Professor Cecil Gray CBE KCSG FRCS FRCP FRCA in interview with Dr Max Blythe: Interview 2

Following the first interview in which Professor T Cecil Gray discusses the start of a career as an anaesthetist, this interview takes up the account of his career from 1944 after being invalided home from North Africa, where he served in the Royal Army Medical Corps. Professor Gray begins by speaking of resuming work as an anaesthetist in Liverpool and the start of his pioneering work on curare in anaesthetic practice, in collaboration with the anaesthetist, John Halton.In the mid-forties, John Halton divided his time between service as a medical officer in the Royal Air Force and working with the distinguished thoracic surgeon, Hugh Morriston Davies, at Clatterbridge Hospital. John Halton learnt from American Air Force colleagues of the first use of curare as a muscle relaxant in anaesthesia (by Harold Griffith in Montreal in 1942), and managed to obtain curare in the form of a crude extract of the vine, Chondodendron tomentosum - a constituent of the South American arrow poison. Professor Gray and John Halton began to experiment with the extract in their respective anaesthetic practices and when supplies ran low started to use the pure alkaloid, Curarin (d-tubocurarine chloride), which they obtained from Rod Gregory. Rod Gregory, who was a senior lecturer and then professor in the physiology department of the University of Liverpool, was to remain an important research collaborator.Professor Gray then goes on to describe the dramatic muscle relaxation effect produced when he first administered Curarin intravenously to a patient undergoing abdominal surgery, using Pentothal and cyclopropane as the anaesthetic. There is discussion of how initially Curarin was given in a low dose so that respiration was not abolished completely, but with experience the dose was gradually increased and respiration was controlled. This technique permitted the use of light anaesthesia for surgery and greatly assisted post-operative recovery. The discussion then progresses to the development of the technique with the use of physostigmine and then prostigmine in conjunction with atropine to reverse the effect of the Curarin.In March 1946 the Liverpool group's early results were presented at a meeting of the Royal Society of Medicine and were published subsequently in the Proceedings of the Society, in what is now recognised as a landmark paper in anaesthesia literature. (General acceptance by anaesthetists of the use of controlled ventilation with muscle relaxants did not come until later, and at first tubocurarine was used almost exclusively as an adjuvant to anaesthesia in the spontaneously respiring patient.) Professor Gray talks of the award of an MD degree in 1947 and his appointment as reader to head a new academic department of anaesthesia at the University of Liverpool, and he acknowledges the support of the professor of surgery, Charles Wells. He then speaks of the appointment to a demonstratorship of Dr Gordon Jackson Rees, who became a highly valued colleague and friend over many years, contributing to both the teaching and research of the department. In the following part of the interview, Professor Gray discusses setting up an administrative structure for anaesthetists in Liverpool and the origins of the renowned Liverpool course in anaesthetics. A discussion follows of a joint publication with Dr Gordon Jackson Rees on the role of apnoea in major surgery, and the essence of the 'Liverpool Technique' being the application of the anaesthetic triad, unconsciousness, analgesia and muscle relaxation.The interview moves on to Professor Gray's involvement with teaching initiatives in Europe, including the WHO course at the Anaesthesiology Centre in Copenhagen. The final part of the interview covers Dr Gordon Jackson Rees' entry into the field of paediatric anaesthesia, the impact of the introduction of the National Health Service, and Professor Gray's invitation in 1948 to join the board of the newly created Faculty of Anaesthetists of the Royal College of Surgeons.

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