Enhancing care,
Advancing health science

The Life and Work of Robert Campbell

From a paper by William S Campbell published in the Ulster Medical Journal 1963 vol 32 p168.

Robert Campbell was born on 1st August, 1866, in the Old Manse, Carnanee, near Templepatrick, County Antrim He was the second son of Reverend Robert Campbell, Minister of the Old Presbyterian Congregation of Templepatrick, Co. Antrim, and his wife, Elizabeth Simpson. Baptized on 8th November, 1866, by Reverend J. Porter of Ballee, he had a long and honourable manse tradition behind him. His early life and education must have involved much physical hardship and, in addition, two tragic happenings marred this early phase. Firstly, at an early age, he contracted scarlet fever, a disease of much greater severity then than now, which resulted in an albuminuria, and this may well have sown the seeds of his subsequent Bright's disease and death from uraemia. Secondly, four days after Christmas in 1875, when he was 9 years old, his mother died suddenly from puerperal eclampsia.

Robert Campbell showed early promise as a scholar and reached the top form at Roughfort National School when only 11 years of age. He subsequently entered the Royal Belfast Academical Institution and studied in the English School under John Carlisle, M.A., father of the future Lady Pirrie, and in the Classical School under Robert Steen, Ph.D. He entered the Arts Faculty of Queen's College, Belfast, in 1884 with an entrance scholarship. His first interests were English Literature and the Ancient Classics, and his studies in the latter must have been assisted by his father, who had then retired from active duty in the ministry, but gave instruction in Ecclesiastical Greek and New Testament Introduction to divinity students. His love of literature remained all his life.

As an undergraduate, Robert Campbell gained first-, second-, and third-year scholarships in Arts (Literary Division) and graduated B.A. in 1887 with second-class honours in Ancient Classics at the Royal University of Ireland. His inclination then is said to have been to read for the Bar, but he yielded to other counsels and entered the medical faculty. In 1890 he was awarded a third-year medical scholarship and in 1891 a fourth-year medical scholarship (Anatomy and Physiology) and the Coulter Exhibition at the Belfast Royal Hospital. He graduated M.B., B.Ch., B.A.O. in 1892 at the Royal University of Ireland with second-class honours. In this final examination he was placed first in his year and awarded an exhibition.

After qualification Robert Campbell was Demonstrator of Anatomy (1892-93) under Professor Peter Redfern. Robert Campbell then took up for a year an appointment as house surgeon in St. Thomas's Hospital, London, a hospital on whose staff his fellow-townsman, Sir William MacCormac, a famous Queen's College graduate, was then surgeon. He later became resident physician to Chester Infirmary until 1896, and he himself regarded his clinical experience there as being of great help in his future career. He further qualified M.R.C.S. and L.R.C.P. London in 1893 and became F.R.C.S. England in 1896, the year in which Sir William MacCormac was for the first time elected as President of the Royal College of Surgeons of England.

In 1897 Robert Campbell returned to Belfast and in 1898 was appointed Honorary Surgeon at the Belfast Hospital for Sick Children, then in Queen Street. His work at this hospital was always a great source of pleasure to him; he became devoted to children and was beloved by them in turn, and he spent more and more time in working there. From 1899 to 1900 he was Surgical Registrar at the Belfast Royal Hospital, and, in 1900 he was appointed Honorary Assistant Surgeon to the same hospital, later, in 1912, when John Walton Browne retired, becoming Honorary Surgeon to the then Royal Victoria Hospital. He also acted as a Clinical Lecturer in Surgery to Queen's University and during the 1914-1918 war acted as Surgeon to the U.V.F. Military Hospital which was set up in the Exhibition Hall in the University's grounds. He joined the Ulster Medical Society in 1897, acted as Honorary Secretary to it from 1900 to 1903 inclusive, was Vice-President in the session 1911-12 and President in the session 1916-17. He was a member of the British Medical Association and was elected President of the Ulster Branch in the 1918-19 session. He was also a fellow of the Royal Society of Medicine.

