Journal of Plastic, Reconstructive & Aesthetic Surgery (2011) 64, 1e3

OBITUARY

James Stanislaus Calnan

James Stanislaus Calnan was born 12 March 1916 as theeldest of five children. His father came from Cork and havingleft school at the age of twelve eventually moved to Englandafter marrying a Dublin girl. He made his living throughdistributing fruit and vegetables fromCovent Gardenmarketto grocers in the south of England via teams of horse-drivencarts. Both parents recognised the importance of educationas is evident from the three sons graduating in medicine.James himself was a boarding pupil in the Jesuit RomanCatholic school of Stoneyhurst in Lancashire where at his

1748-6815/$-seefrontmatterª2010BritishAssociationofPlastic,Reconstrucdoi:10.1016/j.bjps.2010.09.014

confirmation he chose the name of Stanislaus, a visionary17-year-old Jesuit Saint of the 16C.

He entered the London Hospital Medical School qualifyingin 1942, in both dentistry and medicine. He saw militaryservice in India and France before becoming SquadronMedical Officer and anaesthetist specialist in the Royal AirForce having acquired qualifications in anaesthesia andtropical medicine. One senses that after demobilisation hewas uncertain as to what direction to take. In fact he used tosay that he had always wanted to be a chef or a Carpenter.However an initial inclination as physician was indicated bytaking the MRCP of Edinburgh in 1947 although it is clear thatby later taking the Edinburgh FRCS, surgery became hischoice of career. After general surgical experience he star-ted his life in plastic surgery as first assistant then seniorlecturer to the Nuffield Department of Plastic Surgery in theChurchill Hospital, Oxford under the direction of Eric Peetand Pomfret Kilner. There he was not only able to learn thecraft of Plastic and Reconstructive surgery but to develop hisresearch interests, mainly in the treatment of cleft lip andpalate andof velo-pharyngeal incompetence. By liaisingwithanadjacentpaediatric researchunit using lambs asmodels toinvestigate neonatal upper respiratory disorders he adaptedtheir static and cineradiographic x-ray devices to demon-strate the functional anatomy of hypernasality in childrenand adults and to plan any correction accordingly. In 1959 hegave a Hunterian oration: ‘Surgical treatment of nasalspeech disorders’.

Also in 1959 John Barron from the Plastic Surgery Unit inOdstock Hospital Salisbury negotiated his appointment asLecturer in Experimental Plastic Surgery at the Royal Post-graduateMedical School within theHammersmith Hospital inWest London. Those were the heady days of the School withpioneering work in cardiac catheterisation, open heartsurgery facilitated by in-house design of the heart-lungmachine; and renal transplantation. In 1960 the first cyclo-tron unit in the UK for enhanced radiotherapy was installedby theMedical Research Council. Jameswas in his element ina multifaculty and multidisciplinary clinical and researchenvironment at a timewhen the commonest model of plasticsurgery provision was from large isolated units somewhatremote frommainstream complimentary clinical services. As

tiveandAestheticSurgeons.PublishedbyElsevierLtd.All rightsreserved.

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overall head of surgery, Professor Sir Ian Aird was sufficientlyimpressed by the talents of James to appoint him as Directorof the new Experimental Surgery Unit which unified all thesurgically related research departments with the researchfellows, assistants, technicians, laboratories, secretaries,animal house etc. under one roof. The unit was regarded asamong the best of its kind in the world until many years laterwhen it ranout ofmoneyand steam.Apart from initiating andfinding funds for research James attracted and fosteredgifted surgeons who did not always conform to the estab-lishment pattern. One was Freddie Nicolle who, having leftCanada, sought to establish himself in this country. WithJames he developed implantable prostheses to relieve thepain and improve theexcursion of the small joints of the handin rheumatoid arthritis. Together they studied the cytologyand biochemistry of tendon healing and tested two-stageflexor tendon repair with the help of silastic rods. He even-tually became an independent and highly regarded AestheticPlastic Surgeon with a national and international reputationfor setting standards in practice and teaching, and for peer-recognition of this particular surgical art.

