Frank Pantridge

Short abstract

Cardiologist who created pre-hospital coronary care through the invention of the portable defibrillator

Frank Pantridge invented the portable defibrillator. The first model operated from car batteries and weighed 70 kg. Descendants of that clumsy contraption—created in 1965 when Frank was a consultant physician at the Royal Victoria Infirmary in Belfast and produced with technician Alfred Mawhinney and senior house officer John Geddes—are now used a countless number of times daily throughout the world saving an incalculable number of lives annually. Frank installed the “portable” defibrillator in an ambulance, thus creating pre-hospital coronary care.

Frank's concepts were rapidly adopted in the United States and elsewhere. An exception was the United Kingdom, although an editorial in the Lancet in 1967 stated that Pantridge and Geddes had revolutionised emergency medicine.

The portable defibrillator was a response to the epidemic proportions that coronary heart disease had reached by the 1950s. In the early 1960s hospital care units appeared in North America. Frank Pantridge doubted their value since epidemiological data had shown that the majority of coronary deaths occurred suddenly outside hospital. It was known that most coronary deaths resulted from ventricular defibrillation. Frank postulated that if the problem lay outside hospital, ventricular defibrillation should be corrected where it occurred. However, correction required a defibrillator and the machines available operated only in hospital from the mains electricity supply.

James Francis Pantridge was born on the outskirts of the historic village of Hillsborough, northern Ireland, in 1916. He qualified at Queen's University, Belfast, in 1939, and on the declaration of the second world war he immediately reported to the recruiting office, there being no conscription in Northern Ireland. Posted to the Far East he became medical officer of an infantry battalion. During the battle that preceded the fall of Singapore, he was given an immediate award of the Military Cross. The citation read, “This officer worked unceasingly under the most adverse conditions of continuous bombing and shelling and was an inspiring example to all with whom he came in contact. He was absolutely cool under the heaviest fire and completely regardless of his own personal safety at all times.”

Figure 1.

Captured at the fall of Singapore, he spent much of his captivity in the slave labour camps on the Siam-Burma Railway, including some months in the notorious “death” camp Tanbaya, on the Siam-Burma border. He survived the usually fatal cardiac beriberi, an experience that may have initiated a special interest in heart disease. The fall of Singapore, the impregnable fortress, left its mark. He was to say that never again would he have any confidence in those in control of affairs.

Back in Belfast at the end of 1945, the only appointment he could obtain was that of part time supernumerary lecturer in the Queen's University's department of pathology. However, he obtained a scholarship to the United States, where, at the University of Michigan, he worked with F N Wilson, then the world authority on electrocardiography.

He returned to Belfast in 1950 and was appointed physician at the Royal Victoria Hospital. He quickly established an internationally acclaimed cardiology unit, recognised not only in the erudite medical journals but also in the North American lay press.

While Frank supported cardiopulmonary resuscitation (CPR) he was well aware of its limitations. He knew that the longer ventricular fibrillation was present the less likely long term survival would result from its removal. The aim, he preached, should be immediate correction of ventricular fibrillation. He maintained that any lay individual who could do CPR was capable of using a defibrillator. A defibrillator should be beside every fire extinguisher since, Frank said, life was more important than property. Harnessing a miniature capacitor manufactured for NASA he designed a defibrillator weighing only 3 kg.

It was argued that a defibrillator in the hands of a lay individual might be used when unnecessary. The citizen who had fainted or was drunk might be given a potentially dangerous shock. Thus, Frank suggested that the miniature defibrillator should incorporate a fail-safe mechanism like a gun's safety catch. This would ensure that the instrument would not deliver a shock unless ventricular fibrillation was present.

The defibrillator for implantation in the chest developed by Michel Mirowski in Baltimore had just such characteristics. Frank thought that a similar circuit should operate from the chest surface. He discussed this with Mirowski, who was adamant that it was impossible. Frank persisted and eventually the automatic external defibrillator emerged.

Frank had a veneer of arrogance at times but this often concealed an innate shyness. On a good day he looked as though he owned the world, on a bad day he looked as though he didn't care who owned it. He appreciated being stood up to, but this, in truth, was often hard to do. He was a man with staccato delivery and a quickness of wit, which often bore the Irish element of visual humour; the clicked fingers acted as punctuation and the stiff index finger directed the verbal missile.

He never married.

James Francis Pantridge, cardiologist Belfast (b 1916; q Queen's University, Belfast, 1939; CBE, MD, FRCP, FACC), d 26 December 2004.