Designatory Letters: 
MRCS Eng LRCP Lond 1942, MRCP Edin 1948, MRCP Lond 1948, FRCS Edin 1948, FRCP Edin 1972

[Contributed by CHRIS WARD. Oxford]*

James Stanislaus Calnan was born 12 March 1916 as the eldest of five children. His father came from Cork and having left school at the age of twelve eventually moved to England after marrying a Dublin girl. He made his living through distributing fruit and vegetables from Covent Garden market to grocers in the south of England via teams of horse-driven carts. Both parents recognised the importance of education as is evident from the three sons graduating in medicine. James himself was a boarding pupil in the Jesuit Roman Catholic school of Stoneyhurst in Lancashire where at his confirmation he chose the name of Stanislaus, a visionary 17-year-old Jesuit Saint of the 16C.

He entered the London Hospital Medical School qualifying in 1942, in both dentistry and medicine. He saw military service in India and France before becoming Squadron Medical Officer and anaesthetist specialist in the Royal Air Force having acquired qualifications in anaesthesia and tropical medicine. One senses that after demobilisation he was uncertain as to what direction to take. In fact he used to say that he had always wanted to be chef and to manage a restaurant. However an initial inclination as physician was indicated by taking the MRCP of Edinburgh in 1947 although it is clear that by later taking the Edinburgh FRCS, surgery became his choice of career. After general surgical experience he started his life in plastic surgery as first assistant then senior lecturer to the Nuffield Department of Plastic Surgery in the Churchill Hospital, Oxford under the direction of Eric Peet and Pomfret Kilner. There he was not only able to learn the craft of Plastic and Reconstructive surgery but to develop his research interests, mainly in the treatment of cleft lip and palate and of velo-pharyngeal incompetence. By liaising with an adjacent paediatric research unit using lambs as models to investigate neonatal upper respiratory disorders he adapted their static and cineradiographic x-ray devices to demonstrate the functional anatomy of hypernasality in children and adults and to plan any correction accordingly. In 1959 he gave a Hunterian oration: ‘Surgical treatment of nasal speech disorders’.

Also in 1959 John Barron from the Plastic Surgery Unit in Odstock Hospital Salisbury negotiated his appointment as Lecturer in Experimental Plastic Surgery at the Royal Postgraduate Medical School within the Hammersmith Hospital in West London. Those were the heady days of the School with pioneering work in cardiac catheterisation, open heart surgery facilitated by in-house design of the heart-lung machine; and renal transplantation. In 1960 the first cyclotron unit in the UK for enhanced radiotherapy was installed by the Medical Research Council. James was in his element in a multifaculty and multidisciplinary clinical and research environment at a time when the commonest model of plastic surgery provision was from large isolated units somewhat remote from mainstream complimentary clinical services. As overall head of surgery, Professor Sir Ian Aird was sufficiently impressed by the talents of James to appoint him as Director of the new Experimental Surgery Unit which unified all the surgically related research departments with the research fellows, assistants, technicians, laboratories, secretaries, animal house etc. under one roof. The unit was regarded as among the best of its kind in the world until many years later when it ran out of money and steam. Apart from initiating and finding funds for research James attracted and fostered gifted surgeons who did not always conform to the establishment pattern. One was Freddie Nicolle who, having left Canada, sought to establish himself in this country. With James he developed implantable prostheses to relieve the pain and improve the excursion of the small joints of the hand in rheumatoid arthritis. Together they studied the cytology and biochemistry of tendon healing and tested two-stage flexor tendon repair with the help of silastic rods. He eventually became an independent and highly regarded Aesthetic Plastic Surgeon with a national and international reputation for setting standards in practice and teaching, and for peer-recognition of this particular surgical art.

Joseph Pflug had escaped from East Germany in the dark days of Europe, penniless and at great risk to himself and his family. As a surgical assistant near Stuttgart he read about James’ interest and research in the peripheral lymphatic system and was eventually taken under his wing, commuting for two days a week between Stuttgart and London. He became an authority in the pathophysiology of the lymphatic network in primary and secondary lymphoedema. Professor Chisolm turned to him to identify the role of the renal lymphatics in relation to kidney transplantation. He pioneered the role of endolymphatic radioisotope perfusion for malignant melanoma and with James and Professor Melrose (an inventor of the heart-lung machine) developed the pump-linked leggings providing intermittent external compression in the prophylaxis of deep vein thrombosis, a device that remains in worldwide use today.

James was active in a huge variety of biological and biomechanical research themes applied to surgical practice for which he was deservedly recognised. In 1962 he was awarded the Mowlem Prize by the British Association of Plastic Surgeons for the greatest contribution to plastic surgery in the previous four years. In 1970 he was appointed Professor of Plastic and Reconstructive Surgery at the Royal Postgraduate Medical School. In 1972 he was elected as a Fellow of the Royal College of Physicians of Edinburgh. In 1976 at the World Congress of Bioengineering he received the Clemson award for outstanding contributions to the literature in biomaterials and bioengineering. He published over 200 papers and edited or wrote seven books.

His surgical practice was also diverse. He continued in the treatment of infants with cleft lip and palate and developed an interest in the surgery of hypospadias. He carried out reconstruction of defects following intraoral tumour resection and after radiotherapy damage. He and his team managed the maxillofacial trauma and congenital, traumatic and acquired hand problems. In collaboration with the psychiatric unit he engaged in gender reassignment surgery. But his greatest contribution to the practice of surgery came through his establishment of the first adult day surgery unit in the UK. In 1967 he commandeered and converted an army surplus Quonset hut, installing it in the corner of a car park in the hospital. It was open to all interested clinicians and by following strict guidelines for patient selection and practice, 10,000 patients were treated from a variety of specialities in the hospital without a significant incident in the first ten years. There is now not a District Hospital in the UK without a day surgery facility.

