History of the Anaesthetic Department at The National Hospital for Neurology & Neurosurgery, Queen Square 

The history of the anaesthetic department at the National Hospital for Neurology and Neurosurgery (NHNN), Queen Square is intimately tied up with the professionals who worked within and therefore moulded it.  Accordingly, we have produced a section regarding some of these professionals and the department.  The two intensive care units, Medical Intensive Therapy Unit (MITU) and the Surgical Intensive Therapy Unit (SITU), also have separate history sections. 

The National Hospital for Paralysed and Epileptic (1883)

It is difficult to trace the origins of anaesthesia from the earliest times at The National Hospital for the Paralysed and Epileptic as specific records are scarce.  However, the earliest dedicated anaesthetist mentioned in the National Hospital Annual Reports appears to have been Mr J F Silk, a qualified surgeon.  He was instrumental in setting up institutions that were forerunners of the modern Royal College of Anaesthetists (RCOA).  There were no formal qualifications or training for anaesthetists in those times and he was vociferous and instrumental within the medical community in pushing for change.  His favoured apparatus at that time was probably the Clover’s Ether Inhaler.

The department appears to have continued for several years with several lone anaesthetists, providing anaesthesia on an ad hoc basis.  This included the period throughout the Great War (1914-18).  However, in 1919 the department expanded to two anaesthetists, Dr Llewelyn Powell and the augustly named Dr Zebulon Mennell administering anaesthesia for three neurosurgeons.

By 1931 the department had expanded further, to four full-time anaesthetists.  The equipment was still very basic as shown in the photo from the anaesthetic room in 1936.

An anaesthetic Room 1936 – Courtesy Queen Square Archive and Museum collections

An anaesthetic Room 1936 – Courtesy Queen Square Archive and Museum collections

During World War II some of the anaesthetic staff (such as Dr Atwood Beaver) were seconded into the military medical core to serve around the world.

Having been ravaged by World War II, the country and Queen Square started to return to normal in 1946.  Around that time, two more anaesthetists were appointed to take the fledgling department to five full time anaesthetists (one had resigned).  Archives also show that the anaesthetists returned to their pre-war pay of 1 Guinea per hour with a minimum of 3 Guineas per session.  However, following nationalisation of the health system in 1948, evidence from the Institute of Neurology Annual reports show that a consulting anaesthetist could expect to earn around £1000 a year with a £30 per annum pay rise. 

Minutes of the board make mention of ‘salaried anaesthetists available for every operation’, however by mid-1948 there were complaints regarding the ‘ad hoc’ nature of anaesthetists with nobody at the helm to captain them.  It seems likely that in response to this, the ‘band of anaesthetists’ became a department, with Dr Mennell at its head.

In the early 1950s Europe and London faced an epidemic of poliomyelitis.  In October 1953 an isolation unit was therefore established for the treatment of polio, called the Poliomyelitis Batten Unit.  After the abatement of the polio epidemic, the unit continued to treat respiratory failure due to other neurological diseases.  This was the foundation for what is now the Medical Intensive Therapy Unit (MITU).  This unit and in particular Dr Attwood Beaver commenced a steady programme of “research into artificial respiration in all forms and development and manufacture of apparatus to this end.”

The 1960s saw research into drugs such as propanidid as an intravenous induction agent. ‘The haemodynamic effects of the intravenous anaesthetic agents; thiopentone, methohexitone and propanidid’ were also studied.  Monitoring, a new concept at that time, was studied, in particular EEG monitoring of anaesthetised patients. Cerebral blood flow under anaesthesia was also examined.  By the end of the 1970’s the department had expanded to 5 consultants with 8 registrars.  The archives show that research was conducted with “positive pressure breathing with full leg and trunk counter pressure in order to minimise the risk of air embolism during posterior fossa exploration”.  The effects of anaesthetic agents on pulmonary vasculature using isolated lung perfusion and right left heart bypass were also studied.

