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| (above) Sir Victor Horsley was an outstanding practitioner of patient-centered care. The Horesley-Clarke stereotactic frame was first reported in the article “The Structure and Functions of the Cerebellum Examined by a New Method,” published in 1908. The unit displayed is the second Horsely-Clarke device, which was constructed the same year for neurosurgeon Ernest Sachs. |
Victor Horsley (1857–1916) was the first consultant surgeon at the National Hospital at Queen Square in London. Certain of Horsley’s neurosurgical accomplishments are well known, including the introduction of the stereotactic frame (for animal experimentation) and the first reported and successful removal of an intraspinal, intradural tumor. What may be less well known is Sir Victor’s compassion and devotion to his patients.
Ernest Jones, a pioneering British psychoanalyst, served for a time as a “house surgeon” under Horsley. Noting the frenetic pace with which Sir Victor conducted his patient rounds (and everything else), Jones added “but the concentrated attention [Horsley] devoted to each patient gave him the impression that he was his sole care in life, and he would arrange their pillows with a tender deftness that was the envy of the nurses.”
On one particular occasion, Horsley operated on a Canadian patient with torticollis. The surgery was done in a “nursing-home,” a place for care and convalescence at a time when few if any private patients were admitted to hospitals. None of the staff nurses had a good idea of how to position the patient after her surgery. Sir Victor had a particular cushion in mind, went by carriage to purchase it, brought it back to the nursing-home, and arranged the patient on it. In this and in many other cases, Horsley returned the payment offered by the patient. He was not averse to making money (he stated, “I always wish people had my work, on account of its interest…and I wish they had my wages too”) but was keenly aware of who could afford what.
Wilfred Trotter, a British neurosurgeon who trained with Horsley, described his being “free from the slightest affectation of superiority [and having] an assumption of complete equality.” When a poor Irish farm girl with an intracranial tumor came to see him in consultation, she reported that Sir Victor spoke to her “not in the least like a great doctor with an unimportant patient.”
No one used the term 100 years ago, but without question Sir Victor Horsley, a great innovator who blazed a trail in neurological surgery, was a leading exemplar of patient-centered care.
Michael Schulder, MD, is professor and vice-chair in the Department of Neurological Surgery at New Jersey Medical School in Newark.