Joseph Pflug had escaped from East Germany in the darkdays of Europe, penniless and at great risk to himself and hisfamily. As a surgical assistant near Stuttgart he read aboutJames’ interest and research in the peripheral lymphaticsystem and was eventually taken under his wing, commutingfor two days a week between Stuttgart and London. Hebecame an authority in the pathophysiology of the lymphaticnetwork in primary and secondary lymphoedema. ProfessorChisolm turned to him to identify the role of the renallymphatics in relation to kidney transplantation. He pio-neered the role of endolymphatic radioisotape perfusion formalignant melanoma and with James and Professor Melrose(an inventor of the heart-lung machine) developed thepump-linked leggings providing intermittent externalcompression in the prophylaxis of deep vein thrombosis,a device that remains in worldwide use today.

James was active in a huge variety of biological andbiomechanical research themes applied to surgical practicefor which he was deservedly recognised. In 1962 he wasawarded the Mowlem Prize by the British Association ofPlastic Surgeons for the greatest contribution to plasticsurgery in the previous four years. In 1970 he was appointedProfessor of Plastic and Reconstructive Surgery at the RoyalPostgraduate Medical School. In 1972 he was elected asa Fellow of the Royal College of Physicians of Edinburgh. In1976 at the World Congress of Bioengineering he receivedthe Clemson award for outstanding contributions to theliterature in biomaterials and bioengineering. He publishedover 200 papers and edited or wrote seven books.

His surgical practice was also diverse. He continued in thetreatment of infants with cleft lip and palate and developedan interest in the surgery of hypospadias. He carried outreconstruction of defects following intraoral tumour resec-tion and after radiotherapy damage. He and his teammanaged themaxillofacial traumaand congenital, traumaticand acquired hand problems. In collaboration with thepsychiatric unit he engaged in gender reassignment surgery.But his greatest contribution to the practice of surgery camethrough his establishment of the first adult day surgery unitthe UK. In 1967 he commandeered and converted an armysurplus Quonset hut, installing it in the corner of a car park in

the hospital. It was open to all interested clinicians and byfollowing strict guidelines for patient selection and practice,10,000 patients were treated from a variety of specialities inthe hospital without a significant incident in the first tenyears. There is now not a District Hospital in the UK withouta day surgery facility.

In the early 1970s JohnBarron and JamesCalnan agreed toa senior registrar training link between the Wessex RegionalPlastic Surgery Unit and the Hammersmith Hospital. My timeas a trainee under Professor Calnan’s supervision was themost stimulating and rewarding of my career. There was nohierarchy. One was treated as an equal although intellectu-ally I could never be his equal. Apart from the clinicalexperience I was exposed to the discipline of the researchprocess, lecturing, teaching and writing. The grand surgicalrounds on every Friday afternoonwas the climax of theweek,attended by all the relevant professors and consultants andtheir teams where junior staff would deliver research inprocess, a complex casepresentation or a topic review. Itwasa gladiatorial arena and a tough learning process. Anyweakness in delivery, argument or logic was ruthlesslyexposedbyoneof theother surgical teams. Jameswouldonlyintervene on my behalf when I was being embarrassinglyexposed. The bonhomie was restored in the ‘Water-hole’ inthe doctors’ quarters afterwards when James would gentlyexplain how I could do better. On the fourth Friday of themonth a special lecturer was invited which included some ofthe giants of applied science such as Peter Medawar, a Nobelprize-winner for work that helped to launch modern immu-nology and organ transplantation, and Karl Popper,renowned for his publications on the philosophy of science.They were both good friends of James and wrote and spokebeautifully, as did James. He had the ability to disseminateinformation in an easily intelligible and absorbing fashion,and his books entitled Writing Medical Papers and SpeakingatMedicalMeetingspublished in 1972with illustrations byhisartist daughter Cherry remain as gems. His Kay-Kilner prize-winning essay in 1968 on Whither Plastic Surgery? e trendsfor the future is a masterpiece of prose and constructivecriticism. His conference presentations were worth theregistration fee alone. They had always been rehearsed forhours and were delivered fluently and without notes andtimed to the second. Hewould ask penetrating questions andoccasionally prick the pomposity of some of his self-regarding peers, while also coming the aid of nervous traineesurgeons giving their first paper and finding themselves over-aggressively questioned from the floor. Possibly, for thesereasons, he acquired a reputation in some circles for beingprickly and difficult. This was never his nature. The most aptdescription of Professor James Calnan is of a benign,maverick polemicist. Maverick can be interpreted as a pejo-rative termbut the definition in theOxford English Dictionaryfits James perfectly as ‘an unorthodox or independent-minded person: an individualist’.

