WITH the death of Wylie McKissock there comes to a virtual end that generation of neurosurgeons who in the late Thirties and the subsequent two decades established neurosurgery as a recognised speciality in Britain.
Wylie McKissock had a brilliant career as a student and within four years of qualification had obtained his FRCS and MS. By this time he had already decided to make neurosurgery his career. In 1937 he was awarded a Rockefeller Fellowship and spent a year at the Lahey Clinic in Boston. At this time any potential neurosurgeon had to go to the United States to train since there was really no established neurological centre in Britain.
He returned home just before the outbreak of war and was almost immediately involved in organising a neurosurgical unit in the hospital at Levesden, in north London, under the newly established Emergency Medical Service. He had no sooner got established there, with an assistant and two housemen, than the unit had to be moved to make way for the Canadian General Hospital. It was then that beds were found for McKissock's unit at Atkinson Morley's Hospital in Wimbledon, the convalescent wing of his old hospital, St George's.
The working conditions were hardly ideal. The building had a large chapel in the centre and the only room which could be used as an operating theatre opened directly on to the main corridor. It was under these unlikely and apparently unsuitable conditions that McKissock built up a world- renowned neurosurgical unit.
The war years were spent mainly dealing with casualties, only a small proportion of the patients having neurosurgical conditions other than trauma.
With the end of hostilities, McKissock was able to get down to his real aim of building up an effective neurosurgical department. In 1936 he had paid a visit to the neurosurgical unit of Dr Herbert Olivecrona in Stockholm. What had impressed him most was the accuracy with which Olivecrona was able to localise lesions in the brain, using techniques developed by Olivecrona's neuroradiologist, Dr Lysholm. When he returned to London, McKissock encouraged his friend and colleague James Bull to build up at the Atkinson Morley a department of neuroradiology in which new techniques such as angiography were developed. In its own way it became almost as famous as the neurosurgical unit, playing a leading role in the development and early clinical use of the first brain scanner and training such distinguished neuroradiologists as Dick Hoare and George du Boulay. McKissock's primary aim was to provide the best possible service for the maximum number of patients. At that time the accepted neurosurgical practice was for very slow and prolonged operations, often taking six to eight hours and even longer. He realised that this technique imposed very severe strains on the patient and increased very considerably the chance of infection, a deadly complication, particularly in neurosurgery. He proceeded to refine his surgical technique until his operating time for a major craniotomy was under two hours. This was achieved by economy of movement and in the number of instruments used. He worked constantly with the same theatre staff who could anticipate his every move or request.
McKissock always enjoyed the incredulity and near disbelief of visiting neurosurgeons when they saw four craniotomies completed between the hours of 10am and 5.30pm. In their own units one craniotomy would probably have filled that period of time. Watching him operate gave no impression of speed or hurry, and it was only when the clock was checked that the speed of operating was realised.
McKissock also set up the system of speedy return of patients to their referring hospital once he was sure they did not require any further neurosurgical care. This arrangement, coupled with the rapid surgery, meant that very large numbers could be passed through the 44 beds of the unit. By the mid-Fifties the Atkinson Morley was dealing with between 2,000 and 3,000 patients per year, probably three times the number that any other unit in Britain was dealing with. It was these numbers which led to some people feeling that the Atkinson Morley was a rather soulless surgical production line and that the staff was worked relentlessly. This was very far from the truth. Patients were nursed with great care and warmth and Wylie had the gift of inspiring loyalty and a great team spirit.
When a patient was discharged the referring hospital received a type-written case sheet complete with clinical history, examination, investigations, operation note and progress reports. Most patients came from outside the London area and these patients received a follow-up letter from McKissock enquiring about their progress or any worries they might have.
By the Sixties and Seventies the reputation of the unit was such that it was attracting increasing numbers of would-be neurosurgeons from all over the world, anxious to have the experience of seeing such a large number of neurosurgical patients.
One of the greatest contributions made by McKissock's unit was in the management and treatment of subarachnoid haemorrhage and intracranial aneurisms. He and his colleagues were able to publish an authoritative series of papers based on the huge number of these cases which had passed through the unit, making clear the very definite possibilities of surgical treatment in the management of these conditions. In 1966, when a Co-operative Study on Subarachnoid Haemorrhage and Intracranial Aneurisms was organised by 19 neurosurgical units in the US, the Atkinson Morley Unit was asked to join as the 20th unit. It contributed something like one- third of the total number of cases.
In 1946 McKissock was appointed OBE for his wartime work at the Atkinson Morley and in 1971, the year of his retirement, he was knighted. It was heartwarming to see the great pleasure that he and his wife, Rachel, took in this recognition of his achievements.
Wylie McKissock's like was centred round his work, his wife and three children, his garden and his beloved Gairloch, in Wester Ross. He was not really a gregarious man, although he gave this impression. He hated travelling and when he was made President of the Society of British Neurological Surgeons he only accepted the position on condition that he would not have to go abroad.
He retired, as he and Rachel had long planned, to their little converted croft on the shore of Gairloch. There they spent a very happy retirement working in their garden, watching the birdlife and even training the rare pine marten to feed from their balcony.
In 1984 they celebrated their golden anniversary with their son and two daughters, a few close friends and former colleagues. In the last few years Wylie suffered increasing failure of vision until he was virtually blind. This was further complicated by the onset of deafness and Rachel had to become his eyes and ears. He suffered these disabilities with amazing stoicism and uncomplaining acceptance. In June 1992 Rachel died and Wylie had at last to leave Gairloch to be cared for lovingly by his elder daughter Alison at her home in Brighton.