George Edward Hale Enderby

Short abstract

A pioneer of hypotensive anaesthesia

Hale Enderby is best known for his pioneering work in hypotensive anaesthesia. This is the technique of lowering blood pressure during surgery, making operations safer and more rapid, and enabling more complicated surgery while controlling blood loss from the patient.

In 1948-9 the pharmacologists Paton and Zaimis first described a range of new drugs, the methonium compounds, some of which could lower blood pressure. Hale Enderby saw that this fall in blood pressure could be used to lessen bleeding during surgery—the snag was measuring the low blood pressures. Early methods of measurement relied on using a mercury column, but the Korotkov sounds become inaudible below 60 mm Hg systolic. The pulse also becomes impalpable at that pressure. However, this was the level of blood pressure needed to reduce bleeding significantly. Hale Enderby introduced into anaesthesia the oscillometer, an older and largely forgotten method of blood pressure measurement but one that proved capable of measuring accurately these low pressures. He was also responsible for introducing the “anti-trendelenburg” or head-up tilt of the operating table to assist in the lowering of blood pressure.

George Edward Hale Enderby was born in Boston, Lincolnshire. At the start of the second world war he joined the emergency medical service after being turned down for active military service because of a duodenal ulcer. He worked initially at Guy's Hospital and then at Pembury Hospital, Kent, to which many of the Guy's facilities were moved after the hospital was bombed at the start of the war. It was there that he was asked to move into anaesthesia. He organised most of his training himself by reading and visiting notable anaesthetists of the day.

In 1944 he moved to Rooksdown House, Basingstoke, a plastic and jaw unit, where he helped treat injured and burned servicemen, and in 1946, at the end of the war, he set up in practice, taking consultant posts at the Royal National Orthopaedic Hospital, Stanmore, and the Metropolitan Ear, Nose, and Throat Hospital, London, while continuing at Basingstoke one day a week. In 1947 he was invited to Bergen, Norway, where he spent a month teaching anaesthesia for the reconstructive surgery being undertaken there. In 1951 he moved to an NHS post at the Queen Victoria Hospital, East Grinstead, where he was to work for many years with the plastic surgery giant Sir Archibald McIndoe.

Figure 1.

Hale Enderby published his first paper on hypotensive anaesthesia in 1950, going on to publish more than 25 papers on this subject in the anaesthetic, surgical, and medical journals. At that time, as a result of this work, he became one of the most well known anaesthetists in the world and travelled widely, lecturing on hypotensive anaesthesia. He visited the United States, Australia, South Africa, Canada, and most European countries. In 1975-6 he went to Chicago for three months as visiting professor of anaesthesia.

While others also did research and published papers on the new drugs and techniques, Hale Enderby was the ambassador, travelling, lecturing, and visiting departments of anaesthesia worldwide. He wrote a chapter on hypotensive anaesthesia in the Textbook of Anaesthesia edited by Gray, Nunn, and Utting, and in 1984 edited his own book, Hypotensive Anaesthesia, which was a seminal work.

Like many others at the time, Hale Enderby designed and had made his own anaesthetic equipment—for example, a portable anaesthetic machine necessary for his private practice at the start of his career and then, later on, his own tracheal tubes and other anaesthetic equipment, such as one of the first waste gas scavenge valves in the early 1970s.

In the early 1960s he had an increasing private practice in London and would spend midweek in his Harley Street apartment to be near his work. He eventually retired from anaesthesia in 1986 after undergoing coronary artery bypass surgery.

He was a keen golfer from an early age. He became captain of the Medical Golfing Society in 1965 and president in 1972-3. At that time he organised an annual golf match with its American counterpart, an event that continues to this day. He was a member of the Royal Ashdown Forest Golf Club and continued to play there until he was nearly 80 years old. In 1980 he presented an eponymous golfing trophy, the Enderby Plate, for which the staff at the Queen Victoria Hospital, East Grinstead, compete annually.

He also was very fond of his motor cars and for many years enjoyed owning and driving a Bentley.

In his final years he had some cerebrovascular inefficiency as a result of hypertension and was frustrated by his inability to continue life at the pace that he preferred. He leaves a wife, Dorothy; three children; and seven grandchildren.

There will be a thanksgiving service on Monday 24 May at 2 30 pm in Guy's Hospital Chapel, St Thomas's Street, London SE1, and afterwards at the Burfoot Room, Guy's Hospital.

George Edward Hale Enderby, former consultant anaesthetist Queen Victoria Hospital, East Grinstead (b 1915; q Cambridge/Guy's Hospital, London, 1941; DA, FFARCS), d 30 December 2003.