Dr Thomas Boulton is one of the UK’s most eminent anaesthetists: He is a past-president of the AAGBI and has made a huge contribution to the study of the history of anaesthesia as one of the founders of the History of Anaesthesia Society. He originally studied at Cambridge and Barts and in 1950 was drafted for National Service. With just six months training in anaesthesia, Dr Boulton was assigned as the only anaesthetist in North Malaya (“Between Bangkok and Kuala Lumpur”), responsible for over six thousand men. After two years, he returned to Barts as a senior registrar, before studying at the University of Michigan on a Fulbright scholarship.
In this interview, Dr Boulton discusses his work in Vietnam during the 1960s.
My big expedition really was to Vietnam for Children’s Medical Relief International.
Vietnam particularly appealed to me, I think. I won’t say attracted, but appealed to me because the teenage children we’d known as small children in America were beginning to come over to the UK. And it was in the late sixties and they were all on about this Vietnamese war, these American Children, American teenagers during their… hippy times, and I used to get rather sick of them leading off about this. So, I had it sort of in the back of my mind and I thought well, why not, I’ll go and see for myself.
It was not quite as I expected. It was a unit in Saigon, which had been founded by an American plastic surgeon called Baskey. And he was old, elderly- I think he was retired, or practically retired. But he decided on the idea, which was a very good one, that he would raise the money to finance a pavilion within one of the hospitals. And he’d equip it with a small administrative staff and he’s take into it for short periods doctors and nurses in all the relevant specialities, plastic surgeons, anaesthetists, paediatricians and so on. And his initial idea was that he would treat war casualties sort of from the children casualties.
In fact that wasn’t the bulk of our work. The bulk of our work, or a great deal of it, was terrible injuries and adhesions between limbs and so on from people, children, who’d been burnt, I suppose partly as a result of the war. Because one of the awful things that happened was they put aviation gasoline into kerosene stoves and the thing, you know, awful injuries. We had one or two, but very few, direct casualties from napalm because we were tertiary referral hospital. And if they survived in the province hospital which was pretty tough at that time and got into us, then we could undo their scars and their deformities and that sort of thing.
“The bulk of our work was terrible injuries… partly as a result of the war”
And the other great series we had were cleft palates and cleft lips. And they are quite an anaesthetic problem apart from being a surgical problem… For some reason, genetic or otherwise, there were a great number of people that had never been treated. If you walked down the street in Saigon, you’d probably see one or two people with an open lip. So the series that we operated on there were almost unique because instead of being operated on in small children as now, they extended up to about twenty.
“Out in Twenty Minutes…”
The surgeons were very good. The surgeons were mostly Americans, or Australians, and it so happened that he chiefly recruited British anaesthetists. And the situation on the civilian side in Vietnam at that time was that almost every nation on earth in the developed world had a team doing something for the civilians in Vietnam.
“Almost every nation in the developed world had a team doing something for the civilians in Vietnam”
We were able to swap our jobs around so that I got quite a lot of experience… I’d go off for a fortnight and the chap would come in and do my job in my unit, and the other units weren’t particularly bothered provided there was a British type anaesthetist there. And there was a British team… in the big children’s hospital in Saigon. There was a unit, an Australian unit, down at Ben Hien, which were doing general civilian support, including quite a lot of casualties, people with legs blown off in the civilian population and so on.
“It was a boast, they could get them to hospital in 20 minutes, wherever they were wounded”
And there was an Australian anaesthetist with the Australian military… And I went to them for a fortnight and thoroughly enjoyed it and experienced the results of these helicopter evacuations and so on… First of all, unlike Malaya, we got them our in twenty minutes. It was a boast that they could get them into hospital in twenty minutes, wherever they were wounded… So I saw those cases which would have been dead in Malaya. But also it was mostly small arms again, or almost entirely small arms and grenade wounds. But… I was absolutely horrified at first at the devastation of the new weapons, the automatic rifles and so on. Absolutely extraordinary compared with the more or less popguns that were used in Malaya. The damage that could be done was quite extraordinary.
Baskey built up a parallel team of Vietnamese doctors and nurses, so both doctors and nurses had Vietnamese shadows. And the idea was that in the end… the Westerners would slowly withdraw leaving the trained Vietnamese in charge. It also succeeded. By the time the Vietnamese came in from the North, everybody had been withdrawn except the anaesthetist, curiously enough, who was a girl who had been a registrar of mine. And she was one of the last Brits to be lifted out.
Baskey was very keen that we should leave techniques which could be used when we got out. For example, he insisted that his surgeons didn’t use the modern electric dermatomes, they used the Humby knife for taking their grafts and so on.
I was able to offer this draw-over anaesthesia technique… not using ether as Macintosh’s original machines were, but using the more modern anaesthetics such as halothane and, at that time, trilene, but there have been more since. And parallel with that, the Oxford people ha been developing vaporisers for this. And we put together a machine which, instead of using ether, which is inflammable, uses the more modern anaesthetics. And I took that out to Vietnam as a prototype.
“Gee, it’s another philosophy!”
Now, the Baskey unit was well supplied with cylinders and so on and I had American colleagues who used the apparatus. But I set myself to prove this draw-over as being equal of so-called plenum gas-driven techniques during the time and used nothing else. And it proved quite successful. I had for a short time American colleagues who were quite amazed by this small apparatus. They used to say “Gee, it’s another philosophy!” But they accepted that it was a principle they’d like to use.
I wouldn’t describe it as developing, it was merely an extension of things that had been produced at Oxford. But later on I was in the Territorial Army for some years and I was able to persuade the military people that this was a good piece of apparatus. And we produced a thing called the Triservice anaesthetic machine, which was based on the one that I took to Saigon. And this was adopted as the field anaesthetic machine of the Army, incidentally in the end. Brigadier Houghton had a lot to do with developing and improving it, and the chief of anaesthetics in the army also developed [it] and together, the three of us wrote the first paper on this apparatus. And it was proved of considerable use. It was used almost exclusively on land in the 1982 Falklands War.