Norman Barrett
Encyclopedia
Norman Rupert Barrett was an Australian-born British thoracic
surgeon
who is primarily remembered for describing Barrett’s oesophagus.
, South Australia
, to Alfred and Catherine Barrett. His great uncle, James Barrett, was a doctor, and four of James's children became doctors. One of these children, Norman's uncle Sir James Barrett, was a founder of the Royal Australasian College of Surgeons
and a Chancellor
of Melbourne University. He moved to England at the age of 10, and was educated at Eton College
and Trinity College
, Cambridge
. He was given his lifelong nickname, Patsy, while at Eton.
, and graduated in 1928. He continued as resident assistant surgeon at St. Thomas’ Hospital, and was elected as Fellow of the Royal College of Surgeons
in 1930. He was awarded the postgraduate degree M Chir in 1931. In 1935, he became a Consultant Surgeon
at St. Thomas’, where he remained for the rest of his career.
He travelled to the United States of America on a Rockefeller Travelling Fellowship from 1935-6, working at the Mayo Clinic
, and visiting Boston
, St. Louis
and Michigan
. It was during this time that he decided to focus on thoracic surgery
, rather than gastrointestinal surgery as he had initially intended.
In 1946, he wrote a paper for the first issue of Thorax on spontaneous rupture of the oesophagus
(Boerhaave syndrome
), in which he commented that "in the byways of surgery there can be few conditions more dramatic in their presentation and more terrible in their symptoms than spontaneous perforation of the oesophagus. No case has yet been treated successfully, and diagnosis has only been achieved in a very few before death". A year later, on 7 March 1947, he performed the first successful repair of a ruptured oesophagus.
In 1950, he published a paper in which he described the oesophagus as "that part of the foregut
, distal to the cricopharyngeal sphincter, which is lined by squamous epithelium
". In this paper, Barrett suggested that the finding of an oesophagus lined with columnar epithelium
(rather than the usual squamous epithelium) was due to the presence of a congenitally shortened oesophagus leading to a tubular portion of stomach being trapped in the chest. In this article Barrett also introduced the term reflux oesophagitis
, and described the development of benign oesophageal strictures
in patients with this condition.
Allison and Johnstone argued that this columnar epithelium–lined structure was oesophagus and not stomach, and suggested that ulcer
s in this structure be called "Barrett's ulcers". Seven years after his initial article Barrett accepted this view, suggesting that it be called the "lower oesophagus lined by columnar epithelium". The columnar epithelium surrounding the chronic Barrett's ulcers has subsequently become known as Barrett's oesophagus.
In addition to his work on oesophageal disease, Barrett also worked with Leonard Dudgeon, Professor of Pathology
at the University of London
, on the cytology
of sputum
in the diagnosis of pulmonary malignancy
. He is also noted for his treatment of hydatid cysts
.
Barrett was a lecturer in surgery for the University of London
(1935-1970), Surgeon to King Edward VII Sanatorium
in Midhurst
, Sussex
(1938-1970), and Consulting Thoracic Surgeon to both the Royal Navy
and the Ministry of Social Security
(1944-1970). He edited Thorax, the journal of thoracic surgery, from its inception in 1946 until 1971.
, London for about 20 years. In 1954 they moved to Richmond Green
.
Outside his medical interests, he was also interested in the history of medicine
, drawing and painting, and was a keen sailor.
He was awarded the CBE
in 1969, and retired in 1970. He died in London on 8 January 1979.
Chest
The chest is a part of the anatomy of humans and various other animals. It is sometimes referred to as the thorax or the bosom.-Chest anatomy - Humans and other hominids:...
surgeon
Surgeon
In medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
who is primarily remembered for describing Barrett’s oesophagus.
Early life
Norman Barrett was born on 16 May 1903 in AdelaideAdelaide
Adelaide is the capital city of South Australia and the fifth-largest city in Australia. Adelaide has an estimated population of more than 1.2 million...
, South Australia
South Australia
South Australia is a state of Australia in the southern central part of the country. It covers some of the most arid parts of the continent; with a total land area of , it is the fourth largest of Australia's six states and two territories.South Australia shares borders with all of the mainland...
, to Alfred and Catherine Barrett. His great uncle, James Barrett, was a doctor, and four of James's children became doctors. One of these children, Norman's uncle Sir James Barrett, was a founder of the Royal Australasian College of Surgeons
Royal Australasian College of Surgeons
The Royal Australasian College of Surgeons is the body responsible for training and examining surgeons in Australia and New Zealand. The head office of the College is in Melbourne, Australia....
and a Chancellor
Chancellor (education)
A chancellor or vice-chancellor is the chief executive of a university. Other titles are sometimes used, such as president or rector....
of Melbourne University. He moved to England at the age of 10, and was educated at Eton College
Eton College
Eton College, often referred to simply as Eton, is a British independent school for boys aged 13 to 18. It was founded in 1440 by King Henry VI as "The King's College of Our Lady of Eton besides Wyndsor"....
and Trinity College
Trinity College, Cambridge
Trinity College is a constituent college of the University of Cambridge. Trinity has more members than any other college in Cambridge or Oxford, with around 700 undergraduates, 430 graduates, and over 170 Fellows...
