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Plastics
Perfection in plastic surgery is only just good enough: Sir William Manchester
The Kiwi trailblazer plastic surgeon who returned home after WWII and established plastic surgery in Aotearoa New Zealand.
A trailblazing force
From rural beginnings in Waimate, Canterbury to international success and recognition as a surgeon, Sir William Maxwell Manchester (1913 - 2001) was a trailblazing force in the field of plastic surgery in Aotearoa New Zealand. His substantial international contributions to his field including his surgical expertise, advancement of the art and science of cleft lip and palate surgery, establishment of New Zealand's first three plastic surgery units, and far-sighted best practice contributions to global plastic surgery paved the way for the crucial development of plastic surgery in the country.
An injury during his time at Timaru Boys High School inspired the young William (Bill) Manchester to pursue a medical career. He passed his matriculation exam and Medical Preliminary Examination in his fifth form year at school; a year earlier than most. After graduation in 1937, he spent a year as a junior lecturer in the anatomy department before beginning work as a house surgeon at New Plymouth Hospital, gaining critical clinical experience.
War breaks out
The war years were a time of rapid development across medicine, including plastic surgery. In 1940 a year after the outbreak of WWII, Manchester signed up to volunteer for military service and joined the 5th Field Ambulance at Burnham Military Camp as a lieutenant before being posted to London as a medical officer in the 22nd New Zealand Infantry Battalion. He was offered the chance to train in the field of plastic surgery: a crucial specialist area of surgery for the atrocities of war. These injuries during WWII were mainly based on mobility and petrol inflicted accidents, as well as battle wounds. Manchester was under the supervision of renowned New Zealander Sir Harold Gillies.
Manchester spent valuable time training in England with the leading pillars of plastic reconstructive surgery: at Queen Victoria Hospital, East Grinstead with Sir Archibald McIndoe and at Hill End Hospital, St Albans with Rainsford Mowlem and John Barron. Mowlem introduced Manchester to the iconic strip-grafting technique where strips of the patient’s skin were alternated with strips of skin harvested from another donor. During this time saline baths were introduced for the management of extensive burns and tannic acid dressings were banned. Ironically, having travelled from New Zealand to England, his specialist training in plastic surgery was given by an all-New Zealand group of surgeons. By early 1941 Manchester had completed his first skin graft. The young Manchester kept meticulous notes; something he would hold to throughout his career.
A clinic in Egypt
Manchester’s career moved fast. In 1941 he was posted to Egypt, where he used his rapidly gained clinical experience and quick intellect to work out complex plastic surgery problems. He established his first plastic surgical unit in the New Zealand Military Hospital at Helwan, Cairo, in a converted hotel. Here Manchester worked closely alongside his friend and dental colleague, Geoff Gilbert. Manchester treated a wide range of injuries, often alongside general and orthopaedic surgeons. In later years he claimed he could cover a cricket pitch with the number of skin grafts he cut during his career. A major part of his work in Egypt was treating burns, collaborating with the Royal Army Medical Corps (RAMC) research section on treating burns and measuring blood sulpha levels in patients treated with topical sulphanilamide.
“Perfection in plastic surgery is only just good enough.” – Sir William Manchester
Returning to Aotearoa
Manchester was called home towards the end of WWII and established the foundation of modern plastic surgery and hand surgery in Aotearoa. He was posted to the military plastic surgical unit at Burwood Hospital, Christchurch, establishing this as an important centre for reconstructive surgery. He later converted this military unit to a 60-bed civilian plastic surgery establishment. By this time Manchester had been in the Army for over five years and had been awarded the Africa Star 1939-45, Defence Medal 1939-45, and the New Zealand War Service medal 1939-45.
Despite years in the military as a surgeon, Manchester did not have a recognised qualification in surgery. As a small and remote country with a 'young' medical school, in the first half of the 20th century Aotearoa did not offer postgraduate medical training. Due to its historical ties with Britain, many young Kiwi surgeons would travel to England to further their training. In 1948, Manchester set out for England, obtaining the demanding plastic surgery qualification of Fellow of the Royal College of Surgeons of England in 1949.
Establishing plastic surgery at Middlemore Hospital
On his return Manchester established the internationally significant plastic surgical unit at Middlemore Hospital in 1950; his third plastic surgery unit. Here he remained in charge until his retirement from public hospital practice in 1979. He was given a knighthood in 1987 for his services to plastic and reconstructive surgery.
Manchester the inventor
A master at adapting instruments to suit the tasks required, Manchester invented his own specialist tools. Manchester’s modification to his skin grafting knife’s fixation device meant that he could get a very accurate thickness of skin. He added removeable, adjustable, and calibrated brackets at each end of the blade so that the distance between the roller and the blade, and therefore the thickness of the graft, could be adjusted.
A global contribution
Combining advanced surgical techniques and the concept of ‘pre-surgical orthopaedics’, the management of cleft lips and palates in New Zealand made major advances under Manchester’s leadership. Manchester obtained international recognition for his expertise and innovation in treating children with cleft lip and palate, and his special skill in mandibular reconstruction using large free bone grafts. A popular visiting professor to many internationally renowned plastic surgical units, Manchester’s lectures were lucid and well-illustrated, delivered with passion and humour.
Training future generations
After establishing the plastic surgery unit at Middlemore Hospital, Manchester went on to train generations of young surgeons and nurses, leaving a considerable legacy in this field. He continues to be recognised through the work of the Sir William and Lady Lois Manchester Charitable Trust.
Find out more about the history of plastic surgery.
Read about New Zealand’s contribution to plastic surgery and the origins of the word ‘Plastic’.
Discover the work of Sister Joyce Walters in the establishment of the New Zealand plastic surgical nursing service.
Read more about Manchester in “Perfection: the life and times of Sir William Manchester” by Earle Brown and Michael F. Klaassen, Mary Egan Publishing.
Earle Brown is a well-known plastic surgeon who, before retiring from practice in Aotearoa New Zealand, played a role in the development of plastic surgery in our country.