History
Plastic Surgery, Burns and Maxillofacial Surgery
in the West of Scotland - an outline.
With the outbreak of War in 1939, the Government
decided to build a number of Emergency Medical Service Hospitals
outside Glasgow to treat expected casualties. One of these was
Ballochmyle Hospital, which was built in the grounds of Ballochmyle
House.
Robert Burns wrote two songs in praise of Ballochmyle "The Braes of
Ballochmyle" and the better known "Lass of Ballochmyle".
The Mansion House was used as residential accommodation for the
hospital staff. The hospital consisted of 32 main wards arranged in
groups of 8, each ward contained 40 beds.
The Plastic Surgery and Jaw Unit began in December 1940 working
under the periodic guidance of Sir Harold Gillies. Initially Mr
Andrew Hutton from the Western Infirmary, Glasgow was in charge with
the assistance of Mr. MacLennan, a Consultant Surgeon who had done a
short course with Gillies.
Gillies, who made frequent visits to EMS hospitals throughout the
country, met Jack Tough in Stacathro Hospital and thereafter Tough
went for periods of training including a spell in Rainsford Mowlem's
Unit. Jack Tough was appointed Surgeon in Charge of the Plastic
Surgery and Jaw Unit in 1943.
During this spell the unit was used to train officers in the Royal
Army Dental Corps. About the same time beds were made available in
Seafield Children's Hospital in Ayr for the treatment of congenital
and childhood problems.
The population served is almost 3 million in the West of Scotland.
Inpatient treatment for patients continued to be carried out in
Ballochmyle until the opening of The Canniesburn Unit in 1967 and
the Seafield Unit continued to be utilised until October 1991.
Walter Smith OBE, Senior Chief Maxillofacial Technician, worked in
Ballochmyle from 1940 and then in Canniesburn until his retirement
in 1979.
The technical work is continuing under Matt Orr and his colleagues,
who provide a very high standard of orthognathic and prosthetic
services to the maxillofacial and plastic surgeons.
Another member of staff was Ian McIntyre who, on demobilisation from
the Army Medical Corps, did a spell in the Plastic Surgery Unit as a
civilian before joining the Colonial service going to St Helena for
several years, and ultimately to Tasmania where he became Chief
Medical Officer of Health in Hobart.
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Burns Unit
Glasgow Royal Infirmary made separate provision for
the treatment of burns in 1833 followed by the opening of the Burns
Unit in 1873. This was not done out of a sense of altruism for the
burn patient, but to protect the other surgical patients from the
effects of these "nasty smelly infected and infective burns". The
unit was administered by a series of general surgeons until the
1940's when Leonard Colebrook the bacteriologist was put in charge,
the unit becoming a Medical Research Council project. It was during
this time that Tom Gibson carried out his work on the "second set
phenomenon". Peter Medawar, later Sir Peter was brought to the Unit
to carry out further work with Gibson, which formed the basis of
present day tissue transplantation and Medawar being awarded a Nobel
Prize.
Gibson was called up for armed service being demobilised in 1947. In
1948 he joined Tough as a Consultant in the Plastic Surgery Unit.
The Burns Unit became part of the Plastic Surgery Unit in 1948 and
was, as at present, housed in Ward 40/ 41 of the Glasgow Royal
Infirmary. At this time Ward 42/43 was the Department of Urology,
but in the early 1950's became the Plastic Surgery Unit. This was
very convenient as the Plastic Surgical, Maxillofacial and burns
patients were housed in a self contained block with dental chairs
and associated laboratory facilities. In charge of the Maxillofacial
Unit was Dr Stephen Plumpton with Ian McD Allan and Steve Dobbie as
Senior Hospital Dental Officers. Stephen Plumpton in addition to his
dental expertise was an authority of many aspects of sport, in
particular horse racing upon which he would expound at great length
given an opportunity.
In late 1954/early 55 Jack Mustarde joined the unit as a Consultant
and about the same time half a ward was given to Plastic Surgery in
the Western Infirmary from the Professorial Unit. Ian McGregor,
Senior Registrar in the Unit at the time, exchanged with B Herold
(Hal) Griffiths in Herbert Conway's Unit in New York for a period of
6 months, returning in January 1956.