In fact James was extraordinarily kind and self-effacing.His ward rounds could take an age, not just because hespent so much time at the bedside but because, in the walkfrom ward to ward down the central long corridor of theHammersmith Hospital, he would enquire after the welfareof everyone from visiting professors to the clerks, orderlies,porters, cleaners, receptionists, secretaries and all thosewithout whom the hospital would grind to a halt. He was

Obituary 3

always generous with his time and would halt his deskworkat the unscheduled knock on the door of his office greetingyou with that mischievous grin. Knowing how meticulous hewas in his planning, research and surgical handiwork it wasastonishing to find yourself in a disorderly tip. The door wasdifficult to open. Every surface was covered with papers,open books, slides and photographs, old coffee cups,theses, prototypes of devices. Yet when he wanteda reference or a source he knew exactly where to find it.

A certain generation of British plastic surgeonsremember Professor James Calnan as the man who resignedfrom the British Association of Plastic Surgeons. His actionprovoked a disproportionate degree of consternation in theCouncil of the Association. It was assumed that he hadmade his decision in some fit of pique. It was not true, butno one asked him the reason why. A few plastic surgeonssubsequently cold-shouldered him while the WessexRegional Plastic Surgical Unit (John Barron had retired bythen) came to the incomprehensible and unilateral decisionto terminate the senior registrar training thereby deprivinghim or her of a unique and invaluable experience. Jameswas unfazed. He simply carried on with the help of in-housejunior staff and research fellows. However, after I took upa single-handed consultant post in a neighbouring multi-disciplinary district general hospital my department wasable to be built up sufficiently to restore the research andclinical link with James Calnan at the HammersmithHospital until his retirement in 1981.

In retirement James Calnan retained his connection withtheNationalHealthServicebychairing theResearchandEthicsCommittee of the Regional Health Authority. He becameinvolved in the hospice movement and was instrumental inlaunching the local hospice, serving on its committee formanyyears. His writing skills made him an obvious choice asChairman of the Medical Writers’ Group of the Society ofAuthors. Hebecameanenthusiastic gardener, growinghis ownvegetables and herbs, thereby enabling him at last to indulgehis passion for cooking for which he acquired a considerablereputation. He was active in a large number of community

projects in his hometown of Berkhamsted, Hertfordshire, buthis heart was mainly in the town’s Roman Catholic Churchwhere he took a counselling and pastoral role, becominga reader andEucharisticminister and evenembroideringmanyof the kneelers. His secular activities diminished as he foundhimself increasingly caring for his ailing wife Joan, but hisexcitement for reading, conversation and debate was nevercurtailed.

Towards the end of his life we very occasionally met butmore frequently corresponded by ‘phone or letter’. I wasalways intrigued to know how he could conflate his life asa highly regarded and disciplined applied biologist with hisprofound Christian faith, particularly in an increasing trendto quasi-fundamentalist, science-based atheism. As always,his religious convictions prevailed. When his body finallyfailed he was admitted to a nursing home. I spoke to hima month before the end when his mind was as crisp and assharp as ever. It was obvious that he had no fear of death.He died on 23 February 2010.

I was privileged to give a eulogy at the requiem mass inthe Sacred Heart Catholic Church of Berkhamsted attendedby a huge congregation. What would have pleased him wasthe number of technicians, receptionists and secretaries towhom he had been so generous and kind in the old days andwho simply wanted to say thankyou.

One ends with a verse from the entrance hymn as hiscoffin was borne to the altar:

Make me a channel of your peace

It is in pardoning that we are pardoned

In giving to all men that we receive

And in dying that we are born to eternal life

He is survived by his wife Joan and daughter Cherry.

Chris Ward22 Foundry House, Walton Well Road, Oxford OX2 6AQ,

United KingdomE-mail address: christopher.ward3@virgin.net