Acci Anaesthetists

1941 – 1947 (from the Annual Reports)

  • 1941: Dr L J Wolfson (senior) and Miss M J Rowley
  • 1942: Dr L J Wolfson (senior) and Mrs W G Mills
  • 1943: Dr L J Wolfson (senior) and Mrs W G Mills
  • 1944: Dr L J Wolfson (senior), Mrs W G Mills and Dr J T Linklater
  • 1945: Dr L J Wolfson (senior), Mrs W G Mills and Dr J T Linklater
  • 1946: Dr F R J Stoneham is listed as the senior anaesthetist. Dr Wolfson was called up in 1945
  • 1947: Dr L J Wolfson (senior), Dr D J Carter and Dr J R Rook are listed in the annual report but Dr F R J Stoneham’s name appears in the BAH Medical Society reports and the nature of and he stood in for Dr Wolfson until when he was serving in West Africa.
    • Also, Dr Carter told me that Dr Anne Hoult was appointed at the same time as him and started on Team 1 on 1st January 1947 and left in 1948 to start a family and was succeeded by Dr Rook. I can find no reference to her anywhere else.  

Dr Stoneham (Team 2)

  • Little is known about Dr Stoneham but at the BAH Medical Society (BAHMS) meeting on 27th February 1947, the surgeons proposed that all house surgeons should give anaesthetics.
  • Dr Stoneham was strongly not in favour, pointing out that they were only in post for six months and it would take at least four months to train them. 
  • In the 1940s anaesthetic training was minimal, it is notable that every anaesthetist who worked at the Acci during the war years had the Diploma in Anaesthetics (DA) which was awarded by the Royal College of Surgeons and was the highest qualification available at the time.
  • It appears that Dr Stoneham felt that the skills required by anaesthetists were undervalued because on 5th March 1947, he presented a paper to the BAHMS analysing the first 20,000 anaesthetics given at the hospital. 
  • There had only been one death, and this was attributed to the elderly lady’s preoperative comorbidities rather than anaesthesia. 

(Of note and without a better place to record the information, at the BAHMS meeting on 23rd October 1957, Ruscoe Clarke reviewed the causes of death of trauma patients between 1947 and 1956. He noted the mortality rate associated with various injuries but also recorded that 34,738 anaesthetics had been given to in-patients and 59,196 to out-patients. There had only been three anaesthetic deaths attributable to anaesthesia). 

  • On 1st April 1947, the BAHMS agreed that the administration of blood should be the anaesthetist’s responsibility and because this required a continuous presence for monitoring, junior surgeons rather than anaesthetists would be responsible for cross matching blood.

Dr L J (Joe) Wolfson (Team 2)

  • He had been President of the Birmingham Chamber Music Society but did not play an instrument. 
  • Peter London told me he whistled ‘but not at the wrong time’. 
  • Described as unperturbable but not as devoted as Dina. 
  • He attended the RSM regularly and was very good at existing techniques but not an innovator. 
  • Although quite a frequent squash player, he was described as not particularly energetic. 
  • Dr Wolfson had worked with Gissane at St James’s Hospital in London and was chosen by him to be the Acci’s first senior anaesthetist. 
  • At the time he held the DA but by 1962 held the Fellowship of the Faculty of Anaesthetists at the Royal College of Surgeons. 
  • When Dr Wolfson and Mr Badger were called up in 1945, the BAH Board of Management noted with much regret that the war had broken up the close but small team that had successfully put the Acci on a sure footing. 
  • It is worth repeating words from the preface of Wolfson’s book, Anaesthesia for the Injured published in 1962 by Blackwell Scientific Publications. ‘It is the author’s opinion that concentrated experience of anaesthesia for trauma (including burns) in accident centres, which are likely to become established throughout the country in the future should become part of the training of all anaesthetists. 

‘Tribute should be paid here to the vision and drive of Professor William Gissane …. He recognised the value of the anaesthetist as an important member of the clinical team at a time when the status of the anaesthetist was far from having reached its present level’. ‘… the anaesthetist can usefully become a fully integrated member of the team treating injured patients, not only in the operating theatres, but in the management of respiratory and circulatory problems, in resuscitation, in the relief of pain, and in a number of diagnostic and therapeutic procedures in which the techniques can be helpful.’

  • Like Ruscoe Clarke, in his book and by means of other articles published in Journals in the 1960s such as the Annals of the Royal College of Surgeons, he encouraged large blood transfusions to replace blood loss. 
  • He cautioned against the use of anaesthetic agents that caused vasodilatation until a normal blood volume had been restored. 
  • He describes a wide range of general, regional, and local anaesthetic techniques used during surgery for injury and burns. Although he does not go into detail, he writes that nerve blocks could help surgeons determine how well severed nerves were regenerating. 

