Arthur Rainsford Mowlem (1902-1986), plastic surgeon.

Original Article

SURGEONS

Arthur Rainsford Mowlem (1902–1986), plastic surgeon

Journal of Medical Biography 21(3) 180–192 ! The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0967772013479735 jmb.sagepub.com

Richard W Griffiths

Abstract Arthur Rainsford Mowlem, the junior of the ‘big four’ plastic surgeons, with Harold Delf Gillies, Thomas Pomfret Kilner and Archibald Hector McIndoe, came to prominence managing casualties of the Second World War. Rainsford Mowlem’s ancestor was John Mowlem, the creator of the construction firm. Rainsford worked his passage to the United Kingdom from New Zealand in 1927 and did not return to New Zealand but retired at the age of 60 to enjoy 23 more years in Spain. He was the driving force between 1934 and 1939 at the Plastic Surgery Unit at St James’s Hospital, Balham, and instigated the North London Plastic Surgery Unit at Hill End, St Albans, from 1939 to 1953 and subsequently developed the Unit after moving to Mount Vernon Hospital, Northwood, Middlesex. After successfully hosting the International Meeting of Plastic Surgeons in London in 1959, he received recognition and honours in America but soon afterwards he surprised colleagues by retiring in 1962. Despite his significant contributions, he did not receive national honours but his life outside surgery was active including Trusteeship of the Mowlem Estate at Swanage in Dorset for 40 years.

Keywords Development of plastic surgery in the United Kingdom, World War II, the New Zealand Surgical Influence

Introduction There are now some 350 consultant plastic surgeons in the United Kingdom. Three generations ago, in 1939, there were just ‘the big four’ and the youngest was Arthur Rainsford Mowlem. Biographies,1–3 obituaries and remembrances speak of his senior and Knighted New Zealand-born colleagues, Sir Harold Gillies (1882–1960) and Sir Archibald McIndoe (1900–1960), and of Professor Thomas Pomfret Kilner CBE (1890– 1964).4–6 Arthur Rainsford Mowlem died in 1986 and has remained less well-known, almost enigmatic,7 and portrayed perhaps inadequately in his obituaries.8–14

The family background Arthur Rainsford Mowlem’s great, great, great uncle was ‘London’ John Mowlem (1788–1868), founder in the 19th century of the Mowlem Construction Company and custodian of the De Moulham Estate in Swanage, Dorset. John Mowlem’s nephew, Henry Hibbs Mowlem (1817–1874), married Sarah Manwell (1816–1901) in Swanage, their youngest child, Fred, was Arthur Rainsford’s grandfather. The family emigrated to Australia in the 1850s where, in Melbourne, Fred

Mowlem (1846–1925) married Mary Emma Ward (1850–1926) in 1870 and Arthur Manwell, the second of seven children, was born there in 1872. In 1875 or thereabouts, Fred and his family moved to New Zealand.

Arthur Rainsford Mowlem, his parents and his New Zealand education Arthur Manwell Mowlem (1872–1936), solicitor and magistrate, married Shropshire-born Alice Marion Beecroft (1877–1913) on 27 March 1902 in Napier, with her clergyman father, Charles Ernest Beecroft (1845–1913), officiating. Arthur Rainsford Mowlem, their first child, was born on 21 December 1902 in Auckland and his sister, Ailleen Marjorie, was born in Palmerston North in 1908. His first name came from his father and his second name from his mother’s family, her cousin Hettie’s husband being Rainsford 26 Cavendish Avenue, Dore Sheffield, United Kingdom Corresponding author: Richard W Griffiths, 26 Cavendish Avenue, Dore Sheffield S17 3NJ, UK. Email: [email protected]

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Arthur Rainsford Mowlem plastic surgeon

William Wray (1865–1897) who died aged 32, in the year in which Alice sailed to New Zealand. Alice’s parents emigrated to New Zealand without her in 1888 to avoid scandal after adultery by her mother. Alice then spent formative years in the Reading home of her uncle Joseph, father of cousin Hettie. When Alice emigrated in 1897, it was to stay with her father, who was alone after divorce in 1889. Arthur Rainsford Mowlem studied at Auckland Grammar School, his childhood punctuated in 1913 by his mother’s death at the age of 36 years of a cerebral abscess complicating her 20 years of chronic otitis media. His father then married Ailleen Anna White (1880–1951) and he died in 1936 aged 64 years of uraemia, chronic nephritis and cerebral haemorrhage. Rainsford left the lower sixth form in 191915 to enter Otago University, Dunedin, for the four-year degree course in medicine - he was just one year behind Archibald McIndoe. Thus, aged 18 years, he lived at Knox College, Dunedin (from 1 February 1922 to 1 November 1924). The earliest photograph (Figure 1) as a medical student and Knox College resident in 1922 shows him with a good head of hair! These were difficult times for the medical school, overcrowded with

Figure 1. Rainsford Mowlem as a medical student at Knox College, Otago University 1922. Courtesy of Archives Research Centre, Presbyterian Church of Aotearoa, New Zealand.