An anaesthetic Room 1974 – Courtesy Queen Square Archive and Museum collections

An anaesthetic Room 1974 – Courtesy Queen Square Archive and Museum collections

By 1980 the number of consultants had risen to 8, with 17 registrars and in 1983 The National Hospital for Nervous Diseases, Maida Vale closed, the site was sold, and some of the anaesthetists moved to the NHNN full time.  The site has now been demolished and luxury apartments built, but in a nod to its heritage, an NHS diabetic community clinic resides within the building.

In the 1980s research was performed into drugs to prevent peri-operative epilepsy, pipecuronium (Dr Hirsch), duration of atracurium action at different PaCO2 levels (Dr Hirsch).  Airway research into fibre-optic intubation with the ‘new’ laryngeal mask airway (LMA) device and in patients with unstable cerivical spines was conducted by Dr Calder.  Dr Ingram and Dr Jewkes were prominent speakers at the 9th World Congress of Anesthesiology in Washington having just attended the 2nd Anglo-American Neuroanesthesia Conference in Williamsburg.  In 1983, further research on posterior fossa surgery using an anti-gravity suit was conducted and showed statistically significant increases in systolic pressure and mean CVP.  This would later be presented at the 7th European Congress of Anaesthesia in Vienna in 1986 and published by Brodrick and Ingram in Anaesthesia1988;43:762-5 (see picture).
Anaesthesia 1988;63:762-5.  Reproduced with kind permission off John Wiley & Sons Publishing.

Anaesthesia 1988;63:762-5.  Reproduced with kind permission from John Wiley & Sons Publishing.

In July 1990, the Tavistock Surgical Intensive Care Unit (SITU) opened as a 7-bedded intensive care unit specifically for surgical patients under the auspices of Dr Martin Smith.  It was funded by a generous donation to the NHNN Development Fund from the Tavistock family.

In the 1990’s, research projects were undertaken on fibre-optic intubation of patients with cervical spine pathology, integration of Motor Evoked Potentials (MEPs) into anaesthesia for spinal cases and the effects of propofol infusions on evoked potentials and EEG during anaesthesia and on ITU (Dr Jewkes).

In 2010 the neurosurgical department of The Royal Free Hospital, Hampstead, London moved entirely to The National, resulting in changes for existing surgeons and anaesthetists as some of the anaesthetists from The Free also moved.  Today, as a consequence, the anaesthetic department has expanded to 15 substantive consultants.

The department is proud to have had two former presidents of the Neuroanaesthesia Society of Great Britain & Ireland (NASGBI) in Dr Stuart Ingram and Professor Martin Smith.  Professor Smith has also previously been president of the Society for Neuroscience in Anaesthesiology and Critical Care (SNACC).


The Medical Intensive Therapy Unit (MITU)

In 1952, a number of polio epidemics spread through London.  The Board of Governors at the National Hospital for Neurology and Neurosurgery set up a committee to review the evidence coming from Copenhagen, where they had established the first intensive therapy unit (ITU) for treating bulbar and respiratory polio with intermittent positive pressure ventilation (IPPV).  In October 1953, this resulted in the establishment of an isolation unit for the treatment of polio.  The unit was supervised by a neurologist, Dr Michael Kremer.  It was decided by the committee that the unit, named the Poliomyelitis Batten Unit, should continue after the polio epidemic had abated in order to treat respiratory failure due to other neurological diseases.  The foundation of what is now the Medical Intensive Therapy Unit (MITU) is probably best brought to life by excerpts from the archives of the Institute of Neurology (1956-1957).

“The Batten Unit was planned in 1952 as a small Isolation Block for the treatment of Poliomyelitis.  To this end, in addition to three wards for seven patients, there are as far as possible, self-contained facilities.  These include a kitchen, service workshop, two laboratories and a bedroom suite for a Medical Officer to sleep at night…
The foundation of the Unit coincided with the great Copenhagen epidemic and The Ministry of Health held a meeting in April 1955, at which Dr. Beaver  was asked if he could produce Positive Pressure apparatus as rapidly as possible.  With the facilities of the Hospital Workshops and E. T. Eames, Esq a Motor Engineer, and financed by the Queen Square Society, 30 machines were turned out in six weeks.
The British Oxygen Company were interested and thereafter manufactured various models in large numbers, all these developed and type tested in the Unit…  This testing covered every sort of apparatus used for the care and comfort of the patient with Respiratory Paralysis.

