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Sir Harold Gillies: Surgical pioneer

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Innumerable articles and eulogies have been written about Harold Delf Gillies (HDG) detailing his contributions to the field of plastic surgery. There is perhaps more to HDG than this alone. While his singular personality led him to think ‘outside the box’ in surgical terms, his innovations extended past mere technique and he was perhaps responsible for a more generally applicable philosophy -that of the multidisciplinary team. This article examines some of his achievements and looks behind the surgeon to the visionary.
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Trauma
DOI: 10.1177/1460408606072329
2006; 8; 143 Trauma
Andrew Bamji Sir Harold Gillies: surgical pioneer
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more, especially as Gillies had recently reached the
fifth round in the English Amateur Championship.
Afterwards Gillies recalled that during the interview
he thought: ‘This is ridiculous. When is he going to
Trauma 2006; 8: 143–156
© 2006 SAGE Publications 10.1177/1460408606072329
Sir Harold Gillies: surgical pioneer
Andrew Bamji
Innumerable articles and eulogies have been written about Harold Delf Gillies
(HDG) detailing his contributions to the field of plastic surgery. There is perhaps
more to HDG than this alone. While his singular personality led him to think
‘outside the box’ in surgical terms, his innovations extended past mere technique
and he was perhaps responsible for a more generally applicable philosophy – that
of the multidisciplinary team. This article examines some of his achievements and
looks behind the surgeon to the visionary.
Key words: facial injury; plastic surgery; war surgery
Harold Delf Gillies was born in Dunedin on 17 June
1882. Educated at a preparatory school near Rugby
he returned to Wanganui College, where he cap-
tained the first cricket eleven. Proceeding to
Gonville and Caius College, Cambridge in 1901
(Figure 1) he was awarded a chapel scholarship in
his first year and qualified from St Bartholomew’s
Hospital in 1906, becoming a Fellow of the Royal
College of Surgeons four years later. He overcame
the handicap of a stiff elbow sustained in a child-
hood accident and managed not only to row for
Cambridge in the 1904 Boat Race but also to play
golf for England against Scotland, and win the Royal
St George Grand Challenge Cup at Sandwich in
1913. Noted as the best house surgeon at St
Bartholomew’s Hospital in his time, he became an
ear, nose and throat surgeon. Pound, in his biography
of Gillies, records how he went to Harley Street to
apply for Sir Milsom Rees’ assistant post:
(He) went to see him at 18, Upper Wimpole Street,
hiring the morning dress that his income did not
permit him to buy. Sir Milsom disappointed him by
showing indifference both to his appearance and
qualifications. Gillies’ golfing prowess interested him
Gillies Archives, Queen Mary’s Hospital, Sidcup, Kent, UK.
Address for correspondence: Dr Andrew Bamji, Consultant
rheumatologist, Curator, Gillies Archives, Queen Mary’s Hospital,
Sidcup, Kent, DA14 6LT, UK. E-mail: andrew.bamji@qms.nhs.uk
Figure 1 Harold Gillies as an undergraduate at
Gonville & Caius College, Cambridge (courtesy: British
Association of Plastic Surgeons)
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and gained the support of Arbuthnot Lane, head of
army surgery, persuading him that a much larger,
purpose-built facility should be established which
could deal with all facial injuries. Herein lay his
vision – that by concentrating casualties in one
place, with an army of surgeons to deal with them, it
would be possible to make real technical advances
simply because of the scale of the problem. A site
was found in Sidcup, Kent, where Frognal House, an
old mansion, had been for sale with its estate for a
year. The Queen’s Hospital, as it became known,
opened in June 1917 and eventually over a thousand
beds were available on site and in surrounding con-
valescent units, and dozens of surgeons from Great
Britain, the Empire and Dominions were collected.
(Figures 2 and 3)
From the surviving notes of the time – some repa-
triated to Sidcup from New Zealand after their near
destruction in a departmental clear-out (Bamji,
1993) but with in addition about half of the British
Section’s notes which Gillies had retained after
writing his two books – it is possible to understand
the virtues of concentration of effort. Gillies himself
wrote that in an environment like Sidcup ‘it was
more difficult to hide a bad case than to get a good
one’ (Gillies and Millard, 1957). In France, where
facial injury services were dispersed, and likewise in
Germany and Austria, single surgeons such as
Morestin and Esser emerged as pioneers but never
developed the teaching base that Sidcup provided
from its 5000 subjects. American surgeons in France
such as Allbee, Ivy and Kazanjian did pioneering
work, but would send difficult cases to Sidcup, as
indeed would Valadier in due course. Gillies and his
colleagues developed an array of new techniques
including the tube pedicle, the temporalis transfer,
arterial flaps and an adaptation of Esser’s epithelial
inlay for the reconstruction of eyelids. Cartilage and
bone auto- and allografts were developed. Gillies
was particularly fond of nasal reconstruction;
Pickerill, who came with a New Zealand contingent
in 1918, was an expert at upper lip work; Kelsey Fry
developed a number of jaw techniques. Importantly,
both functional and cosmetic aspects were addressed,
an important difference in philosophy from continen-
tal work, and there was emphasis on the rehabilita-
tion of injured men with the provision of numerous
activities and teaching classes (Figure 4). In France,
certainly, this did not happen; it was left to a facially
injured infantry colonel, Yves Picot, to create a self
help group, popularly known as l’Association des
talk about the job?’ Instead, Sir Milsom brought out
his golf clubs for Gillies to inspect and demonstrated
his use of them, posing this way and that in illustration
of his stance for various shots. When he said, with a
hurried glance at his watch: ‘I’ve got a consultation
now’, Gillies’ face evidently showed dismay. ‘Oh, my
dear fellow,’ Sir Milsom said briskly, ‘I’d forgotten!