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servicemen from World War I, and facilities judged deficient when 41 students failed their final examinations in 1923.16 Despite this potentially discouraging environment, he qualified MB ChB in 1924 and graduated the next year.17 He undertook house officer registration appointments at Auckland Public Hospital18,19 followed by general practice positions in a mining village and a city practice.9,13

The journey to Britain Determined on a surgical career, Rainsford headed for England via Cape Horn, joining SS Mamari, a 8113 ton freight steamer (Figure 2), at Wellington on 18 July 1927 to succeed Dr Edward George Sayers (1902– 1985), the medical officer, on the outward voyage from London to Auckland and to work his passage as Ship’s Surgeon.20 Sayers and Rainsford had shared the same final year in 1924 at Otago Medical School. The steamer sailed on 19 July 1927 with a crew of 75 under Captain Falconer as Master. After rounding Cape Horn, she struck a 300-foot iceberg at 1 am on Friday, 5 August, when she was north-east of Port Stanley in the Falkland Islands and south-east of Bahia Blanca in Argentina. Her bows were crushed and the forepeak flooded to 16 feet of water but the holds, tanks and bilges remained dry.21 Escorted by the steamer SS Matakana at the reduced speed of six knots, they reached Bahia Blanca in Argentina on 10 August for repairs and two weeks later, they sailed for London and arrived eventually on 23 September.20,22–26

Figure 2. SS Mamari upon which Rainsford Mowlem sailed from Wellington to England in 1927. Courtesy of National Museums Liverpool, Merseyside Maritime Museum, copyright unknown but information as to copyright would be appreciated.


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Journal of Medical Biography 21(3)

The United Kingdom, the early years (1927–1939) Rainsford’s name appeared in the General Medical Council (GMC) Register Commonwealth List some four months later, on 13 January 1928.27 He studied anatomy and physiology with Professor Thomas ‘Tim’ Yeates (1869–1962) and Samson Wright (1899–1956) (whose well-known Applied Physiology textbook was published in 1926) at the Middlesex Hospital, the Mecca for Australasian graduates preparing for the Fellowship of the Royal College of Surgeons (FRCS).9 Rainsford passed the Primary FRCS England in June 192828 and there followed periods as a GP locum in Dorking and six months as House Surgeon at the Seamen’s Hospital, Greenwich and Woolwich.13,14,29 As Resident Surgical Officer (RSO) at Queen Mary’s Hospital, Stratford, London at the end of 1929, he gained the Final FRCS England.13 Although planning a training in orthopaedics in Auckland, he was asked to take a Locum RSO post at Hammersmith Hospital and crucially this appointment in 1930 brought him under the influence of Sir Harold Gillies, himself just appointed to that hospital.30,31 At first Rainsford was sceptical about the importance of plastic surgery. In 1957 Gillies wrote colourfully Early in 1930 Rainsford Mowlem had finished his general surgical training, booked his return to New Zealand and was packing his bags. Then the sudden death of a Welsh doctor who had eaten too much Christmas pudding left the Hammersmith Hospital a surgeon short, and Mowlem was persuaded to stay on. In typical Mowlem style he took over his ward, filling the beds with general cases and limiting plastic to a meagre few.

Of this, Mowlem recalls From what I had seen of plastic surgery, I was having none of it. Reduced the plastic beds to two and assigned a house officer to cover them. Then one morning on rounds I spotted a patient who had been seen around the ward with no nose sporting a one-stage forehead flap. The house officer was assigned back to the general service, as I arranged to cover Gillies’ beds, and we soon had half the ward filled with plastic cases’.30 He was allocated a few beds in a general surgical ward ‘in which I worked and for some weeks my presence produced no reaction. One morning I saw a reconstruction of a destroyed cheek so surprising in its perfection that I determined then and there to try to cultivate the acquaintance of the man who was so obviously a master of his craft’.4

In December 1930 Archibald McIndoe arrived from America, made contact with Gillies and joined the

GMC Register Commonwealth List on 3 December 1931,27 passing the Final FRCS England in June 1932. Despite his time with Gillies, Mowlem appears to have been ‘overtaken’ by McIndoe - perhaps by age since McIndoe was two years older, McIndoe had had experience at the Mayo Clinic and McIndoe’s personality was dominant and his family links to Gillies. From 1931, Gillies acknowledges that he worked the two of them hard: In 1931 I teamed up with AH McIndoe and RM [sic] Mowlem. These two also slaved away, cutting grafts, sewing up pedicles, and taking on all the hard luck cases while I went fishing or golfing.30

