George Edward Hale Enderby
Pioneer and architect of modern anaesthesia
Hale Enderby was born in Boston, Lincolnshire, the son of the local optician. His early education was at Boston Grammar School and then Kingswood School in Bath (1928-34), his public school, where he won the Victor Ludorum at sports and gained an entrance scholarship to St John’s College, Cambridge, in 1934. His university years 1934-7 were notable for being captain of the St John’s College Athletic Club, excelling in hurdles and discus. He was awarded his BA in 1937. He won a scholarship to Guy’s Hospital, where he went to study medicine in 1937, qualifying in 1940 (LMSSA) and subsequently MA, MB BChir (Cambridge). As a medical student he won the Girling Ball Gold Medal for pathology.
In 1940 he married Dorothy, also from his home town of Boston, Lincolnshire, and they had three children, David, Diana, and Jane, between 1942 and 1947. At the start of the second world war he joined the emergency medical service, having been turned down for active military service on account of a duodenal ulcer. He worked initially at Guy’s Hospital and then at Pembury Hospital, Kent, to which many of the Guy’s Hospital facilities were moved after Guy’s was bombed at the start of the war. It was there that he was asked to move into anaesthesia. He took up the challenge, organising most of his training himself by reading and visiting notable anaesthetists of the day—for example, Sir Ivan Magill. He moved in 1944 to Rooksdown House, Basingstoke, the plastic and jaw unit run by Sir Harold Gillies, where he worked with the plastic surgeons treating injured and burned servicemen. He gained his diploma of anaesthesia in 1943.
In 1946, at the end of the war, he set up in practice taking consultant posts at the Royal National Orthopaedic Hospital, Stanmore, and the Metropolitan Ear, Nose, and Throat Hospital, London, also continuing at Basingstoke one day a week. His expertise was already in demand and in 1947 he was invited to Bergen, Norway, where he spent a month teaching anaesthesia for the reconstructive surgery being undertaken there. In 1951 he moved to an NHS post at the Queen Victoria Hospital, East Grinstead, where he was to work for very many years with the plastic surgery giant Sir Archibald McIndoe. In 1953 he became a fellow of the Faculty of Anaesthetists of the Royal College of Surgeons.
What Hale Enderby is best known for was his pioneering work in hypotensive anaesthesia. This is the technique of lowering blood pressure during surgery to facilitate intricate operations, making surgery safer and more rapid and enabling more complicated surgery while controlling blood loss from the patient.
This started when, in 1948-9, the pharmacologists Paton and Zaimis described for the first time a range of new drugs, the methonium compounds. One of these, decamethonium, showed promise as a muscle relaxant. It was hoped that pentamethonium and hexamethonium would reverse this action. This they did, but their blockade of autonomic ganglia and the resultant fall in blood pressure precluded their use for this purpose. Hale Enderby was one of the pioneers who saw that this fall in blood pressure might be used to lessen bleeding during surgery and he played a major role in the development of this technique of hypotensive anaesthesia.
Early days were difficult since the ability to measure low blood pressures did not exist. Early methods of measurement relied on using a mercury column, but the Korotkov sounds become inaudible below 60 mm Hg systolic. The pulse also becomes impalpable at that pressure. However, this was the level of blood pressure needed to reduce bleeding significantly. Many contemporary early anaesthetic records showed a period, during anaesthesia, of "no recordable blood pressure." That there were few serious consequences of this is a tribute to the skill of the anaesthetists of the day. The most significant event at this time was the introduction by Hale Enderby into anaesthesia of the oscillometer, an older and largely forgotten method of blood pressure measurement but one that proved capable of measuring accurately these low pressures. He was also responsible for introducing the "anti-trendelenburg" or head up tilt of the operating table to assist in the lowering of blood pressure.
In 1950 he published his first paper on hypotensive anaesthesia, going on to publish more than 25 papers on this subject in the anaesthetic, surgical, and medical journals. At that time, as a result of this pioneering work, he became one of the most well known anaesthetists in the world and travelled widely, lecturing on his subject of hypotensive anaesthesia at both anaesthetic and surgical meetings. He visited the USA, Australia, South Africa, Canada, and most European countries. In 1963 Professor James (Jim) Eckenhoff from Philadelphia came to England with his research team to investigate the physiology of this technique, starting a friendship that was to continue throughout their lives. In 1975-6 Hale Enderby returned the compliment by going to Chicago for three months as visiting professor of anaesthesia. He also collaborated with the Westminster Hospital department of anaesthesia in 1973, doing further research into the physiology of the technique.