Well, how would five hundred a year suit you? Any
private patients you pick up you can keep for yourself.
All right?’ (Pound, 1964).
Had the war not intervened he would surely have
become a successful ENT surgeon, not that he was
reliable, even then; deputizing for his chief he forgot
an appointment with Nellie Melba because he was
playing in a golf championship match (which he
won). But in 1915 he volunteered for service with
the Red Cross, was posted to France and met
Auguste Valadier, a French-American dentist who
had succeeded in establishing a unit for jaw work at
the 83rd General Hospital in Wimereux, near
Boulogne. As he was not medically qualified,
Valadier could only operate if a ‘real’ doctor was
present and Gillies, seconded to this task, became
fascinated by facial surgery. His interest was further
stimulated by reading of some of the German
achievements of facial repair, notably – according to
his biography – of Lindemann, though there is anec-
dotal evidence that it may have been a book or books
by L’Ombredanne that he first read (Nélaton and
Ombrédanne, 1904, 1907) as Lindemann’s contribu-
tion is buried in a multiauthored book (Bruhn,
1915–1917). He decided that facial surgery was
what he would do as there was going to be a lot of it.
He visited Paris to observe at first hand the work of
Hippolyte Morestin in Paris. Returning to England,
his personality enabled him to persuade the Army
Surgeon-General, Alfred Keogh, that facial work
should be concentrated in one place, acquiring wards
at the Cambridge Military Hospital in Aldershot. He
tried to persuade the War Office that they should dis-
tribute special facial injury casualty tags and, when
the medical staff there seemed indifferent to the
idea, he found a stationer’s shop in the Strand and
spent £10 on labels addressed to himself at
Aldershot, which he returned to the War Office with
instructions for distribution. He was surprised when
casualties began to appear with his labels attached.
After the carnage of the first day of the Somme on
1 July 1916 it was all too apparent that the facilities
at Aldershot were inadequate. Gillies lobbied hard
144 Andrew Bamji
Trauma 2006; 8: 143–156
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patients, rendered it unnecessary. Gillies became a
friend to his patients. He would review them on
request and many patients had copies of their photo-
graphs as a memento.
‘Gueules Cassées (Roubaud and Brehamet, 1960;
Delaporte, 1996) but no such group arose in Britain
after the First World War, perhaps because Gillies’
attitude, and the support offered by Sidcup to its
Sir Harold Gillies: surgical pioneer 145
Trauma 2006; 8: 143–156
Figure 2 The plastic theatre, Queen’s Hospital, Sidcup
Figure 3 General view of the wards, Queen’s Hospital
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a photograph shows Lindsay completing a painting
using the cast as a model.1Archie Lane, a dental
technician, kept two albums as a record of the men
he had seen and worked with and devised both
splints and odd pieces of anaesthetic equipment.2
The difficulties of operating on the face if it was
concealed by an anaesthetic mask were manifest.
There was also the problem of position; Kelsey Fry,
while a front line medical officer, had realized the
danger of lying flat a man whose tongue would fall
into the airway.3Gillies had two anaesthetists
The reconstructions are for their time impressive.
Many lessons were learned; the importance of treat-
ing infection, of lining flaps, of providing support
using non-artificial materials, of restoring normal
tissue to normal position and then grafting the gaps
(Figures 5–8). But Gillies was not just a surgeon
among surgeons. Other professionals played their
part at his behest partly for the present and partly for
the future. There were dentists, physicians, radio-
logists, dental technicians, artists, sculptors and
photographers – the last three being used both to
plan the reconstructions and to record the results.
Gillies himself had tried to do some surgical drawings
but despite a correspondence course was not very
proficient, although he would annotate photographs
(Figure 9). He was thus happy to enlist others, the
most famous being Henry Tonks, himself a surgeon,
but there are watercolours and drawings in several
hands including Sidney Hornswick, Herbert Cole
and Daryl Lindsay. John Edwards, a sculptor,
oversaw the production of numerous plaster casts;
146 Andrew Bamji
Trauma 2006; 8: 143–156
Figure 4 The toymaking class at Queen’s Hospital, painted by Harold Lobley (courtesy: Imperial War Museum)
1Album donated to the Royal Australasian College of
Surgeons, Melbourne.
2Archie Lane’s albums were donated by a family member to
the British Association of Plastic Surgeons, in whose
archives they reside. The illustrations include a number
of dental models reproduced in the Official History and,
interestingly, show that several of the plaster casts were
painted.
3Principles & Art, p. 23.
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Gillies was a meticulous surgeon (Heneage Ogilvie
ranked him with Jefferson and Russell Brock as one
of the three finest surgeons he had known), was
fiercely critical of others who were not, but was
always prepared to admit his errors. He describes his
embarrassment when, on a visit by Arbuthnot Lane to
Aldershot, his prize patient had an infected wound
from which Lane squeezed a drop of pus.5The Sidcup
casenotes frequently document why a procedure
failed or how it could have been better done. He had
seen too many procedures fail because surgery had
seminal to his work; Rubens Wade, a Barts man, pio-
neered anaesthesia in the sitting position (Booth,
2000), and Ivan Magill, whose ‘invention’ of full
endotracheal anaesthesia at Sidcup was an accident
born from experiment.4One wonders how surgery in
general might have differed without this significant
advance.
In all the Sidcup experience was a success – but it
was a multidisciplinary success, and this itself was
perhaps odd in an age where surgeons reigned
supreme.
Sir Harold Gillies: surgical pioneer 147
Trauma 2006; 8: 143–156
5Principles & Art, p. 11.
Figure 5 Pte Thomas: watercolour by Daryl Lindsay on admission (courtesy: Royal Australasian College of
Surgeons)
4Principles & Art, p. 60.