In the early 1970s John Barron and James Calnan agreed to a senior registrar training link between the Wessex Regional Plastic Surgery Unit and the Hammersmith Hospital. My time as a trainee under Professor Calnan’s supervision was the most stimulating and rewarding of my career. There was no hierarchy. One was treated as an equal although intellectually I could never be his equal. Apart from the clinical experience I was exposed to the discipline of the research process, lecturing, teaching and writing. The grand surgical rounds on every Friday afternoon was the climax of the week, attended by all the relevant professors and consultants and their teams where junior staff would deliver research in process, a complex case presentation or a topic review. It was a gladiatorial arena and a tough learning process. Any weakness in delivery, argument or logic was ruthlessly exposed by one of the other surgical teams. James would only intervene on my behalf when I was being embarrassingly exposed. The bonhomie was restored in the ‘Water-hole’ in the doctors’ quarters afterwards when James would gently explain how I could better. On the fourth Friday of the month a special lecturer was invited which included some of the giants of applied science such as Peter Medawar, a Noble prize-winner for work that helped to launch modern immunology 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 spoke beautifully, as did James. He had the ability to disseminate information in an easily intelligible and absorbing fashion, and his books entitled Writing Medical Papers and Speaking at Medical Meetings published in 1972 with illustrations by his artist daughter Cherry remain as gems. His Kay-Kilner prize-winning essay in 1968 on Whither Plastic Surgery? – trends for the future is a masterpiece of prose and constructive criticism. His conference presentations were worth the registration fee alone. They had always been rehearsed for hours and were delivered fluently and without notes and timed to the second. He would ask penetrating questions and occasionally prick the pomposity of some of his self-regarding peers, while also coming the aid of nervous trainee surgeons giving their first paper and finding themselves over-aggressively questioned from the floor. Possibly, for these reasons, he acquired a reputation in some circles for being prickly and difficult. This was never his nature. The most apt description of Professor James Calnan is of a benign, maverick polemicist. Maverick can be interpreted as a pejorative term but the definition in the Oxford English Dictionary fits 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 he spent so much time at the bedside but because, in the walk from ward to ward down the central long corridor of the Hammersmith Hospital, he would enquire after the welfare of everyone from visiting professors to the clerks, orderlies, porters, cleaners, receptionists, secretaries and all those without whom the hospital would grind to a halt. He was always generous with his time and would halt his deskwork at the unscheduled knock on the door of his office greeting you with that mischievous grin. Knowing how meticulous he was in his planning, research and surgical handiwork it was astonishing to find yourself in a disorderly tip. The door was difficult to open. Every surface was covered with papers, open books, slides and photographs, old coffee cups, theses, prototypes of devices. Yet when he wanted a reference or a source he knew exactly where to find it.

A certain generation of British plastic surgeons remember Professor James Calnan as the man who resigned from the British Association of Plastic Surgeons. His action provoked a disproportionate degree of consternation in the Council of the Association. It was assumed that he had made his decision in some fit of pique. It was not true, but no one asked him the reason why. A few plastic surgeons subsequently cold-shouldered him while the Wessex Regional Plastic Surgical Unit (John Barron had retired by then) came to the incomprehensible and unilateral decision to terminate the senior registrar training thereby depriving him or her of a unique and invaluable experience. James was unfazed. He simply carried on with the help of in-house junior staff and research fellows. However, after I took up a single-handed consultant post in a neighbouring multidisciplinary district general hospital my department was able to be built up sufficiently to restore the research and clinical link with James Calnan at the Hammersmith Hospital until his retirement in 1981.

In retirement James Calnan retained his connection with the National Health Service by chairing the Research and Ethics Committee of the Regional Health Authority. He became involved in the hospice movement and was instrumental in launching the local hospice, serving on its committee for many years. His writing skills made him an obvious choice as Chairman of the Medical Writers’ Group of the Society of Authors. He became an enthusiastic gardener, growing his own vegetables and herbs, thereby enabling him at last to indulge his passion for cooking for which he acquired a considerable reputation. He was active in a large number of community projects in his hometown of Berkhamsted, Hertfordshire, but his heart was mainly in the town’s Roman Catholic Church where he took a counselling and pastoral role, becoming a reader and Eucharistic minister and even embroidering many of the kneelers. His secular activities diminished as he found himself increasingly caring for his adored and ailing wife Joan, but his excitement for reading, conversation and debate was never curtailed.

Towards the end of his life we very occasionally met but more frequently corresponded by ‘phone or letter. I was always intrigued to know how he could conflate his life as a highly regarded and disciplined applied biologist with his profound Christian faith, particularly in an increasing trend to quasi-fundamentalist, science-based atheism. As always, his religious convictions prevailed. When his body finally failed he was admitted to a nursing home. I spoke to him a month before the end when his mind was as crisp and as sharp 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 in the Sacred Heart Catholic Church of Berkhamsted attended by a huge congregation. What would have pleased him was the number of technicians, receptionists and secretaries to whom he had been so generous and kind in the old days and who simply wanted to say thank you.

One ends with a verse from the entrance hymn as his coffin 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 was survived by his wife, Joan, who sadly died on 15th October 2010 and by his only daughter, Cherry Ramseyer.

* This obituary was first published in The Journal of Plastic Reconstructive and Aesthetic Surgery to whom we are most grateful Ed.