Rainsford Mowlem (1902-1986): An unsung father of reconstructive surgery

Abstract

Very little has been documented about the contribution of Rainsford Mowlem to plastic and reconstructive surgery, a well-respected
and innovative surgeon. His era was dominated by key figureheads such as Sir Harold Gillies and Sir Archibald McIndoe, pioneers
of the specialty during the pre- and post-war period. This short article is a commemoration of his work to appreciate the
contribution to an ever evolving specialty.

Full text

ORIGINAL PAPER
Rainsford Mowlem (1902–1986): an unsung father
of reconstructive surgery
Kavit Amin
Received: 16 February 2011 / Accepted: 19 May 2011 /Published online: 8 June 2011
#Springer-Verlag 2011
Abstract Very little has been documented about the
contribution of Rainsford Mowlem to plastic and recon-
structive surgery, a well-respected and innovative surgeon.
His era was dominated by key figureheads such as Sir
Harold Gillies and Sir Archibald McIndoe, pioneers of the
specialty during the pre- and post-war period. This short
article is a commemoration of his work to appreciate the
contribution to an ever evolving specialty.
Keywords Rainsford Mowlem .Gillies .Surgery
The impact of two world wars have had on the develop-
ment of plastic surgery has been widely documented.
Though a disastrous, catastrophic consequence on human
lives, they played a vital role in the evolution and
understanding of the principles of both plastic and
maxillofacial surgery. This article is a historical apprecia-
tion of a pioneer in modern day plastic surgery in Britain,
Rainsford Mowlem, respected and admired by colleagues
and patients, he still remains less acknowledged compared
with key figureheads such as Sir Harold Gillies and Sir
Archibald McIndoe, other than by those well versed in
surgical history. Thomas Pomfret Kilner and Arthur Rainsford
Mowlem (1902–1986) together with Gillies and McIndoe
made the ‘big four’. They developed specialized units that
would become world renowned, attracting visits from
colleagues known worldwide to embrace current advances in
reconstructive surgery. Examples include developments in
wound healing, burns treatment, transplantation immunology
and development of microsurgical techniques [1]. The
specialty grew from these origins, and this is why they were
known as the famous four founding fathers [2].
Rainsford Mowlem, born in Auckland on 21 December
1902 was described as small build and strong willed,
maintaining a hardworking approach whilst at grammar
school in Auckland [3]. His father, Arthur Manwell
Mowlem, a well-respected judge was a descendant of
Durundas de Moulham, carpenter at Corfe castle, Isle of
Purbeck in Dorset. He acquired a land donated to Moulham
by William the Conqueror for the maintenance of the great
tower [4]. Rainsford Mowlem, like Gillies and McIndoe
was a New Zealand borne graduate studying with McIndoe
at the University of Otago, Dunedin. McIndoe was 1 year
his junior [3]. After graduation in 1924, he completed his
registrar year at Auckland Hospital in 1926, later travelling
to England to embark on further training as a junior doctor.
He worked in general practice in Dorking as a locum with a
view to becoming a general surgeon [5]. Six months later,
he became a house surgeon at the Seaman’s Hospital,
Greenwich and then went to Woolwich Hospital. After
studying for his Fellowship of the Royal College of
Surgeons (FRCS) at the London Hospital of Anatomy
under Samson Wright for physiology, he became a Resident
Surgical Officer (RSO) at Queen Mary’sHospitalin
Stratford, London, where he later recieved his FRCS [4].
Ready to return to Auckland with a view to practice
general surgery, he was asked if he would accept a locum at
Hammersmith Hospital to work on the same ward as
Harold Gillies. It was here he observed the work of Harold
Gillies and this deeply fascinated him, and his career
motives changed. He remained as one of five RSOs for
2 years alongside Gillies. Together, he and Gillies moved to
St James’s Hospital, Balham in 1933. It was here in Balham
that Gillies, McIndoe, Kilner and Mowlem all worked
K. Amin (*)
St. George’s Hospital,
London, UK
e-mail: kavamin@yahoo.co.uk
Eur J Plast Surg (2012) 35:97–99
DOI 10.1007/s00238-011-0603-0

