Frank Pantridge

Frank Pantridge

Professor James Francis ("Frank") Pantridge, soldier and cardiologist Belfast (b 3 October 1916; q Queen’s University, Belfast, 1939; CBE, MC, MD, DSc (Hon), DMedSc (Hon), D Univ (Open) (Hon), FRCP, FRCPI (Hon), FACC), d 26 December 2004, aged 88 years.

Why do people read obituaries? I suspect for two main reasons: to find out about the lives of the great and to find out about their own lives. Although Frank was great, readers tending to the latter category should persist as Frank had a few imperfections. For example, he did not suffer fools gladly and in Frank’s eyes there were a great many of us around. When Frank said, "With all due respect," you knew that this was the last thing he meant. Slow learning young doctors in his ward would feel his hyper-extended index finger jabbing into their sterna with the exhortation to "get out of your coma"; or he would tell them to go and write up all the cases of cardiogenic shock who had survived, telling them, "I will make you world famous," safe in the knowledge that there weren’t any survivors. His most severe humiliation, however, was reserved for medical students who were deaf to heart murmurs. He would ask to see their stethoscopes and examine them most fastidiously, trying them out himself, before announcing that, "The problem lies here!" as he pointed to between the ear pieces.

Frank’s reputation route-marched ahead of him: years before I met him I was asked by my barber if I had met Frank. He then recounted how he had been cutting a patient’s hair in Frank’s ward and had looked up to see Frank gesticulating in his direction. The barber bravely walked over to Frank and asked, "Sir, am I annoying you?" ‘No’ replied Frank in a measured way, and then glowering around at his entourage, added, "And come to think of it, you are the only person here who isn’t."

Frank was born into the farming tradition in the plantation town of Hillsborough, Co Down. In his eminently enjoyable autobiography, An Unquiet Life, he tellingly applies the word "farouche" to himself. He attended Friends School in Lisburn, Co Antrim, and contrary to another obituary, he was "not expelled from several schools." He subsequently read medicine at Queen’s University, Belfast, and having survived diphtheria, qualified as a doctor in 1939. The day that the second world war broke out he, Thomas (Toffie) Field, and three others joined the Royal Army Medical Corps. The five of them went off to war in bespoke uniforms provided by Toffie’s father, who owned a clothing company. Toffie was posted to north Africa and Frank was destined for the Far East.

Frank was seconded to the Second Battalion the Gordon Highlanders near Singapore and for a considerable period a phoney war ensued. The British, convinced that only a seaward attack was conceivable, believed that Singapore was impregnable—thanks to the huge guns which were resolutely trained out to sea. Then things began to go badly awry, with the loss of the Repulse and the Prince of Wales in late 1941, due to a total absence of air cover and the onset of the Japanese landward assault down the Malay Peninsula. For Frank, the gruesome helter skelter of war began in deadly earnest. In his autobiography he records that, "One Indian officer came in with a hand on either side of his head. He explained that his head was about to fall off. A massive gash from a Japanese sword had severed all the muscles of the back of the neck down to his spine." Towards the end of the Malay Peninsula campaign Frank won an immediate award of the Military Cross on the field for working " . . . unceasingly under the most adverse conditions of continuous bombing and shelling and was an inspiring example to all . . . He was absolutely cool under the heaviest fire and completely regardless of his own personal safety . . ." Characteristically, Frank makes no mention of these events in his autobiography.

Following the humiliating surrender of Singapore, Frank was taken prisoner of war early in 1942. When Toffie Field learnt of this he is said to have commented, "God help the bloody Japanese." In reality, Singapore and Malaya had been abandoned. Frank was taken to Changi camp where the treatment dished out was barbaric. One day, on the docks in Singapore the Japanese guards were brutalising their British prisoners when Frank saw some German sailors sunbathing on a surfaced U boat. The sailors swam ashore and proceeded to beat up the Japanese guards. In the spring of 1943, 7000 British and Australians were taken to build the 1200 mile long Siam-Burma Railway. It may be added that the first use to which the railway was put was to ferry in prostitutes to entertain the Japanese soldiers. The horror of what unfolded is captured to some extent in Frank’s autobiography, although, for him, the full reality may thankfully have been dulled due to severe nutritional deficiency. Frank meticulously boiled all his drinking water to avoid cholera, thereby exacerbating the nutritional disease that he succumbed to: cardiac beriberi. Frank survived the "death-camp" at Tanbaya in Burma and, altogether, 90 000 of his comrades perished.

Over two years later in 1945 he was liberated by a colleague from the Royal Victoria Hospital, Tom Milliken, who described him thus: "The upper half of his body was emaciated skin and bone, the lower half was bloated with the dropsy of beriberi. The most striking thing were [sic] the blue eyes that blazed with defiance"—at this time he weighed less than five stone. The first thing that Frank did was to dig up his uniform, which he had buried for safe keeping, and put it on; Tom said he resembled a scarecrow. His defiance was certainly directed at his former captors but, it must be understood, that it was also directed at the authoritarian high-handedness which had so badly blundered in the Far East. Frank’s contempt for petty authority ever afterwards must be viewed in the light of his experiences.