Dr David J Carter (Team 3) (personal communication)

  • Dr Carter qualified as a doctor in 1942 and passed his DA in 1945. 
  • In 1945 he was Professor Sir Robert MacIntosh’s research assistant. 
  • MacIntosh was the first British anaesthetic professor. His post at Oxford was endowed by Lord Nuffield, owner of the Morris Motor company. 
  • They researched the muscle relaxant curare which was not used elsewhere in the UK in 1945.
  • In 1946, he and his fiancée, did locums because they wanted jobs in the same hospital. 
  • In 1947, they were both appointed to BAH and married three months after starting their appointments.
  • She was the Team 3 surgical registrar but after starting a family she worked in the BAH Casualty and Pathology departments. Finally, she became a GP.
  • It seems likely that Dr Carter played a significant role in introducing curare into anaesthetic practice at BAH. 
  • He ‘looked after’ all the junior medical staff.
    • A junior house surgeon, Dr Beryl Goetze, became infected with polio. As her breathing deteriorated, Dr Carter borrowed the Iron Lung ventilator from the General Hospital. He had no idea how to use it so tried it out on himself first. Dr Goetze needed it for only 24 hours and eventually recovered. She went on to become an anaesthetist. 
  • Dr Carter went out with the MSU several times but was never required to anaesthetise a patient. 

He gave oxygen and sited cannula for IV fluid administration. He remembered the buzz of setting off in the MSU ‘with flashing lights, clanging bell, and running through red traffic lights.

  • There were two junior anaesthetists during Dr Carter’s time, one of whom was a long serving registrar called Dr Reginald Graham who had previously been a reverend. Eventually he passed his FFARCS and was appointed to a consultant post in Middlesbrough. 
  • Dr Carter retired prematurely in 1958 because of an eye condition that progressively worsened his sight.

Dr John R Rook (Team 1)

  • There is some doubt about whether Dr Rook was appointed in 1947 or 1948. 
  • In the early 1950s, he was the anaesthetist who published papers about anaesthesia at BAH. 
  • For his first paper (The value of intravenous procaine analgesia in the treatment of chest injury, Anaesthesia, 1951, vol 6, p 221 -225), he described the intravenous infusion of 0.2% procaine (a local anaesthetic) in normal saline for the relief of the severe pain from multiple rib fractures after a crushing injury to the chest. 

With careful titration of the dose analgesia was achieved and there was no limit to how long the infusion was continued. The pain relief was good and allowed the patients to breathe deeply and prevented the feared complications of ‘wet lung’ and atelectasis. 

Although initially described for use in chest injuries, the MSU log book reveals that Dr Rook also used the method for pain relief caused by other fractures. 

In his book, Dr Wolfson describes the technique but says that it was used less frequently after tracheostomies were regularly created to allow secretions to be aspirated more easily. Prior to publication, Dr Rook presented his findings to the BAHMS on 11th December 1950.

  • 10th December 1951 he presented his findings to the BAHMS
  • In 1952, he published a paper entitled Anaesthesia in the Casualty Department (The Lancet, June 14th, 1952, p 1202 – 1213). He goes into great detail about the injuries requiring anaesthesia, and the techniques used. 
  • He says the Short Stay Ward was essential for patients to be assessed particularly with respect to whether or not they might have a full stomach. The practice was to allow four hours after a meal to allow the stomach to empty. 
  • He stressed that even a minor injury can delay stomach emptying for far longer hence increasing the risk of aspiration of stomach contents into the lung. ‘This knowledge has been gained from experience – at times bitter experience’. 
  • Consequently, either surgery was delayed or if it could not be, determined efforts were made to empty the stomach using an oesophageal tube. ‘This method of emptying the stomach may appear brutal, it is the only safe way of preventing aspiration of vomit with its dangerous sequelae’. 
  • The Short Stay Ward also permitted the patients to receive intramuscular premedication which was made up in pharmacy in a range of doses suitable for various ages of patients and prescribed according to instructions from a premedication chart that Rook compiled based on 5 years of experience. 
  • He stressed the need for premedication in children to minimise their fear of operations and hospitals but urges the need for caution with the frail elderly who needed minimal premedication and reduced doses of anaesthetic agents.
  • Rook is scathing about the then common practice of giving nitrous oxide in hypoxic mixtures that rendered the patient briefly unconscious by ‘dental asphyxia’ or ‘surgical suffocation’ thus permitting the rapid ‘slashing’ of a septic finger. 
  • Rook wrote ‘In the Birmingham Accident Hospital, we believe that the drainage of a septic finger or the reduction of a Colles’s fracture should be carried out carefully under the best possible operating conditions thus reducing the necessity for further operative procedures to a minimum. Therefore, the aim in the Casualty Theatre is that each patient requiring operation, no matter how minor, shall have a skilfully administered anaesthetic’. 
  • At the time, the general anaesthetic of choice was nitrous oxide combined with an adequate amount of oxygen supplemented by titrated doses of thiopentone. 
  • The Short Stay Ward also allowed adequate time for patients to recover from their anaesthetic. Various techniques using local anaesthesia were used.
  • Dr Rook left in 1954 and went to work in Bromsgrove. 
  • It is of note that Main Theatres did not have a formal Recovery Area until 1979. Before then, patients were kept in theatre for 10 minutes after they woke up and were then sent to the ward.

