I: I’m David Hatch, and we’re here in the Association of Anaesthetists building on 3 August 2015, and I’m here to have a chat with Dr Roger Eltringham. Roger, good morning and thank you for joining us.
P: Good morning. It’s a great pleasure to be here.
I: Let’s start at the beginning, shall we? How did it all begin?
P: Well, if I start with my grandfather, he worked in a shipyard in Gateshead and my father, who was the oldest of 10, joined the Royal Navy in the First World War. When he came out of the Navy there were no work to be had so he moved down to London and married my mother, came from Kent. They lived in Wembley; and I was born in Hampstead, 1939. Shortly afterwards, of course, World War II broke out and the family moved from Wembley to Marden, a village in Kent, to escape the bombing. My father again volunteered for the Navy, so he was away most of the war. My early memories were dominated, really, by the war, because of course Kent was very much in the front line and, although they weren’t aiming for us, a lot of bombers passed overhead and were shot down. And then, of course, doodlebugs started. So we really were in the range, because they would shoot them down before they got to London. So in fact, 19 doodlebugs fell in our village. We thought they were aiming for us, but in fact all the other villages had a similar sort of score. Kent, although we thought we were escaping the bombs, we certainly weren’t, and a number of bombers were going overhead all the time. And all my childhood was all to do with the war. In our house, the village where I lived in, a siren would sound that meant the enemy were on their way, and we would all rush into a nearby shelter, which was dark and you’d fall over people. It was chaos. And then later we had an Anderson shelter, which was like a steel table, which was available, and we put it into the house. And so we’d have meals on this table. And then if there was an air raid warning we’d all get under the table, and my mother would pass food down to us.
I: I can remember with the doodlebugs, if you could hear the engine you knew you were safe. It was when it cut out you had to take cover.
P: Yes, you had to. And then if a plane had crashed or something everybody would go out and look for bullets and shells and things like that. So it was a bizarre sort of life, and I didn’t know anything else different. The church bells would ring only if the Germans had invaded. Now, if you were in Kent, of course, that was quite important to know this, ’cause they were very close by. So I asked my mother what they did. She said, ‘Well, we have a pushchair ready, and got your identity cards, gas masks, ration books and some water and some sandwiches.’ And they were told to walk westward. And I said, ‘Well, then what happened?’ ‘Well, then you were to await further instructions.’ Fortunately, church bells never rang and we never quite came to that. But we were always ready for it. When eventually the war was over, we didn’t really quite know what to do. What are we gonna do now? Weren’t quite ready for peace. Although rationing carried on for a long time and there was quite a lot of bartering that went on. My father came back from the war and he got a job in a paper mill, which is quite useful ’cause in this village nobody could get any paper. And we couldn’t get eggs and cheese and things like that, so we would be sent off to various farmer friends with baskets full of paper and hand them out, and come back with cheese and eggs and things like that. This went on for a long, long time.
I: Did you go to the local village school?
P: Yes. I did for some time, and then I went to a prep school. And then eventually I took the 11-plus and then I went on to Cranbrook School. I’d gone to a grammar school first, but I was removed from there because of disciplinary reasons, and I went on to Cranbrook School, which is a boarding school and very old-fashioned; very strict. We had stiff collars with collar studs, straw hats and a lot of corporal punishment. CCF; we had to join the Combined Cadet Force. And we were a very military-orientated school; and the school band would be marching up and down. So it was a very interesting school. But I was very interested in sport, and I did reasonably well there and played in the school teams.
I: You were particularly good at rugby, I think?
P: Well, some thought so, others had a different opinion, but I did alright and I played for Kent, so that helped me a lot. Then when it came to leaving; ‘What are you going to do?’ I was going to do physical education, and I’d got a place at Loughborough College – I think it’s Loughborough University now – to study that. But in the mean time I went on a cricket tour of Holland. I’d actually left school. So the school cricket team went to Holland to play various teams, and we were playing the Dutch youth 11, I think it was. Big match for us. And after about half an hour we were all called off the field. I thought, what’s going on here? Perhaps they do this in Holland. So we were all told to go into the pavilion. And along came a very distinguished man who wanted to address the team. And he said, ‘I must apologise for being late but I’m a surgeon at the local hospital and I was called back to operate on a child because he was losing blood faster than we could give it. And so I had to scrap the match and deal with this.’ And I’d never heard anything like this. I thought what dedication. Perhaps cricket isn’t as important as I had thought. I wanna do what he’s doing. So I then came back from the tour to Kent, and we’re well into August by this time, and my father said, ‘Oh yes, good, you’ll be at Loughborough in a few weeks’ time.’ I said, ‘Yeah, but I don’t wanna go to Loughborough.’ ‘What do you mean, you don’t want to go? You’ve got a place there.’ ‘Yeah, I don’t want to go there now.’ ‘What do you want to do?’ ‘I want to study medicine.’ ‘Medicine? What are you talking about? You don’t know anything about it.’ I said, ‘Well, that’s the idea of the course. You study it and get to know about it.’ But I hadn’t got any idea where to apply. I applied to all the hospitals in Britain and Ireland.
I: Did you have the appropriate A-levels?
P: Well, I had maths, physics and chemistry, which was almost alright. No biology. I never done any biology at all. So only two places even replied. One was St Mary’s in Paddington, and the interview was something like Doctor in the House. There was a James Robertson Justice type of chap and he was saying – he had my results… there was a lot of indrawing of breath and shaking his head. And I could see where the door was and I was thinking, I’m gonna be there in a minute.’ I’d only got one good thing to put on it, which he missed. But he seemed to read it again, and he suddenly said, ‘Oh, wait a minute. I see you played rugby for Kent.’ I thought, this is the only chance I’ve got. I said, ‘Played for them? I was captain of them.’ ‘Oh. Well, what position can you play?’ I said, ‘Well, I can play anywhere.’ This is a bit of an exaggeration. And then he said, ‘Oh, well we do seem to have, now I look again, an unexpected vacancy.’
P: I’d love to have seen what was in front of him. I don’t think there was anything on the page. So that sounded promising. But then I had an offer at St Andrew’s. And my doctor was a Scotsman, and when he heard this, he said, ‘If you don’t take St Andrew’s I will never speak to you again.’ So St Andrew’s got the vote and that’s where I went. Now that was a very extraordinary university, really. I think it still is. Very, very traditional. Very old-fashioned. We had to wear scarlet gowns, for example, and the girls used to wear mortar boards in the college chapel. It was a very traditional sort of place with a terrific emphasis on anatomy, and very old-fashioned. Nothing modern there. I picked it up reasonably well, but I did get knocked out once in a game, just before an anatomy viva. So anyway, I took this viva the next day and I seemed to be doing alright. The professor of anatomy had a lot of bones on a table and he kept picking them up and passing them over to me and saying, ‘What is this?’ And I’d say what I though it was and, ‘This hole is for this artery.’ ‘How about this bone? What do you make of that one?’ A skull came across. Anyway, after the exam, he said, ‘Now, what do you say your name was?’ ‘Roger.’ He said, ‘Well, look, I’ve been examining in anatomy in this university for 40 years.’ I wasn’t sure whether to applaud or say, ‘Well done.’ He said, ‘In all that time, you are the only candidate that doesn’t… you didn’t know a single thing about the human body.’ ‘What?’ He said, ‘All these bones; you got every one wrong.’ <Laughs> I thought I’d done quite well. So I was dismissed, and luckily a friend of mine came in next, and they obviously discussed this performance, and he said, ‘Oh, did he tell you he was knocked out yesterday?’ ‘No. Get him back.’ So I was called back, and he said, ‘Sit there. You didn’t tell me you were knocked out yesterday. Why didn’t you tell me?’ I said, ‘I didn’t think you’d be interested.’ ‘Of course I’m interested. Come back in a week’s time and we’ll test you again.’ So I came back a week later and remembered a few facts. The annoying this was I thought I’d done so well.
I: You were still playing a lot of rugby then, were you?
P: Yes. Played for the university, and I went on various tours with them, which I enjoyed very much, and then medicine became rather important and I kept failing exams. And in St Andrew’s it’s quite good ’cause you failed in June – we had very early exams so that they could fill up our beds with golfers – and we could resit it in September. And if you sat it in September you didn’t have to miss a year. So I was back every September.
I: And you got married in your final year, rather like I did, actually.
