The past, present and future of colorectal cancer: The legacy of Dr Basil C Morson
Thursday, 19 January 2017 11:23
2nd May 2017
St James's Church, Spanish Place, London
The RSM Pathology and Coloproctology Sections in association with the Royal College of Pathologists and the St Mark's Association
- The life and times of Dr Basil Morson
- The adenoma-carcinoma sequence: from Morson to Vogelstein and beyond
- Morson's polyps and colorectal cancer screening
- The mystery of metaplastic polyps
- Basil Morson: his contributions to the concept of clonal evolution in gastro-intestinal cancer
- Polyposis syndromes: Morson's impact on understanding and evolution of clinical management
- Basil Morson and the surgeon: inflammatory bowel disease and rectal cancer
- Dysplasia in the Basil era and beyond
- Shedding new light on an old problem: colonoscopic detection and treatment of UC dysplasia
- Further information [ 21 kb ]
Obituary: Dr Basil C Morson, CBE, VRD, DM, FRCPath, FRCSE, FRCP, FRACS
Born: November 13, 1921; London, UK
Died: October 13, 2016; aged 94 years; West Chiltington, Sussex, UK
Dr Basil Morson, one of the most eminent (if not the most eminent) gastrointestinal pathologists world-wide, died peacefully at home, in West Sussex, on 13 October 2016. He was exactly one month shy of his 95th birthday. He had been a long-term member of the British Society of Gastroenterology and he was the first pathologist to be President of the BSG. His esteem was such that, on his retirement in 1985, the Society created the Basil Morson Lecture, now regarded as the most prestigious named GI pathology lecture in the UK, in Europe and likely in the world. Basil himself gave the inaugural lecture in 1987.
His achievements in gastrointestinal pathology and surgery are almost legendary. This is extraordinary, given that he was the only Consultant Pathologist in a small specialist hospital, St Mark's Hospital, in London. He achieved this fame by dynamism and commitment to clinical research in gastro-intestinal pathology. Indeed, it is hard to find a disease of the gastro-intestinal tract about which Basil Morson has not been an initial describer or has not had a major influence in the understanding of its pathology. This particularly opines to colorectal cancer, inflammatory bowel disease, intestinal polyps and diverticular disease but his earlier work was also very influential in our understanding of the development of cancer in Barrett's oesophagus and in the stomach.
Born in London in 1921, he was the son of an eminent London-based Consultant Surgeon. He served in the Second World War as an ordinary seaman but, in 1944, he transferred to the Special Executive Branch of the Royal Navy. He trained in midget submarines and later worked as a physiologist studying the problems of deep water diving. After the war, he joined the Royal Naval Reserve and rose to the rank of Surgeon Commander, serving until 1971. His Volunteer Reserve Decoration (VRD), bestowed in 1964 for services in the Royal Naval Reserve, was an award, amongst so many, that he was most proud of.
He graduated in Medicine from the Middlesex Hospital Medical School, London, in 1949. At that hospital, in 1950, he initiated his career in Pathology. He also gained further academic qualifications at Oxford University, with an MA in 1953 and a DM in 1955. His initial pathological research at the Middlesex Hospital was in the study of gastric and oesophageal pathology. Indeed, in 1953, he was the first to describe gastric-type metaplasia in the disease that subsequently became known as Barrett's oesophagus and he also undertook innovative work on intestinal metaplasia in the stomach as a precursor of gastric cancer. Having initiated his research in the upper gut, he rapidly progressed down the GI tract when, in the early 1950s, he started working closely with the eminent pathologist Dr Cuthbert Dukes at St Mark's Hospital, London. It was no surprise, therefore, that he was appointed as his successor when Cuthbert Dukes retired in 1956. Basil was particularly attracted to Dr Dukes' work on pathological specimens of colorectal cancer. Prior to that time, most studies of gastro-intestinal disease had been on autopsy specimens and Dr Dukes and Dr Morson were really the first to concentrate studies on surgical specimens. Much later, Basil Morson was also a very important player in the development of endoscopic biopsy and wrote seminal articles on the pathology of such biopsies.