, Cambridge
University of Cambridge
The University of Cambridge is a public research university located in Cambridge, United Kingdom. It is the second-oldest university in both the United Kingdom and the English-speaking world , and the seventh-oldest globally...
. He was given his lifelong nickname, Patsy, while at Eton.
Career
He trained at St. Thomas’ HospitalSt Thomas' Hospital
St Thomas' Hospital is a large NHS hospital in London, England. It is administratively a part of Guy's & St Thomas' NHS Foundation Trust. It has provided health care freely or under charitable auspices since the 12th century and was originally located in Southwark.St Thomas' Hospital is accessible...
, and graduated in 1928. He continued as resident assistant surgeon at St. Thomas’ Hospital, and was elected as Fellow of the Royal College of Surgeons
Fellowship of the Royal College of Surgeons
Fellowship of the Royal College of Surgeons is a professional qualification to practise as a surgeon in the United Kingdom and Republic of Ireland...
in 1930. He was awarded the postgraduate degree M Chir in 1931. In 1935, he became a Consultant Surgeon
Consultant (medicine)
In the United Kingdom, Republic of Ireland, and parts of the Commonwealth, consultant is the title of a senior doctor who has completed all of his or her specialist training and been placed on the specialist register in their chosen specialty...
at St. Thomas’, where he remained for the rest of his career.
He travelled to the United States of America on a Rockefeller Travelling Fellowship from 1935-6, working at the Mayo Clinic
Mayo Clinic
Mayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
, and visiting Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
, St. Louis
St. Louis, Missouri
St. Louis is an independent city on the eastern border of Missouri, United States. With a population of 319,294, it was the 58th-largest U.S. city at the 2010 U.S. Census. The Greater St...
and Michigan
Michigan
Michigan is a U.S. state located in the Great Lakes Region of the United States of America. The name Michigan is the French form of the Ojibwa word mishigamaa, meaning "large water" or "large lake"....
. It was during this time that he decided to focus on thoracic surgery
Thoracic surgery
Thoracic surgery is the field of medicine involved in the surgical treatment of diseases affecting organs inside the thorax . Generally treatment of conditions of the lungs, chest wall, and diaphragm....
, rather than gastrointestinal surgery as he had initially intended.
In 1946, he wrote a paper for the first issue of Thorax on spontaneous rupture of the oesophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
(Boerhaave syndrome
Boerhaave syndrome
Esophageal rupture is rupture of the esophageal wall due to vomiting. 56% of esophageal perforations are iatrogenic, usually due to medical instrumentation such as an endoscopy or paraesophageal surgery...
), in which he commented that "in the byways of surgery there can be few conditions more dramatic in their presentation and more terrible in their symptoms than spontaneous perforation of the oesophagus. No case has yet been treated successfully, and diagnosis has only been achieved in a very few before death". A year later, on 7 March 1947, he performed the first successful repair of a ruptured oesophagus.
In 1950, he published a paper in which he described the oesophagus as "that part of the foregut
Foregut
The foregut is the anterior part of the alimentary canal, from the mouth to the duodenum at the entrance of the bile duct. At this point it is continuous with the midgut...
, distal to the cricopharyngeal sphincter, which is lined by squamous epithelium
Squamous epithelium
In anatomy, squamous epithelium is an epithelium characterised by its most superficial layer consisting of flat, scale-like cells called squamous epithelial cells...
". In this paper, Barrett suggested that the finding of an oesophagus lined with columnar epithelium
Simple columnar epithelium
A simple columnar epithelium is a columnar epithelium that is uni-layered. In humans, a simple columnar epithelium lines most organs of the digestive tract including the stomach, small intestine, and large intestine...
(rather than the usual squamous epithelium) was due to the presence of a congenitally shortened oesophagus leading to a tubular portion of stomach being trapped in the chest. In this article Barrett also introduced the term reflux oesophagitis
Esophagitis
Esophagitis is inflammation of the esophagus. It may be acute or chronic. The acute esophagitis can be catarrhal or phlegmonous, whereas the chronic esophagitis may be hypertrophic or atrophic.-Infectious:...
, and described the development of benign oesophageal strictures
Esophageal stricture
Benign esophageal stricture is a narrowing or tightening of the esophagus that causes swallowing difficulties.-Causes:It can be caused by or associated with gastroesophageal reflux disease, esophagitis , dysfunctional lower esophageal sphincter, disordered motility, lye ingestion, or a hiatal hernia...
in patients with this condition.