Robert Campbell's contribution to the advancement of surgery was due probably not so much to the originality of his views as to his gift of clarity of logical thought which enabled him to recognise the best of the ideas available and then put them into practice. He was first and foremost a clinician, rather than a mere surgical carpenter; he condemned in his 1902 address the needless multiplication of operative procedures under various names, and made a strong plea for a more energetic study of surgery in its scientific aspects. In describing and condemning repeated mutilating operations for recurrence of tuberculous disease he remarked, "If things continue at their present rate I foresee the time when as much of that patient shall be resting quietly beneath the sod as shall be above ground striving to fulfil the duties of a citizen." He wrote very little and published less, although he often orally demonstrated cases at medical meetings. This is much to be regretted as he had a clear simple style, accompanied by a logical presentation of his facts, which renders reading of his manuscripts, beautifully penned in his own hand, a pleasant experience. Apart from his surgical papers, considered later, he undertook the surgical section of a Textbook of Treatment (alphabetically arranged) to be published by Sidney Appleton, London, the other sections on obstetrics and gynaecology and medicine being in the hands of his brother John and William Calwell respectively. Regrettably, he never finished his manuscript, and only John Campbell's volume on Obstetrics and Gynaecology was subsequently published (1908) in book form.

Robert Campbell was one of the first in Ulster to adopt in its entirety the system of aseptic surgery. The use of rubber gloves had been introduced by Halstead about 1890 in Johns Hopkins Hospital, and their use became a regular part of the technique at that hospital by 1896. At that time, too, they were being used for some operations by John Campbell at the Samaritan Hospital. Robert Campbell was also an early user, and he was, in addition, the first in Ulster to advocate the use of face masks covering the mouth and nose. Credit for the introduction of these is usually given to Mikulicz (Breslau) and Berger (Paris) in 1897, but they were not generally in use until as late as 1906. Robert Campbell's description of his reasons for adopting face masks illustrates his clear thinking and his odd turn of phrase, which so captivated his colleagues, and is worth recording. In describing his technique in operations for hernia in infants and children (1903) he remarked, "In the majority of the operations I have worn thin rubber gloves and I frequently, especially when demonstrating the operation to students, wear over the head a square piece of sterilized gauze split into two tails at either side, the anterior two being tied behind the neck and the posterior two being brought forward over the mouth. This latter precaution I adopted after seeing operators and their assistants now and again during an operation in which they were much interested, shed showers of dandruff into the wound, and also from the observation that some people cannot speak to you without spitting into your face."

His first published work was a short presentation of a case of club hand, illustrated by a skiagraph, to the Ulster Medical Society on 7th April, 1898. He was an early advocate of operation in all cases of perforated typhoid ulcer, whether in the active or the convalescent stage of the disease, and on 12th December, 1898, he was the first in Ulster to close such a perforation. It is interesting to recall that the first perforation of a gastric ulcer to be closed by laparotomy in Ulster was by his brother John on 21st July, 1897, the patient, a woman of 35, surviving.

In 1906, before the Ulster Medical Society, he read a paper on acid intoxication following general anaesthesia. He described three cases of delayed chloroform poisoning in children and strongly insisted on the greater safety of ether as compared with chloroform in operations. In 1909 he read a well-composed and interesting paper on the surgical treatment of exophthalmic goitre, some of his partial thyroidectomies being done under local anaesthesia, and in 1915 one on fractures of the head of the radius. He maintained "in all but the mildest forms of fracture excision of the whole head of the radius is the best treatment." He argued that the usual cause of the condition was a fall on the outer side of the elbow and not on the palm of the hand.

Robert Campbell's most important contributions were, however, in the fields of the operative treatment of hernia in infants and children, and the aetiological types of acute appendicitis. In the former subject, by careful and laborious work, he succeeded in perfecting the operation for hernia in the young, and making it a recognised and successful method of treatment in spite of much opposition. In so doing, he not only gained personal fame, but brought great credit to the Belfast Medical School.

