Obituary

Professor Thomas Cecil GrayCBE KCSG FRCP FRCS FRCA Thomas Cecil Gray was born on 11 March 1913, in a room above a public house in Scotland Road, Liverpool, where his father was the publican. He attended preparatory and public schools at Ampleforth College in Yorkshire. The latter was very influential in Cecil’s life, as he later became a novice monk there, for two months. Medicine, however, had a stronger influence and he enrolled as a student in the University of Liverpool. Thus began a long association with the University which saw the development of the techniques for which he was justly famous and his leading the Department of Anaesthetics and, later, the Medical School. After his marriage and graduation in 1937, Cecil decided to become a General Practitioner and secured an assistantship in a practice in Liverpool, later (1939) buying his own practice in Wallasey. At the time, anaesthesia was administered by General Practitioners and some non-medically qualified staff and this single-handed practitioner decided to acquire some specialist knowledge. Accordingly, he attended the sessions of another General Practitioner and anaesthetist, R. J. Minnitt. He was instructed on two afternoons a week by this prominent member of the Liverpool Society of Anaesthetists and shortly afterwards took the Diploma in Anaesthetics, which required the documentation of one thousand cases. At the outbreak of the Second World War, in September 1939, Cecil was turned down by the forces because of long-term asthma and so continued as a GP and part-time anaesthetist. As anaesthesia increased in importance as a speciality, he gave up the GP side of the work and was appointed as a full time anaesthetist at the Northern General Hospital in Liverpool. His persistence and desire to serve paid off, however, as he was accepted by the RAMC to work in a neurosurgical unit in North Africa as a Captain but was invalided home in 1944 after contracting bronchopneumonia. Back in Liverpool, having recovered, Dr Gray then proceeded to begin the pioneering work on curare, assisted by John Halton. John was the Medical Officer to the Royal Air Force locally and this put him in touch with the mess and doctors at the United States Air Force (USAF) base at Burtonwood near Warrington, Lancashire. Here, he learnt of the work of Harold Griffith in Montréal, using curare as a muscle relaxant, the first occasion being in January 1942. Cecil and John persuaded the USAF to fly over some crude extract of Chondrodendron tomentosum which they put to use, initially experimentally on themselves, then on patients, realising that this South American arrow poison worked on the neuromuscular junction and could assist the surgeon by causing relaxation of muscle. Cecil’s first experience of this was with a patient for abdominal surgery. Although the anaesthesia was described as ‘lissive’ (incomplete paralysis with assisted ventilation), the effect was ‘dramatic’. When the initial supplies of the drug ran out, Curarine (d-tubocurarine chloride) was obtained from Doctor, later Professor, Rod Gregory, of the Physics Department in Liverpool University. This was a pure form of the alkaloid, with much more predictable effects. Eventually, respiration was entirely controlled, after an increase in the dose of the relaxant, so the amount of other anaesthetic agents (principally thiopentone and cyclopropane) could be reduced. The triad of light hypnosis, analgesia and relaxation was born. This ‘Milestone in Anaesthesia’ was presented to the Royal Society of Medicine (RSM) on 1 March 1946 and was subsequently published in the Proceedings of the Society, in May of that year. It was, however, some years before the technique became universal and a paper published in 1949 outlined a more advanced technique using controlled respiration and reversal of paralysis, with prostigmine. This spread into general use in the early 1950s. After the award of an MD in 1947, Cecil Gray went on, first as Senior Lecturer and then as Reader, to head the newly formed academic Department of Anaesthesia in Liverpool. This Department attracted great talent and he was rewarded, in 1959, with the award of a personal chair. The Liverpool Technique was disseminated around the world and was introduced into paediatric surgery by Dr Gordon Jackson Rees, a Demonstrator in the Department. Professor Gray was invited to be a founder member of the newly established Faculty of Anaesthetists of the Royal College of Surgeons in 1948 and was President of the Section of Anaesthetics of the Royal Society of Medicine in 1955. From 1957 to 1959, he was President of the Association of Anaesthetists of Great Britain and Ireland (AAGBI). His commitment to teaching was recognised by his appointment, in 1966, as Postgraduate Dean of the Faculty of Medicine in Liverpool and, in 1970, Dean of the Faculty of Medicine, holding this post until his retirement in 1976. Cecil’s curriculum vitae shows the many awards and honours bestowed upon him. The last, in 2003, his ninetieth year, was the presentation at an annual dinner of the Royal College of Anaesthetists of the Magill Gold Medal, awarded by the Association of Anaesthetists of Great Britain and Ireland. Cecil Gray died on 5 January 2008, peacefully at his home in Formby, Merseyside. He is survived by his second wife, two sons and one daughter and four grandchildren. His very full curriculum vitae ends with four thoughts of how he would like to be remembered. These can be paraphrased as – the introduction of d-tubocurarine chloride and the Liverpool Technique, the institution of the first day-release course for junior anaesthetists, being the first anaesthetist to be a Sims Commonwealth Travelling Professor and giving the anaesthetic for the first open-heart surgery in South America. Professor Gray will certainly be remembered for many things. He was a Roman Catholic, a Liverpudlian, a musician, a generous host, a gifted teacher and, perhaps most of all, an approachable friend and mentor to many.

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