Harvey Brown, BDS (NZ), DDSc (Otago)
Formerly Associate Professor, Head of the Department of Community Dental
Health and Deputy Dean, Faculty of Dentistry, University of Otago
Dunedin, New Zealand

Englishman Percy Pickerill, a graduate in dentistry and medicine of the University of Birmingham in England, was appointed in 1907, at the age of just 28 years, as the first Dean of the Faculty of Dentistry in the University of Otago, Dunedin, New Zealand. There he became New Zealand’s first maxillofacial surgeon and an internationally recognised researcher in dental caries.

Leading up to the First World War, he was, with Thomas (later Sir Thomas) Hunter, a founder of the New Zealand Dental Corps (later the Royal New Zealand Dental Corps), a unit that became the envy of the military health services of the Allies in the First World War. Pickerill was appointed in 1917 to establish a jaw department at the Second New Zealand General Hospital at Walton-on-Thames near London, England, where he treated New Zealand soldiers returning from the fronts of Belgium and France. Amongst his other achievements at this time was being one of the first to use bone grafts in the repair of the fearsome injuries of the face and jaws resulting from trench warfare.

Lieutenant Colonel Pickerill, NZMC, (center) with his post-war surgical, nursing, and technical team at Dunedin Hospital, New Zealand. From the Pickerill Papers, Hocken Collections, Uare Taoka o Hockena, University of Otago, Dunedin (www.otago.ac.nz/library/hocken/).

Meanwhile the New Zealand-born ear, nose and throat surgeon Harold Gillies (later Sir Harold) became the senior surgeon at the newly established hospital - The Queen’s Hospital - in Sidcup, Kent. This became the center for all Empire soldiers with jaw and facial injuries, taking advantage of the specialised surgery and convalescence services being located in the one hospital. Englishman Major Pickerill commanded the New Zealand section and New Zealander Major Gillies commanded the British section; there were also Australian, Canadian, and South African sections, and an American contingent of surgeons joined them in a largely observational role toward the end of the War.

Rivalry existed among the surgeons, and each made claims to be the first to develop or use a new technique or approach. But from this Sidcup team of pioneering surgeons, dental surgeons, and dental technicians came modern plastic and reconstructive facial surgery.

Infection of wounds was a major problem for troops returning from the mud of the trenches in this pre-antibiotic era. But infection could be brought under control to allow repair and reconstruction of shattered faces and jaws. This is revealed in Pickerill’s description of the management of infection in the ‘fresh’ cases, the men who had received, at the Front, just enough attention to control bleeding and to stabilise their airways:

These always arrive in a very septic condition, and have, first of all, to be cleaned up and X-
rayed … Usually there is a piece of shrapnel somewhere embedded in the tissues which has
to be removed … They have … a habit of moving about, and may be quite an inch from
where they were when the skiagram [radiograph] was taken. At the time of removing the
‘F.B.’ [foreign body] the bone may be wired, a splint inserted, or inter-maxillary lacing
adopted … Septic mouths are atomised with a pressure atomiser, using peroxide or weak
iodine solution [a chlorine solution became the standard at Sidcup] from two to six times a
day … Every mouth must be kept clean. Patients are weighed once a week, and I expect all
of them to put on weight …

After the War, Pickerill returned to New Zealand with many of his patients to complete treatment and rehabilitation at his specialised facial and jaw unit set up in the Dunedin Hospital.

Tracing from a radiograph of a shattered jaw, with splint in situ. From the folder of Captain JW Turner, NZDC, Jaw Records, Queen’s Hospital, Sidcup, held at the Defence Dental Directorate, Wellington, New Zealand.

Many years later, Dr A.D. Macalister, then Professor of Oral Surgery at the Otago Dental School, discovered a large group of records brought back by Pickerill. These records were eventually sent back to Sidcup some 70 years after they had left. There, under the curatorship of Dr Andrew Bamji, they became the focus for a major archive of World War I medical records, photographs, wax models, water-colour paintings of injured faces, books and documents under the name ‘The Gillies Archives from Queen Mary’s Hospital, Sidcup’ (www.gilliesarchives.org.uk).

Wax model of the head of a soldier injured by shrapnel. From the Pickerill collection of wax models, University of Otago, Faculty of Dentistry, Dunedin, New Zealand.

Another collection of Pickerill’s Sidcup records, including clinical details, photographs, and water-colour paintings are archived at the Hocken Collections, Uare Taoka o Hockena, University of Otago, Dunedin (www.otago.ac.nz/library/hocken/).

Water-colour painting of a soldier with shrapnel wound, between operations for repair of the wound on his left cheek. From the Gillies Archives of the Queen Mary’s Hospital, Sidcup (www.gilliesarchives.org.uk).

Pickerill returned to his peacetime duties in 1920 to continue his surgery as New Zealand’s only recognised specialist maxillofacial surgeon, and to continue his caries research. He resigned from the University in 1927 to practise as a plastic surgeon in Sydney, Australia. His wife and family did not join him in Sydney. Following a divorce, Pickerill married his former house-surgeon and protégée, Cecily Clarkson. They returned to New Zealand in 1937, and practised plastic surgery in Wellington. In 1947, they established - in the nearby city of Lower Hutt - their own private hospital, ‘Bassam’, designed to treat the hitherto badly served infants and children with cleft lip, cleft palate and other congenital conditions requiring plastic surgery. They held contracts for the treatment of such children from almost all the public hospital authorities in New Zealand.

Before and after surgical repair of the bilateral cleft lip by the Pickerills, circa 1947. From the Pickerill Papers, Hockena Collections, Uare Taoka o Hockena, University of Otago, Dunedin (www.otago.ac.nz/library/hocken/).

Pickerill applied the lessons of the First World War to the prevention of post-surgical and cross infection – all nursing at Bassam, except during surgery and the changing of dressings, was done by the mothers of the young patients. Contributing to such success was their practice of allowing no visitors while infant and mother were in residence and no observers were invited into the operating room.

Their outstanding work was acclaimed by the public (Cecily Pickerill became a Dame Commander of the British Empire in 1977), but the medical profession largely ignored them, not least because Cecily held no postgraduate qualifications. Her husband was her mentor and teacher.

In 1946 the Pickerills also began monthly visits to the Middlemore Hospital, a former US military hospital near Auckland. There they provided general plastic surgery, facial and jaw surgery, and repairs of cleft lips and palates. These essentially weekend flying visits were inadequate in providing a full service, but they continued until 1950 when a resident plastic surgeon was appointed. William (later Sir William) Manchester - who had served in England during the Second World War and then specialised in plastic surgery - developed a team approach to the care of infants with clefts. 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.

Pickerill brought back to New Zealand from the First World War the most up-to-date plastic surgery techniques of the day. In turn, he was succeeded by the younger generation of plastic surgeons, whose experience and skills also had been nurtured in war. Pickerill died in 1956, his pioneering methods and service regrettably largely forgotten by New Zealand’s surgical establishment.

Dr. Harvey Brown is the author of: Pickerill, Pioneer in Plastic Surgery, Dental Education and Dental Research (2007). Otago University Press, ISBN 978 1 877372 46 9.