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148 Andrew Bamji
Trauma 2006; 8: 143–156
Figure 6 Pte Thomas: final photographs, 1924
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American surgeons to observe (and the notes record
that many of them operated, among them Ferris
Smith) Vilray Blair was asked to report back to Lane
and Keogh that all was well. In each case the senior
men deferred to Gillies, noting that his vast experi-
ence outweighed their own and that the organization
should be left undisturbed. Gillies was however not
the easiest of colleagues; he fell out with the South
African, Aymard, and later a bitter dispute over the
origins of the tube pedicle ensued. For all that Gillies
fulsomely acknowledged the contributions of the
other surgeons it would appear that his fellow New
Zealander Pickerill also had an axe to grind; his own
book recording his work, and based on his MS thesis
for the University of Birmingham (Pickerill, 1924)
does not mention Gillies at all.
After the war the teams dispersed, the overseas
members returning home to establish their own
units. It might be imagined that Gillies and his
English colleagues would have found an eager
been hurried, frequently quoting as an example one of
his fatalities, a burned airman called Lumley, on
whom in his enthusiasm he operated before the man
was fit for surgery (Gillies, 1920). In applying the
principle to life in general, as well as surgery in par-
ticular, he would be late for lists and make escapist
forays to fish or to the local golf club (The Queen’s
Hospital Challenge Cup is still played for) where his
habit of teeing off from beer bottles on the practice
green earned him a mild reprimand. His relationship
with colleagues is intriguing. Set up as the head of the
British section at Sidcup the powers-that-be were not
entirely happy to leave such a large enterprise to a rel-
atively junior man (Gillies began as a captain, and
ended the war as a major) and it would appear that two
attempts were made to deal with this. First, when the
Australian section was set up, an experienced colonel,
Henry Simpson Newland, who had had considerable
experience at the front, was drafted in to command the
section. Later, when the hospital invited a swarm of
Sir Harold Gillies: surgical pioneer 149
Trauma 2006; 8: 143–156
Figure 7 Pte Bell: photograph on admission (Bell had
been referred by Valadier)
Figure 8 Pte Bell: final appearance. The initial
primary closures have been undone and normal
tissue returned to normal position – the first patient to
exemplify Gillies’ principle
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page proofs were with them relating to the chapter
on the nose (Figure 10). Gillies had been correcting
these during a fishing trip; having realized that the
daughter of the house in which he was staying (who
had a nose that he thought could be improved) he left
the proofs on his bedside table so she would see
them when she cleaned his room. A referral followed
a few weeks later. But there was clearly a view that
plastic surgery was not a vital specialty, perhaps
because cosmetic surgery was seen as an unneces-
sary vanity, and while Gillies did a considerable
amount of facial reconstruction (cleft palates, burns)
he also moved into the cosmetic side, embarking
upon ‘nose jobs’ and breast reductions. Again he
found it difficult on occasion to be serious, telling an
improbable tale to an old patient of his from the war,
Captain J.K. Wilson:
Sir Harold Gillies was a wonderful man, a genius and
a success in everything to which he turned his hand:
surgery, international golfer, music, inventor. It did not
matter what. He was a law unto himself. Between the
wars he was supposed to have taken up plastic beauty
culture about which he told an amusing story. A young
married woman had suffered facial disfigurement in a
car accident. Sir H was called in to see what he could
do in restoring her pristine beauty. After having had a
look at her he turned to the husband, saying: ‘Yes I
think I can help, but it will need rather a large skin
graft on her cheeks’ for which purpose he took skin
from the husband’s bottom. The op was more than suc-
cessful. Some time after the young husband bumped
into Sir H embracing him in a most affectionate
manner saying ‘that he would never be able to thank
him enough for what he had done’, adding that he
would never regret giving his wife the necessary skin
and particularly from that part of his anatomy from
which it was taken ‘as whenever my mother-in-law
spends the W/E with us and kisses my wife goodby
I always feel I’m getting my own back’.7
He received perhaps overdue recognition in 1930
with the award of a knighthood and was honoured by
a cartoon in ‘Punch’, but he and his colleague from
Sidcup, Tommy Kilner, remained the only two dedi-
cated specialists in England until the 1930s, when
Gillies was joined by Rainsford Mowlem and
Archibald McIndoe. These four were the only plastic
surgeons in the UK at the outbreak of the Second
reception in the nation’s teaching hospitals. It was
not to be although it must be owned that Gillies does
not appear to have been in a hurry to put himself
about. He wrote ‘There was a very enticing position
waiting for me in my previous E.N.T. specialty, but
in plastic surgery there was only a nebulous future’.6
He devoted some considerable time to writing with
Mendelson the chapter on facial injury in the
Official History (HMSO, 1922) and his first text-
book Plastic Surgery of the Face, illustrated by
cases from Sidcup, which is a masterpiece of clarity
not least because of the profuse illustrations. When
I recovered Sidcup’s British Section notes from
Queen Mary’s Hospital Roehampton a small file of
150 Andrew Bamji
Trauma 2006; 8: 143–156
6Principles & Art, p. 45. 7IWM PP/MCR/100; Capt JK Wilson.
Figure 9 Photograph of Lt Stacey, RND, annotated by
Gillies to show stages in the operative procedures
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work on burned airmen was to help cast into obliv-
ion Gillies’s WW1 work on burns, was appointed to
the RAF designated hospital at East Grinstead.
After the war Gillies stayed on at Basingstoke and
took on work at Roehampton. Always willing to
embrace up-to-date recording of his operations he
continued to use extensive black and white photog-
raphy (sadly now disfigured by the extensive use of
the new adhesive tape) but also experimented with
colour, making use of a new (and very expensive)
technique invented by Percy Hennell, which process
produced prints that have not faded even today. His
World War. Retained as an advisor to the armed
forces and with Kelsey Fry, the dental surgeon with
whom he had worked at Sidcup, he was instrumental
in the organization of plastic surgery services. This
time the idea of a single hospital was abandoned;
Sidcup was well within range of enemy aircraft
(indeed it was bombed twice) and it was decided to
split the service. Gillies had already found a base at
Rooksdown House, at Park Prewett Hospital near
Basingstoke and it was here that the main centre for
the army was established. Mowlem went to St
Albans, Kilner to Roehampton and McIndoe, whose
Sir Harold Gillies: surgical pioneer 151
Trauma 2006; 8: 143–156
Figure 10 Page proof from
Plastic Surgery of the Face
; Pte Palmer is the subject
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had not the speed of McIndoe and was frequently
very late for his theatre lists. In his surgery as well
as on the social scene he would push the boundaries
of tolerance. Jacques Joseph had, between the wars,
performed sex-change operations (male to female)
but no-one had attempted the technically much more
difficult operation the other way about until Gillies
was persuaded to attempt this by Laura Dillon (who
had had mastectomies and taken testosterone,
turning into Michael before appearing at Harley
Street). The story is stranger than fiction
(Hodgleinson, 1989). The surgery, which began at
Rooksdown in 1946, was protracted but eventually
successful – after a fashion, as a photograph in the
casenotes shows the new organ passing urine but
being a rather odd shape. Certainly the procedure
appears to have been done on an empirical basis.
Doing the opposite from male to female for the first
time was, however, preceded by a trial run 24 hours
beforehand:
On the night before, the bust of Virchov and the
Waterford glass in the consulting room had been
moved out of the way to clear a place for three
anatomists and three plastic surgeons to rehearse the
steps of the operation on a dissected torso.8
Furthermore there was a legal issue to be overcome;
castration without a medical indication was at the
time illegal in the UK and Gillies glosses over how,
and where, the operation was performed – although
there is evidence that Dillon, then a male medical
student in Dublin, may have done it.9But the whole
tale indicates, in more than one sense, Gillies’s will-
ingness to do the unthinkable. It seems likely that
Gordon Ostlere had something to do with this, for
writing as Richard Gordon (1967) he describes
similar surgery in a novel.
Gillies was always kindness itself to his patients,
for whom he would pen deprecating self-portraits.
Pedicles would be given names, and if they failed
would receive a funeral reading; one epitaph was to
Horace ‘to whom I was so attached’.10 A lifelong
smoker (his official portrait on the occasion of his
knighthood shows him seated in an awkward pose,
best cases were made up into glass lantern slides of
which many survive in the archives. He also
embraced the moving image; we have copies of films
made in the 1930s through to the 1960s and he was
involved in a propaganda film during the war, shot in
colour and with sound. His second book, Principles
and Art, took shape with the help of a young
American collaborator, Ralph Millard, who
described how difficult life might be working for the
irrepressible and often rude master (Millard, 1972).
By this time plastic surgery was at last firmly estab-
lished as a specialty in Britain, but Gillies continued
to innovate and often offend people with his pranks.
He would replace golf balls with ones of a different
colour; he fooled his own butler by appearing at his
front door in disguise. Denis Sugrue (1997) went to
Rooksdown for an interview with echoes of Gillies’s
own first interview:
On inquiry at the porter’s office, I was directed by an
elderly gentleman to wait in the main hall along with
the other candidates. Being last in line for interview
I was left in glorious isolation until joined by the
porter who proceeded to make conversation. His
opening gambit was to inquire how much fishing I had
done in Ireland, to which I replied in the negative. As
to other sporting activities, I admitted there were none
at that particular time. There followed a few desultory
questions about my surgical activities, which I thought
were none of his business. Returning to the question of
sport, he expressed further curiosity regarding my
sporting interests in the past. Feeling slightly irritated
and intimidated by the old man’s persistence I
announced that I had been a member of the Irish
Olympic rowing team which competed at Henley in
1948. He was most interested in this information and
casually mentioned that he had rowed for Cambridge
in the Boat Race. It emerged that he had also played
golf for England and that painting and fishing were his
main interests apart, of course, from plastic surgery.
Shortly afterwards I was called in to see the medical
superintendent who, after a few perfunctory remarks,
told me that Sir Harold Gillies had interviewed me in
the hall and that my application was satisfactory.
During the ensuing three years at Rooksdown House
Sir Harold made no reference to our unconventional
interview.
Technically he remained a brilliant and meticu-
lous surgeon, instilling this virtue in others, but he
152 Andrew Bamji
Trauma 2006; 8: 143–156
8Principles & Art, p. 387. The male-to female referred to is
almost certainly Roberta Cowell, who wrote her autobi-
ography (Roberta Cowell’s story, Heinemann, 1954).
9Pagan Kennedy, personal communication.
10P. Lilley, personal communication.
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Reid DA. Founders of hand surgery. Sir Harold Gillies:
plastic surgeon extraordinary. J Hand Surg 1989; 14:
460–62
Triana Rudy. Sir Harold Gillies. Arch Facial Plast Surg
1999;1: 142–43.
Bibliography of papers with Gillies as first author
(extracted from the McDowell Series of Plastic Surgery
Indices)
Gillies HD. Formation of the upper half of the bridge of the
nose; case report. St Barts Hosp Med J 1917; 24: 79.
Gillies HD. Temporal muscle transplantation for deformi-
ties caused by loss of the malar bone. St Barts Hosp.
J1917; 24: 80.
Gillies HD. Formation of new corners to the mouth,
together with the repair of the adjacent portions of lips
and cheek; fracture of the jaw. St Barts Hosp Med J
1917; 24: 82.
Gillies HD. Some cases of facial deformity treated in the
Department of Plastic Surgery at the Cambridge
Hospital, Aldershot. J Laryng 1917; 32: 274.
