Thomas Babington Boulton

Abstract

Anaesthetist specialising in difficult environments. Born in Bishop Auckland, UK, on Nov 6, 1925, he died in Goring-on-Thames, UK, on July 1, 2016, aged 90 years. The many contributions for which anaesthetist Thomas Boulton will be remembered include his support for the introduction of intensive care, his 1984–86 Presidency of the Association of Anaesthetists of Great Britain and Ireland, his editorship of the journal Anaesthesia, and his interest in the history of his specialty. But it's the part he played as a champion of draw-over anaesthesia that fellow professional David Wilkinson picks out as being one of Boulton's most noteworthy achievements. Recently retired from his term as President of the World Federation of Societies of Anaesthesiologists, Wilkinson was still a medical student when he first encountered Boulton in lectures on anaesthetic techniques. As he explains, Boulton's advocacy of the draw-over approach led to the development of some anaesthetic kit used for many years by the British military, including during the Falklands conflict. Boulton's entry into anaesthetics, and indeed to medicine as a whole, was a matter less of firm intention than of barely calculated drift. His schooldays enthusiasm for physics and chemistry gradually gave way to an attraction to medicine, not least because at the age of 17 he'd learned to drive and, during the holidays, began to chauffeur the local general practitioner on his rounds. Although accepted in 1943 by Cambridge University to begin studying engineering, his very first day found him contriving to get a transfer to medicine. Boulton completed his clinical studies at St Bartholomew's Hospital in London, toyed with the idea of becoming a general practitioner but moved tentatively into anaesthetics. He enjoyed it—but even then might not have stayed had it not been for conscription during the period of guerrilla fighting known at the time as the Malayan Emergency. As Boulton recalled in an interview he gave in 1998 to the Oxford Brookes University Medical Sciences Video Archive, the British Army seemed to regard his brief stint in anaesthesia as definitive experience. “I found myself in North Malaya as the only anaesthetist with any sort of postgraduate training between Bangkok and Kuala Lumpur.” He described the equipment available to him as surprisingly good in the context of the times. His other compensation, he recalled, was to find himself living a pleasant colonial lifestyle much as portrayed in the stories of author Somerset Maugham. After 3 years of anaesthesia, a bit of surgery, and even some venereal disease work (the Army was short of specialists) he returned to the UK. By now hooked on anaesthetics he rejoined St Bartholomew's Hospital as a senior registrar. A 1956 Fulbright Scholarship took him to the University of Michigan in the USA where he had an opportunity to witness some early examples of postoperative intensive care. His first consultant post on coming back to the UK was at Reading's Royal Berkshire Hospital. He then returned yet again to London. “He founded the Bart's intensive care unit”, says Wilkinson. “He persuaded the thoracic surgeon at that time to give up four of his beds, which was an extraordinary thing for a surgeon to do in that hierarchical structure.” It was Boulton's time in Malaysia that had first engendered his interest in draw-over anaesthesia. Given that this technique relies on the patient's own breathing to draw air through the vaporiser containing the volatile anaesthetic agent, and therefore requires neither compressed gas nor a power supply, it has a self-evident relevance to resource-poor countries. His interest was reinforced in the late 1960s during the 6 months he spent in Ho Chi Minh City working for Children's Medical Relief International. With him Boulton took a prototype draw-over system developed by a research group at Oxford University with a vaporiser for using the then newer anaesthetics such as halothane. It proved a success. Some years later, having joined the Territorial Army, Boulton was able to persuade the British military authorities of the value of the equipment. This lead to the development of the Triservice anaesthetic apparatus; it was adopted for use in the field and remained so for many years. Wilkinson describes Boulton as a big bear of a man. “A big character, a cheerful man. But he could be quite stern. He wanted things done correctly. He was also a great listener, and when you were a trainee he could make you feel as if what you had to say was important. That's a great gift.” Boulton is survived by his wife Helen, a daughter, and two sons.