Edgar Williams ParryBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4622 (Published 20 July 2011) Cite this as: BMJ 2011;343:d4622
- Averil Mansfield
Edgar Parry’s key legacies are in the emerging specialty of vascular surgery, which has developed from its traditional role in sympathectomy, varicose veins, and amputations. In the 1950s opportunities arose to repair and replace diseased blood vessels, and this was what Parry decided to pursue.
In 1952 about 12% of the 78% of hospital deaths that were investigated by postmortem examination involved pulmonary emboli, a worryingly high incidence, especially in apparently fit patients after operation. Working with Professors Milnes Walker and T F Hewer in Bristol, Parry observed that the massive pulmonary emboluses almost always occurred in patients older than 40 after an operation. There was substantially increased risk in malignancy. Anticoagulants had been prescribed only in half of these patients, and Parry recognised the paucity and therefore unreliability of the clinical signs of deep vein thrombosis.
Clots above the knee
He saw that thrombuses were often bilateral and that the more proximal the thrombus the greater the risk of embolism—for example, 70% in femoral vein thrombuses and 30% in calf thrombuses. He also saw that in 10 limbs out of 104, clots were above the knee but not below. This indicates that new clots could arise in proximal veins, contrary to the belief that they all progressed from the calf.
Parry counselled against ignoring “a touch of pleurisy” and also warned that “early ambulation” did not equate with sitting in the chair while the bed was made. He looked at possible therapeutic ways to prevent thrombuses and carried out a clinical trial of α tocopherol in the prophylaxis of thromboembolism (Lancet 1954;266:486-8). He wrote, “Against the benefit apparently obtained by the method must be offset the not inconsiderable labour of giving a large number of patients an intravenous injection every other day.”
Edgar Williams Parry, the son of a farmer, was born in north Wales on 1 May 1919. He chose to study medicine at Liverpool University. After graduating in 1943 he began surgical training in Liverpool, which included several academic appointments. He was a demonstrator in anatomy and physiology, an excellent foundation for a surgical career.
After appointments as a house officer and then a resident surgical officer at Liverpool he went back to north Wales as a registrar. He decided to expand his surgical horizons by training and undertaking surgical research in Bristol and at the Mayo Clinic, in Rochester, Minnesota. At the Mayo Clinic he investigated pressures in the pancreatic and common ducts in relation to fasting, meals, and sphincterotomy (Archives of Surgery 1955;70:757-65).
On his return to the United Kingdom he worked for the innovative general surgeon Professor Charles Wells. As senior lecturer he had consultant status; however, in 1956 at Broadgreen Hospital he became junior consultant on a firm with Professor Wells and Mr John A Shepherd, allowing him to widen the scope of his surgical practice and to develop vascular surgery.
This was the time of the earliest explorations of replacing the abdominal aorta, first with homografts and later with prostheses. There were huge difficulties in the care of patients undergoing such major procedures, including lack of imaging and lack of intensive care after operation.
Felix Eastcott in London had operated on the carotid artery for the first time in 1954, and Parry wanted to establish this procedure in Liverpool. Like Eastcott he used hypothermia to protect the brain from ischaemia when the carotid artery was clamped. Edgar’s technical skills ensured this operation’s success.
Parry was a master of general surgery, which then encompassed the modern specialties of upper gastrointestinal, colorectal, breast, and endocrine surgery and included some head and neck surgery. He was appointed a consultant general surgeon to Bootle, Waterloo, and Broadgreen Hospitals in 1956 and rapidly became the “doctor’s surgeon.” His expertise and gentle manner were soon recognised and sought after. His skill and demeanour earnt him the supported he needed to explore vascular surgery.
His interest in venous thrombosis developed further during the early use of the oral contraceptive in high dose, which was accompanied by extensive deep vein thrombosis in some young women. These iliofemoral thromboses were a problem, their surgical removal was sometimes carried out, and for the first time it was done with the help of on-table imaging. This was made possible by the advent of the image intensifier and might be one of the earliest examples of operative angiography or venography (Br J Surg 1971;58:119-23).
Advent of the fistula
Renal dialysis was greatly improved by the advent of the fistula, and Parry was one of the first in the field of the required operation to create a fistula. The patients were bereft of veins because they had all been used for the insertion of shunts. The surgery was difficult, and using an accompanying vein for the first stage fistula allowed the development of larger veins for later use. Parry did the vascular anastomoses for the first six kidney transplants carried out in Merseyside.
In the late 1970s Parry took an interest in the thoracic outlet and its arterial, venous, and neurological problems. Surgical relief of thoracic outlet compression is difficult and can be hazardous but there is undoubted need. Parry made important original contributions to this area and wrote and spoke about it.
Parry wrote a monograph and contributed to Eastcott’s Arterial Surgery and to other vascular textbooks and had worldwide influence as a teacher. He was an enthusiastic lifelong supporter of the Welsh rugby team. In retirement he returned to north Wales and lived with Enid, his wife of 60 years and also a doctor, on the island of Anglesey. He leaves Enid and their two children.
Cite this as: BMJ 2011;343:d4622
Edgar Parry, surgeon (b 1919; q 1943, Liverpool), died on 9 February 2011.