BIOGRAPHICAL SKETCH

Biographical sketch: F. John Gillingham

E. A. C. PEREIRA, P. M. SCHWEDER, A. L. GREEN & T. Z. AZIZ

Department of Neurological Surgery, The West Wing, The John Radcliffe Hospital, Oxford and Oxford Functional

Neurosurgery, Nuffield Department of Surgery, University of Oxford

Francis John Gillingham (Fig. 1) was born on 15th

March 1916 in Dorchester. He studied at Hardye’s

School, Dorset then at St. Bartholomew’s Hospital

Medical College of London University, graduating in

1939. After house officer positions in Bart’s and the

Lord Mayor Treloar Cripples’ Hospital, Alton,

Hampshire, he joined the Royal Army Medical

Corps. Appointed General Duties Officer at the

Oxford Military Hospital at St Hugh’s College, he

managed head injuries under Colonel Hugh Cairns

and Group Captain Symonds. In 1941, Gillingham

was deployed for 18 months in Cairns’ field surgical

unit, a ‘‘crash course’’ in all aspects of neurosurgical

trauma as well as general military surgery.

The young lieutenant then embarked from Liver-

pool via the Cape of Good Hope to serve from the

Battle of El Alamein onwards including the ferocious

Northern Italian campaign. Gillingham recalls that

‘‘in one battle in North Italy we had 1556 patients in

56 days and 6063 overall in three years.’’1 He later

returned to Oxford under Sir Hugh Cairns and

married Judy Irene Jude in 1945. Cairns, a brilliant

administrator, arranged the wedding locally in

Oxford followed by a reception at his home, such

that Gillingham could continue his busy clinical

service until up to the wedding, resuming it after the

briefest of honeymoons nearby. Nevertheless, the

demands of Cairns and later Norman Dott still

allowed time to see four sons raised and enjoy

grandchildren in retirement.

After Oxford, he returned to Bart’s, training under

Sir James Paterson Ross and Mr. John O’Connell. In

1950, he was appointed Consultant Neurosurgeon in

Edinburgh, Deputy Director of the Department of

Surgical Neurology and Senior Lecturer in Surgical

Neurology at the University of Edinburgh. In 1962,

he was named Reader and, in 1963, became

Professor of Surgical Neurology at the University of

Edinburgh. Academic and clinical neurosurgery at

Edinburgh prospered under him with the establish-

ment of a 18-bed head and spinal injuries research

unit, expanded to 30 beds as required, at the Royal

Infirmary and a 65-bed elective surgery and stereo-

tactic neurology service at the Western General

Hospital.2

In 1955, he was elected a Fellow of the Royal

College of Surgeons of Edinburgh. In 1960 he

became its Morison Lecturer and was elected to its

council in 1968.In 1980 he resigned the Edinburgh

Chair of Neurosurgery to take up his position as

President of the Royal College of Surgeons of

Edinburgh. He was made a Fellow of the Royal

Society of Edinburgh in 1970.

Gillingham was one of three surgeons younger than

28 years of age who together performed almost 4000

field operations for missile injuries during wartime.

He kept meticulous notes in three dimensions of each

patient’s injury and operation performed. Inspired by

Gordon Holmes’ wartime discoveries, an interest in

functional neurosurgery arose from detailed diagrams

of bullet and shrapnel trajectories correlated with

clinical findings, leading to postulates on the necessity

of functioning midbrain structures for consciousnessFIG. 1. Frances John Gillingham, PRCS(Ed), CBE, FRSE.

Correspondence: Professor T. Z. Aziz, Department of Neurological Surgery, The West Wing, The John Radcliffe Hospital, Oxford, OX3 9DU.

Tel: þ44 (0) 1865 234605. Fax: þ44 (0) 1865 231885. E-mail: tipu.aziz@nds.ox.ac.uk

Received for publication 7 January 2009. Accepted 9 January 2009.

British Journal of Neurosurgery, April 2009; 23(2): 143–146

ISSN 0268-8697 print/ISSN 1360-046X online ª The Neurosurgical Foundation

DOI: 10.1080/02688690902736993

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that later came to be known as the reticular activating

system. An enduring interest in neurosurgical trauma

and the prevention of head injury led to implementa-

tion of a head injury assessment scale in Edinburgh

prior to others’ establishment of the Glasgow Coma

Scale.As Cairns had done for motorcyclists’ crash

helmets,3–5 Gillingham became a prominent cam-

paigner for the introduction of the car seatbelt

legislation and in 1979 he was the recipient of the

Clark Foundation Award for Services to Road Safety.

In 1982, he was made a Commander of the Most

Excellent Order of the British Empire.

Gillingham spent 12 years alongside Norman

McOmish Dott, one of the great triumvirate, along-

side Sir Hugh Cairns in Oxford and Sir Geoffrey

Jefferson in Manchester, the apostles of Cushing,

who definitively established neurosurgery as a speci-

alty in Great Britain. Like Dott who first taught him

to wrap and clip cerebral aneurysms, Gillingham was

a brilliant and pioneering vascular neurosurgeon. As

well as establishing the optimal time between sentinel

bleed and rupture to clip cerebral aneurysms and

minimise haemorrhage, pioneering use was made of

wrapping, coiling and papavarine lavage.6,7 Dott and

Gillingham also related arterial pulsations to cere-

brospinal fluid flow in normal cisterns and suggested

a vasogenic origin for subarachnoid cystic collec-

tions.

