British Columbia's first plastic surgeon

Dr Robert Langston was training as a general surgeon in Scotland in 1940 when a chance encounter with the imperious Sir Harold Gillies led him to work in the famous Rookswood burn unit near London.

It was in 1960 while working at St. Paul’s Hospital on the surgical rotation as a junior intern that I first encountered Dr Robert Langston, the first in British Columbia to specialize in plastic surgery.

Our patient was a middle-aged logger who, while pumping gasoline from the barrel on the back of his truck to a gas can, had allowed it to overflow and had spilled fuel onto his woolen trousers and his boots. After replacing the filler caps he jumped off the truck and, without thinking, kicked out the embers of his fire. A sheet of flame engulfed him and he endeavored to extinguish it by beating it out with his bare arms. It was some time before he finally rolled on the ground and succeeded in putting out the last of the burning clothing. He was a strong man in the prime of life, and despite the severity of his injuries was able to climb into his cab and to drive to the nearest small town whence he was evacuated to St. Paul’s Hospital in Vancouver.

When I first saw him he had already had numerous procedures to graft the deep burns of his arms, face, and thorax. The problem now was of flexion deformity of the elbows and wrists due to the deep scarring. Dr Langston released the cicatrix by incising and undermining the fibrous scar while I was delighted to harvest a split thickness graft from the upper thigh using the manually operated dermatome. I remarked on the unusual needle holder which had no ratchet and was combined with scissors. Dr Langston said that it had been invented by Sir Harold Gillies and it was then that Dr Langston told of the curious chance which led him to become a plastic surgeon. In those days general surgeons were just that. Nothing came amiss and they would as cheerfully remove a hypertrophied prostate as hammer a Thompson nail into a fractured hip.

In the summer of 1940, Dr Langston was a registrar in general surgery working in a Scottish hospital. One evening he was approached by a fellow registrar who was in charge of the plastic surgery ward and was asked to look after the ward for the next few days because his new wife, an officer in the Royal Air Force, had been given a week’s leave and he was off to make the most of it. “By the way,” he added casually, “there is a slight complication. Sir Harold Gillies is coming up from Rookswood to make rounds and give a lecture here the day after tomorrow. Good luck.”

That same summer saw the most extensive aerial engagements in the history of humankind. Massive Luftwaffe raids with more than 500 bombers accompanied by their fighter escorts of Messerschmitt 109s and 110s were bombing ports, airfields, and later cities such as Coventry, Birmingham, and London. The Fighter Command pilots suffered huge losses: half of those who began the action were either killed or wounded within the year. Those who survived the landing were frequently terribly burned, as were the aircrew of the bombers they had attacked. The self-sealing fuel tank was a later invention and high-octane gasoline spraying from the bullet-riddled machine and onto the red-hot exhaust manifold was an incendiary combination. As if this were not enough, superheated ethylene glycol from punctured radiators and engines was an equally deadly hazard. Should pilots be able to crash land or make a successful parachute jump, the price was often to be terribly burned, especially on the unprotected hands and face.

Harold Gillies,* cousin of the equally famous Sir Archibald McIndoe, had trained in New Zealand and moved to the UK at the instigation of Lord Moynihan, who had met him at the Mayo Clinic. The burn unit at Rookswood near London was equal to but less famous than the one at East Grinstead. It is to the credit of the RAF that the excellence of his pioneering work was soon recognized and arrangements made for seriously injured aircrew, British or German, to be transferred to either of these two units.

In preparation for the arrival of the great man and his entourage, Langston and his house officers diligently worked up all the patients on the large open ward in readiness for the next day’s rounds. The ward rounds went well and Gillies was particularly interested in a sailor who, in the course of escaping from a torpedoed freighter, had suffered a badly comminuted fractured jaw. After supper the hospital staff assembled in the auditorium and Gillies presented his ideas for a new technique of mandibular external fixation using transdermal pins and an external jig rather than wiring the jaw to the maxilla. When he had finished he asked for comments and questions. Just before the meeting concluded, Langston stood and said he was most interested to hear about the idea, but in fact it was not original and a Seattle surgeon, Smith-Peterson, had been using it for some time but had not published his results. While it was especially useful in comminuted fractures, there had been a number of problems, particularly with osteomyelitis and cellulitis, and the fixation frame made the patient very uncomfortable. There followed a prolonged silence and Gillies, autocratic, crusty, and overbearing, known for his intolerance of triflers, looked sour and the meeting broke up.

