Norman Capener Symposium he enjoyed his garden; he derived outstanding pleasure from the Cathedral-its architecture and carvings, its music, its services, and its library. I spoke at the beginning of Norman's childhood home. What of the family that he created? He was devoted to them all: son John, and daughters Margaret, Elizabeth (now in Bogota) and Jennifer. He cared tenderly for his first wife, Marion, in her long illness; and Jennifer cared both for her
287
and for him. I am told that he influenced and inspired his numerous grandchildren to a quite unusual degree. Many of us know the deep affection that he bestowed upon Elsaand she upon him, especially during the sad days of the illness that he, and she, faced so bravely and in which she nursed him so devotedly. Let me conclude with a picture of this man: so kindly, so lively, so full of character (Fig. i).
V ° Rtrt9
FIG. I Norman Capener with John Jens (Past President of the Australian Orthopaedic Association).
/~~~~~~~~~~~it.*8
NORMAN CAPENER, THE SURGEON F C Durbin FRCS We are here today taking part in an act of homage in memory of a most remarkable man-Norman Capener, a leading orthopaedic surgeon of his generation and a talented performer in so many other activities, ranging from art and sculpture to that of farming. Mr Jackson Burrows has spoken eloquently of him with affection and admiration,
which is shared by those who knew him well. I, as surgical colleague of Norman's for nearly 30 years at the Princess Elizabeth Orthopaedic Hospital at Exeter, Devon, where he lived, worked, and died, have been asked to talk about his surgical activities and his life in Devon. Norman Capener, a Londoner, arrived in Exeter in I93I as the first surgeon to devote
288
Norman Capener Symposium
himself entirely to orthopaedics in Devon. At the time of his appointment he was Assistant Professor of Orthopaedic Surgery at Ann Arbor, Michigan, and he took over the orthopaedic service which had been started in 1927. This was almost the last of the pioneer units in Britain, but had not yet got into its stride as it was staffed by part-time general surgeons. He was single-handed at first and, as he put it, 'the one orthopaedic surgeon, like everyone else, did many other jobs' for he had no house surgeon or radiographer and there were few nursing staff. Although of medium stature, he possessed great physical strength and inexhaustible energy. He needed very little sleep, seemingly a common factor in many of those who achieve intellectual greatness. Four or five hours was about his normal stint in his active years, but he was capable of cat-naps when tired which rapidly restored his mental vigour, and he used to work far into the night as a regular habit. He was entirely dedicated to surgery and, being a perfectionist, demanded the highest standard from those who worked with and for him. With characteristic drive he rapidly built up the hospital and clinic systems both in Exeter and Plymouth, based on the national plan of Sir Robert Jones and Mr Gaythome Girdlestone. From the start he kept meticulous records, including clinical photographs which he took himself, as he realized that the standard of the work of a hospital depends to a large extent on its records. Although extremely busy, he travelled much and took part in many medical meetings, particularly those of the British Orthopaedic Association, in which he soon achieved prominence, being a member of the executive committee in I940, editorial secretary in I942, president in I958, and archivist in , and he was a valuable chairman and member of subcommittees of the association. He regularly
attended the monthly meetings of the Orthopaedic Section of the Royal Society of Medicine, driving up in the afternoon and back again in the night in his sports Bentley, which he drove with much verve and skill for nearly 25 years. Then he went by train, but he still commuted to London twice a week until his last illness. He invited the Orthopaedic Section of the Royal Society of Medicine to Exeter in 1937 and again in I950 when he was president. His presidential address at this time was 'The hand in surgery'-a scholarly essay on the movement and action of the hand using surgical instruments based on the premise that a surgeon's study of his own hands should give a better appreciation of the manual disabilities of a craftsman. He illustrated his lecture with photographs of his own hands, which were powerful, sensitive, and flexible, well seen in his own sculpture (Fig. 2) and in the bronze cast by Barbara Hepworth. He was much interested in the design of instruments. As he said, 'If a bad workman complains of his tools it is also true that a good craftsman deserves the best'. In this context he adapted a number of tradesmen's tools to his principles and designed a par-
'Clasped hands>. Bianca del mare. (Submitted for the International Sculpture Competition 'The unknown political
FIG. 2
prisoner'.)