From RSO, Mowlem was appointed Assistant Medical Officer in January 193232 and on 17 June 1933, at the Presbyterian Church, Regent Square, London, he married Margaret West Harvey, a nurse and the daughter of John Lamb Harvey, a Baptist minister. Of the ‘big four,’ Mowlem alone had a single marriage that lasted for almost 50 years until Margaret’s death. Gillies and Kilner remarried after the deaths of their first wives and McIndoe divorced and remarried. In 1934 the plastic surgery unit moved to St James’ Hospital, Balham33 with Mowlem as Assistant Medical Officer grade I until 1938 when he became plastic surgery specialist.34 By 1938 an unequal partnership of Gillies, McIndoe and Mowlem existed, with Mowlem receiving just 15% of the profits,3 perhaps reflecting his selectivity in aesthetic cases, whereas most of the lucrative work fell to Gillies and McIndoe. Balham was part of a larger commitment and development of the specialty between 1933 and 1939 and therefore meant the ‘big four’ worked at many hospitals. Mowlem was plastic surgeon to the City of Birmingham, Selly Oak Hospital from 1938 to 194835 and Assistant Medical Officer in charge of the plastic surgery unit at the London County Council St Charles Hospital, Ladbrooke Grove from 1933 to 1939, Assistant Plastic Surgeon at St Andrew’s Hospital Dollis Hill from 1937 to 193912,13 and in 1939–1940 he was appointed to the staff of the Middlesex Hospital in London.9 From 1936 to retirement, his professional private practice address was 149 Harley Street. Gillies, McIndoe and Kilner visited the St James’ Hospital Unit but Mowlem was its ‘presiding genius’, shouldering the lion’s share of the work.36,37 Mowlem recalled ‘We had 10 male, 10 female and 5 children’s beds, a dental laboratory, and secretarial and photographic department . . . It grew by accretion and not a little local scheming. It was fortunate for us that in the early days most medical superintendents didn’t have to


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consult 10 committees before doing anything. One could achieve much by persuasion, or the presentation of a fait accompli. I know I had an immense amount of fun’.37

Benjamin Rank (1911–2002) came from Australia to St James’ Hospital in 1937, with Mowlem being his dominant influence. He worked between the plastic surgery unit and the new accident service, under another Australian, Bill Gissane (1898–1981). The overseas visiting surgeons (‘the foreign legion’) christened Gillies ‘the Archbishop’ and Mowlem and McIndoe ‘the Bishops’!38 Mowlem and Rank worked increasingly closely and on 24 August 1939 Rank was informed that, in the event of war, he would become Assistant Plastic Surgeon to Rainsford Mowlem at Hill End Hospital, the North London Centre attached to St Bartholomew’s Hospital.

Mowlem’s personality Rainsford has trod the hard way.36 His personality and straightforward qualities were summed up well by Rank, Norman Hughes (1915–1995) and Richard Battle (1907–1982).38–40 In his memoirs published in 1987, the year after Mowlem’s death, Rank wrote Mowlem’s forte was good organisation, clear thinking and deft techniques. Always direct and outspoken, his frankness often made him unpopular with the more conservative elements of the profession - he, too, was allergic to bureaucracy. However, perhaps because we both appreciated the frontal approach, I was never put off by his lack of hesitation to call a spade a spade and accepted his lessons with gratitude, knowing that behind any superficial brusqueness lay genuine kindness. Rainsford Mowlem was a sprightly person with a sharp, decisive mind - often the mark of a man of slight build . . . Although to some, Rainsford may have seemed abrasive at times, to those fortunate enough to be close, he was kindness itself, a great teacher and a great surgeon. He had no tinge of the exhibitionism or of the entrepreneurship sometimes displayed, each in his own way, by both his confre`res Gillies and McIndoe’.38

Battle added ‘he disliked fuss of any kind and was quite happy to plough a lone furrow without public adulation. He was in every way as good a surgeon as the other three. He would have made an excellent lawyer, like his father, but not a politician or a diplomat. He always spoke his mind’.40

He was precise and well dressed, a ‘debonair master surgeon’.41

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The war years (1939–1945) At the outbreak of war, four plastic surgery units under the Emergency Medical Service (EMS) were developed around London, Gillies at Basingstoke, McIndoe at East Grinstead, Kilner at Roehampton and Mowlem at Hill End Hospital, St Albans, which was vacated of psychiatric patients. Rainsford and his oral surgery colleague Benjamin Fickling (1909–2007) used wards FG1 and FG2, each with 33 beds, one sister and 18 nurses. When busy, beds were moved together and then each ward could accommodate 80 patients. Rank wrote: ‘I became much closer to Mowlem over that period – he treated me there as a colleague rather than understudy’.38

Burn casualties represented a major workload and challenge, involving a steep learning curve: ‘even Rainsford Mowlem, consultant plastic surgeon to the Army, had only seen four serious burn injuries by 1 October 1940 at his St Albans Unit’.42

Hill End Hospital accommodated surgical units from St Bartholomew’s Hospital in central London, with all disciplines and Mowlem in particular liaising closely and this benefited surgical training.43 The unit received civilian air raid casualties north of the Thames40 and Dunkirk evacuation casualties38,42 and it trained the British Army’s Number 6 Maxillofacial Team1 to be led into France and Belgium by Wilfred Hynes (1903– 1991) in 1944–1945.44 When Rank was released to join the Australian Army in December 1940, there was a very happy farewell party at Mowlem’s house.38 John Barron (1911–1991) and Oliver Mansfield (1912–1997) succeeded Rank as Mowlem’s permanent assistants.45 Links with Birmingham Accident Hospital and with his colleague from Balham, William Gissane, were fostered35 with Mowlem, an early proponent of alternative strip homograft/autograft for treating large burns.30 Between 1942 and 1946, the artist Diana Evelyn (‘Dickie’) Orpen/Olivier (1914–2008) (daughter of Sir William Orpen (1878–1931), World War I artist), illustrated the Hill End work, often allowed barely 15 seconds to view a stage in the operation46 (Figure 3).

