Horsley, Victor Alexander Haden

(b. Kensington, London, England, 14 April 1857; d. Amara, near Baghdad, Mesopotamia [now Iraq], 16 July 1916)

neurosurgery, neurophysiology, pathology, social reform.

Horsley was the son of John Callcott Horsley, R. A., a prominent artist, and Rosamund Haden, sister of Sir Francis Seymour Haden, the surgeon and etcher. He attended Cranbrook Grammar School and then University College Hospital Medical School (1875–1880). After qualification he spent four years in junior surgical posts and in 1884 he was made professor-superintendent of the Brown Institution, a center for human and animal physiological and pathological research. He resigned in 1890. At University College, London, he was appointed assistant professor of pathology (1882–1893) and later full professor (1893–1896). He was admitted to the Royal College of Surgeons of England in 1883 and to the Royal College Society in 1886. He carried on private surgical practice and in 1885 he was appointed to the surgical staff of University College Hospital and in 1886 to that of the National Hospital for the Paralysed and Epileptic.

Horsley became professor of clinical surgery in 1899. For his contributions to medicine he was knighted in 1902. At the outbreak of war in 1914 he sought active service in the army and was eventually posted as consultant surgeon to the Mediterranean Expeditionary Force. He died of heat exhaustion, said to have been complicated by a gastrointestinal infection.

Horsley possessed outstanding intellect, creativity, inventiveness, and indefatigable and restless energy. His memory was exceptional; he was skillfully ambidextrous and he had well-developed qualities of leadership, which evoked admiration and devotion in those who worked with him. He had wide interests, both medical and social, and was an agnostic and Huxleyite. Although violent in expression and passionate in his convictions, he was also fastidious, generous, and humorous. He married Eldred, daughter of the engineer Sir Frederick Bramwell, in 1887; they had two sons and a daughter.

Horsley’s many contributions to medicine fall in three general areas: experimental work, surgical innovation, and political and social reform.

His experimental work began with the study of thyroid physiology and pathology. In 1884, his experiments on the monkey led him to maintain that endemic cretinism, myxedema, and the results of surgical removal of the gland were the same condition. He thus initiated thyroid research in Britain and was the first to suggest replacement therapy in hypothyroidism using the transplant. He also carried out pioneer work on pituitary extirpation before the endocrinological function of the gland had been established, and he was one of the first to tackle a pituitary tumor surgically.

In 1886 Horsley confirmed Pasteur’s discovery of a method to protect animals from rabies. In the same year he began research on localization of function in the brain. The investigations of Fritsch and Hitzig in 1870, on cerebral cortical function, had stimulated many to repeat and extend them. From 1886 to 1891 Horsley, with a series of collaborators, made important contributions to this area of neurophysiology, especially that concerning the motor cortex. From this research grew his interest in making precise experimental lesions in the deep parts of the brain, such as the cerebellum. He worked with R. H. Clarke and together they created the Horsley-Clarke stereotaxic apparatus, which only recently has become a popular and useful surgical technique in certain human disorders such as Parkinson’s disease.

It was due to his demanding researches that Horsley gave up his professorship of surgery in 1906 and relinquished his charge of beds at University College Hospital. His studies were of greater importance to him than teaching or the care of general surgical cases. His post at the National Hospital and as private consultant allowed him adequate neurosurgical practice. He was one of the pioneers of brain surgery, which at the turn of the century was gradually developing into a specialty. Some have claimed that he was the most outstanding surgeon of his day, and his experimental work thoroughly prepared and fortified him for the task of advancing this new field. As in the laboratory, so in the operating theater, he was continually devising and conducting new experiments. In 1888 he published, with W. R. Gowers, an account of the first case of spinal tumor in which diagnosis led to removal and to recovery from paraplegia. His operation for trigeminal neuralgia was also an important advance.

Horsley tackled the problems of the British Medical Association with characteristic vigor and was one of the founders of its new constitution. He was equally active and outspoken in the various crusades he led; for example, in his support of temperance in alcohol, the necessity for animal experimentation, universal women’s suffrage, government provision of free medical treatment for the workingman, and in his opposition to tobacco smoking. Horsley was also involved in national politics but his hatred for compromise, hypocrisy, and verbal diplomacies prevented him from gaining office. His crusade for better conditions for the wounded and sick in World War I cost him his life.