P: Yes. It made a big difference to me. For the first time I started to pass exams. And Lorna was a sister at the London Hospital, and by that time I’d got a house job – or soon afterwards – in Dundee. Lorna was planning to go to San Francisco. I had to persuade her to come to Dundee. I had to be quite persuasive on this particular issue. But it did help a tremendous lot.
I: Because married life for a young houseman wasn’t terribly easy in those days.
P: No. We hardly met, actually, ’cause we only had a half a day off a week, and alternative weekends. But if the other chap was on holiday, of course, you lost your weekend off as well. So it was quite difficult, house jobs, but…
I: Had you decided what branch of medicine to go into at that point?
P: General practice, everybody had assumed, and I went along with them. One or two of the year were going to be neurosurgeons and a few were going to be cardiac surgeons and so and so; and the rest of us assumed that we would go into general practice. I was in this group.
I: So the house job was a house physician job, was it?
P: House physician in Dundee, and then house surgeon, Hastings, which was quite near where I came from. And then somebody said, ‘Well, for general practice you’ve got to know about obstetrics.’ So I applied for the Rotunda Hospital in Dublin, which was where a lot of deliveries took place, and it was regarded as a good place to go. So I went to the interview, and it was a rather unusual interview. He only asked one… he said, ‘Have you got a driving licence?’ I said, ‘Yeah.’ ‘Is it up to date?’ ‘Yeah.’ ‘Good. Well, you can start next week.’ I thought, I wonder what I’ve agreed to. Perhaps this is the hospital chauffeur he’s interviewing for. <Laughs> But it turned out to be very relevant, because the job of the house… I think they called us clinical clerks for the first month, and our job was to drive the hospital ambulance around. And you’d go to all the people who were having home deliveries, which seemed to be just about everybody. And on day one I arrived at the hospital and collected the keys and I was very relieved to see in the passenger seat an experienced obstetrician and a map of Dublin. And in the back were two cases. One was marked ‘obstetrics’ and the other was marked ‘anaesthetics’, which I didn’t take too much notice of. Wish I had, now. When we got to the various houses my job was fairly basic. I’d pick up the two cases and follow him up the steps and then we’d go into the bedroom and he’d either deliver a baby or sew up something. My job was to sit there and take notes and keep quiet. And then one day I could see he was struggling, and things were obviously not going very well. And he suddenly said, ‘Open that case marked “anaesthetics”.’ So I opened it and there was a lot of things I’d never seen inside it before. I was getting a bit nervous at this point, so rather optimistically I said, ‘Shall I phone back to try and summon an anaesthetist from the hospital?’ He answered with words I did not want to hear. He said, ‘You are the anaesthetist.’ So this was very alarming and I got out… I’d seen a picture of a Schimmelbusch mask and I could see something rather like it. I said, ‘What do I do?’ He said, ‘Put the gauze on there and then there’s a bottle of chloroform there.’ ‘Yeah?’ ‘Well, pour the chloroform onto the mask until I tell you to stop.’ Oh my god. So I did this, and patient collapsed unconscious, but had a difficult airway; and I knew to hold up the jaw but there was quite a lot of noisy breathing and the patient went blue. He was white and I was feeling very yellow at the time. So it was a most awful situation. Luckily she survived, but I thought, this is not for me; I’ve gotta get back to England. So I left as soon as possible.
I: So that didn’t endear you to the subject?
P: No. I thought, I never want to have anything to do with this; this is the most dangerous subject I can possibly imagine. So I decided, it’s gotta be general practice. So I went back and I got a job in Bath as an SHO and then a casualty in Bristol. Now casualty in Bristol, I think – probably like most big cities – was not a rest cure. There was punch-ups every night. I think at the end of my six months I was punched three times and bitten twice. There was quite a lot of action going on. But for recreation I joined the hospital rugby club, where there was still a lot of biting and punching but we were able to take part. So I did alright in this team, and they were very good. I did notice most of the players seemed to be anaesthetists, which was a striking feature of the team. And a very, very sociable team. I didn’t realise how important this was to my subsequent career ’cause in the showers afterwards – in those days, I’m not sure if they still do it, but there was a big room and water would come out of showers and you couldn’t really see, there was so much steam and a lot of singing was going on and various other entertainments – suddenly, out of the mist came this burly-looking figure with a Northern Ireland accent. And I noticed he had a cauliflower ear and there seemed to be some blood coming down here, and his teeth bleeding as well, and his eye was slightly closed. And he said, ‘What are your plans for the future?’ Something like that. I said, ‘Oh, general practice.’ ‘You won’t be any good at that.’ Which was a bit of a blow, really, ’cause I thought I was going to do that. He said, ‘If you want to play for this team you have to study anaesthetics.’ I said, ‘I’ve got no interest in it.’ ‘You’ll get some.’ ‘I’m not very good at exams.’ ‘We’ll help you.’ ‘Well, there’s a lot of good candidates for this job.’ ‘The job will be yours. Forget the candidates.’ So he wouldn’t take no for an answer. So I did apply. I had to do a few other jobs first. I did some general practice, while this job that I’d been promised came up. And so I got a job at Butlin’s in Minehead, which was rather more than I was expecting, because I thought it would be a little holiday with Lorna and the children, but as we approached the camp it was like a concentration camp. There was huge, big fences up around it, and watchtowers that seemed to have searchlights. I said, ‘This is rather bigger than I thought. How many people are here?’ ‘Oh, 12,000 holidaymakers.’ I said, ‘12,000? That’s a lot.’ He said, ‘Oh, there’s another 3,000 on the staff.’ I said, ‘Gosh, 15,000. How many are we in the team?’ He said, ‘Team, what are you talking about? Team? It’s you. You are the doctor for this lot.’ So it was quite a busy job; lots of emergencies.
And then I got a job with one of these mobile… GP deputy in Bristol. And the beauty of this was you had a radio in the car – that was quite unusual in those days – and call signs, and ‘Hello one-zero, proceed to so and so.’ And we used to deputise for the emergencies. And one Sunday night – it was Easter Sunday – I got called to some alms-houses in Bristol, and it was getting dark so it was a bit spooky and they were spooky alms-houses and grey, big arches around the central lawn. And I was told to go to residence number three. So I went to this residence and knocked on the door. Nobody came. So I shouted out; nobody. So I opened the door and it opened with a creak <makes creaking noise>; and I called out, ‘Mrs Jones?’ No. I couldn’t find a light. And I fell over something, and it seemed to be a foot. And I suddenly realised, oh god, there’s a body on the floor. So still no lights but I could make out… and I called out. Felt the pulse. There’s no pulse; no breathing. I thought, my god, this patient’s dead. So I’d better go to the warden; tell them. So I went to the warden’s house and it was pretty eerie. Strange feelings down the back of my neck. I went to the warden’s; knocked on his door. There was no answer, so I knocked a bit louder. There was no answer. So I opened his door and it was a similar creaking door <makes creaking noise>. I went in; he was dead. And I thought, oh god, this is terrible. Maybe there’s been some awful incident here or some chemical’s been released. So I thought, I won’t try any other doors in case everybody’s dead. So I phoned the police in Bristol and said, ‘Look, who are you?’ ‘Doctor.’ ‘Never heard of you.’ I said, ‘Well, I’m a locum but I think you ought to come down to this alms-house because I was summoned to a patient. The first two doors I’ve been into, they’re both dead, and I’d rather some police were down here before I go anywhere else.’ And eventually they came, and we went into a third door, and this one was alive. It was just a freak coincidence. But that did put me off. So it was quite a relief to get back into the hospital.
I: You had started a family by then?
P: Yes. I think I had one or two daughters by then, and then I had a third daughter. So I think at that time I had at least two.
I: And there was some story about a disturbance in a church, I think?
