Careers in Anesthesiology IX: Three Pioneer British Anaesthetists. By Anthony Edridge, M.R.C.S., L.R.C.P., D.A., F.F.A.R.C.S., Keith Sykes, M.B., B.Chir., M.A., D.A., F.F.A.R.C.S., and Stanley Feldman, M.B., B.S., B.Sc., D.A., F.F.A.R.C.S.; Donald Caton, M.D., Kathryn E. McGoldrick, M.D., Editors; John S. M. Zorab, M.R.C.S., L.R.C.P., D.A., F.F.A.R.C.S., Guest Editor. Park Ridge, Illinois, Wood Library-Museum of Anesthesiology, 2005. Pages: 99. Price: $30.00.

This latest addition to the Wood Library-Museum’s admirable series Careers in Anesthesiology  consists of biographies of three eminent British anesthesiologists: Sir Ivan Magill, K.C.V.O., D.Sc. (Hon), M.B., B.Ch., B.A.O., F.R.C.S. (Hon), F.F.A.R.C.S. (Hon), F.F.A.R.C.S.I. (Hon), D.A. (Consultant Anaesthetist, Westminster Hospital, London, United Kingdom; 1888–1986), Sir Robert Macintosh, M.A., D.M., F.R.C.S.E., F.F.A.R.C.S., D.Sc., M.D. (Nuffield Professor of Anaesthetics, Oxford University, Oxford, United Kingdom; 1897–1989), and Sir Geoffrey Organe, M.A., M.R.C.S., L.R.C.P., M.B., B.Chir., M.D., F.F.A.R.C.S., F.F.R.A.C.S. (Hon), F.R.C.S., F.F.A.R.C.S. (Hon), D.A. (London University Professor of Anaesthesia at the Westminster Hospital, London, United Kingdom; 1908–1989). All three shared the rare distinction of being knighted by their monarch for their contributions to medicine. John Zorab, the guest editor for this book, which is published jointly with the Association of Anaesthetists of Great Britain and Ireland, chose the biographers, Anthony Edridge, Keith Sykes, and Stanley Feldman, well. Each writes well and has an intimate knowledge of and profound respect for his subject. The result is that this book is an enjoyable read about three major figures in our specialty’s history who helped define the modern practice of anesthesia in the United Kingdom and, indeed, in many parts of the world. Although very different, the subjects were interesting, well-rounded individuals. In the case of Magill and Macintosh, serendipity seems to have played an important role in their remarkable careers. What this reviewer was not aware of was the extent to which these individuals related to their North American counterparts, particularly, Ralph Waters, M.D. (Professor, Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin; 1883–1979), and John Lundy, M.D. (Professor of Anesthesiology, Mayo Clinic, Rochester, Minnesota; 1894–1973). Indeed, Ralph Waters had an influential role in the extraordinary career of his friend Robert Macintosh.

Near the end of the First World War, Ivan Magill and Stanley Rowbotham (1890–1979), both young physicians with little or no anesthesia training, were assigned to give anesthetics in a surgical unit caring for the war injured, many of whom had severe facial disfigurement. To permit control of the airway during the long, complex operations on these patients, Magill and Rowbotham gradually perfected blind nasal tracheal intubation. Magill designed the forceps and the semiclosed anesthetic circuit named after him to help care for such patients. Magill, indeed, was an inventor par excellence and responsible for many other innovations to help manage clinical problems he had to confront. These included endobronchial tubes and blockers, which were to make thoracic surgery truly feasible and safe for the first time. On another front, Magill was also influential in efforts to improve the status of anesthetists in the United Kingdom. To this end, he played a leading role in establishing the Diploma of Anaesthesia examination, first given in 1935. This was the first such qualification in anesthesia anywhere in the world.

Sir Robert Macintosh’s story is remarkable. We learn how his friendship with and the fact that he had given an anesthetic to the philanthropist Lord Nuffield (1877–1963) led to Nuffield’s stipulating that his offer to create a postgraduate medical center Oxford University was contingent on this center having a chair in anesthesia. After initially objecting, the University relented, and Macintosh in 1937 thus became the second professor of anesthesia worldwide. Soon after being appointed, Macintosh traveled to Madison, Wisconsin, to meet his friend and holder of the first such chair in anesthesia, Ralph Waters. Apparently, coming home, Macintosh resolved to follow Waters’ general concepts on how to run a successful department. In this, he succeeded admirably. He and his department were responsible for many innovations, including the Macintosh laryngoscope, draw-over vaporizers, and tank ventilators for polio victims. In the Second World War, they did important work investigating how to survive high-altitude parachute descent and designing safe life jackets. Macintosh and his colleagues did much to promote safety in anesthesia by studying and publishing data on the causes and incidence of avoidable anesthetic-associated deaths. He and his colleagues also coauthored many well-received books—several of which, particularly the ones on regional anesthesia, have become classics. This work, combined with his lecturing in many countries, led to widespread recognition of his department, and this, in turn, did much to improve the status of anesthesia worldwide.

Sir Geoffrey Organe belonged to the generation that followed Magill and Macintosh. He was one of the first to pass the new Diploma in Anaesthesia examination, established by Magill and his colleagues, and this led to Magill inviting him to join his department at the Westminster Hospital in London. In due course, Organe was to become head of this department named after Magill, and its subsequent outstanding reputation appears in large part to be due to the influence of Organe. With his vision for promoting science and education, he was able to attract some of the brightest minds to the department. Organe also traveled widely, visiting more than 40 countries, teaching and promoting anesthesia as a physician-based specialty. In addition, he became heavily involved in the professional organizations representing anesthesia in Britain. As such, he played a leading part in negotiations with the government over anesthetists’ role in the new National Health Service created in 1948, and this led to anesthesia’s being recognized as being on a par with other specialties in this Service. To confirm this equivalence, Organe and his colleagues established a new two-part board examination comparable to the two-part examinations that already existed for other specialties. Organe was also instrumental in establishing the World Federation of Anaesthesiology and, in 1964, served as the president of this federation. Organe can rightly be said to have laid the foundation on which anesthesia is practiced today—not only in the United Kingdom, but in many other countries.

Magill, Macintosh, and Organe were giants in British anesthesiology. This book is enjoyable, short, and well written, and is a wonderful place to start to learn about the lives of these worthy individuals.

Mayo Clinic College of Medicine, Rochester, Minnesota.