Gillingham was introduced to stereotactic surgery

by Guiot, who had visited Edinburgh to learn

aneurysmal surgery from Dott and Gillingham.8

Guiot’s 1953 telegram to Gillingham read ‘‘I have

something interesting to show you – come over.’’

Gillingham obeyed and four days were spent

performing freehand pallidotomies under local

anaesthesia using a subfrontal approach to the

anterior perforated substance.9 Gillingham’s wealth

of experience in aneurysmal surgery led him to adapt

Guiot’s stereotactic method to an occipitoparietal

approach to avoid striate arteries (Fig. 2).10 Thus the

Guiot-Gillingham stereotactic apparatus was devised

(Fig. 3).

In 1960 he published results from stereotactic

‘‘thermal electrocoagulation lesions of the globus

pallidus, internal capsule and thalamus either sepa-

rately or in combination’’ in 60 patients.11 ‘‘Of these

patients 53, or 88%, had tremor and/or rigidity

abolished or significantly reduced without complica-

tions.’’ On his modification of Guiot’s stereotactic

apparatus he stated

that the merits of this method lie in the relatively

short operative procedure and in its accuracy and

simplicity. Its principles are based on the fact that

the globus pallidus and thalamus bear a reasonably

constant anatomical relationship to the anterior

and posterior commissures, the intercommissural

line, and the mid-sagittal plane of the head. . . . The

method used has evolved progressively, and is

unique, in allowing the creation of lesions in the

globus pallidus, internal capsule, or thalamus with

one electrode track at different depths.

The Guiot-Gillingham frame’s conception pre-

ceded Hassler’s discovery of the thalamus as a target

for tremor and Gillingham attributed to serendipity

that his posterior approach enabled multiple targets

to be lesioned in a single pass.12

Despite impressive clinical outcomes, Gillingham

noted some inaccuracy to his lesions given observa-

tions that relationships between basal ganglia struc-

tures and commissural landmarks were highly

variable.13,14 David Whitteridge, his neurophysiolo-

gist colleague at Edinburgh, had demonstrated to

him in 1961 how microelectrode recording could

distinguish between grey and white matter and thus

delineate the lateral geniculate nuclei in the cat.15

He immediately saw its utility for distinguishing

functionally between deep brain structures and

FIG. 2. Gillingham (left) preparing for a stereotactic thalamotomy

in 1968 (after Housepian, 2004).24

FIG. 3. The Guiot-Gillingham stereotactic apparatus using a

posterior rather than a coronal approach (after Gillingham et al.,

1960).11

144 E. A. C. Pereira et al.

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developed the technique for humans as did Guiot.16

Fundamental physiological insights were gained from

the first human microelectrode recording studies in a

quest to improve lesion accuracy and clinical efficacy,

including the observation that spontaneous rhythmi-

cal discharge in the thalamus was synchronous with

tremor (Fig. 4).17 This new technology enabled

Gillingham to target accurately with a margin of error

less than 1 mm.

Throughout the 1960s and 1970s, Gillingham

evolved the Guiot-Gillingham apparatus. He added a

phantom to allow an oblique track to more medial

brain targets for epilepsy and psychiatric disorders,

then an inferior extension to the posterior limb of the

frame for targeting the cerebellum, brain stem and

cervical spine in chronic pain and dystonias.18 In

1977 he added a motor to automatically drive an

electrode in at a slow and measured rate for

microelectrode recording. Alongside the functional

treatments, stereotactic surgery for deep haematomas

and tumour biopsies were also performed.19 Ten-

year follow-up in the postlevodopa era of a second

60-patient Parkinsonian cohort of Gillingham’s

operated upon between 1965 and 1967 showed a

decline in efficacy for bradykinesia, but consistent

relief of tremor and rigidity.20

Alongside his many clinical and scientific con-

tributions, Gillingham was also a passionate educator

who introduced subspecialty fellowships to British

neurosurgical training.21 He remained engaged in

academic neurosurgery well into his ninth decade,

authoring insightful reviews of stereotactic surgery

for Parkinson’s disease and continues to consider

neurosurgical issues.22 He is currently preparing a

pictorial summary of his experiences of field neuro-

surgery during the Second World War.

Cushing said of Dott, ‘‘Should you scratch deeply

enough a man of pioneering spirit, the chances are

that you will draw Scottish blood.’’23 Having made

seminal contributions to neurosurgical postgraduate

education, basic sciences, trauma, vascular, stereo-

tactic and functional neurosurgery to name but a few

domains, and trained nearly 100 heads of neurosur-

gical departments worldwide, Frances John Gilling-

ham, an Englishman who made Edinburgh

neurosurgery truly international, has embodied

throughout his work the pioneering spirit wryly

observed by his mentor’s mentor.

Acknowledgements

The authors thank John Gillingham for comments

and regret that brevity precludes many of his

fascinating anecdotes being recounted here. The

authors receive financial support from the U.K.

Medical Research Council, Oxford Comprehensive

Biomedical Centre, Norman Collisson Foundation

and Sir Charles Wolfson Charitable Trust. This

article was produced without funding assistance.

References

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FIG. 4. Spontaneous rhythmical activity synchronous with tremor

recorded from the human thalamus. The lowest record is a

speeded-up version of that at the top. The middle record is taken

from an accelerometer on the wrist (after Gillingham, 1966).15

F. John Gillingham 145

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