Gillies HD. Two cases illustrating plastic and dental treat-
ment. Lancet 1917; 2: 850.
Gillies HD. Demonstration on rhinoplasty. Proc Roy Soc
Med 1918; 11: 87.
Gillies HD. The problems of facial reconstruction. Tr Med
Soc Lond 1918; 42: 165–70.
Gillies HD. Some general principles of facial reconstruction
with individual examples. Atti Conf Interall Inval
Guerra 1919; 3: 551.
Gillies HD. Paraffin wax in facial surgery. Lancet 1919; 2: 174.
Gillies HD. Present day plastic operations of the face. J Nat
Dent Ass 1920; 7:3.
Gillies HD. The tubed pedicle in plastic surgery (letter).
Lancet 1920; 7: 320.
Gillies HD. The tubed pedicle in plastic surgery. New York
M J 1920; 111:1.
Gillies HD. Plastic surgery of facial burns. Surg Gynec &
Obst 1920; 30: 121.
Gillies HD. Case after operation for hairy mole of the face.
Proc Roy Soc Med (Sect Dermat) 1921; 14: 31.
Gillies HD, King LAB. Mechanical supports in plastic
surgery. Lancet 1917; 1: 412 (also Dent Rec, 1917; 37:
283).
Gillies HD, Fry K, Cole PP. Discussion on the surgical and
dental treatment of severe facial injuries. Jr Med Soc
Lond 1918; 41: 165.
Gillies HD et al. Discussion on plastic operations of eyelids.
Tr Ophth Soc UK 1918; 38: 70.
Gillies HD. ‘Eternal (plastic) triangle’, simple cure. Lancet
1923; 2: 930–31.
Gillies HD. Deformities of syphilitic nose. Br Med J 1924;
2: 977–79.
Gillies HD. Design of direct pedicle flaps. Br Med J 1932;
2: 1008.
with cigarette dangling, and photographs of clinics
at Rooksdown of his outpatient clinic show his stu-
dents smoking during a consultation), he had to give
up his outside pursuits when he developed intermit-
tent claudication and his sudden death in 1960,
admittedly at the age of 78, was the result of arterial
disease.
What would Gillies have made of surgery today?
He would undoubtedly have been impressed by, and
enthusiastically employed, microsurgical techniques
and MRI modelling which have, with other develop-
ments, enabled plastic surgery to advance in a way
that Gillies could scarcely have predicted 40 years
ago, but as an outsider I remain impressed that his
guiding principles still guide and that later surgeons
who have operated on his old patients did so with a
sense of awe (Pigott, 2000). The plethora of articles
that continue to revisit his work, his instruments and
his antics only reinforce his stature as one of the great
surgeons of the 20th century. However I doubt he
would have tolerated the finance- and management-
driven culture of today’s National Health Service –
and as for practising evidence-based medicine, he
epitomizes the absurdity of slavish devotion to this
creed, as he and his colleagues had no evidence
base until they created their own on the battlefield
casualties of the Great War.
Other articles on Gillies
Antia NH. Sir Harold Gillies. Ann Plast Surg 1979; 3:
467–68.
Brain D. Facial surgery during World War I. Facial Plastic
Surgery 1993; 9: 157–64.
Battle R. Plastic surgery in the two world wars and in the
years between. J Roy Soc Med 1978; 71: 844–48.
Grogogno BJS. Changing the hideous face of war. Br Med
J1991; 303: 1586–88.
FitzGibbon GM. The commandments of Gillies. Br J Plast
Surg 1968; 21: 226–39.
Henderson JR. Mrs Starling’s leg. J Roy Soc Med 2000; 93:
84–86.
Holdsworth WG. Sir Harold Gillies. Ann Plast Surg 1979;
3: 464–68.
Matthews DN. Gillies: mastermind of modern plastic
surgery. Br J Plast Surg 1979; 32: 68–77.
Millard DR. Gillies memorial lecture: Jousting with the
first knight of plastic surgery. Br J Plast Surg 1972; 25:
73–82.
Millard DR. Sir Harold Gillies. Ann Plast Surg 1979; 3:
454–63.
Negus V. Sir Harold Gillies. Arch Otolaryngol 1966; 83:
372–78.
Sir Harold Gillies: surgical pioneer 153
Trauma 2006; 8: 143–156
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Gillies HD, McIndoe AH. Role of plastic surgery in burns
due to roentgen rays and radium. Ann Surg 1935; 201:
979–6.
Gillies HD, McIndoe AH. Technic of mammaplasty
(for hypertrophy). Surg Gynec and Obst 1939; 65:
658–65.
Gillies HD, Mowlem R. Prognosis in plastic surgery.
Lancet 1936; 2: 1346–7.
Gillies HD, Mowlem R. Prognosis in plastic surgery.
Lancet 1936; 2: 1411–12.
Gillies HD. The columella. Br J Plast Surg 1949; 2: 192.
Gillies HD. My most interesting case. XXI. Navel on knee.
Practitioner 1956; 177: 512.
Gillies HD. Plastic surgery in naval cases. J Roy Nav M Serv
1958; 45:7.
Gillies HD. Surgical replacement of breast Proc Roy Soc
Med 1959; 52: 597.
Gillies HD, Harrison RJ. Congenital absence of penis. Br
J Plast Surg 1948; 2:8.
Gillies HD, Harrison, SH. Operative correction of recessed
malar-maxillary complex in oxycephaly. Br J Plast Surg
1950; 3: 123.
Gillies HD, Kristensen HK. Ox cartilage in plastic surgery.
Br J Plast Surg 1951; 4: 63.
Gillies HD, Marino H. Periwinkle-shell principle in treat-
ment of small ptotic breast. Plast & Reconstr Surg.
