James Sherren

James Sherren (1872-1945) was an English General surgeon.

Sherren assisted in the transection and repair of the left radial nerve of Sir Henry Head in 1903 to determine the sensibility remaining after complete division of cutaneous nerves.

Eponymously associated with Sherren triangle (appendix triangle of hyperaesthesia). Sherren triangle described in 1903 – Lines joining the summit of the iliac crest, the pubic tubercle and umbilicus form “Sherren Triangle“. Sherren refers to this area of skin hyperaesthesia met with obstructive appendicitis as an indication that the appendix is distended and may burst at any moment hence immediate surgery is needed.

Biography

• Born in 1872 in Weymouth, Dorset
• Went to sea, at age 13 as an apprentice in a four-masted ship. He was trained in both sail and steam. Obtained his Masters Mariner’s certificate at the age of 21. Became interested in medicine when he served as an apprentice at sea and assisted the ship’s doctor as an anaesthetist
• 1894 – London Hospital Medical College
• 1900 – FRCS
• 1914-1918 Colonel with War Office in World War I
• 1919 – Commander of the Most Excellent Order of the British Empire (CBE)
• 1926 – Quit hospital practice to become Ships surgeon
• 1939-1945 General surgeon at Cornelia and East Dorset Hospital, Poole
• Died on October 29, 1945

While Britain breeds such men, her position in surgery remains assured

A.M.A. Moore

Medical Eponyms

Sherren triangle (1903)

Area of skin hyperaesthesia bounded by lines joining anterior superior iliac spine, the pubic symphysis and umbilicus. One of myriad signs associated with acute appendicitis.

1903 – Sherren examined 51 consecutive cases of appendicitis to evaluate deep versus cutaneous signs of the disease process

Cutaneous hyperalgesia is tested by gently pinching or stroking the skin, beginning if possible in an area which is not tender and working towards the suspected tender area and so marking out its boundaries.

In appendicitis cutaneous hyperalgesia varies from a complete band extending on the right side from the middle line below the umbilicus in front to the lumbar spines behind, down to a small circular spot a little above the middle point between the umbilicus and the anterior superior spine.

As an aid in determining operation the disappearance of hyperalgesia is of the utmost importance. If well-marked superficial tenderness disappears without coincident amelioration of the general condition of the patient it is a sign of perforation or gangrene of the appendix.

Sherren 1903

1905 – Sherren further defines the ‘appendix triangle’ to assist in decision for operative intervention in regards to appendix abscess. Sherren describes the area of superficial hyperalgesia as

…a triangular area on the right side of the abdomen, which I described as ‘the appendix triangle’, bounded below by Poupart’s ligament, above by a line drawn out from the umbilicus, and to the inner side by a vertical line just to the right of the mid-line. Its apex is at the anterior superior spine

Sherren 1905

Other eponyms

• Ochsner-Sherren procedure (1902) Delayed treatment for appendicitis. [Bailey H 1930]

Other Medical Contributions

Sherren and Sir Henry Head (1861 – 1940) had tried to determine the sensibility remaining after complete division of all cutaneous nerves without injury to the muscular branches. However accidents of this nature were exceedingly rare, and although ‘real patients’ were helpful it was deemed that “Introspection could be made fruitful by the personal experiences of a trained observer only“. The decision was therefore made to perform surgical transection on the left hand radial nerve of Head, with evaluation of results by William Halse Rivers (1864 – 1922)…

At the time of the experiment, H. was nearly 42 years of age and in perfect health. Since boyhood he had suffered from no illnesses, excepting as the consequence of wounds in the post-mortem room….For two years before these experiments began he had given up smoking entirely. No alcohol was ever taken on the days during which he was under examination.

On April 25, 1903…an incision 6.5 in. (16.5 cm.) long was made in the outer bicipital fossa extending along the axial line of the left upper extremity…the radial nerve was divided at the point where it arises from the musculospiral (N. radialis). A small portion was excised, and the ends united with two fine silk sutures. The external cutaneous nerve (N. cutaneus antibrachii lateralis) was also divided…and sutured with fine silk

Rivers 1908

Following the surgical section and repair of Head’s superficial radial nerve, Sherren and Rivers commenced rigorous and meticulous observation through sensory testing and evaluating psycho-social responses during the period of recovery and for the following 5 years. This contributed greatly to the understanding of the sensory examination following nerve injury

Major Publications

• Sherren J. On the occurrence and significance of cutaneous hyperalgesia in appendicitis. Lancet 1903; 162(4177): 816-821
• Sherren J. The causation and treatment of Appendicitis. Practitioner, 1905; 74: 833-844
• Sherren J. Injuries of Nerves and Their Treatment, 1908
• Hutchison R, Sherren J. An Index of treatment, Bristol, 1908
• Head, Sir Henry, Rivers WHR, Sherren J. Studies in Neurology, 1920
• Sherren J. Lectures on the Surgery of the Stomach and Duodenum, 1921
• Sherren J. An Address on appendicitis. Br Med J. 1925; 1(3355): 727–730

References

Biography

• Moore AM, Moore MA. James Sherren – surgeon and sailor. Br J Surg, 1973;60: 841–846.
• Sherren JC. Sherren’s of the World pp 1-25
• Biography: Sherren, James (1872 – 1945) Plarr’s Lives of the Fellows Online. Royal College of Surgeons of England.
• Bibliography. Sherren, James. WorldCat Identities

Eponymous terms

• Head H. On disturbances of sensation with especial reference to the pain of visceral disease. Brain. 1893; 16(1-2): 1-133
• Ochsner AJ. A Handbook of Appendicitis. Engelhard & Co., Chicago, 1902, page 110.
• Bailey H. The Ochsner-Sherren (Delayed) Treatment Of Acute Appendicitis: Indications And Technique. Br Med J 1930;1:140 [PDF]
• Eponymythology: Appendicitis eponymous signs. LITFL

Mike Cadogan

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |