The History of NACCS
Kindly submitted by Dr Peter Farling
The Neuroanaesthesia Society was the first sub-specialist group of anesthetists to be formed and in September 2015 it will have been in existence for 50 years. The Society was delighted that Dr. Jean Horton, one of the founder members, and many past-Presidents, including Dr. Stuart Ingram, attended the recent dinner in Manchester (May 2015).
Picture of Dr Peter Farling, Dr Jean Horton and Dr Stuart Ingram at 2015 ASM
In 2006 Dr Horton gave me the original minute book of the Neurosurgical Anaesthetists Travelling Club. I then obtained the minute book that had been maintained from 1981 by Dr Jim Jenkinson, the last Honorary Secretary of the Travelling Club. Information from these sources, and from Dr Horton’s article,1 has formed the basis of this short paper.
A number of eminent British and Irish neurosurgeons trained in North America during the 1920s. These included Mr Geoffrey Jefferson, Mr Norman Dott CBE and Sir Hugh Cairns, all of whom trained with Harvey Cushing in Boston. They returned to Manchester, Edinburgh and London respectively and brought with them the team model employed by Harvey Cushing (1869–1939).
Cushing had been profoundly influenced by his experience when, as a medical student, he was called from the ‘benches’ to administer ether. The patient promptly vomited, aspirated and died. His seniors told him ‘Don’t worry. This happens all the time’! Cushing was one of the first clinicians to record the patient’s vital signs throughout surgical procedures. He appreciated the need for care when administering anaesthesia and was quoted as saying ‘regardless of the drug to be employed it is essential that it be employed by an expert – preferably by one who makes this his specialty’. On returning to London Sir Hugh Cairns adopted Cushing’s approach and persuaded the Rockefeller Foundation to provide funding for the first specialist neuroanaesthetist, Dr Olive Jones. She followed Cairns to Oxford when he moved there in 1938.
The National Health Service was formed in 1948 and anaesthetists obtained consultant status. By the 1960s neurosurgical units existed throughout Great Britain and Ireland and a number of anaesthetists specialised in anaesthesia for neurosurgery. However, the meetings and conferences of that time did not fulfill their academic needs. For example, the 131st Annual Meeting of the British Medical Association was held in Oxford in 1963. There was a section for anaesthetics and within that section Professor Cecil Gray chaired a symposium on anaesthesia for neurosurgery. The speakers included Dr Norman McCleery from Sheffield, Dr Andrew Hunter from Manchester and Dr Jan Hewer from London.4 Dr Allan Brown from Edinburgh, who was the Honorary Secretary of the Scottish Society of Anaesthetists, began discussion groups for specialist anaesthetists. Neuroanaesthetists from Edinburgh, Glasgow, Aberdeen and Dundee met twice a year. In 1964 this Scottish group met in Newcastle and Dr Andrew Hunter, from Manchester, was present. He invited those present to Manchester and hence the first meeting of what was to become the Neuroanaesthesia Society took place in the Clinical Lecture Theatre at the Manchester Royal Infirmary on Saturday 18th September 1965.
Portrait of Dr Andrew Hunter
Dr Hunter was in the Chair and papers were presented as follows:
1. Dr J Hewer: Hypothermia during neurosurgical anaesthesia
2. Dr V Campkin: Moderate hypothermia and circulatory arrest for operations on intracranial aneurysms
3. Dr N McCleery: Some aspects of anaesthesia for cerebral aneurysm
4. Dr D Potter: A comment on the use of ECG during Pudens shunts
5. Dr A Brown: The treatment of status epilepticus
6. Dr R Keen: Variations in venous pressure during controlled respiration
There were 40 delegates representing 20 centres. It is of interest that many of the hospitals are no longer in existence, for example Crumpsall Hospital in Manchester, The Midland Centre for Neurosurgery in Smethwick, and Killearn in Glasgow. Notable among the founder members were Dr Olive Jones, Dr Jean Horton, Dr Aileen Adams, Dr John Barker, Dr Gordon McDowall (bi-annual lecture) and Dr Harvey Granat (registrars’ prize).
Following the meeting, Dr Hunter wrote to Dr Peter Dinnick, the then Secretary of the Association of Anaesthetists of Great Britain & Ireland (AAGBI), which at that time had premises in the Royal College of Surgeons in Lincoln Inn Fields, London. The letter is in the original minute book and explains why the meeting took place. He wrote ‘We discussed the question of the formation of some kind of organisation of neurosurgical anaesthetists in Great Britain, but decided emphatically against this for we were most anxious not to set up anything which would seem like a sectional organisation among anaesthetists’. However, it was agreed to hold similar meetings in the future. Rather than being named an association or society the members decided to form the Neurosurgical Anaesthetists Travelling Club.
