Geoffrey Kaye--a man of many parts.
Geoffrey Kaye was primarily an anaesthetist, but there were many facets to his life, not all of them involving medicine. He was also a researcher, author, teacher, engineer, inventor, metalworker, organiser, traveller, visionary and collector.
Geoffrey Kaye had a vision for Australian anaesthesia. He put many of his own resources into the establishment of a 'centre of excellence' where the needs of a specialist society could be accompanied by an active educational and research facility. He was so far ahead of his time that his vision foundered on lack of enthusiasm from others. There is no doubt that Geoffrey is best remembered for his lasting legacy, the Geoffrey Kaye Museum of Anaesthetic History, now housed at the Australian and New Zealand College of Anaesthetists in Melbourne. It is his core collection of equipment, documents and memorabilia that now gives us insight into the development of our specialty. His collecting extended beyond his love of medicine. He was renowned for his collection and knowledge of exquisite tableware, porcelain, and furniture, much of which now remains in the Ian Potter Museum collection, also in Melbourne.
Geoffrey Kaye was arguably the most influential anaesthetist in Australia. His primary passion was anaesthesia. However the association with the specialty was a complex one and he embraced many other interests during his lifetime.
He was born in Melbourne on April 9, 1903, the youngest of four children of a Jewish family whose father, Alfred, was involved in the furnishings business. He was born Geoffrey Kornblum, later changing his name to Kaye. He did not follow the Jewish religion and in later life professed to being an atheist.
The family moved to London when Geoffrey was a young child and he recalled that he was "put to sleep" in 1908 with a Clover's inhaler. He enjoyed a privileged upbringing and describes his mother as "exacting", and his aunts, who lived in Porchester Terrace and Park Lane, as "daunting". His father, who had significant business interests in London, is described as being more easy-going and as an unfulfilled historian. He went to preparatory school at Peterborough Lodge in Finchley Road and spent his secondary school years at Gresham's School in Holt, Norfolk.
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He returned to Melbourne in 1920 completing his secondary education in 1921 with Honours in French, English and British History. He commenced medical school in 1921 at the University of Melbourne, graduating in 1926 with MB, BS. During his course he obtained awards in pathology, public health, forensic medicine, medicine and obstetrics.
As a student he wrote poems, medical articles, including stories of Lister and Pasteur, and fictional essays, all published in university or hospital magazines. He prepared sketches for amateur productions in university and one unpublished essay, entered in an essay competition on "Religious beliefs of ancient Egypt". In total he produced some 30 or more literary works.
He was appointed a Resident Medical Officer at the Alfred Hospital in Melbourne. He soon took a keen interest in research, with his first publication in the Medical Journal of Australia in June 1927, a case report of subacute bacterial endocarditis.
It was also at this early stage that he developed an interest in anaesthesia. He describes the interest being kindled by a case where a patient was inappropriately recommended for surgery. Geoffrey was "put on the mat" although he had obtained the permission of the senior medical officer. He was then assigned to be resident anaesthetist and found that he liked it!
In 1928, he also took on positions of Honorary Research Assistant at the Baker Institute of Medical Research in Melbourne and Clinical Assistant to the Alfred Hospital (to keep in touch with general medicine). He began work on research into chemical reactions in urine. This work, published in the Journal of Experimental Biology and Medical Science in 1929, was rewarded with an MD and the University of Melbourne Armytage Prize for "the young beginner" at medical research.
So began a momentous year for Geoffrey Kaye and for Australian anaesthesia.
In 1929, the specialty of anaesthesia was in its infancy in Australia. There were only three 'specialists' in this field in Australia at the time, Rupert Hornabrook and Frederick Green in Melbourne, and Gilbert Brown in Adelaide. As a specialty, anaesthesia enjoyed a low reputation, being considered "suitable only for the physically unfit or the unambitious".
Nevertheless, sufficient interest had been shown in the development of anaesthesia for there to be established in 1929, a Section of Anaesthetics in the Australasian Medical Congress, held in Sydney under the auspices of the British Medical Association. The Guest of Honour was Francis Hoeffer McMechan, at the time the Secretary General of the IARS and a man who, despite being crippled with arthritis, travelled the world preaching scientific anaesthesia and trying to bring anaesthetists of all lands together.
Frederick Green had planned to present a paper to the Congress on anaesthetic mortality, but became ill and was unable to travel to Sydney. He asked Geoffrey Kaye, who had done all the statistical work on the paper, to complete the paper and present it instead. So impressed was McMechan by this 26-year-old Australian and his enthusiasm for anaesthesia research, that he convinced him to visit North America. Geoffrey had already made plans to travel to England and Germany at the end of 1929.
Geoffrey Kaye was no less impressed by McMechan, remembering as "quite electrifying", his description of the American approach to anaesthetics. Anaesthetists trained in basic sciences, keeping anaesthesia record charts and looking after their patients was "such a shock!".
Geoffrey set off to return to London for a short period as an honorary research worker at St Thomas's Hospital. His plans now included an extended tour to the U.S.A. and Canada, as well as Germany.
In London he met Magill, Nosworthy, Shipway, Langton Hewer, Blomfield (Editor of the British Journal of Anaesthesia) and Zebulon Menell at St Thomas's, among others. He noted that British anaesthesia had developed with more and better trained anaesthetists than in Australia.
He then travelled to Hamburg, Berlin, Vienna, Munich and Freiburg, where he was particularly impressed by Schmidt, Killian and Nordmeyer. He noted that anaesthesia at the time was dominated by surgeons with both Schmidt and Killian, whom he described as "tall, fine-looking chaps" being sufficiently impressed by the importance of anaesthesia to have done courses in America.