P: There was. Yes, that was another one. A call to Sunday night, and they said, ‘Go to such and such a church in Bristol.’ So I said, ‘What’s happening?’ ‘Well,’ they said, ‘one of the members of the congregation has got upset. He got very disturbed. Got into the pulpit; told the vicar to shut up and sit down and he was going to take over the service.’ So I said, ‘What have you done?’ They said, ‘Well, we’ve evacuated the church and sent for you.’ Which was not what I wanted to hear. So we were in his house by this time, and we’re trying to work out a plan how to… when this chap came in, and he was a very big physical specimen, demanded to know who I was. And I tried to explain. I couldn’t remember much about getting people certified but you have to get a couple of opinions, and you’re including the duty psychiatrist. Well, this was another saint’s day, I think, and there was nobody around. And I phoned about 20 psychiatrists in Bristol, and eventually somebody… He said, ‘Who are you?’ I said, ‘I’m a locum doctor.’ ‘What do you want me for?’ I said, ‘Well, in your role as duty psychiatrist, I’ve got a patient who needs to be sectioned.’ ‘Why do you think he needs to be sectioned?’ I said, ‘Well, he’s been punching me.’ ‘We can’t section people ’cause they punch you.’ I said, ‘Well, also, he’s caused chaos in the service and he’s dismissed the congregation and the vicar and refuses any form of therapy that I’ve offered him <laughs> and we need to get him in hospital.’ Eventually he came, after a very long interval. But in the meantime my bag was between him and me, and I just noticed every time I looked down it was nearer to him and further from me; and then it was out of reach! And I thought, if you’re not careful, this psychiatrist is gonna come in and say, ‘Well, he’s the patient.’ ‘No, I’m a doctor; he’s the patient!’ Anyway, luckily it all ended happily with him being carted off. But my background in psychiatry was exposed rather, I’m afraid.
I: So that was your experience in general practice. What got you interested in general practice, then?
P: Well, for the interview with Peter Basket, it was made clear that I couldn’t play for this team unless I was an anaesthetist. And as I was the kicker they were quite keen for me to play. So I did get in as…
I: This was Peter Basket, this man with the cauliflower ear?
P: Yes. I didn’t realise at the time, but he was to play a huge influence in my career. And he did look after me, I must say, both on the field and off it. So I owe a tremendous lot to this character.
I: So what was your first experience of proper anaesthesia, then? It was in Bath, wasn’t it?
P: Yes. The Royal United, Bath. This wasn’t a big department and anaesthetics wasn’t a very popular speciality, and my interview was a bit strange because I was being interviewed by the committee and I’d worked there as an orthopaedic SHO previously. And the interview wasn’t really going terribly well. Suddenly a door burst open and this Irishman came in and said, ‘Hello, Roger, I hear you’re joining us.’ And the rest of the committee looked a bit surprised at that. Anyway, we shook hands, and the deal seemed to be clinched, so I did unexpectedly get this job in Bath. It was very good. In those days, of course, you were thrown in very much at the deep end. So you had a couple of days with the registrar and it seemed after a very few days you were given your own list. But they said, ‘Don’t worry, he will be in the next room.’ Luckily, we had in those days people called technicians. I’m not sure they still have them. But these were Second World War veterans, people who’d fought the Germans, and they were not easily frightened, thank goodness. So they would tell you what to do. You would be greeted in the morning. They’d say, ‘Doctor, I drawn up all the drugs in the correct doses and I’ve labelled them for you. But don’t give anything unless you check with me first.’ So you would hold up a syringe and they would go nodding; and then you’d hold up and then you’d get an affirmative. So they did look after you, I must admit, and they were very calm, and I owe them an awful lot.
I: But you didn’t get much formal teaching?
P: No. Very little formal teaching. There was no tutorials or teaching sessions; you just learned everything with the registrar. Occasionally, if you were very good, you’d have a session with the consultant anaesthetist, but often they wouldn’t be present in the room for quite a lot of the time. And they would say, ‘Well, look, Roger, if you need me I’m having a cigar with Matron in her office. Call if you need me, but do what you’re happy with.’ Or else they’d say, ‘Now, Roger, this list; there’s still another three cases, but I have to go off to the Nuffield. If you wouldn’t mind just finishing off these easy cases.’ So we got a lot more… but it was good for getting experience.
I: There wasn’t much regional or local…
P: No. Spinals were banned because, I think, there had been a famous case somewhere where people had been paralysed. And so we weren’t to touch any spinal anaesthetics at all. Everything was under general and we only had a few drugs. We had thiopentone and suxamethonium, and then we had ether, I think, and chloroform. Chloroform was going out. I was very pleased after my previous experience with that. Ether was coming in as regarded as safe. Halothane had been introduced. And there was a vaporiser – wasn’t part of a machine, it was a standalone vaporiser – but the SHOs weren’t allowed to use it because it might cause cardiac arrest and you wouldn’t be able to deal with that. So stick to ether and Trilene. Those were the main agents at the time.
I: And curare?
P: And curare, yeah.
I: So you paralysed a lot of patients?
P: We paralysed a lot, and occasionally we… and face masks and Guedel airways were very much to the fore.
I: Boyle’s machines?
P: Boyle’s machines, yes, of course, with low central gas…
I: Glass bottles?
P: Glass bottles, yeah, which got very cold of course, and then you had to… There was a thing like a saucepan that you put the vaporiser in…
I: With warm water?
P: With warm water in it, yeah. That’s right. So it kept the temperature. I didn’t really understand the physics to start with.
I: And gases in cylinders?
P: Gases in cylinders. We had oxygen, of course, and a bosun whistle. And that wasn’t supposed to go off because it disturbed the surgeons, but luckily there was a dial, so as you were getting near, the clever chaps would wait until it just about to go off, switch off, and then these cylinders would be changed. And nitrous oxide.
I: Used to be carbon dioxides too, didn’t they?
P: Carbon dioxide, yes. I never quite understood what that was for, but I was told, ‘If they’re not breathing, give them carbon dioxide.’ I didn’t use it very often.
P: Yes, cyclopropane was a winner. Now, I did like this drug because it was easy to give. They said, ‘One litre of cyclo, one litre of oxygen. Put them to sleep. Once they’re asleep, get rid of the cyclo. Turn it off. Don’t take it into theatre otherwise there’d be explosion; everybody would be killed; bad medicine.’ So we used it. We were very careful not to bring it into the theatre itself.
I: Not much monitoring, either?
P: No, there wasn’t. Hardly … there wasn’t any monitoring, to be honest. Finger on the pulse; watch the breathing; look at the pupils of the eyes. If they’re big then either you’ve got too much or too little; and if they react to light they’re just about to wake up. So watch those pupils very carefully. If there’s tears coming down then they’re probably a little bit light. Respiratory rate was very important, and pulse. To be honest, it was good training, because in later life I came across places where there wasn’t any monitoring, and this training came in terrifically helpful.
I: Difficult to tell the colour, too, in some lighting, wasn’t it? Cyanosis was difficult to pick up.
P: Yes, cyanosis was very difficult. I was told to look here – the eyes – which was quite a good one. A little torch that you could show, but the monitoring was really clinical and nothing scientific at all.
I: Glass syringes?
P: Yeah, glass syringes we used, which we had the responsibility of keeping clean. So at the end of the case, or during the cases, you rinsed them out and then put them in a steriliser at the end of the anaesthetic room. One occasion I noticed that – it was just before Christmas – a lot of nurses kept coming into the anaesthetic room who weren’t really due in there, and would go up to the far end, open this steriliser and do something and then walk out. And after about three or four different nurses came, I thought, I’ll go and see what’s going on. There’s something strange going on. So I went along and opened this steriliser, and inside were three Christmas puddings. They were getting their Christmas puddings.
I: Reusable needles and so on?
P: Yeah, reusable needles, glass syringes, everything. The other thing, which was very strange: all the intravenous drugs and fluids, including blood, came in glass bottles. And the only way you could pump it in was to pump air into the glass bottles and build up the pressure. But you had to pay close attention because, of course, if it ran out, all this air would go into the circulation and be fatal. So although it was effective, I was very pleased when plastic bottles came in and we didn’t have to do this. I think it was a Higginson syringe we used to pressurise them with.
I: And were you involved in any perioperative care?
P: No, not at all. We weren’t expected to see the cases beforehand. They’d say, ‘No, this is your list. The house surgeon has [31:07] them’ – he always gave [31:10] to everybody – ‘and you will see the patient in the anaesthetic room and introduce yourself.’ There wasn’t much time for any talk. The surgeon’s face would be at the door if there was any chit-chat.
I: No recovery area?
P: No recovery area, no. As soon as the case was over, turn them on their side and took them outside. And then you handed… You phoned the ward and the nurse would come back and you had to explain what they’d had. No notes, of course, that was the other thing. We just had a piece of sticky paper, which you put in the notes, and it said patient’s name and what drugs you’d given and what the operation was, and any comments. And that was the anaesthetic notes. You weren’t expected to see them again.
I: So your next job was in Bristol?
P: That was a huge change, yes.
I: Was that a rotation or did you apply?
