Brigadier Ivan Houghton: The Triservice Apparatus

Brigadier Ivan Houghton joined the RAMC in 1972 after several years in the TA, and soon recognised the need for an easily portable anaesthetic apparatus for use in the field. By modifying existing equipment, Brigadier Houghton created an anaesthetic apparatus that could be easily carried by Field Surgical Troops and which used modern equipment and agents familiar to most anaesthetists. Diplomatically named the ‘Triservice’, it was taken up by the Army, Navy and RAF around the world, and was the only anaesthetic apparatus to be used on land in the Falklands Conflict.

The Army

I joined the Royal Engineers wing of the Cambridge University Officers Training Corp. I’d been in the Combined Cadet Force at school and done a number of courses, some engineering, the Cadet Commando course, Eastern Command Leadership course and others. As it may be important later, it seemed that it would be desirable that I did a parachute course, which I duly did the selection and passed and qualified as a military parachutist in 1961.

I was commissioned into 131 Parachute Engineer Regiment in 1963, which of course would be towards the end of my final year at Cambridge. So during my time as a medical student at St Thomas’s I was actually also started off as the plant troop officer with a parachutable load plant, with bulldozers, chicken tractors and other such things in Luton, which I would go to once a week or on some weekends, and then I became the recruit training officer.

“I was immediately sent to 23 Parachute Field Ambulance”

In 1971 having got my final, I was sent to the Royal Southern Hospital and towards the end of my time there, Professor Gray called me in and said he’d like me to go to Vietnam for a few months. So I said yes, but I needed a job to come back to a senior registrar level… and they very kindly gave me a job at Whiston. And then during that time although enjoying my time there, I thought I wasn’t so keen, that I would have the same job in the same hospital, doing the same lists, for the same surgeons for the next 35 years, and that’s when I applied to join the Army.

Having already served as Regimental Medical Officer with 23rd Special Air Service Regiment TA, I had done a fair amount of work in the field and I had remained qualified as a military parachutist, so after initial training, I was immediately sent to 23 Parachute Field Ambulance, one of two anaesthetists, of which I was the senior.

I had two emergency tours to Dhofar and one to Northern Ireland, which were operational. I was at the receiving end of a casualty line in Northern Ireland, I did go out on patrol probably, a couple of times. In Dhofar I did accompany the helicopter and the aircraft pilots out into the disputed areas, but I could hardly say it was being shot at.

The Triservice on display in the museum in the 'Out of Our Comfort Zone' exhibition

The Triservice on display in the museum in the ‘Out of Our Comfort Zone’ exhibition

Anaesthetic Equipment

On the first tour, Brigadier Belsham who by then was the Consultant Advisor to the Army had given me an auto-valve. It was one of these things in an aluminium box with an anaesthetic bag, which would stretch, but was constrained by the box, and I was told to evaluate it. Anyway I think the first time I used it, the valve jammed and the bag obviously got bigger and bigger, the machine burst open! So with a bit of panel beating from the MT Department, we got it back working and it did work, but it happened again. I never used it again.

But I did use the OMV 50 as the basis of the Triservice apparatus I had created whilst at Whiston. Fortunately Dr Asorio had got an OMV, we were having new maternity theatres built at Whiston and the rep just happened to leave a Laerdal bag and I thought, ‘Ah, that’s just what I need,’ and I asked the rep could I have it and he said yes, and the first Triservice was made. That would have been [used] with halothane and nitrous oxide.

“If you are in the middle of nowhere, how would you give an anaesthetic?”

Normal anaesthetic of course would be nitrous oxide, oxygen, maybe nitrous oxide and triline with controlled ventilation. I can’t remember when we stopped using nitrous oxide oxygen and triline on spontaneous respiration, but I think it was probably going out of fashion.

Dhofar, which was my first medical operation at all, I had been to Aden with the Engineers, was a graveyard of anaesthetic apparatus, but it was expected, I think, that one would use the Haloxair – Which was a draw-over apparatus… an AE vaporiser on aluminium base plate, containing a reservoir.

[It was] the same size as the Triservice anaesthetic apparatus, but with nothing else, it came with a laryngoscope, some tubes and this apparatus. So if you really wanted to give an anaesthetic, you would have to have taken a whole lot else, you couldn’t have just lifted up the box and gone, and anyway, it was a very heavy suitcase. That was the later version, the earlier one, which we also would have had in Salalah, came in a wooden, mahogany case.

The Triservice on display as part of the ‘Out of Our Comfort Zone’ exhibition

The Triservice on display as part of the ‘Out of Our Comfort Zone’ exhibition

Developing the Triservice

I first went [to Salalah] in 1973 and I went back again in 1975 and then I returned a few times operationally when I was Regimental Medical Officer of 22 Special Air Service Regiment, so that would have been in the firing line. I was on the ground for the final, successful battle.

My next operational tour the next year to Northern Ireland, I had the prototype of the Triservice apparatus, which I used for just about everything. I think two anaesthetics I didn’t give, but this was to satisfy surgeons who were about to retire.

The Triservice development really started when I was at Whiston, RMO of 23 SAS, and had to think, ‘Well if you are in the middle of nowhere, how would you give an anaesthetic?’ So that would have been in ’72 at Whiston, ’73 was Dhofar, then ’74 was Ireland with the prototype. Then ’75 when I was using more or less the first production model, the Triservice vaporizers, would have gone into production.

