The life of John Cedric Goligher (1912–1998) revisited

The early years

John Cedric Goligher (Figure 1) was born in Londonderry (Northern Ireland) on 13 March 1912. He graduated at the University of Edinburgh Medical School in 1934 and then served as a House Officer at the Royal Infirmary in that city. In 1938 he obtained Fellowship in the Royal College of Surgeons in Scotland and England. In 1948 he received his Master of Surgery (ChM) degree from the University of Edinburgh. ¹ OPEN IN VIEWER

At St Mark’s Hospital he was first a House Surgeon and later Resident Surgical Officer in the early years of the Second World War. Certainly this period helped him to shape his future career under the influence of well-known members of staff including William Ernest Miles (1869–1947), Clifford Isaac Naunton Morgan (1901–1986), Edward Thomas Campbell Milligan (1886–1972), Oswald Vaughan Lloyd-Davies (1905–1987), William Bashall Gabriel (1893–1975) and Cuthbert Esquire Dukes (1890–1977). ²

Later Goligher entered the Royal Army Medical Corps in 1941, serving as a surgical specialist in Greece and Italy and achieving the rank of Lieutenant Colonel. Back in London in 1946 he was appointed Honorary Assistant Surgeon to St Mark’s and St Mary’s Hospitals from 1947 to 1954. This four decades’ association with this institution graded him as Honorary Consultant, later Emeritus, Surgeon. ³

To Leeds

For almost 200 years Leeds has been considered one of the leading surgical institutions in the UK, housing influential persons including Arthur Fergusson McGill (1846–1890), Arthur W Mayo-Robson (1853–1933) and Lord Berkeley George Andrew Moynihan (1865–1936). Leeds had a tremendous reputation for surgical skills despite little academic activity in surgery (Figure 2). On the basis of his distinguished and full experience during the War and in London hospitals, Goligher was invited to set up a University Department in 1955 and to become Professor of Surgery and Chairman of the University Department of Surgery at the General Infirmary at Leeds. OPEN IN VIEWER

In 1996 he wrote:

since the 1880s there have always been few surgeons who devoted special attention to rectal and colonic surgery, particularly in Britain with exponents including Frederick Salmon [1796–1868], Ernest Miles, Cuthbert Dukes [1890–1977] John-Percy Lockhart-Mummery [1875–1957] [Sir Clifford] Naunton Morgan [1901–86], Edward Milligan and Lloyd-Davies. Until lately, the vast bulk of bowel surgery remained in the hands of general surgeons but the past couple of decades have witnessed a striking change whereby colorectal surgery is the chief attraction for many surgeons. ⁴

Within this paper he commented that in his early years as a Consultant at St Mary’s and St Mark’s Hospitals in London he was very much a general surgeon with strong interests not only in colorectal surgery but also in surgery of the stomach and duodenum. He wrote

However, as my career progressed and I moved to the Chair of Surgery in Leeds – partly, I may say, in the hope of being better able to maintain my general interests - colorectal surgery came to dominate my practice and I was eventually doing little else. ⁴

Working in Leeds, he obtained full recognition as a brilliant Professor due to his clinical academic career and the huge number of operated patients. During this period, many visitors from all over used to watch him performing operations through the viewing gallery specially constructed in the operating theatre. According to Marvin Corman, ⁵ it is no exaggeration to state that his operating theatres have been a Mecca for surgeons from all over the world. The young doctors he trained developed a firm loyalty to his ideas and turned out to be leaders in the coloproctology field as they returned home. ⁵

He stayed there until 1978 when he became Emeritus Professor and the Department of Surgery assumed a leading position as a centre of academic gastrointestinal surgery. ⁵

Scientific contributions

Goligher’s scientific contributions are unique and his texts reflect his analytical personality and honesty of reporting. He made a critical and methodical evaluation of his clinical data. ⁵ These features helped him amass great fame in many countries. He wrote dozens of chapters, scientific papers and books. His main contribution was focused on colorectal surgery and in this matter he published the Textbook of British Surgery (1956–1959), Ulcerative Colitis (1968) and Surgery of the Anus, Rectum and Colon (1961). One important feature of his books is that Goligher was always sure to present the available modalities of treatment together with his personal advice and current practice. One of his greatest works was developed in the field of peptic ulcer disease. He pioneered randomized controlled trials concerning the surgical treatment of peptic ulcer, focusing on the long-term outcome after vagotomy and gastric resections. The Leeds-York series has become the classic controlled trial in ulcer surgery. This and other studies were all accompanied by data produced in his unit. In this context he wrote about rectal cancer surgery, inflammatory bowel diseases (IBD) and anorectal diseases.