Norman Capener Symposium
ticularly useful angulated laminectomy gouge which in graduated sizes can be employed for a number of orthopaedic procedures. He built up the hospital workshop, which he felt formed a vital link between surgeon, craftsmen, and patients, and it flourished under his direction and achieved a national and international reputation. Coming from an engineering family but himself without an engineering degree, his inventive genius enabled him, with the assistance of the late Mr Fred Suter, the senior workshop technician, to devise a number of revolutionary or lively spring splints to promote his principle of physiological rest, which is now widely accepted. A keen protagonist of team work, he was in the forefront of those who campaigned successfully for the closer integration of amputation surgery and prosthetic supply within the hospital service. As a result there is a firstclass limb-fitting centre within the grounds of the Princess Elizabeth Orthopaedic Hospital and there is a very close liaison between the orthopaedic staff and the limb-fitting surgeons working there. He made a great contribution to the rehabilitation of the elderly patient with a trochanteric fracture of the femur by making popular in this country in the I 940s a fixation device which bears his name-the Capener nail plate-a fixed plate and nail of V section. He was one of the pioneers of biomechanics in orthopaedic surgery. Having been a demonstrator of anatomy in his early days he was most facile in the art of surgical exposure, and it was possibly the challenge presented by hip and spinal surgery in this regard that led him to develop a special interest in conditions affecting them. He was not deterred by prolonged or difficult operations, and for many years did long operating lists without apparent fatigue. I well remember his comments: 'There is an old Italian saying
289
that a surgeon must have the eye of an eagle, the heart of a lion, and the hand of a woman'. 'Keenness of observation is still essential, but with modern anaesthetics lionheartedness is less needed but not the hand of a woman.' 'Patience, sensitivity, and delicacy of movement are not particular sexual features of femininity.' His contributions to spinal surgery were in spondylolisthesis, which he believed was a stress phenomenon. He was the first to suggest the operation of anterior fusion for this condition. But his greatest contribution without doubt was the anterolateral approach to the spine, which enabled the spinal cord to be decompressed, especially in tuberculous paraplegia, removing tuberculous debris and a sharp bony projection if present. Many patients, thousands of them, must have been relieved of an otherwise permanent paralysis by this operation. The very large number of ex-patients and friends who attended his memorial service in Exeter was a demonstration of the confidence and loyalty which he inspired in his patients. Norman counted himself as one of the second generation of orthopaedic surgeons who were trained in general surgery even though they did not go out into the world to practise it. He said once, 'An important part of the background of our training was practical experience in the departments of anatomy and physiology. We learnt by teaching others and by observing our betters.' He remained a perpetual student and was always interested in new ideas and methods, which may have been the secret of his apparent youthfulness. His activities in the Royal College of Surgeons-he was for many years an examiner in anatomy for the Primary Fellowship and became a member of Council and Senior Vice-President-are another part of his life and are well known to you and I will leave it at that. The award of the College's Gold
290
Norman Capener Symposium
Medal and the holding of this symposium in his memory are sufficient testimony to his work. At the time of his last illness he was completing the arrangements for the December Provincial Meeting of the College at Exeter-the first such meeting to be held at a centre without a medical faculty-and a highly successful one it was. He was most interested in the English language, the origin and meaning of words and the ideas which they expressed, and he was gifted with a facility of expression and a power of eloquence which made writing and speaking for him a great pleasure and relaxation. It was natural therefore that he should enjoy teaching, and he lectured to nurses and postgraduate students at rounds and seminars which were stimulating and well attended. He strove to make Exeter a centre of excellence, complete with an undergraduate medical school. In this he was disappointed, but he was one of those who campaigned successfully for the establishment of the University of Exeter and the opening in I965 of the first postgraduate medical institute in the country outside a centre with a medical faculty. He said, in a farewell speech when he retired from the National Health Service in I963, that he hoped he would be remembered in Exeter (if for nothing else) for his teaching activities. His organization of clinical meetings was a model of excellence. Because he travelled and lectured widely he attracted a number of men from overseas, including Canada, America, South Africa, Australia, Greece, Persia, and India, and he had a special link with Northern Ireland. In 1955, when president of the Devon and Exeter Medical Society, he presented an exhibition of books, documents, and pictures of medical art and history in Exeter which he obtained from the library of the Cathedral and the Exeter Medical Library and which he documented in a most valuable catalogue.