together, Mowlem as an assistant [6]. Four years later, he
became one of the famous quartet lasting until the outbreak
of the Second World War (1939–1945).
The outlook for war was inevitable. Since the Spanish
Civil War, the British realized that battles in trenches would
be replaced by battles in the air and with Gillies given the
lead role of consulting surgeon to the army, he set up plastic
surgical units around London. He ensured units were
dispersed and purposefully, he avoided large caseloads in
single hospitals. For example, Queen Mary’s had reduced
patient beds because it was deemed a prime target for enemy
attack upon the route to London [7]. The quartet then split
to take command of their OWN plastic surgery units.
Mowlem took up wards FG1 and FG2 at Hill End Hospital,
St Albans. He was to become the leader of the plastic
surgery and jaw unit [8]. Hill End Hospital was one of four
plastic surgery units within the surrounding region. Other
units included Stoke Mandeville, Park Prewitt at Basing-
stoke and Queen Mary’s Roehampton. Later, the Canadian
wing at the Queen Victoria Hospital, East Grinstead was
developed when Archibald McIndoe took charge.
He had been at the helm of Hill End Hospital at the
outbreak of the war in 1939. In an editorial piece for the
British Journal of Plastic Surgery in 1949, Mowlem
expressed the need to eliminate ‘watertight compartments
of specialisation’, with the need to disseminate knowledge
in plastic surgery through the use of journals [9]. It was
through this vision that operations involving both soft
tissue and bone would lead to new advances in reconstruc-
tive methods. Mowlem and his team were the first to
introduce pin fixation methods to enable stabilization of
mandibular fractures. Intraosseous pins were drilled into
bone and used in cases where intermaxillary dental fixation
was not deemed appropriate [8]. Regarded as his greatest
contribution to reconstructive surgery, Mowlem was able to
recognise that there was a vast number of mal-unions and
non-unions from injured war soldiers. In 1944, he used
cancellous bone to fill traumatic defects and later published
an article in the Lancet evaluating the results of 75 cases of
cancellous chip bone grafts in the repair of osseous defects
of the jaw. He also harvested iliac crest bone chips for non-
union of tibial fractures with encouraging results. These
chips would range in size measuring roughly 1 ×0.5 ×
0.2 cm. At the time, this was an accomplishment for two
reasons. Firstly, the notion that multiple ossifying surfaces
re-vascularize more rapidly enabling faster tissue and bony
healing [4]. Secondly, infection rates were found to be
lower with this new method [10]. He was subsequently
awarded the Hunterian Professorship in 1940 by the Royal
College of Surgeons of England for this contribution. This
has benefited modern day orthopaedic surgery, with these
techniques still being employed on a regular basis such as
during foot and ankle joint stabilization [11].
He also have a conducted preliminary trials on penicillin.
Hill End Hospital was the only unit requested by Professor
Fleming of trial penicillin. Antibiotics were used to dress
infected wounds and stored in brown powder form,
delivered in milk bottles from Oxford. Small amounts were
dissolved in saline and injected into the patient. A
subsequent reduction in soft tissue infection and osteomy-
elitis was noted. It was Mowlem in 1944 that identified the
anatomical features of the mandible predispose itself to
osteomyelitis when compared with the upper jaw [12].
Residual penicillin powder was added to saline and given to
those with tonsillitis with encouraging results [13].
The Mount Vernon Centre for Plastic Surgery became the
successor of the former Hill End Hospital on 17 March 1953.
Hill End hospital was refurbished into a mental health unit,
the initial purpose of the building when first constructed.
Rainsford Mowlem decided to take his team to Mount Vernon
after debating whether to transfer the unit to Mount Vernon in
Northwood or Archway Hospital. He was swift to associate
the unit with a London teaching hospital in Middlesex. He
was regarded as a dedicated teacher. After negotiation of the
transfer of 30 nursing staff from Bart’s for 3 months, the
move was complete [8]. It is at Mount Vernon Hospital that
the ‘Rainsford Mowlem Burn Unit’remains today [7]. Like
Gillies and McIndoe he was regarded as a keen teacher,
never easy on his trainees continually striving for precision.
Outside the operating room, he was a strong influence in
the founding of the British Association of Plastic Surgeons
(BAPS), and in 1950, he became the fourth president of
BAPS, after Gillies, Kilner and McIndoe, and was then
again re-elected in 1959. Post-war, he became a consultant
for the National Health Service (NHS) and developed his
private practice at the London Clinic. The bureaucratic
nature of the new NHS meant early retirement was the most
appropriate option at the time [14]. He continued to be the
advisor on plastic surgery to the Minister of Health before
retiring. He retired to Spain aged 60, became fluent in
Spanish and accustomed to the Spanish way of life [13].
Regrettably he suffered illness, with lateral column degen-
eration of the cord, making routine tasks such as walking
difficult, though his friends remark that he was still able to
accurately handle his motor vehicle [15]. His friends and
colleagues always held him in high regard. He was
described thus ‘a superb surgeon with a charming,
unassuming, witty personality’as quoted by Dr. Hector
Marino, a friend from Buenos Aires, Argentina, known for
having introduced plastic surgery to South America [16].
Furthermore, Bernard Morgan, his registrar until 1948,
quoted and described him as 'purposeful and one who
could evaluate a problem and supply a definitive solution in
a brief period of time’[17]. An avid reader, medical and
non-medical journals alike, he would read the National
Geographic and journals on wider scientific issues. Quoted
98 Eur J Plast Surg (2012) 35:97–99

