The TSS first visited Ireland (Eire as it was then known) in 1954, many members going by plane (‘a novel form of transport’) to Dublin where they visited St Vincent’s Hospital, Dr Steven’s Hospital (now no longer a hospital), the Mater Misericordiae (‘The Mater’ – Dublin’s largest hospital) and the Meath Hospital. Founded in 1834, St Vincent’s was the first hospital in the British Isles to be run and staffed by women, the Irish Sisters of Charity who refused Florence Nightingale’s request to nurse there. Of the £70,000 it cost annually, £5,000 came from the Sweepstake Fund. A National Insurance patient cost the hospital £8-10s a week, the Government contributing £5-12s. Here an operating list (including Mr O’Connell’s 48th mitral valvotomy – a mitral stenosis patient cost the hospital £12 a week), was followed by what was held to be a fine lunch at the Guinness Brewery. Dr Steven’s Hospital (founded in 1720) appeared in a poor state of repair, though Abraham Colles worked here for 40 years. Charnley’s hip operation was discussed and demonstrated by Mr Chance and Mr Cherry.
The Mater Misericordiae Hospital had been founded in 1861 by the Sisters of Mercy, some of whom had trained in the Hotel Dieu in Paris, and there are now Mercy Hospitals throughout the world. Received by Professor Barniville in 1954, the surgical group watched operations by Messrs Butler, O’Malley, Corcoran, O’Sullivan and Byrnes. Members learnt at the Meath Hospital that it was the only hospital in Ireland to have an English surgeon, Professor Kilner attending twice a year to do plastic procedures. Mr Lane advised members that during the 19th century this hospital was staffed by some of the most distinguished consultants in Europe, including Graves, Stokes and Cheyne. Mr Lane himself had invented a number of instruments and apparatus, and a brass model was viewed of a bed for shaking stones out of the renal pelvis. In Dublin three members were elected to the Society: Fred Hanna, Brian Truscott and Sinclair Irwin. Following this visit, the group headed north to Belfast from Dublin by train.
Belfast received the Society on no less than four occasions in total (1954, 1976, 1997 and 2012). In 1954 the group arrived by train from Dublin and was met on Belfast station by surgeons headed by Mr Ian Fraser (who was later knighted as President of his College). The Report for that year states that “it would not be out of place to mention the great kindness and friendliness shown us by Mr and Mrs Sinclair Irwin, who did everything to make our visit in Belfast a happy and memorable occasion.” In 1976 Sinclair and Betty Irwin again arranged the Belfast visit, and in 1997 it was the turn of their son Terry with his wife Jenny when Northern Ireland’s static population and its legacy of terrorism made for interesting surgical papers at the Belfast City Hospital, followed by a tour which included the Giant’s Causeway. Happily our visit in 1997 coincided with an IRA ceasefire preceding the first peace talks for 75 years. Travel was facilitated by Belfast having two airports (International and City) to which members flew from the increasingly numerous ones on mainland Britain.
The spring of 2012 saw the TSS again combining – as in 1954 – visits to Belfast and Dublin. In two very modern hospitals and one research unit we had outstanding scientific presentations on a wide range of subjects, many of them cutting-edge and some confronting the difficulties of providing screening or specialist services to a dispersed population (6 million in total) albeit largely concentrated in the two largest cities on the Emerald Isle. Thanks to the success of the peace process, in both Northern Ireland and the Republic we felt safe, our military members contrasting this with what they experienced during their own spells of duty in ‘the Troubles’.
Under the Presidency of Professor Pierre Guillou with his wife Pat, our host in Belfast in 2012 was again our Secretary Terry Irwin with his wife Jenny, helped by local vascular surgeon and TSS member Paul Blair. We did not visit clinical facilities, which these days hardly vary between centres, but were impressed by the airy open lay-out of the Royal Victoria Hospital in Belfast and of St Vincent’s Hospital (our host was Professor Ronan O’Connell) in Dublin where the second session was held near the Mater Misericordiae – ‘The Mater’ – University Hospital (which has a new build in prospect) in the Catherine McAuley lecture theatre of the modern teaching and research complex housed in Nelson Street, where Professor Tom Gorey welcomed us amongst posters outlining the life and work of James Joyce (one of four Dublin Nobel literary laureates) who was born in neighbouring Eccles Street and briefly studied medicine; indeed he based each major episode in his book Ulysses on a bodily organ.
