Obstinate valour: the military service and death of Sir Victor Horsley.

A leading proponent of neurological surgery at the onset of World War I, Victor Horsley's uncompromising liberalism was unpopular among the medical hierarchy. Assigned to the Mediterranean Expeditionary Force (MEF) his political activism proved more valuable than his surgical talent. This report will outline his military career and death in 1916. As a member of the local Territorial Force at the outbreak of the war, Horsley requested active duty on the Western Front. He was eventually posted as Director of Surgery of the 21st General Hospital and sent to Egypt for the Dardanelles Campaign in May 1915. Several months later he was promoted to colonel and appointed surgical consultant of the Army Medical Service. Although he operated electively and lectured to medical officers on Gallipoli, the chaotic medical conditions promoted him (and others) to push for re-organization of the medical services; public outcry succeeded in effecting a change. At the end of this campaign, Horsley volunteered for duty in Mesopotamia. The appalling medical conditions prevented adequate surgery and for the next 4 months he devoted his attention to transport, equipment and ancillary care for the diseased troops. His death was sudden and controversial. A vehement opponent of alcohol and the 'rum ration', he publicly testified to his own good health in the tropics as an example of the benefit of abstinence. In mid-July, 1916, he developed severe hyperpyrexia and died within 36 h. Detractors pointed to the uselessness of abstinence while proponents described his death as the unavoidable result of epidemic paratyphoid. In summary, Horsley's political activism was partially successful in medical reorganization, but his surgical abilities could not be used appropriately in a theatre of operations where infectious disease played a major role. His early death mirrored the waste and tragedy of the Great War.