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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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References

1 Lucas GHW, Henderson VE. A new anaesthetic gas: cyclopropane - a preliminary report. Can Med Assoc J 1929; 21: 173-5.

2 Stiles JA, Neff WB, Rovenstine EA, Waters RM. Cyclopropane as an anesthetic agent: a preliminary clinical report. Anesth Analg Curr Res 1934; 13: 56-60.