Inevitably the Unit became associated in the people’s minds with Positive Pressure Respiration and probably as a result has had an unusual share of Bulbar Paralysis.  The distribution of admissions is as follows:
Or in the proportion of 37 Poliomyelitis to 90 other.  It will be seen that the unit became essentially a Respiratory Unit with Polio an incidental to that purpose.”  
Patient on positive pressure, 1953.

Portable apparatus and sucker, 1955.

In 1960 a section on the Batten Unit appeared for the first time in the Institute of Neurology’s Annual report, perhaps signifying its’ importance within the hospital.  Of interest to modern intensive care practice, Dr Beaver was developing a patient-triggered positive pressure ventilation machine which was quoted as being ‘in extensive use’.  In the same year he also exhibited his Mk III Beaver respirator in America.

In 1962 the Batten Unit was “temporarily closed for structural alterations and improvement and cases of respiratory failure were successfully cared for elsewhere”.

Dr Beaver and his successors continued to pursue a vigorous programme of research over the next few years.  Some of the highlights from the archives of the Institute of Neurology were:

  • 1964  Investigation of blood gases in artificial respiration
  • 1967  Development of “an all-pneumatic respirator using fluid amplifiers.”
  • 1972 Research into “The neurogenic control of respiration using computer controlled analysis of breath by breath changes in ventilation in response to low grade carbon dioxide stimulation” (DR L Loh and Dr JM Newsom Davies).  Over the next few years more research continued on the Batten Unit, using computers to quantify respiratory (in particular diaphragmatic) weakness and treat it.  An MRC grant allowed the purchase of a computer for the Batten unit in 1974, allowing further work.  Their work was published in the British Journal of Anaesthesia by Loh et al in 1978.  
  • 1974  Breathing during sleep was investigated with the new computer and a technique using magnetometers produced results suggesting different breathing patters during sleep.
  • 1977  Research commenced on the ‘utility of thymectomy and plasma exchange in myasthenia gravis’.
  • 1980 The Batten unit investigates the responsiveness of the respiratory control mechanism in chronic neuromuscular ventilatory failure

In 1971 Dr Loh took over the anaesthetic leadership of the Batten Unit following the retirement of Dr Atwood Beaver after 21 years at The National.

In 1986 the Unit changed its location again and became the Harris Medical Intensive Care Unit (MITU) after a generous donation from the Harris family.  It was relocated to the first floor of the Queen Mary Wing.

In January 1988,  Dr Nicholas Hirsch took over from Dr Loh as anaesthetic lead of the Harris Medical Intensive Care Unit, with Dr Mark Wiles as neurology lead. 

After a number of moves, in 2009, a newly built MITU facility opened on the first floor of the Chandler wing, opposite the surgical ITU.  It is a 6 bedded unit which cares for approximately 150 patients per annum as well as housing the plasma exchange service.  It remains the only dedicated neurorespiratory unit in the UK.  Anaesthetists involved in the unit include Drs Hirsch, Radcliffe, Taylor, Amin and Reddy; neurologist consultant input is from Drs Howard and Kullmann.

The Surgical Intensive Care Unit (SITU)

Although there had been a medical intensive care unit for nearly thirty years taking patients with respiratory muscle weakness of varying causes, surgical patients who required ventilation had been managed on an ad hoc basis in general neurosurgical wards, sometimes ventilated in situ.

Lord TavistockThe first patient was admitted to the newly opened Tavistock Surgical Intensive Care Unit (SITU) on 16th July 1990.  The unit initially had 7 beds and was funded by a generous donation (£1m) to the NHNN Development Fund from the Tavistock family. It was initially on the 7th floor of the Queen Mary wing.

In 1995 the unit moved to its current position in the Chandler Wing, where it initially had 9 beds that could be used flexibly to provide level 2 (HDU) or level 3 (ICU) care. Six additional beds were added in 1999 and the unit now has 9 level 3 and 6 level 2 beds, and by 2000 SITU was caring for over 1000 patients a year.  In 2005 the unit (in combination with MITU) set up an outreach team which provides invaluable intensive care without walls.