Some time before 1909 Robert Campbell began to perform these operations in the out-patients' department of the Queen Street Children's Hospital. This at first gave rise to criticism by the governors of the hospital, but all objections were overcome in the end, and a well-equipped out-patient theatre was provided. This procedure received support from a paper by J. H. Nicholl of Glasgow, read at the B.M.A. meeting in Belfast in 1909, which recommended that a much larger share of operative work at a children's hospital should be done in the out-patients' department. Robert Campbell, at the same meeting, supported this policy completely in the case of those children who could be easily carried by the mother. This work was later taken up by Professor Fullerton.

Robert Campbell was not a spectacular operator. He laid great stress on accurate and detailed anatomical knowledge, and, although he was not slow, he never made speed for its own sake one of his ideals; rather he would methodically, step by step, complete the stages of a complicated operation often in silence and with very little assistance. The thoroughness of his aseptic technique was such that wound sepsis was very uncommon in his wards, e.g., in his series of three hundred and five inguinal hernia operations, reported in 1906, there were only two cases of suppuration. He was credited with great powers as a diagnostician. These powers, however, appear to have been based on careful study of all the factors bearing on the case rather than to any intuitive flair. It was his logical and orderly mind, combined with the thoroughness which was always one of his characteristics, that made his diagnoses always sound and worthy of unusual respect.

As a teacher Robert Campbell was held in the very highest regard by his house surgeons, pupils, and others. This is perhaps strange, as he was a man of few words with long periods of silence. In an unpublished manuscript of an address to the Belfast Students' Medical Association in 1906, entitled, "The Student and His Teachers," Robert Campbell, in elaborating certain themes, affords some clues regarding the nature of his teaching :

1. The basis of clinical work should rest on a sound knowledge of anatomy and physiology.
2. In examination of the patient he stressed the great importance of looking at things. He held that in searching for the signs of injury or disease we mainly depend on our sight, our hearing and our touch, and the most accurate observations and the most lasting impressions are those conveyed to our mind by our sense of sight.
3. Students should always verify for themselves the statements made by their teachers of the signs present in a given case. "Never take authority when you can get fact, and never guess what you can know."
4. As a corollary regarding students in hospital Robert Campbell added: "The main object of their attendance at hospital is not that they may listen to the views expressed by other people, but rather that they should train their organs of special sense in the detection of disease by constant practice."
5. He held that the asking of questions was of great importance (a) of the teacher to clarify obscure points and (b) of the patient especially with the view of gaining experience in talking to sick people.
6. His remarks on set lectures are worth quoting: "Courses of lectures are relics of the days when printing was in its infancy and treatises on medical subjects were few and far between. Nowadays books are published yearly in every subject in the medical curriculum, most of which contain in readable form the greater part of the material professors and lecturers grind out in mechanical fashion session after session. I do not suggest that lectures should be entirely abandoned. I would merely propose they should be limited in scope—that they should not deal with matters contained in every text book—but rather that they should be confined to the discussion of subjects about which some recent information, not yet embodied in the hand books, could be given, and to the elucidation of difficult points which could be more clearly expressed by oral teaching." He believed, however, that there should be a course of lectures on medical ethics."

In the same paper, with a mixture of idealism and earthly wisdom he suggested there were three requisites for a successful career in medicine:

1. A sound knowledge of professional work.
2. A sound personal character as shown by conduct and manner. Regarding this he quoted Professor Redfern's dictum, "Any man who possessed a diploma in medicine was certain to gain a fair measure of success in his profession provided he was sober and kind to his patients."
3. Pushfulness, i.e., the spirit of self-advertisement.

Robert Campbell had, undoubtedly, the first two of these requisites in abundance, but the last was completely foreign to his nature—he hated all pomp, boastfulness, and show, and detested all sham and humbug.