P: No, I think I had to apply. I think Peter Basket had quite a lot to do with this appointment, and I was very grateful to him because it was a very, very excellent hospital. I loved it.
I: Had you got the primary by then?
P: No. But there was actually a primary course. I’d never heard of primary courses; this was something new to me. It was terrific; they really looked after you and helped you with the training and taking exams.
I: But I assume by then you had begun to develop a real interest in the subject?
P: Yes, very much.
I: It wasn’t just to play rugby.
P: No, I got very interested in it, and I liked the fact that you were working with different people all the time and you got to know them very well. And I liked the atmosphere in a theatre, and it was a very sociable place. And they did help you a lot with the teaching and training. Although I did fail the exam a few times, they were always very encouraging and blamed the examiners. I remember one examiner who I kept seem to meeting, and I didn’t know at the time was Professor Mushin. And when he’d failed me on the third occasion, he did suggest that perhaps another speciality might be more suitable for my skills. He put it in a very kind way. I think if he realised that I eventually got the Mushin Medal, he would have cancelled it. I think he would have withdrawn it from circulation.
I: But of course quite a few of the examiners came from Bristol in those days.
P: They did in those days, yes. You weren’t supposed to be examined by people you knew.
I: There was John [Bows 33:40].
P: John Bows; John Zorab, I think, was another; Donald Short was an examiner.
I: So you took the exams then from Bristol, did you?
P: I did. And eventually, after four occasions I did pass, and that was a great celebration. So eventually got this exam.
I: What next?
P: Well, then I joined a rotation… in Bristol they would rotate you around the various hospitals. And they said to me, ‘You’re going to Truro.’ So I said, ‘Are there any other alternatives? Nothing against Truro, but I just wondered.’ He said, ‘Well, there is Denver in Colorado.’ Actually I said, ‘No, I think Denver’s probably more suited for my skills.’ Or lack of them. So anyway, I went to Denver, because we had a bit of a link with Denver. And Jack O’Higgins and John Powell had both been to Denver and recommended it strongly. So I went to Denver, where I found they were very impressed that I had so many years of anaesthesia and I was immediately put onto the consultant rota. It was a very big hospital and the catchment area was not just Colorado, but quite a lot of states nearby seemed to use us. But we’d get things like a Tetralogy of Fallot in a neonate. You can imagine this taxed me quite seriously. Denver Airport was very high – I think it’s about 5,000 feet above sea level – so it was one of the only two hospitals in the United States where you could land a plane which had an atmospheric bomb on board, which was something I hadn’t really come across before. But there was an SOS from the Denver police saying, ‘A plane with an atmospheric bomb is approaching; get ready for it.’ Which taxed my imagination. Luckily, it was diverted to Grand Falls in Michigan, I think, so it didn’t land.
I: Did the altitude affect the anaesthetic?
P: Yes, it did, because nitrous oxide and oxygen wasn’t enough. Partial pressure, apparently. I’ve forgotten what it was at 5,000 feet. So you had to make sure. I was used to using nitrous oxide and oxygen, so that had to change. The other thing that was strange there, they had a… Professor Starzl was the great transplant surgeon, and he was in the early part of liver transplants. And sometimes they couldn’t get a liver. Lots of people lived around the hospital waiting for transplants but if there was no matching they used to use a chimpanzee. And they couldn’t get any Americans to work on the liver transplant service because it was a miserable service and lots of long cases going on for about 23 hours. So you dreaded a French accent. And one night I was on call. ‘Is zat you, Roger?’ ‘Yes.’ ‘Ici Jacques.’ Who was the last person I wanted to hear from. ‘Yeah, what do you want, Jack?’ ‘Professor Starzl, he wants to do a liver transplant in about three hours.’ This was about midnight. ‘Oh, yeah. Tell me some more.’ ‘Well, you have to anaesthetise a chimpanzee.’ I said, ‘What are you talking about?’ ‘Well, there’s no human donor so we use the chimpanzee.’ So I thought, my god. I couldn’t even envisage what I could… I knew it was a sort of monkey, but I… So I phoned up one of the American chaps and I said, ‘Look, I don’t know what to do here but he wants to anaesthetise a chimpanzee.’ He said, ‘Oh, no, I’ll do the chimp; you do the human.’ So I was very happy with this arrangement. So I got my patient in a nice position, and there was no sign of the operating theatre where the donor was coming from. So I phoned up the animal house and I said, ‘Look, we’re ready to go. What’s happening up there?’ ‘Oh, Christ, there’s a lot gone wrong.’ I said, ‘What’s happened?’ ‘We lost the key to her cage.’ I said, ‘You’d better bloody well find it because we’ve started.’ So apparently there was chaos up there and they sawed a bar through this cage. Anyway, somehow this chimpanzee was overpowered and brought into the next room. Then he went home and one of the residents looked after the chimpanzee. Messages would come through, like, ‘Wow, got some trouble in here. The chimp’s got asthma. What do you usually do?’ I said, ‘Well, what we usually do is to titrate aminophylline until the breathing’s better.’ ‘Oh yes, of course, thank you very much. Glad to have someone with such experience on duty with me.’ ‘Pleasure.’ Anyway, this got through. Unfortunately it wasn’t a success, but it bought some time for this operation to go ahead.
I: And did you have the family with you in there?
P: Yes. Family came and the girls went to an American school and came back with American accents.
I: Enjoyed it?
P: They loved it. Yeah. ‘Get outta here, dad.’ They used to talk with these quite unusual accents; it was quite good.
I: Was your wife working there?
P: She did get a job in the Jewish community centre, and also with the local radio station. So she really joined in. I joined the local rugby club and they weren’t very good but they were good blokes, and we had to go miles to get fixtures. And then after the year… I was made captain of this team. I said, ‘What, captain?’ I was only just about good enough to get in. ‘Yeah, all the other teams have got captains with English accents. We want you to captain the team.’ So I said, ‘Well, if you want the accent I can do the accent and I’ll play.’ ’cause it’s very high above sea level, so the tactic was to kick the ball into the corners ’cause the others would soon get tired and then we would overpower them. But there was one big black American footballer who came to join us, and he had played for… the local football team’s called Denver Broncos, but unlike rugby there’s no old boys. Once you’re finished, you had to go and join a rugby club. So this huge man appears and he was fantastic, he went all over the place scything people down. But after about five minutes, he got a bit breathless and he came up to me. He said, ‘Hey you’re the captain, ain’t you?’ I said, ‘Yes.’ ‘When am I going off?’ I said, ‘What are you talking about?’ He said, ‘Well, I’ve been all over the field, I gotta go off.’ I said, ‘Look, I’ve got some bad news for you. You can’t go off in this game. You’ve gotta stay. You better slow up a bit ’cause you’re on for the full duration.’ <Laughs> But it was after this, when I went back to England, they said, ‘Where do you come from?’ ‘Bristol.’ ‘Well, we’re touring England. We’ll fix a game with Bristol.’ They were about level with Chipping Sodbury Seconds. I said, ‘Well, to be honest I don’t recommend this.’ ‘No, we’ve heard of Bristol. We wanna play in Bristol. Fix it up.’ So by this time I was in Gloucester and I managed to get a fixture with Cheltenham Civil Service, which was a three-all draw, so everybody was happy.
I: So you came back to Bristol.
P: Wasn’t the tradition, though, in Bristol, to call the consultants. And one time we had a ruptured aortic aneurysm, which I hadn’t seen at the time. So I thought, ‘Well, I’d better call the consultant on call. He’d want to know about it.’ So I called this consultant, who wasn’t used to being called at night. He was rather an elderly man. And he said, ‘Who are you?’ ‘Roger Eltringham.’ ‘I’ve never heard of you.’ I said, ‘Well, anyway, that’s who I am.’ ‘What do you want?’ I said, ‘Well, you’re the consultant on call.’ ‘Consultant on call? What are you talking about?’ I thought, ‘God, where do I start?’ He didn’t seem to know what I was talking about. I said, ‘Well, every night there’s a consultant on call and tonight it’s you.’ ‘Well, what do you want me to do?’ I said, ‘Well, we have a ruptured aortic aneurysm here. I think I really need some advice.’ He said, ‘I haven’t been into that hospital at night for 40 years. You know what to do. Goodnight.’ Luckily there was a senior registrar on to help me, but it wasn’t apparently the tradition that you would call this particular consultant at night, and he seemed to forget what the duty involved.