With the addition of neurosurgery from The Royal Free Hospital, workload and case-mix has changed, capacity has become restricted and there are plans to extend the neurosurgical critical care facility to 20 beds within the next 2 years.

Dr Smith has become a world renowned authority in the arena of neurosurgical critical care and has conducted extensive research into novel optical techniques to measure changes in cerebral oxygenation, including near infrared spectroscopy (NIRS) for the non-invasive measurement of cerebral oxygenation and haemodynamics in critically ill brain-injured adults.  This research continues at a pace to this day.  His publications can be found here.  

Founding & Former Anaesthetists at Queen Square

This section concerns some of the many luminaries from the Department of Neuroanaesthesia at Queen Square over the years.  We very much hope that this will be of historical and anaesthetic interest to those outside the department.  It is thought-provoking to note how many of our former colleagues have held high office within various anaesthetic societies, founding the forerunners of the institutions that we know today, such as the Royal College of Anaesthetists (RCOA) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI).  Some were even instrumental in the establishment of anaesthesia as a new specialty in the United Kingdom, as well as improving safety for those undergoing anaesthesia.  We have written this section by gathering information from a variety of sources, including obituaries in medical journals and national newspapers, and from the Institute of Neurology’s archives and minutes of the board meetings of the National Hospital.

Mr J F Silk LSA MB MD MRCS (Eng)
John Frederick Silk was a man ahead of his time in that he was one of the first to propose that medical students should learn how to administer anaesthetics, and that resident posts be made available for anaesthetists, whom should undergo examinations in the subject.  These views were published in The Lancet in May 1892 (Anaesthetics a necessary part of the curriculum - a plea for more systematic teaching. The Lancet 1892; 1178-80).  Born in 1858, he went to King’s College Medical School.  He learnt to use Clover’s inhaler while in Leeds as a houseman.  He started work in London as a General Practitioner and was appointed to work at The Hospital for Epilepsy (now NHNN) in 1888 and The ‘Royal Northern’.  In 1888 he published a textbook on the use of Nitrous Oxide anaesthesia.  He is credited with being the founder of what eventually morphed (exactly 100 years later) into the Royal College of Anaesthetists, by forming the Society of Anaesthetists in 1893 after writing to leading proponents in the field of anaesthesia.  Again, ahead of his time, in a meeting of the council later in 1983, their rules were altered to allow the admission of women, apparently being the first medical organisation in the UK to do so.  The society was amalgamated with the Royal Society of Medicine in 1908. (Source Dr C Howat “The Founders of the First Society”. The History of Anaesthesia Society Proceedings.  Vol 35.  Proceedings of the Meeting in Liverpool 13th November 2004 and Joint Meeting with the Section of Anaesthesia in the RSM 4th March 2005. ISSN 1360-6891).

Dr Dudley Wilmot Buxton MBBS MD MRCP Lond.
He was educated at University College Hospital London, qualifying MBBS in 1882 and MD in 1883.  He colluded with Sydney Ringer, Professor of Medicine at University College on the action of certain drugs upon the heart.  In 1885 he went into full time anaesthetics, and worked as a salaried anaesthetist at Queen Square from 1891 following the resignation of Silk.  In 1901 the British Medical Association appointed him Honorary Secretary of the Special Chloroform Committee, presenting its final report in 1910.  Like Silk before him, he believed that every qualified doctor should have a proficient knowledge of anaesthetics.  In addition to working at The National, he also worked in the Hospital for Women (Soho Square), King George V Hospital and then at University College Hospital and The Royal Dental Hospital. He retired in 1919. (b. 1855 – d. 1931)

Dr Robert T Bakewell MRCP LRCS
Educated at University College Hospital and worked at The National from 1901.  He is also credited in 1895 as being the first full time anaesthetist to be appointed at the new premises of The Hospital for Sick Children, in Great Ormond Street. (b.1867- d.1932).

