Alfred W Adson 1887-1951Alfred Washington Adson was born at Terrill, Iowa in 1887, his parents immigrated to the United States from Norway.
Adson attained his degree in 1912, M.D in 1914 and M.A. in 1918. He entered the Mayo clinic in July 1914 where he was invited to develop a section of neurological surgery.
He became a substantive member of staff on January 1, 1917, and became one of the world’s leading authorities on neurosurgery. Adson’s sign is still used to diagnose a particular syndrome (Thoracic outlet Syndrome). He was a First Lieutenant in the Medical Reserve Corps of the US Army during WW1.
After the war, he continued to head the Section of Neurological surgery at the now famous Mayo Clinic, until 1946, when he was appointed to senior consultant in the same section.1
He was president of the Society of Neurological Surgeons in 1932 and 1933, the Minnesota State Medical Association In 1937, the Minnesota State Board of Medical Examiners in 1938 and 1943, the Minnesota Neurological Society in 1941, and of the North Central Medical Conference in 1948.
This surgeon who is known to us mainly by the instrument named after him (Adson’s dissecting forceps + others).
Nicolas Andry 1658-1742Nicolas Andry was born in 1658 in Lyon France.
He originally started his career in the ministry and became a priest; he went on to teach theology before becoming a doctor.
In 1697 he defended his thesis: "The Relationship in the Management of Diseases Between the Happiness of the Doctor and the Obedience of the Patient".
He became well known for his stand against the: “bleeding barber surgeons” and he worked tirelessly to limit their venues. 2
He has cemented his place in the history of surgery simply because the word Orthopaedic came from him. The picture of a tree being supported by a post to encourage it to grow strait and now used as an emblem for many organisations aligned to Orthopaedics.
The orthopaedic profession in Andry's days were mainly concerned with the treatment of conditions such as Rickets and such, these conditions when caught early were treatable using the splints developed at the time. He wrote a book in two volumes called L'Orthopedia which was published in 1741 just before his death.
Christiaan Neethling Barnard 1922-2001Christiaan Neethling Barnard was born in Beaufort West, in the Western Cape, South Africa. He obtained his medical degree in the late 1940s in South Africa. In 1956 he went to the USA to study cardiac surgery.
Three years after his return to South Africa, he was appointed Head of the Department of Cardiothoracic Surgery at the teaching hospitals at the University of Cape Town.
In 1962, he was promoted to Associate Professor in the Department of Surgery at the University of Cape Town.
I first heard of Christian Barnard on the News in 1967 when he led the team that carried out the first human heart transplant. (on Louis Washansky, who died soon after.) Even I understood the significance of this surgical breakthrough as a schoolboy. (I remember I had not long got back from watching Frankenstein at the all-night cinema).
Barnard had demonstrated that heart transplants were possible. Even though many of his patients died soon after their operation, he had taken the first steps into a new form of surgery which is now routine in medical practise.
In 1974, Christian Barnard carried out the first double heart transplant.
He ended his career in surgery because of the impact of arthritis which made it too painful and dangerous (for the patient) to work.3
Barnard died in Pathos, Cyprus possibly from an Asthma attack.
Apart from Nelson Mandela, he will be remembered as the most famous South African.
When asked what his greatest achievement was, he answered: "It's difficult to say. If you ask me what I would like to be remembered for, I would not say the transplants, but the surgery I have performed on children with abnormal hearts. It is much more difficult than transplantation and much more satisfying. With the surgical facilities we give a child a chance to lead a normal life."
Arthur Sidney Blundell Bankart 1879-1951Arthur Bankart was born in Exeter the son of surgeon James Bankart. He was a pupil of Rugby school and a student of Trinity College Cambridge. He qualified as a doctor in 1906.
Bankart was appointed in 1909 the first registrar of the newly formed Royal National Orthopaedic Hospital, became assistant surgeon in 1911, and Consultant surgeon in 1913, a position he held till 1947.
He worked tirelessly all his life, during 1911 he simultaneously served several hospitals – one orthopaedic, two children's’ hospitals and a neurological hospital.
He thus practised three surgical specialities at the same time. He conducted the majority of neurosurgery at the Maida Vale Hospital for Nervous Diseases during his service there 1911-1933, and parallel to this did much of the neurosurgery at Middlesex Hospital – where he was an orthopaedic surgeon.
Bankart was interested in spinal surgery and was one of the first in Great Britain to perform lateral cordotomy for relieving pain.
During the First World War he was called in and worked even harder through increased activity in some military hospitals as well as with Robert Jones in the newly opened Shepherd’s Bush Military Orthopaedic Centre with 800 beds. During the Second World War he again worked hard and cared for 100 more beds in the Mount Vernon Hospital. 4
We know this surgeon because of Bankart's procedure and the skids he developed. He trained at Guys hospital in London and worked as a surgeon at the Royal National Orthopaedic hospital London. He was known as a man with a lot of energy and hyperactive. During the WW1 he worked alongside the military surgeons including Robert Jones at Shepherds Bush.
During the Second World War he worked at Mount Vernon Hospital. He retired in 1944, but continued working until his death, after a full day of operating at Mount Vernon Hospital, on 8 April 1951.
He is best known for his work on recurrent dislocation, Bankart lesion, and Bankart repair for shoulder dislocation. and also, for the skids that are named after him.
Henry Jacob Bigelow 1818-1890Henry Bigelow was born in Boston Massachusetts in 1818. He was the son of a doctor and followed in his father’s footsteps and entered into the profession with the aim of pursuing a career as an Orthopaedic surgeon.
He graduated from Harvard College in 1837.
Dr James Jackson said about Dr Bigelow while he was still at school, “If he does not become a distinguished man it will because Boston is not a large enough field for his ability.” Prior to attending Harvard Medical School where he received his medical degree in 1841, Dr Bigelow spent a period of time studying medicine abroad in Paris and London, under the direction of famed doctor Sir James Paget. After graduating, he opened a private practise devoted to surgery. 5
He took some time to complete his studies as illness and travels to Europe impeded his progress.
Although eventually becoming a very eminent professor of orthopaedics, and lecturer at his father’s place of work, Harvard University, he is best known for his contribution to the publicising of the discovery of anaesthesia at his hospital (Massachusetts).
It was a paper written by him on Morton's discovery that went around the world announcing the birth of painless operations by the use of Sulphuric ether. "Insensibility during surgical operations produced by inhalation". An extract: "On the 16th of Oct 1846, an operation was performed at the hospital upon a patient who had inhaled a preparation administered by Dr Morton, a dentist of this city, with the alleged intention of producing insensibility to pain.
Dr Morton was understood to have extracted teeth under similar circumstances, without the knowledge of the patient. The present operation was performed by Dr Warren, and though comparatively slight, involved an incision near the lower jaw of some inches in extent.
During the operation the patient muttered, as in a semi-conscious state, and afterwards stated that the pain was considerable, though mitigated; in his own words, as though the skin had been scratched with a hoe.
There was, probably, in this instance, some defect in the process of inhalation, for on the following day the vapour was administered to another patient with complete success. A fatty tumour of considerable size was removed, by Dr Hayward, from the arm of a woman near the deltoid muscle.
The operation lasted four or five minutes, during which time the patient betrayed occasional marks of uneasiness; but upon subsequently regaining her consciousness, professed not only to have felt no pain, but to have been insensible to surrounding objects, to have known nothing of the operation, being only uneasy about a child left at home.
No doubt, I think, existed, in the minds of those who saw this operation, that the unconsciousness was real; nor could the imagination be accused of any share in the production of these remarkable phenomena".
Having gradually retired from practise his last two years were spent at his country place, Oak Hill, Newton, where, while driving, he was thrown from his carriage, receiving a blow on the head that was followed by a long illness. There he died, October 30, 1890, from a non-malignant stenosis of the pyloric orifice of the stomach, as verified by Post Mortem.6
Christian Albert Theodor Billroth 1829-1894Theodor Billroth’s family was of Swedish origin although he was born on the island of Rügen in 1829.
Billroth worked as a doctor from 1853-1860 at the Charité in Berlin.
In Berlin he was also apprenticed to Carl Langenbuch. From 1860-1867 he was Professor at the University of Zurich and director of the surgical hospital and clinic in Zurich.
While in Zurich, Billroth published his classic textbook "Die allgemeine chirurgische Pathologie und Therapie" (General Surgical Pathology and Therapy) (1863).
At the same time, he introduced the concept of audits, publishing all results, good and bad, which automatically resulted in honest discussion on morbidity, mortality, and techniques - with resultant improvement in patient selection.
He was appointed professor of surgery at the university of Vienna in 1867 and practised surgery as chief of the Second Surgical Clinic at the Allgemeine Krankenhaus (Vienna General Hospital). 7
He is buried in Vienna Austria.
He is famous for stomach operations he was the first surgeon on the world to achieve success against stomach cancer by removing a part of the stomach.
These operations carry his name, Billroth 1 and Billroth 2.
Walter Rowley Bristow 1882-1947Walter Rowley Bristow was born in Bexley in Kent in 1882. After attending Medical school at St Thomas's in London he obtained his FRCS in 1909. During the First World War his served with distinction at Gallipoli.
As a young man he was into fast cars and sport and did become a scratch golfer.
When he returned to England in 1916, he was recruited by Robert Jones at Shepherd's Bush Military Hospital. His association with Robert Jones continued after WW1 and Bristow built up his own reputation as an orthopaedic surgeon par excellence.