'A short time thereafter beds were made available at Philipshill
Hospital for Plastic Surgery, which Tom Gibson utilised, and then a
Spinal Injuries Unit was opened in the early 60's, surgery of the
pressure sores being carried out by the Plastic Surgeons.
From 1958 to 1960 Ian McGregor moved to be in Charge of the Casualty
Department in Glasgow Royal Infirmary, during which time he
published the "Fundamental Techniques of Plastic Surgery", returning
at the end of this period as a Consultant to the Plastic Surgery
Unit.
In the early 1960's the Association of the Unit with what was to
become the Bio-Engineering Unit of Strathclyde University began and
Tom Gibson carried out his work on tissue mechanics especially skin
and cartilage. He also was appointed to the Department of Surgery in
the Western Infirmary, Glasgow as Senior Lecturer in Tissue
Transplantation and had access to beds and a theatre session in the
Professorial Unit of Sir Charles Illingworth.
Bill Reid rejoined the unit as Senior Registrar in mid 1961 and
largely was responsible for the Burns Unit until his retirement.
This responsibility has now been taken over by Ian Taggart and
Stewart Watson.
In 1961, plans were drawn up for a new Plastic Surgery Unit of 138
beds and associated facilities to be built at Canniesburn where the
Royal Infirmary already had convalescent and private beds. At this
time proposals were also made for the building of a Geriatric Unit.
Jack 'Tough and one of the Health Board Architects John Peters
between them designed the building. The completion and opening of
the Plastic Surgery Unit at Canniesburn and the achievement of a now
world recognised centre is outstanding, and due tribute should be
made to the diligence, determination and forethought which Tough put
into the project. The very fact that the building was completed and
became operational is in itself a great tribute, especially when
considered in the light of the amount of powerful opposition to the
project in the Medical/Surgical establishment. The cost of the Unit
was £996,000 (less than the estimate of over 1 million pounds).
Comparatively the Western Region Hospital Boards expenditure on
heating, lighting and power was £1.6 million in 1965 for all its
hospitals.
Although the unit admitted patients in September of 1967, it was not
officially opened until the 23rd of May 1968 by the then Chairman of
the Western Regional Hospital Board Sir Simpson Stevenson.
Unfortunately, the full bed complement has never been utilised, a
maximum of 122 beds being used, but the throughput of patients has
steadily increased during the years.
The essentially peripatetic nature of the Plastic Surgeons' practice
was reduced by the opening of Canniesburn and the closure, apart
from out patients, of the beds in Ballochmyle and the Western
Infirmary. To some extent this was countered by a few "grace and
favour beds" in the Dermatology Department of the Western Infirmary
under Professor John Milne, which gave him the only Dermatology
Department at the time in the UK to have surgery carried out. The
surgery was performed by Ian McGregor. Bill Reid began a Clinic in
Stobhill Hospital in 1961 which was taken over in 1980 by Gus
McGrouther and during 1980 Ian McGregor started an out patient
clinic in Monklands Hospital which was taken over by David Soutar on
his appointment as a Consultant Plastic Surgeon in 1981 and later by
Stewart Watson. More recently clinics and out patient operating
sessions have been started in Paisley and Greenock by Martyn
Webster. The only associated Health Boards in the West of Scotland
today in which the Plastic Surgeons do not have clinics are Forth
Valley and Highland and Islands, but Maxillofacial Surgeons have
regular commitment there.
Jack Tough retired in 1970 prematurely, due to ill health and
survived until 1977. However, he had seen his plan come to fruition.
Tom Gibson was Director in 1970 to 1980 followed by Ian McGregor
until 1986. Bill Reid became Head of Unit 1986 until his retirement,
when the responsibility passed on to David Soutar.
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Maxillofacial Department
Stephen Plumpton retired in 1969 and was replaced by
Derek Henderson who was in post until his move to St Thomas's
Hospital London in 1975. Khursheed Moos, who became a Consultant in
1974 was joined by Amir El-Attar in 1975 followed by Mr Wood thus
providing a specialist service for the West of Scotland. Derek
Henderson developed the first comprehensive planning system for
orthognathic deformity. The Department has the largest maxillofacial
trauma commitment in the UK and has researched widely in this field,
especially with our ophthalmic colleagues for orbital trauma. A
general interest in oral pathology, TM joint surgery and
preprosthetic surgery has been maintained with the development of a
cranioplasty and craniofacial implant service for Scotland.
