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Norman Walter Nisbet
Orthopaedic Surgeon and Researcher
(1909–2007)
Norman Walter Nisbet who died in September 2007 was noted
for his work in New Zealand and the United Kingdom in the fields of orthopaedic
surgery and basic research.
Born in Edinburgh in 1909, Norman Nisbet as a child
developed considerable practical ability with his hands and enjoyed
"making things" but had a self-confessed difficulty with languages
and maths. Prompted by this, his father, a science master, suggested that Norman
should train in dentistry. This he subsequently did, winning a medal for
practical skill along the way. At his father's further suggestion he then
studied medicine and surgery, graduating in Edinburgh in 1934.In 1938 Nisbet took up a post as house surgeon at the
well-known orthopaedic hospital in Oswestry founded by Dame Agnes Hunt and the
doyen of orthopaedic surgery Sir Robert Jones.
At the outbreak of the Second World War, Nisbet was
appointed resident surgical officer at the Robert Jones and Agnes Hunt
Orthopaedic Hospital. The hospital in Oswestry was now essentially a military
hospital and, as the resident surgeon, Nisbet developed a close working
relationship with Agnes Hunt. Working with senior colleagues such as Sir
Reginald Watson Jones, Sir Harry Platt, and Naughton Dunn and with a huge
workload treating war casualties, Nisbet soon gained invaluable orthopaedic
experience.
He recalled that following the invasion of Europe on D Day
trainloads of wounded soldiers arrived at Oswestry resulting in continuous
operating lists often extending through the night. Subsequently Nisbet served as
a wing commander and consultant surgeon at an RAF Hospital in Wiltshire and
following demobilisation in 1947 he held consultant posts in Coventry.
For many post-war doctors in the UK there was uncertainty
about the way medical practice would develop following the introduction of the
National Health Service. In 1950 Nisbet made the decision to move to New Zealand
and in early March of that year he took over from Mr J Renfrew White as Head of
the Orthopaedic Department at Dunedin Hospital.
Although initially having a part time private practice in
Dunedin, Nisbet preferred a full time university and hospital post. This was
granted and he was made an Associate Professor at Otago University. There was
now time not only for clinical and administrative work but also time to develop
research interests. As a surgeon, Nisbet had a deft and delicate touch. He was
always concerned that tissues were handled gently and always conscious of the
changes happening at a cellular level before, during, and after surgery. He was
also keenly aware of the importance of the blood/vascular system in tissue
healing. Early research included a study of the vascular supply of tendon and
bone and a Lord Nuffield Scholarship in 1955 allowed further study in this area,
working with Joseph Trueta at the Nuffield Orthopaedic Hospital in Oxford.
Nisbet's surgical skill, his strong interest in
reconstructive surgery including bone and skin grafting, and his enquiring mind,
resulted in a rewarding research partnership with Professor (later Sir Michael)
Woodruff who had been appointed in 1952 as the first whole-time Professor of
Surgery at the Otago University.
In 1956 Woodruff was appointed to Edinburgh as Professor of
Surgical Sciences but before leaving Dunedin Nisbet had joined forces with him
in the transplantation laboratories. After Woodruff's departure Nisbet
gathered a talented team together that continued to make important contributions
in the rapidly emerging fields of immunology and transplantation. Although
research became increasingly important to Nisbet he continued to be active as a
surgeon. The month he arrived in New Zealand a group of seven surgeons had
decided to form the New Zealand Orthopaedic Association.
At that time only 16 surgeons in the country were practising
orthopaedic surgery exclusively. Four months later, at the first Annual
Scientific Meeting of the Association, Nisbet presented a paper. He was
subsequently an active and supportive member of the growing association and a
regular contributor of papers to its scientific meetings.
He is remembered for his quick mind, a countenance that
could be stern, and his crisp and to-the-point comments delivered in a Scottish
brogue, more often than not accompanied by a twinkle in the eye. He was
unstinting in his help and guidance for colleagues and students alike.
In the 10 years following Nisbet's arrival in New
Zealand the scope of orthopaedic surgery and volume of work had increased
greatly. In spite of the support from his colleagues Walden Fitzgerald and Alan
Alldred, Nisbet must have been frustrated by the increasing workload
particularly in the clinical and administrative areas. Although a personal chair
at Otago seemed assured, early in 1964, during a period of leave in Britain,
Nisbet resigned and took up a newly created research post at his old hospital at
Oswestry as Director of the Charles Salt Research Centre.
He no longer undertook clinical work but continued with
productive research retiring as director in 1983 aged 74. The MRC continued to
support him and his research into the origins of osteoclasts for a further 3
years.
Norman Nisbet retired to Bognor Regis on the south coast of
England where he continued an active life enjoying a daily swim, joining a
shooting party, and latterly, clay pigeon shooting. On reaching 95 his health
gradually failed, and he died at the age of 98. His wife predeceased him in 2005
after a long illness. Norman is survived by his daughter, his son-in-law, and
two grandchildren.
A Keith Jeffery (Emeritus Professor, Dunedin) wrote
this obituary.
Additional Comments by Emeritus Professor Barbara
Heslop
Soon after his arrival in Dunedin, Norman Nisbet contacted
the histopathologists at the Medical School, and arranged to send them an
assortment of tissues that he proposed to biopsy during surgical operations.
This interest was unusual, as was the enthusiasm with which he turned up in the
lab to look at the sections and to discuss the findings. This was where I first
met him in the early 1950s.
When Michael Woodruff (later Sir Michael Woodruff FRS) was
appointed to the first academic chair of surgery at Dunedin in 1953,
Norman's enthusiasm for the laboratory found an outlet in the new
department, and later in its laboratories, which were lavishly equipped by the
standards of the day. He fitted naturally and easily into Michael's
transplantation programme. Experimental transplantation was in its very early
days in the 1950s, and clinical allografting as we know it today was
nonexistent.
Research papers were often published in Transplantation
Bulletin, a small section at the back of Plastic and Reconstructive Surgery.
This no doubt seems a strange juxtaposition today, but experimental
transplantation had been triggered by the need for skin grafts during the
war.
Professor Peter Medawar FRS, the founding father of
experimental transplantation, and a future Nobel prize winner (for immunological
tolerance), spent some time in Dunedin as Chaffer Lecturer in 1956, at the
instigation of Michael Woodruff. Medawar's elegant experiments in the
1940s had established that graft rejection was an immunological phenomenon.
His visit to Dunedin could scarcely have come at a better
time for Norman Nisbet. When Michael Woodruff left Dunedin to take up the chair
of surgical sciences in Edinburgh in 1957, Norman took over the Dunedin
transplantation laboratories. He gathered together a small group of people who
happened to be available – Irmgard Zeiss, a PhD agricultural scientist from
Giessen, myself as a pathologist recently returned from the UK with a young
child, and a couple of Michael's former technicians. There were no worries
about money. The MRC (today's HRC) had not yet instituted personal
grants – the dean simply approved the research expenditure.
We started off studying various aspects of the tissue
response to bone grafts, an appropriate choice for an orthopaedic surgeon. But
every transplanter is ultimately committed to understanding the genetic
interrelationship between donor and host. The major histocompatibility
complex – later destined to occupy a position right at the centre of
immunology – was very obtrusive in experimental transplants, although at the
time almost nothing was known about it. Not surprisingly, transplantation,
immunology, and immunogenetics grew up side by side.
In Dunedin we were lucky to have a large colony of partially
inbred rats, so like every other transplantation group of the day, we set about
establishing our inbred strains and defining their histocompatibility
interrelationships. Immunological tolerance had recently been demonstrated for
the first time by Medawar's group, as had the graft versus host reactions
that were an unexpected complication of tolerance induction. We worked some
strange hours, as tolerance induction entailed injecting neonates shortly after
birth. Norman always relished his time in the lab, and his enthusiasm was
infectious.
And of course there is the wonderful "Wow"
factor that goes with a new field in its early days, even when one is a long way
from most of the action. Norman might have stayed in New Zealand had the
university not been so slow to make him a full professor. While he was on
sabbatical leave in the UK in the mid 1960s, he was offered and accepted a job
at Oswestry. Norman's Oswestry unit was in many ways fairly similar to his
Dunedin laboratories. But the need to practise orthopaedic surgery was
considerably less, and his preference for experimental work was now clearly
established. He virtually gave up clinical surgery. Transplanters and
immunologists in those early days came from a variety of backgrounds;
orthopaedic surgery would have to be one of the more unusual of them.
I saw Norman and Mary fairly often after they left
Dunedin–at Oswestry, which always entailed visiting his favourite pubs
near the Welsh border, and at Bognor Regis after his retirement, where he took a
great pride in serving up freshly caught fish for lunch.
Irmgard Zeiss's return to Germany, to the Max Planck
Institute in Freiburg, shortly after Norman's departure, brought an era in
the Dunedin department to an end. By chance it coincided with the beginnings of
the new era of cellular immunology – we were now finding out for the first
time what lymphocytes did.
On a personal note, I recall that at a time when the
attitude to women doctors in Dunedin could, as Dorothy Page* recently put it,
come "perilously close to the patronising", Norman Nisbet saw his
female colleague as a future professor and, in his forthright non-nonsense
manner, he said so. In this he belonged to a very small and much appreciated
minority.
*Page D. Anatomy of a Medical School. Otago University
Press; 2008, p294.
Barbara Heslop (Emeritus Professor, Dunedin) wrote
these additional comments.
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