Obituary: Professor Robert Zachary

ROBERT ZACHARY was a leading figure in that small group of surgeons whose existence became possible by the creation of the National Health Service. Within one generation they revolutionised surgery for the newborn and young child. Of these surgeons, Zachary will be remembered as one around whom circulated a dilemma that is still with us, concerning the right to life of infants with treatable, very severe, congenital deformities.

Before the National Health Service was established in the late Forties, surgeons were "honoraries" in teaching hospitals and earned their livelihood in private work; in the provinces there was no money in child surgery. A system had developed where trainee surgeons became attached to children's hospitals and "learned to cut" there. When a vacancy occurred in an adult hospital, they applied for it and, if successful, were transferred, leaving the children's hospital free to take on a new trainee. Thus adult surgeons considered themselves to be competent with children and looked on all of the staff at the children's hospital as trainees and not full specialists.

This was the general situation at the Sheffield Children's Hospital when Zachary was appointed as its first full-time surgeon in 1947. The surgical mortality was high, there was little status, and laboratory support was scanty. Zachary threw himself into the work with enthusiasm. He was a small man with a severe scoliosis but with great intelligence, charm, drive and energy. He was a superb actor and well above average on the dance floor. He had a high level of charisma, overcame many problems and carried all before him.

Within 10 years he had established Sheffield as an important centre for children's surgery. In 1953 he was a prime mover in setting up the British Association of Paediatric Surgeons, which has become the premier international society in this field. He went on to become President of the association in 1962-63, and was a founder member of the Society for Research into Hydrocephalus and Spina Bifida (and Chairman, 1969-71).

His experience in neuro-spinal research, and his personal experience of congenital deformities involving the spine, focused his attention on spina bifida and on the possibility of preventing deformities, rather than adopting the traditional "wait-and-see" regime. With his clinical colleagues, the orthopaedic surgeon John Sharrard and the paediatrician John Lorber, Zachary formed an investigative team treating newborns with spina bifida as medical emergencies and operated as soon as possible after birth.

Some of the results were striking, creating world-wide interest, and within a few years Sheffield had become an international centre for the treatment of this condition. The hospital became flooded with patients. Parents who had infants with spina bifida moved jobs to Sheffield to obtain what was then a unique combined medical and surgical service. Many children with the disease who would have died in infancy survived. Sheffield had to open special schools to look after these children and the cost of care escalated. Where would all this end? The question of "quality of life" arose.

Classical readers will recall that the cadicus, the staff of Aesculapius- Hermes, has two intertwined and controlled snakes. These were the fighting snakes of knowledge and wisdom or science and humanism. Zachary was an active Roman Catholic, Knight Commander of St Gregory with Star, and believed that his duty was to do all that he could for any child. He had more faith in moral than statistical truths; thus when the question arose concerning the selection of babies at birth whose outlook was so poor that some thought that treatment should be withheld, he took a humanistic line.

His philosophy created a debate with colleagues in Sheffield - a debate that extended way beyond the paediatric surgical world. Winners and losers of such conflicts are not doctors but the infants, and the arguments are not over yet. The Zachary/Lorber conflict was a product of the rapid growth of science in medical and surgical care of infants in the years 1970-80. The debate relating to spina bifida subsequently resolved itself to a large extent with a great diminution of child births with that particular deformity.

Zachary attracted numerous assistants and colleagues during his long career, many of whom now occupy senior positions in hospitals in this country and abroad. His work was not confined to Sheffield; he had close contacts all over the world and was a popular speaker. His acting skills were combined with linguistic ones and he always attempted to give a lecture in the home language of any country he visited - and he frequently visited countries in eastern Europe, Poland and Russia. The hospital in Sheffield where he did all of the paediatric surgery for over 10 years now needs four full-time surgeons. Such men as Bob Zachary, and his great friend and rival at Liverpool, Peter Rickam, were the giants of an era.

Zachary was born in Leeds in 1913 and received his schooling at the Jesuit- run St Michael's College. Though he trained as a pharmacist, he subsequently decided to study medicine and graduated from Leeds University in 1940 with first class honours and the Gold Medal, gaining prizes in both surgery and clinical medicine. From the outset he knew that he wished to be a surgeon and went directly to the department of anatomy to get his "Primary" exams. He became a Fellow of the Royal College of Surgeons in 1943.

Working at Leeds Royal Infirmary with the professor of surgery, he met his future wife, Faith, a theatre sister. He then went to the Surgical Research Unit at Oxford University under Professor Herbert Seddon, initially working with the Spanish surgeon Joseph Trueta, who during the Spanish Civil War had revolutionised the treatment of wounds.

Zachary's spinal deformity excluded him from the armed forces and he spent the war years carrying out research in the Peripheral Nerve Injury Unit at Oxford, where he made several original contributions. In 1944 he was elected Hunterian Professor at the Royal College of Surgeons for research on orthopaedics. By this time, Zachary had decided that he wanted to be a children's surgeon, so in 1945 he went to the United States to work under Dr Frank Ingham at the Boston Children's Hospital, in Massachusetts, which was at that time the leading children's unit in the world. It was during the final few months of this Nuffield fellowship that Zachary was appointed in 1947 to the Sheffield Children's Hospital.

When Bob Zachary retired in 1978, he left Sheffield and started a new life in Australia and later Canada. His second wife, Winifred, died in 1990, but he is survived by his third wife, Janetta, and by two sons and a daughter from his first marriage, all of whom are doctors.

At one time he wrote an autobiography that was never published, and its final sentence to a great extent sums up his life: "In my own small way I feel a common bond with all those who have spina bifida when I say, `We who were born with a deformed spine . . .' "

Robert Bransby Zachary, paediatric surgeon: born Leeds 1 March 1913; Consultant Paediatric Surgeon, Sheffield Children's Hospital 1947-78; Professor Associate in Paediatric Surgery, Sheffield University 1976-78 (Emeritus); three times married (two sons, one daughter); died St Alban's, Newfoundland 1 February 1999.