John Dundee

John Wharry Dundee OBE, was an anaesthetist and prolific medical researcher from Ballyclare, County Antrim, Northern Ireland.^[1]

Biography

Early life

John W. Dundee was born (9th November 1921) in Larne, Country Antrim, Northern Ireland. He was the eldest son of William Dundee, a farmer in Ballyrobert, near Ballyclare, County Antrim, Northern Ireland. The family home has now been converted into a restaurant, Barnabys in Ballyrobert. The farmland surrounding the house is now a golf course, Greenacres.

John was educated at Ballyclare High School,^[2] studied medicine at Queen's University Belfast(graduated 1947), and undertook postgraduate studies at Liverpool, Oxford and Philadelphia. He graduated with a PhD from Liverpool University in 1957.^[3]

As a student he played in a dance band and was a part-time member of ENSA between 1941 and 1944. It is believed that these activities helped to finance his studies. After graduating QUB in 1947 he then spent two years in the City and County Hospital, Londonderry, where he met his future wife, Sarah (Sally) Irwin Houston. After house appointments at the City and County Hospital, Londonderry, he was appointed resident anaesthetist at that hospital in 1948, and obtained the D A (Ireland). A year later he made his way to Liverpool, like many graduates from N I. Sir Ivan Magill, who was a house officer at the Stanley Hospital, Maurice Burrows, who joined the post-graduate course and H. H. McWilliam, the legendary medical superintendent at Walton Hospital, to which John came as Registrar in 1949 were a few of the distinguished migrants.

John Hargreaves, at that time chief anaesthetist at Walton recalls how quickly he saw that John was 'an exceptionally able anaesthetist', a 'highly beneficial influence on the rest of the staff, especially the juniors' and a 'regular powerhouse'. His 'high principles, colossal energy and immense enthusiasm' were early in evidence and marked him out for rapid advancement.

These characteristics observed by John Hargreaves were evident to all those with whom he came Into contact throughout his years in Liverpool. What impelled him to take up a career in anaesthesia, many have been unable to establish. The question is of interest because many ambitious graduates aspiring to a career in clinical medicine were more attracted to what were then regarded as the major specialities of medicine, surgery and obstetrics.

Word of the young man's exceptional abilities and original mind quickly spread and in 1950 Cecil Gray appointed him Lecturer in the University Department. He had by this time passed the D A (England). The postgraduate course of that year, of which 1 was a member, attended his lectures with pleasure and profit for he was a lively, humorous and kindly teacher whose material was always well prepared and up-to-date and was delivered with enthusiasm and lucidity He maintained an informal atmosphere and possessed the gift of encouraging comment and opinions from the more reticent members of the class. A special interest in pharmacology was clearly evident at this early stage in his career, although he lectured most capably on a diversity of topics, including refrigeration analgesia and anaesthetic apparatus.

In many ways his most valuable role was as supervisor of abstract and discussion groups. Each member of the course was given a topic, provided with selected references, asked to study the literature and then to prepare an abstract for circulation to the class. The member subsequently presented the results of his or her survey and these were discussed by the group, often at length and vigorously. In this way, over several years, John introduced young people to the study of journal literature and to the elements of speaking before an audience - both activities being quite new to most students at that time. As a clinical teacher, he was excellent, imparting information easily and continuously. Whilst testing a trainee's knowledge constantly (for he was rarely silent!) he did so in such a fashion that many enjoyed working with him in the operating theatre.

John's interest in research was evident from a very early stage. His thesis on aspects of thiopentone anaesthesia led to the award of the degree of M D of The Queen's University, with commendation, in 1951. He had already published work before this, and thereafter a stream of papers on clinical and laboratory research and clinical reports poured forth throughout his years in Liverpool, continuing by the end of his career to a total of more than 500.

During the 1950s, his principal interest lay with thiopentone and other barbiturates. Such aspects as the influence of body weight and sex on dosage requirements, the phenomenon of acute tolerance, the effects of renal and hepatic dysfunction and the importance of redistribution all led to publications. As Professor R Clarke has stated, John was one of the earlier workers in the field of pharmacokinetics before this term was widely used. These studies led to the appearance in 1956 of his monograph Thropenrone and other barbiturates, described by Professor Mushin in his review as probably the most important contribution to the literature on the thiobarbiturates'.

Intravenous anaesthetics were not by any means his only field of interest and he published work on muscle relaxants, adrenal insufficiency, dystrophia myotonia and phenothiazines amongst other subjects. With L F Tinckler he drew attention to the exaggerated and sometimes alarming response to injection of pethidine in patients suffering from severe liver damage. As non-barbiturate intravenous agents were developed, so his studies widened.