It must have been a mammoth task assem-
bling the exhibits and it has provided enduring pleasure to those fortunate to view them. Apart from his surgical pursuits he became an enthusiastic Devonian. He loved his native England and particularly Devon with its historical past and its ancient buildings and libraries, especially the Cathedral in Exeter, the architecture of which he made a particular study and where at times, latterly, he acted as a guide to visitors. He was a member of the Devonshire Association for the advancement of science, literature, and art in Devon and in I965 was made its president. As a small farmer for 25 years or so he was especially interested in the preservation of the ancient crafts still practised in the county, where the sophistication of modern times is slower to transform the lives of an essentially agricultural community. With the inception of the National Health Service in I948 he became a member of the South West Regional Hospital Board and was concerned with the organization of the orthopaedic services in the South West Region and with the hospital service generally. He was a keen protagonist of medical integration and the team spirit. He once wrote: 'There should be a closer association of physicians and surgeons. In orthopaedics, we must bring physicians into the team and ourselves become physicians no less than surgeons'. His own summary of his attitude to surgical operations is worth quoting and should be observed by every surgeon. Talking of the hip joint, he remarked, 'I would not like it to be thought that surgical methods are the only solution to the clinical problems involved. In some few conditions surgery is the method of choice; in others it must be followed when conservative methods have failed. When, however, the decision to operate is made the attitude of the surgeon must
Normanl Capener Symposium be that of eclecticism. No one approach or any single type of operation is perfect. We must select critically the technique which best suits the particular circumstances of each individual case, and the surgeon's every action must be dominated by regard for the living tissues beneath his hands and an awareness of the biomechanical problems involved. In his approach he must not be dominated by
29I
the mechanics of his tools'. There can be no doubt that Norman Capener was unique and that he will be ranked among those other great surgeons of Exeter of nearly I65 years ago, John Sheldon and John Haddy James, whose careers he so admired. The present status of Exeter as an advanced medical centre owes much to his stimulus and we salute his passing.
NORMAN CAPENER AND THE MEDICAL COMMISSION ON ACCIDENT PREVENTION Rt Hon Lord Porritt GCMG GCVO CBE PPRCS Last week there was a debate in the House of Lords on the place of 'voluntary organizations' in today's world-a debate to which the Prince of Wales made a notable contribution. He chose to stress the part that youthand particularly that section of youth which tended to be rather uninhibited and inclined to run off the rails-wvas playing in various voluntarv life-saving organizations. He gave it as his opinion that under suitable leadership this youth force could be increasingly mobilized, both to its own considerable advantage and to the benefit of the community as a whole. As he said, such voluntary work, especially if spiced with a tinge of adventure, was 'good for the soul' and, properly presented, appealed to the young irrespective of grades of society. To exemplify this thesis he quoted experiences at his old school, Gordonstoun, and made flattering reference to its old headmaster, Kurt Hahn. That combination of voluntary accident prevention work and the name of Kurt Hahn took me back nostalgically to the prenatal days of the Medical Commission on Accident Prevention. In I96I that same old 'Machiavelli', Kurt Hahn, whom I had met previously in various community activities, came to me as PRCS
asking if the College would be prepared to give a categorical statement on which was the best of several methods of resuscitation for the apparently drowned then being advocated. I said to him that this was rather a limited sphere of activity for the College as a whole to take up but would try to get an answer to his problem. After discussion I suggested that we might be prepared to consider the question of accident prevention as a whole in view of its importance nationally from both humanistic and economic aspects, as it seemed that in general the medical profession was somewhat lacking in positive interest in the subject. Having obtained from the then Dean of the Faculty of Anaesthetists (Geoffrey Organe) an answer on the specific question of resuscitating the apparently drowned, I turned to one of my 'wise men' on Council for advice on the wisdom of getting the College involved in the sphere of accident prevention as a whole. From what you have already heard and from what many of you know personally you will not be surprised to know that the 'wise man' I first consulted was Norman Capener. His sound common sense, his breadth of vision, his human approach, and his forward-looking views on current prob-
287
and for him. I am told that he influenced and inspired his numerous grandchildren to a quite unusual degree. Many of us know the deep affection that he bestowed upon Elsaand she upon him, especially during the sad days of the illness that he, and she, faced so bravely and in which she nursed him so devotedly. Let me conclude with a picture of this man: so kindly, so lively, so full of character (Fig. i).