Goligher also studied the substitution of pharynx and oesophagus in attempts at resection and reconstruction, using the left colon placed in the antethoracic position. This appears to have replaced most of the methods where anastomosis to the pharynx is required, though others preferred the stomach. ⁶

Within the field of inflammatory bowel disease (IBD) Goligher preferred to perform primary colectomies and proctocolectomies simultaneously with ileostomy instead of three-stage operations for chronic cases. He thought this ‘procedure could be accomplished without increasing the dangers, contrary to the general beliefs at that time’. ⁷

Without doubt, his masterpiece is his book Surgery of the Anus, Rectum, and Colon, published in five editions from 1961 to 1984. Having almost all text written by him (except one chapter), the first edition turned to be a world reference for students and young doctors and achieved translations into Spanish and Italian. Thus, since the beginning this reference book turned out to be the most comprehensive and influential text in the field of coloproctology. ⁸ The third edition inspired the following words:

Professor Goligher’s textbook is unquestionably the most authoritative account of the surgery of the distal bowel. The third edition, in spite of contributions by others, remains predominantly the monumental achievement of one man. The author frequently describes his own actions in difficult circumstances while modestly forbearing to claim superior knowledge. It is truly an encyclopedia and has many virtues that stamp it as the outstanding volume in its field. Nearly all such texts in these days are multi-authored. It is a relief to discover an authority that, because of his personal experience, has written 25 of the 27 chapters. ⁹

With reference to the fourth edition, it has been stated that it is a pity that every surgical specialty does not have a writer of Professor Goligher’s experience and authority. ¹⁰ In another text concerning the fourth edition it was noted that anyone who has had the experience of writing a surgical textbook feels humble when he reads through Professor Goligher’s classical magnum opus on surgery of the large bowel. Magnificently written, profusely and beautifully illustrated and with extensive and up-to-date bibliographic reviews, it represents undoubtedly the standard source book of information in this field in the English language. Having made these comments, one can only salute an outstanding example of British surgical writing and illustration: this book is the standard by which all other contributions on colorectal surgery must be judged. ¹¹

The fifth and last edition also deserved so many compliments. It has been said that Professor Goligher’s textbook was always excellent but this new edition can only be described as superb. It is a ‘must’ for all colorectal surgeons and general surgeons who operate in this area. Even those who already own a copy of an earlier edition should invest in this fifth edition. ¹²

Emeritus Professor John Goligher has been a leading authority on surgical diseases of the intestine and his editions of the textbook Surgery of the Anus, Rectum and Colon have been the most lucid, comprehensive and authoritative expositions of our specialty practice during the past three decades. ¹³

During his life Goligher became recognized largely for his numerous contributions to the literature and he wrote more than 200 papers as sole or first author which granted him an enormous reputation as an honest investigator. Probably he was the most active promulgator of prospective controlled and randomized trials in surgical research, ¹⁴ dealing with issues including high ligation of the inferior mesenteric artery, sphincterotomy for anal fissure, single versus two-layer anastomosis, drainage versus primary closure of pelvic abscess and other areas.

Contributions to medical societies and world recognition

Goligher served on the Council of The Royal College of Surgeons of England from 1968 to 1980. He was President of the Royal Society of Medicine Section of Proctology, where he was elected to the Roll of Honorary Fellows in 1986. ¹⁶ According to Gordon Robson (President in 1986), he added distinction to the Society. ²

He was also elected President of the Association of Surgeons of Great Britain and Ireland as well as of the British Society of Gastroenterology (1975–1976). Moreover, he received many fellowships and doctorates from around the world, including the American College of Surgeons and The American Society of Colon and Rectal Surgeons. ² All of this reflected the esteem in which he was held by his professional peers. ⁵ These activities put him in great demand as a visiting professor and lecturer in Europe, North America and the UK. He used to manifest great enthusiasm during his lectures and his encyclopaedic knowledge of the literature made him a formidable participant in scientific meetings.

Personality, death and legacy

John Goligher has received many definitions during his life. Technically he was defined as a master surgeon by Marvin Corman ⁵ for whom he had ‘clarity of thinking and expression’. He was meticulous, bloodless, anatomic, gentle, efficient and organized, a master at his work. Personally, he was slim and austere, with a dry humour, insatiable energy (at one time he had five secretaries), erudition and expertise, a master craftsman renowned worldwide as an ambassador for Britain in gastroenterological surgery. A shy and somewhat self-effacing man, he was held in affection by both staff and his patients. ⁵

His interests outside medicine included reading, classical music, gastronomy and oenology. He loved cars and loved the sun and used to go to the south of France and Italy to relax and write. ¹⁷ Many times he manifested his personal admiration of Dr Cuthbert Dukes and William Gabriel whom he considered dear friends and ideals of researcher and surgeon.

He has always been considered a great surgeon and a great scientist. Some of his texts revealed his thoughts about ideas that were truly representing himself. In 1984 he wrote

You are all familiar with the often- repeated phrases ‘the art and science of surgery’ or ‘the principles and practice of surgery’. Both these terms imply that there are two sides to surgery on the one hand the operative act (or the skill with which it is performed) and on the other hand, the body of knowledge that underlies or surrounds that act. ¹⁶

He continued:

it follows from this definition that a scientific surgeon is not just a particularly erudite or scholarly surgeon but one with an enquiring or sceptical turn of mind who is prepared - nay anxious - to challenge accepted doctrines and formulate original concepts and to submit both old and new ideas to the test of really stringent scrutiny.

After retirement Goligher established a considerable private practice for many years. He married Nancy Williams in 1952, an Australian whom he met when she was an Almoner on his ward at St Mary’s. He died of carcinomatosis on 18 January 1998, leaving two daughters, a son and three grandchildren. ¹⁷

Those who have lived with him wrote

he always had something important or at least meaning-full to say. For all of this, he certainly has been greatly missed by his family, friends, and colleagues at home and abroad. Nonetheless, his influence on surgery, and colon and rectal surgery in particular, will remain. ⁵