Gordon, Derek Stanley

by Turlough O'Riordan

Gordon, Derek Stanley (1926–2009), neurosurgeon, was born 8 May 1926 in Belfast, the third of four sons of Ernest Gordon, a manager in a glassworks, and his wife Ann (née McFarland); the family were then living at 48 Ravenhill Road, Belfast. All Derek's brothers became doctors, and he himself attended Methodist College, Belfast, before entering QUB to study medicine. A talented athlete, he captained the QUB athletics team and represented the university and Northern Ireland in the mile race. Graduating MB, B.Ch. (hons) in 1948, he initially trained in pathology and then in thoracic surgery under George Purce (d. 1950) and in general surgery under Sir Ian Fraser, before specialising in neurosurgery. Made a fellow of the Royal College of Surgeons (Edinburgh) (1954), he graduated M.Ch. from QUB (1957). After training as a research fellow in surgery under William Sweet at Harvard Medical School and the Massachusetts General Hospital in Boston, USA (1957–8), he was appointed a consultant in neurosurgery at the Royal Victoria Hospital (RVH), Belfast (1958).

Neurosurgical practice benefited from improved anaesthesiology and imaging techniques which enabled stereotaxic surgery on the brain, based on precise three-dimensional reference coordination. Head injuries were the most common cause of death from accidents, and through the late 1960s Gordon urged the co-location of neurosurgical and accident and emergency services. As a result, the newly built Quinn House, housing the RVH neurosurgery unit, was sited adjacent to the casualty and intensive care departments. The interdependence of these units, alongside neuroradiology (increasingly reliant on CAT scanning), became integral to Gordon's work.

From the late 1960s, the RVH, located in west Belfast, found itself at the centre of violent urban conflict. The principal source of severe trauma and head injuries rapidly changed from road-traffic accidents to injuries caused by explosions and shootings. The increased use of high-velocity rifles by paramilitaries from 1971 onwards greatly increased the number and seriousness of head injuries, with 90 per cent of serious cerebral injuries suffered in the conflict being caused by bullet wounds. Owing to the central location of the RVH – itself surrounded by the conflict with bullets fired into the grounds and buildings by all sides – one-third of patients reached the hospital within fifteen minutes and three-quarters within thirty (Gordon, BMJ, Mar. 1975). The constant stream of critical brain and spinal injuries was unknown in any other major western European hospital since the second world war.

Gordon was at the forefront of a generation of specialists improving critical-care management, developing innovative multi-disciplinary techniques. Responding to the rapid rise of cerebral gunshot wounds, he promoted rapid resuscitation (intubation and ventilation) and early blood transfusion (controlling blood oxygen and carbon dioxide levels) to combat shock and preclude generating excess pressure upon the brain. Championing the important role of anaesthetists in resuscitation (to manage the airway) and intensive therapy and supervision during any necessary transportation, Gordon instituted important protocols on surgical and critical-care management. Arresting haemorrhage, preventing infection by removing bone fragments, and repairing the head in advance of cranioplasty were all time-critical. The success of these protocols paradoxically relied on the proximity of the RVH to the troubles.

High-velocity bullet wounds to the head required repair of the skull, usually with bone grafts or plates composed of metal or acrylic. Gordon, working with George Blair, a consultant in dental prosthetics at RVH, developed titanium cranioplasty. First reported in the British Medical Journal (1974), customised titanium plates are hydraulic-press-moulded to match the contours of a patient's skull, then attached by screws. Titanium – being inert, radiolucent, rigid and light – does not react with or generate an immune response with tissues, is visible through x-rays and other imaging techniques, and protects the skull from further injury. Gordon and Blair, along with another colleague, published a BMJ paper (1976) adapting the technique to general use for simpler defects with modular titanium strips, a dental drill and orthodontic pliers.

Gordon's and Blair's titanium cranioplasty technique, adapting to the specific curves, undulations and shape of each patient, became a standard treatment worldwide for the repair and reconstruction of the skull. A significant achievement, indicative of Gordon's inter-disciplinary thinking and practice, the technique is represented in the permanent collection of the Science Museum, London. Gordon also served as neurosurgeon to the Royal Belfast Hospital for Sick Children and worked closely with the Ulster branch of the Irish Rugby Football Union on developing protocols for treatment of spinal trauma.

Made OBE (1976) and CBE (1988), Gordon was elected president of the Society of British Neurological Surgeons (1986–8), and was awarded their medal for outstanding achievement (2008), only its third recipient. He was also a fellow (ad eundem) (1979) and travelling professor (1988) of the RCSI, a member of the General Medical Council (1985–94), chair of the Northern Ireland Council for Postgraduate Medical Education (1989–95), and chair of the Distinction and Meritorious Service Awards Committee in Northern Ireland (1990–95). As an examiner with the RCS (Edinburgh), he was integral to their establishment of the specialist fellowship in neurosurgery, and published over fifty papers and book chapters. An active member of the Medico-Legal Society of Ireland, he was often an expert witness in court cases, while also advising the UK and NI governments on the use of seat belts and also head injuries.

Deeply interested in the evolution of his own speciality of neurosurgery, and of critical trauma care, spurred by warfare and conflict, Gordon gave the title 'Penetrating head injuries' to his 1988 presidential address to the Ulster Medical Society. Appreciative of the essential support provided by nursing and medical colleagues (while opposing political and bureaucratic interference in the provision of care), Gordon exhibited a warm, restrained sense of humour alongside notable authoritative dignity, and was regarded as 'the father figure of Northern Irish, indeed Irish, neurosurgery in the second half of the twentieth century' (O'Donnell, 140). He died 13 May 2009. He married (1953) Mavis Bell, with whom he had three sons and three daughters; one of their sons, Derek J. Gordon, is a consultant plastic surgeon in Northern Ireland, who treated many of those injured by the 1998 Omagh bombing.