I: Did you get involved in intensive care?
P: Yes. Intensive care, for the first time. I loved that. That was tremendous. There was a cardiac arrest unit and you had to go round. Occasionally we had to cover the cardiac unit, which I hadn’t done a lot. And the cardiac anaesthetist, he disappeared one night; gave me his bleep; said, ‘Everything’s quiet. These cardiac cases, nothing will happen.’ So he handed me his bleep. Sure enough, he went out of the hospital and it went. ‘Get up to the cardiac unit.’ So I went up to the cardiac unit and there was a patient seemed to be struggling to breathe, so I called for some drugs and put a tube down. There was another man standing by the bed who I didn’t recognise, but nurse gave the drugs to him and he gave them to me and I injected them. And then he started punching me and got into great rage. I didn’t even know who he was. And he said, ‘You didn’t check that drug.’ I said, ‘Well, I saw you were looking at it; I thought you were checking it.’ Anyway, it was the cardiac surgeon, who I’d never met before. The tube went in; it was hard to get a tube in when people are punching you but I got it in and carried on. And I didn’t think any more. I thought, this chap’s… I wasn’t sure who he was. Anyway, the story got back to Peter Basket and I was called before the anaesthetic committee in Bristol, and they said, ‘Is it true that Mr X punched you last night?’ I said, ‘He did, yeah. He was in a bit of a panic.’ ‘Well, this is disgraceful. There must be a case about this. Why didn’t you report it?’ I said, ‘Well, I thought maybe this is what he always does. I’d never met such a peculiar person.’ <Laughs> Anyway, it all calmed down but he was told not to get in such a state in future.
I: So who was running the intensive care side of things then? Was [Sheila Willis 44:14] there?
P: In those days… Sheila came while I was there, I think, and she was very spectacular and very keen on the unit. We kept changing round, up to Frenchay and then you were at Southmead. John Powell was at Southmead; and John Zorab and Peter Basket at Frenchay, Ronnie Greenbaum. It was such a smooth-running unit and you had such support, and it was a wonderful place, a wonderful hospital to work at. Bristol was absolutely superb.
I: So then consultant jobs lured over the horizon?
P: They did, yes. I applied for one or two and came second or third. At one interview I went to, it was a well-known professor and he was fairly aggressive in his questioning. First question was, ‘Well, tell us why we should appoint you as opposed to those excellent candidates outside.’ Well, if you’re not ready for that sort of question… I couldn’t think of any reason; nor could he or the rest of the panel. And I was shown out. But when I eventually came to Gloucester – I’d had a lot of coaching by this time – believe it or not, the same chap was on the committee, and he asked the same question; but I was ready for him this time. ‘Why do you think we should appoint you as opposed to the others?’ I said, ‘Well, I’m afraid I can’t comment on the others – I don’t know anything about them – but I can tell you why I think I should get the job.’ And Peter told me, ‘No modesty.’ I said, ‘I see from the advertisement that you’re looking for someone who can run an intensive care unit. I’ve had a lot of experience in that, not only in this country but in the United States of America. I know I can do that.’ And then he took a breath. I said, ‘Also, there’s no teaching in this hospital.’ ‘What?’ I said, ‘There’s no teaching going on.’ And you could see there was a bit of confusion on the other side. ‘How do you know that?’ I said, ‘Well, I’ve been on several visits. Everybody has said there’s no teaching. I shall start a teaching course straight away.’ So they took that, and he went to take another breath. ‘And another thing: there’s no obstetric epidural service. I’d start that straight away.’ I had about four things. And in the end he said, ‘Alright, alright. Yes.’ And Mike Hills was on the committee, and he said, ‘I told them that you’d be positive, but blimey, we weren’t expecting anything like that.’ So I owe a great … to them. I’d been too modest in the past.
I: So you got that job. We’re talking 1974, I think?
P: Yes. It was 1974. And I got the job, and the job was to start an intensive care unit. Mike Hills and I did that. And of course it was quite new, and nobody knew how to do it. So we ran it on Bristol lines; resuscitation service and that sort of…
I: Did you have theatre sessions as well, or were you a full-time intensivist?
P: Yes. No, not full-time. I think we had two sessions a week. And then the two of us would alternate cover. So it was a pretty heavy job.
I: How big was the unit?
P: Six beds. But some consultants wouldn’t use it, and others used it all the time. They weren’t used to working with us but eventually it worked very well.
I: So you then got established in Gloucester. Still playing rugby?
P: I did play a few games.
I: Getting a bit long in the tooth for rugby?
P: Well, yes. I always seem to be long in the tooth. In fact, I did play for an under-23 team – going back a few [48:00] year. And the referee would not start the game. And I could see the captain and the referee kept looking at me and pointing. Eventually, I said, ‘Well, what was all that about?’ He said, ‘He didn’t believe you were under 23. I had to get that verified.’ By the time I came across I didn’t, but of course one of the attractions of Gloucester was this team that I’d seen coming up. They weren’t the most fashionable team in England, but they were very good. Always had a huge pack. And no three-quarters, we couldn’t find any, but we could keep the opposition in their 25 and eventually somebody would be offside and we’d kick a penalty goal. So we were the most unpopular team in England, I think.
I: But you became medical officer to…
P: I did. Well, a friend of mine was the medical officer, and he’d been a St Andrew’s graduate, and when he retired he told the club, apparently, ‘Well, there’s only one person. You’ve gotta get Roger Eltringham from the…’ So I was called to interview at Kingsholm. And I was expecting to face the committee… and instead this chap, he said, ‘Hello Roge, I hear you’re joining us.’ I thought, I seem to have got the job. He said, ‘Do you know anything about rugby injuries?’ I said, ‘Well, no, not really.’ ‘Good,’ he said. There were no subs in those days, but he said, ‘In Gloucester, what we do, if they play for the opposition, don’t take any chances: send them up the hospital straight away. They play for Gloucester, you try to keep them on the field.’ So I got very strict instructions on this.
I: And going back to the teaching, I believe you had quite a few overseas visitors.
P: We did, yes. Because by this time I’d got quite involved with the WFSA, and I did travel abroad quite a lot. And a number of hospitals wanted to have people trained in England. So at one stage we had a link with New Orleans, where Professor Grogono was in charge – you remember him; we had a link from Yale; and also from Wisconsin. So we had those three American, and then Brisbane. So we had lots of overseas doctors. In fact, not everybody agreed with this policy and somebody said to me, ‘Have you got something against the English?’ I said, ‘Well, yes, because we have to find them a job whereas these chaps go home again.’ So we did have a bit of an overseas department.
I: You mentioned the WFSA. Did you get involved in that before you were involved in the Association?
I: Tell us about how that developed.
P: Well, when I came to the Association, Peter Basket – again – phoned me up, and he said, ‘I’m putting you forward for nomination for the Council of the Association.’ And I’d never thought of this. I said, ‘Well, why me? I don’t have any qualifications.’ He said, ‘No, it’s too full of academics and we want somebody to redress the balance,’ which I think was meant as a compliment, but I’m not absolutely sure. <Laughs> Anyway, I stood rather reluctantly, and I came fourth. I said, ‘I’m sorry I came fourth. I’m sorry to let you down.’ He said, ‘Don’t be ridiculous. Fourth is excellent. I’m putting you up next year.’ So next year I was put up and I came top. So there was no way of getting out of it then. So I came up to the Association. I think they were in Bedford Square at the time, or maybe even before that.
I: We were in BMA House.
P: BMA House.
I: Were you involved? Little room.