V ° Rtrt9
FIG. I Norman Capener with John Jens (Past President of the Australian Orthopaedic Association).
/~~~~~~~~~~~it.*8
NORMAN CAPENER, THE SURGEON F C Durbin FRCS We are here today taking part in an act of homage in memory of a most remarkable man-Norman Capener, a leading orthopaedic surgeon of his generation and a talented performer in so many other activities, ranging from art and sculpture to that of farming. Mr Jackson Burrows has spoken eloquently of him with affection and admiration,
which is shared by those who knew him well. I, as surgical colleague of Norman's for nearly 30 years at the Princess Elizabeth Orthopaedic Hospital at Exeter, Devon, where he lived, worked, and died, have been asked to talk about his surgical activities and his life in Devon. Norman Capener, a Londoner, arrived in Exeter in I93I as the first surgeon to devote
288
Norman Capener Symposium
himself entirely to orthopaedics in Devon. At the time of his appointment he was Assistant Professor of Orthopaedic Surgery at Ann Arbor, Michigan, and he took over the orthopaedic service which had been started in 1927. This was almost the last of the pioneer units in Britain, but had not yet got into its stride as it was staffed by part-time general surgeons. He was single-handed at first and, as he put it, 'the one orthopaedic surgeon, like everyone else, did many other jobs' for he had no house surgeon or radiographer and there were few nursing staff. Although of medium stature, he possessed great physical strength and inexhaustible energy. He needed very little sleep, seemingly a common factor in many of those who achieve intellectual greatness. Four or five hours was about his normal stint in his active years, but he was capable of cat-naps when tired which rapidly restored his mental vigour, and he used to work far into the night as a regular habit. He was entirely dedicated to surgery and, being a perfectionist, demanded the highest standard from those who worked with and for him. With characteristic drive he rapidly built up the hospital and clinic systems both in Exeter and Plymouth, based on the national plan of Sir Robert Jones and Mr Gaythome Girdlestone. From the start he kept meticulous records, including clinical photographs which he took himself, as he realized that the standard of the work of a hospital depends to a large extent on its records. Although extremely busy, he travelled much and took part in many medical meetings, particularly those of the British Orthopaedic Association, in which he soon achieved prominence, being a member of the executive committee in I940, editorial secretary in I942, president in I958, and archivist in , and he was a valuable chairman and member of subcommittees of the association. He regularly
attended the monthly meetings of the Orthopaedic Section of the Royal Society of Medicine, driving up in the afternoon and back again in the night in his sports Bentley, which he drove with much verve and skill for nearly 25 years. Then he went by train, but he still commuted to London twice a week until his last illness. He invited the Orthopaedic Section of the Royal Society of Medicine to Exeter in 1937 and again in I950 when he was president. His presidential address at this time was 'The hand in surgery'-a scholarly essay on the movement and action of the hand using surgical instruments based on the premise that a surgeon's study of his own hands should give a better appreciation of the manual disabilities of a craftsman. He illustrated his lecture with photographs of his own hands, which were powerful, sensitive, and flexible, well seen in his own sculpture (Fig. 2) and in the bronze cast by Barbara Hepworth. He was much interested in the design of instruments. As he said, 'If a bad workman complains of his tools it is also true that a good craftsman deserves the best'. In this context he adapted a number of tradesmen's tools to his principles and designed a par-
'Clasped hands>. Bianca del mare. (Submitted for the International Sculpture Competition 'The unknown political
FIG. 2
prisoner'.)
