August 2012 Newsletter: James Berry and His Thyroid Clinic

JAMES BERRY AND HIS THYROID CLINIC

Berry’s Ligament is certainly the most well known eponymous anatomical structure of relevance to thyroid surgery, tethering the thyroid gland to the trachea and lying, as it does, at the crucial point where the recurrent laryngeal nerve is most likely to be injured. James Berry was a formidable surgeon who established a Thyroid Surgical Clinic at the Royal Free Hospital in London, one which became recognised as one of the most active clinics in the country both from an educational and technical point of view.

James Berry, a Canadian who undertook his training in London, established one of the first ever dedicated Thyroid Surgical Clinics at the Royal Free Hospital at the beginning of the twentieth century. His clinic was described as having managed "to preserve all that is the best of the essentially British methods in the teaching of surgery to which has been added the cream of Continental and American methods...". What is most impressive is that, over 100 years ago, Berry had established the principles of multidisciplinary care of patients with thyroid disease who required surgery. Consultations were held at 1.30 pm on Wednesdays at The Royal Free Hospital. Cases were all presented to members of the Honorary Staff, both medical and surgical, and examined by all staff present, with medical students encouraged to examine and handle all the cases themselves. The patients were then removed and the case discussed by the staff in order of seniority, with a decision then made as to the best form of management. Operations were done on Mondays commencing 2.00 pm sharp, with Fridays as a second day should it prove necessary. Also impressive was the concept of team-based management in the operating theatres, a concept well ahead of its time. The team comprised the surgeon and surgical assistants, a number of trained surgical dressers each with a sepcific role such as holding retractors, as well as a specialist anaesthetic team, something almost unheard of at the time. Most operating days, the list of operations was formidable, running into a dozen or more. There were two theatres, each with an anaesthetic room, which communicated through the intermediation of a sterilizing room, and when an operation was finished in one theatre, the surgeon and his assistants walked through this to the adjoining theatre where all was in readiness for the next operation. One of the most important factors in the success of this team was that Berry had been fortunate in having an anaesthetist who was accustomed to his methods, and who had worked with him for many years. A second anaesthetist was also available, and helped very much in avoiding the irritating delays between operations which seem inevitable with a single anaesthetist. On Fridays, Berry gave a most valuable clinical lecture utilizing the specimens removed at surgery, as well as museum specimens and the epidiascope, giving the students a complete picture of the thyroid disease with which the Clinic dealt.

(from: Brit J Surgery Vol VIII, No 31; 361-365)