Dr. W.H. Kirkaldy-Willis
Recipient of the CSS Lifetime Achievement Award for 2002

Dr. Kirkaldy-Willis was born in 1914 in a town near London. He spent his childhood in the South of England and attended school at Marlborough College in Wiltshire. In 1933 he entered Cambridge University to study medicine. His orthopaedic training was done at the Royal College of Surgeons in Edinburgh and the King George VI Hospital in Nairobi, between 1941 and 1950.

He worked for three years at the CMS Hospital in Mombasa and for 19 at King George VI Hospital in Nairobi. In 1964 he came to Canada and was professor of orthopaedic surgery at the University of Saskatchewan in Saskatoon from 1966 onwards.

Since that time Dr. Kirkaldy-Willis has helped to train a number of orthopedic surgeons now in practice all over the world. In 1990 Dr. Kirkaldy-Willis and his wife, after many happy years together in Kenya and Saskatoon, retired to
their home in Victoria.

The following recounts a few highlights along Dr. Kirkaldy-Willis’ journey through the spine, in his own words.

You have asked me for what you call a “Bio”, a new word for me. On reflection I think it must be something halfway between a C.V. (dull facts) and a Myth (a story with a meaning.). Like fundamental physics this “bio” deals with the very small and the very large. The very small, that’s me: the very large, all the wise men and women who have been the chief actors in this saga. I have been on the stage most of the time for the past 60 years but acting a very small part in the drama. I’ll try to condense the story into six or seven scenes.

In 1944 I’d been three years in a small mission hospital near Mombasa doing a bit of everything and learning a lot. I wanted a change and found myself on the train that takes two days and two nights to reach Kampala. The train stops every ten to twenty miles. The journey is hot and boring. I had four hours in between trains in Nairobi and to while away the time I took myself to the Anglican Church Bookshop which carries supplies for schools and for churches. On an upper shelf, wedged in between two large theological tomes was a book with a red cover that on closer inspection carried the title “Tuberculosis of Bone and Joint”, written by an Oxford professor. I bought the book to
pass the time on this tiring and boring journey. The contents were fascinating and quite new to me.

Returning to my home near Mombasa I put the book to one side and forgot about it. A few months later I’d signed up for a new job in the central hospital in Nairobi and was looking for more work. Quite soon a physician asked me to see a young African man with tuberculosis of the thoracic spine. No one had so far attempted to treat this condition in East Africa. I reached for the book bought in that bookshop, studied it in detail and embarked on the treatment of bone and joint tuberculosis of which spinal lesions formed a large part.

The Director of Medical Services told me that this was a waste of time advised me to let these patients die and hope the next generation would have more resistance. I didn’t take his advice and found that over 80% of such patients did very well. That was how my interest in spinal lesions began.

The Mystery- how did that one book get onto that shelf in a bookshop that had no other medical books? Who put it
there? Why should I find it there? We’ll never know. Which makes the question almost a theological one like for example what or who was responsible for the “The Big Bang”!?

The new rehabilitation center in Nairobi was under the aegis of Frank, a remarkable man, graduate of an Ivy League Academy in England, radiographer for Armed Forces in China, seconded to Kenya as radiographer in Mombasa and then acting physical therapist in Nairobi because there was no one else for the job! He was just the right man for us at that time in 1944. Soon there were 6 or 7 patients in a ward in plaster shells for 3 months after posterior spinal fusions for T.B. Frank suggested a program of vigorous exercises for arms and legs twice a day to music, directed by a sergeant major, himself. I was very doubtful but agreed to this. The patients welcomed it. All were the better for it.

My discovery – the best results came from rest to the affected part, the spine and activity for the other parts of the body. We called this “Health through Activity” and applied it to other musculoskeletal lesions for the next 20 years in Nairobi and after that in Saskatoon. This treatment – early fusion with 3 months in a plaster shell became routine for patients with Potts disease. Patients with paraplegia however presented a great problem. The results of laminectomy were appalling. Fortunately Nobby, a British orthopaedic surgeon, paid us a visit about that time. And this was his advice. “There’s a neurosurgeon in Edinburgh who’s invented an anterolateral approach to the spinal cord. He removes the posterior portions of three ribs and transverse processes, identifies the intercostal nerves, traces them to the foramina and makes a lateral window to expose the dura and remove the cause of pressure on the front of the spinal cord. You may find this helpful”.

And so it was. It revolutionized the treatment of paraplegia. The procedure is illustrated in the new Spine Atlas published by Parthenon. In East Africa, Asians and Europeans presented with the symptoms of Low Back Pain so
common in North America. Black Africans were free of this problem. In the 1940s the accepted treatment was the application of a plaster of Paris cast from sternal notch to the iliac crest, a sweat for the surgeon in that hot climate and a burden for the patient.

Bill, a British MD with an American diploma in osteopathy, arrived in Nairobi to practice osteopathy just at the critical moment. He instructed Frank (the physical therapist) in spinal manipulation to a sufficient degree to benefit many patients and obviate the necessity for plaster jackets, greatly to our relief. This was my introduction to Osteopathy and Chiropractic which was to influence me very greatly in my practice in Canada for more than 20 years, obviating the need for many surgical procedures and greatly enlarging the scope of my practice through cooperation, mainly with chiropractors, who attended orthopaedic rounds and outpatient clinics each week.

In 1953 whilst visiting the medical school in Kampala I was asked to see an African patient with a high fever and paraplegia due to osteomyelitis at C56 with an abscess and sequestrum pressing on the front of the cord. It was Ian, a Rhodesian and professor of surgery, who commented that often when doing a thyroidectomy he had an excellent
view of the front of the cervical spine. Using this anterior approach we were able to evacuate the abscess and remove the sequestrum. The patient recovered well. We used this approach on many occasions in treating spinal infections and in other anterior spinal surgery both in Africa and in Canada.

This will I hope make the point that whilst I had the privilege of being involved in several exciting advances in spinal surgery, it was a number of others who earned the right to be considered prime movers in all this work. In his theorem John Bell of the particle physics laboratory at CERN near Geneva postulated that when two subatomic particles have been in contact, if separated even for a great distance they will continue to interact. Changes in
the behaviour of one will affect the other and vice versa. There is a similar unexplained interconnectedness between us. One individual’s discovery often comes from things done previously by others. It was my good fortune to be in Africa and in Canada where the action was taking place. I salute my masters.

W.H.K.W. Victoria, B.C.