In subsequent years meetings were held in London, Edinburgh, Cardiff and Oxford. The pattern remained similar with delegates visiting the host department who displayed their current work. A number of papers were presented after lunch and a dinner was held in the evening. Different centres hosted the annual scientific meeting, which was originally on a Saturday but moved first to a Friday then extended to two days, Thursday and Friday.
On 4th February 1972 there was a meeting between officers of the AAGBI and representatives of specialist anaesthetic groups in the Royal Society of Medicine, London. Dr John Barker represented the Neurosurgical Anaesthetists Travelling Club and other groups in attendance were the Association of Professors of Anaesthesia, Intensive Care Society, Anaesthetic Research Society, Obstetric Anaesthetists Association and Intractable Pain Society. The meeting had been arranged to exchange information and views concerning the desirability of formalising a relationship between the Association and the specialist groups. Such a relationship was deemed to be difficult and perhaps inappropriate.
In October 1974 Dr S Lipton hosted the annual meeting in Liverpool. He wrote a letter of invitation to Dr Harvey Shapiro of Philadelphia, who was the Secretary/Treasurer of the Society of Neurosurgical Anaesthesia and Neurologic Supportive Care of the USA. This was the beginning of the links between the two societies. The first McDowall lecturer was Prof J Michenfelder of the Mayo Clinic. There were a number of joint meetings with other societies. In 1987 the Travelling Club met with the Society of British Neurological Surgeons in Oxford to celebrate 50 years of neurosurgery. In July 1991, at the Royal College of Surgeons in Dublin, there was a combined meeting of the Travelling Club with German and Austrian neuroanaesthetists and with members of the Association of Cardiothoracic Anaesthetists.
During the business meeting in Dublin, Dr Stuart Ingram, London, tabled a suggestion that the time had possibly now come that the Travelling Club should have a formal structure and constitution. A working party was formed; it was chaired by Dr Aileen Adams and consisted of Professor Bill Fitch, Dr Jim Jenkinson and Dr Stuart Ingram. They prepared a document that was circulated to members prior to the next Annual Meeting. This paved the way for the change from the informal Travelling Club to the Neuroanaesthesia Society of Great Britain & Ireland (NASGBI; www.nasgbi.org.uk).
From left in clockwise direction: 1. Ed Moss (Leeds) 2. Peter Farling (Belfast), 3. Jim Jenkinson (Edinburgh), 4. Adrian Gelb (San Francisco, USA), 5. Bill Fitch (Glasgow), 6. Bo Siesjö (Lund, Sweden) McDowall Lecturer, 7. VKN Unni (Belfast)
The NASGBI became the ‘voice’ of neuroanaesthesia and the contact point for education and political issues. A website was developed, a network of ‘linkmen’ was created and Travelling Fellowships established. An elected Council was formed in 2006 to cope with the expansion and to allow future office bearers to obtain experience in Society matters.
Council Members 2015 – Dr Platon Razis, Dr Ian Appleby, Dr Judith Dinsmore, Dr Ian Tweedie, Dr John Andrzejowski, Dr Craig Carroll
At the 50th anniversary meeting, in Manchester in May 2015, it was agreed to change the name of the society once again. It will now be known as the Neuroanaesthesia & Critical Care Society of Great Britain and Ireland.
The original minute books are in safe keeping in the AAGBI Museum in London. Members of the society can view them by contacting Trish Willis, Heritage & Records Manager, e-mail: [email protected]
Dr Peter Farling handing over minutes books to Trish Wills
Dr Peter Farling
1. Horton J. The First Specialist Anaesthetic Society – The Neurosurgical Anaesthetists Travelling Club. Anaesthesia News 2002; 184: 6 (http://www.aagbi.org/sites/default/files/ nov02.pdf).
2. Hirsch N, Smith G. Harvey Cushing: his contribution to anesthesia. Anaesthesia 1986; 65: 288-93.
3. Taylor J, Handa A. Hugh Cairns and the origin of British neurosurgery. British Journal of Neurosurgery 2007; 21: 190-1096
4. BMA Annual Meeting, Oxford: Scientific Proceedings. British Medical Journal 1963; 2: 371.