3 - History of Anaesthesia Society

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Dr J M Hot-ton (Cambridge) Denis Browne's lbp Hat was the name given by successive generations of anaesthetists at the Hospital for Sick Children, Great Omnd Street, (GOS), London, to the ether inhaler devised by the ~ediatric surgeon Sir Denis Brame. Denis John Wolko Bruwne, KCVD, W3 BS (~ydney), FRCS, ADn FRACS, 1892- 1967, was a pioneer of wediatric surgery who spent his mrking life at the Hospital for Sick Children. He was the first strgeon in 'hgland to devote all his time to children, and was affectionately !mown to all who worked with him as 'DB' . A great original thinker and innovator, he developed many ingenious instruments for techniques specifically suited to children. Of inter st to the anaesthetist are an ether inhaler (the Denis l3r-e 'bp Hat).' a mth tube for delivering anaesthetic gases, a mouth gag for edentulous children, an endotracheal tube, a blood transfusion apgziratus for children (modified from that described in 1927 by R R Macint~sh)~ and a cruciform supp3rt far use when operating on infant^.^ Lknis Brawne was born in Melbourne, Ustralia in 1892, the son of an Australian pioneer in mining and sheep farming, and educated at Kings' Schaol, Pararmtta and the University of Sydney. Both at school and university he was very mch an individualist and, as well as being academically able, he excelled at tennis, shooting athletics and billiards. He graduated in 1914 and Wiately joined the 13th Light Horse Regiment of the Australian Imperial Force as a medical officer and served at Gallipoli and in France with the ANZACS. After denmbilisation he elected to live, train, succeed am3 then die in England. After training in Liverpool and London and taking the FRCS in 1922 he became a casualty officer, then resident Medical Superintendent at GQS and was appointed to the consultant staff in 1928, serving the hospital until 1957, when he was electerl emeritus surgeon. He was appoint& KCVO in 1961. He was also interested in history and in 1960 gave a paper at the Royal Society of Medicine on Byron's 1 ~ness, based on a careful study of the leg appliance that the poet mre. amune-S ether inhaler ('lbp mt) Vhen Derljis Brme was casualty officer and then Resident Medical Officer at ?AS, one of his duties was to deal with the enormous tonsil and adenoid waiting list which the hospital had acquired as a legacy of the work of the ENT surgeon George Waugh who had propounded the need for the operation to be done by carem dissection rather than by the generally accept4 guillotine rnethd. DB was a demon for work and organised oprating sessions of 25 tonsils and adenoids a day and 10 on Saturdays. Ckl Sundays, according to James Crooks his EWl' surgeon colleague a t GOS, DB would think about tonsils and adenoids! !
He described a tortuous vein lying between the tonsil and posterior pillar of the fauces (thought to be the cause of the bleeding tonsil), developed suitable surgical instruments for the operation and for anaesthesia, an ether inhaler and a muth gag for delivering the anaesthetic gases and ether. These instnnwnts were fomd in all the mjor anaesthetic catalogues of the day. He attxhed his name to all the instruments he devised, so using one of the few advertising channels open to the medical proEession. In a letter1 to the Sritish Medical Journal of 6th &to& 1928, DB comnented on an article fi in the Et of 28th July 1928 by a P4r Sandiford (an surgeon) and a Dr Cl3yt0n (an anaesthetist) from Sneen Nary's Hospital, Stratford, landon who had described the use of ethyl chloride and the millotine for tonsillectomy. DB's letter pints out that the operation for Ether Inhaler (1928) tonsillectomy should be unhurried and that the best anaesthetic was ether, and proceeded to describe his m inhaler which he said had Rlotoqr;lph m*?e from sIi:9e no. 71 been used in mny thousands of Aysn.of .bae.ithetisrs c~lle;tion cases. Ilis description of his of photoqr-iphs of ether inhaler shors he was Charle.; King Collection familiar with, and understood the workings of, other ether inhalers avaiL3ble at the time, and their disadvantages. In DB's own words: 'The main difficulty in giving ether is to vary the concentr+tion of the vapour from the very weak at the start to very strong when deep anaesthesia is needed. With the open methd a high concentration can only be obtained by muffling the mask with towels etc. - a crude rvasteful and inexact proceeding. Also the ordinary Sckimnel~ch msk has the fatal defect for ether that as soon as the fluid is poured onto the convex gmze pd it runs down to its brders, leaving a dry patch throuqh which the patient breathes. The Clover inhaler, well used, gives a mst excellent anaesthetic, h t it is expnsive, fragile, and difficult to clean, while its proper handling is a rare accomplishment. Silk's inhaler has the sound principle of retaining the heavy ether vapour where it must be braathed by the
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Page 10 and 11: Pimot did not believe that dentists
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Page 14 and 15: increased. In haloperidol the neuro
Page 16 and 17: 9000 times as potent as pethidine a
Page 18 and 19: Flacke JW et al. Comparison of morp
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Page 22 and 23: 1 Landon, H.C.Robbins Ed. The Colle
Page 24 and 25: dogs with a cl system. His reprt of
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Page 40 and 41: Professor H Reinhold (73nlssels) Hi
Page 42 and 43: In the early pst-mr perid the neces
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3 - History of Anaesthesia Society

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