He was one of original members of the British Orthopaedic associations and was even the President of the association in 1936/7.
Girdlestone who was a very good friend, said of him: "He taught well, penetrating to the heart of the subject, picking up on the essentials with clarity and emphasis."
Bristow obtained the rank of Brigadier during the Second World War and played the same role as his friend Robert Jones did during the First World War, in coordinating all the military's orthopaedic services.
We as practitioners will remember him more so because of his lever which is still commonly used today the "Bristow's”.
He died in a London nursing-home on 10th November 1947, aged 64, and was cremated. 8
Benjamin Collins Brodie 1783-1862Brodie was born the son of a Reverend Peter Brodie, the rector of the parish of Winterslow, and Sarah Collins, the daughter of a banker from Salisbury in Wiltshire. His primary education, as was common for children of church professionals at the time was, by his father and mother. The good majority of church pastors were very well educated especially in the classics. He eventually ended up in London training under Abernathy at St Bartholomew's and then to Hunters hospital, St Georges.
He obtained positions he would otherwise not have got due to the absence of several surgeons seconded to the military during the times of the Napoleonic wars. He went on to specialise in orthopaedic conditions and we know him today for his instruments that carry his name, the Brodie's probe being a good example. After attending with Sir Ashley Cooper, the King of England, he eventually went on to become the Kings surgeon.
A quote by Brodie: "You must feel and act as a gentleman. .... But let there be no misunderstanding as to who is to be regarded as a gentleman. It is not he who is fashionable in his dress, expensive in his habits, fond of fine equipages, pushing himself into the society of those who are above him in their worldly station that is entitled to that appellation. It is he who sympathizes with others and is careful not to hurt their feelings even on trifling occasions; who, in little things as well as in great, .... assumes nothing which does not belong to him, and yet respects himself; this is the kind of gentleman which a medical practitioner should wish to be. Never pretend to know what cannot be known; make no promise which it is not probable that you will be able to fulfil; you will not satisfy everyone at the moment, for many require of our art that which our art cannot bestow."9
Jacques-Alexander César Charles 1746-1823Jacques Charles was a mathematician and physicist remembered for his pioneering work with gases and hydrogen balloon flights.
Charles was born on November 12, 1746, in Beaugency, Loire, France; his first job was as a clerk at the Ministry of Finance in Paris. However, his interests eventually turned to science.
Although Charles is relatively unknown, both during his lifetime and currently, he made some contributions to science that he is remembered for.
He redesigned the way hot-air balloons were built. He invented the valve line which enables an operator to release gas from the balloon for an easy descent, the appendix, a tube that lets expanded gas out of the balloon, and the nacelle, a wicker basket that is held onto the balloon by a network of ropes and a wooden hoop. He also suggested the use of "inflammable" hydrogen instead of plain "hot-air".
His work with gases resulted in the forming of Charles' Law in 1787, although his law is the thing he is probably most famous for, it wasn't published by him. 10.
In 1766 the British scientist Henry Cavendish had isolated a gas that was 4 times lighter than air, hydrogen. So, with this evidence on the 27th of August 1783 Charles’ first balloon was released. The balloon was made of silk with a cover of rubber solution varnish to keep the hydrogen inside.
One of the spectators was the American Ambassador to France, Benjamin Franklin, who replied, when someone asked him of what possible use this invention could have:“And of what use is a new-born baby?” This discovery was of course the birth of human flight. He died in Paris on April 7, 1823.
Charles's Law. "The volume of a gas equals a constant value multiplied by its temperature as measured on the Kelvin scale".
Sir John Charnley 1911-1982John Charnley was born in Bury and educated at the grammar school and then went on to Manchester University.
He was a bright student and passed his primary's whilst still an undergraduate.
He became an FRCS in 1936 and worked at Salford Hospital before WW2 started.
He joined the military and after serving at Dunkirk, ran an orthopaedic hospital in Cairo during the Second World War.
He modified the widely used Thomas splint, and altered the design, so it was adjustable, and was also instrumental in the design of the "Tubruk Splint", which when used with Plaster of Paris, was ideal for desert conditions.
In the sixties, John Charnley was pioneering hip replacements at the Wrightington Hospital in Wigan. The hip replacements were a success, but many patients were dying from infections.
He was put in touch with Hugh Howorth (died 2004), whose company specialised in clean air solutions for various industrial processes, including the brewing industry.
Howorth designed an airflow system to filter air and direct sources of infection away from the patient.11
As a result of this partnership, the now famous Charnley-Howorth clean air flow system is used worldwide and has saved many lives.
We also know Charnley because of his innovative work on hip prosthesis, it bears his name and is still widely used today. He was appointed Professor of Orthopaedic surgery at the Manchester Royal Infirmary in 1972.
He received a C.B.E and a Knighthood in 1977. He insisted that surgeons who wished to master his technique for hip arthroplasty should work with him, and many did, from all the corners of the earth.
This remarkable inventor and innovator died in August 1982 aged 70 a brilliantorthopaedic surgeon.12
Joseph Thomas Clover 1825-1882Clover was born in the town of Aylesham in Norfolk. He was educated at the Gray Friars' Priory School, Norwich.
When he was 16, Clover was apprenticed as a surgical dresser to a local surgeon, Charles Gibson.
Clover became house surgeon to James Syme upon graduation in 1846.
He became Resident Medical Officer at University College Hospital in 1848 and was admitted as a Fellow of the Royal College of Surgeons in 1850. Originally Clover developed an interest in the field of urology.
He then worked as a general practitioner in 1853, and was James Symes house surgeon for some time.
He set up his practise at 3 Cavendish Place, London, which became his home until his death in 1882.
This site is now commemorated by a plaque which bears his name.
After several years in general practise, he devoted his practise to anaesthetics and became "chloroformist " to the University College Hospital, the Westminster Hospital and the London Dental Hospital. It was there he developed his own inhaler.
Clover's choice of speciality helped to fill the vacancy created by the death of John Snow in 1858. 13
Clover was probably present at Robert Liston's first operation under ether anaesthesia at University College Hospital in December 1846.
Clover wrote in 1871 that he had given chloroform more than 7000 times, in addition to other anaesthetics in another 4000 cases, without a fatality. However, he lost a patient to chloroform under his hands in 1874. He described the case in the British medical Journal.
John Snow is heralded as the first physician anaesthetist in this country if not the world.
Joseph Clover however is probably regarded as the first real working anaesthetist and innovator. Like John Snow before him, he anaesthetised many a famous name; Sir Robert Peel and Florence Nightingale were among them.
He developed the first apparatus to deliver chloroform in a controllable amount and having delivered many thousands of anaesthetics in his lifetime he is only known to have had one death as a result.
He also devised and invented an ether inhaler.
Unfortunately, he died quite young aged just 57.
Abraham Colles 1773-1843Abraham Colles was born at Kilkenny in Ireland and became one of the most recognisable names in Orthopaedic Surgery. It is said that during his attendance at Kilkenny Grammar School a flood swept part of the house of a local doctor away.
An anatomy book was found by Colles in a field near his home. When he took the book to the doctor, Dr Butler, Butler told him to keep it, and it was this incident that influenced Colles' choice of future profession. (It could be an old Irish Tale). 14
It has been said that Colles in order to get from Edinburgh to London (where he obtained a Medical Degree), walked the 400 or so miles.
When in London, he worked with Sir Ashley Cooper, who was to become a very good friend.
In 1804 he was appointed professor of both anatomy/physiology and surgery. at the Royal College of Surgeons (Ireland), to which he was later elected president in 1802, at the age of only 29 years, and again in 1830.
Colles was both generous and modest. As a competent lecturer he contributed to making his college one of the most respected in Europe, for a couple of decades.
During his year in Dublin, Colles married Sofia Cope. He had several children and his oldest son followed in his footsteps, even being elected to president of the Royal College of Surgeons.
He spent most of his working life at a practise in Dublin, and is looked upon with admiration from orthopaedic surgeons throughout the world.
Everybody understands the term Colles Fracture.
Sir Astley Paston Cooper 1768-1841Cooper was born in 1768 in the village of Brooke Norfolk. He was the son of clergyman.
A wild but charismatic child, Astley was born in 1768 and spent a period being fostered out to a nearby farming family. The story went that when he saw a foster brother run over by a cart, his femur shattered and all around him panicking, Astley saved the boy's life by calmly pressing on his femoral artery until a surgeon could arrive.
This, went the tale, set him on the road to becoming a surgeon. 15 It is likely however his uncle was the main influence.
At the age of 16 he was sent to London to study under Henry Cline at St Thomas's hospital. He attended lectures given by the influential surgeon and lecturer, John Hunter at St Georges Hospital.
His uncle William Cooper was also a surgeon at Guys, when he died, Astley took over his position at Guys.
Cooper lived at Gadebridge House in the market town of Hemel Hempstead.
Astley Cooper became very famous in his day as the leading surgeon of the time. He carried out a hind leg amputation and was present at Hoo Loos unsuccessful operation.
He also carried out the very first ligation of the abdominal aorta in 1817, assisted by Aston Key (who 14 years later operated on Hoo Loo assisted by Cooper).
The patient, Charles Huston unfortunately died 40 hours after the operation. The surgery was a success however, no doubt the patient would have died sooner if Cooper had not carried out the procedure.
He eventually became Surgeon to the Royal family and removed an infected cyst from King George IV.