Norman Capener Symposium
ticularly useful angulated laminectomy gouge which in graduated sizes can be employed for a number of orthopaedic procedures. He built up the hospital workshop, which he felt formed a vital link between surgeon, craftsmen, and patients, and it flourished under his direction and achieved a national and international reputation. Coming from an engineering family but himself without an engineering degree, his inventive genius enabled him, with the assistance of the late Mr Fred Suter, the senior workshop technician, to devise a number of revolutionary or lively spring splints to promote his principle of physiological rest, which is now widely accepted. A keen protagonist of team work, he was in the forefront of those who campaigned successfully for the closer integration of amputation surgery and prosthetic supply within the hospital service. As a result there is a firstclass limb-fitting centre within the grounds of the Princess Elizabeth Orthopaedic Hospital and there is a very close liaison between the orthopaedic staff and the limb-fitting surgeons working there. He made a great contribution to the rehabilitation of the elderly patient with a trochanteric fracture of the femur by making popular in this country in the I 940s a fixation device which bears his name-the Capener nail plate-a fixed plate and nail of V section. He was one of the pioneers of biomechanics in orthopaedic surgery. Having been a demonstrator of anatomy in his early days he was most facile in the art of surgical exposure, and it was possibly the challenge presented by hip and spinal surgery in this regard that led him to develop a special interest in conditions affecting them. He was not deterred by prolonged or difficult operations, and for many years did long operating lists without apparent fatigue. I well remember his comments: 'There is an old Italian saying
289
that a surgeon must have the eye of an eagle, the heart of a lion, and the hand of a woman'. 'Keenness of observation is still essential, but with modern anaesthetics lionheartedness is less needed but not the hand of a woman.' 'Patience, sensitivity, and delicacy of movement are not particular sexual features of femininity.' His contributions to spinal surgery were in spondylolisthesis, which he believed was a stress phenomenon. He was the first to suggest the operation of anterior fusion for this condition. But his greatest contribution without doubt was the anterolateral approach to the spine, which enabled the spinal cord to be decompressed, especially in tuberculous paraplegia, removing tuberculous debris and a sharp bony projection if present. Many patients, thousands of them, must have been relieved of an otherwise permanent paralysis by this operation. The very large number of ex-patients and friends who attended his memorial service in Exeter was a demonstration of the confidence and loyalty which he inspired in his patients. Norman counted himself as one of the second generation of orthopaedic surgeons who were trained in general surgery even though they did not go out into the world to practise it. He said once, 'An important part of the background of our training was practical experience in the departments of anatomy and physiology. We learnt by teaching others and by observing our betters.' He remained a perpetual student and was always interested in new ideas and methods, which may have been the secret of his apparent youthfulness. His activities in the Royal College of Surgeons-he was for many years an examiner in anatomy for the Primary Fellowship and became a member of Council and Senior Vice-President-are another part of his life and are well known to you and I will leave it at that. The award of the College's Gold
290
Norman Capener Symposium
Medal and the holding of this symposium in his memory are sufficient testimony to his work. At the time of his last illness he was completing the arrangements for the December Provincial Meeting of the College at Exeter-the first such meeting to be held at a centre without a medical faculty-and a highly successful one it was. He was most interested in the English language, the origin and meaning of words and the ideas which they expressed, and he was gifted with a facility of expression and a power of eloquence which made writing and speaking for him a great pleasure and relaxation. It was natural therefore that he should enjoy teaching, and he lectured to nurses and postgraduate students at rounds and seminars which were stimulating and well attended. He strove to make Exeter a centre of excellence, complete with an undergraduate medical school. In this he was disappointed, but he was one of those who campaigned successfully for the establishment of the University of Exeter and the opening in I965 of the first postgraduate medical institute in the country outside a centre with a medical faculty. He said, in a farewell speech when he retired from the National Health Service in I963, that he hoped he would be remembered in Exeter (if for nothing else) for his teaching activities. His organization of clinical meetings was a model of excellence. Because he travelled and lectured widely he attracted a number of men from overseas, including Canada, America, South Africa, Australia, Greece, Persia, and India, and he had a special link with Northern Ireland. In 1955, when president of the Devon and Exeter Medical Society, he presented an exhibition of books, documents, and pictures of medical art and history in Exeter which he obtained from the library of the Cathedral and the Exeter Medical Library and which he documented in a most valuable catalogue.