Frank returned to England, and with a friend, in the absence of a welcoming party (for after all he had been a player in a losing theatre of war), he absconded for his beloved County Down. With the war over, Frank toyed with a career in general practice but opted for studying beriberi in pigs. After he passed his MRCP he took up a two year fellowship in the United States, when he worked with Frank N Wilson, the then world authority on electrocardiography. He also developed a sound knowledge of electronics, which was to later serve him so well. He also saw Charles Bailey demonstrate his new technique of mitral valvotomy.

In 1951 he was appointed consultant physician in the Royal Victoria Hospital, Belfast. This was, in fact, an outpatient physician post, which was, in time, to evolve into a cardiology post. He set about building up a good working relationship with the surgeons and, by the mid-1960s, 2500 mitral valvotomies had been performed and other residual problems such as constrictive pericarditis were mopped up. Frank would dismiss this as routine, but it brought huge benefits to those who received the operations. In the early to mid-1960s, the concept of the coronary care unit came to be established in Westernised countries. Frank was aware of epidemiological studies in America that showed that mortality in myocardial infarction was highest in the very early hours, ie a significant proportion of death was sudden. In 1965, after discussion with Frank, John Pemberton and Harry McNeilly of the department of social and preventive medicine at Queen’s University, Belfast, began a study of survival in fatal cases of infarction over a one-year period. It confirmed that most of the patients developing primary ventricular fibrillation did so during the first five hours after the onset of symptoms, so that, "Those who are admitted to hospital represent, in fact, the survivors of a storm which has already taken its main toll."

There is an apocryphal story about Frank having lost a golf ball in gorse and setting fire to the bush. Certainly, he loved to quote the American gangster Willie Sutton, who on being asked why he always robbed banks, replied, "That’s where the money is." So it was with Frank’s great achievements: having identified a worthwhile goal he would pursue it relentlessly. His response to the high early mortality from myocardial infarction was to deliver coronary care to the patient in the workplace, street, or home. Cardiopulmonary resuscitation had been shown to be effective and defibrillation was a reality, but the equipment was only portable in the sense that you were a contestant in the World’s Strongest Man/Woman competition.

Frank’s approach was to commandeer an ambulance, and with the assistance of Dr John Geddes fitted it out with the help of a British Heart Foundation grant. It went on the road on the 1 January 1966. The defibrillator was powered by car batteries, weighing 70 kg. Mobile coronary/intensive care was now effectively delivered to the patient at the right time. The epidemic of coronary heart disease was still on the increase in the province and was not to decline until the early 1980s. Frank’s innovations continued: the introduction of the first truly portable defibrillator in 1968, weighing roughly the same as a newborn baby, and the concept of the automatic defibrillator which Frank first conceived on Saturday 6 March 1976 on a train travelling between Ghent and Amsterdam.

Mobile coronary care was avidly accepted in North America and taken up by Grace in New York, Crampton in Charlottesville, Virginia, and Cobb in Seattle. In Great Britain, however, attitudes were more phlegmatic. At a symposium in London in 1974, the distinguished cardiologist Celia Oakley asked how it could be that in Belfast a considerable proportion of patients with a coronary attack got intensive care within one hour while in London patients, on average, did not notify their doctor within eight hours. Were the Londoners more stoical than the Belfast citizens? "No, ma’am," snapped Frank, "more stupid." Today, Frank’s ideas are part of mainstream medicine throughout North America, and beyond. It has been recorded that the name of Pantridge is known everywhere in North America from the humblest ambulance of the inner city ghetto emergency service, to the most erudite members of university faculties. Frank was so well known there that an American colleague commented, "Literally he could run for political office." Indeed, in the Americas he is known as the "father of emergency medicine."

He was elected to the fellowship of the American College of Cardiology in 1974 and in 1999 the combined Latin-American and First Uruguayan Congresses of Pre-Hospital Coronary Care invited him as a guest of honour, along with John Geddes. Frank was presented with a statuette of a gaucho by the president of Uruguay. I received a postcard of Montevideo on which Frank had written, "I seem to be better known in South America than I am in North Ireland." This was just one of a long series of awards he received, mainly from outside the United Kingdom.

Does mobile coronary care work? A study carried out by Charlie Wilson of Ballymena and Clive Russell of Omagh in the early 1980s strongly suggests that it does. Frank’s goal was the early stabilisation of rhythm not only through defibrillation but also by the correction of slow heart rates, which are conducive to ventricular fibrillation. In fact, mobile coronary/intensive care can be justified in humanitarian terms alone: good doctors should ensure that patients have pain relief in the shortest possible time—which may make a modest contribution to stabilising heart rhythms. The importance of early treatment in the acute coronary attack has been increasingly accepted with the advent of thrombolytic therapy.