Feeling under a cloud Dr Langston, weary from two long days, went to bed in the residence and was soon asleep. There was a knock on the door, which was unlocked, and Langston told the caller to come in. He was astounded to see Gillies and for a moment was nonplussed. Gillies said that he would like to talk to him and asked whether he played billiards. On being assured that he did he was told to put on his dressing gown and slippers and to accompany him to the billiard room. As they played they talked and Gillies learned a good deal about Langston’s having moved to Alberta from Texas when a child, of his training at the University of Alberta Medical School and his residency in obstetrics and gynecology at the Vancouver General Hospital, and that his wife, who had graduated with him from the Alberta Medical School, was an anesthesiologist.

War had been declared while they were sailing to Britain for him to complete post-graduate training in general surgery. Gillies was a shrewd judge of men and it was known that he had not only a high proportion of Commonwealth graduates but he also drove them at a ferocious pace. He subscribed to the doctrine:

Those who the heights attained and kept 
Did not achieve by sudden flight
But they whilst their companions slept
Climbed slowly upwards in the night.

Gillies, before bidding him good night, offered Langston a position on his unit at Rookswood. When he protested that it would be impossible to find a replacement, that he was only half way through his present engagement and that his wife was also working in the unit, his objections were brushed aside and he was assured that everything would be arranged. Gillies was as good as his word and less than a week later a new registrar arrived and Langston and his wife were at work in Rookswood. For the dedication of the staff and the courage and good humor of the quietly heroic young men he treated, Langston could not find adequate praise. Multiple skin grafting and reconstruction of hand and face improved the outcome in each new case. Not only the hospital but the entire local area became involved including the pubs, cafes, and the churches. It was remarkable that so many of the pilots, after recovering from their wounds, gladly returned to fly again. One of the best-known and most poignant works, The Last Enemy, written by a fighter pilot who was just out of high school as he recovered from his burns, gives an unrivalled insight into the feelings of those involved.

Among the serendipitous findings of the plastic surgical unit was that shards of Perspex from the bullet-shattered canopy frequently punctured the eye. Instead of the anticipated panophthalmitis there was often no foreign body reaction. Acting on this knowledge Harold Ridley, in 1949, implanted the first artificial lens into the aphakic eye.**

When Dr Langston and his wife returned to Vancouver they joined the staff of the Shaughnessy Military hospital. Dr Kathleen Woods Langston gained an excellent reputation for her skill with plastic surgical cases and was an expert in blind transnasal intubation.

Dr Langston, full of years and of honors, passed away at the age of 92.

* Among his many other innovations, Sir Harold Gillies performed the first sex change operation of a woman to man using a pedicle graft in 1948.

** It was many years before the work of Dr Harold Ridley was recognized and it was not until he was 91 that he was knighted. Which goes to show that there may be advantages in not dying too soon.

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By H. Ewart Woolley, MD, FRCSC, FSOGC, MCFP(honoris causa)

Dr Woolley, the second of four sons of a Cheshire farmer, moved to Alberta in 1952 to work on a ranch. He had just completed 2 years in the British Army and served with the Parachute Regiment. He failed to kill anyone at the time, but came close to doing so when he and his passenger crashed the motorcycle he was riding. Undergraduate and graduate medical training at UBC was followed by residency training at St. Paul's, VGH, and the Royal Postgraduate School, Hammersmith. Dr Woolley practised obstetrics/gynecology at Burnaby Hospital until retiring in 2000. His greatest achievement, he claims, is to be surrounded by so many nursing and medical colleagues in whose company he takes such pride and pleasure.