Archibald McIndoe’s Dupuytren’s contracture In 1943 Archibald McIndoe was troubled by Dupuytren’s palmar contracture that caused his fingers to become flexed.2,3 It is testimony to Mowlem’s reputation that McIndoe turned to him. After surgery performed at the London Clinic, Mowlem’s instructions to


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Journal of Medical Biography 21(3) Gillies as Founding President and Rainsford was elected as one of eight members of Council.48 Barron and Mansfield went to Yugoslavia in 1946 to aid post-war reconstructive surgery in Belgrade,45,49 followed by Rainsford during his first presidential term in March 1950, to lecture and demonstrate plastic surgery techniques.50 Consequently, many Yugoslavian trainees came to study with Mowlem.14 British trainees, influenced by Mowlem, established units throughout the country and thereby developed the specialty. Visitors from North America reported their experiences:

Figure 3. Pastel print by Diana ‘Dickie’ Orpen, of Rainsford Mowlem (foreground) and John Barron (background) operating at Hill End Hospital during the War. Courtesy of the Honorary Archivist, British Association of Plastic, Reconstructive and Aesthetic Surgeons, and the artist’s sons, Richard and William Olivier.

elevate the hand were disregarded when McIndoe rushed to East Grinstead one night when he heard of air raid casualties. Tension between Gillies, McIndoe and Mowlem increased throughout the war and the partnership was dissolved as from 31 December 1944 ‘by mutual consent’.47 Interestingly, on 6 July 1945 Gillies wrote to the Director-General of the EMS in relation to plans to send maxillofacial teams to the Far East where fighting continued: ‘Very great resentment is and will be felt that the Emergency Medical Service surgeons have done no service abroad’.

He recommended seven plastic surgeons who might be sent to relieve those who had been serving with the Royal Army Medical Corps adding: ‘and I see no reason to omit the names of McIndoe and Mowlem’.1

In the event, neither Mowlem nor McIndoe was sent abroad.

Post-war professional (1945–1962) After a wartime meeting at Hill End at which the formation of a plastic club or association was discussed on 20 November 1946, the Inaugural meeting of the British Association of Plastic Surgeons (BAPS) elected Harold

‘I had been abroad well over a year before I dared visit Mr Rainsford Mowlem. He has a reputation for speed in the operating theater and impatience with persistent ignorance . . . ‘‘You can’t teach a man to be a first-class plastic surgeon’’ he [Mowlem] snapped, ‘‘he either is or he isn’t and what I won’t do is tell a student anything more than once. As for speed, I’m not fast but I believe that once a surgeon has decided what he is going to do, he should get on with it’’.51

His philosophy of rehabilitation at the Vauxhall Motor Works at Luton in 1946 and the ‘elevated arm technique’ instead of tourniquet to avoid oedema in hand surgery impressed Richard B Stark (1915–2008).52

The move to Mount Vernon Hospital After World War II, hut accommodation became available at Mount Vernon Hospital, Northwood; the Hill End plastic surgery unit moved to Mount Vernon on 17 March 1953 and, by the official opening on 20 October 1955, the new centre had three operating rooms, five wards each of 20 beds and an additional 16 beds for private patients.53 There were dental and photographic departments and a library; 30% of admissions would be for maxillofacial injuries. The ethos of rehabilitation that had started at Hill End developed here.54

Family After living in Putney and St John’s Wood pre-war, Rainsford and Margaret moved near to St Albans at the outbreak of war. Daughters Ann and Jill were born in 1937 and 1939, respectively. In December 1946 he bought ‘Thornhay’, Little Kingshill near Great Missenden. Margaret gardened while Rainsford built terracing, high walls and garden furniture and learned to graft apple trees. His Alsatian dogs and Aston Martin and Bentley cars were his passions. To escape London weather, from the early 1950s, the family took summer holidays at their cottage at Swanage and subsequently in Spain.22,55


