Geoffrey Jefferson Case Notes

Scope and Content

The collections consists of the patient case notes of individuals seen by Jefferson at the Manchester Royal Infirmary admitted between 1926 and 1940 but excluding those he treated in the private patients' home. Many of these patients continued to be seen for many years beyond this date and their files reflect this. There are also a handful of files for patients admitted in the early 1940s.

Over this period Jefferson treated a large number of patients with many and varied neurological symptoms and diagnoses which is reflected in the surviving patient records. This includes, but is not limited to, a significant number of patients with pituitary tumours, aneurysms, trigeminal neuralgia, epilepsy, and spina bifida. The work of Manchester's pathology department is also well represented throughout the collection with numerous pathological and port mortem reports from key individuals including Eugen Pollak, Harold Sheehan, and William Susman. This adds to the diagnoses made by Jefferson and his colleagues by giving further detail as to the histology of the various brain and spinal neoplasms they encountered.

There are valuable details and operation reports relating to significant surgical procedures undertaken during this period, some considered to be somewhat controversial and others pioneering for the time. For instance Jefferson describes what he claims is the first example of the clipping of an intracranial aneurysm in the UK in relation to patient 1939/165 (JCN/14/161). During the 1930s and 1940s Jefferson was a great exponent of the value of the lobectomy for the removal of tumours and this is reflected in the files. There are at least twenty examples of frontal lobectomies being performed in addition to a number of temporal and occipital lobectomies.

The collection is particularly rich in visual materials including x-rays, sketches and drawings, and clinical, pathological, and operative photographs adding a further dimension to the clinical information in the files. Not all files contain visual material but it is made quite clear in the descriptions of individual files whether or not such material can be found within them.

Administrative / Biographical History

Geoffrey Jefferson (1886-1961) was a pioneer in neurosurgery, but also had expertise in neuroanatomy and neurophysiology. Jefferson, known called GJ or Jeff by his friends, was honoured by his country, and by universities and societies around the world.

Jefferson was born in County Durham on 10 April 1886, the son of a general practitioner. On the death of his father, Arthur John Jefferson (1857-1915), a doctor in Rochdale, Jefferson's younger brother Jack, who also studied medicine at Manchester, took over the practice. Geoffrey was educated at Manchester Grammar School before beginning his medical studies at Manchester University in 1904. He took the London University degree of Bachelor of Medicine and Surgery as an external student, passing in 1909 with a distinction in surgery. The same year Jefferson also was awarded MRCS and LRCP, and in 1913, FRCS. His talent for surgery was further recognized when he was awarded the gold medal for his Master of Surgery exam in 1913. During his time at Manchester University, Jefferson studied anatomy and physiology under Sir Grafton Elliot Smith (1871-1937), who exerted a profound influence on Jefferson in directing his interest towards the nervous system. In 1911, Sir Grafton Elliot Smith appointed Jefferson and Harry Platt as demonstrators in anatomy, where he oversaw their research into parotid glands. Jefferson's friendship with Platt, which began when they were students, continued throughout their lives. Jefferson's first medical positions were at MRI under George Arthur Wright and Arthur Henry Burgess. Burgess had introduced modern surgical methods to Manchester and both doctors were interested in diseases of children. Herbert Waterhouse, for whom Jefferson was house surgeon at the Victoria Children's Hospital in London, had worked under Sir William Macewen, the Scottish neurological pioneer. Waterhouse would later have a significant effect on Jefferson's life through his involvement in the Anglo-Russian Hospital.

While in Manchester, Jefferson met and became engaged to a medical student from Canada, Gertrude Flumerfelt (1882-1961). In 1913, they emigrated to Canada and were married on 17 January 1914. Gertrude worked for many years at the Manchester Maternity and Child Welfare Services, later qualifying as a psychologist. They had three children, Monica (born in Canada in 1915), Michael (born in Russia in 1916) and Antony Andrew (born in Manchester in 1922). While in Canada, Jefferson and Gertrude set up a small general practice in Victoria, BC. Both joined the Victoria Medical Society where Jefferson gave various papers. However, Jefferson was frustrated by the limited opportunities for surgical practice and this was compounded by war in Europe and the death of his father. Jefferson wrote to Herbert Waterhouse about opportunities in London and Europe. Waterhouse had been involved in the founding of the Anglo-Russian Hospital in Petrograd and in 1916 Jefferson was appointed there as a surgeon. In May 1917, Jefferson read his first purely neurological paper, on the removal of a bullet from the cerebellum, to the Russian Society of Surgeons of Pirogov. He returned to England in 1917 and worked in the 2nd Western General Hospital in Manchester. In 1918 he joined the RAMC and was posted to France where he specialized in head injuries. On his return to England in 1919, Jefferson studied the brain injury specimens he had collected, and published an important paper on gunshot wounds to the head.

