Professor David Poswillo, CBE, 1927–2003

Abstract

David Poswillo was born in Gisborne, New Zealand, on 1st January 1927. Educated in his home town he qualified in dentistry at the University of Otago in 1948. Following a period of postgraduate study in England, he returned to New Zealand where he worked as consultant oral surgeon in the Plastic Surgery Unit and in private practice in Christchurch from 1953 to 1968. In 1957 he was appointed Co-director of the Cleft Palate Clinic in Christchurch. He showed himself to be a gifted surgeon who cared deeply for his patients, whose skill was combined with a scholarly mind. At an early stage he realised that a clearer understanding of the nature of disease, as a basis for management and prevention, was fundamental to better patient care. This was a challenge that he relished and marked the beginning of a career of unusual distinction.It was during this period that he developed what was to become a lifelong interest in patients with craniofacial deformities. His early groundbreaking research, carried out in a laboratory that he set up in his garden shed without the infrastructure of a major academic institution, fortuitously came to the notice of the international community. During an official visit to New Zealand, Sir Harold Himsworth, a legendary secretary of the Medical Research Council, found his work so thoughtful and so unusual that he urged the organisers to invite Poswillo to speak at the International Conference on Oral Biology held in London in 1964. As a consequence of this meeting he was encouraged to apply for a Nuffield Dominion Travelling Fellowship in Medicine to continue his work at the Royal College of Surgeons of England in London and the Oral Surgery Unit at the University of Zurich. His very special qualities soon became apparent and in the following year he was offered a chair in Teratology at the College, a post specially created for him with generous support from Action for the Crippled Child. From this base he developed and led a research team which rapidly established a reputation as a centre of excellence in the field. Through his dynamism he established links throughout the world and the improved understanding of the pathogenesis of deformity that emerged had a real impact on the management of patients.He maintained his clinical work as a consultant at the Queen Victoria Hospital East Grinstead. Sought after as a practical surgeon and teacher, it was his enquiring and agile mind and boundless energy and enthusiasm that drew trainees to him. He was fiercely loyal and supportive of his younger colleagues for whom he provided important introductions to overseas units as part of their professional development. Within the practical craft of surgery, he inspired lateral thinking and the fundamental need to question established practice. He encouraged his trainees to undertake research and those who had the opportunity to learn from him at an early stage in their careers were indeed fortunate. The research projects of several of his proteges led to the award of Hunterian Professorships of the Royal College of Surgeons while they were still trainees – a remarkable achievement and a reflection of his mentorship. The warm personality of this charismatic man attracted loyalty and commitment from those around him. His simultaneous achievements as a research scientist, an outstanding lecturer and a skilled clinician, evoked wide admiration.His research in Teratology attracted an influx of visiting scientists to the Royal College of Surgeons research establishment at Downe in Kent, that was in close proximity to the house of Charles Darwin. This appealed greatly to his keen appreciation of history and tradition that had also attracted him to the college with its links to John Hunter. The inspiration he derived from the lives of both Darwin and Hunter found expression in many of his lectures and addresses as well as in the design of his research. This began with cleft lip and palate and went on to other congenital abnormalities affecting facial structure.In a reversal of the usual search for causal agents, Poswillo used thalidomide as an experimental tool in the hope of elucidating the causal mechanism. Although thalidomide is generally associated with limb defects, the disastrous effects of this drug also include a significant increase in otomandibular defects. He was able to show that the far-reaching effects of thalidomide began with a minor disturbance of vascular growth in the developing embryo.What might appear to be no more than a small haematoma arising from the disruption of a minor anastomosis resulted in localised obstruction to normal development that could be the cause of a range of deformities. He was able to correlate the ultimate manifestation of thalidomide toxicity with the extent and duration of the blood clot arising from a relatively insignificant leaky blood vessel.In 1977 he returned to the southern hemisphere as Professor and Chairman of the Department of Craniofacial Surgery and Associate Dean of the Faculty of Dentistry in Adelaide. However, in 1979 he came back to England as Professor of Oral Surgery at the Royal Dental Hospital of London School of Dental Surgery. With the closure of the school in Leicester Square in 1983 he moved south of the river as Professor and Head of the Department of Oral and Maxillofacial Surgery at the