During a career of almost 30 years at St Mark's Hospital, it is extraordinary how much innovative research Basil produced. He wrote influential papers, with Sir Hugh Lockhart-Mummery, on the clinical and pathological distinction of Crohn's disease from ulcerative colitis in the 1960s and also authored the initial description of the biopsy appearances of dysplasia complicating ulcerative colitis in 1967. In the 1970s, he produced ground-breaking work on the concept of the adenoma-carcinoma sequence in the large intestine. Particularly working with his great friend and colleague, Dr H J R "Dick" Bussey, his research remains critical to our understanding of the development of colorectal cancer. He also worked extensively on various other tumours of the gut, intestinal polyps, polyposis syndromes, inflammatory bowel disease and diverticular disease. In the 1980s, he worked closely with the late Professor Jeremy Jass and together they produced many important papers, especially on intestinal polyps and colorectal cancer.
Basil's life was not just about academic gastro-intestinal pathology. He was also a consummate administrator and was President of the Section of Proctology of the RSM, President of the Section of United Services of the RSM, Vice-President of the Royal College of Pathologists, Treasurer of the Royal College of Pathologists and President of the British Division of the International Academy of Pathology (IAP). He is one of only two pathologists to be the President of the British Society of Gastroenterology. He also gave numerous prestigious named lectures around the world and his work in gastrointestinal pathology has been recognised by numerous Colleges and Societies worldwide. Most recently, he was awarded the inaugural President's Medal of the British Division of the IAP, for services to education in Pathology, in 2005.
His contributions to the literature are enormous. Perhaps above all else, he conceived and wrote the first textbook of gastrointestinal pathology, forever known as 'Morson & Dawson', with Professor Ian Dawson. The first edition was published in 1972. That text is still the UK flagship textbook of gastrointestinal pathology with the fifth edition having been published in 2013 and a sixth edition in its early stages of production. He was the author of 11 other books, 20 book chapters and more than 200 original publications.
Legend to photo: Dr Basil Morson (centre), in 2005, holding the fourth edition of 'Morson & Dawson's Gastrointestinal Pathology' with the editors/authors, Dr David Day, Professor Bryan Warren, Professor Ashley Price, Professor Neil Shepherd, Professor Geraint Williams and Dr James Sloan.
Basil was proud to be a clinical pathologist. As the only Consultant in Pathology at St Mark's Hospital, he worked very closely with physicians, surgeons, radiologists and endoscopists, all of whom appreciated his acumen in clinical medicine. Indeed, his trainees in pathology were encouraged to practice clinical medicine and not practice what he called 'postal pathology'. This trainee, looking back 30 years, was often told to 'get himself on the wards and talk to and examine patients' as he was a "clinical pathologist". Further, Basil was not afraid to ensure the appropriate clinical management of patients by disciplining his clinical colleagues. Many a lecture to pathology trainees would start with the words "It is your job to control surgeons". His rationale for this was that a single inappropriate word on a pathology report could provoke unnecessary major surgery.
Basil was a man of compassion and dignity and yet had a wicked sense of humour. He was also a man of humility. He steadfastly refused the offer of Professorships, preferring instead to regard himself as a clinical pathologist and he was proud of his title of 'Dr Morson'. When he retired in 1985, he indicated that he was going to fully retire and did not want to be 'an old man shuffling on to the stage and embarrassing both his listeners and himself with outmoded science'. However, with his knowledge, experience and clinical guile, he was not allowed to fully retire. Indeed the research on colorectal polyps he undertook in the 1990s, with Professors Wendy Atkin and Jack Cuzick, paved the way for the establishment of a major part of colorectal cancer screening in England, instituted just two years ago.
Outside work, like so many histopathologists in the UK and elsewhere, he was a keen ornithologist and also took pride in his gardens. He married twice and had three children, Christopher, Caroline and Clare. His second wife, Sylvia, was his soulmate and they spent many happy years together. She had been the Senior Matron at the London Clinic, where Basil also worked, and she was awarded the MBE for services to Nursing. She predeceased him in 2014. In 1987, he himself had been awarded the prestigious honour of Commander of the Order of the British Empire (CBE) for services to Medicine.
At St Mark's Hospital, he had many visiting Fellows in Pathology from all round the world, especially the USA and Japan. Many of those Fellows have gone on to become world leaders in gastrointestinal pathology themselves, such as Professor Tetsu Muto, from Japan, and Professors Stan Hamilton and Joel Greenson from the USA. It is testament to his reputation and teaching skills that so many of these Fellows, and indeed many gastrointestinal pathologists who never worked with him, have acknowledged his huge contribution to their professional lives. There is no doubt that Basil's legacy to pathology, and gastroenterology, is enormous and that he was, and is, very much THE pioneer of gastrointestinal pathology around the world.
Obituary kindly provided by: Professor Neil A Shepherd, DM FRCPath
Professor Neil A Shepherd, DM FRCPath
Professor of Gastrointestinal Pathology & Consultant Histopathologist
Gloucestershire Cellular Pathology Laboratory
Cheltenham General Hospital
Glos GL53 7AN
Professor Bryan F Warren
(15 April 1958 to 28 March 2012):
Bryan Warren, that most unique of gastrointestinal pathologists, died at home on 28th March 2012 at the cruelly young age of 53. It is a sad irony that he died of a complication of Crohn’s disease, a condition about which he was a world expert. He fought his intestinal cancer with remarkable stoicism for five years and would accept any treatment oncologists were prepared to throw at him, sadly, in the end, to no avail.
Bryan was born in Cheshire and was proud to have been educated in state schools in Nantwich. He read Medicine at the University of Liverpool. There he developed a great interest in gastroenterology, partly driven, no doubt, by his own diagnosis of Crohn’s disease in early childhood. Initially, he trained in gastroenterology in the North West and developed a particular fascination with endoscopy, something that paved the way for his remarkable reputation for integrating endoscopic appearances with those down the microscope and eventually led to him enlightening a generation of endoscopists. Luckily for his fellow histopathologists, MRCP exams were not his strong point and this ensured that he transferred to Pathology. How pleasing it was for Bryan, therefore, to be elected a Fellow of the Royal College of Physicians, without examination, twenty years later, in 2007. We know that was a very proud moment for him.
There were some real characters in Pathology on Merseyside in the mid 1980s and this ensured that Bryan was caught, hook, line and sinker. Later, his training was undertaken in Bristol, especially with Jack Davies and John Bradfield. He made some great friends in fellow trainees there, especially Howard Rigby, who was to remain a life-long close friend. Even as a trainee, he wrote seminal papers in Gastrointestinal Pathology, especially inflammatory bowel disease. He also started his research in comparative pathology, studying inflammatory bowel disease in cotton top tamarins. His humour always shone through in all parts of his work, not least in the development of an interesting and unique scoring system for assessing the severity of colitis in the tamarins....
Bryan was thrilled to be appointed Consultant Gastrointestinal Pathologist in Oxford in 1994. He was, above all, a clinical pathologist and was determined that he would never be what our old mentor, Basil Morson, called a "postal pathologist". Bryan spent hours in Endoscopy with Derek Jewell, Simon Travis and their colleagues. Further, the Department of Cellular Pathology at Oxford was perfectly suited to him because the operating theatres were immediately adjacent to his department, assuring that he could don his blues and go and quiz Neil Mortensen and his surgeon colleagues to his heart’s content. His collaborations with clinical colleagues were legion. He had a very close relationship with gastro-intestinal surgeons and physicians at Oxford and was one of the very few pathologists to be a longstanding member of the Association of Coloproctology. He was so proud to be made an Honorary Member of that Society in June 2010, receiving the award just two weeks after major surgery.