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A trip to America Between 26 April and 2 May 1947, Rainsford and Margaret travelled from Liverpool to New York on the SS Mauretania, its first voyage after refurbishment following war service, with the British delegation of the BAPS to attend the Meeting of the American Society for Plastic Surgery at Nashville and Memphis, Tennessee, from 5 to 8 May. The British group included Sir Harold Gillies, John Grocott and his wife, Geoffrey Fitzgibbon (1903–1990), Joseph P Reidy (1907–1991) and Rowland P Osborne (1904–1981). This provided welcome diversion after the rigours of the war. On 6 May, Rainsford read his paper ‘Observations in the treatment of lymphoedema’56 and subsequently the group visited surgical units in St Louis, Chicago, Detroit, New York, Toronto and Newark before sailing on RMS Queen Elizabeth from New York on 24 May to arrive at Southampton on 29 May, while enjoying excellent food before returning to rationing!.53,57

The inheritance obligation from John Ernest Mowlem In 1946 Mowlem inherited the Trusteeship of the De Moulham estate in Swanage from his distant cousin twice removed, John Ernest Mowlem (1868–1946), who wished the Mowlem name to continue attached to land in Swanage. When Rainsford died in 1986, his Will set up The Mowlem Land Trust (Charity number 1049323) to reflect best the spirit of his cousin’s wishes. He gifted the estate in trust to Swanage Town Council. After his death in February 1986, in April The Western Gazette published an appreciation: ‘[he] never ceased to maintain the keenest interest in the town. He did not hesitate to waive covenants on the Mowlem land where it would benefit a good cause’58

Rainsford Mowlem’s published work and symposia contributions Rank wrote (1949) ‘It is unfortunate that we see so little of his clear and constructive thought precipitated into print. He is not active enough with his teaching capacity. There is some consolation in that what little he does write is to the point, devoid of frill, and with that soundness which stands the test of time’.36

Perhaps Rank was unduly harsh. Arguably, his main contribution was from 1935, the re-introduction and

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development of the method of cancellous bone chip graft, emphasising the great osteogenic power of the medullary blocks and chips.30,59–61 He also described the behaviour of cartilage grafts.62 Initial results in 36 cases were reported at the Second International Congress of the Socie´te´ Europeénne de Chiurgie Structive at the Royal Society of Medicine in London 6–8 October 1937.63,64 In January 1940 he delivered his lecture as Hunterian Professor of the Royal College of Surgeons of England entitled ‘The use and behaviour of cartilage and bone transplants’. He also wrote on the fixation of facial fractures,65,66 lymphoedema,30,67 the early use of penicillin68,69 and skin homografting30,70–72 Mowlem published particularly via the Royal Society of Medicine to reach a wide audience and to influence surgery as a whole.39,43 Mowlem often said ‘We are now the last of the general surgeons’.73

Long after he retired, this philosophy of a sound grounding in surgery in general before embarking on plastic surgery was applied in advice to aspiring trainees by his colleague Richard (Dick) Dawson (1916– 1992). Rainsford was a founder member of the Hand Club of Great Britain in 1952 with a joint membership of orthopaedic and plastic surgeons.74

A special hand In December 1953 Rainsford Mowlem was called to treat that patient with whom he shared an interest in building garden walls. On 18 December 1953 Sir Winston Churchill (1874–1965) telephoned Lord Moran (1882–1977), his doctor, to say he had burned his hand. Lord Moran later recorded events: ‘In the early afternoon the P.M. telephoned that he had burnt his hand. I said I would bring Sir Thomas Dunhill. He asked if he was well versed in the modern treatment of burns . . . He had some big blisters on his left hand. I explained that Dunhill would see him before he went to Chartwell’.75

Sir Thomas Dunhill (1876–1957), GCVO, KCVO, was an Australian-born surgeon who developed thyroid surgery. Lord Moran describes Churchill’s irascibility in response to Dunhill’s bandaging technique and recalls Churchill saying ‘When I get to Chequers, what shall I do?’ Dunhill suggested that when the dressing had to be changed the PM should go to Stoke Mandeville Hospital but Churchill replied that he could not think of going to the surgeon; the surgeon must come to him. ‘I hope’ Winston added ‘he will accept my assistance’.75


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Lord Moran’s diary entry for 30 December 1953 continues

kindness all his own. His reprimands feel like compliments.36

‘At that moment Mowlem, the plastic surgeon, who had been looking after his hand while he was at Chequers, came into the room. Winston had already related how Mowlem had told him ‘‘The recuperative powers shown by your hand are those of a much younger man’’. That is the kind of patter Winston likes. It showed, on Mowlem’s part, a good working knowledge of psychology. I had not met him before, but I knew without asking that the P.M. liked him and had confidence in his skill, so that he did not suggest that Dunhill should see him again; in the field of surgery Winston can usually spot a master craftsman. His answers to Winston’s questions were clear and decisive. There were no doubts in his mind; his manner was full of easy reassurance. When we left the room Mowlem recalled the first time he saw the P.M. at Chequers; how he sat on his bed for nearly an hour while Winston talked about Omdurman. It took me about a year to reach that stage with Winston. I left Mowlem and returned to the P.M’.75