United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals.He was a Fellow in Dental Surgery of the Royal Colleges of Surgeons of England and Ireland and a Fellow of the Royal Australasian College of Dental Surgeons, the Royal Institute of Biology, the Royal College of Pathologists and the Leopoldina Academy for Natural Sciences. His contributions to the scientific literature were prolific. He was visiting overseas professor from Copenhagen to Capetown, from Toronto to Baghdad, from New York to Barcelona. He was an examiner and held editorial appointments to many professional bodies around the world.In recognition of his contributions, honours were showered upon him by the international scientific community in the United Kingdom, France, the United States of America, Switzerland, Germany and South America. These included Doctorates of Medicine from the Universities of Otago and Zurich, the Colyer Gold Medal and Hunter Medal of the Royal College of Surgeons of England, and the Honorary Fellowship of the Royal Society of Medicine. He was awarded the Por Cristo Medal for surgical services to injured and malformed children in Ecuador. A frequently invited principal speaker at international meetings he delivered innumerable eponymous lectures across Europe, the Americas and Australasia. He was appointed Commander of the Order of the British Empire for services to health in 1989.He was Senior Vice President of the Royal Society of Medicine and President of the Section of Odontology, Secretary General of the International Association of Oral and Maxillofacial Surgeons, President of the Institute of Oral and Maxillofacial Technology and President of the British Association of Oral and Maxillofacial Surgeons. His BAOMS Spring Meeting in Harrogate in 1991 was the first to he held at a major, purpose built conference centre and marked the beginning of a new era in the profile of the association.He gained particular pleasure from his election to the Board of Trustees of the Hunterian Collection at the Royal College of Surgeons in 1994. He succeeded Lord Porritt, an erstwhile Governor-General of New Zealand and a Past-President of the Royal College of Surgeons, who had taken a benevolent interest in his career. It was fitting that he should become one of the guardians of the great scientific collection assembled by John Hunter, the father of scientific surgery, whose work he so much admired.With his depth and breadth of experience, and his ability not to beat about the bush, it was appropriate that governments and administrations should seek his advice. He was chairman of the Scientific Committee on Smoking and Health which published its hard-hitting report in 1999. This did much to reduce smoking in public places and curtail tobacco advertising. Chairman of the Committee on Dental and Surgical Materials, he held executive and advisory positions in many bodies with diverse remits including the management of craniofacial anomalies; injuries in the unborn child; toxicity of chemicals in food, consumer products and the environment; adverse drug reactions and environmental health. As chairman of the Department of Health Working Party on Anaesthesia, Sedation and Resuscitation in Dental Practice, the “Poswillo Report” set the scene for major reforms and represented a watershed in the improvement of safety in the provision of dental treatment in this country. “Poswillo” became a byword for quality and excellence and many units set up in the wake of the reforms proudly bear his name. This was appropriate as he had been one of the first to recognise the potential applications of benzodiazepines to provide sedation for patients undergoing invasive procedures, both within dentistry and the wider context of medicine.He was Consultant Adviser in Dental Science to the Chief Medical Officer and was Chairman of the Dental Committee and a Member of the Board of Directors of the Medical Defence Union. Internationally he was Consultant Adviser on Craniofacial Anomalies to the National Institute of Health in Washington, DC and an executive member of the World Health Organisation Human Task Force. His positive engagement where it mattered had a real and lasting influence in many areas of health care both within UK and throughout the world.In later years he was on the governing body of St Cecilia’s Cheshire Home in Bromley and chairman of the Facial Surgery Research Foundation.There are few whose lives have not been influenced directly or indirectly by this remarkable New Zealander. A practising surgeon of ability and compassion, an inspirational teacher, a talented and innovative scientist contributing to the furtherance of knowledge in so many fields, a driving professional leader, he was a great humanitarian and an effective advocate for patients in the broadest sense. This distinguished and charismatic man who gave a personal buzz to all who came into contact with him will always be remembered and sadly missed.It was only over the last few years that his extraordinary energy and intellect started to slow up due to failing health. The tragic death of his beloved wife Elizabeth last year was a major blow to him. David Poswillo died on 3rd June 2003. He was devoted to his four children Jane, Jill, Stephen and Mark and six grandchildren.View Large Image Figure ViewerDownload (PPT)David Poswillo on one of his several visits to Ecuador to assist a Charity caring