Dr Campbell: two lectures with contradictory conclusions

Dr Maurice Campbell (1891–1973) was from 1936 the first Secretary of the British Cardiac Society, and in 1938 he was the first editor of the British Heart Journal, but it was as a general physician that he went on 3 September 1939 to Orpington, Kent, with a contingent of 87 nurses, to set up an outpost hospital away from the London bombing for the duration of the Second World War. In January 1946 after his return, he gave one of the standard lunchtime lectures to the staff and clinical students on the subject of congenital heart disease. In keeping with a practice which persisted until my time as a student in the 1960s, a transcript appeared in Guy’s Hospital Gazette soon after. Dr Campbell opened by saying ‘Sometimes this seems a dull subject because of the lack of treatment for this condition, so that there is a feeling that it does not much matter about the diagnosis’. He explained that making the diagnosis was necessary to forewarn parents of a bleak prognosis. This was his justification for teaching congenital heart disease to the students. He gave a very different account in the Gazette in October 1947. Campbell then knew the results of Blalock’s operations in children with Fallot’s tetralogy in their hundreds at Johns Hopkins, and in 10 children at Guy’s during Blalock’s visit in September 1947. In the Gazette Campbell wrote specifically about ‘a little boy called Peter’ (figure 1).

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Figure 1

Peter was perhaps the first patient selected by Maurice Campbell for Alfred Blalock to operate on at Guy’s in 1947. I believe that Peter was the angelic child in a Guy’s nurse’s arms and picked out by a spotlight at the conclusion of Blalock’s lecture in London in 1947. Back home in Baltimore, Blalock put the framed picture of Peter on the wall in his department in Johns Hopkins Hospital. Peter lived until 2005. (Image provided by the Estate of Yousuf Karsh.)

The Peacock Club with Maurice Campbell as its chair

The experience of Blalock’s visit made a lasting impression. In April 1948 a meeting was convened at Guy’s bringing together ‘those concerned in the management of Congenital disease of the Heart’.1 The staff of the cardiac department, members of the MRC research unit and Russell Brock’s team including his anaesthetist were present.2 At the time Maurice Campbell was at Johns Hopkins with Blalock, Helen Taussig and Richard Bing, but on his return he accepted the proposal that he should be chair and he named the group the Peacock Club, reading from Peacock’s book what he regarded to be the first description of the tetrad in 1858, 30 years before the description by Fallot.3

The general format of the meeting was to select a topic in advance and designate a Club member or an invited speaker to present on an aspect of their new work. Campbell took the lead with a review of 460 patients with congenital heart disease seen since Blalock’s visit in 1947. In successive meetings the clinical scientists of the MRC unit reported their first attempts at catheterisation and the Bing test; Club members reviewed aspects of haematology, thrombosis, radiology, embryology and specifically the anatomy of the infundibulum. Not infrequently they went on to the pathology department to review ‘complete’ cases—that is when they had hearts to examine postmortem from operated or unoperated patients.1

Direct cardiac operations

In early 1950s there was an evident turning point. The astute clinical observation and imagination of Helen Taussig, the skilled experimental surgery of Vivien Thomas and the remarkable success of Blalock in his now vast clinical experience with a systemic to pulmonary shunt had established that surgery to improve the physiology of children with cyanotic congenital heart disease was consistently achievable. By 1949 the Club had 50 cases to report in the British Heart Journal. By the end of 1951 Campbell, with Denis Deuchar, had a collected experience of 200 cases to report in the BMJ. But in his 1947 lecture in the Gazette Campbell revealed that ‘…Mr Brock has already been discussing with me a more direct attack on pulmonary stenosis which would include the possibility of dealing with the infundibular obstruction’. By late 1949 Brock had performed 22 direct valve and/or infundibular operations at Guy’s and a further 20 were performed with Blalock at Johns Hopkins. The Club reported 100 direct right ventricular outflow operations in the BMJ in 19544 (figure 2).

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Figure 2

Dr Campbell, Mr Brock and Dr Rink are central with a theatre nurse to either side. Behind are Peter Fleming, Chris Jones (Brock’s secretary), Ben Milstein, Charles Baker, an unnamed doctor and nurse, Eddie Holling and Ian Hill. The photograph was taken to celebrate the 100th ‘Brock procedure’ on the right ventricular outflow. (I am grateful to Alison Hill for the photograph from her late father’s collection.)

Maurice Campbell’s legacy

Returning from his war service, Maurice Campbell, OBE MD FRCP, aged 54, may have been looking forward to a more leisurely life. From his 1946 lecture it is clear that he did not anticipate the work he would be doing and what he would achieve in the last 10 years of his professional life. The Guy’s team were inundated with patients for operation. For mitral stenosis, Brock saw the need for the numerous competent thoracic surgeons around the world to learn to perform mitral valvotomy.5 Previously untreatable blue babies were being referred. One was Geraldine, who tells her story in The Heart Club: “…when I was six, my mother was approached by someone in the street who told her that her cousin was one of the leading heart specialists at Guy’s and that she could arrange for me to see him. His name was Dr Campbell.” This was in 1950.1

At the time of his retirement in 1956, Campbell wrote in Guy’s Hospital Gazette: ‘I should like to give one message, the importance of following up groups of patients: we sometimes think of this as an uninteresting form of research, but now that we have to take decisions about when to advise operation for these patients we realise the urgent need of accurate knowledge of the natural history and prognosis, and this is often very incomplete even for common Conditions’. And so he did. In the last two meeting Peacock Club minutes, Campbell was completing that work, reviewing his experience of ventricular septal defect with Leon Brotmacher and atrial septal defects with Catherine Annie Neill. Russell Brock was undoubtedly the driving force and innovator of the Peacock Club, but Maurice Campbell was its anchor-man. The Peacock Club does not appear to have met again after his retirement.