3 - History of Anaesthesia Society

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-mtient, by mans of a cylinder fitting belaw, closely to the face. The sponge, however, when soaked in ether, is almost impenetrable to air, and tends to clrip from its 1-r surface. 'My own pattern (mde by Allen and Hanixry) is an aluminium 'cylinder' 7 inches in height, and shaped to fit tine face, with a Sorbo sponqy r ubr pad at the lower end. 'The ether is held by an oval game pd, 7 inches by 5, and at least 8 layers thick, preferably hemned so that it can 'be rvashed and used again. This is placed on top of the cylinder, and thrust down into it, on to the bars across the 1mer end, by a mller cylinder munted on a handle. This gives a flat gauze surface, down which all ether poured into the inh3ler nms, so that the ptient's breath rmlst pass through it; while owing to its flatness, there is no tendency to driming.' DR consirlered that his inhaler had the following advantages: '1. It w ill give a very high concentration of ether with a percentage of CO2 much as in tFle Clover inhaler. 2. It is very economical, its consqtion being only one third of that of the open method. In on lent alone at GK~ilt Omond Street this difference meant a s £50 a year. 3. It is sinple, cheap, easily cleaned between anaesthetics, and has that priceless quality for 'nospit31 equipnt of surviving after being d rom on a stone floor. 4. It does not cover tile yes, thus avoiding what I think to ke one of the main causes of panic in children.' DB then described his main points on how to use his inhaler: ' 1. Start the induction with a single drop of sther in the inhaler. Anyone who thinks this is too little is recmded to experiment on himself. 2. Keep the mask closely on the face, and as soon as the patient is breathing one strength of the ether easily, increase it. A fairly wide experience of inducing all types of cases with ether has convinced me that the main causes of failure are starting with too strong a vawur, and taking the mask off for no particular reason except to see if the patient is still underneath it. 3. As soon as the patient is deeply anaesthetisd, with dilated ppils and easy breathing, hang a weighted hooked imuthpiece on the top of the inhaler and puntp ether vapour through it. If this provokes coughinq, gag t3e muth open and hang the tube in it to continue the anaesthetic, again carefully avoiding giving one breath of etherless air. DB then corrmented that he found this method quicker and better than inducing with ethyl chloride and charging to ether, as it avoided the 'no-MS-landr when thn pltient is clxning out of deep ethyl chloride into sha1101~ ether, and an expsrt surgeon and anaesthetist team could do almut eight cases an hour.
In Allen and Hankury's &t;ilogue of Surqical Instruments for 1930, the ether inhaler was priced at one pound two shillings and sixpence (C1.2.a) and the double r~eighted muth tube at eight shillings and sixnence (8 .a) . Working with DB the 'Top F&tl DB ms an outstanding five of a van, well over six foot, having in'lerited from his forefathers rtronq cpalities of physical stature, adventlre, leadxshin, courdge and scholarship. 'I\iolko1, his third naw, in abriginal language mans 'Big Win', appropriate to this man who probably contributd more tc pdiatric sxrgery over a wider range of conditions than any other surgeon. He was an ~ntellect~~l adventurer, a rebel, and a cynic who took nothlng at ~ts face value. Altgetl~er a formidable character. I was a s.znior House Officer in anaesthztics at GOS from 1951-195?, and privileged to have given anaesthetics for DB, who taught me how to use his 'Top Hat'. In thos? days a senior house officer would give anaesthetics for him vit:iout aqy condtant supervision, and I went once a week to the cou~try branch at Tadmrth Court in Surrey to give anaesthetics €or an operation list F%- DR. Providing that you did what he ask4 a d used his techniques 0.- ones of wrich he approveli, he was very kind and tolerant with a junior and ineprienc~ed ana.?sti~i?tist. If one sxnt too long over an induction, he would offer to holp, saying that he knew a thing or two abut anaesthesia and tracheal intuhation! mere 1s no longer a need for the 'Ton Hat1 ln ppsdlatr~c anaesthesia, but ~t a s one of knis Browne's in~onio~ls and 11seFul gadqets, md 'ie ra&s mng tho5e fa~nous slrqeons who have contr~butec! to t h ~ developnent of anaestk~asra, References 1 Rrome DR. Annest:~esia for tonsillectomy and remvsL of adenoids. 2 British Wdic31 Journal 1928; 2:532. 'lacintosh W. 4 simple methcd of blood transfusion. Lancet 1927; ii:22. 3 Brome RB. .?n aid to o:xr;ltions on infants. British ?Mica1 Journal 1930; 1:54'7. 4 Uoituary. Sir Denis Rr3wne. British N4ical Journal 1967; 1: 50'3. 5 Stepliens D. 0'7ituar-y. Sir Wnis Srowne. British Medicll Journal 1967; 1:509. 6 Rruwne RB.The prol-~lem of Ryron's lameness. Prxeedi.lqs of the Royal Wiety of Medicine 1963; 53:440-442. 7 Crcm'rs J. Denis Br,me : Colleague. In: Nixon HH, r,iat.?rs ton D and ifink CAS eds. Selected VJritings of Sir Wnis Rrowne. London. Trujtees of the Sir &nis Rrme Xemria7 Furld 1983; 1-2. 8 Sandiford CR. CLay'on JC. The quillotine and ethyl c'llorirle. British rwicsl Journal 1928; 2: 149-157.
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3 - History of Anaesthesia Society

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