He would be termed today as an Orthopaedic surgeon, or by others a Vascular surgeon (the approach to the external iliac artery are named after him) but as was the case in that era, they did not limit themselves to just orthopaedics or vascular, they were all general surgeons.
Ronald Sidney Cormack 1930- John Robert Lehane 1945-Ronnie Cormack and John Lehane have given the anaesthetist the means to grade a difficult intubation. Used in conjunction with Malampati's Score, it is an excellent indicator to an anaesthetist on how difficult the intubation about to be performed is going to be.
Cormack was born in Burma in 1930 of Scottish parentage.
He worked mainly in Bristol, London and Oxford during his career.
Lehane was born and educated in Merseyside then moving to Northwick Park Hospital in the mid-seventies.
It was here in 1984 that they wrote the paper on their now famous intubation Grades. 16
Their landmark contribution to clinical anaesthesia soon achieved general acceptance and promoted further improvements.
Since the publication the two names have become linked like the two sides of a coin, and it is difficult to mention one without mentioning the other. Internet journal of airway management in December 2009 wrote a special piece to celebrate the 25 years of Cormack and Lehane classification.
Such is the significance of their work that it is impossible to read or write a chapter on airway management without referring to these two famous names.
Lehane’s published work is amongst the most read and quoted papers in the world, and Dr Lehane with Dr Cormack are amongst the most famous names in anaesthesia. 17
Michael E DeBakey 1908-2008Michael Ellis DeBakey was born on September 7th, 1908, he was the son of Lebanese immigrants who later after becoming Anglicised, changed their name from Dabaghi to DeBakey.
DeBakey was educated at Tulane University where he also received his MD.
In World War II, Dr DeBakey helped modernize battlefield surgery by urging that doctors be moved from hospitals to the front lines, where only first aid had previously been given.
DeBakey said that he and others created early versions of what became the mobile army surgical hospital, or MASH unit, in the Korean War. For changing the strategy of treating the wounded, the Army awarded him the Legion of Merit.
He was instrumental in the development of heart lung machine and he himself carried out the first coronary artery bypass surgery.
He was to go on to pioneer many operations for conditions such as Aortic Dissection, ironically, he himself was to suffer from this condition in his last years although he died of natural causes at the age of 99 in 2008.
Edmond I Eger II 1930- 2017Edmond Eger was born in Chicago, when Al Capone was at his worst. He was maturated at Illinois and trained as an anaesthetist at St Luke's. He moved about the country with the Army and joined the University of California in 1960.
Dr. Eger devised a method working with Dr Giles Merkel, Dr Lawrence Saidman and other anaesthesiologists at the University of California, San Francisco. They identified one value to use as a benchmark: the concentration of anaesthesia at which 50 percent of patients did not move in response to a painful stimulus, like being cut with a scalpel.
Other patients would require a slightly higher or lower concentration to achieve the same effect, but the variations were not large.
That led to their introduction in 1965 of a concept, called the minimum alveolar concentration, or MAC, which quickly became the standard measure of potency for anaesthetic gases. 18
Eger has given the Anaesthetic profession the Minimum Alveolar Concentration or MAC for short. This gives the anaesthetist a guide to Anaesthetic depth.19
He died of pancreatic cancer on Aug. 26, 2017 at his home in Tiburon, California. He was 86.
Hans G Epstein 1909-2002Hans Epstein (always known in College and his Department as "Ep" or "Eppy"), was born in Berlin and educated in Switzerland and Bavaria, returning to Berlin where he received a doctorate in physics, summa cum laude in 1934.
As Jews in Germany were undergoing severe harassment and brutality, he realised that it would be better for him and his family to move to England. It was in Oxford that Epstein began specialising in research and development in the field of anaesthesia.
He was employed at the Clarendon Laboratory where Sir Robert Macintosh, who was keen to develop a new Ether inhaler: Ether being the principle anaesthetic of the day.
With support from Lord Nuffield, an academic, the "Department of Anaesthetics" was established in Oxford, the first in the country. Its Director was interested in developing new forms of inhaler for delivering Ether, and Epstein began work on this at the Clarendon.
The need became urgent for inhalers suitable for use under field conditions, in 1939 when war with Germany broke out.
Hans Epstein because he was German by birth, was restricted in what he could do, but helped to design a simple, portable, and effective ether vaporiser, known as the Oxford inhaler.
These were manufactured in thousands and used throughout the world.
Through the 1950s and 1960s Epstein continued his research and development of anaesthesia inhalers, building himself a global reputation as a leading expert in this field.
His inhalers harnessed the latest anaesthesia agents, such as Halothane: an example was the Oxford Miniature Vaporizer (OMV), a version of which found use during the Falklands conflict in 1982. Version 50, this particular set-up was supplemented by the use of Ivan Houghton's design of tubing using and "Laerdal Resusci Bag", his own "Hautonox Valve" and a "Sanders T piece" to supplement the oxygen.
In his retirement he was able to pursue many outdoor interests including study of wildlife, mountains and cycling. He is survived by his wife, Vera, and two sons.20
Johann F.A von Esmarch 1823-1908I have included this particular German Surgeon Johann Von Esmarch because He was one of the last great surgeons of the nineteenth century German school.
He was primarily a military surgeon and has been therefore called the "Ambroise Paré of Germany".
Born on January 9, 1823, in the small town of Tonning, on the west coast of Schleswig-Holstein, he was the son of a district surgeon. As a nine-year-old schoolboy, he dissected frogs, and accompanied his father on his rounds.
His schooling was in Redsburg and Flensburg, though he was less than a model student.
Esmarch was a proud German patriot and participated in the struggle to free his native Schleswig-Holstein from Danish control. 21
I am familiar with the Esmarch bandage which we used to use in the seventies and eighties. It was made of red rubber and was really good at exsanguinating limbs. It has made a comeback with hand surgeons although not of rubber.
He was mainly concerned in his life with first aid, and obtaining bloodless fields during surgery. The bandage was originally designed to help in the reduction of fractures.
As Surgeon-General, Esmarch required every German soldier to have an "Antiseptic Dressing Package". This is described in the German Military Sanitary Regulations of 1886 as containing, "Two antiseptic muslin compresses 40 cm. X 20 cm., a cambric bandage 300 cm. X 5 cm., a safety pin, and waterproof material 28 cm. X 18 cm., for covering." 21
Harold Delf Gillies 1882-1960Harold Delf Gillies was born in Dunedin, New Zealand, in 1882. He studied medicine at Cambridge University and qualified from St Bartholomew’s Hospital in 1906, becoming a Fellow of the Royal College of Surgeons four years later.
He served in France during the First World War, where he met an American-French dentist called Charles Auguste Valadier, who had succeeded in establishing a unit for jaw work, at the 83rd General Hospital in Wimereux, near Boulogne. 22
Gillies became enthusiastic about Valadier’s efforts to replace missing jaws resulting from gunshot wounds.
He was persuaded by the Army Surgeon-General, Alfred Keogh that facial surgery should be concentrated in one place, acquiring wards at the Cambridge Military Hospital in Aldershot, where I was trained.
Harold Gillies was one of the pioneers of facial reconstructive surgery. His instruments remain in use today.
Gillies not only concentrated on plastic surgery but was one of the first, if not the first to perform the Le Fort osteotomy. He worked alongside Ivan Magill and Rowbotham and as a team they developed a new gear for plastic reconstructive surgery. The picture shows Gilles with his team at St Marys in Sidcup during the first world war. 23
In 1945 Gillies, ever the pioneer, carried out the world's first sex change of a woman into a man.
His dissecting forceps are still one of the commonest in use today. Gillies died on 10 September 1960 at 20 Devonshire Place, Marylebone. Despite earning an estimated ₤30,000 a year between the First and Second World Wars he left an estate of only ₤21,161. 24
Gathorne Robert Girdlestone 1881-1950Gathorne Robert Girdlestone was born at Christ Church in Oxford on 8 October 1881. His father, Robert Baker Girdlestone – the seventh son of Charles Girdlestone (a Fellow of Balliol) and Anne (daughter of Baker Morrell, Solicitor to the University of Oxford) – was Principal of Wycliffe Hall at the time.
Girdlestone’s father had had two sons by his first marriage, but GRG was the only son of his second marriage to Annis, who named him after her brother, Sir Gathorne Hardy (who defeated Gladstone to become MP for Oxford from 1865 to 1876 and was made first Earl of Chambrook in 1892).25
He went to Charterhouse School in 1896, and read Medicine at New College, Oxford, and started his clinical training at St. Thomas’s Hospital in London in 1905.
He was to take an interest in orthopaedics under the guidance of Robert Jones.
Having been involved in a motor cycle accident in which he suffered major chest injuries, he was kept in the UK during the First World War, working with Robert Jones.
Post war Robert Jones along with many other orthopaedic surgeons, and Agnes Hunt, campaigned for orthopaedic services to be established country-wide.
In 1937 he was appointed Nuffield Professor of Orthopaedic Surgery (thus becoming the first professor of orthopaedics in Britain). He retired from the chair in 1939 and moved to Frilford Heath in 1948, but continued to be interested in the hospital, helping to launch the scheme for the Nuffield Orthopaedic Centre in 1949.
We know him mainly by the procedure named after him in hip surgery.
GRG died at St. Bartholomew's Hospital in London at the age of 69 on 30 December 1950. 25
Thomas Cecil Gray 1913-2008Thomas Cecil Gray will be remembered for what was known as the "Liverpool Technique". Thomas Cecil Gray was born in Liverpool in 1913. After his education at Ampleforth College he went on to graduate at Liverpool University in 1937.