Much of his time was devoted to the work of the Neurosurgical Unit at Walton Hospital. When the French work on artificial hibernation appeared, he was quick to see how this might be adapted to permit safer arterial hypotension for the better performance of intracranial surgery and especially that for subarachnoid haemorrhage. The technique he developed, and the results obtained in 50 cases, were published in 1956. Although now superseded, it represented a valuable advance at that time. With Cecil Gray and others he had already published an account of the use of hypothermia with autonomic block in general surgery.

John Dundee was a regular speaker at the Liverpool Society of Anaesthetists, his first appearance being in 1950, when just 29, on anaesthesia for intestinal obstruction. His appearance at the LS A became a keenly awaited annual event. Perhaps of unusual interest in so young a man was his attraction to the history of anaesthesia. In 1952 he presented a well-researched and illustrated paper on David Waldie and his role in the story of chloroform anaesthesia, which was later published. In the following year he spoke on artificial hibernation. He spoke also at the Section of Anaesthetics of the RSM, and to many local societies, often on abnormal responses to thiopentone. The newly introduced anti-hypertensive drugs, corticosteroids and tranquillisers were of great interest to him. He reviewed the subject of drugs influencing the responses of patients to anaesthetics in 1958, in a paper which had great practical value at that time.

In 1955, he travelled to Philadelphia to spend a year as research fellow at the University of Pennsylvania and as staff anaesthetist at the University Hospital. During that fruitful year, apart from publications arising from research, he delivered some half dozen papers to learned societies in the United States and Canada. In the year after his return, he submitted a them for the degree of Ph D Liverpool. Dr J Riding (Formerly Consultant Anaesthetist, Liverpool Health Authority) well recalls the day of the viva voce examination as he waited in the office we shared The normally ebullient and cheerful John fell prey to doubts as he prepared to be examined by Cecil Gray and the formidable Gar Pask Happily, all went well.

A less well-known aspect of hls contributions to anaesthesia whilst in Liverpool was his keen interest in the management of chronic pain. In about 1952 he assumed the running of the clinic started by Cecil Gray a few years earlier. He rapidly established excellent relationships with surgeons and physicians, particularly Dr Eric Baker Bates. He established, contrary to the then current opinion, that local analgesia could sometimes be effective in providing worthwhile, and occasionally permanent relief in non-malignant conditions. Dr J Riding recalls a patient with a recurrence of tic douloureux who had had almost ten years without symptoms following Gasserian ganglion blockade using lignocaine. Neurolytic drugs he found were all too often effective for disappointingly short periods. He was always alert to the possibilities of new techniques. When Robert Maher, the Rochdale physician, published his technique of using phenol by spinal injection, he lost no time in arranging a visit to study the matter at first hand. Immediately, Maher's technique was adopted and was used In selected cases for the next 25 years.

John was fearless and became expert wlth the needle It will be recalled that spinal and regional blocks were not widely used In the 1950s This may be explained by the Woolley and Roe case of 1953, the serious complications following the use of Efocaine, and the advances In quick and convenient general anaesthetic techniques It IS horrifying to recall that blocks of the Gasserian ganglion, the coeliac plexus and the lumbar sympathetic chain were performed In the outpatient clinic, without radiological control, and without the precautions against infection regarded as normal today

His deep interest in the pharmacology of analgesics led to extensive study of their use for chronic pain, a field of medicine exciting little general interest at that time. He promoted the value of oral analgesics, especially for cancer pain. Strong analgesics asserted in the laboratory to be equipotent were, he stressed, not necessarily equipotent, nor associated wlth equivalent side effects, such as dizziness and nausea, in the individual patient. This point was clearly confirmed by the results of trials of analgesics made in each patient suffering pain of malignant origin. He was constantly concerned with the brevity of action of strong analgesics As new groups of drugs such as phenothiazines, tranquillisers and antidepressants appeared, so he studied the possibilities of extending analgesic action by combining one or more of these drugs with conventional analgesics. Geoffrey Burton recalls 'his astute ability to categorise and label the degrees of disability which a patient showed before, during and following some type of therapy', thus enabling him to obtain values for use in statistical comparisons. A paper summarising his experience of the use of drug combinations over a five year period were published in 1957.

A sympathetic, approachable and optimistic manner ensured that he was very popular with patients attending his clinic, some of whom enquired after his welfare years later This fortunate constellation of attributes was much needed in a clinic of last resort. One of John's outstanding features was a tireless restless energy. This was combined with a fierce, though largely concealed, ambition, great self-confidence and an insatiable scientific curiosity Again, as Geoffrey Burton put it, he was 'apparently able to put in' about 24 hours per day wlth a negative amount 'left over for sleep'. He was popular with senior and junior colleagues, though he was outspokenly critical of anything approaching disinterest or idleness. HIS good humour, practical kindness and special concern for overseas postgraduates were greatly appreciated. He would, for example, offer to relieve juniors who had been too long on duty and would spend time generously to help and advise in the preparation of lectures or on setting up research projects.