as having ‘a formidable memory for facts and figures and
quantities’, he was regarded as having a ‘sharp’mental
function until his demise. He died on the 5th of February
1986 at his home in Mijas, Spain at the age of 83. The late
Rainsford Mowlem was the last surviving member of the
‘big four’. Though never reaching the heights of fame as
Gillies or McIndoe, he will always be remembered for his
contribution to plastic surgery in Britain for his innovative
work combined with methodical teaching principles and
sheer humility.
Rainsford Mowlem (1902–1986)
Conflicts of interest None.
References
1. Bennett JP (1983) Aspects of the history of plastic surgery since
the 16th century. J R Soc Med 76(2):152–156
2. Saontoni-Rugiu PS (2007) A history of plastic surgery. Springer,
Heidelberg
3. Battle R (1978) Plastic surgery in the two world wars and in the
years between. J R Soc Med 71(11):844–848
4. Meikle MC (2006) The evolution of plastic and maxillofacial surgery
in the twentieth century: the Dunedin connection. Surgeon 4:325–334
5. Dawson (1987) Obituary. Br J Plast Surg 40:102–103
6. Hughes NC (1969) A short history of plastic surgery. Ulster Med J
38(1):55–61
7. Mills SM (2005) Burns down under: lessons lost, lessons learned.
J Burn Care Rehabil 26(1):42–52
8. Dawson RL (1988) The history, antecedents and progress of the
Mount Vernon Centre for Plastic Surgery and Jaw Injuries,
Northwood, Middlesex 1939–1983. Br J Plast Surg 41(1):83–91
9. Parkhouse N (1998) The 50th Anniversary of the British Journal
of Plastic Surgery. Br J Plast Surg 51:153
10. Mowlem AR (1945) Cancellous chip grafts for the restoration of
bone defects. Proc R Soc Med 38(4):171–174
11. DeOrio JK, Farber DC (2005) Morbidity associated with anterior
iliac crest bone grafting in foot and ankle surgery. Foot Ankle Int
26(2):147–151
12. Wass SH (1949) Osteomyelitis of the mandible. Ann R Coll Surg
Engl 4(1):48–57
13. JNB (1944) Report on therapeutic properties of penicillin: III. Surgery
and penicillin in mandibular infection. Br Med J 1(4345):517–519
14. Tong DB, Andrew, Brooking Tom, Love Robert (2008) Plastic Kiwis—
New Zealanders and the developmentofaspecialty.JMVH17(1):11–18
15. Dawson R (1986) Obituary. Plast Reconstr Surg 78(2):280–281
16. Hector M (1989) Obituary. Plast Reconstr Surg 83(6):1079
17. Morgan B (1987) Obituary. Plast Reconstr Surg 79(3):499
Eur J Plast Surg (2012) 35:97–99 99