In those days it was not unusual for a GP to give an anaesthetic, he formalised himself by doing a diploma in anaesthetics and work at the local hospitals in Liverpool.
Becoming interested in the subject, he took the Diploma in Anaesthetics, sold his general practise and developed an extensive anaesthetic practise in the leading local hospitals.
Enlisting in the Army in 1942, he was posted to a mobile neurosurgical unit in Oxford.
Later, in North Africa, he suffered a severe bronchopneumonia and was discharged in 1944. On recovery, he resumed his hospital practise. Having read of "The use of curare to improve abdominal muscle relaxation during general anaesthesia", by Griffiths in Canada, he began laboratory and clinical investigations. 26
In 1946 he presented the results of its use in abdominal surgery and those of John Halton who was at that time was a doctor with the RAF, at the Royal Society of Medicine - a total of more than 1,000 cases.
Gray and Halton's trial was successful and the birth of relaxation anaesthesia in this country was established. He extended his trials to full relaxation and with eventual reversal of the relaxant with atropine and neostigmine. (Liverpool Technique)
He was also the first to describe the train of four technique before reversal. He edited several publications.
Harold Randall Griffith 1894-1985Harold Randall Griffith was born in Montreal, Quebec Canada. His father was a doctor, so it seemed natural for him to follow suit. He studied at the same Magill University as Murphy, but unlike Murphy, he continued to work in Montreal after qualifying.
He served in the 6th Field Hospital with the Canadian Expeditionary force during the Great War and was awarded the Military Medal for Gallantry during the battle of Vimy Ridge.
He spent some time as a surgeon with the Royal Navy towards the end of WW1.
After the war he returned to Canada and in 1923 took up the position as Senior Anaesthetist at the Homeopathic Hospital in Montreal.
Harold Griffith was the first to use the Non-Depolarising muscle relaxant, Curare (Intercostin) with his assistant Dr Enid Johnson on 23 January 1942 on a patient who underwent appendicectomy, this after being given the idea by Dr Lewis Wright. 27
This man was as brave at the later part of his life as he was in the early part. He died after a losing the battle against Parkinson’s Disease in 1985.
Arthur E Guedel 1883-1956Arthur Guedel is better known today for his design of the oropharyngeal airway. Guedel is another of the Anaesthetists who cut his teeth during the great war. He put together his Guedel chart which explained the depth and signs of Ether anaesthesia.
This was done so that the operators during the war could recognise the stages the patient was in. However, anaesthetist and assistants know Guedel for his classification or stages of anaesthesia, which are:
Stage I (Stage of Analgesia or the stage of Disorientation): from beginning of induction of anaesthesia to loss of consciousness.
Stage II (Stage of Excitement or the stage of Delirium): from loss of consciousness to onset of automatic breathing. Eyelash reflex disappear but other reflexes remain intact and coughing, vomiting and struggling may occur; respiration can be irregular with breath-holding.
Stage III (Stage of Surgical anaesthesia): from onset of automatic respiration to respiratory paralysis. It is divided into four planes:
Plane I" - from onset of automatic respiration to cessation of eyeball movements. Eyelid reflex is lost, swallowing reflex disappears, marked eyeball movement may occur but conjunctival reflex is lost at the bottom of the plane.
"Plane II" - from cessation of eyeball movements to beginning of paralysis of intercostal muscles. Laryngeal reflex is lost although inflammation of the upper respiratory tract increases reflex irritability, corneal reflex disappears, secretion of tears increases (a useful sign of light anaesthesia), respiration is automatic and regular, movement and deep breathing as a response to skin stimulation disappears.
"Plane III" - (Surgical Anaesthesia) from beginning to completion of intercostal muscle paralysis. Diaphragmatic respiration persists but there is progressive intercostal paralysis, pupils dilated, and light reflex is abolished. The laryngeal reflex lost in plane II can still be initiated by painful stimuli arising from the dilatation of anus or cervix. This was the desired plane for surgery when muscle relaxants were not used.
"Plane IV" - from complete intercostal paralysis to diaphragmatic paralysis (apnoea). 28
Stage IV: from stoppage of respiration till death. Anaesthetic overdose cause medullary paralysis with respiratory arrest and vasomotor collapse. Pupils are widely dilated, and muscles are relaxed.
Guedel married Florence Fulton in 1909. They had two children: Guedel died in California in 1956 at the age of 72. 29
Agnes Hunt 1866-1948She was born in London, on the last day of the year in 1866, there is some confusion about this date as she says in her book that she was born in 1867.
She was the daughter of Rowland Hunt (1828-1878) and his wife, Florence Marianne. Hunt was brought up at Boreatton Park until 1882, then at Kibworth Hall, Leicestershire before her mother took the children to Australia after the death of her father.
They lived on a small farmstead. She was disabled from osteomyelitis of the hip that she suffered from as a child following septicaemia.
This painful disorder was to go on to give her the impetus to become a nurse to those with a similar condition.
In 1887, she returned to England with her brother Thomas and she began training as a "lady pupil" nurse at the Royal Alexandra Hospital in Rhyl, Wales.
In 1891 she qualified as a nurse at the Salop Infirmary, Shrewsbury. One of her first jobs was to work as a district nurse and on October 1st, 1900 she opened a convalescent home for children at Florence House, Baschurch with nursing colleague Emily Goodford as joint superintendent.30
She had her first meeting in Liverpool with the great Robert Jones, orthopaedic surgeon, for a consultation about her continuing hip problem.
He immobilised her on his abduction frame for a few months. This was also the start of a friendship that would last.
In 1918, Agnes Hunt was awarded the Royal Red Cross for her contribution during the war. In 1919, the British Red Cross Society and the Shropshire War Memorial Fund provided financing to move the facility, renamed the Shropshire Orthopaedic Hospital, to a former military hospital at Park Hall, near Gobowen, Oswestry.
The hospital also provided training for nurses.
Later, a school begun for the children which developed into a training college for disabled adults, Derwen College.
The hospital was used once again to treat wounded soldiers during World War II. Following an extensive fire in 1948, the hospital underwent a period of reconstruction and expansion, developing into what is now called "The Robert Jones and Agnes Hunt Orthopaedic Hospital".31
Gordon Jackson Rees FRCA, FRCP, FRCPCH 1918-2001Gordon (Jack) Jackson Rees was born in Oswestry Shropshire the son of a farmer. Early in 1943, Jack was called up into the Royal Air Force medical branch and served as a station medical officer before being sent to the Radcliffe Infirmary, Oxford, to study anaesthesia under Professor Robert Macintosh and William Mushin. 32 He obtained the one-part Diploma in Anaesthetics in 1946.
He became a pioneer of paediatric anaesthesia, but his earlier scholastic achievements, by his standards, were modest and gave little hint of his later academic brilliance.
He was appointed a consultant anaesthetist to the Royal Liverpool Hospitals in 1949 and joined the new university department of anaesthesia as a part-time demonstrator.
He introduced the revolutionary concept of the “Triad of anaesthesia”.
After the war he remained in the RAF for a short period before being offered a position at Liverpool Hospital working alongside Thomas Cecil Gray. He will be known as one of the pioneers and developers of paediatric anaesthesia and was known with Gray for the "The Liverpool Technique".
He will be known to us as ODP's and Nurses for his Jackson Rees modification of the "Ayres T-piece" for the ventilation of babies and small children. We use a modification of this circuit today and call it the "Mapleson F".
Michael Johnstone d2007Michael Johnstone was the anaesthetist who led the clinical introduction of Halothane in 1956 he was based at Manchester Royal Infirmary. There were others involved, one particular anaesthetist of note was Frank Robert-Shaw of Sheffield.
Johnstone a Queens University Hospital Belfast graduate in 1941, became an anaesthetist in 1953 because he had a bad experience when he was a house officer.
Having had little training, he sought advice from an experienced house officer. The advice given was: "Oh, you don’t have to do much. Just drip chloroform on to the mask and if the patient goes grey, send for me".
The patient did go grey and Johnstone was determined to find a better agent.
In 1956, he was offered the opportunity to trial Halothane, which had been developed in the UK, and was the agent he felt that ticked the boxes.
This halogenated hydrocarbon was first synthesized by C. W. Suckling of Imperial Chemical Industries (ICI) in 1951. Halothane became popular as a non-flammable general anaesthetic replacing other volatile anaesthetics such as Diethyl Ether and Cyclopropane. Use of the anaesthetic was phased out during the 1980s and 1990s as newer anaesthetic agents like Sevoflurane and Desflurane became popular. Halothane still retains some use in the Third World because of its lower cost.33
He was a champion for ODPs in his time. He died in October 2007 of a CVA. Also, in the photo at top. Charles Sucking (centre), and James Raventos the co discoverers of Halothane.
Thomas Pomfret Kilner 1890-1964Thomas Kilner was born on 17 September 1890, the son of a master at Manchester Grammar School.
He was educated at Queen Elizabeth Grammar School, Blackburn, and at Manchester University, where he won the Dauntesey Scholarship at the Sidney Renshaw Exhibition, and was later awarded medals in anatomy and physiology. He won distinctions in surgery and pathology when he qualified in 1912. 34
He Graduated into medicine at Manchester. He worked alongside Harold Gilles at Sidcup in 1919. Tommy Kilner, with Gilles remained the only two dedicated specialists in England until the 1930s, when they were joined by Rainsford Mowlem and Archibald McIndoe. He was to remain great friends with Harold Gilles all of his life.