He was a friend to many and his sincerity, personal integrity, and clarity of mind proved of benefit to many of his colleagues when in difficulties, either professional or personal. As Professor Sinclair said, "What a support he was in anxious and difficult situations so that if he did not speak (for he was a man of few words and well chosen) his influence was sustaining; and in many respects an inspiration to those whose inexperience or timidity demanded a strong arm on which to lean." A most touching tribute came from Sir Thomas Houston when he remarked, "I have to acknowledge with gratitude how his logical mind made straight many of the difficulties of my early professional life. He had the faculty, which few men have, of brushing aside all that is irrelevant and non-essential and coming with logical precision to the heart of the matter discussed. He was a kind and generous friend and when he died I felt something had gone out of my life that could never be regained."

Robert Campbell had suffered from Bright's disease for some years when, in March, 1920, he became seriously ill with a uraemic condition. He rallied, however, and was able to resume work, but this improvement was short-lived. He died at his home, 22 College Gardens, from uraemia, in the early hours of the morning of 6th September, 1920. He was only 54 years of age.

Robert Campbell was interred in the old burial ground at Templepatrick, the ground where the old church of the Knights of St. John of Jerusalem once stood, and where his ancestors lie at rest. A stained-glass window was erected to his memory by his widow in the old meeting-house where his father and great-uncle once preached the Gospel. This was dedicated at a special service on 25th June, 1922, by Reverend Alfred Turner.

A question remains—what quality or qualities of his led to the rapid subscription of nearly £900 by some one hundred and ten of his friends and colleagues, and to the novel form that the memorial took? All the aspects of his personality and work, previously mentioned, may have made some contribution, but the fons et origo may well have been an echo of the character of the first Reverend Robert Campbell, who, for freedom of thought, defied the General Synod and the wrath of Reverend Henry Cooke, and was known throughout the countryside in his lifetime as "honest Bob"—an echo reflected in the honesty of thought, clear vision, and integrity of moral purpose of his descendant and namesake, the pioneer of aseptic surgery at Queen Street and the Royal Victoria Hospitals. Perhaps the epitaph, composed over one hundred years ago by the Templepatrick congregation for his great-uncle, would not be so very much out of place in describing Robert Campbell's own life—"Unassuming in manners, unswerving in integrity, unostentatious in piety, and unblemished in moral character, he enjoyed in a remarkable degree the esteem and confidence of the entire community."

"For I loved the man, and do honour his memory,
on this side idolatry, as much as any" (Jonson).

The Robert Campbell Oration

Shortly after the death of Robert Campbell on 6th September 1920, a fund was established by his medical friends and colleagues to commemorate the pioneer work Robert Campbell had done for surgery in Ulster. The future Sir Thomas Houston, who was President of the Ulster Medical Society at the time, and a close friend of Robert Campbell, played a leading part in this. By the 8th November, 1920, a sum of £456. 12s. 0d. had been subscribed (it eventually reached a total of £874. 7s. 0d. two months later), and a meeting of the subscribers was held in the Whitla Medical Institute to determine what form the memorial should take. After some discussion it was decided that it should be something of "recurring practical utility rather than to seek to enshrine his well-known personality in some form of pictorial or plastic art." The meeting agreed that the fund should be called the Robert Campbell Memorial Fund, and the memorial should take the form of a prize, to be called the Robert Campbell Memorial Prize "to be awarded periodically for distinguished work in any branch of medical science to that member of the profession in Ulster or to that graduate of Queen's University, Belfast, whom, at the time of the selection the committee should consider most deserving of the honour." It was also decided that the recipient of the prize should have the duty of delivering an oration to the profession, to be called the Robert Campbell Memorial Oration. This was the first memorial oration of this type to be founded in Ulster.