“I had the prototype of the Triservice in Northern Ireland, which I used for just about everything”

I had been allowed back to Liverpool for a week or so, to do some lab work and I had the pre-emergency tours I’d kept, as I say, very full records, with the intention that I would write up the Triservice apparatus, which of course, I did. Unfortunately it wasn’t actually published until some years later, but the work had been done based on my pre-emergency tours.

Brigadier Charles Sanders, who by then was the consultant adviser, was enthusiastic, because no way a Major would have persuaded the Ministry of Defence to actually buy, but he did.

The changeover from Haloxair to Triservice would have been ’75-’76, so in actual fact the Haloxair had had a relatively short life, it only lasted about 10 years. And then Triservice took the whole market. There was very little call for any modification as far as I know, apart from the use of different volatile agents as they came into fashion, but the apparatus is still very much as it was conceived. The Laerdal bag became made out of a silicone rubber, rather than a polyvinyl chloride, but apart from that…

The military casing for the Triservice

The military casing for the Triservice

The first layer of the Triservice box contains various drugs and pieces of equipment to be used in an emergency

The first layer of the Triservice box contains various drugs and pieces of equipment to be used in an emergency

The ventilator and vaporiser for the Triservice can be seen in the case on the left

The ventilator and vaporiser for the Triservice can be seen in the case on the left

The Triservice in Wartime

The selling to the other two services would have been done by Brigadier Charles Sanders. The naming was done by me, but yes, if I had given it too much of an army name, it would have discouraged the other two services, so yes, it was entirely political!

It was widely used in the Falklands. As far as I know, exclusively, was that the only piece of apparatus. They wouldn’t have had anything else. Whether or not they had it on the ships I don’t know, but ships have got lots of space, storage, they can have months’ worth of medical gases, so their priorities are different. The commandoes, if they had had… well, they probably did have a field surgical team, but that would have been all mixed up in the same meat refrigeration plant as everybody else was, so there wasn’t anything else on land, other than the Triservice apparatus.

“It was widely used in the Falklands… there wasn’t anything else on land”

It’s not particularly lightweight, the picture of me on the back is the box on a carrier man pack. Yes I have carried it, I’ve carried it a few miles between Aldershot, the Cambridge Military Hospital and Keogh Barracks, the genuine article. The photographs you see, there’s nothing in the box!

It could and it has been parachuted out of a plane, but not necessarily in the box, because if you had it in the box that would be all you could take out in your container, so you would take what you absolutely needed, but you’d leave the box behind.

The Triservice case strapped to a carrying frame. Oxygen and a suction machine are being carried in the rucksack.

The Triservice case strapped to a carrying frame. Oxygen and a suction machine are being carried in the rucksack.

Vietnam and Hong Kong

In 1971 I was in Saigon. I did four months with Children’s Medical Relief International, where anaesthesia was being done with draw-over apparatus. They usually used an Ohio military portable apparatus, which I got to know, it had a large circle absorber, with an ether vaporizer with electrical heater, but it also had its graveyard of apparatus, which together with the hospital engineer, I set about getting to work again. And I suppose that’s where I had first got to know the OMV and how to service it, because it didn’t work there, but the engineer and myself got it to work and we came up with ways of using it.

I had to consider its use in different climates, very hot climates and then in the Falklands, it would have been extremely cold. My advice for the cold is, put it in your pocket and warm it up, or dunk it in the tea!

I first visited Hong Kong in ’74 when one of the consultants got some kidney problem stone and I was on the next plane out for a month. I realised it was a wonderful place. Went back in ’77 for four months, when there was a gap between postings, and I had been quite friendly with one of the theatre sisters, Teresa Wong, and within a week or two, she was also posted out as the theatre superintendent. Anyway, at the end of four months we got engaged and we got married the next year. After my tour in Ireland and my wife’s also, I went back to Hong Kong, on a three year posting as the sole consultant.

Life After the Army

Hidden in amongst other qualifications there is a law degree too. I had been second in command of Five Field Force Field Ambulance in Münster. From there I had moved to the military hospital, they’re about a mile apart, so I could keep the quarter and things, but then a few soldiers had got into trouble in the Field Ambulance, and they needed somebody who was independent of other defending officers and I hadn’t the faintest idea what I was doing. Of course I got a bit of help, and I thought, ‘I really ought to know a little bit more.’ So with a little bit of pushing from my wife, I started doing an LLB by correspondence course, which after six years, I got in 1997, just before going back to Hong Kong.

“I was lucky enough to be appointed the Queen’s Honorary Surgeon”

Towards the end of my career, I was lucky enough to be appointed the Queen’s Honorary Surgeon and finally retired in 2002.

Having retired, after about six months, I went back to university at the start of the next academic year and I did a BSc in Conservation & Restoration of Decorative, Hard Surfaces, during which I did a work attachment at The Tate, and I did the conservation work on one of the frames of Sir Joshua Reynolds Age of Innocence and I wrote my dissertation on the Frames of the Vernon Collection, which also included having to produce a catalogue of the frames. Having got my degree, I should have got a job, but I didn’t, I stayed at London Metropolitan University and I did a two-year, full-time Higher National Diploma in Furniture Restoration, after which, The Tate were persuaded to take me on as a volunteer researcher in frames conservation, and then the university said, ‘Well if you can work for The Tate, why can’t you work for us?’ And so since 2007, I have been a visiting Research Fellow at London Metropolitan University, working in the furniture restoration workshop, and I have also been the researcher at The Tate, where my main work had been focussed on producing a catalogue raisonne of the Frames of the Turner Bequest, and also more importantly for The Tate, trying to make sense of the frames and how they have been moved around and how they should be framed.