These four were the only plastic surgeons in the UK at the outbreak of the Second World War in the nation’s teaching hospitals.
He worked at Sidcup, Roehampton and Oxford where he became Nuffield Professor of Plastic Surgery. He held this Chair from 1945 - 1957.
He retired in 1957 and died of an abdominal aortic aneurysm in 1964. 35
We in theatre are still reminded of him because of his still commonly used Kilner needle holder and fine scissors.
John Knight 1600-1680John Knight was born in Warwick in 1600 and was admitted to Caius college in 1619. In 1625 he was ordained by the Bishop of Peterborough as deacon and as priest after taking his degree and received his M.A. in 1626.
He served most of his military career as a naval surgeon. Pepys met Knight and his wife at a dinner in 1662 where he has written in his diary "We were pretty merry".
The surgeons started to receive a higher and respectable form of professional recognition, as in 1664 John Knight was made Surgeon General of all the forces in England and Wales. John Knight was a supporter of the royalist cause and was a contemporary of Richard Wiseman.
He followed Prince Charles to Europe during the time of the royalist exile and returned with Charles II in 1660. He was favoured by the king simply because of his loyalty towards the crown.
In the seventeenth century, a change of attitude took place, which was to change the nature of thought towards medicine. This was in part because of the reformation; the influence of the Catholic Church had collapsed in Britain and elsewhere.
Previously, Galileo pronounced that science is measurement.
With scientific discoveries by the likes of the well-respected Isaac Newton (1643- 1727) and others, the investigation into medical properties of substances speeded up, and did not stir up a panic by the clergy on the opposition to God’s will. 36
Morel introduced the tourniquet into common use in 1674; the screw tourniquet was introduced in 1718 by Petit.
This change of attitude towards scientific and medical research became known as the enlightenment. John Knight died in 1680 and was buried at St Brides Church in Fleet Street, London. John Knight was also associated with the Hunstanton lighthouse and was a close friend of Samuel Pepys. He was granted the first patent for the lighthouse.
Robert Jones 1857-1933Robert Jones was born in Wales and was brought up in London, where he studied to become a doctor. After qualification he became a surgeon, his uncle Hugh Thomas, had taught him the nature of fractures and bone deformities when he was a child, so he was natural for him to choose Orthopaedics as a profession.
When the WW1 broke out he joined the Army and was eventually responsible for setting up several orthopaedic hospitals with the intention of returning the injured soldiers back to duty as soon as possible.
He recruited a team of Orthopaedic doctors, some of which were to become very eminent surgeons. He directed 20 military orthopaedic hospitals which rehabilitated many injured soldiers. At one hospital, Shepherd’s Bush in London, Jones oversaw the return of 1,000 out of 1,300 injured soldiers to the fighting.37
Robert Jones was director of military orthopaedics from 1916. His uncle Hugh Thomas had invented a splint (the Thomas splint,) which was introduced by Jones and used extensively during the conflict. His main place of operations was Shepherds Bush Military Hospital.
He worked closely with Agnes Hunt in later years and a hospital is now named after them both.
We will also remember him for the bandage that is named after him. 38
Theodor Kocher (1841-1917)Theodor Kocher was born in Switzerland. The son of Jacob Alexander and Maria Kocher, He spent most of his life at the University of Bern and graduated in 1865.
He was a student of Bernhard von Langenbeck in Berlin and Theodor Billroth in Vienna before being appointed Professor of Surgery in Bern in 1872 at the age of 31 years.
Kocher further contributed to medicine with his Textbook of Operative Surgery, his pioneering of ovariotomy and, especially, his application of the antiseptic techniques of Joseph Lister.
He actually put down his success to Listers technique for his thyroid surgery.
He was mainly a thyroid surgeon and he performed over 2,000 thyroidectomies. Received the Nobel Prize in Physiology or Medicine for discovering that the thyroid gland was an essential organ.
He introduced the use of sterilised silk sutures into his surgical practise in 1882. His name is associated with a toothed surgical clamp, an atraumatic bowel clamp and a curved director.
The sub-costal incision for an open cholecystectomy is called the Kocher's incision.39
Gerhard Küntscher 1900-1972Everybody has heard of the "K Nail" or "K wire" it was Küntscher who was the innovator of that device.
This surgeon was born in Germany in 1900. He was educated at Wurzburg and Hamburg and was made a Professor of Surgery in 1942.
He served with the German Army on the Eastern Front and when the war ended went back to what was left of Hamburg.
While in Finnish Lapland from 1942 to 1944, Küntscher taught Finnish surgeons to do intramedullary nailing’s, which earned him recognition and respect in the orthopaedic community.
The war also prevented the knowledge of Kuntscher’s use of the IM nail to exit Germany. The German military had the upper hand in treating soldiers with the IM nail and having them return to fighting status in just a few weeks.
Worldwide knowledge was not established until the the "Kuntscher Nail" prisoners of war (POW’s), returned to their home countries., identified by Küntscher’s legacy, i.e. steel nails in their legs. 40 He wrote several books and introduced femoral nailing in the 1930s.
He is said to have died at his desk in Hamburg in 1972.
Sir William Arbuthnot Lane Bt, CB, FRCS, Legion of Honour 1856-1943William Lane was a jack of all trades. He pioneered internal fixation of displaced fractures, procedures on cleft palate, ,colon resection and colectomy to treat "Lane's disease", now otherwise termed colonic inertia.
He identified this in 1908, and the surgery, although controversial, advanced abdominal surgery.
Hw was the pre-eminent surgeon for the late-Victorian and Edwardian periods. Lane operated on socialites, politicians, and royalty.
Lane was made a Baron in 1913.41
During World War I, as an officer with the Royal Army Medical Corps, he organised and opened Queen Mary's Hospital in Sidcup, which pioneered reconstructive surgery. His surgical colleagues included the late great Harold Delph Gilles and anaesthetists Sir Ivan Magill and Stanley Rowbotham.
We as Operating Department Practitioners and theatre Nurses, know him today for his many instruments that are named after him, dissecting forceps and bone levers and holders. He was the surgeon who introduced the non-touch technique to reduce the incidence of infection in orthopaedic surgery. You will also notice the length of his bone holders and levers which were designed to keep the hands away from the wound.
He was known also for his dexterity which fascinated his assistants at the time and is very rarely seen today, the only surgeon I have ever had the pleasure of working for with anything like that is Professor James (Jim) Ryan when I was in the Military.
Bernhard von Langenbeck 1810-1887Langenbeck was born at Padingbüttel, and received his medical education at Göttingen, where one of his teachers was his uncle Konrad Johann Martin Langenbeck. He took his doctorate in 1835 with a thesis on the structure of the retina. 42
Von Langenbeck is perhaps best-known today as the "father of the surgical residency". Under his tutellage at the Charite in Berlin, he conceived and developed a system whereby new medical graduates would live at the hospital as they gradually assumed a greater role in the day-to-day care and supervision of surgical patients. Among his most well-known "house staff" were such illustrious surgeons as Billroth and Kocher. 42
Bernard Von Langenbeck is best remembered by his inventions especially his hand- held retractors, these instruments are used in probably every country in the world that has a general surgical tray.
His life as a surgeon was once again dominated by his military career specialising in the injuries received as a result of war. He is credited as the father of the house surgeon (the resident surgeon).
He was buried in Berlin on the 5 October 1887 next to his wife.
John Alfred Lee 1906-1987Having worked at the hospital in Southend during my agency years I find it impossible to resist the inclusion of the great Anaesthetist Alfred Lee. As an ODP, I consider him a champion for the group of people known as OTT's / ODA's. I omit the ODP's as during his tenure as an anaesthetist they never existed.
This “Liverpudian” Anaesthetist was born in 1906 and trained as a doctor in Newcastle upon Tyne and qualified in 1927. A spell at the Royal Victoria Hospital followed,and he eventually moved on as a general practitioner who administered anaesthetics at Southend General Hospital.
It was at the start of WW2 that he became a fully-fledged Anaesthetist and concentrated on that speciality, along with trauma medicine, to treat the many victims of the regular bomb raids upon London by the Luftwaffe.
During the latter end of the war he started to write "The Synopsis of Anaesthesia", this book was the first anaesthetic book I read that gave me an interest in the History of Anaesthesia. It was first published in 1947. The book is still popular now with Dr Richard Atkinson who died in 2001 and Rushman updating the later editions.
I worked with Dr Rushman during the 90s and he had a great deal of respect for Alfred Lee. He retired from the NHS in 1971 but still carried on updating the synopsis, and was the founder member of the History of Anaesthesia Society.
He was proactive in the early days of the OTT when it struggled to gain recognition as a profession. I have published one of his letters 43in the section on ODPs.
Alfred Lee was President (1959) and Hickman Medallist (1976) of the Section of Anaesthetics, at the Royal Society of Medicine. He was President (1972-3) and later an Honorary Member of the Association of Anaesthetists of Great Britain and Ireland. He was elected and re-elected to the Board of Faculty of Anaesthetists of the Royal College of Surgeons of England and was the Faculty Clover Lecturer in 1960, and was awarded the Faculty Gold Medal in 1976.
It cannot be said that he found public duties or public speaking entirely enjoyable, but he undertook them willingly, competently and successfully.44
Lee opened the first British anaesthetic outpatient’s department in 1948.
