Noblett, Helen


    21/01/1933 - 25/12/2020

    By E Durham Smith AO MD MS FRACS FACS

    Helen was a pioneering and innovative paediatric surgeon, with outstanding careers in both Australia and the United Kingdom. She was born in Terowie, South Australia, and the family then moved to Queensland, where Helen excelled at the Roma primary and Secondary schools, winning a scholarship to the University of Queensland Medical School, graduating BM BS in 1957. After residency and General Surgery at the Royal Brisbane Hospital, she commenced paediatric training at the Brisbane Royal Children’s Hospital, under Mr Des McGuckin until 1963. In that year she moved to the Royal Children’s Hospital in Melbourne, Victoria, where she continued training as Registrar to the General Surgical Units of Douglas Stephens (Robert Fowler, Durham Smith) and Russell Howard (Nate Myers, Max Kent). She obtained the FRACS in 1964,

    In 1967-68, she gained further experience as a research fellow at the Columbus Children’s Hospital in USA, with William Clatworthy and James O'Neill. Returning to Australia she progressed to senior consultancy at the RCH in 1972, in the Russell Howard Unit. This unit specialised in thoracic surgery, including diaphragmatic surgery, oesophageal surgery, etc.

    During her time in Melbourne from 1963-1976, Helen pursued research interests in gastrointestinal diseases in parallel with

    her clinical commitments in surgery. She worked with Ruth Bishop's pioneering group (who described the Rotavirus, in 1973), and it was at this time Helen devised a device for sampling ganglion cells in rats It was the basis of the rectal suction biopsy instrument she later designed for the diagnosis of Hirschsprung Disease, an invention in regular use world-wide to this day. She made other contributions to clinical management; In the operative management of oesophageal atresia, she fashioned a gastrostomy with a trans-pyloric feeding tube to enable immediate enteral feeding without the complication of g-o reflux. In long gap atresia she favoured a reversed gastric tube, but later was open to other methods. In 1969 she published two landmark papers — the rectal biopsy suction Instrument described above, and the non-operative management of meconium ileus by Gastrografin enema, recognising the value of specific properties in this enema,

    In 1976, Helen left Melbourne to become the first paediatric surgeon to be appointed to the Royal Hospital for Children, Bristol UK.    

    For her career in Bristol we are indebted to Richard Spicer, a retired paediatric surgeon who worked with Helen, and who wrote the following obituary after her death in 2020:

    "Helen arrived in Bristol and had to establish by her expertise and strength of character that she was taking over care of all children with paediatric surgical conditions. Helen was a very strong character and she needed to be resilient. The entrenched views of some senior surgeons and paediatricians in Bristol and the District General Hospitals (DGHs) in the South West were very deep and the task would have been more difficult for a woman in the seventies. However, within a short time she had demonstrated that her outcomes were as good any centre in the country and the first battle was won. The next battle was to get Helen a colleague, but it was not until 1982 that David Frank was appointed to share the large workload and develop Paediatric Urology in Bristol. It is difficult to understand how one person coped for 5 years with the workload generated by a population of 4 million, but she did, and to an extremely high standard.

    There is an interesting connection between Melbourne and Bristol concerning oesophageal atresia. The first attempted operation for oesophageal atresia was in 1888 at the Bristol Hospital for Sick Children. Helen performed the first successful primary' repair operation in Bristol 88 years later in 1976. The first successful repair was performed at Ann Arbor, Michigan in 1941. The first in the UK in 1947. Russell Howard performed the first in Australia in 1949.

    In Bristol, before Helen Noblett arrived, children with oesophageal atresia were treated by an adult thoracic surgeon Ronald Belsey. He never attempted primary repair and treated 24 patients by colonic interposition. Presumably, some babies from the South West of England must have bypassed Bristol and been referred to other centres in the UK. It seems extraordinary that Bristol Clinicians did not refer all cases to another centre before she was appointed but it is a measure of her that once appointed all babies were referred to her.

    Helen was a scholarly and cerebral surgeon. She published 22 papers on a variety of topics after 1976 and was always innovative and up to date. She served as examiner for the newly introduced FRCS (Paed). She had little taste for managerial or administrative duties and concentrated on her patents, who were the driving force behind her extraordinary energy and stamina. Her patients and their families appreciated how fortunate they were to be under her care and spoke of her with affection and respect.

    Helen had exceptional technical expertise and clinical judgement. She cherished the concept of a strong team and glowed in the company of her favourite colleagues and trainees. She took her responsibility as trainer very seriously and many distinguished surgeons from a variety of countries regard her the formative figure in their careers. These connections live on in Bristol with an arrangement for registrar exchange with Australia.

    There was steely side to Helen which was apparent whenever anything threatened to interfere with patient care. 'Tough but fair' was how one trainee described her. Other comments from trainees include 'a hard taskmaster', 'did not take any nonsense', had no time for sycophants or weaklings, but all emphasise how supportive she was to those who she assessed as sensible, competent, and hard-working though they could be sharply corrected when necessary. She was free of prejudice and was a shrewd judge of trainees. She was uncompromising. If a trainee did not come up to her high standards, she made sure they went into a different branch of medicine.

    Valued colleagues were not immune from her scrutiny. A now eminent professor of paediatric Pathology examining a frozen section was surprised to find her at his side. With her eye to the microscope she said "Are you sure you know what a ganglion cell looks like?" When she had reassured herself that he did she did not question his opinion again.

    Helen could be seen as eccentric, but her eccentricities had purpose. She carried a large handbag at all times. If it was mislaid that was the junior trainee's responsibility. Its contents included menthol cigarettes (with characteristic fortitude she decided to give up one day and never smoked again), arrowroot biscuits and a tool kit. The biscuits were so that she could work through mealtimes and get on with the next operation, The tool kit (which tended to cause problems at airports) ensured that if there was an equipment failure, she could attend to it herself and get on with the work promptly. 

    Away from work Helen was cultured and sociable, warm and humorous. She could discuss art, literature and muslc knowledgeably - Mozart was a particular favourite.

    Her annual Christmas party was eagerly anticipated; the food and drink were lavish, and all gathered round the piano (Helen playing) to sing carols. Her relaxation often centred round her canal narrowboat Katkin and she had many amusing anecdotes concerning boating mishaps to tell between operations in the theatre coffee room.

    Helen was proud, but reticent about her achievements, not given to self-promotion. Jesus said that "A prophet is not without honour save in his own country" and Helen exemplified this proverb. Carachi in his book “The History of Surgical Paediatrics 2009”, makes no mention of Noblett or Bristol in his 14- page chapter on Great Britain. E. Durham Smith, in his chapter on Australia, does however give her credit.

    She was much revered in other countries. In a recent publication, “Vignettes from the History of Pediatric Surgery” (Journal Of Pediatric Surgery 2020) which almost entirely concerns USA surgeons, she merits a full section devoted to her achievements, Helen is survived by Dr Maria Spyt her friend and companion for over 30 years, and by her cousin Peter who was born on the same day as her and is still living in Australia.

    Helen Noblett deserves to be remembered as a great character and a paediatric surgeon of the highest calibre. Her legacies are her innovations in field, the many departments around the world which she inspired, the large number of children (now adults) who owe their lives to her exceptional abilities and the large and thriving department of paediatric surgery in Bristol today.