BIBLIOGRAPHY

I. Original Works. There is an unpublished bibliography of Horsley’s publications (278 items) in the University of London Library, compiled by Cecilia E. Holder in 1949. The biography by Paget (see below, pp. 341–349) contains a list of 129 titles. Horsley’s descendants possess most of his MSS, but some relating to his patients are in the University College Hospital Medical School Library. The University College Hospital Medical School Museum has remnants of the original Horsley-Clarke stereotaxic machine.

The following papers and books, arranged according to the order of the text, are Horsley’s more important contributions: “The Brown Lectures,” in British Medical Journal (1885), 1 , 111–115, 211–213, 419–423, on myxedema; “Note on a Possible Means of Arresting the Progress of Myxoedema, Cachexia Strumipriva, and Allied Diseases,” ibid. (1890), 1 , 287–288, on transplantation; “Preliminary Note on Experimental Investigations on the Pituitary Body,” ibid. (1911), 2 , 1150–1151, written with Dr. Handelsmann; and Reports on the Outbreak of Rabies Among Deer in Richmond During the Years 1886–7 (London, 1888), written with A. C. Cope.

See also “A Record of Experiments Upon the Functions of the Cerebral Cortex,” in Philosophical Transactions of the Royal Society, 179B (1888), 1–45, written with E. A. Schäfer; “A Further Minute Analysis by Electrical Stimuli of the So-Called Motor-Region of the Cortex Cerebri in the Monkey (Macacus sinicis),” idid., pp. 205–256, written with C. E. Beevor; “On the Mammalian Nervous System, Its Functions, and Their Localisation Determined by an Electrical Method,” ibid., 182B (1891), 267–526, written with F. Gotch; “On the Intrinsic Fibres of the Cerebellum, Its Nuclei and Its Efferent Tracts,” in Brain, 28 (1905), 13–29, written with R. H. Clarke; “The Structure and Functions of the Cerebellum Examined by a New Method,” ibid., 31 (1908), 45–124, written with R. H. Clarke; “The Linacre Lecture on the Function of the So-Called Motor Area of the Brain,” in British Medical Journal (1909), 2 , 125–132; The Structure and Functions of the Brain and Spinal Cord, Being the Fullerian Lectures for 1891 (London, 1892); “A Case of Tumour of the Spinal Cord. Removal; Recovery,” in Transactions of the Medico-Chirurgical Society, 71 (1888), 377–430, written with W. R. Gowers; “Mr. Victor Horsley and the General Medical Council,” in British Medical Journal (1898), 1 , 225–226, and passim; and Alcohol and the Human Body: an Introduction to the Study of the Subject (London, 1907), written with Mary Sturge.

II. Secondary Literature. There are two biographies of Horsley: Stephen Paget, Sir Victor Horsley: A Study of His Life and Work (London, 1919), authoritative and the best source; and J. B. Lyons, The Citizen Surgeon: a Life of Sir Victor Horsley F.R.S., F.R.C.S., 1857–1916 (London, 1966), well written but less reliable than Paget.

Other sources of information, in chronological order, are “Obituary. Sir Victor Horsley, C.B., F.R.S., M.B., F.R.C.S.,” in British Medical Journal (1916), 2 , 162–167, with portrait; C. J. Bond, Recollections of Student Life and Later Days. A Tribute to the Memory of the Late Sir Victor Horsley, F.R.S. (London, 1939), the disjointed but revealing recollections of a very close friend; W. Haymaker and F. Schiller, eds., The Founders of Neurology, 2nd ed. (Springfield, Ill., 1970) pp. 562–566, with portrait; G. Jefferson, “Sir Victor Horsley, 1857–1916. Centenary Lecture,” in British Medical Journal (1957), 1, 903–910, a neurosurgeon’s assessment; and A. MacNalty, “Sir Victor Horsley. His Life and Work,” ibid., pp. 910–916, a research colleague’s opinion.

Edwin Clarke