In May 1919, Jefferson was appointed honorary assistant surgeon at Salford Royal Hospital. At Salford, Jefferson was able to specialize to a greater extent than before; he continued work on phantom limbs, but also began to study pituitary lesions and intracranial aneurysms. That year he published an important article on fractures of the atlas vertebra, often referred to as Jefferson's Fracture. In 1924, he was the first surgeon in Britain to perform a successful embolectomy and in 1931 he reported the first case of glosso-pharyngeal neuralgia operated upon in Britain. Jefferson held a number of surgical positions in the Manchester area. He was in charge of head injuries and general surgical cases at Grangethorpe Ministry of Pensions Hospital and was consultant surgeon to Eccles and Patricroft Hospital and to Manchester Royal Eye Hospital. In 1920, Jefferson was appointed lecturer in applied anatomy (neurology) at the University of Manchester. In 1926 he finally secured a position at MRI as honorary neurological surgeon. 1930 marked the beginning of a long friendship with George Frederick Rowbotham, who in this year became Jefferson's chief assistant. The facilities for neurosurgery at MRI were limited and in 1933 Jefferson took up an honorary appointment at the National Hospital for Nervous Diseases in London. Although he could only attend one day a fortnight, Jefferson gained much influence there. Jefferson was extremely busy and resigned from Salford Royal Hospital in 1935.

Jefferson had been considering a suggestion that he might take up a full time position at the National Hospital. However, in 1939, the University of Manchester offered Jefferson a personal professorial chair in a neurosurgical department in MRI. This was the first neurosurgical chair in England and included research facilities, staff, and freedom to continue private practice. At the outbreak of war in 1939 Jefferson gave up his position at the National Hospital. Jefferson continued his campaign for increased specialist resources until his retirement and in 1945 was appointed professor of neurological surgery at the University of Manchester and Director of the Neurological Laboratories. Finally, in 1950, a new Department of Neurosurgery at the MRI was opened. Jefferson retired in 1951 and was made emeritus professor.

During the Second World War, Jefferson had branched out from hospital work to become consultant advisor to the Ministries of Health and Pensions. In 1940, he also became a member of the Brain Injuries Committee set up by the Medical Research Council. Jefferson was instrumental in setting up twelve special head centres and was engaged in the training of neurosurgeons through the Medical Manpower Committee. Jefferson later became a member of the MRC and in 1953 was the first chairman of the Clinical Research Board. Jefferson's role in the development of neurosurgery can be seen not only in his hospital career, but also in his involvement with professional associations. He was a founding member of the Society of British Neurological Surgeons and was president from 1934-1936 and 1954-1956. The Society was pivotal to the development of neurosurgery and held meetings in England and Europe. Jefferson was president of the first International Congress of Neurosurgery, held in Brussels in 1957, and of the Section of Neurology of the Royal Society of Medicine in 1940. He was also involved in less specialist medical societies, being a founding member and president of the Manchester Surgical Society and president of the Pathological Society of Manchester. In addition to those he worked with at MRI, Jefferson developed a number of friendships with fellow neurosurgeons, corresponding with the pioneer neurosurgeons of the British Isles, namely Norman Dott, Hugh Cairns and Adams McConnell. He had a particularly close friendship with Hugh Cairns. They worked together to establish the Society for British Neurological Surgeons (SBNS) and were jointly responsible for British neurological services during World War Two. In the 1920s, Jefferson developed a friendship with Harvey Cushing, an American pioneer in neurosurgery, to whom he paid a prolonged visit in 1924.

Jefferson read a large number of papers to various societies. In 1923 he was awarded a Hunterian Professorship by the Royal College of Surgeons and gave a lecture on fractures of the cervical vertebra. He also read papers to the Sections of Surgery and Neurology of the BMA and the Section of Neurology of the Royal Society of Medicine. In 1948 the Royal College of Surgeons awarded him the Lister Medal, for which he gave an oration on the Mind of Mechanical Man. Jefferson published extensively throughout his life, many papers based on his prolific lectures. Jefferson wrote important papers on head wounds, spinal column injuries, intracranial pressure, pituitary tumours and trigeminal neuralgia. He also wrote essays on major figures in the history of neurosurgery, including William Macewen, Sir Victor Horsley and Harvey Cushing. A large number of his papers were published in Selected papers (see bibliography); this volume illustrates the breadth of his writing, encompassing neurosurgery, biography and general essays.

In March 1947 Jefferson became a fellow of the Royal Society, a rare distinction for a surgeon. The same year he was made an honorary fellow of the Royal College of Physicians and in 1955 was given honorary fellowship of the Royal Society of Medicine. Jefferson was also awarded honorary memberships to medical societies around the world and was awarded honorary degrees from the Universities of Glasgow, Manchester, Dublin, Cambridge and Birmingham. Jefferson was made Commander of the Order of the British Empire in 1943 and was knighted in June 1950. Before retiring, Jefferson had worked in Canada, Russia and France and had visited America and various European cities. After his retirement, Jefferson was to travel yet more in his role as "ambassador for British neurosurgery' (Schurr, p.286) making four visits to America and Canada, and also visiting Lisbon, Russia and Australia. On these trips Jefferson visited hospitals, met neurosurgeons and gave many lectures.