The team system

  • The three surgical team system was started in 1947. 
  • The BAHMS record for 3rd March 1947 included the new team rotas. 

There are some discrepancies in the available information about dates but as far as I can ascertain these were the anaesthetic members of the teams.

Team 1

  • 1947 – 1948: Dr Anne Hoult
  • 1947/8 – 1954: Dr John Rook
  • 1954 – 1983: Dr Donald Bigley
  • 1983 – 1993: Dr Magdi Ghoris (worked at GHB AND SOH until retirement)

Team 2

  • 1947 – 1947/8: Dr J Stoneham
  • 1947/8 – 1975: Dr L J Wolfson
  • 1975 – 1988: Dr Colin Thomas
  • 1988 – 1993: Dr Graeme Dickson (worked at GHB AND SOH until retirement)

Dr Colin Thomas’s multiple contributions are described elsewhere

Dr Graeme Dickson 

  • Best known for his work investigating the best sedation methods for change of burns dressings and also, in collaboration with Dr John Bull, for auditing the outcomes of BAH patients using the new TRISS methodology. Both studies were presented at national meetings, but I do not know if they were formally published.

Team 3

  • 1947 – 1958: Dr David Carter
  • 1958 – 1981: Dr Dina Langrana
  • 1981 – 1993: Dr Anne Sutcliffe
  • 1993 – 1993: Drs Paul Wood and Dr Martin King (worked at GHB AND SOH until retirement)

Dr Dina Langrana:

The articles written about her by PSL encapsulate her unique contributions and her colourful personality

Dr Anne Sutcliffe

  • Director of Trauma Services from late 1987 to 1990
  • ‘Handbook of Emergency Anaesthesia’ published by Butterworths in 1983. At this time junior anaesthetists were generally unsupported in hospital This book was written for trainees who were faced with a clinical problem, e.g.  cyanosis or unexplained hypotension and gave practical advice about how to determine the cause of the problem and how to rectify it. 
  • Does early fixation of fractures reduce mortality in severely injured patients? European Journal of Emergency Medicine 1994

(see Acci Greats)

Anaesthetic Joint Initiatives in the 1980s

  • Around 1987 I was part of a small group of anaesthetists led by Dr Jim Watt from the General Hospital who, at their request, provided lectures and demonstrations for members of the West Midlands Ambulance Service about basic management of severely injured patients. 
  • One night a young woman was brought in whose face and bony structures had been badly damaged in a confrontation with a large lorry. The ambulance man kept his cool and using his additional knowledge had managed to place a basic Guedal airway and supported the girls mangled jaw so that she could freely breathe in oxygen via a face mask. There is no doubt in my mind that her subsequent recovery without neurological deficit was entirely due to his actions.
  • Sometime later, extended training for ambulance men was approved and in 1979, Acci anaesthetists helped with their training. 
  • In the first year of their operation, ambulance men with extended training provided 638 treatments (cardiac monitoring 59%, venous cannulation 12%, cardiac drugs given 6%, defibrillation 6%, IV fluids 11%, endotracheal intubation 6%)
  • Also, around this time we provided training for ‘the boys from Hereford’ and 2 Para.
  • In 1986, 1987 and after that, nurses, surgeons, and anaesthetists provided medical support for the Lombard RAC rally. 
  • Only once in the first two years were, we asked for medical help. A young lad had been caught between a competitor’s car and another solid object in a rest area. He was clearly not badly injured. I was driving and we were asked to take him to the nearest hospital somewhere in darkest Wales. 
  • After being told to switch on the green lights and not knowing where the hospital was, we were told that we would have people stationed along the route to direct us. The directions soon disappeared but we got stuck in a traffic jam. My colleagues urged me to pull out and drive down the right side of the road which was bendy but apparently clear. With my heart in my mouth, I did as instructed and seconds after I had pulled back on to the left-hand side of the road, a police car came speeding past on the other.