It must have been a mammoth task assem-
bling the exhibits and it has provided enduring pleasure to those fortunate to view them. Apart from his surgical pursuits he became an enthusiastic Devonian. He loved his native England and particularly Devon with its historical past and its ancient buildings and libraries, especially the Cathedral in Exeter, the architecture of which he made a particular study and where at times, latterly, he acted as a guide to visitors. He was a member of the Devonshire Association for the advancement of science, literature, and art in Devon and in I965 was made its president. As a small farmer for 25 years or so he was especially interested in the preservation of the ancient crafts still practised in the county, where the sophistication of modern times is slower to transform the lives of an essentially agricultural community. With the inception of the National Health Service in I948 he became a member of the South West Regional Hospital Board and was concerned with the organization of the orthopaedic services in the South West Region and with the hospital service generally. He was a keen protagonist of medical integration and the team spirit. He once wrote: 'There should be a closer association of physicians and surgeons. In orthopaedics, we must bring physicians into the team and ourselves become physicians no less than surgeons'. His own summary of his attitude to surgical operations is worth quoting and should be observed by every surgeon. Talking of the hip joint, he remarked, 'I would not like it to be thought that surgical methods are the only solution to the clinical problems involved. In some few conditions surgery is the method of choice; in others it must be followed when conservative methods have failed. When, however, the decision to operate is made the attitude of the surgeon must
Normanl Capener Symposium be that of eclecticism. No one approach or any single type of operation is perfect. We must select critically the technique which best suits the particular circumstances of each individual case, and the surgeon's every action must be dominated by regard for the living tissues beneath his hands and an awareness of the biomechanical problems involved. In his approach he must not be dominated by
29I
the mechanics of his tools'. There can be no doubt that Norman Capener was unique and that he will be ranked among those other great surgeons of Exeter of nearly I65 years ago, John Sheldon and John Haddy James, whose careers he so admired. The present status of Exeter as an advanced medical centre owes much to his stimulus and we salute his passing.
NORMAN CAPENER AND THE MEDICAL COMMISSION ON ACCIDENT PREVENTION Rt Hon Lord Porritt GCMG GCVO CBE PPRCS Last week there was a debate in the House of Lords on the place of 'voluntary organizations' in today's world-a debate to which the Prince of Wales made a notable contribution. He chose to stress the part that youthand particularly that section of youth which tended to be rather uninhibited and inclined to run off the rails-wvas playing in various voluntarv life-saving organizations. He gave it as his opinion that under suitable leadership this youth force could be increasingly mobilized, both to its own considerable advantage and to the benefit of the community as a whole. As he said, such voluntary work, especially if spiced with a tinge of adventure, was 'good for the soul' and, properly presented, appealed to the young irrespective of grades of society. To exemplify this thesis he quoted experiences at his old school, Gordonstoun, and made flattering reference to its old headmaster, Kurt Hahn. That combination of voluntary accident prevention work and the name of Kurt Hahn took me back nostalgically to the prenatal days of the Medical Commission on Accident Prevention. In I96I that same old 'Machiavelli', Kurt Hahn, whom I had met previously in various community activities, came to me as PRCS
asking if the College would be prepared to give a categorical statement on which was the best of several methods of resuscitation for the apparently drowned then being advocated. I said to him that this was rather a limited sphere of activity for the College as a whole to take up but would try to get an answer to his problem. After discussion I suggested that we might be prepared to consider the question of accident prevention as a whole in view of its importance nationally from both humanistic and economic aspects, as it seemed that in general the medical profession was somewhat lacking in positive interest in the subject. Having obtained from the then Dean of the Faculty of Anaesthetists (Geoffrey Organe) an answer on the specific question of resuscitating the apparently drowned, I turned to one of my 'wise men' on Council for advice on the wisdom of getting the College involved in the sphere of accident prevention as a whole. From what you have already heard and from what many of you know personally you will not be surprised to know that the 'wise man' I first consulted was Norman Capener. His sound common sense, his breadth of vision, his human approach, and his forward-looking views on current prob-