After his retirement, freed from clinical and teaching responsibilities, Jefferson was in great demand as a speaker. Two lectures he gave at this time were particularly close to his heart, the Victor Horsley Memorial Lecture and the Hugh Cairns Memorial Lecture. Jefferson had suffered poor health since before his retirement. He had recurring bouts of diverticulitis throughout the 1940s and 1950s and had a gastro-intestinal haemorrhage in 1958. Jefferson continued to be very active despite developing heart troubles. In 1960, he developed a coronary infraction on the way to America and was admitted to Lenox Hill Hospital in New York. Jefferson died of a heart attack in Manchester, on 28 January 1961.

Arrangement

The files are arranged chronologically by patient number allocated to them on their admission. These are subdivided into series based on the year of admission.

  • JCN/1 Pre-1927 admissions
  • JCN/2 1927 admissions
  • JCN/3 1928 admissions
  • JCN/4 1929 admissions
  • JCN/5 1930 admissions
  • JCN/6 1931 admissions
  • JCN/7 1932 admissions
  • JCN/8 1933 admissions
  • JCN/9 1934 admissions
  • JCN/10 1935 admissions
  • JCN/11 1936 admissions
  • JCN/12 1937 admissions
  • JCN/13 1938 admissions
  • JCN/14 1939 admissions
  • JCN/15 1940 admissions
  • JCN/16 1942 admissions
  • JCN/17 1943 admissions
  • JCN/18 1946 admissions
  • JCN/19 Files with unknown patient numbers

Conditions Governing Access

The collection is subject to a number of access restrictions.

The finding aid for this collection is made available to researchers in the Special Collections reading room. Patient information in this catalogue is anonymised.

The patient files themselves are subject to a number of restrictions. Files which relate to living or potentially living individuals under the age of one hundred years are closed to public inspection. This closure will relate to the entirety of their case file. I

Patient files which date from before 1934, where the patient can be determined to be over sixteen years of age in 1934 are open to public inspection. Files dating from 1934 to 1940, where the patient can be confirmed to be deceased may be open to public inspection, although disclosure of some details may be restricted.

Open files may be made available only in the Special Collections reading room.

The collection includes material which is subject to the Data Protection Act 2018. Under Section 19 of the Data Protection Act 2018 (DPA), The University of Manchester Library (UML) holds the right to process personal data for research purposes. In accordance with the DPA, UML has made every attempt to ensure that all personal and sensitive personal data has been processed fairly, lawfully and accurately. Users of the archive are expected to comply with the Data Protection Act 1998, and will be required to sign a form acknowledging that they will abide by the requirements of the Act in any further processing of the material by themselves.

Conditions Governing Use

Photocopies and photographic copies of material in the archive can be supplied for private study purposes only, depending on the condition of the documents, and their access status.

A number of items within the archive remain within copyright under the terms of the Copyright, Designs and Patents Act 1988; it is the responsibility of users to obtain the copyright holder's permission for reproduction of copyright material for purposes other than research or private study.

Prior written permission must be obtained from the Library for publication or reproduction of any material within the archive. Please contact the Head of Special Collections, John Rylands Library, 150 Deansgate, Manchester, M3 3EH.

Custodial History

It is believed that the case-notes may have been retained at the Manchester Royal Infirmary, Department of Neurosurgery until this moved to Hope Hospital, Salford in the 1990s. They were transferred from the Hospital to the University Library on 18 December 2002.

Related Material

The Papers of and Relating to Sir Geoffrey Jefferson (JEF) are also held at the University of Manchester Library and contain a number of files of his research papers reflecting some of his particular interests, a number of which contain information relating directly to some of the patient files in this collection. Similarly there are copies of published works for which patient files in this collection formed the basis and correspondence with other key practitioners demonstrating Jefferson's role in the wider national and international sphere.

The Medical Illustrations of Dorothy Davison (VFA.7) are also held at the University of Manchester Library. Davison worked closely with Jefferson throughout her career as a medical artist and produced a great number images for his publications, teaching, and conferences. Many of these link directly to specific patient files and in each individual case the links have been made clear.

A similar collection of case notes of the neurosurgeon Norman Dott is held at the Lothian Health Services Archive, Edinburgh.

Bibliography

G. Jefferson, Sir Geoffrey Jefferson: Selected Papers, 1960.

P. Schurr, So That Was Life: A Biography of Sir Geoffrey Jefferson, 1997.