In Belfast at the Royal Victoria Hospital we heard about new approaches to cancer (cell biology, rapid access, screening), trauma management (the fractured pelvis; interventional radiology), gastrointestinal failure and repairing abdominal wall defects, and managing metastatic disease (the role of PET scanning and of lung and liver resection, improving survival). There was advice on how to handle the trainee in difficulty and the meaning of professionalism to the modern surgeon. Stone surgery was reviewed by local endo-urologist Trevor Thompson, later elected to the TSS with whom he spent the week.
In Dublin we attended an early-morning Grand Round at St Vincent’s Hospital, of three case presentations from trainees: on the urachal remnant (and its risk of malignancy in adults), cardiac tamponade, and troublesome complications from prolonged pouchitis with occult Crohn’s disease. Outstanding was a discussion of rugby injuries by Professor John Ryan who showed just how dangerous the modern tackle and line-out can be, perhaps warranting further changes to the rules. Between them the two hospitals covered liver and heart transplantation, the plans for colorectal screening and rapid access prostate assessment (most men with prostate cancer opting for radiotherapy), the rise of endovascular aortic stenting, how to manage pelvic floor disorders, and sacral neuromodulation for faecal incontinence. There were research presentations on drugs to treat triple negative breast cancer, and on the microbiome of the gut and the importance of bacterial translocation. We were updated on modern robotics in urology, imaging to plan cranio-facial reconstruction, and a better ankle prosthesis than anything worldwide. Two excellent papers were given by our Price Thomas Travelling Fellow Justin Davies, a colorectal surgeon in Cambridge who joined us for the meeting in Dublin: he discussed molecular stool analysis (currently too expensive for colorectal cancer screening) and the virtues of chlorhexidine over povidone-iodine for operative skin preparation, which stimulated much discussion.
In Belfast we stayed in the city centre at the Europa Hotel now that the peace process had settled the Troubles, while Brooks Hotel housed us in the heart of Dublin, within walking distance of most historic sites. Like several other European countries, the Republic was reeling from the recession, posters on walls and lamp-posts vying to persuade voters in the forthcoming referendum on the European fiscal compact treaty that austerity and a secure future (that is, growth) are mutually exclusive.
As 2012 was the centenary year of the loss (on 15 April) of the White Star Line’s RMS Titanic, many events and exhibitions commemorate the memory of this largest liner of its day, built in Belfast by Harland and Wolff and considered unsinkable though its watertight bulkheads did not reach topside for fear of encroaching on passenger corridors, nor were there enough lifeboats. All this was recalled in the massive Titanic Experience, opened at the beginning of April as a permanent display in a huge symbolic star-shaped building. It covered the history of Belfast (‘Linenopolis’), the role of shipbuilding, and the whole Titanic story using state-of-the-art audio-visual aids and a simulated ride through the shipyard. The ladies later visited the linen museum, a scutching mill (turning flax into fibres) then Hillsborough. That evening everyone had a tour and dinner at the Houses of Parliament, Stormont, with the charismatic Unionist MP Ian Paisley (junior) and MLA Basil McCrea offering witty exchanges.
We travelled from Belfast to Dublin by coach, stopping half way (near Drogheda) in ‘soft rain’ to visit Knowth, one the three 5000 year old major mounds of Brú na Boinne. Excavations have shed light on the Neolithic way of life 600 years before the pyramids were built, yet fail to explain the meaning of Megalithic art on stones erected a millennium before Stonehenge.
The ladies were well catered for with a fabulous food tasting trail, having the previous day had a walking tour of Dublin, the National Gallery of Ireland and Trinity College with its famous Book of Kells. On our final day we toured the city, ending up at the remarkable Guinness Storehouse, its five storeys reshaped inside as a huge pint glass for the black stuff with simulated displays of how it is brewed from roasted barley, hops, yeast and of course water from the Wicklow Mountains with the fifth ingredient of passion imbued by Arthur Guinness who had a 9000 year lease on the St James’s Gate site. We learnt how to pull and taste a pint, and have certificates to prove it. Dinner that night – after Grace in Gaelic by William Shand – was in the Board Room (a finger panel was dented by a bullet in the Easter Rising of 1916) of the elegant Royal College of Surgeons in Ireland where our guests were Professors Tom Gorey (with Mary) and John Hyland (and Anne), and vascular surgeon Stephen Sheehan with his wife Anne. Thus ended our week in Ireland, superbly educative surgically and historically thanks to our Secretary and Belfast host Terry Irwin – and we fittingly renamed ourselves the Travelling Surgical Society of Great Britain and Ireland.