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-~ 30/03/90
HAROLD GRIFFITH: A FORMER STUDENT REMEMBERS . . . \ .
William B. Neff
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I q 3 t' On my arrival at the Homoeopathic Hospital in Montreal i .. ? . to begin a
rotating internship, I was warmly welcomed by Harold Griffith who then introduced
me to his father A.R. Griffith, the medical superintendent, and his brother James, a
staff surgeon. The hospital was a new, small, well-equipped institution with an
excellent nursing staff, all of which made it attractive to many McGill faculty
members from both the Montreal General and Royal Victoria hospitals to become
its section chiefs.
It soon became evident that, although Harold Griffith was primarily
interested in specializing in internal medicine, a time came when he was rapidly
becoming internationally known in the developing field of anaesthesia. He
informed me that he felt that anaesthesia, in order to progress as a specialty, had to
be closely related to internal medicine and must not be regarded as a "handmaiden
of surgery", which was a common North American custom at the time. As time went
on I became more interested in his concept of anaesthesia as a branch of internal
medicine than in other areas of my duty.
At that time rotations within the rotating internship were not clearly defined.
While on the surgical rotation, the intern could be called upon to do blood
chemistry on a patient, or while on the medical rotation we could be requested to
assist in surgery. He pointed out that the practice of assigning surgical residents "to
give the anaesthesia" as part of their training often resulted in a diversion of their
attention, sometimes with disastrous consequences. Griffith had a quiet way of
sharing his medical knowledge with the interns not only in anaesthesia but in the
broad spectrum of medicine, albeit, he always returned to his thesis that anaesthesia
was a subspecialty of medicine rather than surgery. Since there was no resident staff
he saw to it that the interns, in addition to guidance by department chiefs, received
practical experience according to their capabilities. It was on these latter occasions,
while holding retractors during lengthy operations, that I became aware of Griffith's
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ability to provide muscular relaxation for the surgeon only when really needed,
usually resulting in a more rapid patient recovery.
Griffith's success with the endotracheal technique both for anaesthesia and
the resuscitation of the newborn attracted visiting anaesthetists from many
institutions, mostly from Canada and the United States. Olive Jones was sent by the
London neurosurgeon, Hugh Cairns, to observe endotracheal anaesthesia as
performed by Griffith. Since neurosurgical operations at his hospital were a rarity,
he demonstrated his technique on patients undergoing general surgical or
otorhinolaryngological procedures, of which there were plenty. During the course of
her stay, he recommended that she visit other Montreal hospitals (both English and
French) and I was elected to be her guide. Transportation was entirely by bus and
tram. On the return she told me that, as far as the administration of anaesthesia
was concerned, she preferred what she had seen at "Dr Griffith's hospital."
I find it interesting that all of his 1930 interns and their friends carried on a
continuing respect for medical anaesthesia following subsequent advancement to
responsible positions which included Medical Director at the Rockefeller Institute,
Professor of Medicine at Oxford, and Professor of Paediatrics in British Columbia.
Later in life, at one time or another, we met and reminisced over the direct personal
association the interns had with McGill faculty members and others during the times
we spent with Griffith at the old "Romeo." On the lighter side, our conversation was
directed to an appreciation of the amenities offered in days of deep economic
depression, such as the high quality of the food served in style by uniformed Scotch
waitresses. Although his father was the medical superintendent, Harold was given
full reign over the support structure of the hospital, including the housekeeping and
dietary services which he handled in such a quiet, pleasant, effective manner that it
evoked few, if any, complaints. We had the privilege of inviting colleagues who
were interns in other hospitals for dinner. They all agreed we had it pretty good.
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The Griffith family owned a country place on a lake in the Laurentian foothills
where the interns were invited by Griffith for weekends of swimming, boating and,
of course, eating.
Griffith had been interested in cyclopropane ever since Lucas and
Henderson discovered its anaesthetic properties at the University of Toronto in
1929.(1) He and Easson Brown, the only clinical anaesthetist who participated in
the original study, were members of the Anaesthetists' Travel Club, a very informal
gathering, which was hosted by Ralph Waters at the University of Wisconsin in
1930. On his return, and before my departure for Wisconsin, Griffith reported on a
possible promising extension of the original study to clinical application by Waters,
before an equally informal organization, the Montreal Society of Anaesthetists.
Naturally, with this background, I was highly pleased when, shortly after my arrival
at the University of Wisconsin I was assigned to the pharmacological and clinical
study of cyclopropane then in progress, and thus to be included in the original team
that culminated in the first clinical cyclopropane report.(2)
When the cyclopropane study was midway to completion, I had to return to
Montreal for a non-related matter so Waters asked me to stop off in Toronto en
route for a brief conference with Henderson, Lucas and Brown in the pharmacology
laboratory. I was directed to convey Waters' opinion that, if at all possible, the first
clinical report on cyclopropane should come from the University of Toronto. This I
did, but they assured me that, for them, the clinical introduction of any potentially
explosive anaesthetic was impossible. Furthermore, they felt deeply honoured to
have the experimental study and clinical application extended and reported only
after the administration of more than 200 anaesthetics by the Wisconsin team. The
following day I informed Griffith of the results of the Toronto conference and he
was not at all surprised. He said he had already been advised that cyclopropane
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would first be released for clinical use to members of the Anaesthetists' Travel
Club. In 1933 he became the first to administer it in Canada.
Fifty years on, after his complete retirement, I visited Griffith in his
Montreal home. Although he was very ill, when I told him I had been successful in
substituting weak, non-explosive concentrations of cyclopropane, established by the
U.S. Bureau of Mines, for meperidine to fortify nitrous oxide anaesthesia, his face
beamed as he said, "Bill, cyclopropane certainly served me well throughout my
professional career."
After Griffith's successful clinical use of curare as a muscle relaxant during
cyclopropane anaesthesia, he suggested that the West Coast Squibb representative
should contact me, relate his further experience and off er me a substantial supply
for clinical trial at Stanford. Having been familiar with the safety of curare in
properly ventilated animals, and knowing the reliability of Griffith's observation, I
administered it and recorded its use for over a month without mentioning it to
anyone. The additional relaxation was noted and appreciated by the surgeons.
Even though it was recorded in detail, quite legibly on the chart, surgeons never
seemed curious enough to refer to the record. The following summer, during my
family's annual return to Canada, when I related the course of events to Harold he
responded with the usual big smile and shoulder shrug.
As I look back over a fifty year period of time, I realize that my continuing
medical relationships with Harold Griffith were based entirely on the spoken word,
either in the form of direct personal conversation or transmitted by third party
association in which I was always referred to as his former student.
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