While others also did research and published papers on the new drugs and techniques, Hale Enderby was the ambassador, travelling, lecturing, and visiting departments of anaesthesia worldwide. He wrote a chapter on hypotensive anaesthesia in the Textbook of Anaesthesia edited by Gray, Nunn, and Utting, and in 1984 edited his own book, Hypotensive Anaesthesia, which crystallised his experience. This was a seminal work, never repeated and which reads today 20 years on as if it was written yesterday.
As well as pioneering hypotensive anaesthesia he also, like many others at the time, designed and had made his own anaesthetic equipment. He designed a portable anaesthetic machine necessary for his private practice at the start of his career and then, later on, his own tracheal tubes and other anaesthetic equipment—for example, one of the first waste gas scavenge valves in the early 1970s.
At the Queen Victoria Hospital after the war the burned servicemen became known as the "Guinea Pigs" as they were the first to receive skin grafts. The "Guinea Pig Club" members often needed many repeated operations and his interest in the club continued long into his retirement. At this time he also worked with Sir Edward Muir, then president of the College of Surgeons, whose specialty was general surgery. In the early 1960s he had an increasing private practice in London and would spend midweek in his Harley Street apartment to be near his work. He eventually retired from anaesthesia in 1986 after undergoing coronary artery bypass surgery.
As well as having a busy private practice and NHS practice in East Grinstead, he became an examiner for the final fellowship examinations of the Faculty of Anaesthetists from 1976 to 1981 and was elected to the council of the Faculty of Anaesthetists (1977 to 1983), where his special efforts for the fundraising committee culminated in his being awarded a Faculty Gold Medal. He was also president of the anaesthetic section of the Royal Society of Medicine, for which he received an RSM medal and served on the council of the Association of Anaesthetists. After his retirement from anaesthesia he undertook medicolegal work and made many appearances in court as an expert witness on behalf of the Medical Defence Union.
As well as his work with hypotensive anaesthesia and his role on the Faculty of Anaesthetists he also enjoyed golf. He was a keen golfer from an early age. He became captain of the Medical Golfing Society in 1965 and president in 1972-3. At that time he organised an annual golf match with its American counterpart along Ryder Cup format, an event that continues to this day. He was a member of the Royal Ashdown Forest Golf Club and continued to play there until he was nearly 80 years old. In 1980 he presented an eponymous golfing trophy, the Enderby Plate, for which the staff at the Queen Victoria Hospital, East Grinstead, compete annually.
His early interest in athletics led to an interest in tennis, which he played to a very high standard until the early 1960s. He also was very fond of his motor cars and for many years enjoyed owning and driving a Bentley.
He was also a keen Freemason, initiated in 1942, going on to become a member of London Grand Rank. He was elected to Grand Metropolitan Chapter in 1966. He was a founder member of the John Snow Lodge for anaesthetists and was a member of Aesculapius and Rose Croix Lodges.
In his final years he suffered some cerebrovascular inefficiency as a result of hypertension and was frustrated by his inability to continue life at the pace that he preferred. He was a kind, gentle, and distinguished man with an easy manner, well liked by everyone with whom he came into contact—colleagues and patients (some of whom became very close friends)—and had very many friends from all over the world. To the end he would have a lively discussion on sports or politics over a glass of whisky of an evening. He loved his food and wine and with his wife entertained very regularly all his life. He will be sadly missed by so many; a remarkable and distinguished man the like of which we are unlikely to see again.
He leaves his wife of 64 years, Dorothy; three children; seven grandchildren; and two great grandchildren.
There will be a thanksgiving service for Dr Hale Enderby on Monday 24
May at 2 30 pm in Guy’s Hospital Chapel, St Thomas’s Street, London SE1,
and afterwards at the Burfoot Room, Guy’s Hospital. [David Enderby]