P: Very little room. And a very nice secretary. I’ve forgotten what her name was. But anyway, I went there and I was greeted by someone – I think it was the secretary – who said, ‘Who are you?’ ‘Roger.’ ‘I never heard of you.’ It wasn’t the warmest welcome I would ever get. ‘Well, what are you doing here?’ I said, ‘I’m the new councillor, I’m a new council member. I came top of the poll.’ ‘Oh, alright. Well, what are you an expert on?’ I said, ‘Well, nothing, really.’ ‘Well, you’ve gotta be an expert. You’ve gotta sit on one of these committees. How about finance?’ ‘I don’t really know much about money.’ ‘Oh, alright. Research?’ I said, ‘Well, no, I’ve not had an original idea in my life.’ ‘Education?’ I said, ‘Well, I failed the exams.’ ‘Safety?’ I said, ‘No, I take a lot of risks.’ By this time he was practically hysterical, and he said, ‘Alright, well if you’re no good at anything we’ll put you on the international relations committee.’ So I was put onto this committee and it was fabulous. I loved this committee. It was full of people who I think had similar <chuckles> knowledge to myself. There was Tom Ogg from Cambridge, I remember, and quite a few from Northern Ireland, and they came from out-of-the-way places. And they were basically people that nobody else wanted on their committees; and therefore they were excellent people and it was a fabulous committee. And we would take in the requests from overseas. The tradition seemed to be that we turned everything down. And I said, ‘We could do that. We could help them.’ They said, ‘Well, they want someone to go to Nigeria.’ I said, ‘I’ll go to Nigeria,’ which wasn’t the most popular place to go. And I had to lecture to the Nigerian army, which was quite handy, really, because after the lecture they said, ‘Look, that was a very good lecture. Is there anything we can do for you? Is there anything you want from us?’ I said, ‘Yes; I would like an armed escort to Lagos Airport,’ because it was a bit hairy. So that international relations committee, we accepted everything and got to have links and be invited all over the place.
I: And that became one of your big interests, really?
P: A very big interest, yeah. I loved it.
I: You’re still slightly involved in it.
P: Well, I’m still involved with it. It was quite useful that I had to organise rugby tours, because it’s rather like organising rugby tours. You had to suddenly get people out of bed and say, ‘Get changed; you’re playing.’ Instead it was, ‘Get changed; you’re lecturing.’ So I’d had quite a lot of experience with getting people out of bed and getting them doing things they didn’t want to do; and that came in very useful on these tours. And we all enjoyed it very much.
I: Did you then develop a formal role in the WFSA, or was that just a…?
P: No. In the WFSA… This is right. Dr Zorab was very… and Kester Brown, who had been to St Andrew’s and therefore, again, he said, ‘Well, this chap’s been to St Andrew’s. He must be good.’ Nobody else agreed with this assessment, but anyway… And so I was elected to the international relations committee there, I think they called it. And so we assembled in this room in the Washington Convention Centre – I don’t know if you were there that day, but… told to go to this room, and this chap comes in, and there was about 10 of us sitting round a table. And he came, ‘I’m Kester Brown. I’m the chairman, and there’s a lot of problems out in the world, and you lot have gotta solve them. Who’s Roger Eltringham?’ I said, ‘Well, me.’ ‘Right. You take care of Africa.’ I thought, Africa? That seems a big area. Anyway, the next chap was told to look after Asia, so I thought, maybe Africa’s not as bad as I thought. So I looked after Africa. You were given quite a free range. He said, ‘Look, work out where they need refresher courses.’ That was right: Dr Zorab said he wanted refresher courses. And you take a party of three or four and cover as many subjects as you could in about three or four days, and then perhaps go on to the next country and do the same. And we got better and better at these as time passed.
I: Did you go to many African countries?
P: Yeah. Most of them I seemed to go to. The most difficult one was when they wanted to make an official WFSA refresher course. It was inaugural; they’d never had one before. And John Zorab said, ‘Look, you go and set it up. Your job is to set this up. There will be’ – I’ve forgotten, so many thousand pounds. ‘You can have eight lecturers from all over the world. But it needs setting up, so up and arrange it.’ So I went to Nairobi and met the sort of East African group. I had a list of people. He wanted the WFSA to be represented, so there were people from Japan and Professor Green from Yale, and somebody from Moscow, and all this thing. So anyway, the Africans said, ‘Who are you proposing to bring to us?’ And there was one I was slightly worried about, and I’ve forgotten his name, but he came from Pretoria. And this was the time of the terrific upsets in South Africa and riots and people being killed. So I knew Pretoria was gonna be quite a difficult one to sell. ‘Where’re they coming from?’ I said, ‘Well, these are where we’ve got. Yale University, Moscow, so and so’ – I put him sort of two thirds of the way down – ‘and South Africa and Germany.’ And it seemed to go off alright. But somebody said, ‘Read that list again.’ I thought, he’s spotted this. So I changed the order a little bit, but I kept, ‘so and so, doctor from South Africa, and from Yale.’ ‘Did you say South Africa?’ I said, ‘Oh, yes, South Africa. Dr so-and-so from South Africa.’ ‘He can’t come.’ I said, ‘Well, he’s treasurer of the WFSA; he has to come.’ ‘He can’t come.’ ‘Well, why not?’ ‘He’s from South Africa.’ I said, ‘I’m from Britain, he’s from Ireland, he’s from Moscow.’ ‘Yeah, but if he’s South African he cannot come to this meeting.’ I said, ‘Well, that’s one of the conditions.’ And then somebody said, ‘Well, if he comes then Uganda will leave the WFSA.’ ‘And if you’re going to leave Tanzania are walking out straight away.’ And then somebody else said, ‘And then the whole of black Africa will leave the WFSA.’ And I was thinking of Dr Zorab, and I’ve got to go back and report this to him; and I was thinking of all these people who set up the WFSA, and I was gonna be known as the person who disintegrated it. So it’s a difficult [matter 58:12]. I said, ‘Let’s stop for a cup of tea. We’ll have a cup of tea. There’s a tea break and we’ll reassemble in 15 minutes.’ And during the tea break there was an Indian army fellow I hadn’t really noticed – he hadn’t said anything – and he came up to me and said, ‘I’ve written a piece of paper you might find helpful.’ And he’d written it out. He said, ‘This is a form of words that might help.’ And it said something like this: ‘The African Association of Anaesthetists, everybody is welcome to this. We are not a political group and therefore everybody is welcome. From whatever country they come from, they are welcome.’ And then he said, ‘Unfortunately, owing to a political argument between the government of Pretoria and the government of Nairobi, anyone with a South African passport won’t be allowed off the plane; so, obviously, there’s no point in them coming.’ So I thought, well, this could do it. So I read it out, and they didn’t like it too much but they couldn’t find anything wrong with it. So we went ahead. Dr Zorab bought me a drink for that. I thought I deserved more, as a matter of fact. But it went ahead, luckily, and we wrote a polite letter to South Africa saying that, ‘Afraid you wouldn’t be able to join the group but you’d be very welcome to contribute in other ways.’
I: Did you meet Patricia Coyle when you were in Uganda?
P: Oh yes, very much so.
I: She was very active.
P: Amazing lady. I think she was a nun, wasn’t she?
I: She was. Australian anaesthetist.
P: Australian nun, yes, who used to drive around in a sort of bulletproof car. I felt safer with her, I must say, having this nun with me. But an extraordinarily brave lady. Went to her house, and I remember her bed was in a strange place. It seemed to be in a corridor. And I did comment, I thought it was slightly unusual. She said, ‘I have it in the corridor ’cause if bullets come in from either side they have to pass several walls before they got to me.’ So she was very realistic, but nothing threw her. Nothing.
I: Another of your great interests, which we mustn’t forget about, is equipment.
I: Particularly the Glostavent and its development. You had also seen inappropriate equipment being sent to the developing world. Were those two things linked?
P: Absolutely, yeah. I think one of the things that absolutely shocked me would be to go to these very poor countries with very rusty equipment, which was a bit old-fashioned, and then go into the store rooms and see modern Drägers costing hundreds of thousands of pounds – well, £50,000-£100,000 – with all monitors…
P: Useless. They’d say, ‘We couldn’t get this to work.’ ‘Why not?’ ‘Well, when the electricity failed the machine stopped working.’ Or, ‘When we were out of oxygen it wouldn’t work.’ So there were all these very expensive machines. And this went not just once but city after city, all these machines, and I thought, this is awful. ‘Why don’t you do something?’ ‘Well, we can’t do anything about it. This is what the aid agencies have provided.’ And millions of pounds were being wasted; nothing. And I was thinking, Tom Bolton used to have a drawover anaesthesia, which of course could work without oxygen. He said, ‘If you’ve got no oxygen, use air. What’s wrong with that?’ I couldn’t think of anything wrong with it. So anyway, I used to talk to him about it a lot, and then Dr Manley invented this gas-driven ventilator; and then I’d been seeing the drawover and, I think it was the OMV, wasn’t it? – and then EMO. EMO was for ether, wasn’t it? OMV you could put anything in it. And then at that time we had a Russian naval lieutenant came to Gloucester, and just after they were allowed to leave – I think he left the navy and then he wanted to get out of Russia, and he ended up in Gloucester – he said, ‘Well, we’re using oxygen concentrators in parts of the Russian navy.’ So we managed to get one from somewhere and we put it on a trolley and had a Manley multi-vent and a drawover circuit. And we worked out, there was no nitrous oxide but oxygen-air was becoming fashionable, and we thought, we can do all this. So we put this lot together and wrote it up. And we called it the Oxyvent. And I sent it, it got in, and it was published in Anaesthesia. And then I got a strict letter from someone in the United States saying, ‘You’ve gotta change the name. Oxyvent we already have.’ So for reasons of copyright we changed it. And as I was working at Gloucester rugby club we thought we would call it the Glostavent. And I pointed out to the president, ‘I think we’re the only rugby team in the world with an anaesthetic machine named after it. But if we discover another one, we should play them in a championship.’ We haven’t found another one.
