The legacy of the giants (Gillies Memorial Lecture 1985)

Abstract

I consider it a great honour to have been invited to give this 15th Gillies Memorial Lecture. Whilst I never worked with Sir Harold I suppose I could be said to have been a second generation Gillies’ student as I was trained in plastic surgery by Archibald McIndoe who had received his training in the specialty from his kinsman, Harold Gillies, with whom he worked from 1931 until shortly before the outbreak of the Second World War. The same careful planning and meticulous attention to detail which “Giles” had instilled into “Archie” when converting him from a general surgeon into a plastic surgeon were practised at East Grinstead. I did, of course, know Sir Harold well both from visiting Basingstoke and from meeting him regularly at gatherings of our Association. He was a man always stimulating, enthusiastic and bubbling over with original ideas. His puckish sense of humour, liking for practical jokes and his very considerable artistic ability were obviously genetic characteristics. His great-greatuncle was Edward Lear, writer of nonsense verses and distinguished artist to boot. You are fully aware of Harold Gillies’s greatness as a surgeon, which earned him the title of the father of modern plastic surgery. What is perhaps not so well appreciated is the vital role which he played in getting plastic surgery established as a specialty in the British Isles. His initial success was in convincing the War Office in 1915 of the need for a special centre for the treatment of maxillofacial injuries which was established at the Cambridge Hospital, Aldershot, and in August 1917 moved to the Queen’s Hospital at Sidcup in Kent. However, progress in the inter-war years was slow so that when the war clouds were gathering in 1939 it was once more necessary for him to join battle with the Government and it was he who masterminded the organisation of plastic surgery centres to cater for the service and civilian air-raid casualties and to train surgeons to staff these centres and the Army maxillo-facial units and the Special Air Force units. It was only after the last war that his long uphill struggle to get the specialty recognised really came to fruition. He was a giant of our time. I propose on this occasion to look back from this giant of our time to some giants from the past, all of whom have had an important influence on the development of surgery. First, from the 18th century, is William Hunter who was born in the year 1718 at Long Calderwood near East Kilbride, about 7 miles south of Glasgow. William was a bright boy and at the age of 13f matriculated and then studied theology for 5 years in the Faculty of Arts at Glasgow University but decided not to enter the Ministry. Instead he joined William Cullen, an ambitious young doctor at nearby Hamilton, with whom he worked for almost 3 years. Then in 1740 after attending Alexander Monroe’s famous course of anatomy lectures in Edinburgh he set sail from there for London, armed with letters of introduction to two fellow Scats, Andrew Smellie from Lanark and James Douglas from West Calder. At that time anatomy was mainly taught in private schools by dissection of animals supplemented by diagrams and some specimens from humans, and medicine was largely an art shrouded in myth and religious dogma and with little or no scientific background. Training was by the apprentice system. Little was known of the functions of the body in health or of the changes which occurred in disease. William completed his studies at the newly founded St George’s Hospital and in 1746, established his own School of Anatomy and commenced his course of anatomical lectures which he conducted each winter up to the time of his death in 1783. He also became the leading physician and obstetrician in London and in 1762 attended the Queen during her pregnancy which culminated in the birth of a son, later to become George IV. However, it is as an anatomist that William Hunter is best remembered. He set new standards in the teaching of that subject and it has been written of him that “in perseverance, industry, knowledge and judgment he excelled, elegant in diction, apt in illustration, clear in description, he was perhaps the best teacher of anatomy that ever lived”. He