1958; 22:1.
Gillies HD, Reid DAC. Autograft of amputated digit. Br J
Plast Surg1955; 7: 338.
Gillies HD, Reid DAC. Survival of fingernail following
digital autograft. Br J Plast Surg 1955; 8: 174.
Gillies HD, Rowe NL. Osteotomy of jaw in treatment of
case of total cleft lip. G Rev Stomatol 1954; 55: 545.
Appendices: Sir Harold Gillies
Principles (as outlined in Principles & Art of Plastic
Surgery)
1) Observation is the basis of surgical diagnosis
There is no better training for a surgeon than to
be taught observation by a physician.
2) Diagnose before you treat
3) Make a plan and a pattern for this plan
Use paper, bandage or jaconet shaped to the
defect and carry out a pretence operation in
reverse. Do not rush in with a piece of skin
hoping it will fit.
Gillies HD. Experience with fascia lata grafts in operative
treatment of facial paralysis. Proc Roy Soc Med 1934;
27: 1372–1378 (also J Laryng and Otol 1934; 49:
743–756.)
Gillies HD. Plastic surgery of eyelids. Jr Ophth Soc UK
1935; 55: 357–73.
Gillies HD. Development and scope of plastic surgery
(Charles H. Mayo lecture). North-western Univ Bull,
Med School 1935; 35: 1–32.
Gillies HD. Experiences with tubed pedicle flaps. Surg
Gynec and Obst 1935; 60: 291–303.
Gillies HD. Reconstructive surgery; repair of superficial
injuries. Surg Gynec and Obst 1935; 60: 559–67.
Gillies HD. Reconstruction of external ear with special ref-
erence to use of maternal ear cartilage as supporting
structure (cases). Rev de Chir Structive 1937; 169–79.
Gillies HD. Syphilitic saddle nose. Deutsche Ztschr f Chir
1938 ; 250: 379–401.
Gillies HD. Primary treatment of facial fractures.
Practitioner 1938; 240: 414–25.
Gillies HD. Practical uses of tubed pedicle flap. Am J Surg
1939; 43: 201–15.
Gillies HD. Autograft of amputated digit; suggested opera-
tion. Lancet 1940; 1: 1002–1003.
Gillies HD. Technic in construction of auricle. Jr Am Acad
Ophth. 1941; 46: 119–121.
Gillies HD. Plastic surgery of burns. Rev Asoc Med Argent
1942; 56: 196–98.
Gillies HD. New free graft (of skin and ear cartilage) applied
to reconstruction of nostril. Br J Surg 1943; 30: 305–7.
Gillies HD. Technique of good suturing. St Barts Hosp Med
J1943; 47: 170–3.
Gillies HD. Closure of wounds of the scalp. Lancet 1944; 2:
310–11.
Gillies HD. Operative replacement of mammary promi-
nence. Br J Surg 1945; 32: 477–9.
Gillies HD, Fraser FR. Treatment of lymphedema by
plastic operation; preliminary report. Br Med J 1935; 2:
96–8.
Gillies HD, Kelsey Fry W. A new principle in surgical treat-
ment of ‘congenital cleft palate,’ and its mechanical
counterpart. Br Med J 1921; 1: 335.
Gillies HD, Kilner TP. Symblepharon of eyelids; treatment
by Thiersch and mucous membrane grafting. Jr Ophth
Soc UK 1929; 49: 470–79.
Gillies HD, Kilner TP. Treatment of nasal fractures. Lancet
1929; 1: 147–49.
Gillies HD, Kilner TP. Operations for correction of second-
ary deformities of cleft lip Lancet 1932; 2: 1369–75.
Gillies HD, Kilner TP, Stone D. Fractures of malar-
zygomatic compound, with description of new X-ray
position. Br J Surg 1927; 24: 651–56.
Gillies HD, McIndoe AH. Plastic surgery in chronic radioder-
matitis and radionecrosis. Brit J Radiol 1933; 6: 132–47.
Gillies HD, McIndoe AH. Late surgical complications of
fracture of mandible. Br Med J 1933; 2: 1060–63.
154 Andrew Bamji
Trauma 2006; 8: 143–156
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How do you make this or do that? should be, as
in all surgery, ‘Show me the case!’
13) Consult other specialists
The reaction of one man’s mind to another’s is
increased by the stimulus of sharing mutual
problems . . .
14) Speed in surgery consists of not doing the
same thing twice
It’s the old story of the hare racing back and
forth at terrific speed while the tortoise, without
retracing one step, slowly crosses the finish
line.
15) The after care is as important as the planning
or the surgery itself
Or, for that matter, the surgery itself! . . . How
futile it is to lose flap or graft for the lack of a
little postoperative care.
16) Never do today what can be honourably be
put off till tomorrow
... when in doubt, don’t! . .. It is well to remem-
ber that Time, although the plastic surgeons
most trenchant critic, is also his greatest ally.
References
Bamji AN. The Macalister archive: Records from the
Queen’s Hospital, Sidcup, 1917–1921. Journal of
Audiovisual Media in Medicine 1993; 16: 76–84.
Booth JB. Tracheostomy and intubation in military history.
J Roy Soc Med 2000; 93: 380–83.
Bruhn C. Die gegenwärtigen Behandlungswege der
Kieferschussverletzungen. Ergebnisse aus dem
Düsseldorfer Lazarett für Kieferverletzte (Kgl
Reservelazarett). (Management of gunshot injuries of
the jaw, based on the experience of the Jaw hospital in
Düsseldorf). Verlag von JF Bergmann, 1915–1917.
Delaporte S. Les Gueules Cassées. Les blessés de la face de
la Grande Guerre. Noêsis, 1996.
Gillies H.D. Plastic surgery of the face. Henry Frowde,
Hodder & Stoughton, 1920; 364.
