In 1981, Dr Archie Brain completed his first prototype of the Laryngeal Mask at his home in London. Safer, more reliable and easier to use than any other equipment available at that time, this device is designed to keep the airway clear and to seal the larynx, thus protecting the lungs. Though it was originally turned down by several companies, since its development in the 1980s, the laryngeal airway has been used over 350 million times worldwide.
In this interview, Dr Brain discusses how he became interested in anaesthesia, companies’ rejection of his invention and its ultimate success.
I was born in Kobe in Japan, my parents were diplomats, in 1942. I was there for about six weeks and then my existence in fact enabled my parents to be released because the Japanese didn’t want any more mouths to feed and we were able to escape if that’s the right word on a Red Cross ship, a fairly risky voyage I suppose at that time and there was an exchange of prisoners of war in Madagascar and it was there that I became a British subject. And then we also went back on a different ship and arrived in Liverpool the same year, 1942.
I went back to Kobe to lecture. I can’t remember the year, it would have been more than 10 years ago and I certainly was not the most senior anaesthetist present but the Japanese had cottoned onto the fact that I was born there so I was quite surprised to find myself hauled up to give a totally peremptory speech.
I was always interested in inventing things but there was no potential scene in that tendency as mine as I was also good at languages as had been my father and I was good at French because I already spoke a bit and so eventually I was streamed into the direction of taking a Degree in languages and I got a scholarship to Oxford.
“I’d been completely useless at science at school”
I’d been completely useless at science at school, nobody in my family was scientific. My father was an out and out musician, he played piano and I’ve inherited that from both sides, I love art, I love music.
I was at Oxford and I was doing the modern languages and asked if I could change and start doing medicine and they said, ‘There’s absolutely no question of it, you’ve got no science qualifications at all but if you get a Degree in modern languages which is what you’re supposed to be doing, we’ll give you a chance to start at Oxford.’
I had already been offered a place at Bart’s with the proviso that I had to have a Degree first to show that I was serious. So that’s basically what happened. I took the first year to get the basic scientific background which I needed and then I started clinical work at Bart’s. This would have been ’66 I think or ’67.
Beginnings in Anaesthesia
It was purely accidental that I got into anaesthesia. A job came up in Hastings and I went to the interview only to find that someone had just been given the job. They said, ‘Well sorry about that but there is actually an anaesthetist job going, why don’t you try your hand at that?’
In those days and certainly at Bart’s anaesthesia was very much the last thing anyone would consider but I met the anaesthetists and I thought they were a marvellous bunch of people, quite different to the consultants I’d met in other specialities up until then. So I said, ‘Well I might as well have a go, why not?’ It was only six months and it was good to have a bit of anaesthetics anyway and so I started. And basically as soon as I started doing anaesthetics I remember I anaesthetised a caesarean section six weeks after I’d started which of course these days would never happen and I just loved it.
“I might as well have a go, why not?”
I actually did a total of six years outside of the UK (Holland & the Seychelles) with really very little in the UK apart from the year in Hastings and several locums. I finally went back in 1980 to the UK having left in 1973.
I went up to London again in 1980 still and I applied to see Professor Payne, he was actually busy and I saw his deputy who was a senior lecturer again, and this senior lecturer liked the various ideas which I was proposing, I had various ideas of things I wanted to do in research and so they said, ‘OK you can have a job, we’ll give you a lecturer job,’ just like that, so I became a lecturer in anaesthetics at the London Hospital in the later part of 1980.
Professor Payne gave me as my first job to go and clear out Ashford Street which was full of laboratory equipment which had been discarded by various other previous lecturers who’d done some research and in the course of doing this I realised most of it was unused laboratory equipment which had come from America. Massively expensive amount of equipment and he said, ‘You can help yourself to anything you want there because it’s all going to be dumped.’ So I found an empty room at the London and started putting all sorts of bits and pieces in there which became the basis for making my own prototypes for various different inventions which I was keen to try to make at that time. So I’d suddenly realised I’d actually found what I needed to develop my inventing interests and by this time I had the skills in anaesthesia to know what the problems were.
I think then it became very much a question of what was really missing in anaesthesia and what was the bit that was really most unsure and I thought, ‘Well all this holding of facemasks does seem to me to be a bit awkward really.’ My training was to use the facemask most of the time and you were intubating perhaps less than 40% of people that they would intubate in America at the same time.
The Laryngeal Airway
It occurred to me that the anatomy surrounding the larynx was of similar proportions to the shape and size of [Goldman dental] mask and that lead me to make the first prototypes of the laryngeal mask. And I actually had them in my car for six weeks before I dared to use one and then I thought, ‘Well I wonder what this feels like?’ and I tried putting it in my throat and I was rather excited because it seemed to go in, I coughed and spluttered a bit but I could breathe through it, it was a very exciting moment.
So I went down to the photographic department and said, ‘Can we photograph this because this is quite interesting, I can breathe through this device?’ So was it a party trick or was it something useful?
