Edgar Pask - information for the uninitiated

1. Edgar Pask - information for the uninitiated Dr Gary R Enever Royal Victoria Infirmary Newcastle upon Tyne, UK

3. Ralph Waters and the early years of British academic anaesthesia • Waters was the first Professor of anaesthesia in the world • Pioneer of anaesthesia in fields of teaching, research and professionalism • Visits to England in 1933 and 1936 • Robert Macintosh, and the first British professorship in the new Nuffield department in Oxford (1937), modelled on the department in Madison, Wisconsin • Then, along came the Second World War

4. Who was Pask? • Born in Lancashire in 1912 • Studied Medicine in Cambridge and London, qualified 1933 • Became Macintosh’s “first assistant” in Oxford before the war

5. The Royal Air Force Years • Macintosh and Pask went to work in the RAF’s physiological research institute • As the war progressed, aircrew were dying, perhaps unnecessarily, and every pilot was needed - questions needed answering • Could aircrew bale out at 40,000 feet and survive? • Could a drowned airman be ventilated in a speeding rescue launch? • What was the best lifejacket for an unconscious pilot? • Could Winston Churchill still smoke a cigar with an oxygen mask on?

6. “convenient to use the author as an experimental subject” Macintosh commented that Pask did most of the work for his MD thesis whilst anaesthetised...

7. (1)The Descent Experiments • Pask used himself for the majority of the descents, including the extremely dangerous first four • Mixtures of gases were used to simulate the partial pressures of oxygen at high altitude experienced by an airman descending by parachute • All the subjects suffered from the effects of profound hypoxia

10. (2)The Artificial Ventilation Experiments • Pask used himself as the experimental subject • He was deeply anaesthetised with ether, and then connected to apparatus that measured his expired tidal volumes. • He was used to evaluate available methods of articially ventilating the lungs • In later experiments he was also paralysed with curare - this is before it had come into common use in anaesthesia

11. (3)The Floatation Trails • Pask was anaesthetised with ether, intubated, and placed in a swimming pool • A variety of lifejackets and floatation suits were tested • He undoubtably suffered aspiration and lung damage during these experiments • Incidently, the circuit used was developed by the team - it was later independently rediscovered and described. At the flows used (20 litres min) it probably worked as a co-axial T piece

13. “Intothe drink”

14. Some lifejackets worked

16. Pretty good

18. Not all experiments were successful

19. This floatation suit looks quite effective

20. Perhaps not…….

22. Back to the drawing board

23. Pask after the RAF • King George awarded Pask the Order of the British Empire in 1944, for his selfless actions that undoubtably helped to save the lives of many aircrew. • However, although he was a brave and brilliant man, he had little experience of giving anaesthetics, or running a department. • In 1947 he went to Madison, Wisconsin, to finish his “training” under Ralph Waters.

24. Pask and Newcastle • At the end of 1947, Pask took up his newly created post of Reader in Anaesthetics at the University of Durham. • He was based in King’s College, Newcastle upon Tyne, and became Head of the Department in the Royal Victoria Infirmary. • He was made a Professor in 1949, and remained so until his death in 1966 at the age of 53 years. • He was provided with lab facilities and a workshop, with technicians to create his inventions

25. Pask’s achievements • Established a University department that went on to lead research and train a number of Britain’s influencial anaesthetists - People such as Nunn and Vickers • Led research in artificial ventilation and the development of ventilators, and monitoring • Continued work on lifejackets with “Sierra Sam” • Tradition of quality, teaching, research and co-operation

26. Newcastle ventilators • After his personal experiences of being ventilated, Pask and Norman Burn invented many devices - here is an early one using mercury switches • The threat of polio epidemics spurred invention, after the experiences in Denmark

27. Newcastle ventilators • This ventilator, from the mid 50’s, could be used in theatre or on the wards. If a patient was on the ward ( this is before ITU) the trainees stayed by the bed in shifts

28. Newcastle ventilators • These very neat injector ventilators also date from the 50’s. One is brass, the other perspex. At the bottom is a Beaver non return valve

29. Newcastle ventilators • This injector, known as the “bluebird” has bits of “Meccano” inside. It dates from about 1967, and is probably the last that Pask had a direct influence on

30. Newcastle ventilators • This shows the last of the line, which was produced semi commercially. A ventilator using Pask’s ideas was produced by BOC - the Cyclator

31. Sierra Sam • Common sense precluded using Pask for further lifejacket experiments • A specialist medical equipment manufacturer in the Sierra Nevada created “Sam” for Pask

32. Early Sam work in the pool

33. Inside Sam

34. Ready for the plunge

35. Sam in action

36. Pask the man • Passionate about patient care • Quiet, unassuming and almost shy • A poor sleeper, and often found in the hospital at night helping juniors, after his compulsory 11pm phone call • Inventive and determined • A prolific and effective lecturer • Suffered poor health, not helped by his chain smoking

41. Thank you http://www.ncl.ac.uk/nsa/museum.html