September 1998
Volume 62 |
Number 9
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| M. Digby Leigh,
M.D., Pioneer Pediatric Anesthesiologist |
C. Ronald Stephen, M.D., Trustee
Wood Library-Museum of Anesthesiology
If the following remarks appear to be biased, the reason is that
I was exposed, some 55 years ago in the formative years of my
career, to the teaching prowess of M. Digby Leigh, M.D.
Dr. Leigh was born in 1904 in Jersey, Channel Island.
His early life and schooling were in British Columbia. His medical
education was at McGill University, Montreal, Quebec, Canada,
obtaining his M.D. degree in 1932. One year of internship and
one of general surgery were followed by a year of general practice
in Montreal. His anesthetic career, no doubt influenced by Wesley
Bourne, M.D., the doyen of anesthesia in Montreal, was launched
by a residency with Ralph Waters, M.D., from 1935 to 1938. Returning
to Montreal, he was appointed Director of Anesthesia at the Children's
Memorial Hospital.
With the onset of the second World War in 1939, the Royal
Canadian Army Medical Corps (R.C.A.M.C.) recognized a shortage
of anesthesia personnel to serve in the forces. Drs. Bourne, Leigh
and Harold Griffith banded together to train such personnel as
well as other residents in three months of intensive training
courses.
In 1947, Dr. Leigh moved to British Columbia where he
became Director of Anesthesia at the Vancouver General Hospital.
In 1954, he was lured to Los Angeles, California, where he became
Director of Anesthesiology at Children's Hospital and Professor
of Anesthesiology at the University of Southern California, positions
that he held until his retirement in 1970.
Dr. Leigh was certified in anesthesia by the Royal College
of Physicians and Surgeons in Canada and was a diplomate of the
American Board of Anesthesiology. In collaboration with Kay Belton,
M.D., he authored two editions of Pediatric Anesthesia
in 1948 and 1960.
My first contact with Dr. Leigh was from December 1, 1942,
to February 28, 1943, when I was one of four young R.C.A.M.C.
officers assigned to attend an intensive course in anesthesia.
Dr. Leigh, along with Dr. Bourne and Dr. Griffith, gave us sufficient
knowledge to practice anesthesia independently. It was indeed
an arduous task.
Some 55 years later, as I write this tribute, the teaching
abilities of Dr. Leigh stand clearest in my mind:
Here we are in the operating room with a 6- or 7-year-old
child on the table with his chest and abdomen laid bare (the operating
room is warm). Dr. Leigh begins the induction, after premedication
with atropine, with a Vinethane drip on the mask, followed by
the gentle administration of ethyl ether.
"Now follow the chest and abdomen. Bend down so you are
level with the chest. See the chest movements."
As one looks, the muscles of the chest appear to move
upward and evenly with each breath. As the administrator provides
more ether, Dr. Leigh says, "Now look at the chest. I am relaxing
my hold on the jaws." Sure enough, the movements of the chest
become jerky and the abdomen tends to balloon.
"See, the child has developed some upper respiratory obstruction
from the tongue falling back in the throat. Now I will try to
relieve the obstruction by holding the jaw properly again." The
chest movements again become regular and even, and the ballooning
of the abdomen stops.
"Now I am going to deepen the anesthetic and see what
happens." As one watches, the movements of the chest become less
active.
"See, the patient is progressing from the second to the
third plane of anesthesia. The chest movements are becoming less
active. Now watch what happens." The chest movements appear to
almost stop and the abdomen tends to balloon again.
"Now the patient is in the fourth plane of the third stage
of anesthesia and, if one continues to drop ether, the patient
will stop breathing entirely. So we will stop giving ether for
a minute or two. See what happens." Gradually the chest movements
begin to function again.
"Now the patient is in the third plane of the third stage
of anesthesia. The jaw is completely relaxed, and I am going to
insert a curved airway to prevent the tongue from falling back
again to cause upper respiratory obstruction." He deftly inserts
the airway and the chest muscles move freely up and down.
"At this stage, since we want to maintain a free airway
through the operation, we are going to insert an endotracheal
tube into the larynx." He again deftly does so and the incision
is made after the tube is taped securely to the face.
So the operation proceeds.
One soon learns how Dr. Leigh has become the consummate pediatric
anesthesiologist. As he stands at one's side, driven, shrewd,
rambunctious and dynamic, he spots one's errors as they occur
and one soon recognizes his tremendous abilities as a teacher.
The lessons that one learns are never to be forgotten.
Dr. Leigh invented other ways to reduce the hazards of anesthesia
in infants and children. He devised the first nonrebreathing valve
to reduce the dead space in the anesthetic systems used. Others
recognized its value and made modifications, such as B. Raymond
Fink, M.D., C. Ronald Stephen, M.D., and Harry M. Slater, M.D.
With the same concept in mind, Dr. Leigh made an infant circle
filter that became widely used.
Dr. Leigh always had the idea of making weekly conferences not
didactic, but rather lively and full of audience participation.
The concept resulted in the audience preparing itself in advance
of the topic to be presented, which served a dual purpose in the
minds of the participants. Drs. Leigh, Bourne and Griffith began
these conferences while still in Montreal, and the participants,
both English- and French-speaking, responded by attending in large
numbers.
So, Dr. Leigh made his mark in pediatric anesthesia, making
it live and prosper as he imbued his students and colleagues with
the importance of fostering this new subspecialty of anesthesiology.
C. Ronald Stephen, M.D., is Professor
Emeritus, Washington University School of Medicine, St. Louis,
Missouri.
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