Dr Llewelyn Powell Dr Llewelyn Powell MB BCh
In place of Bakewell 1905, resigned 1921, died 1934.  Wrote “regarding chloroform” and “on Nitrous Oxide as an Anaesthetic” both of which can be read in the reprinted “The Dental Record, Vol. 10” (ASIN: B00807BENC).  Was also Hon. Secretary of the Section, of Section of Anaesthetics, Royal Society of Medicine.

By 1911 there were two anaesthetists, Dr Zebulon Mennell and Lewellyn Powell for 3 consultant surgeons.

Dr Zebulon Mennell MRCS LRCP FFARCS.
Appointed in 1911 and worked for 34 years at The National Hospital (and St Thomas’) before retiring in 1945 (Died 1959).  Although records show he only commenced work as a consultant anaesthetist in 1919, having been a captain in the army in The Great War. Worked with Sir Victor Horsley.  A pioneer of hedonal, tracheal intubation and deep muscle relaxation (for abdominal cases).  Lectured to The Royal Society and in America.  A former president of the Section of Anaesthetists of The Royal Society of Medicine (1926), founding member of the AAGBI and president from 1938-40. ‘Zeb’ was also described as an “ardent motorist”. (Obituary - http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1959.tb13770.x/pdf)

Dr JF Ryan Was appointed 1925 honorary anaesthetist and resigned in 1935.

By 1931 the anaesthetic compliment stood at four anaesthetists:

Records state that Drs Hall, Jones and Taylor were formally appointed in June 1935 as salaried anaesthetists earning 1 pound 1 shilling 1pence /hour n(a guinea per hour), with a minimum of minimum £3.3.0 per session.

Possibly attended at the birth of Queen Elizabeth’s 3rd daughter and was awarded CVO for her part in proceedings.

Dr Olive MG Jones MRCS LRCP
Formally appointed 1935, resigned 1938.

Dr Edith Margaret Taylor MBBS FFARCS
Took Natural Sciences at Newham College Cambridge, then worked as a demonstrator in physiology at the London School of Medicine.  She then went to medical school at University College Hospital qualifying in 1925, and became anaesthetic registrar 1926.  Her main appointment was to the Elizabeth Garrett Anderson Hospital for Women where she was much loved but, among others also held a consultant appointment at NHNN.  Of interest, during the second World War she served as an anaesthetist in the Neurosurgical Hospital Haywards Heath.  (b 1896 d. 1955) (Obituary: http://www.bmj.com/content/2/4949/1211.4.)

Mr R Atwood Beaver  MA BM BCh FFA RCS DA (1906-72).
Worked at The London Chest Hospital and The National.  During World War II he served as part of a thoracic team in North Africa, Italy and France, then ‘resumed normal duties once his service commitments ceased’ in 1945. 

Dr Attwood Beaver’s position was ‘regularised’ at The National in 1948 replacing Dr Olive Jones (who retired due to ill health) as the fourth member of the anaesthetic department.  Born out of his frustration with the current technology, he economically produced a ventilator bearing his name (see picture) from a predictor motor, ‘Moth’ aeroplane altimeter and other equipment in his own garage for £5, which he later developed further and marketed internationally.  He was also notable for instigating the first specific respiratory unit in the country, The Batten Unit, following the Poliomyelitis epidemic of the early 1950s and later adapted his own ventilator for use with tracheostomies. 

Beaver was very much a character, attaining a blue at Oxford for athletics, having several oil paintings accepted by The Royal Academy and being a competent yachtsman often found on the Solent .  Additionally he was an ‘enthusiastic’ motor racer, sometimes scaring neighbours to the National with his antics in his Mini Cooper.  He raced at Brooklands and acted as a reserve in several of the teams in the 1920s and 30s.  Latterly he acted as a medical adviser to motor racing teams and attended races in that capacity, including Monte Carlo . Dr Atwood Beaver retired in 1971 and passed away in June 1975.  (Obituary  http://www.bmj.com/content/3/5975/103).



