Edgar Pask
Edgar ‘Gar’ Alexander Pask (1912 – 1966) was an English anaesthetist
Pask was Professor of Anaesthesia in Newcastle upon Tyne. During the Second World War he was junior anaesthetist to Professor Macintosh and volunteered for the RAF where he was involved in a number of dangerous and remarkable experiments; including investigating the effects of acute hypoxia related to high altitude parachute descents, artificial ventilation resuscitation techniques and testing survival in cold water and the effectiveness of lifejackets…whilst intubated and prone.
Pask volunteer work included being deeply anaesthetised to compare different ventilation methods. He was initially induced with thiopentone and maintained with ether; after forced hyperventilation with the ether respiratory arrest was achieved – this then made it possible to compare varying techniques of ventilation such as the the Silvester method; the Shaefer method; and Eve’s rocking method…
After the war he was appointed to the anaesthetics division in the university of Durham. In 1949 he became a professor of anaesthesia, the second person in the country to be appointed to such a position. He was a founding member of the faculty of anaesthetists of the Royal College of Surgeons.
Biography
- Born on September 4, 1912 in Derby, UK
- Educated at Rydal School, Colwyn Bay
- 1934 – BA (double first) in Natural Sciences from Downing College, Cambridge.
- 1937 – MB BCh, London University. MA (Cantab). MRCS, LRCP.
- 1939 – Junior assistant at the Nuffield Department of anaesthesia, Oxford; Britain’s only academic anaesthetic department run by Robert Reynolds Macintosh (1897-1989)
- 1940 – DA(RCP&S)
- 1944 – Order of the British Empire
- 1946– Recipient of the John Snow Silver Medal
- 1947 – MD, Cambridge University. Thesis: Applications of Anaesthetic Techniques in Physiological Research
- 1948 – Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons (FFARCS) by Election
- 1949 – Professor of Anaesthesia in the University of Durham (the Medical School of which is now part of the University of Newcastle-upon-Tyne); the second Professor of Anaesthesia in the UK
- Died on May 30, 1966 aged 53; sudden death (from myocardial infarction) was thought to be related to injuries sustained during the war-time experiments although tobacco played its part
The bravest man in the RAF who never flew an aircraft
Medical Eponyms
The Pask award (1977)
Created by the Association of Anaesthetists in 1977 following the Moorgate underground railway disaster on February 28, 1975.
The award is named after Professor EA Pask, who had a distinguished career in the Royal Air Force Medical Branch as an experimental physiologist in the Second World War. This included dangerous self experimentation requiring considerable personal courage.
Association of Anaesthetists
The Pask Award is given to those who’ve rendered distinguished service, either with gallantry in the performance of their clinical duties, in a single meritorious act, or consistently and faithfully over a long period.
The first award was to Philip Michael Finch, an anaesthetic registrar who was vital in the rescue efforts of the Moorgate incident.
Key Medical Contributions
Pask stated in the introduction to his MD thesis on the Applications of Anaesthetic Techniques in Physiological Research, he had ‘certain experience in the clinical and experimental practice of anaesthesia’ and he believed that the ‘methods used in such practice could usefully be employed in the solution of the problems under consideration‘
High altitude parachute descents
B17 bombers were ‘designed’ to fly higher than Everest in a thin, un-pressurised aluminium tube, exposed to bitter cold and severe hypoxia. Pask was ordered to investigate the effects of altitude and hypoxia and RAF crew survival if they needed to bail out of aircraft at high altitude.
Pask looked into the effects of being exposed to very low levels of oxygen (risking his life doing so), concluding that bailing out of an aircraft at 35,000 feet was the highest level someone could survive parachuting without an oxygen supply.
Sixteen experiments of ‘simulated parachute descent’ on 5 physician colleagues, all heavy smokers (9 experiments) and himself, a 60-a day man (7 experiments). They were exposed to hypoxic gas mixtures in a decompression chamber, with the mixtures designed to simulate the inspired oxygen concentrations encountered whilst descending.
Descent No. 14
Subject – E.A.P.
Gas Mixture – Nitrogen/Oxygen
Posture – suspended in parachute harness.
Simulated altitude – 35,000ft.
This and the next descent caused certain anxiety and necessitated close attention to the subject. As a result, the clinical notes were compiled after the experiment, not during it: At 1½ mins., the subject became limp and relaxed, the head falling forward, but although it must have been merely a matter of chance, it was not thought that laryngeal or pharyngeal obstruction actually developed, though vigorous inspiratory efforts were made.
Life Jackets and their efficiency
The Royal Navy Talbot Report of 1946 concluded that 30-40,000 officers and men had died at sea during the Second World War. One third had been killed in action and two thirds had drowned in the survival phase, principally as a result of poor survival equipment.
Pask examined the efficacy of life jackets when the wearer is unconscious; this was of concern as it was found the commonly used Mae West jacket sometimes led to drowning as despite keeping someone afloat they would often be in a head down position.
