“It was a lovely evening in the first week in May 1880 when I first set foot in Edinburgh and, walking up the Calton Hill, I vowed that as I could not succeed to my father’s practice, I would endeavour to make my home in Edinburgh and that I would not leave it when I was starved out”. This was the recollection in later life of an Englishman who, far from being starved out of Edinburgh, has a strong claim to be regarded as the most distinguished surgical alumnus of the Edinburgh Medical School and as one of the greatest paladins of Scottish Surgery.
Harold Jalland Stiles, the son and grandson of doctors who practised in Spalding, Lincolnshire, was born there in 1863 and in 1880 became a medical student at Edinburgh University. His elder brother, also a medical student, would in due course inherit his father’s practice and Harold knew from the beginning that he would have to make his own way in medicine.
Before coming to Edinburgh he had received from his father a thorough grounding in anatomy and it is likely that his ambition to become a surgeon was stimulated by this teaching.
His undergraduate career was one of the highest academic distinction and in 1885 he graduated MBCM as Ettles Scholar with 1st Class Honours.
After serving as House Surgeon to Professor John Chiene he became a demonstrator in Sir William Turner’s University department of Anatomy before being appointed assistant in charge of pathology in the surgical laboratory established by Professor Chiene. There is no doubt that this training laid the foundations of his unequalled knowledge of anatomy and pathology.
He became a Fellow of the College in 1889 and during the next three years carried out impressive studies of the surgical anatomy of the breast and of the pathology of breast cancer which brought him international recognition. It was during his time with Professor Chiene that he first made his name as a teacher and the extra mural course in Anatomy and Pathology which he conducted with his friend Alexis Thomson attracted large numbers of students.
In 1895 Stiles was appointed assistant surgeon to the Edinburgh Royal Infirmary and soon after this he spent six months in Berne at the Clinic of Professor Theodor Kocher with whom he established a warm friendship. From Kocher he acquired the practical skills on which he based his own operative technique and he translated into English his mentor’s monumental textbook “Chirurgische Operationslehre”.
The most important result of Stiles’ sojourn with Kocher was, however, his conversion from Listerian antisepsis to the aseptic system of surgery and on his return from Berne he became a pioneer of asepsis in Scotland.
In 1898 Stiles was appointed Surgeon to the Edinburgh Sick Childrens’ Hospital which meant that he had to give up his post as assistant Surgeon to the Royal Infirmary but soon after this he became Surgeon to Chalmers Hospital and was thereby able to maintain his involvement in adult surgery. Within a few years his clinical brilliance, his technical innovations and his superb operative skill had earned for him an international reputation which was enhanced by his scientific publications and by the inspirational quality of his teaching. Stiles travelled widely and although a very bad sailor he made several transatlantic voyages to visit major American surgical centres. Nowhere was he more highly regarded than the United States where he established close friendships with many distinguished American colleagues by whom he was rated as one of the best European surgeons.
A full account of Stiles’ achievements during his 20 years at the Sick Childrens’ Hospital would fill many pages and space restrictions preclude mention of more than two of his major contributions to paediatric surgery. He showed clearly that, contrary to Robert Koch’s teaching, the bovine form of the tubercle bacillus was frequently the cause of tuberculosis of the bones and joints and of the cervical lymph nodes. He was the first surgeon to treat extroversion of the bladder (ectopia vesicae) by transplantation of the ureters into the sigmoid colon and the original patient on whom, in 1911, he carried out this procedure was alive, well and content 23 years later.
The operation of pyloromyotomy for congenital hypertrophic pyloric stenosis is associated with the name of Rammstedt of Munster who first carried it out fortuitously in July 1911. Stiles did this operation as a deliberate planned procedure in February 1910 but his patient died of gastro-enteritis four days post operatively and he did not repeat it until after Rammstedt’s experience and results were published in 1912.
On the outbreak of World War I in 1914, Stiles was appointed consultant surgeon to the Army in Scotland with charge of the large military surgical division at Bangour Hospital a few miles out of Edinburgh where he was responsible for the secondary and tertiary care of battle casualties from the Western Front and other theatres of war. He became especially interested in the treatment of peripheral nerve injuries and his publications on this subject added further lustre to his reputation.
His outstanding achievements in the care and rehabilitation of the war wounded earned for him in 1981 the honour of Knighthood (KBE) and, in the following year, his appointment to the Edinburgh University Regius Chair of Clinical Surgery was the realisation of his most cherished ambition. As Regius Professor, Stiles returned to the Royal Infirmary and over the next six years his fame as a teacher and as a supreme master surgeon attracted large numbers of visiting surgeons to his wards from all over the world. Among many honours and distinctions which came to him during this period were his appointment as Surgeon to HM King George V in Scotland and his Presidency of the College which he held from 1923 - 1925.
In 1925 at the very apogee of his prestige and influence, Stiles suddenly and inexplicably retired from the Chair of Clinical Surgery. It may be that the pace and intensity of his professional life had caused him to fear the onset of physical and mental exhaustion but he never gave any reason for his abrupt departure. It was, however, a complete severance from all his professional activities and thereafter he devoted himself to the study of geology, botany and ornithology with photography and watercolour painting by way of relaxation.
Sir Harold Stiles set for himself the highest standards and was a perfectionist in everything he did. As “Chief” and Professor he was a hard and sometimes severe taskmaster but his was a warm hearted generous nature and he was held in total respect and no little affection by all who worked for him.
The originality of his ever enquiring mind and his intellectual dynamism no less than his teaching and his exceptional operative expertise entitle Sir Harold Stiles, an Englishman, to an honoured place in the very first rank of Scottish surgeons and to recognition for all time as one of the College’s greatest Fellows.
British Journal of Surgery; 1921; v9; p281
Journal of the Royal College of Surgeons of Edinburgh; 1955; v1; p316
Journal of Medical Biography; 1998; v6; p128