Allison and Johnstone argued that this columnar epithelium–lined structure was oesophagus and not stomach, and suggested that ulcer
Peptic ulcer
A peptic ulcer, also known as PUD or peptic ulcer disease, is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm...
s in this structure be called "Barrett's ulcers". Seven years after his initial article Barrett accepted this view, suggesting that it be called the "lower oesophagus lined by columnar epithelium". The columnar epithelium surrounding the chronic Barrett's ulcers has subsequently become known as Barrett's oesophagus.
In addition to his work on oesophageal disease, Barrett also worked with Leonard Dudgeon, Professor of Pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
at the University of London
University of London
-20th century:Shortly after 6 Burlington Gardens was vacated, the University went through a period of rapid expansion. Bedford College, Royal Holloway and the London School of Economics all joined in 1900, Regent's Park College, which had affiliated in 1841 became an official divinity school of the...
, on the cytology
Cytopathology
Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level. The discipline was founded by Rudolf Virchow in 1858. A common application of cytopathology is the Pap smear, used as a screening tool, to detect precancerous cervical lesions and prevent cervical...
of sputum
Sputum
Sputum is mucus that is coughed up from the lower airways. It is usually used for microbiological investigations of respiratory infections....
in the diagnosis of pulmonary malignancy
Lung cancer
Lung cancer is a disease characterized by uncontrolled cell growth in tissues of the lung. If left untreated, this growth can spread beyond the lung in a process called metastasis into nearby tissue and, eventually, into other parts of the body. Most cancers that start in lung, known as primary...
. He is also noted for his treatment of hydatid cysts
Echinococcosis
Echinococcosis, which is often referred to as hydatid disease or echinococcal disease, is a parasitic disease that affects both humans and other mammals, such as sheep, dogs, rodents and horses. There are three different forms of echinococcosis found in humans, each of which is caused by the larval...
.
Barrett was a lecturer in surgery for the University of London
University of London
-20th century:Shortly after 6 Burlington Gardens was vacated, the University went through a period of rapid expansion. Bedford College, Royal Holloway and the London School of Economics all joined in 1900, Regent's Park College, which had affiliated in 1841 became an official divinity school of the...
(1935-1970), Surgeon to King Edward VII Sanatorium
Sanatorium
A sanatorium is a medical facility for long-term illness, most typically associated with treatment of tuberculosis before antibiotics...
in Midhurst
Midhurst
Midhurst is a market town and civil parish in the Chichester district of West Sussex, England, with a population of 4,889 in 2001. The town is situated on the River Rother and is home to the ruin of the Tudor Cowdray House and the stately Victorian Cowdray Park...
, Sussex
Sussex
Sussex , from the Old English Sūþsēaxe , is an historic county in South East England corresponding roughly in area to the ancient Kingdom of Sussex. It is bounded on the north by Surrey, east by Kent, south by the English Channel, and west by Hampshire, and is divided for local government into West...
(1938-1970), and Consulting Thoracic Surgeon to both the Royal Navy
Royal Navy
The Royal Navy is the naval warfare service branch of the British Armed Forces. Founded in the 16th century, it is the oldest service branch and is known as the Senior Service...
and the Ministry of Social Security
Ministry of Pensions and National Insurance
The Ministry of Pensions and National Insurance or MPNI was a British government ministry responsible for the administration and delivery of welfare benefits...
(1944-1970). He edited Thorax, the journal of thoracic surgery, from its inception in 1946 until 1971.
Personal life
Norman Barrett married Annabel Elizabeth "Betty" Warington Smyth on 21 April 1931. She was the sister of a school friend, and they had met six years previously. Betty had studied English and Art, and later became a novelist. They had two children, Julia and Althea. After Norman had been appointed a Consultant at St. Thomas’ Hospital, the Barrett family lived at 2 Dorset Street, MaryleboneMarylebone
Marylebone is an affluent inner-city area of central London, located within the City of Westminster. It is sometimes written as St. Marylebone or Mary-le-bone....
, London for about 20 years. In 1954 they moved to Richmond Green
Richmond Green
Richmond Green is a recreation area located near the centre of Richmond, which is a town of about twenty thousand inhabitants situated in south west London. The green is essentially square in shape and its open grassland, framed with broadleaf trees, extends to roughly twelve acres...
.
Outside his medical interests, he was also interested in the history of medicine
History of medicine
All human societies have medical beliefs that provide explanations for birth, death, and disease. Throughout history, illness has been attributed to witchcraft, demons, astral influence, or the will of the gods...
, drawing and painting, and was a keen sailor.
He was awarded the CBE
CBE
CBE and C.B.E. are abbreviations for "Commander of the Order of the British Empire", a grade in the Order of the British Empire.Other uses include:* Chemical and Biochemical Engineering...
in 1969, and retired in 1970. He died in London on 8 January 1979.