The second Presidential term in 1959 was dominated by the International Congress in London (13–17 July)76,77 (Figure 4). AB Wallace (1906–1974) described Rainsford Mowlem’s conduct of proceedings as of ‘a President of quiet dignity and example whom it was a pleasure to serve’.76 After the Congress, units throughout the country hosted their overseas colleagues. Rainsford entertained Jerome Webster (1888–1974) and his wife at ‘Thornhay’ but then entered the Middlesex Hospital for surgery and a ‘longish period off duty’ followed by further time off work in November after an accident.53 Jerome Webster invited Rainsford as guest of the American Association of Plastic Surgeons at the Milwaukee meeting for May 1960 and to accept from his Alma Mater (Trinity College, Hartford Connecticut) the degree Doctor of Science, honoris causa.53 Rainsford hesitated to accept and an approach from Lyndon Peer (1898–1977) (President of the American Association) in December 1959 pressed him:

The first meeting between Mowlem and Churchill was held at 9 o’clock on Christmas morning, with Churchill demonstrating battle positions with brandy glass as enemy, ashtray main British troops, and the matchbox Churchill’s cavalry in which he was an ensign.10 Rainsford Mowlem may have been chosen to attend Churchill since his home near Great Missenden was very close to Ellesborough, the site of Chequers. Rainsford’s decisive manner, following Dunhill’s tentative ministrations, must have been reassuring to the ageing premier.

‘You have been chosen by our Trustees and Officers as the honored guest of the American Association of Plastic Surgeons because they felt that you were the outstanding man in British Plastic Surgery. Your skilful handling of the recent International Congress Meeting in London probably enhanced this feeling and, quite frankly, we would like to have you rather than any

The Presidential terms (1950 and 1959) and the International Congress in London (1959) In 1950 Rainsford Mowlem became President of the BAPS for the first of two occasions, one of six individuals to hold the post twice: ‘Mere flow of time and practice do not make experience, but Mowlem had a well-developed critical faculty so essential to this end. With patient and lucid exposition his fearless objective criticism of his own mistakes, as of others, has made him one of the world’s best teachers of our craft – always with the commonsense approach, the eye focussed on the practical and economic. Shoddy thought to him is a sin no less than shoddy work. He was not born to suffer fools gladly, and no one is better at deflating the proud or debunking the fanciful, but with an effect and

Figure 4. Guildhall reception, London, at the International Meeting in 1959 showing Rainsford and Margaret Mowlem being received by the Lord Mayor of London, Sir Harold Gillett, and his wife, Lady Gillett. Courtesy of the Honorary Archivist, British Association of Plastic, Reconstructive and Aesthetic Surgeons.


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other English plastic surgeon as our guest of honor. I did not psychoanalyze the Trustees as to their hidden motives but believe quite possibly that they respect and like you for your charming manners’.53

Mowlem’s response continued to show much diffidence but eventually he accepted. For five weeks during May and June of 1960, Rainsford and Margaret visited the United States. They flew to Cleveland, Ohio, where Rainsford and David Matthews (1911–1997) attended The Plastic Surgery Research Council Meeting at The Cleveland Clinic,78 thereafter travelling to the American Association of Plastic Surgeons meeting in Milwaukee from 18 to 20 May under Lyndon A Peer’s Presidency.79 Despite his antipathy to state medicine, Rainsford addressed the banquet on 19 May at the Wisconsin Club80 and was reported as saying the NHS had raised hospital standards and that large parts of the service were controlled by the profession. He encouraged American doctors to co-operate with US politicians on health service affairs.81 Two weeks of sightseeing followed and after the Degree Ceremony at Hartford on Sunday 12 June, they returned from New York to Southampton on RMS Queen Mary. On 7 December 1962 Rainsford Mowlem gave the second Gillies lecture on ‘Bone grafting’ for which he was awarded the Gillies Gold Medal (Figure 5), apparently his last official duty before retirement. He had sold ‘Thornhay’ two days earlier.

Figure 5. Rainsford Mowlem receiving the Gillies medal from Mr JP Reidy, in December 1962 just after giving the Gillies Memorial Lecture, having sold ‘Thornhay’ 2 days earlier and within a few weeks of retiring to Spain. Courtesy of the Honorary Archivist, British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Recognition Post war he held the posts of plastic surgery adviser to the Ministry of Health, Senior Fellow Association of Surgeons of Great Britain and Ireland, Fellow of the Royal Society of Medicine, Fellow of the British Orthopaedic Association, Honorary Member of the National Plastic Surgery Societies of Netherlands, Italy, France, Norway and Spain, and Honorary Member of the International Society of Aesthetic Plastic Surgery and of the Institute of Accident Surgery. He received an Honorary Membership of the Association of Plastic and Reconstructive Surgeons of South Africa and a Distinguished Honorary Fellowship from the American Society of Plastic and Reconstructive Surgeons in 1966.56 Rainsford is remembered in the Mowlem Award of the British Association of Plastic Reconstructive and Aesthetic Surgeons, commemorating his 1959 Presidency of the International meeting. His name was given to the Burn Unit built at Mount Vernon Hospital in 1972 and used until the unit closed some 35 years later. His name has most recently been given to a ward at Chelsea and Westminster Hospital, London.

