Within medicine, travelling groups are to be found mainly amongst British general surgeons and urologists, though some are found in other countries (France and the United States especially) and in other specialties, such as orthopaedics and anaesthetics. Travelling abroad to learn about medicine dates back at least to the Middle Ages, when a few great universities dominated medical thought, including Paris (founded in 1110), Bologna (1158), Montpellier (1181), Padua (1222), and Naples (1224), as well as Oxford (1167) and Cambridge (1209).
The southern European universities, whose main subjects were religion and the law, included Salamanca, still thriving in northern Spain, and in Italy Salerno which was one of the most famous during the 13th – 14th centuries but has disappeared without trace. Salerno was apparently a lay foundation providing a happy union of Greek, Arabic, Roman and Jewish cultures, and one of few medical schools at that time to admit women.
Until the 19th century the only surgical education was by apprenticeship, and many surgeons learnt their trade on the battlefield. John Hunter, for instance, published his observations from Belle Isle as a Treatise on the Blood, Inflammation and Gunshot Wounds.
Nowadays, the modern surgeon has little contact with the Armed Forces other than through the presence of patients in the military wings of the three civilian hospitals designated as Military Defence Hospital Units (MDHUs). The Royal Haslar Hospital is currently the only hospital run entirely by any of the Armed Forces, and is due for closure.
The first British surgical travelling groups took shape around the time of the First World War, under the auspices of Lord Moynihan – then Sir Berkeley – who saw a need to expand the horizons of surgeons working in restricted circumstances with little knowledge of what their colleagues in other towns were doing.
Sir Clifford Allbutt, for instance, wrote to Moynihan that “in those days the Staff operated as a whole, all putting their dirty fingers into interesting wounds, and exhaling vapours from their unwashed woollen dressing gowns ! They frankly criticised each other during the operation. ”
It was this ethos that Moynihan sought to improve. He himself was regarded by some of his contemporaries as a publicist, and his popularity was not increased by his habit of charging doctors and their families for any professional services, though he defended this on the grounds that otherwise his practice would be swamped to the extent he could hardly make a living.
Nonetheless, he was widely held in awe and respect and his contributions to the practice of surgery and the education of surgeons are legendary, and include the founding of the Association of Surgeons of Great Britain and Ireland and of the British Journal of Surgery.
He brought a dozen pairs of gloves back from the United States and by dint of careful washing and patching they lasted many operations. He also introduced the use of sterile gowns, caps and masks and rubber boots to the operating theatre in this country (receiving some criticism and even ribaldry for this, though their use was established on the Continent and in the United States) and opened up a new era of surgery with a reduced incidence of infection.
Seeing how generally isolated English surgeons were and how little they knew of what was done surgically in the next town, let alone other countries, he encouraged the formation of a number of travelling groups.
The first was the Moynihan Chirurgical Club, which he started in 1909 for surgeons practising in teaching hospitals outside London. Then in June 1921 Sir Berkeley Moynihan invited 28 surgeons from hospitals outside teaching schools to become part of “the Surgical Union”, and after the Second World War this became the Provincial Surgical Club and in 1969 it assumed its current name of the 1921 Surgical Club of Great Britain, or simply the 1921 Club.
In July 1924 Sir Berkeley entertained twelve surgeons to dinner at his Leeds home, the splendour of the occasion enhanced by a black silk tablecloth which set off to perfection the array of antique silver, especially the centrepiece of a huge silver bowl containing red roses.
His conversation and wit dominated the evening, which followed a day at his Leeds hospital in which he had performed a series of operations and presentations described as extraordinarily interesting by those who were there. And why were they there, those twelve surgeons who came from as far afield as Aberdeen, Swansea and Liverpool, as well as Birmingham, Cardiff, London, Oxford and Norwich, in days when transport was not always reliable ?
During the First World War, British surgeons working in the Casualty Clearing Stations of the Royal Army Medical Corps in Beauval in Northern France had resolved to keep in touch with each other after the war. Smarting from the gibe that the British were “the best amateur surgeons in the world” and feeling they had something useful to contribute to surgical thought, they resolved to meet again.
Once established in consultant posts back home, these surgeons approached Sir Berkeley because of his reputation and influence, and their overtures resulted in the surgical meeting in his home town of Leeds in 1924, at which Mr H H Sampson of Birmingham took the chair.
The group agreed to call themselves the Travelling Surgical Club (TSC) and drew up a set of rules. These stated that The Club, as it became known, should consist of twenty members, each of whom must have served in the Great War and currently be in consultant practice on the staff of a provincial hospital. The subscription was fixed at fifteen shillings. Sir Berkeley consented to become the Club’s first President, but although he sent many letters of encouragement he never found the time to attend in person.
In 1988 the name was changed to the Travelling Surgical Society to underline its serious scientific intent. Thus one of today’s most active travelling societies arose from the experiences of surgeons in the first World War, and indeed one of the earliest groups of all – the First Army Travelling Surgical Club – was exclusively military.
The link with the Armed forces within the Travelling Surgical Society remains strong with ten Service members (active or retired), and is reflected in the three oblique stripes (red, dark blue and light blue for the Army, Royal Navy and Royal Air Force) adorning the Society’s tie.
The Travelling Surgical Society meets twice a year, travelling abroad in the spring for about a week and congregating for two days in the autumn at a home meeting hosted by a member. The wives of deceased members are warmly welcomed for the social events at our meetings.
The meetings abroad consist of visits to several hospitals, usually for one day each, during which the group may attend an operating theatre suite, tour a ward and other facilities (such as an intensive care unit) and have a scientific session in which papers are presented by the host surgeons and by the members.
The topics cover as wide a range as the Secretary and the host surgeons wish, the more unusual including the Lockerbie disaster, the history of surgery during the Crusades, and a gruesome account of injuries from the conflict in Northern Ireland. Of late, Telemedicine demonstrations have figured prominently. On visits abroad an ‘internal’ meeting of presentations within the group is usually held, though the chief stimulation is from the company of our hosts, with whom we also arrange social events.