Professor T. Cecil Gray: General practitioner whose 'Liverpool Technique' established modern methods in anaesthesia
Saturday 26 January 2008
Thomas Cecil Gray, anaesthetist: born Liverpool 11 March 1913; Demonstrator in Anaesthesia, Liverpool University 1942, 1944-46, Reader in Anaesthesia, and Head of Department of Anaesthesia 1947-59, Professor of Anaesthesia 1959-76 (Emeritus), Dean of Postgraduate Medical Studies 1966-70, Dean of the Faculty of Medicine 1970-76; Editor, British Journal of Anaesthesia 1948-64; President, Anaesthesia Section, Royal Society of Medicine 1955-56; President, Association of Anaesthetists of Great Britain and Ireland 1957-59; Dean of the Faculty of Anaesthetists, Royal College of Surgeons of England 1964-67; CBE 1976; married 1937 Marjorie Hely (died 1978; one son, one daughter), 1979 Pamela Corning (one son); died Formby, Merseyside 5 January 2008.
T. Cecil Gray, Professor of Anaesthesia at Liverpool University from 1959 to 1976, was one of the most influential and charismatic pioneers of this budding medical specialty in post-war Britain and abroad. Among his many achievements was the introduction of the muscle relaxant d-tubocurarine chloride, derived from the South American arrow poison curare, into general anaesthesia. It opened a vast scope of new options and possibilities for the rapid and dramatic development of surgery.
This advance was based on years of research into the effects and safety of a class of drugs that are still in use today to relax the abdominal and thoracic muscles – essential for the performance of major surgery. Before the introduction of these drugs, relaxation of the muscles had to be provided by very deep anaesthesia with vapours such as ether, which caused a dangerously prolonged and unpleasant recovery. Mortality after anaesthesia was high.
Gray was not the first to use relaxants in anaesthesia, but previously they had been used somewhat reluctantly, as mere supplements to the standard anaesthetic agents to provide increased relaxation of muscles as and when required by surgeons. The dose of relaxant had been very much limited by the fear that in depressing the action of the muscles of respiration, breathing would be adversely affected.
However, Gray knew that anaesthetists had for several years been supporting respiration by inflating the lungs. He was able to show that by using larger doses of relaxants which completely stopped the breathing and by replacing spontaneous respiration with "manual ventilation of the lungs" the amount of drugs needed to provide sleep and freedom from the effects of reflex reaction to surgery could be greatly reduced.
Patients were markedly safer during surgery and woke up almost immediately after the relaxant was reversed and the anaesthetic stopped. This turned out to be a paradigm shift and Gray's methods came to be recognised worldwide as the "Liverpool Technique". It took a decade or more of careful research, however, and the publication of several classic papers to convince anaesthetists of the advantages and safety of the new methods.
Equally pioneering was Cecil Gray's contribution to postgraduate education in anaesthesia, in particular, the organisation of the first "day-release" course in Britain for junior anaesthetists preparing for their examinations. Gray's course attracted trainees to Merseyside from all over the UK, Europe, the Far East, the Middle East, Australia, Africa and India.
Born in Liverpool in 1913, the only son of Thomas Gray and his wife Ethel (*ée Unwin), Thomas Cecil Gray was educated at the Benedictine college of Ampleforth in Yorkshire. On leaving school, thinking he might have a vocation, he joined the Ampleforth community as a novice monk. However, within two months, as he has recorded with characteristic good humour, it became clear to all but himself that, if he had a vocation, it was not as a man of the cloth. Thus he returned home to Liverpool, to the quiet disappointment of his mother and the unmistakable joy of his father.
His education at Ampleforth having had a scientific slant, Gray then applied to read Medicine at Liverpool University. After graduating in 1937 – and engaged to be married – he joined a general practice as an assistant doctor. Early in 1939, encouraged and supported by his father, he purchased a practice in Wallasey. At that time anaesthesia in most hospitals was administered by general practitioners who, although the remuneration was minimal, welcomed the occasional part-time association with the hospitals and their personnel.
Gray, quickly fascinated by anaesthesia, soon came under the influence of R.J. Minnitt, another GP, but one with an established anaesthetic practice at the Liverpool Northern Hospital. Minnitt, seemingly recognising promise and commitment, suggested that Gray should work with him for two half-days a week and thus accumulate the 500 anaesthetics – 250 for major surgery and 250 for minor surgery – required for the Diploma in Anaesthetics (DA).
With the outbreak of the Second World War, Gray was rejected for service on account of the asthma which had blighted his life since childhood. On obtaining the DA in 1941, he sold his practice and became, like Minnitt, one of the few full-time anaesthetists in Liverpool. At the same time, he accepted an appointment as part-time Demonstrator in Anaesthesia at Liverpool University.
However, in November 1942, feeling fit enough for service, he volunteered for another medical and within a short time was on his way by troopship to join a mobile neurosurgical unit in North Africa. In 1944 he became critically ill with bronchopneumonia and, having been treated and saved by injections of what he described as "trial samples" of crystalline penicillin, he was invalided out of active service and sent home to England. After a short convalescence, he resumed his hospital and university practice.
Another hospital anaesthetist at that time, John Halton (1903-68), was on friendly terms with the officers at the American Air Force base at Burtonwood, a few miles outside Liverpool. Both he and Gray had heard of the use of the muscle relaxant curare by Harold Griffiths and others in Canada and the United States, and he persuaded his American friends to procure some for him and Gray with which to experiment. The curare was forthcoming and the eventual result of their research was the joint paper "A Milestone in Anaesthesia" presented to the Section of Anaesthesia of the Royal Society of Medicine in May 1946.
In 1947, Gray was appointed full-time Reader in Anaesthesia at Liverpool and, within a few years, he had created one of the leading anaesthetic departments in the country such that, in 1959, the university rewarded him with a personal chair. Under Gray and the talented team he had enticed into the department, Liverpool attracted anaesthetists from around the world who came to learn and practice the Liverpool Technique. Many returned home to establish their own departments of anaesthesia based on the Liverpool model.
Gray was elected a Fellow of the Royal College of Surgeons of England and the Royal College of Physicians as well as the Colleges of Anaesthesia of Australia and New Zealand and the Faculty of Anaesthetists of the Royal College of Surgeons in Ireland. He received the Gold Medal of the Royal Society of Medicine in London and awards from numerous societies including several in the US. He edited several textbooks which went to many editions and was Editor in Chief of the British Journal of Anaesthesia from 1948 to 1964.
In 1966, in recognition of his commitment to and concern for postgraduate education, Gray was appointed Postgraduate Dean of the Faculty of Medicine at Liverpool University, the first occupant of this post in Merseyside. He closed a distinguished academic career as Dean of the Faculty of Medicine, 1970-76.
Cecil Gray was a strong, independent and open-minded character, a proud Liverpudlian and a devout Catholic. An enthusiastic host and an entertaining guest, he had a passion for music and opera and possessed a library of books that reflected his wide, eclectic tastes. He was also an accomplished pianist. In retirement he took an active part in university affairs, regularly attended the University Court until a few years ago. He continued writing well into his eighties and in 2003 published Dr Richard Formby, a biography of the founder of the Liverpool Medical School.
Martin Leuwer, Raymond Ahearn and Tony Gilbertson
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