Recollections Colleagues remember him fondly: He always knew exactly where he was going. He drove his Bentley and Aston Martin rapidly but in a controlled way. He operated rapidly, but with absolute control of all his incisions and manipulations. He made his plans and kept to them. He was the fastest surgeon that I have known, and like many good and fast surgeons, his infection rate was very low.10

Stewart Harrison remembers him as the finest technician, regarding cosmetic work as relatively unimportant. He was greatly admired at Mount Vernon and certainly did not suffer fools gladly82 (Figure 6). Mowlem encouraged junior consultants trying new techniques. He was a speedy operator, who would have been keen to take up microsurgery. He became disenchanted by the administrative work.83


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Journal of Medical Biography 21(3) cosmetic plastic surgery should be embroiled in this matter. The GMC proceedings show Rainsford behaved entirely properly - and no one was struck off or suspended!.85 There may have been more calculation to his retirement than has been acknowledged. In the late 1950s Rainsford saw an advertisement in The Times newspaper for land for sale - a ten-acre plot with a continuous water supply,10 in the hills about a mile outside Mijas, Marbella in Southern Spain. The young South African architect Aubrey David was consulted,55 the land bought and the house ‘La Morena’ built over several years using marble from the local quarry - so entirely appropriate for a descendent of ‘London’ John Mowlem!. He put ‘Thornhay’ up for sale in 1961 and sold it on 5 December 1962 just before his 60th birthday, co-incidentally to an ex-patient! Six months later he and Margaret moved into the new house55 with views as far as North Africa53 and later christened it ‘nid d’aigle’ (eagle’s nest).8 Writing to Jerome Webster in 1965, he described room for two guests, no near neighbours, but many good Spanish friends. Visits from old colleagues were relatively easy, being only a couple of hours from London.53 Five years after moving to Spain Rainsford wrote

Figure 6. Rainsford Mowlem, a fine portrait, probably from the late 1950s. Courtesy of the Honorary Archivist, British Association of Plastic, Reconstructive and Aesthetic Surgeons, and with permission of Elsevier Ltd. This portrait photograph was published previously in the British Journal of Plastic Surgery 1987; 40: 102–103 and 1988; 41: 83–91 without attribution.

Retirement (1962–1986) His retirement in 1962 was sudden and complete.38,84 Retirement at 60 years of age was unusual then. He was financially secure and his dislike of the bureaucracy of state medicine may have influenced his decision.83 He may have reflected on his own health in 1959 and subsequently after the deaths in 1960 of Sir Harold Gillies at the age of 78 years and of Sir Archibald McIndoe at the age of 59 years.18 The premature deaths of his parents may also have influenced him. His wife Margaret’s chest problems and arthritis were increasingly troublesome,22,83 and moving to a warm climate would have appeared attractive. Another issue distracted him. Complaints had been made regarding plastic surgeons advertising. The matter was somewhat convoluted,85 although now would barely raise an eyebrow. However, because of his prominent position in the BAPS, Rainsford, now almost 59 years of age, became involved in a GMC hearing in November 1961. Ironic indeed that Rainsford who was so scrupulous in his approach to

‘I must confess I don’t look over my shoulder, even though I was very content at work in England . . . At all events, in this part of Spain, there are few who take their frustrations very seriously – after all, its warm and the sun shines!’53

In retirement he maintained close links with Dawson, Rank and colleagues from Mount Vernon Hospital, all of whom visited. Rainsford returned to England for medical advice and to administer the Swanage Estate, staying at the Oriental Club in London where he was elected a member in 195786 but always returning eagerly to Spanish tranquillity.38 His Spanish plastic surgery colleague from Barcelona, Jaime Planas (1915–2004), would visit and in 1994 recalled ‘He gardened and once I had to remove a foreign body from his finger from this activity. One day he did us the favour of inaugurating a congress of our Society but afterwards he told me never to ask him again to do anything related to plastic surgery. We never dared to ask him the reason. He was a very likeable and simple man. The whole village knew him, he spoke Spanish, and became the counsellor and friend of all the families there. After his wife died he stayed there alone until he fell ill’.87

His retirement gift from staff at Mount Vernon Hospital was a trunk filled with tools which he would


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lateral column degeneration of the spinal cord causing hand weakness and tremor that impeded writing. He learned to type and, though walking became difficult, he drove his car well.10 He died in Mijas on 6 February 1986 and he is buried with Margaret in Mijas churchyard. Surgeons can feel indispensable. Rainsford Mowlem’s life appears to reflect a more modest personality and, by retiring at age 60 years, he indicated clearly that he did not consider himself irreplaceable. He enjoyed almost 25 years of retirement in the Mediterranean sunshine. Furthermore, he retired with his reputation intact, a fine example to future generations of surgeons. Acknowledgements

Figure 7. Rainsford and Margaret in 1972 at ‘La Morena’ when visited by Rainsford’s cousin, Dudley, and his wife, Dorothy. Courtesy of Dorothy Mowlem.