John could be a formidable opponent and occasionally displayed a brisk temper. A famous story concerns his appointment to the session at which a particularly difficult ENT surgeon worked. On arrival at 9am, .lohn was confronted by the surgeon demanding that only open ether should be used. An altercation ensued and by 10.30am John was back in the Department, having been to the Regional Hospital Board office to resign the session.

For him, material for research was to be found everywhere, and each patient, it seemed, merited an entry of some sort in the research notebook he invariably carried.

He and his wife, Sally, lived in a flat above Dr Sellwood's general practice surgery In Walton, Liverpool, very near to Walton Hospital. John undertook surgeries to help out in the general practice and to help meet the rent. He was thrifty in private life and yielded too few in the matter of how far a pound could be made to stretch. Leisure activities could be strenuous as when he and his wife took up the then popular pastme of square dancing. He took a keen interest in football. Photography was also one of his interests. He photographed (and perhaps travelled on) the last tram journey in Liverpool. A deeply religious man, his convictions profoundly influenced the conduct of his life. He was a capable church organist and played other musical instruments including the accordion to great acclaim at the Department of Anaesthesia Christmas parties.

For John Dundee, his period In Liverpool, first at Walton and then at the University Department, was a crucial stage toward achieving his constant goal of returning to The Queen's University of Belfast. It was an immensely fruitful period, for his own career, and for the beneficial influences he brought to bear on so many young anaesthetists. He was ever conscious of his indebtedness to Cecil Gray, for encouraging his academic development in every way possible and for making available every facility for the conduct of research including collaboration with members of the Department of Surgery. In return. John's loyalty and devotion to the Department never wavered and his contribution to the Liverpool scene was outstanding.

When John Dundee returned to Belfast as Head of Department, all were sorry to see him go. Yet they knew that the time had arrived for the next step in what was to prove a remarkable career.

Tragically, their only son Wharry died when a student in Glasgow and Sally herself suffered from repeated illnesses borne with great fortitude. John’s long earned retirement was troubled by repeated exacerbations of his ischaemic heart disease. It must be said that he made no concessions to this and indeed saw no point in doing so since travelling to medical meetings was an essential part of his life, even in retirement. In November 1991 Sally died, three weeks later John also died. Their three daughters and six grandchildren survived them.

Career highlights

Dundee founded the Department of Anaesthetics at Queen's University Belfast in 1958. He was appointed Professor of Anaesthetics there in 1964—a post he held until his retirement in 1987. He worked as an anaesthetist in the Royal Victoria Hospital of Belfast,^[1] was a Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons, and was Dean of the Faculty of Anaesthetists at the Royal College of Surgeons in Ireland. He presented the Joseph Clover Lecture in 1988.^[4]

A frequent international traveller, Dundee developed a great interest in acupuncture. One of his most notable achievements was the discovery that appropriate use of acupressure can provide relief of morning sickness in pregnant women. His 1988 report on this work, published in the Journal of the Royal Society of Medicine, demonstrates significant reduction of nausea and vomiting in a controlled trial.^[5]

Dundee originated many anaesthetic techniques which remain in use, and his extensive writings on the subject continue to be consulted.^[6] He was a principal researcher of the human and veterinary anaesthetic ketamine and assisted in the development of intravenous anaesthesia. He also assisted with the development of cyclomorph, a preparation combining morphine and cyclizine.

His "service to medicine in Northern Ireland" was acknowledged by the award of the Order of the British Empire in the 1989 New Year's Honours List.^[7] That year, he was also the first anaesthetist to be elected President of the Royal Academy of Medicine in Ireland. After his retirement, he was appointed Professor Emeritus and continued to undertake research into acupressure as an anti-emetic until his death, work which was sponsored by the Friends of Montgomery House, Belfast.

Besides receiving international awards and accolades in medicine, Dundee also held an internationally prestigious musical qualification (Associate of Trinity College London (ATCL). As a medical student, he had been an organist at Raloo Church near Larne. He continued to play the instrument in later life at church services throughout Northern Ireland, and he also sang in the choir at Windsor Presbyterian Church, Belfast. At various times, he was superintendent of Windsor Mission and a member of the board of Belfast City Mission. From 1985 to 1987, he was President of the Christian Medical Fellowship of UK and Ireland.

References