightly flexible tip. Hermon bought one of the prototypes, but export was forbidden by the Nazis, so he slipped it down his trouser leg and limped stiff-legged through customs. (Two years later, Schindler escaped to Chicago to continue his work.)

Back at Bart's, Taylor became as adept in passing the gastroscope as any sword-swallower, and, together with Mr Schranz of the GU company, designed significant improvements to the flexible end of the instrument, fitting it with a steering system controlled by the observer. He was soon much sought-after in the diagnosis of disorders of the stomach and duodenum.

In 1934, he was appointed first assistant to Sir James Walton and Victor Dix at the London Hospital. Walton was then the exponent of gastro-enterostomy for the treatment of peptic ulcer. Dix was a rising urologist who had just introduced intravenous pyelography to Britain. When a vacancy arose on the staff in 1939, against a galaxy of local talent, Hermon was elected to the position of assistant surgeon by an overwhelming majority.

At the outbreak of war, it was predicted from the experience in Barcelona during the Spanish civil war, that there would be large numbers of civilian casualties from the bombing of London. Surgeons from the London teaching hospitals were drafted to the sector hospitals and Taylor, whose asthma prevented him from joining the services as he wished, was posted to Billericay. He was a restless surgeon who questioned the conventional wisdom in every problem that he encountered.

One of the first of these was prostatectomy. He found himself in charge of wards full of old men with suprapubic tubes, all regarded as unfit to undergo the 'second stage' suprapubic prostatectomy, which in those days carried a mortality of more than 20 per cent from inability to control haemorrhage. Hermon devised a simple method. After enucleation of the adenoma, he packed the cavity with gauze. This was then removed after a few days through a suprapubic tube, with a removable inner sleeve like a tracheostomy. He made the prototype in his own workshop out of brass. This simple gadget enabled him to do large numbers of prostatectomies without mortality. (He was still using this simple method in 1956, but never thought it worth writing up. His juniors who cared for Hermon's patients and those of his colleagues knew otherwise.)

For malignant ascites diagnosis in those days required a laparotomy, which was often lethal. Hermon developed a simple method of laparoscopy, using an ordinary cystoscope, which would reveal omental and hepatic deposits, even though the view was limited and the distal illumination from the bijou lamp was dim and unreliable. If only the Hopkins telescope and fibre lighting had been available then it is interesting to speculate how Taylor might have taken laparoscopic surgery half a century earlier.

In the breast, Hermon was equally unorthodox. His training in pathology had taught him that radical removal of the breast for carcinoma was as futile in some cases as it was unnecessary in others. At St Mary's, Arthur Porritt was independently developing his 'lumpectomy' for the same reasons. Hermon's solution was a neat, elegant, anatomical 'sector mastectomy'. For cysts, he was an early advocate of aspiration. Both these innovations were frowned on by his peers at the London, who denounced them to their students as unethical.

For perforated peptic ulcers, Hermon was an early advocate of 'suck and drip', independently of the work of Wangensteen in the United States. His results were excellent, but again little thought of in his own hospital. He regularly audited his results and soon realised that when a chronic ulcer perforated, the patient would inevitably require gastrectomy within the next few months, so he decided to do the gastrectomy there and then. Since these cases often came in during the night, he went out of his way to make sure that his registrars could do it safely. Hermon thought nothing of coming in late at night to take the junior surgeon through the operation, stitch by stitch, and would only let him go solo when he was satisfied that the junior was thoroughly competent. It took some time before he could validate this policy by presenting his statistics to the International Society of Gastroenterology.

For the next two decades, his main interest continued to be the surgery of peptic ulceration, especially the use of the gastroscope to distinguish benign from malignant ulcers. He developed a neat method for avoiding the dumping syndrome: he thought that this was caused by obstruction to the afferent limb of the duodenum which was kinked when pulled up to join the stomach. His remedy was to mobilise the greater curve from the spleen, and so allow the stomach to be brought down without tension to the duodenum: he called it the 'no-loop' gastrectomy. This took a little longer than the standard operation, and his contemporaries mocked him, claiming that their methods were never followed by dumping. The juniors, who followed both groups of patients in the clinic, knew better.

Hermon Taylor's operative technique became a byword at the London; he was a master of sharp dissection and exact haemostasis. For him the tissue planes seemed to open without bleeding: assisting Hermon was always a lesson - easier to admire than to emulate.

In the 1950s, he turned his attention to vascular disease. Once heparin became available he turned to endarterectomy, removing the entire block of atheroma and intima. This called for endless patience and immaculate stitching, where his craftsmanship - always using a straight needle - came into its own. Successful for middle-sized arteries, endarterectomy was less successful in the aorta and great vessels, so he sent his assistants to get aortas from animals, freeze-dry and sterilise them, and used them to replace the aorta. Shortly before he retired these animal grafts were superseded by prostheses made from Dacron and other artificial materials.

Many honours came his way. He was Moynihan Fellow of the British Association of Surgeons; Hunterian Professor at the College of Surgeons; President of the British Society of Gastroenterology; an honorary member of the American Gastro-Enterological Association, and honorary Fellow of the London Hospital Medical College. He wrote extensively, and always very clearly and simply.

He married in 1932 Méarie Amélie Pearson, by whom he had three sons and two daughters. She predeceased him in 1981. He later married Mrs Noreen Cooke. His eldest son, John, followed him into surgery at the London Hospital and became Professor of Surgery at St George's Hospital. In 1999 he opened the new Hermon Taylor department of endoscopy at his old hospital - now Bart's and the Royal London - where they keep a bronze portrait of him by one of his former registrars and colleagues, John Blandy.

A keen yachtsman, Hermon retired to Bosham Hoe, where he could see his moorings from his drawing room. There on a summer's day in 2000, as enthusiastic and charming as ever, he celebrated his 95th birthday, surrounded by his five children and a cluster of grandchildren. He died in his sleep on 10 January 2001.

The Royal College of Surgeons of England