I: It was the rugby club, not the hospital, then?
P: It was actually the rugby club which was the stimulus to get it called that.
I: I didn’t know that.
P: No. It did appear in the programme, but we didn’t get enough publicity. I was thinking they’d be playing matches for it but they didn’t. <Laughs>
I: So that got developed and is still being developed?
P: Yes, it took a long time, ’cause it didn’t look good and it did take a long time. But several people got interested. We had a doctor came over from Kiev, and he said, ‘That’s just what they need in Kiev. Can I take one there?’ There was a coach went from Victoria Coach Station to Kiev and he managed to get this into his personal luggage. And it crossed the border and got into Kiev and it was used in that country for a while. But it didn’t catch on. Nobody liked the look of it. And then eventually, didn’t seem to be many invitations to talk about it until one day I had, out of the blue, an invitation from the Institute of Electrical Engineers. And with the sort of friends I’ve got I thought this must be a practical joke. And I showed it to my wife, said, ‘I’m not falling for this. Ridiculous.’ She said, ‘No, it’s on their paper. You’d better go.’ So I went to this Institute of Electrical Engineers, somewhere near Charing Cross. And there’s a whole room full of people; and lights went out; I started to talk. And then I could hear there was a snoring. And no questions; there was a modest applause. And nobody took any interest. And I was just about to leave for the train and somebody came over and said, ‘Who’s manufacturing this?’ I said, ‘Well, that’s the problem. Nobody’s interested in it and yet it’d be good.’ ‘Can you get down to Devon?’ I said, ‘Yeah, I’ll go anywhere.’ ‘’cause I’ve got an engineering firm which would be interested.’ Well, I went down and they were making things like mosquito nets and things like that. But there was a brilliant engineer there and his name was Robert [Neighbour 65:45]. I didn’t know who he was. Never met him before. But he said, ‘We can make this.’ And every Tuesday he would come up to Gloucester… by this time I think I’d retired from the hospital but I did work on a Tuesday. So he’d come up every Tuesday and come into theatre and say, ‘What do you want?’ I’d say, ‘Well, I need a vaporiser. It’s got to do this, that and the other.’ So he built one. ‘I need another ventilator,’ and I said, ‘It’s gotta look good and it’s gotta be able to work if the oxygen fails, and we don’t want the anaesthetist to have to think. It’s gotta automatically go onto the cylinder of oxygen so that nobody has to do any thinking.’ ‘Yeah, I can do that.’ Everything I asked for this chap could do, and he’s brilliant. So then he said, ‘We’ll call it the Glostavent.’ And it started to catch on. When Professor Rosen was secretary of the WFSA he was very keen on the Glostavent, and he knew it was important to have a machine which countries could afford, and so he backed this very much. And he contacted the British Council and, I think, the ODA. Clare Short, I think, was the Minister for Overseas Development at the time. And he arranged for her to come down to Gloucester and see this machine. And she was very interested. One of the things I remember about the day is I’d forgotten to warn the hospital secretary about this, so there was pandemonium when they heard, ‘Clare Short’. And I was summoned up. ‘What’s this about Clare Short? When’s she coming?’ I said, ‘Well, she’ll be here in about half an hour.’ ‘What? Hospital administration don’t know anything about it.’ I said, ‘Well, they’d better get ready ’cause she’ll be here very quickly.’ So, anyway, Clare Short came and she saw this machine and agreed to breathe it, and was very, very supportive for us, and awarded a big grant for us to try it out in southern Africa. And so I think we bought 18 machines and put them in 18 different hospitals in southern Africa, and tested them out. And some went better than others, but quite a few are still working. And that’s about 15 years ago. So I was very grateful to the professor and Clare Short for their support for that, and that went very well. Gradually, as the machine got better and more smooth and more popular, it succeeded. I think Robert Neighbour, our engineer, has a lot… I’m very grateful to him because there doesn’t seem to be any problem he can’t solve. He carries a screwdriver in his pocket and will take things apart, put them together… And sometimes you’ll be miles from anywhere and he’ll take their machine apart, and I’m thinking, I wonder if we might have to get away from here in a hurry. But he always put it back together, and there seemed to be nothing he can’t mend or repair. So Glostavent gradually started to look better, and now it looks like any other machine, really. It’s now in 70 countries.
I: Really? Excellent.
P: They can’t seem to meet the demand for it.
I: <Laughs> Still being made by the same firm?
P: Still being made by the same firm. Cooperating with engineers was something which wasn’t really fashionable. But this is the best thing we ever did.
I: Well, Roger, we’ve talked about your clinical career and a little bit about your political career – shall we call it? – with the Association and WFSA. There are one or two other bodies that you have been involved. British Council adviser on anaesthesia?
P: Yes. I think this was via the Association. They said, ‘Would you help the British Council? They want to appoint somebody to go to Zambia.’ So I went along to interview this chap, and a very smart-looking fellow came in with a Royal Air Force uniform, with a Glasgow accent. And it didn’t take many questions, any hospital that gets this chap is gonna do well. So we appointed him straight away. And his name was Ian Wilson. And, as you know, he became very famous himself. But at that time he went to Zambia.
I: And you had training programmes in Khartoum?
P: Yes, in Khartoum, we did, and Ghana as well, the British Council. And you had to write a report for them.
I: Of course you also got involved with Ian Wilson and Mike Dobson in World Anaesthesia.
P: World Anaesthesia. They founded it, and I think I was the secretary or had some important office. But I had to write the journal – newsletter. I think I was editor of that.
I: Any other international bodies or anaesthetic bodies that you…?
P: Well, I seemed to get on to the American Association. I’m not sure what I was doing there, really, but via Yale I was nominated for their international education committee. So that meant going to the ASA, which was very interesting, and I managed to make a lot of very good contacts there.
I: Not very popular in Gloucester, I understand?
P: <Laughs> Not really. I was told we had too many Americans. But I didn’t think we had enough. I don’t know if they still do it, but each university has a reception at the ASA. So we had so many contacts it was quite difficult to stay sober, really. And I went around with one of the American doctors, and there was one reception where they were playing music, a string quintet playing, so I said to him, ‘Let’s go in here.’ He said, ‘We don’t know anybody in here.’ I said, ‘Leave the talking to me.’ So we went in there but we were approached by a young registrar type, and he said, ‘When were you with us?’ So it was a difficult one to answer ’cause I didn’t notice which particular university we’d gone into. So I stalled a bit, and he said, ‘Who was chair when you were there?’ I hadn’t got a clue who the chair was. I said, ‘Well, to be honest, he wasn’t very well known. He used to stay in his office most of the time.’ And I could see my colleague’s hands were in his… and it turned out it was Leroy Vandam, who was a world famous chap. Anyway, we were allowed out. The next day there was a great meeting of these American grandees. A professor from Yale was there, Harvard and everywhere. And the professor from Yale called me over and said, ‘Roger, I want you to meet these gentlemen.’ And they were all the famous names in America. And he said, ‘Roger, do you mind just repeating that story about what happened at this reception the other night?’ I knew I was being set up. I told the story. And I could see they were really looking for this. And then he said, ‘Well now, Roger, I’d like you to meet Professor Leroy Vandam.’ So I said, ‘I’m sorry, I had to use your name.’ Anyway, he loved the story and we corresponded for several years. But it was a difficult situation.
I: And you did become vice president of the WFSA under Anneke Meursing?