In Britain, automatic defibrillators are now ubiquitous: for example, British Airways has installed them on all its planes and has trained its staff, albeit years after American Airlines and Quantas did so. To mark the millennium and its own silver jubilee, the European Congress of Cardiology, in Amsterdam, held a special exhibition in which Frank was honoured as one of the great contributors to cardiology since 1950.

In Frank Partridge we have lost a pillar whose contribution in so many important areas has been immense. He had an extremely interesting and eventful life. Apart from his adventures in the Far East, he eluded a kidnap attempt by a paramilitary group, and was rushed to Sligo to advise on possible treatment after the horrifying attack on Lord Mountbatten’s yacht. He was a man of huge vision and also one of breadth of intellect. He was a keen reader, a keen salmon fisherman, had great taste in architecture, furniture, and gardens, was very widely read, and an avid follower of cricket. He was a connoisseur of malt whiskey which was old enough to vote, and which he referred to as "Synapse Medicine/Relaxant." Not long ago in a good restaurant he asked for a not particularly obscure malt, which the shamefaced barman did not have in stock. In reparation the barman picked up a large tray loaded with bottles of malt and proffered it to Frank, who quipped, "I couldn’t possibly drink all that."

He had a veneer of arrogance at times but this often concealed an innate shyness. On a good day Frank looked as though he owned the world, on a bad day he looked as though he didn’t care who owned it. He appreciated being stood up to, but this, in truth, was often hard to do. He was a man with staccato delivery and a quickness of wit, which often bore the Irish element of visual humour; the clicked fingers acted as punctuation and the stiff index finger directed the verbal missile: a nattily dressed young consultant resembled "a walking Christmas tree," an ex-rugby playing surgeon "a great slab of mesoderm," dermatologists and radiologists were "scratch" and "shadow" doctors, respectively.

Frank had a sure eye for detecting nonsense: after George Bull, the professor of medicine, had introduced the concept of multiple choice questions at a clinical meeting, a group of physicians were walking up the corridor arguing about which of the five answers were correct, Frank came up behind them and observed, "There is a sixth possibility—the professor of medicine is a bloody fool." It must be admitted here that George Bull may have given the idea of pre-hospital coronary care to Frank who was initially hostile to it. None the less it was Frank who developed the idea and invented the portable defibrillator. Frank often adopted an ultra right-wing stance, sometimes specifically to infuriate those in whom he had detected a streak of liberalism (which he could spot at 40 paces). It came as no surprise that during a strike of the cooks at the Royal Victoria Hospital in 1981, he was prepared to organise the catering himself. This was not a case of strike-busting but a desire to ensure that patients did not suffer. His patients, particularly children, loved him. He strongly approved of the original ethos of the NHS and deplored the "Laocoonian" bureaucracy that developed.

Although in his early days, Frank was not too concerned about cardiovascular risk factors, latterly, having endured quadruple coronary artery bypass grafting he became a disciple. He eschewed both his pipe and saturated fat, and An Unquiet Life contains these memorable lines: "Common sense, however, would suggest it might be unwise to consume large quantities of milk or milk products. Man is the only mammal which consistently consumes the milk of another species." Frank had learnt which side of his bread not to butter. Until now, he was an incredible survivor: as he remarked recently, "If I’d known I was going to live to this age, I would have looked after myself better." He would reflect on how he had out-survived his surgeon. Even in his decline his wit never deserted him: a nurse unwisely asked him why he fell down and got the swift and immaculately timed reply, "The reason I fall down is because I can’t stand up."

As we have seen honours were more likely to come from abroad than from home—although he was made a freeman of Lisburn, Co Down, and there is a road named for him in west Belfast. Admittedly, Queen’s University, Belfast, did include him in its millennium exhibition, Faces of Queen’s, and the following year finally awarded him an honorary degree. Sporadically, correspondents would write to our local newspapers from the United States asking why Frank had not been honoured more fully. Some of us did try to remedy this but to no avail, but perhaps this says more about the honours system than it does about Frank. Word did filter down from above that Frank was viewed as "controversial." In 2001 there was a piece in the BMJ entitled, "A paper that saved my life." The author was a Sydney based general practitioner whose life had been saved by mobile intensive care units serving the population of 4 million people: undoubtedly countless others around the world are still alive today thanks to Frank’s "controversial" ideas. Maybe, Frank’s view of the world was just too large and uncomfortable to fit into the cosy milieu that is Belfast medicine. Some time ago I mentioned to him that the gene for hibernation had been detected in primates for the first time, suggesting that humans would also carry it, and if it could be activated it would be useful in space travel. In a manner reminiscent of the Duke of Wellington’s advice on controlling the sparrow population at the Great Exhibition (sparrowhawks), Frank spat out one word, "surgery." As another great Irishman, Jonathan Swift, wrote, "When a true genius appears in the world you may know him by this sign, that the dunces are all in confederacy against him."

Why do people write obituaries? In this case because Frank paid me the honour of asking me to. Frank fell out with most of us but I was lucky enough to have fallen in with him again. In common with many, I miss him hugely. As Frank often said, "Good people are scarce." As Frank’s nephew added recently, "They are now even scarcer." [Alun Evans]