He was very interested in regional analgesia and was instrumental in keeping the practise of spinal and extradural analgesia alive. He retired in 1971 but continued working and teaching as a locum in Southend until after his 80th birthday. He was President of the Association of Anaesthetists of Great Britain and Ireland from 1986-88 and attended meetings of the Section of Anaesthetics of the Royal Society of Medicine until the month of his death, in April 1989.45
A man who was awarded several honours in the field of medicine and in my little world one of the great names in Anaesthesia a deserving in his place in history.
Robert Liston 1794-1847Robert Liston was born in Ecclesmachan Scotland and was the son of a Pastor. He was educated in Edinburgh and London.
He was appointed lecturer of anatomy in Edinburgh and left Scotland for London in the 1830s after disagreements with colleagues at the Edinburgh hospital where he worked; he was known to be a very abrasive and arrogant person.
He was known to have operated very quickly which lessened the suffering of the patient.
He was also the inventor of the Liston splint, which is still in use at some hospitals today.
There are stories of occasions when his operations went wrong due to the speed at which he attempted them. The two most notable examples of this were when he amputated a man's testicles along with his leg by mistake, and another operation where the patient died of infection.
He cut off the fingers of his assistant (who also died due to infection) and slashed the coat of a spectator who died of fright.
Robert Liston is the only surgeon in known history to have performed an operation with a 300% mortality rate. There is, however, apparently no precise source for these stories, so they might well just be regarded as urban legends.
Although it sounds as though this man should not be let loose on anyone, Robert Liston was the best surgeon of his time and all those who could afford his services would have had no hesitation in doing so. He saved a lot of people that would have died a miserable long and painful death.
It is easy to judge using our standards.
On December 21, 1846, at University College Hospital, London, Robert Liston, performed the first operation in England using anaesthetic (Ether) administered by Dr Squire. He operated on a patient named Frederick Churchill; he performed a above knee amputation with great success. He was to say to his audience of medical professionals
“This Yankee dodge, gentleman, and beats mesmerism hollow” 46
He knew now that the “age of agony” had come to an end in surgery. Robert Liston was to die shortly after in December 1847.
There are those who saw Liston as a mad eccentric surgeon, however, you must understand that speed was of the essence in pre-anaesthetic surgery, who would you rather amputate your leg whilst completely awake, Liston who will complete the procedure in 2-3 minutes or another less competent surgeon in 5-10 minutes, I know who I would choose.
We cannot judge these surgeons using our modern-day expectations.
MacheonA son of Aesculapius by Epeione or, according to others, a son of Poseidon. He was married to Anticleia, the daughter of Diocles.
In the Trojan war Macheon appears as the surgeon of the Greeks, the early Greeks and Romans used vegetable and mineral styptics on wounds received in battle; it was with these that Macheon ministered to Menelaus during the battle of Troy, with his brother Podaleirius who was a physician, they had gone to Troy with thirty ships, commanding the men who came from Tricca, Ithome, and Oechalia. Unlike today where doctors keep clear of actual combat, in those days everyone was a warrior first. Homer says he was wounded by Paris but was carried from the field of battle by Nestor.
Later writers mention him as one of the Greek heroes that were concealed in the wooden horse. He was said to have been killed by Eurypylus, the son of Telephus, (although some say he was killed by the Amazon Queen Penthesileia) and his remains were carried to Messenia by Nestor.
His tomb was believed to be at Gerenia, in Messenia, where a sanctuary was dedicated to him, in which sick persons sought relief of their sufferings. It was there that Glaucus, the son of Aepytus, was believed to have first paid him heroic honours. 47
Homer writes: "Meanwhile Achilles was standing by the stern of his ship watching the defeat of the Greeks, but when he saw Macheon being carried past, sorely wounded, in the chariot of Nestor, he bade his friend Patroclus, whom he loved better than all the rest, to go and ask how Macheon is." 48
Seshhagiri Rao Mallampati 1941-Mallampati was born in Andhra Pradesh India in 1941. He was educated in India and immigrated to the USA in 1971.
Whilst working at the Brigham and Women's Hospital, he encountered a patient who was difficult to intubate, despite the usual routine of positioning.
The patient had a normal head and neck. He found that the Tonsils and uvula were concealed by the base of the tongue, Mallampati suggested that this anatomical feature would be sign of a difficult intubation.
He subsequently validated this clinical sign and refined it to the four-grade system that is now widely used in today's anaesthesia.49
Class 1: Tonsils clearly visible
Class 2: Hard and soft palate Visible Upper half of tonsil visible
Class 3: Soft and Hard Palate base are clearly visible
Class 4: Only Hard Palate visible.
Roger Edward Wentworth Manley 1930-1991This inventor, anaesthetist and engineer, was described as a quiet, modest man and was another graduate of the Westminster hospital in London. He was appointed in the year of my birth in 1954 as an anaesthetist.
With always one eye in a medical magazine and the other in an engineering manual he was soon to start work on improving the ventilators that were in use at that time, most of them were noisy, unreliable, heavy and cumbersome. His first minute volume divider (Manley Ventilator) was to appear in 1961. It was easy to use at it only required a fresh gas flow.
In a lot of places, the anaesthetist used to hand ventilate the patients for the shorter procedures as the equipment prior to the reliable Manley was troublesome at times. The term educated hand was often used.
It was built in the workshops of John Blease, who had previously designed an anaesthetic machine and ventilator. Used in conjunction with the Boyles machine it was a revelation and made life so much easier for the anaesthetists.
It was the main ventilator used in the United Kingdom for decades as it was easy to use and set up and now and then you had to find a Wrights Respirometer to ensure the calibration was ok.
I remember the machine used to make a noise if the patient started to breath. He was in the process of developing the mutivent version when he died.
Roger Eltringham continued this development and Penlon manufactured it. Roger Manley was only 61 when he died but can be put up there with the best of the anaesthetic innovators.
William Wellesley Mapleson 1926-This son of an insurance clerk was born in London in 1926. William Mapleson was educated in Amersham, Buckinghamshire, where his family moved in 1937. 50
He attended Durham university where he studied physics. He successfully applied for a position as lecturer at the Welsh National School of Medicine to which to this day he is still employed as Professor.
Mapleson’s main research interests were in the pharmacokinetics of inhaled anaesthetics and the functioning of automatic lung ventilators.
He published over 100 research papers and other publications. 50
His place in the history of anaesthesia and surgery is because of his work on the major breathing circuits of the day to eliminate re-breathing. His naming of those circuits were A,B,C,D,E and F
I was once told a story about an anaesthetist who was being interviewed by a panel for the RCA, and the interviewee was asked what he knew Mapleson Circuits about Mapleson, he replied with knowledge of his achievements but said he thinks he is now dead! to which a voice at the rear of the panel said "No, I'm Not!"
So, at the time of writing this he is still alive and for quite a few years more we hope.
Sir Archibald McIndoe 1900-1960Sir Archibald was born on the 4th of May 1900 in Dunedin, New Zealand. He was one of four children of John McIndoe and studied Medicine at Otago University.
After qualifying, he worked locally at Waikato Hospital and in 1924, was awarded a Fellowship at the Mayo Clinic in the United States.
Lord Moynihan persuaded him to work in England, where He studied Plastic Surgery.
He was Plastic Surgeon to St Bartholomew’s Hospital.
He also worked at the Queen Victoria hospital in East Grinstead. There during WW2 he treated patients with severe burns especially the RAF fighter pilots, who suffered atrocious injuries.
A club was formed after the war called the "Guinea Pig Club" which contained McIndoe's Hurricane and Spitfire patients from the Battle of Britain. It was called this because of the new treatments he tried.
"The Guinea Pig Club" is the name given to the pilots injured in the Battle of Britain who were treated by Sir Archibald McIndoe at the burns unit of Queen Victoria's Hospital in East Grinstead, West Sussex.
He was the first person to do plastic surgery on the Spitfire pilots who had been badly burned during the Second World War.
By the end of the war, the total number of Guinea Pigs stood at 649; 57% were British; 27% were Canadian; 8% were New Zealanders; 8% were Australian. 51
Surviving members of the club try to meet each year and since the death of McIndoe in 1960, the Duke of Edinburgh has been the club's president. We as theatre practitioners, of course know him for his dissecting forceps and scissors.
Robert Arden Miller 1906- 1976Robert Miller was born in 1906 in Pennsylvania and obtained a medical degree in Ohio in 1929. Robert Miller like so many others of his generation saw service during the WW2 and he served with the Army as a Captain.
Robert Miller was the designer of the Miller blade laryngoscope which is in common use today (more so in the USA).
He was not the first to use a laryngoscope as the German Alfred Kirsten designed one in 1896.
Chevalier Jackson produced the first workable model in 1913. This Chevalier Jackson design however was extremely bulky and dangerous and there was one known fatality caused by a spark from one whilst the patient was given Ether. 52
Ivan Magill had also put into use his design in the early 20's and this was popular certainly with the British Anaesthetists at that time. It contained its own batteries and was thus more portable than the others at the time.
These like all other scopes were rigid at the time.
The folding scopes started to appear during the latter part of the WW2 with several of the great names in anaesthesia on both sides of the Atlantic contributing.
Miller produced the straight bladed version with a longer blade and a well-designed end to enable a less traumatic intubation. The straight Miller blade is inserted deep into the oro-pharynx, past the epiglottis. Providing sufficient lifting force in parallel with the handle yet avoiding posterior rotation that causes the blade to press against the teeth.