P: Yes, under Anneke Meursing, who did actually resign for a short while, and I was told – I wasn’t in the room – they said, ‘You’re the president.’ I said, ‘What?’ ‘No, the president’s resigned. You’ve gotta take over.’ To be honest, I felt like resigning myself. <Laughs> Anyway, she withdrew her resignation. I think when she realised who was going to take over she decided perhaps she would stay on. So I wasn’t president for very long, but I was vice president. And of course the vice president had a lot of difficult… they used to give me some difficult jobs, one of which I can remember with Kester Brown. We had trouble with the Chinese society, and the Chinese society weren’t paying their subscriptions. And the subscription was based on how many members you had. For example, I think we had about 10,000 members so we paid £10,000, and the Americans paid £75,000. And the Chinese had declared 250 members. So Kester said, ‘Look, will you just sort it out? We’ll get the rest of the money from the Chinese.’ Which I thought was going to be a hard one. He said, ‘That’s the treasurer over there.’ So I went over to this treasurer and introduced myself. ‘Yes?’ I said, ‘I’m from the WFSA, I’m vice president.’ ‘Yes?’ I said, ‘I’d like to, if we may, discuss the Chinese subscription returns.’ ‘Yes?’ ‘Well, I don’t think we’ve got the right number – members.’ ‘Well, what do you think we’ve got?’ I said, ‘Well, we seem to have you down as having 250 members.’ ‘Yes.’ ‘I think you’ve got more than that.’ ‘What do you think the figure is?’ I said, ‘Well, I think it’s closer to 75,000 members.’ Still no response. ‘Yes?’ ‘Well, seems to be a bit of a difference between 75,000 and 250. Seems to be a gap of unexplained members here.’ Anyway, at this moment she lost her ability to speak English; and so I had to go down to Kester and say, ‘Look, we’d better start another approach ’cause this has failed totally.’ <Laughs> She said, ‘What’s wrong with that?’ I said, ‘Well, 75,000 and 250, seem to be a few…’
I: Despite that, you were given several awards and honours.
P: I was, yes.
I: You became an honorary member of the Association.
P: I did. Absolutely. Great honour.
I: And of the Intensive Care Society.
I: They gave you the Ralph Waters Memorial Lecture in Wisconsin.
P: They did, yes.
I: And you had the Humphrey Davy Award of the College.
P: I did, yes.
I: And of course you’ve won an Innovation Award from the Association.
P: Yes. For the last three years we have won awards; different types. I think a recent one that went down very well was the CPAP generator. The problem with this treatment is that it works very well if you’ve got the money, but so many of the hospitals we visit can’t afford the vast amount of oxygen that’s needed or compressed air. So Robert devised a sort of mobile machine where the oxygen and the air mixture came from the oxygen concentrate, so they could have whichever volume they wanted of each; vary the percentage. And of course this was done at a fraction of the price. Probably less than 5% of the price. And suddenly hospitals all over the world are asking for this equipment, because they can do such a successful treatment. But sometimes it needs to be carried on for not just hours but days and even weeks, and of course devastating if they start it but can’t finish it. So this is probably the most popular thing that we’ve devised.
I: And it’s rather ironic that you were a little bit negative when it was suggested you might go on the safety committee ’cause of the number of risks you’ve taken – I remember you said – but that’s slightly changed now, hasn’t it?
P: Yes, it has. If you get enough experience you can cut down the risks, I think. And I like to think that the risk factor was lower towards the end of my career.
I: And in retirement now you have established something else related to safe anaesthesia. Tell us about that. It’s a charity?
P: It is a charity. When I left Gloucester, I still used to go on these teaching tours for the WFSA and refresher courses. But it struck me we needed to be able to respond to urgent requests for help, and that often it wasn’t a lot of money they were looking for; they just wanted some immediate help. So I talked to a few friends in the local pub and we decided that we could set up a charity and that we should concentrate on safe, and that we should concentrate on the world, because there seemed to be so many parts of the world… we were so safe here, and the Association, and the World… are getting so safe and so expensive, that most of the world was falling further and further behind. There was no way they could cope with what we were expecting. So we decided that with the aid of Diamedica, who were making very inexpensive machine but they were making exactly what was needed…
P: Glostavent. And then their oximeter, Lifebox, came on the scene and we thought, this is just the sort of thing we could buy. This is not expensive. So we started this charity and we had three aims: equipment, teaching and research. We thought, these are three things which we could do. Equipment would be expensive but the other two weren’t. So we started to raise money locally, but it got bigger and bigger. It was quite slow to take off but gradually more… Schools were one great source of money because they like a lecture on anaesthetics. And I used to take a mobile anaesthetic machine with me, and this always went down very well. And we went to Cheltenham Ladies’ College. Now you can imagine that’s quite a formidable audience there. I did take the precaution of taking with me one of these… we had this big black American footballer working for us so I took him with me in the audience, and there you are, Cheltenham Ladies’ College, down the bottom. And I could see one girl in the audience; she was very good-looking – looked too confident – and I could see she was gonna cause an awful lot of trouble, but I thought, I must take the initiative here. So I said, ‘Look, this is the machine. I’d like a volunteer from the audience – you.’ Before anybody else could. I said, ‘Yes, you.’ So she came down, and I said to this big chap, ‘Look, put these electrodes on this lady; pulse and blood pressure.’ And I said, ‘Take your time about it.’ So he put these electrodes on and of course her pulse was very high and her blood pressure was sky-high. And I thought, I can’t miss it. And I said, ‘Your pulse is sky-high, your blood pressure’s out of control. What on earth are you thinking about?’ Anyway, I didn’t have any more problems with her after that. I know she would have done it to me, but I just had to do it first. So the schools have contributed a lot, and a lot of the schools have charity committees, so that’s helpful.
I: So is this entirely medically run? Who’s on the Safe Anaesthesia…?
P: Well, I think I’m the only doc… no, a GP is on it; but I’m the only anaesthetist. But we do have… there’s the former British ambassador for India, who lives nearby, and he’s very keen on this sort of work. And we’ve got a white van driver and a butcher and a greengrocer. A great cross-section of people from local businesses. They’re very keen on this work, and these chaps have all sorts of… they keep saying, ‘I’ve arranged for you to go to Rotary there, and there’s a Women’s Institute, you’ve gotta go there, and a rugby club there.’ So it’s quite busy work, really. But I enjoy it very much.
I: Sounds as if you’re busier in your retirement, like most of us, than you were when you were…
P: <Laughs> Yes, I am.
I: You started this in 2012, I think.
P: Yes, that’s right.
I: When did you retire?
P: About 10 years ago, I suppose. I retired in stages. I stopped doing intensive care one year; and then the next year I stopped doing night call; and then the next year I stopped doing something else; and then gradually I was hardly doing anything.
I: So you had a fairly soft landing.
P: Soft landing. I didn’t want to go flat out. And then this has taken off, and this has really got quite heavy. But it’s very enjoyable.
I: Have you any other interests in retirement outside medicine?
P: Outside medicine? Well, I’m very involved in things in the village.
I: Family, of course.
P: And family keep us very busy, yes. Grandchildren.
I: You’ve got three children?
P: I’ve got three daughters and about seven grandchildren. I should know exactly how many. I have exactly seven grandchildren. Very busy.
I: Rugby, you still interested in?
P: Well, in Kent it’s not such a big game as it was in Gloucester, although I have identified three Gloucester supporters in Kent. But we haven’t been doing so well, so we haven’t really had occasion to celebrate much.
I: I don’t think we’ve pointed out that in retirement you’ve virtually come full circle by moving back to where you started, almost.
P: That’s right. In fact I live now next door to the house where I was brought up in, where we had to hide in the air raid shelters and that sort of thing.
I: In Marden?
P: In Marden, yes. And my brother lives in this old house, and one of my daughters and their family in the other half. And then another daughter lives about 50 yards away with her family. And I’ve got another daughter in Brighton. So they’re all pretty close. But Lorna’s family live in Cranbrook, very close by as well. So we have a lot of extra… there’s a family crisis nearly every day but usually there’s enough of us just to…
I: <Laughs> It looks as if you’ve been living life to the full. Any regrets?
P: No. I’m very grateful to those that have helped me in my career; Peter, especially, but I was so lucky with the people I was surrounded by. No, I feel I’ve been very fortunate and I’ve met some really first-class people all over the world. After a bit you realise there are nice people everywhere. Even people that we’ve fought against, you think, well, what were we doing fighting against them? These are good blokes. So I think I’ve been very lucky to be able to travel so many countries.
I: Well, Roger, thank you very much for sharing your experiences with us, and it’s been a delight chatting with you.
P: It’s been my pleasure.
<End of interview>