use often doing handyman jobs around the house.22 His grandchildren were born after his retirement, John Philip (Johnny) becoming a racing driver and thus inheriting his grandfather’s passion for fast cars, and Sarah Katharyn, an attorney in America.55 With a small legacy from his grandfather, Johnny bought his first racing car. Rainsford’s contentment in retirement was confirmed by Morgan and Emmett. Morgan saw him in Spain a year or so before he died and wrote ‘He was happy and contented with his years in Spain and was proud of his beautiful garden which he had cultivated from a rocky hillside. Publicity and a search for honours were never part of his personality. He remained a surgeon’s surgeon’.88 Emmett added ‘He had found a life beyond surgery able to nourish and sustain his intellect, free from the stress that so often cripples us when we hold on too long’.89

He and Margaret enjoyed the first 10 years of retirement (Figure 7) travelling, particularly to France. Rainsford read diverse non-medical journals, enjoyed classical music and visits to the ballet. After 1972, trips away from Mijas become only occasional as Margaret’s health waned.53 Margaret predeceased Rainsford by several years55,58 and in his last two years he suffered

This biography came to fruition only because of generous help from numerous sources. I am deeply grateful to Rainsford’s daughters, Ann and Jill, and to his grandson, Johnny, for all their assistance, and to Dorothy Mowlem, the wife of Rainsford’s cousin Dudley, for all the family history she provided. Murray Meikle generously provided further information from the New Zealand perspective. References to dates of births, marriages, deaths and Wills are from original certificates and documents sourced from the United Kingdom General Register Office, the Probate Office, York and the Births, Deaths, Marriages Office in Wellington, New Zealand. I am also grateful to Donald Cochrane, Curator of Photographs, Archives Research Centre, Presbyterian Church of Aotearoa, Knox College, Arden Street, Dunedin, for supplying the photograph of Rainsford Mowlem as a medical student (Figure 1) and also to Deborah Gale, Arrangement and Description Archivist, Hocken Collections/Te Uare Taoka o Hakena, Anzac Avenue, Dunedin, New Zealand, for supplying details of Rainsford’s undergraduate years of study and examination and graduation dates. I am most grateful to Sarah Starkey, Curator of Maritime Archives, and Lorna Hyland, Assistant Librarian, Maritime Archives and Library, Merseyside Maritime Museum, National Museums, Liverpool, for identifying the SS Mamari (Figure 2) as the ship upon which Rainsford sailed and for identifying relevant entries in Lloyd’s lists. Anne Gleave, Curator of Photographic Archives, provided the photograph of the SS Mamari, which is reproduced with her permission. Tanya McDonald, Archival Assistant, Maritime History Archive, Memorial University of Newfoundland, St John’s, NL, provided the agreement and account of the crew for that voyage. The comments from William and Richard Olivier, Diana (Dickie) Orpen’s sons, have given a valuable insight into Rainsford Mowlem’s speed whilst operating. Brian Morgan, Honorary Archivist of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, has generously provided archive photographs (Figures 3–6) of Rainsford Mowlem and, with his permission and that of the Association, they are reproduced here. The portrait photograph (Figure 6) has been published previously in the British Journal of Plastic Surgery 1987; 40: 102–103 and


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1988; 41: 83–91 and is reproduced here with the permission of Elsevier Ltd. I am most grateful to Chris Foote and Nigel Edgeley for generously providing details of the history of ownership of ‘Thornhay’ and to David Swain of the Oriental Club for information on Rainsford’s date of election. Henry Blanco, Library Assistant, facilitated my access to the Rainsford Mowlem Jerome P Webster correspondence from 1947 to 1973, from the Archives and Special Collections, Augustus C Long, Health Sciences Library, Columbia University Medical Center, New York. These papers allow a fascinating insight into Rainsford Mowlem’s character and relationship with Jerome Webster, who was 14 years his senior. I am most grateful to have been granted access to this correspondence and for being allowed to refer freely to these letters. My good friend Gavin Miller transcribed the photographs of the illustrations to disc for which I am most grateful.

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Author biography Richard W Griffiths MS, FRCS, held the post of Consultant Plastic Surgeon at the Northern General Hospital in Sheffield, England, and now is retired and has an interest in medical history.

Notes and Jottings Sir Jonathan Hutchinson (1828–1913), physician and editor of his own medical journal, has a centenary this year. Dr Nadeem Toodayan from Brisbane has published Remembering Sir Jonathan Hutchinson 1828–1913, a centenary hagiography with many illustrations. A slim paperback (ISBN 978-0-9875759-0-6), this is biography that tells much about London medicine around the time he was practising, and is a good read. In 1905, in relation to war, ‘all the symptoms were brewing; economic rivalries, patriotic frustrations, the ambitions of leaders, dynastic squabbles, the general sense that an epoch was disintegrating and could only be cleared away by violence’. James Morris. Chapter 8, On Power. Farewell the Trumpets. Penguin Books 1979. Page 145.


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