Left Photo - With thanks to the “Science Museum / Science & Society Picture Library”


Dr William CobbDr William Cobb  MRCS LRCP DA. 
In November 1945 the department expanded (temporarily) to five with the addition of Dr Cobb (a class II officer), who was initially ‘seconded from the ministry of health’ who were responsible for his salary.  He was terminated by the DOH and received £800/year as a researcher an part-time sessional anaesthetist.  He started in Anaesthetics then moved on to the developing field of EEG.  In the 1950s he gave up anaesthesia and helped build EEG machines, in an era when parts were scarce, reportedly salvaging parts from downed fighter planes!  He helped develop the EEG service, and was infamous for his field EEG recordings in New Guinea of tribesmen with Kuru (a spongiform encephalopathy with some similarities to CJD).  Dr Cobb (b.1913) finally retired in 1980 (pictured) and died in 1999.

Dr David Aserman MD DA
Joined the department as an anaesthetist to Mr McKissock from who was sited at Atkinson Morley with sessions at The National.  His original contract was a temporary 6-month appointment, for this surgeon only, but his contract was extended and made permanent with Dr Cobb in February 1947.

Derek Wylie MA MB BChir MRCP DA.
Another St Thomas’ graduate (1943), he joined the RAF volunteer reserve in Aden and Palestine as a physician gaining his MRCP.  He was head-hunted by St Thomas’ for anaesthesia being appointed there in 1948.  Additionally he worked as a Consultant Anaesthetist at NHNN from 1950 to 67. He was heavily involved in medical safety and with the AAGBI he set up a committee to investigate deaths associated with anaesthesia, which is considered a direct forerunner of the National Confidential Enquiry into Perioperative Death. 

He was elected dean of St Thomas’ medical school in 1974 and served for 5 years.  Additionally he served on the Council of the Medical Defence Union and served as their President from 1982 to 1988, forwarding the process of a prospective prevention of accidents rather than a reactive strategy. 

He was author of  ‘The Practical Management of Pain in Labour’ (1953) and co-wrote the best-selling textbook A Practice of Anaesthesia (1960).  (b. 1918 d. 1998). (Source: The Independent 21 November 1998 - http://www.independent.co.uk/arts-entertainment/obituary-derek-wylie-1186241.html

Dr Peter MurphyDr Peter Murphy, Senior Registrar 1966-67. 
He performed the first ever fibre-optic intubation.  His inspiration arose from a paper in The Lancet, regarding gastroscopy and he had the idea of broadening the uses for the new fibre optic scope.  Dr Murphy went on to pursue a successful career in Chicago, eventually retiring in 1984. 

Dr Loh took over the anaesthetic leadership of the medical intensive care unit from, Dr Atwood Beaver.  In 1987 he moved to Oxford and continued practicing until he (recently) retired. He was particularly interested in research into respiratory weakness and myasthenia gravis.

Dr MR Bowen-Wright  Dr MR Bowen-Wright  MBBS MRCS LRCP FFARCS. 
Initially appointed at The Middlesex in 1979 and credited with founding what became the Pain Management Service of the National.  He had also worked as a ship’s doctor prior to his appointment, and as one would expect had a renowned sense of humour and was an advocate of the social side of medicine.  (b. 1946 d.1998).

Dr Doreen Jewkes Dr Doreen Jewkes MBBS MRCS LRCP FFARCS DA
Appointed 1967 - 1995.  Dr Jewkes worked with Professor Lindsay Symon and was one of the established ‘names’ in neuroanaesthesia.  She was head of department for many years. Among many publications she published research with Professor Lindsay Symon regarding motor evoked potentials during propofol and volatile anaesthesia.  Dr Jewkes sadly passed away in January 2015. 

Dr G Stuart Ingram Dr G Stuart Ingram MBBS FFA RCS
Retired 2001. Former chairman of the final Fellowship examination, sat on the committee of the RCOA and was one of the first five co-ordinators of the National Confidential Enquiry into Perioperative Deaths.  He also co-edited “Anaesthesia and Intensive Care for the Neurosurgical Patient” (1994). Dr Ingram passed away in May 2016 following a serious head injury sustained on his boat in bad weather. He will be greatly missed.

Dr Ian Calder  Dr Ian Calder  MB ChB DRCOG FFARCS 
Ian was a founding member of the Difficult Airway Society (DAS) and won the DAS Macewen Medal in 2011 in recognition of his work developing fibre optic intubation.  Ian was a co-author of “Core topics in airway management” Cambridge University Press, 2005. He also moderated the influential NAP4 study.   