Gillies Sir H, Millard DR. The principles and art of plastic
surgery. Butterworth; Little, Brown and Co, 1957: 31.
Gordon R. The facemaker. William Heinemann, 1967.
HMSO. Official history of the great war medical services;
surgery of the war, Volumes 1 and 2. HMSO, 1922.
Hodgkinson L. Michael née Laura Columbus Books, 1989.
Millard DR. Gillies Memorial Lecture: Jousting with the first
knight of plastic surgery. Br J Plas Surg 1972; 25: 73–82.
4) Make a record
Start with a diagram in the notes . . . while you
operate have special methods recorded by
artists or Leica . . . Follow up the case with the
camera, for that is where most of us slip up.
5) The lifeboat
. . . It is well to have a reserve plan.
6) A good style will get you through
Surgical style is the expression of personality
and training exhibited by the movements of the
fingers; its hallmark – dexterity and gentleness.
7) Replace what is normal in a normal position
and retain it there
If some of the bones of the face have got out of
place . . . it is incumbent on you to put them
back in place and hold them there . . . If the soft
tissue defect is too large for primary closure
without distortion, it is better to retain what is
left in normal position and so define the defect
to be filled.
8) Treat the primary defect first
Borrow from Peter to pay Paul only when Peter
can afford it. When Mahomet is a long way
from the mountain, try to move the mountain to
Mahomet.
9) Losses must be replaced in kind
. . . thus the eyebrow is grafted from the hairy
scalp, thin skin for an eyelid and thick for the
palm.
10) Do something positive
When a lacerated lip is a jig-saw puzzle, look
for landmarks and if you can find two bits that
definitely fit, put them together – at least you
will have made a vital first move ...
11) Never throw anything away
In plastic surgery never throw anything away
until you are sure you do not want it.
12) Never let routine methods become your
master
Routine methods must be mastered, but never let
them master you. The answer to the question,
Sir Harold Gillies: surgical pioneer 155
Trauma 2006; 8: 143–156
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Pound R. Gillies. Surgeon extraordinary. Michael Joseph,
1964; 18.
Roubaud N, Brehamet RN. Le Colonel Picot
et les Gueules Cassées. Nouvelles Ed. Latines,
1960.
Sugrue D. A memorable interview. Br Med J 1997; 314.
Nélaton C, Ombrédanne L. La rhinoplastie. Steinheil, 1904.
Nélaton C, Ombrédanne L. Les autoplasties. lèvres, joues,
oreilles, tronc, membres. Steinheil, 1907.
Pickerill HP. Facial surgery. Livingstone, 1924.
Pigott R. Harold Gillies Memorial lecture: Speak ye com-
fortably. Br J Plast Surg 2000; 53: 641–51.
156 Andrew Bamji
Trauma 2006; 8: 143–156
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... Gillies, who was Dunedin born and who undertook medical training in the UK, was an ear nose and throat surgeon at the time WWI was declared. He has been described as the "father of the speciality of plastic surgery" and was instrumental in establishing dedicated hospital clinics to provide surgical care of facial and jaw wounds inflicted during WWI (Bamji 2006). In the earlier stages of the war in France Gillies worked with Major Sir Auguste Charles Valadier, a French-American dentist. ...
Article
Background: Approximately 100 children are currently born in New Zealand (NZ) each year with an orofacial cleft (OFC). OFC are a heterogeneous group of embryologic developmental structural defects of the facial processes which can occur as either unilateral or bilateral and involve combinations of the lip, alveolus, hard or soft palate. Children born with an OFC often experience complications with feeding, hearing, appearance, dental anomalies, malocclusions, speech and at times, psychological issues. Many require numerous surgical and non-surgical treatments from infancy to adulthood. This treatment can be complex and in NZ this is provided by various health professionals working in five interdisciplinary cleft services, although the locations and structure of these cleft teams have evolved and changed over time. Objectives: This article examines the history of cleft services in NZ, the role of the multidisciplinary team (MDT) which contribute to current cleft care and provide some insight into the current pathway of treatment and the dispersed nature of its delivery. Conclusions: Present-day cleft surgical services in NZ have evolved essentially from the expertise and experiences gained by NZ surgeons based in the UK during and following both World Wars. The development of interdisciplinary cleft teams has become integral to the staging of both surgical and non-surgical treatments which can extend from birth to early adulthood. The burden of care undertaken can be extensive and parent support services have also evolved to aid the families understanding of cleft treatment. The way the cleft centres have evolved and the low population density in NZ has resulted in lower case numbers by surgeons than international best practice recommendations.
Article
Full-text available
Photographer Percy Hennell (1911–1987) is best known for his colour images of Second World War reconstructive surgery, but he also illustrated the books British Women Go to War (1943) by J. B. Priestley and An English Farmhouse and Its Neighbourhood (1948) by Geoffrey Grigson and John Piper. Seemingly disparate, these three groups of 1940s photographs are united by the devices – specifically British colour, the before-and-after trope and detailed documentation – that showcase British nationalisms and anxieties. Hennell’s more commercial projects help to provide a better understanding of the role of propaganda and nationalism in Second World War surgical imagery.
Chapter
This chapter focuses on the challenges of treating the common basal cell carcinoma of the face. These skin cancers are complex, and not all BCCs are the same in morphology or clinical behaviour. The fundamental Gillies’s principle of Diagnose Before You Treat is so important in this regard. Basal cell carcinoma can be categorised into high and low risk, and knowing which category you are treating is mandatory for effective and curative surgical management. The high-risk category includes large and deep BCCs; infiltrating and multifocal variants; micronodular, metatypical and sclerosing/morphoeic variants; recurrent BCCs especially in a field of irradiation; and BCCs exhibiting perineural spread. Certain anatomical zones of the face are at higher risk especially the inner/medial canthus, nostril base and periauricular zones. Certain genetic syndromes (Gorlin’s syndrome) and immunosuppressed patients often present with high-risk BCCs. Rarely the pathological process of de-differentiation into more aggressive cancers such as squamous cell carcinoma has been reported. Tumour behaviour awareness by the treating surgeon is an important principle, and Milton Edgerton’s salutary philosophies of cancer control versus cancer cure emphasise this modern approach. A particular surgical enigma is the reality that for incomplete BCC excision, residual tumour cells are found in only 25–55% of the re-excision samples.