It appears from the above that the original intention was to confine the prize to Ulstermen and Queen's men, but its scope was later broadened, and when the Trust Deed was drawn up the appropriate phrase read, "The prize shall be awarded by the committee at such time or times as it shall think fit, and shall on the occasion of its being so awarded be of such amount as the committee shall decide to some of the following persons, namely, to a medical man residing in Ulster, or a graduate of Queen's University of Belfast, or some other distinguished medical practitioner or surgeon who in the opinion of the committee shall have performed distinguished work in some department of medical or surgical science." The object of the Trust was stated to be "to perpetuate the memory of the said Robert Campbell and to advance the cause of medical and surgical science."

At the subscribers' meeting on 8th November, 1920, the following constitution for the executive committee was agreed on:

1. The Professors of Surgery, Medicine, Midwifery, Gynaecology, Ophthalmology (altered in the Trust Deed to Lecturer), Pathology, Anatomy, and Physiology in Queen's University, Belfast.
2. The Presidents of the Ulster Branch of the British Medical Association and of the Ulster Medical Society.
3. The Chairman of Staff at the following hospitals: Royal Victoria, Mater Infirmorum, Queen Street, and the Ulster.
4. Dr. John Campbell and Dr. J. Walton Browne (during their lifetime).
5. Dr. James Colville was appointed Treasurer and Dr. Thomas Houston Secretary.

The executive committee was given power to appoint five trustees, two of whom must be general practitioners. The trustees with the executive committee were to award the prize from time to time. The original trustees appointed were James Colville, Thomas Houston, William Burns, James Moore, and John Smith Morrow. After the death of Dr. Burns and Dr. Colville two new trustees were appointed at a meeting held on 12th June, 1936—W. S. Campbell and R. W. M. Strain. The latter was appointed Treasurer on 15th January, 1937, and the former Secretary on 11th January, 1950, to succeed Sir Thomas Houston. Dr. Moore, Dr. Morrow, and Sir Thomas Houston have been replaced as trustees by W. Dickey, W. G. Frackelton, and Professor C. H. G. Macafee.

The original executive committee decided that the orator should receive, in addition to his honorarium, a memorial medal. The design of the medal, which is executed in bronze, was entrusted to the Ulster sculptress, Miss Rosamond Praeger. The obverse (Plate II) shows Robert Campbell's head, his name and the dates 1866 and 1920. Although Miss Praeger had never met Robert Campbell, the head, designed from a photograph, is regarded as being a very good likeness. The reverse of the medal (Plate III) shows a group, of Miss Praeger's own composition, illustrating a very appropriate subject—a surgeon attending to an injured child, seated on its mother's lap—and it also bears an inscription in Greek taken from the Precepts, one of the Hippocratic writings, generally now regarded as being of later date than Hippocrates but the work of one of his school. A translation of this is "Where there is the love of man, there is also love of the art," i.e., the art of medicine. This inscription or motto was suggested as a suitable one by Sir Richard Livingstone, who was at the time Vice-Chancellor of Queen's University. Two large wall plaques, illustrating the design on the obverse and the reverse of the medal, were presented to the Ulster Medical Society by Sir Thomas Houston, representing the executive committee of the Robert Campbell Memorial Fund, at the close of the third memorial oration on 10th February, 1927.

The first oration was given on 16th February, 1922, by Professor Thomas Sinclair, Professor of Surgery at Queen's University, who had been teacher, colleague and friend of Robert Campbell, and the three following orators included his brother and two of his closest friends. Since then a variety of orations on different subjects has been given by some who were ex-house surgeons or pupils of Robert Campbell and others who had never met him. While a very high standard has always been maintained, perhaps the two most memorable orations were that of Sir Alexander Fleming on penicillin, attended by the Duchess of Abercorn representing the Governor, and a huge audience which overflowed throughout the Whitla Medical Institute, and that of Sir William MacArthur, whose oration on the Irish famine of 1846 was delivered to a packed Great Hall of Queen's University, without the aid of a single note and without a single sign of hesitancy.