Robert Reynolds Macintosh

The dramatic advances in the safety and efficacy of anaesthesia in the 20th and 21st centuries, make it difficult to believe that, within living memory, anaesthetics were routinely delivered by medical students. As anaesthesia emerged as a speciality it its own right, it was Sir Robert Macintosh, the first Professor of Anaesthetics in Europe, who did much to give this new speciality the status of a University discipline. He was influential in the development of anaesthetics from a secondary service performed, often reluctantly, by students, surgical assistants or general practitioners without training, into a well organised, scientifically based specialty in its own right. His emphasis on accurate observation, safety and simplicity did much to raise the standards of anaesthetic practice in Britain and indeed throughout the world.

Robert Macintosh was born in Timaru, New Zealand, the son of Charles Macintosh who had been a member of the original All Blacks rugby team. He was educated in Waitaki Boys High School and in 1916 sailed for Britain taking a commission in The Royal Scots Fusiliers and then enlisting in The Royal Flying Corps as a fighter pilot. He was shot down over France and taken prisoner – an experience similar to that of Sir Charles Illingworth (qv). After the War he qualified in medicine from Guy’s Hospital in 1924, originally intending to be a surgeon, and was elected FRCSEd in 1927. He took on sessions in dental anaesthesia at Guy’s Hospital with little knowledge of or training in the subject, but then as he often said, neither did anyone else. Soon he turned to anaesthesia full time and began a practice of peripatetic anaesthetists operating out of Harley Street – the “Mayfair Gas Company”.

Through his Golf Club he met and befriended Lord Nuffield and was able to offer advice on Nuffield’s proposed benefactions to medicine. On one occasion he anaesthetised Lord Nuffield who described Macintosh’s anaesthetic as a pleasurable experience, which compared favourably to previous anaesthetics. When Nuffield proposed to fund Chairs in medicine, surgery and obstetrics in Oxford University, Macintosh suggested he should include anaesthesia. The University of Oxford felt that there was inadequate academic status in anaesthesia to justify a Chair, but Nuffield made this a condition of his offer to endow the two other chairs, and Macintosh was appointed the first Professor of Anaesthesia in Britain and indeed in Europe.

Amongst the early achievements in this new position was a classical textbook “Essentials of General Anaesthesia” written with Dr. Freda Bannister. In the years immediately before the Second World War his department collaborated with physicists in the University to produce the Oxford vaporiser. This simple device accurately delivered precise concentrations of ether to the nitrous oxide/oxygen mixture and was produced in Nuffield’s Cowley works. Its widespread use throughout the Second World War was a major step in safe anaesthesia. At the outbreak of the war Macintosh was appointed Consultant in Anaesthetics to The Royal Navy and The Royal Air Force eventually being promoted Air Commodore. He frequently visited each of the RAF hospital where his arrival, wearing pilot’s wings and First World War medal ribbons was to prove a great morale booster for service doctors. His department at the Radcliffe Infirmary continued with projects on artificial ventilation, the design of lifejackets and hypoxia in airmen.

After the war postgraduate teaching expanded and so began the long series of courses at Oxford which were to produce competent anaesthetists. In an era before audit of clinical practice was accepted Macintosh established the first audits into unexplained anaesthetic deaths and with Dr. William Mushin persuaded the Association of Anaesthetists to establish more formal audit of anaesthetic mishaps.

His latter years were marked by a personal campaign to improve standards of anaesthesia characterised by safety, simplicity, detailed observation and clarity of expression. His influence was felt particularly in under-developed countries where these standard were just as applicable in the absence of expensive resource.

He was knighted in 1955 and made a Fellow of The Royal Society of Medicine in 1966 but remained modest despite these and many other honours. While his name lives on with the laryngoscope blade which he designed, he wrote that he wished to be remembered “as someone who encouraged people not to be afraid to acknowledge their mistakes”. His influence on the development of safety in anaesthesia was immense.