Macintosh and Pask researched the behaviour of an unconscious human in the water with and without a life jacket. In 1940/41, Pask was anaesthetized, intubated and lowered into the deep end of the Farnborough swimming pool, and much to everyone’s surprise – he sank
Over many weeks, Pask was anaesthetised by Macintosh and was allowed to float or sink whilst wearing a life jacket prototype, to assess flotation angle and self righting capability. This selfless dedication to human service has seen Pask termed ‘the father of the modern life jacket’
All of Pask’s experiments demonstrated that the design of the German life jacket was far superior to anything worn by the Allies. As a result, the Royal Navy Personnel Research Committee undertook an extensive research programme and created the new RFD Admiralty pattern 5580 inflatable life jacket; a marvel in design simplicity, performance and durability.
B. Buoyant overall, stable when prone.
C. Buoyant overall in rough water.
D. No life-jacket!
Pask and Macintosh 1941-1957.
The efficiency of methods of Artificial Respiration
During wartime, many aircrew were forced to eject into the sea where cold and injuries would end in drowning. Artificial respiration, on , was extremely difficult. Pask reviewed the most popular methods of artificial respiration to determine which method was most efficient and could be best performed on the cramped, wet, turbulent environment of rescue launches.
The efficacy of methods had only previously been studied on conscious subjects or corpses…so, of course…Pask allowed himself to be anaesthetised with ether to the point of apneoa, then intubated and attached to a smoked drum. Each of the methods was applied and tidal volumes measured.
The range of methods of artificial respiration reviewed included the Silvester method; the Shaefer method; mouth to mouth; the Oxford inflating bellows and Eve’s rocking method.
Pask concluded that Eve’s rocking method (rocking on a stretcher to 45 degrees either side) was the method which could be most easily and safely applied. This method was duly adopted by the RAF and then the Navy.
To take things one stage further…Pask obtained some early curare from his friend Harold Griffith in 1945. He persuaded Macintosh to repeat the experiments on himself, fully paralysed for two hours, to compare results with his earlier experiment
Hypothermia prevention
Aircrew ditching in the waters around the British Isles were likely to suffer hypothermia. Pask was tasked with creating an effective immersion suit to allow temperature maintenance in cold water. Once designs were complete Pask obviously had to test them…by being parachuted into the sea in winter.
Major Publications
- MacIntosh RR, Pask EA. Floating Posture of the Unconscious Body. Flying Personnel Research Committee. FRPC550, 1943
- MacIntosh RR, Pask EA. Unconscious Flotation Posture: Tests of Eight Types of LifeSaving Equipment. FRPC550(a), 1944
- Pask EA. Applications of Anaesthetic Techniques in Physiological Research. MD Thesis, University of Cambridge 1946
- Pask EA. Artificial Respiration. Anaesthesia 1948; 3(2): 58-66
- Macintosh RR, Pask EA. The testing of life-jackets. Br J Ind Med. 1957 Jul; 14(3): 168-76.
- Pask EA. The design of life-jackets. Br Med J. 1961 Oct 28;2(5260):1140-2.
- Pask EA, Christie PD. Design of life-jackets. Br Med J. 1962 Aug 4;2(5300):333-5
Controversies
A lifelong smoker of 60 a day, it was said during his lectures he struggled to talk for longer than 30 minutes at a time, he even expected his students to smoke.
References
Biography
- Macintosh RR. Professor E.A. Pask. Anaesthesia 1966; 21: 437-8
- Armstrong Davison MH. Professor E. A. Pask, O.B.E., M.D., F.F.A.R.C.S. (1912-1966). Ann R Coll Surg Engl. 1966 Aug; 39(2): 131-2.
- Taylor A. Professor Edgar Alexander Pask. Curr Anaes Crit Care 1998; 9: 156-160
- Enever GR. Edgar Alexander Pask – a hero of resuscitation. In : Baskett P, Baskett T (eds) Resuscitation Greats. Clinical Press Ltd, 2007
- Conacher ID. The big ideas of Edgar Alexander Pask (1912-66). J Med Biogr. 2010 Feb;18(1):44-8.
- Enever G. Edgar Pask and his physiological research–an unsung hero of World War Two. J R Army Med Corps. 2011 Mar;157(1):8-11.
- Wildsmith T. Prof Edgar Alexander Pask. RCOA
- Maltby R. Robert Reynolds Macintosh. Notable Names in Anaesthesia. The Choir Press; 2003: 120-122)
- Bibliography. Pask E.A. WorldCat Identities
Eponymous terms
- Brooks CJ. Chapter 9B A Tribute to Edgar Pask. Designed for life: Lifejackets through the Ages. Mustang Eng. Tech. Apparel Corp, 1995
- Finch P, Nancekiecill D. The Role of Hospital Medical Teams at a Major Accident. Anaesthesia. 1975; 30(5): 666–676.
- Pask Award. Association of Anaesthetists
Resuscitation papers
- Hall M. The ready method in asphyxia. Lancet 1856; 68(1730): 458-459
- Silvester HR. The true physiological method of restoring persons drowned or dead, and of resuscitating still-born children. 1858
- Schäfer EA. The relative efficiency of certain methods of performing artificial respiration in man. Proc Roy Soc Edin 1903; 25: 39-50
- Eve FC. Actuation of the inert diaphragm by a gravity method. Lancet 1932; 220(5697): 995-997
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Doctor currently working in South Wales, training in anaesthetics. Graduated Leeds University with MB ChB with BSc in microbiology in relation to medicine. Special interests in emergency medicine, critical care and anaesthetics