Stephen Plumpton made a most generous bequest to the unit which has
allowed a trust fund to be set up for educational and research
purposes.
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Trainees
It is impossible to mention each and every trainee,
but some of the details on most people will be in the accompanying
section on Alumni. The trainees from Ballochmyle during and after
the War in the various branches of the unit became scattered
throughout the World.
Over the last 20 years or so the unit has had regular trainees on an
annual basis from the Royal Australasian College of Surgeons and for
a period of about 10 years on a 6 monthly rotation trainees from
Norfolk, Virginia came to the unit. Other countries have also sent
trainees, Scandinavia, most countries in Europe, South Africa, New
Zealand, South America, Canada, South East Asia. In addition there
have been Fellows attending, particularly in Head and Neck and Hand
Surgery.
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Head and Neck Surgery
In the mid 1970's a formal Head and Neck Clinic was
begun by Ian McGregor with Gerry Flatman, (Radiotherapist). The head
and neck team is now composed of David Soutar, David Dunaway, Ivan
Camilleri and Gerry Robertson (Radiotherapist). In addition to the
surgical aspects many areas of research are being investigated,
including speech, nutrition, morbidity and cure rate.
Cleft Palate
In the late 1950's and early 60's an embryonic cleft
palate clinic was begun in the Royal Infirmary with Kerr McNeill,
Consultant in Oral Orthognathics and this was expanded when
Canniesburn opened, especially after Ian Jackson came back from his
spell with Tord Skoog and Paul Tessier. When Ian left Gus McGrouther
and later on John Boorman took over this commitment until 1989 and
now Arup Ray deals with these cases, including developing a
much-improved relationship with the Royal Hospital for Sick
Children.
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Craniofacial Surgery
Ian Jackson's contribution to this field began in
the late 1960's with Derek Henderson and Rab Hide (Neurosurgeon).
Today David Soutar, David Dunaway and Khursheed Moos have taken on
their role and many procedures are now performed in close
cooperation with the neurosurgical unit based at the Southern
General.
Hand Surgery
When Ian McGregor went to the Casualty Department
the interest in Hand Surgery in all its aspects began to increase
and this has continued with acute trauma particularly and now a
diminishing amount of rheumatoid surgery being performed. Bill Reid
and Ian Jackson were particularly involved with Ian McGregor in the
early days followed by Gus McGrouther until his departure as
Professor of Plastic Surgery to University College in London. At
present Stewart Watson is dealing with this facet
of the work.
Burns Unit
Over the past 30 years the number of cases has not
significantly diminished and a considerable amount of research has
been carried out into inhalational damage, post burn scarring and
more recently skin culture, and assessment of dressing materials and
objective burn depth measurement. Stewart Watson and Ian Taggart
have enthusiastically taken over this commitment and the unit is
flourishing.
Microsurgery
The unit is very active in all aspects of
microvascular and microneural repair, free tissue transfer and
replantation with recent emphasis on repair of head and neck
defects, breast reconstruction and lower limb injuries. Recent
developments include extensive development and use of perforator
based free flaps for breast and trunk reconstruction.
Lasers
The application of laser technology to various
fields of plastic surgery has been investigated and developed over
the past 12 years in collaboration with the Bioengineering Unit.
This research is continuing and the particular areas which have been
studied are treatment of tattoos, portwine stains, vessel
anastomosis, continuing with research into the treatment of benign
pigmented lesions and photodynamic therapy for malignancy. Ian McKay
is in charge of the Laser Unit at Canniesburn and continues to
develop the service.
Courses
When Graham Lister joined the Unit as a Senior
Registrar he was instrumental in setting up the original Canniesburn
Instructional Course, the first being in 1972. These were held on a
yearly basis in the springtime and lasted a week. Eleven such
courses were held. At present four categories of
courses are organised.
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