for children with facial deformities. David Poswillo was born in Gisborne, New Zealand, on 1st January 1927. Educated in his home town he qualified in dentistry at the University of Otago in 1948. Following a period of postgraduate study in England, he returned to New Zealand where he worked as consultant oral surgeon in the Plastic Surgery Unit and in private practice in Christchurch from 1953 to 1968. In 1957 he was appointed Co-director of the Cleft Palate Clinic in Christchurch. He showed himself to be a gifted surgeon who cared deeply for his patients, whose skill was combined with a scholarly mind. At an early stage he realised that a clearer understanding of the nature of disease, as a basis for management and prevention, was fundamental to better patient care. This was a challenge that he relished and marked the beginning of a career of unusual distinction. It was during this period that he developed what was to become a lifelong interest in patients with craniofacial deformities. His early groundbreaking research, carried out in a laboratory that he set up in his garden shed without the infrastructure of a major academic institution, fortuitously came to the notice of the international community. During an official visit to New Zealand, Sir Harold Himsworth, a legendary secretary of the Medical Research Council, found his work so thoughtful and so unusual that he urged the organisers to invite Poswillo to speak at the International Conference on Oral Biology held in London in 1964. As a consequence of this meeting he was encouraged to apply for a Nuffield Dominion Travelling Fellowship in Medicine to continue his work at the Royal College of Surgeons of England in London and the Oral Surgery Unit at the University of Zurich. His very special qualities soon became apparent and in the following year he was offered a chair in Teratology at the College, a post specially created for him with generous support from Action for the Crippled Child. From this base he developed and led a research team which rapidly established a reputation as a centre of excellence in the field. Through his dynamism he established links throughout the world and the improved understanding of the pathogenesis of deformity that emerged had a real impact on the management of patients. He maintained his clinical work as a consultant at the Queen Victoria Hospital East Grinstead. Sought after as a practical surgeon and teacher, it was his enquiring and agile mind and boundless energy and enthusiasm that drew trainees to him. He was fiercely loyal and supportive of his younger colleagues for whom he provided important introductions to overseas units as part of their professional development. Within the practical craft of surgery, he inspired lateral thinking and the fundamental need to question established practice. He encouraged his trainees to undertake research and those who had the opportunity to learn from him at an early stage in their careers were indeed fortunate. The research projects of several of his proteges led to the award of Hunterian Professorships of the Royal College of Surgeons while they were still trainees – a remarkable achievement and a reflection of his mentorship. The warm personality of this charismatic man attracted loyalty and commitment from those around him. His simultaneous achievements as a research scientist, an outstanding lecturer and a skilled clinician, evoked wide admiration. His research in Teratology attracted an influx of visiting scientists to the Royal College of Surgeons research establishment at Downe in Kent, that was in close proximity to the house of Charles Darwin. This appealed greatly to his keen appreciation of history and tradition that had also attracted him to the college with its links to John Hunter. The inspiration he derived from the lives of both Darwin and Hunter found expression in many of his lectures and addresses as well as in the design of his research. This began with cleft lip and palate and went on to other congenital abnormalities affecting facial structure. In a reversal of the usual search for causal agents, Poswillo used thalidomide as an experimental tool in the hope of elucidating the causal mechanism. Although thalidomide is generally associated with limb defects, the disastrous effects of this drug also include a significant increase in otomandibular defects. He was able to show that the far-reaching effects of thalidomide began with a minor disturbance of vascular growth in the developing embryo. What might appear to be no more than a small haematoma arising from the disruption of a minor anastomosis resulted in localised obstruction to normal development that could be the cause of a range of deformities. He was able to correlate the ultimate manifestation of thalidomide toxicity with the extent and duration of the blood clot arising from a relatively insignificant leaky blood vessel. In 1977 he returned to the southern hemisphere as Professor and Chairman of the Department of Craniofacial Surgery and Associate Dean of the Faculty of Dentistry in Adelaide. However, in 1979 he came back to England as Professor of Oral Surgery at the Royal Dental Hospital of London School of Dental Surgery. With the closure of the school in Leicester Square in 1983 he moved south of the river as Professor and Head of the Department of Oral and Maxillofacial Surgery at the