Journal of the New Zealand Medical Association, 12-December-2008, Vol 121 No 1287
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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