Actually I didn’t dare to try it in a patient until I went down to my previous hospital in Folkestone to do a locum for one of the anaesthetists I knew well from my time doing my house jobs down there. And I was doing a list and there were some very simple cases and I thought, ‘Well why don’t I try it?’ No Ethics Committee approval, nothing like this! We might need to edit this out! And so I tried slipping this thing in and having proved it myself, I thought, ‘Why not? It seems to be OK.’ And it was really a very, very exciting moment because they just breathed happily through this. And then I tried squeezing it a bit and then I found I could actually also ventilate.
I think it might have been into 1981 by this time, yes, because then I very quickly started about how I could protect this idea and also who might be able to make it. And as I knew that Portex was down in Hythe only 10 minutes away from Folkestone. I showed the other consultant anaesthetists who were there and they all thought this was rather fun, you know. Nobody was saying, ‘Eureka!’ or anything, it was just quite fun. And Portex were unimpressed. The first question was, ‘Can it be made disposable?’ and I said, ‘Well I haven’t really thought about that but aren’t you interested?’ And they said, ‘Not really.’
So I was a bit disappointed, I went back to London and got on with my inventing various other things. After I’d been at the London a year, I had six patent applications which were in process but I didn’t have the money to keep them going, it’s an extremely expensive business, so I allowed all of them to lapse except for the laryngeal mask.
“There was very little commercial interest”
I remember Jimmy Payne said, ‘Well you’ll need 20 patients,’ actually turned into 7,000 patients and the fact that I could do things with my hands to make my own prototypes meant that I was literally at one time working deep late into the night making the next batch of prototypes and then during the day trying them out in an extremely large number of patients and virtually all the patients I was anaesthetising.
There was very little commercial interest and Portex really was losing interest, they really wanted a disposable device. So in I think 1983 I met a rather crazy individual who was, however, an extremely successful businessman, his name was Mr Gaines-Cooper and he subsequently became extremely important in my life because he was the first chap who said, ‘I will take this on. I don’t know what you’re talking about but it sounds interesting.’ He said, ‘I will fund this.’
There was a lot of clinical obstruction from people higher up in the anaesthetic hierarchy if you like who felt that this was dangerous but everyone who used it rapidly converted to it and once it was actually made available and people could try it which happened in 1988 in the UK only, then it spread like wild fire in the United Kingdom and six months after it was first launched in the United Kingdom, I’m told that it was in about 50% of NHS hospitals and an unknown number of private hospitals. So as soon as you had a device which was available on the market, it was distributed in England by a company called Colegate, they couldn’t make enough.
“Six months after it was first launched it was in about 50% of NHS hospitals”
The company which of course now is a public quoted company, it’s on the Singapore Stock Exchange and there are 83 distributors around the world, so the whole thing is up and running. I’ve never been part of the company, I’ve always insisted on being outside it and maintaining clinical independence even though I don’t have a clinical position. And really I can say since 1990 it has been more and more lecturing and teaching. First of all of course it was in the UK and then all around the world.
I should say that another very important help to me has been the Institute of Laryngology in London and that’s from quite early on because when I initially had the idea of making the laryngeal mask I thought to myself, ‘I really need to get to grips with the anatomy,’ because it’s one thing to put it in your own throat but you actually need to see what’s happening. I can still remember going on the tube to the Institute of Laryngology and getting to know people there and went to their anatomy department and getting specimens of the larynx and taking them home with me on the tube. And the smell of formalin was spreading around me and it was slightly embarrassing. And then of course having to make prototypes, I also had to teach myself how to make rubber masks. That was the reason I went to the Institute of Laryngology, to get specimens of the larynx so that I could then put plaster of Paris against them and see what the resulting space was… and clearly that produced a highly corrugated and traumatic shape which you couldn’t possibly put in the throat, so then I if you like, idealised that shape by smoothing out all the corrugations which were of course large post mortem in the specimens and produced a smoothed out shape which is what actually became the classic laryngeal mask.
“People come up to me and say, ‘Last week I managed to save a patient using a laryngeal mask’. That’s really what it’s all about”
I have for a long time had a lot of inventions which are completely outside this field and clearly really to get something off the ground, you’ve got to spend a certain amount of time within that field to which the invention applies… So I’m not sure whether these inventions are ever going to get done.
Well I think when dear Peter Basket decided to put me up for the Gold Medal, that was a tremendous accolade and I was enormously proud and happy to receive that and in fact the Irish College struck a Gold Medal for me and I believe I’m going to get a Macewan Medal from the Difficult Airways Society which again will be a great honour, that’s another nice medal I think. So I’ve had quite a few other medals and various honorary positions but it’s very nice to get these accolades but it’s not really for me what it’s all about. The greatest satisfaction for me is when I’m in different countries and people come up to me and say, ‘Last week I managed to save a patient using a laryngeal mask,’ I mean that’s really what it’s all about. That’s what I did it for and that’s tremendously satisfying.
“I’ve had a wonderful time, I’ve been very lucky”