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October 13, 2007
2:00 PM - 4:00 PM
Room Hall D, Area N,
Endotracheal Anaesthesia: The Story behind Noel Gillespie's Monograph
Mark E. Schroeder, M.D.
Department of Anesthesiology, University of Wisconsin, Madison, Wisconisn
Vesalius described endotracheal intubation for resuscitation using a reed in 1543. More than three hundred years later, William MacEwen of Glasgow described passing a tube through the mouth into the trachea for anesthesia to remove a malignant pharyngeal tumor in 1880. Somewhat surprisingly, the first monograph on the subject, Noel Gillespie's classic Endotracheal Anaesthesia, was not published until 1941. His notes, original manuscript and diaries provide an interesting historical insight to the origin of the book.

Noel A. Gillespie (1904-1955) was born and educated in England, receiving a DM for Oxford University's first thesis on anesthesia. He learned to intubate the trachea as a house surgeon at the Royal South Hants Hospital, Southampton in 1932 with a particular interest in blind nasal intubation. While training at London Hospital, a patient he anesthetized died when a pulmonary abscess ruptured into the trachea. Gillespie records in his diary a visit to discuss the case with Ivan Magill at Brompton Hospital. This was the beginning of a professional friendship continuing even after Gillespie moved to the University of Wisconsin to join Ralph Waters in May 1939.

Gillespie read about endotracheal anesthesia for his thesis and saw the need to collect the “pertinent facts” into a monograph. In Madison he sought to divert his mind from the onset of World War II. Gillespie records in his diary, “The bombing of London for the first time had now begun, and my nights were made particularly miserable by my over-active imagination…In London I had tried hard to get Magill to write such a book—for he was the obvious person to do so. He had always said he was too busy. At this point I discussed the idea with Waters, who also pleaded that he was too busy. We then wrote to Guedel, who was by now laid up with an attack of coronary thrombosis—and so could not. In turn they urged me to do the job.”

Beginning in September 1940 and working at night while his roommate, Harvey Slocum, slept, Gillespie abstracted everything he could find on the subject, some in Latin and German. By mid-December he was ready to write. He was anxious to produce, “something worthy as a piece of English as well as a technical contribution.” The first pen-and-paper draft was completed on January 15th. Next he typed three copies. One went to Arthur Guedel who returned a chapter at a time, each with a long accompanying letter. Waters annotated his copy. The third copy Gillespie carried to Chicago to review with Bill Cassels. While there, Gillespie met Paul Holinger, a laryngologist, who offered full-color pictures for a front plate. In spring of 1941, Wisconsin colleagues juried suggested revisions at “literature meetings.” The final typescript was sent to the University Publications Committee who questioned the need for the color photos that doubled the printing cost. Only after an agreement with Gillespie to share the financial risk was the book printed.

Gillespie's mentors, Magill, Waters and Guedel wrote the forward to the book correctly predicting the monograph would be a foundation for modern endotracheal anesthesia.

[1] Gillespie NA. Endotracheal Anaesthesia. Madison, University of Wisconsin Press, 1941.

[2] Gillespie NA. Wood Library-Museum Gillespie Collection. Diary VI 1933-1939.

[3] Gillespie NA. Wood Library-Museum Gillespie Collection. Libre VII The New World 1939-1943.

Anesthesiology 2007; 107: A402