'Wars Have An Overflow on Everything': Interview with Ian R. Mackay and Patricia Mackay

Abstract

104 Health & History, 2013. 15/1 ‘Wars Have An Overflow on Everything’: Interview with Ian R. Mackay and Patricia Mackay Warwick Anderson and Cecily Hunter On the morning of November 3 2012, at Albert Park, Melbourne, Warwick Anderson (WA) and Cecily Hunter (CH) asked Ian R. Mackay (IRM, b. 1922) and Patricia Mackay (PM, b. 1926) to reflect on the impact of World War II on Australian medicine, surgery, and anaesthetics. Their house is not far from the beach, where Ian swims every morning. Ian continues as an active researcher in immunology, especially autoimmune diseases, at Monash University, after retirement from his post of director of the Clinical Research Unit at the Walter and Eliza Hall Institute. Pat was an acting director or director of anaesthetics at the Royal Melbourne Hospital over many years, through to her retirement in 1991. We hoped to get from them a sense of what it was like to make a medical career in postwar Melbourne. WA: We thought it might be best to start with you Pat, because of your emphasis on clinical work. We wonder if you could tell us how the war might have affected your specialty, anaesthetics? PM: Well, I don’t think there’s any doubt the war changed anaesthetic practice. Before the war, here, in Britain, and in the U.S.A., anaesthetists were pretty lowly members of the profession. But when war came they contributed a great deal to the resuscitation of the wounded, and proved to be invaluable in all the camps, and also on home territory. The remarkable work Sir Harry Gillies did for the injured, for example, was absolutely dependent on the anaesthetist keeping his patients alive.1 I think it changed the attitude of surgeons especially. When they went away to the war, surgeons were accustomed to general practitioner anaesthetists; when they came back they wanted to have specialist anaesthetists, they recognised that specialists could give them much more. CH: Why did the surgeons need the specialist anaesthetist? Interview with Ian R. Mackay and Patricia Mackay 105 PM: Basically, specialist anaesthetists allowed them to do more complex surgery and suddenly, we were seeing major new developments. Certainly in Melbourne, for instance, by 1948 it was recognised that the leading surgeons couldn’t move into thoracic and neurosurgery unless they had specialist anaesthetists. That realisation prompted the establishment of the anaesthetics department at the Melbourne Hospital, and I think everywhere else around Australia. So the war changed the image of the anaesthetist from a general practitioner to a specialist. The change was even more pronounced in the United States because there it went from nurse anaesthetist to specialist anaesthetist. The turning point was around 1948, when the country was settling down after the war. WA: Did that mark the beginning of departments of anaesthesia? PM:Well, there were always anaesthetists, often grouped together, but nobody full-time. Among the earliest departments were those at the Alfred Hospital and at the Melbourne Hospital, in 1948. The very first department was, I think, at Newcastle: they beat us [Melbourne] by aboutsixmonths.Atthesametime,itwasrecognisedthatanaesthetists had to be university-trained. The first Australian university to take this up was Sydney, I think. The Diploma of Anaesthesia was offered there in 1947; and at the University of Melbourne in 1948. The people who had come back from the war needed to be properly trained as specialists. Image 1: Ian and Pat Mackay in the 1950s, courtesy of I.R. Mackay. 106 WARWICK ANDERSON & CECILY HUNTER WA: The training was promoted by the surgeons? PM: Yes, most of the surgeons at that time would have served in the war. They’d served in the war and had high expectations. WA: It wasn’t led by anaesthetists themselves? PM: To some extent, but anaesthetists had a very low status at that stage—the war interrupted their development in some ways. The Australian Society of Anaesthetists was formed in 1934 in Hobart. That was done by some very visionary anaesthetists—one in Melbourne and one from South Australia—and then the war came just as they were starting to raise their status. There was a hiatus when nothing happened. CH: What was the...