His teaching, training and writing outputs were remarkable, not least because his prime commitment was to diagnostic gastrointestinal pathology. And commitment it was. We knew that if we ever wanted to speak to Bryan at 9.00 pm, we just had to ring his office in Oxford. He would think nothing of reporting 8000 surgicals a year whilst pathologists elsewhere could barely scrape 2000.
His supreme talent was in teaching. He organised and facilitated seminal courses even as a trainee in Bristol, especially the "Cut-up course", then unique in UK pathology. Anyone who has sat in a Bryan Warren lecture will remember his style and his dynamism with particular fondness. He enjoyed, of course, cultivating his broad Cheshire accent, especially in Oxford, and had a unique way with words. "Ulcerative colitis goes up to where it stops", "Low power lens and high power brain" and "If you don’t know what it is, staring at it won’t help" are particular favourites of ours.
His reputation as a remarkable communicator meant that Bryan was always in demand to lecture worldwide. He was instrumental in establishing (under the auspices of the British Division of the International Academy of Pathology, the BDIAP) Pathology Schools in places of need, primarily in Bosnia (with the help of his great friend Mike Franey and Acorn Aid) and this remains as one of his many legacies to international pathology. Indeed, BDIAP Council has, this month, ratified a change of title of the Bosnian British School of Pathology to the ‘Bryan Warren School of Pathology’. Bryan welcomed innumerable clinical fellows from around the world to his laboratory in Oxford. He instilled in them the importance, above all, of practising in a clinical context (sometimes amazing them by visiting the wards to speak to patients!) and they all left with great affection and respect for him.
Although teaching, training and research were central to his professional life, he was also an administrator and organiser of consummate skill. He had little interest in NHS administration, but give him a conference to organise and he was away. He was Meetings Secretary to both the Association of Clinical Pathologists and the BDIAP and an elected member of the Pathological Society Committee. Always highly innovative, he also had a skill fairly unique in pathology, an ability to extract sponsorship money from organisations not so keen on dispensing funds to pathological causes. In 2010, the BDIAP awarded him its Cunningham Medal in recognition of his huge contribution to that Society. He also had major involvement of the British Society of Gastroenterology, having been an elected member of Council and served as both Chairman and Secretary of the Pathology Section of the BSG, the leading body for GI pathology in the UK.
Although highly important to him, Bryan’s life was not just about gastroenterological pathology. He had strong family bonds and our thoughts and prayers go out to Tracy, his wife, and to Scott and Emma, his step-children, to whom he was very close. Sadly his own dear mother predeceased him just one month before. Outside work, Bryan had an extraordinary enthusiasm for cars and for the process of driving itself. At any one time, he owned six or seven cars, including three Bristols, of which he was most proud. He was an active member of the Bristol Owners’ Club and the Institute of Advanced Motorists. Despite none of us considering cars to be anything more than a means of getting from A to B, Bryan would regale us for hours on end with the particular properties of various engine parts of which we had little or no idea. Bless his enthusiasm and his single-mindedness!
We will all miss his peerless enthusiasm and his extraordinary appetite for work. He leaves behind a vast legacy of original papers, chapters and books. The latter include important endoscopic-pathological correlation tomes and, of course, Morson & Dawson's Gastro-intestinal Pathology. Sadly, he did not live to see the final publication of the 5th Edition but that book will be surely dedicated to his memory. So many of his writings were composed in the singular way, direct and uncompromising, but always with clinical relevance. Bryan's academic contributions were recognised in 2009 by the award of an Honorary Chair from the University of London, of which he was immensely proud.
So many people have bemoaned his sad and premature parting to us, describing him as a “larger than life character”. And he certainly was ‘big-boned” but few knew the main reason for this. When he had such a voracious appetite, he could be fairly confident that his Crohn’s disease was in remission. Bryan was hugely admired for his intelligence, his dynamism and his extraordinary sense of fun here in the UK and internationally. We have all lost a great friend, a loyal colleague and a supreme intellect.
Professor Neil A Shepherd
Professor Marco R Novelli
Professor Geraint T Williams
Thursday, 05 March 2009 10:36