Dr Frank L Kurer  MBBS MD FFA RCS RIP 1996.
Dr Kurer, was important in founding the current pain service at The National, and as such was an early adopter of the multi-professional model of pain treatment, recruiting specialist pain physiotherapists and psychologists among others.  He was also a protagonist of total intravenous anaesthesia.

The departmental history has been compiled from the National Hospital Annual Reports, Institute of Neurology Annual Reports, National Hospital Board of Management minutes, newspapers and other publically available sources.  The list of persons above is not exhaustive.  Whilst every effort has been made to ensure that the information is accurate, we are at the mercy of our sources and sometimes a lack of information from the pre-internet era.

Dr Nicholas Hirsch  MBBS FRCA FRCP FFICM.

Retired in December 2015.  Dr Hirsch was instrumental in advancing the Harris Medical Intensive Therapy Unit and became the unit anaesthetic lead in 1988.  Dr Hirsch had a long and distinguished career with many publications including “The Anaesthesia and Intensive Care A-Z”, which is used by almost all UK anaesthetists in preparation for their FRCA and intensive care examinations.  He wrote multiple chapters on coma assessment, neuromuscular disorders and the neuromuscular junction in “Core Topics in Neuroanaesthesia and Neurointensive Care” (2011) and “Handbook of Clinical Anaesthesia” (2011).  He also published a great many research, observational studies and CPD papers and articles in “Anaesthesia”, the “British Journal of Anaesthesia”, “Anaesthesia and Intensive Care Medicine”, “Clinical Medicine” and the “European Journal of Neurology”.  In addition to his work on the medical ITU, he ran sleep studies clinics and anaesthetised for many lists including awake craniotomy and pituitary surgery lists.  Known for his academic prowess and clarity of thought, he will be much missed by the department.


Nick Hirsch - retirement photo Dr Nicholas Hirsch - front centre with Neuroanaesthesia team at NHNN


A note regarding the changing letters after consultant’s names…

Many of the early anaesthetists possessed the Diploma of Anaesthetics (DA) which started in 1934 after Sir Ivan Magill founded the Association of Anaesthetists of Great Britain and Ireland (AAGBI) in 1932, having tried to arrange a formal examination for anaesthetists through the Royal Society of Medicine.  Founding a ‘Fellowship’ type exam without a charter from an established college proved impossible, hence the formation of the AAGBI.

However, this was superseded by the Faculty of Anaesthetists which was founded as part of the Royal College of Surgeons of England in 1948.  This led to the FFA RCS (Fellow of the Faculty of Anaesthesia of the Royal College of Surgeons) examination, as well as formalised inspections of hospital anaesthetic posts, leading to a more professional accreditation system for anaesthetists.  In 1989 this exam was replaced by the FCA examination, Fellowship of the College of Anaesthetists, which was granted until March 1992.  This was superseded by the current FRCA (Fellow of the Royal College of Anaesthesia), which remains to this day as the examination all anaesthetists must poses to allow them to work as consultants.

It was not until 1988 that The Royal College of Anaesthetists was formed, although it was not formally granted its own Royal Charter until 1992.  The independent college was originally sited at 48/49 Russell Square so has always had close ties with The National Hospital for Neurology and Neurosurgery, only a street or two away.


Many thanks to the flowing for their help with this history:

  • Dr Ian Calder, Dr Nick Hirsch and Professor Martin Smith for historical background regarding the two intensive care units and the department.
  • Sarah Lawson and The Library of the Institute of Neurology for help with pictures and content.
  • Derek and Robert at Medical Illustration at The National Hospital for Neurology & Neurosurgery for historic photos.
  • Mrs Rose Sayce at The Royal College of Anaesthetists for help with historical figures.
  • History of Anaesthesia Society  www.histansoc.org.uk
  • The Science Museum, London - photo.
  • The British Medical Journal for obituaries.
  • British Journal of Anaesthesia for photos and obituaries.
  • The Independent Newspaper for obituary information.
  • John Wiley and Sons Publishing for photos
  • History written by Dr Gordon Bird

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