A rare photograph of Professor George Hoxley author of A Study
of Tribal Deformity and Mythopoesis in the Lower Territories
The following is an extract from the volume The Separation of Tumours, Cysts, and Conjoined Twins published by D H Knowle, Dec. 1932 where it appears entitled
A Note of Caution to Surgeons
As in all surgery, there may come a time during a procedure when it becomes clear that to continue would lead to the certain loss of the patient’s life and it seems appropriate here to add a few further words on this subject in anticipation of the quite possible occurrence of these sad circumstances.
Much reference is made earlier in this volume to the importance of keeping the blood supply to any tumour intact until after its successful removal. However, on occasion, separation of a blood vessel is unavoidable early in a procedure or it may happen accidentally. The resulting ‘death’ of the tumour and subsequent necessity to remove the tissue may mean a surgery has no way of succeeding.
There are many examples that may be given of surgeries which, though started in good faith of a successful outcome, have ended in disaster following the discovery of some previously unsuspected anomaly of the deformity. Sometimes, the growth may have fingers or tentacles that weave with the structures of the patient’s organs to such an extent that full separation may be impossible. In his much recommended publication, A Study of Tribal Deformity and Mythopoesis in the Lower Territories, Professor Hoxley tells of the curious case of a young girl whose tumour, though appearing quite unremarkable otherwise, had thick hair and a number of teeth. Although the girls family and indeed the young girl, who was quite terrified by her tumour’s appearance, were in agreement with Prof. Hoxley that removal was the only sensible course of action, during the procedure, the growth was found also to have an ‘arm’, the hand of which was quite inextricably woven into the musculature of the girls heart. Without this support it was clear that there was no hope that the organ could function in such a way as to sustain life and, as the tumour had already been estranged from its blood supply, there was no hope of the girls survival (1)
There are many other variations to this general principle. Sometimes an apparently benign cyst may, on division, reveal a much more complex structure than might ever be suspected on examination by even the most meticulous surgeon. Other times, the sheer mass of growth presenting beneath the surface may be so huge that to remove it would clearly leave insufficient tissue to perform a competent closure of the wound. If the blood supply to the tumour remains intact then the possibility of a partial removal may remain. But otherwise, the outlook will be bleak.
Should these sad circumstances arise, they may cause some discomfort to you. Most frequently, the decision to operate is made in the certain knowledge that the patient will shortly die without your intervention. But sometimes, on meeting your patient prior to surgery, you may have noted that he appeared to have resigned himself to his affliction and seemed to be leading some semblance to a normal life. In such a case, you may have felt some consternation over the dilemma of whether or not it would be in his best interests to proceed.
The surgeons task is always to preserve life rather than to end it. On the death of any patient it is only natural to feel some sadness or sense of failure. However, if you have approached your work with delicacy and with due regard to the advice contained in this publication and other modern tracts on the subject, you will have carried out diligently your duty to your patient and therefore will have no real need to reproach yourself.
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1. The so called ‘hand on heart tumour’ uncovered by Prof. Hoxley currently resides under his widow’s ownership in the collection of medical curiosities and anatomical variations arranged in the pavilion of The Warley Hospital, Brentwood, Essex. It may be viewed at all reasonable hours by simple arrangement with the curator