United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals. He was a Fellow in Dental Surgery of the Royal Colleges of Surgeons of England and Ireland and a Fellow of the Royal Australasian College of Dental Surgeons, the Royal Institute of Biology, the Royal College of Pathologists and the Leopoldina Academy for Natural Sciences. His contributions to the scientific literature were prolific. He was visiting overseas professor from Copenhagen to Capetown, from Toronto to Baghdad, from New York to Barcelona. He was an examiner and held editorial appointments to many professional bodies around the world. In recognition of his contributions, honours were showered upon him by the international scientific community in the United Kingdom, France, the United States of America, Switzerland, Germany and South America. These included Doctorates of Medicine from the Universities of Otago and Zurich, the Colyer Gold Medal and Hunter Medal of the Royal College of Surgeons of England, and the Honorary Fellowship of the Royal Society of Medicine. He was awarded the Por Cristo Medal for surgical services to injured and malformed children in Ecuador. A frequently invited principal speaker at international meetings he delivered innumerable eponymous lectures across Europe, the Americas and Australasia. He was appointed Commander of the Order of the British Empire for services to health in 1989. He was Senior Vice President of the Royal Society of Medicine and President of the Section of Odontology, Secretary General of the International Association of Oral and Maxillofacial Surgeons, President of the Institute of Oral and Maxillofacial Technology and President of the British Association of Oral and Maxillofacial Surgeons. His BAOMS Spring Meeting in Harrogate in 1991 was the first to he held at a major, purpose built conference centre and marked the beginning of a new era in the profile of the association. He gained particular pleasure from his election to the Board of Trustees of the Hunterian Collection at the Royal College of Surgeons in 1994. He succeeded Lord Porritt, an erstwhile Governor-General of New Zealand and a Past-President of the Royal College of Surgeons, who had taken a benevolent interest in his career. It was fitting that he should become one of the guardians of the great scientific collection assembled by John Hunter, the father of scientific surgery, whose work he so much admired. With his depth and breadth of experience, and his ability not to beat about the bush, it was appropriate that governments and administrations should seek his advice. He was chairman of the Scientific Committee on Smoking and Health which published its hard-hitting report in 1999. This did much to reduce smoking in public places and curtail tobacco advertising. Chairman of the Committee on Dental and Surgical Materials, he held executive and advisory positions in many bodies with diverse remits including the management of craniofacial anomalies; injuries in the unborn child; toxicity of chemicals in food, consumer products and the environment; adverse drug reactions and environmental health. As chairman of the Department of Health Working Party on Anaesthesia, Sedation and Resuscitation in Dental Practice, the “Poswillo Report” set the scene for major reforms and represented a watershed in the improvement of safety in the provision of dental treatment in this country. “Poswillo” became a byword for quality and excellence and many units set up in the wake of the reforms proudly bear his name. This was appropriate as he had been one of the first to recognise the potential applications of benzodiazepines to provide sedation for patients undergoing invasive procedures, both within dentistry and the wider context of medicine. He was Consultant Adviser in Dental Science to the Chief Medical Officer and was Chairman of the Dental Committee and a Member of the Board of Directors of the Medical Defence Union. Internationally he was Consultant Adviser on Craniofacial Anomalies to the National Institute of Health in Washington, DC and an executive member of the World Health Organisation Human Task Force. His positive engagement where it mattered had a real and lasting influence in many areas of health care both within UK and throughout the world. In later years he was on the governing body of St Cecilia’s Cheshire Home in Bromley and chairman of the Facial Surgery Research Foundation. There are few whose lives have not been influenced directly or indirectly by this remarkable New Zealander. A practising surgeon of ability and compassion, an inspirational teacher, a talented and innovative scientist contributing to the furtherance of knowledge in so many fields, a driving professional leader, he was a great humanitarian and an effective advocate for patients in the broadest sense. This distinguished and charismatic man who gave a personal buzz to all who came into contact with him will always be remembered and sadly missed. It was only over the last few years that his extraordinary energy and intellect started to slow up due to failing health. The tragic death of his beloved wife Elizabeth last year was a major blow to him. David Poswillo died on 3rd June 2003. He was devoted to his four children Jane, Jill, Stephen and Mark and six grandchildren.David Poswillo on one of his several visits to Ecuador to assist a Charity caring for children with facial deformities.