Thesis
The Mary Rose sank in the Solent on 19th July 1545. Only a few dozen of the 450+ crew survived, the rest, trapped beneath anti-boarding netting and on the lower decks, went down with the ship. Despite numerous attempts to salvage and explore the wreck site over the centuries, it was not until excavations in the 1970s and 80s that revealed the starboard side of the Mary Rose, preserved beneath the silts of the Solent. Along with the ship, the contents were similarly preserved, including an undisturbed medical chest. The excavation not only revealed the material contents of the ship, but additionally the remains of at least 179 crew members, 92 of which were deemed as ‘Fairly Complete Skeletons’ and form the basis of this study. This thesis aims to examine the medical care available to a military crew in the mid-16th Century. The Mary Rose provides a unique case study with the human remains being closely associated with evidence of medical practice, through the presence of the medical chest found in the Surgeon’s Cabin. The known date of the sinking places the site firmly within the wider context of Tudor medicine. Alongside the excavated evidence from the ship, the practice of surgery is examined through the texts available in the 16th century. The texts offer an understanding as to how a surgeon on board the Mary Rose may have treated the crew under his care. This thesis provides an insight into the types of injury and trauma that affected a living and working naval crew. The pathology found within the skeletal material was not the cause of death, but rather a representation of injuries with which they lived. The results show that alongside traumatic fractures and dislocations, the crew also suffered from degenerative changes to their joints and spines. The medical chest demonstrates that the Surgeon on board the Mary Rose would have been prepared with a wide range of equipment to perform everyday tasks, such as barbery, to the more extreme surgical procedures, such as amputation. This thesis provides a deeper insight into the health of the Mary Rose crew, and the medical treatment available to them as a living, fighting force of the Tudor navy.<br/
Chapter
World War I, “The Great War,” brought to reality a suffering, violence, and destruction that were new to the human experience. Trench warfare during World War I provided surgeons with new challenges in facial trauma and laid the cornerstone for modern-day oral and maxillofacial surgery. The work of surgeons such as Gillies, Kazanjian, Ivy, Morestin, Valadier, and others provided the basis for facial reconstruction. The principles of facial reconstruction that were created during the Great War are still used today.
Chapter
A historical account of the evolution of orthognathic surgery extends nearly two centuries with contributions from surgeons and clinicians across Europe and the United States. With the ability to correct malocclusion, improve function and TMJ mechanics, reduce muscle pain, and enhance facial balance, orthognathic surgery has evolved into one of the most powerful tools in the oral and maxillofacial surgeon’s armamentarium. A chronological description of how orthognathic procedures evolved is complex, as they were often developed simultaneously by various surgeons on both sides of the Atlantic. Beginning in the 1840s West Virginia, this chapter chronicles many of the major milestones, pioneers, and breakthroughs in the evolution of orthognathic surgery. The first section reviews its early history through pioneering surgeons who first addressed mandibular and maxillary deformities and established the surgical specialty. The second section reviews the discovery, establishment, acceptance of orthognathic surgery and refinement of techniques, highlighting the rich history and future challenges.
Article
Full-text available
In the southwest Pacific, in the first decades of the twentieth century, a small country produced a disproportionately large number of itinerant young surgeons who travelled far and wide to improve their skills by gaining experience in nations of much larger populations. Serendipity and providence saw them apply their surgical skills and training in the major theatres of world wars. In a spirit of dynamic energy and passion, their peripatetic travels saw them embrace the new surgical specialty of plastic and reconstructive surgery. This paper describes the historical and significant contributions of Kiwis (New Zealanders) to the world story of plastic surgery. Over the years some have stood out more than others, but this account considers each and every significant plastic surgeon in the global picture that begins with World War I and evolves to the present day. We should not forget them.
Article
Hand surgery in New Zealand has steadily grown from its origins in plastic surgery and orthopaedic surgery into its own discipline. There has been much progress and innovation in hand surgery that has originated from New Zealand and this review acknowledges the historical figures and events that have led to our present position. The current and future directions of hand surgery in our country are also discussed. As a small and remote country, we are very fortunate to have close relationships with other international hand societies. Through these relationships and the efforts of committed regional hand surgeons, the art and science of hand surgery in New Zealand continues to progress.
Article
Harold Gillies, a plastic surgeon who created the discipline of plastic surgery and trained hundreds of young surgeons, was foremost an artist. In a short historical perspective, we illustrate this facet of the Gillies' life through a friendship with the British ecologist William Sladen and a painting that Gillies drew during their encounters.
Article
SIR Harold Gillies (1882-1960), Giles, as his friends called him, ranks high in the surgical world and, more than any one other person, was instrumental in the founding of plastic surgery as a specialty. He was in every respect a character (Fig 1). To explain what this means comparison may be drawn with the senior ophthalmologist at King's College Hospital in the early days, Professor McHardy. This man was of imposing stature and of remarkable individuality. When he visited the eye ward, a rather small room with a highly polished floor, he kept his top hat on to avoid draughts as he made his ward-round. After entering the room he walked very gingerly to the fireplace, took the shovel, raked out some ashes and scattered them over the floor, as one would over an icy path, to the sister's silent disgust. There are few characters of this caliber in medicine