He further developed his design after the war by introducing a paediatric version. Although this particular laryngoscope is mainly kept on the 'difficult intubation' trolley in UK hospitals, it is still used by some anaesthetists. The common laryngoscope in this country is still the Macintosh design.
Francis John Murphy 1900-1972Francis John Murphy was born in Oldham, South Dakota. He was educated in Alberta Canada and studied at Magill University in Montreal.
As with many other anaesthetist of the time, when the call to war came he enlisted in the American Navy in 1942.
He however suggested the "Murphy eye ” in 1941, this is the hole that you commonly see at the right tip of the endotracheal tube, between the leading edge of the bevel and the cuff.
It was taken on by Magill, and included in all his designs of endotracheal tubes. The term "Murphy's Eye" is well understood today, even though the inventor is not well known in historical circles.
In 1944, Murphy was moved to Hawaii to serve for 16 months as Chief of Anaesthesia at Pearl Harbour Naval Hospital.
When Murphy left the Navy in March 1946, he had decided against returning to Detroit, because he and the family wanted to stay in the west. 53.
Murphy opened an anaesthesia practise in Spokane, moving the family there from Spirit Lake. But then, unexpectedly, Murphy received a job offer that was hard to turn down: Chief of Anaesthesia at the University of California Hospital, San Francisco. 54
Frank Murphy retired and moved to Idaho, to live his dream and be a cattle rancher; he was however diagnosed with carcinoma of the bladder and died after only two years. He is buried alongside his wife in Idaho.54
Sir James Paget 1814-1899Sir James Paget was born on Tuesday, January 11, 1814 in Great Yarmouth. Even though he came from a fairly wealthy family, the time were harsh, and he was one of only eight children of eighteen to make it into adulthood.
James Paget graduated from the College of Surgeons in 1836, becoming a member of the Royal College of Surgeons the same year.
During the years 1837 to 1843 he was curator of the College of Surgeons Anatomy Museum, a post in which he was responsible for procuring bodies and performing dissections. 55
He is another of the St Bartholomew's brilliant surgeons and lecturers. He is described by some as the father of pathology and is responsible for describing several conditions that bear his name.
He is also one of the founding fathers of the Royal College of Surgeons. Best remembered for “Paget’s Disease” of the bone.
He is considered as the founder of scientific medical pathology.
He developed septicaemia after a self-inflicted injury during an autopsy.
Percival Pott 1714-1788Percival Pott was born very close to where the Bank of England is today, in Threadneedle Street. He was from a poor family but a relative of his mother provided for his education. He completed his apprenticeship under the surgeon Edward Nourse.
He was initially offered the post of assistant at St Bartholomew's hospital and ended as a senior professor.
He became one of the very many great names that worked at St Bartholomew's in London.
Pott nearly had his leg amputated when he broke it after falling from his horse, another surgeon suggested that he should have it splinted, and he agreed, and it healed without complication.
Those who knew him report that he had a kindly, charitable nature. It is said that returning in foul weather from a sick call about 32 km from London on December 11 1788, Percival Pott complained of having caught cold.
On the day for his return call, the 14th, he was persuaded by his son-in-law, James Earle, also a physician, to stay home and let his son in law do the call. During James Earle's absence Pott made a sick round of London.
His condition deteriorated, and on December 21 he made his last diagnosis:"My lamp is almost extinguished: I hope it has burned for the benefit of others".
The next day Pott died of pneumonia. 56
Today we are familiar with Potts fracture of the ankle and Potts disease of the spine.
Sir Harold Ridley 1906-2001Cataract surgery is to remove the opacity from the line of sight. In ancient time's cataract was believed to be caused by a solidifying of a humour known as hypochymia, or suffusio, in the space in front of the lens. It was in early Egypt that the method was adopted to Displace the opaque material away from the Lens and would therefore allow some sight to return. This was called couching.
The operation was also described in detail in an ancient Indian Sushruta Samhita. As with the age of Sushruta, the dates involved are very uncertain, but the operation has been described in early Greek and Egyptian writings.
Harold Ridley was born in Leicestershire on 10 July 1906, as a young child he was privileged to have sat on the lap of the very old Florence Nightingale who was a good friend of his mothers. He was educated at Charterhouse School before studying at Pembroke College, Cambridge from 1924–1927, and completed his medical training in 1930 at St Thomas' Hospital.
Subsequently he worked as a surgeon at both St Thomas' Hospital and Moorfields Eye Hospital in London, specialising in ophthalmology.
On August 15, 1940, Flight Lt Gordon “Mouse” Cleaver of 601, County of London, Squadron was shot down in combat over Winchester. His Hurricane’s canopy was shattered, and his eyes were filled with Perspex splinters. He had been blinded in both eyes, Sir Harold operated on him 19 times enabling him to see again, but only from one eye.
Harold Ridley saw the Perspex splinters were not rejected by the body’s immune system. This led him to work with Rayners Optical Company, the manufacturers of the first Perspex intraocular lens, and on 29 November 1949 at St Thomas’ Hospital, he performed the first-ever implant of a lens.57
Although it took a long time to be accepted by the ocular establishment, the IOL has altered the approach to cataract surgery. In our small hospital alone, hundreds of IOLs are implanted into patients each year enabling all of them to have excellent sight.
Sir Harold Ridley was deservedly knighted by the Queen in 2000.
Fritz Steinmann 1872-1932Fritz Steinmann was born in Bern Switzerland. He is famous for his method for reducing fractures. He invented a metal nail that was passed through the distal fragment of the break, and then traction was applied to reduce the fracture. It is a device which is still in popular use today, everybody who works in orthopaedics is familiar with the pin. He first suggested it in 1908. He was a student of Kocher.
Martin Kirschner, German professor of surgery at Heidelberg, built on the skeletal traction techniques introduced by Steinmann The "K wire" was the result.
Steinmann was committed to a public argument regarding the priority of his traction apparatus. Italian orthopaedist Alessandro Codivilla had described a similar means of applying traction in 1903 and 1904. In 1910, Codivilla publicly accused Steinmann of stealing his idea.
An impolite dialogue ensued between the two, and a series of rebuttals were published in a popular journal of the time . 58
He died at the age of 60 whilst professor of the surgery of accidents at Bern in 1932.
Although he will be mainly remembered for his traction nail, he contributed greatly to the treatment of gunshot wounds.
Conrad Ramstedt 1867-1963Conrad Ramstedt was born in Hamersleben, a village in central Prussia in 1867. His father was a local physician. He attended at the gymnasium at Magdeburg and studied medicine at Heidelberg, Berlin and Halle, graduating from the latter in 1894.
From 1895 to 1901 he was an assistant in the surgical clinic at Halle before joining the German army.
As a military surgeon he was promoted several times and served with distinction during the First World War.
On his discharge from the army in 1919, he became chief surgeon to the RafaelKlinik at Munster where he stayed for the remainder of his professional life.59
He is famous in the surgical arena for his study of the infant condition known as pyloric stenosis, first described by another German surgeon Harold Hirschprung.
A common symptom of this disease was projectile vomit; the operation to correct this was named after him Ramstedt's Procedure.
Brian Arthur Sellick (1918-1996)Brian Sellick was born at Dorking at the end of the Great War. He worked initially at the Middlesex hospital in London and joined the Royal Naval Volunteer Reserve during the WW2.
After the war he returned to service at the Middlesex Hospital. He was one of the early anaesthetists for cardiac surgery and was responsible for introducing the hypothermic anaesthesia for cardiac surgery.
While working at Middlesex Hospital, London, he developed a method of applying cricoid pressure during the induction of anaesthesia to prevent aspiration.
He demonstrated the efficacy of the manoeuvre using a cadaver.
The stomach was filled with fluid and the cadaver was then placed in the Trendelenburg position. With cricoid pressure, regurgitation of fluid into the pharynx could be prevented. There is also a “reverse Sellick” manoeuvre, used as an aid to pass tubes or probes into the oesophagus.
Over the years the manoeuvre has been reassessed and modifications recommended, the work done by the likes of Vanner and Duggan has relinquished the need for applying the high pressure recommended by Sellick (44n) down to 30 newtons.
Brian Sellick has been described by his contemporaries:"that sort of a chap who was full of good ideas"
Sellick spent his entire career at the Middlesex Hospital, where he was a consultant anaesthetist when he died in 1996, aged 77. 60
Thomas Spencer Wells 1818-1897Thomas Spencer Wells was born in St Albans, Hertfordshire the son of William Wells, who was a builder. He received his early education at St Albans School.
In 1836 he enrolled into Trinity College, Dublin, where he studied surgery under Whitley Stokes, Sir Philip Crampton, and Arthur Jacob. He completed his studies at St. Thomas’s Hospital, London. He went on to serve in the Royal Navy as a surgeon and saw service during the Crimean War.
His reputation in surgery had obtained for him in 1844 the fellowship of the Royal College of Surgeons, and he subsequently became a member of council, Hunterian professor of surgery and pathology (1878), President (1882) and Hunterian Orator (1883). In 1883 he was made a baronet.
His name is best known in connection with his successful revival of the operation of ovariotomy, which had fallen into disrepute owing to the excessive mortality attending it; and in his skilful hands, assisted by modern surgical methods, the operation lost almost all its danger. Wells was one of the earliest surgeons to make use of anaesthetics in operation.
His book on Diseases of the Ovaries was published in 1865.
Sir Spencer Wells married in 1853 Miss Elizabeth Wright and had a son and daughters. He died on the 31st of Spencer Wells Artery Forceps January 1897. His estate at Golder's Hill, Hampstead, was sold after his death to the London County Council and converted into a public park. 61
James Syme 1799-1870The first case that I scrubbed for during the first Gulf War, was a Symes amputation on an unfortunate Iraqi soldier who was captured by the SAS and delivered to our Field Hospital in the desert.
James Syme was a Scottish Surgeon from Edinburgh. Like most surgeons of that era he came from a middle-class family.
He was nearly famous for inventing Macintosh's rubber rainproof garments but failed to pursue his wondrous idea. Syme was a contemporary of Robert Liston and it is true to say that they did not get on, he worked with him at a stage in his career as his assistant.
Syme became a good friend of Joseph Lister, and Lister married his eldest daughter Agnus.
Symes amputation was successful because the cartilage is less susceptible to infection, and during this time when there was a high mortality rate as a result of infection, this was a major achievement.
Symes was aware of the impact that antisepsis had on the surgical patient and pursued and encouraged his son-in-law Joseph Lister to find a treatment for sepsis.
Hugh Owen Thomas 1834-1891Hugh Owen Thomas was born at Bodedern, Anglesey, on August 23, 1834. He was descended from a well-known family of bonesetters, who for three generations had practised their art in North Wales.62
Hugh Owen Thomas started practise on his own at 24 Hardy Street in 1859, and became medical officer to several labour organisations and societies. He married Elizabeth, the daughter of Robert Jones of Rhyl, (of bandage fame)
Thomas is mostly remembered for his innovative splint which bears his name and is still in use today worldwide. Thomas was to be the main teacher of his nephew Robert and was an extremely hard worker.
Thomas’s methods gained some acceptance, but wider take-up was slow. This was not helped by his abrasive personality. He was not considered a Gentleman by his colleagues because his social skills were low. He was ignored, and his ideas were completely shelved during his lifetime. The result was numerous children left untreated and out of sight in homes and hospitals.
Thomas’s methods finally gained greater acceptance during the Great War. Sir Robert Jones, his nephew advocated the use of the Thomas splint, it is believed to have saved the lives of thousands of soldiers who would otherwise have died from their limb injuries. 63
He is said to have died of exhaustion because of his workload.
Friedrich Trendelenburg 1844-1924Friedrich Trendelenburg was the son of the well-known philosopher Friedrich Adolf Trendelenburg (1802-1872), was born in Berlin, which at this time was a world centre of medical science and teaching.
He completed his training in Germany at Berlin and became first assistant to Bernhard von Langenbeck.
It was during his time as assistant to Langenbeck that Trendelenburg worked on stricture of the trachea.
In Rostock he introduced gastrostomy in the treatment of oesophageal stricture, and in 1878 was the first surgeon to suture the patella in Germany. He first used his position for operating on viscera in 1881. 64
Friedrich Trendelenburg is immediately known because of the 45º head down (and reverse Trendelenburg 45º head up) position used in surgery for varicose vein surgery. Varicose vein surgery is commonly referred to as Trendelenburg procedure.
At the age of seventeen Friedrich went to Glasgow and was influenced greatly by Englishman Joseph Lister and decided to train as a surgeon.
He is credited as the first person to perform endotracheal anaesthesia; prior to this all gases were delivered via mask.
William Henry Trethowan 1882-1934Born 7 February 1882 in, Cornwall, to William Henry Trethowan and his wife, Mary Phillips Hutchings. He went to Devonport High School and later, Plymouth Technical College.
He received a commission as captain, RAMC(T) on 10 May 1918, and was selected by Sir Robert Jones to serve at the Military Orthopaedic Hospital in Ducane Road, Hammersmith.
At the end of the war he was appointed surgeon to the Royal National Orthopaedic Hospital in Great Portland Street, and in October of the same year (1919) he became consulting orthopaedic surgeon to Queen Mary's Hospital for Children, Carshalton.65
The name of Trethowan is associated with his bone levers that he designed.
When I was doing the agency circuit in the North of England they were known to many as "Jimmy's". These levers were found in every major orthopaedic set as a basic instrument.
William Trethowan was yet again a product of Guys in London and was part of the famous Robert Jones Team in Shepherd's Bush where I was born.
He went on to practise at the Royal National Orthopaedic Hospital and the Queen Marys Orthopaedic Hospital for Children.
"Treth" as he was known was quite young when he died but his name will live on in the instruments that he designed.
Michael Tunstall 1928-2011Mike Tunstall revolutionised the control of labour pains for millions of women all around the globe.
He invented Entonox, this gas not only relieved women’s childbirth pain whilst in labour but has brought comfort to others across the globe with its use, and is still widely used in A&E and Ambulances to alleviate pain.
It was the American, Arthur Guedel who first described the use of an N2O O2 mix in 1911 but it was Mike Tunstall who invented the one-cylinder Entonox in 1961.
He was also responsible for the "Failed Intubation Drill" for Obstetrics that is in common use today.
He contracted Leukaemia in 1991 and died as a result of a long battle with this illness at his home in Newtonhill Aberdeen. 66
Richard Von Volkmann 1830-1889Richard Von Volkmann was born in Leipzig, Germany and attended medical schools in Giessen, Halle, and Berlin.
His father was the Professor of Anatomy and Physiology.
Starting in 1867, he worked as a professor of surgery at the University of Halle, also directing its medical clinic.
Like Lister and unlike many of his colleagues, Volkmann believed in maintaining a sterile environment during surgery.
His status as a surgeon encouraged the acceptance of antiseptic practises.
In 1878 Von Volkmann became the first surgeon to excise a cancerous rectum, while several years earlier, he discovered that long exposure to tar and paraffin can precipitate skin cancer.
In 1881, he provided the first clinical description of a contraction of the fingers, now known as Volkmann's contracture, caused by pressure or injury.
He is well known to us for his instrument widely used today, the Volkmann's Spoon and Volkmann's bone curettes.
Volkmann died in Jena, Germany, in 1889. 67
Ralph M Waters 1883-1979Ralph Milton Waters was born in 1883, in Iowa USA.
He studied Medicine in Western Reserve Medical School and received his medical degree in 1912.
Like most of the pioneering anaesthetists, he cut his teeth in World War I, and is better known for his academic approach to anaesthesia. By 1927, his reputation had grown such that he was engaged as a professor at the University of Wisconsin.
There, he set up the country's first separate department of anaesthesia and set up a resident training program in anaesthesia.
Among his contributions to the field, were the development of the gas cyclopropane for clinical use, the carbon dioxide absorption method, and endobronchial anaesthesia for thoracic surgery.68
He improved the training of the American Anaesthetists and became the first Professor of anaesthesia in the world.
These in the early days were known as his Water Babies. His influence went on to improve the training of anaesthetist’s world-wide.
Ralph Waters was the Anaesthetist who led the trials of the induction agent Thiopentone Sodium in 1936.
He developed several pieces of equipment and some like his connector, and his circuit are known to many an old ODP of my era.
Sir Reginald Watson-Jones 1902-1972Reginald Watson-Jones was another protégé of the great Robert Jones. He was born in Sussex of Welsh Parents, and was brought up in Liverpool, where he attended university and studied medicine.
He became a key figure in military surgery during the Second World War. He has been described as "an orthopaedic surgeon second only in this century to his mentor in Liverpool, the late Sir Robert Jones." 69 He served in the RAF during the second world war.
He established an orthopaedic rehabilitation service for rehabilitation would start as soon as possible - within a few days of surgery and overseen by a group of doctors, nurses and physiotherapists.
Once they had recovered from surgery, RAF personnel were sent to specialist centres to undertake rehabilitation by exercise and sport, including football (one of them is now Loughborough University). The system established by Watson-Jones returned 77% of personnel to full combat duty and only 4.8% were invalided or discharged out of the services.
He was knighted at the end of the war for his contribution to orthopaedic service.69
We as theatre personnel will know him for his Anterolateral Approach to Hip Joint: (Watson Jones) and Watson-Jones tenodesis and of course his bone levers.
12 Who's Who in Orthopaedics, Seyed Behrooz Mostofi, Springer May, 2004 p60
16 Notable Names in Anaesthesia Ed. J.R Maltby p43
19 Notable Names in Anaesthesia Ed. J.R Maltby p55
20 http://www.stx.ox.ac.uk/about/publications/record/20/obituaries#epstein 288.
21 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2328936/pdf/iowaorthj00 026-0087.pdf
27 Notable Names in Anaesthesia J R Maltby p81
33 The discovery of halothane: a product of Liverpool and Merseyside, Colin Sucking 2005
35 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2311759/pdf/annrcse0020 7-0059.pdf
36 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294988/pdf/jrsocmed00 078-0038.pdf
37 http://www.sciencemuseum.org.uk/broughttolife/people/robertjones.asp x
43 British Medical Journal
47 Tales of Troy: Ulysses the Sacker of Cities, a fiction by Andrew Lang
49 Notable names in anaesthesia / edited by J. Roger Maltby
52 Notable Names in Anaesthesia J R Maltby p143
53 Jack O'Brien, personal communication, interviews, September 2009
63 http://www.sciencemuseum.org.uk/broughttolife/people/hughowenthom as.aspx
65 http://livesonline.rcseng.ac.uk/biogs/E004721b.htm 66 http://www.oaa-anaes.ac.uk/content.asp?ContentID=33
69 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785780/pdf/brmedj0221 9-0067.pdf