From Europe he journeyed, as promised, to North America. There he went to Philadelphia, Louisville, Toledo, Madison, Rochester, Buffalo, Toronto, Montreal, Boston, Newhaven and New York. He met all of the significant anaesthetists of the era.
He took a number of courses, one being a full-time course with McKesson in Toledo, Ohio. McKesson, who trained as a physiologist and then became an anaesthetist and manufacturer, was a great advocate of clinical measurement. Geoffrey Kaye was impressed by McKesson's techniques including rebreathing and secondary saturation after intentional hypoxia; however, he later came to recognise the shortcomings of the techniques. The greatest legacy of his time with McKesson, whom he described as a very capable mechanical engineer, was his lifelong interest in engineering and metalwork.
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He took a course in regional anaesthesia with Gaston Labat in New York. He attended Anaesthetists' Society meetings in both Canada and the U.S.A. In particular, he attended the IARS meeting in New York in October, 1930. He spent time with Paul Wood, John Lundy, Wesley Bourne and, significantly, with Ralph Waters in Madison, Wisconsin. It was Waters, more than anyone else, who shaped and encouraged Geoffrey Kaye's development as a teacher and researcher.
Before he returned to Melbourne in early 1931, Geoffrey Kaye had met most, if not all, the significant names in anaesthesia on both sides of the Atlantic. Many of these developed life-long friendships and correspondence with Geoffrey Kaye, reflecting the influence that this young and enthusiastic traveller and researcher had on those with whom he came in contact.
On his return to the Alfred Hospital and the Baker Institute, he was appointed as organising editor of the first textbook on anaesthesia published in Australia and the first monograph published by the Baker Institute. Practical Anaesthesia was published in 1932 and was the collated work of several contributors, all anaesthetists at the Alfred Hospital. The introduction is by Francis H. McMechan.
Stimulated by his time spent with McKesson, Geoffrey soon established an engineering machine shop at his residence. This was to become, over the years, a substantial focus of his life.
He also immediately became involved in the organisation of anaesthesia, becoming Secretary of the Victorian State Section of Anaesthetics. He was instrumental in seeing that a successful section meeting was organised at the 1934 Australasian Medical Congress in Hobart. During the Congress he convened a meeting of six prominent anaesthetists from various States and in January 1934, the Australian Society of Anaesthetists was born, with Gilbert Brown installed as President and Geoffrey Kaye as Secretary.
The first years of the Society were difficult ones. Non-anaesthetists did not appreciate the necessity of a separate society, the British Medical Association did not take kindly to the establishment of a group "in opposition" to the State Sections of Anaesthetics, the members of the Executive were idealistic in their expectations of the Society and the general members were struggling to make a living. Nevertheless, Geoffrey's dogged determination as Secretary was instrumental in ensuring that the Society endure.
These were difficult times and international hostilities were imminent.
Geoffrey was also actively engaged in research and publication and in 1937 began a long association with Melbourne University as a lecturer and instructor in anaesthesia to both the Medical and Dental schools. He published "memorandums" for the Society's members on new drugs or subjects of interest, the forerunners of later newsletters. He conducted a number of surveys of members, with the results collated and published in the memorandums and newsletters.
Over the years 1931 to 1939, at least 16 scientific publications are recorded. One publication, for which he did not claim authorship, is worthy of particular mention. In June 1938, an 'Anaesthetic Number" of the Medical Journal of Australia included the results of a survey of anaesthetic fatalities which had been presented at the Australasian Congress in Adelaide in 1937. The data, collated by Geoffrey Kaye, were from 500,000 anaesthetics at 14 hospitals from around the country. A mortality of 1:1000 was the outcome.
He also set about designing a demand flow anaesthetic machine, similar in principle to the McKesson. The DM (Dental-Midwifery) machine became widely used in its various forms for many years.
In 1938, Geoffrey again travelled overseas to Europe and America, this time because "it seemed inevitable that Europe was going to be shot up before long".
He went via Canada and the U.S.A., soon arriving in Madison to renew his acquaintance with Waters. He clearly felt that he had something of a mission to complete in Australia, since a thinly veiled invitation by Waters to stay in Wisconsin was declined. Had he accepted, the history of anaesthesia in Australia would have been very different indeed.
In Rochester, he met with Lundy who was jealous that he had visited Waters first; however the principal reason for the timing of his visit was to coincide with the meeting of the Anaesthesia Travel Club at the Mayo Clinic. He visited Clement in Toledo, who then drove him the 800 miles to New York for the IARS Congress. Geoffrey presented a paper comparing carbon dioxide absorption and positive pressure techniques of gas anaesthesia.
McMechan also attended the Congress but was too ill to be present at the program. He summoned Geoffrey to his room. The account of the conversation is from Kaye's documentation of his experiences, made in 1976.
"He asked me if I knew why I had been so well received ... on my previous visit to Europe and North America. I said that I had possibly been a personable young man. No, he said, that was not the reason: I was being 'vetted' as his possible successor as Secretary General of the IARS. He indicated the requirements of the post, the incumbent had to be an anaesthetist, internationally known, capable of handling meetings and secretarial work, not at a loss in Congress ante-rooms or in private homes, fluent in English, French and German, '... but now', said McMechan, 'it will not do. The world is sliding into war. When that war ends, the only country possessed of money will be the United States, and they will want an American Secretary General. Therefore, go back to Australia and do the best you can. If you survive the war, do your best to bring the anaesthetists of the world together again'."
He continued to London, where he met up with his previous acquaintances as well as the recently appointed Nuffield Professor in Oxford, Robert Macintosh.
Having returned to Australia, he set about re-equipping the Australian Armed Forces Medical Corps with replacements for the Junker's and Shipway's inhalers which remained from the First World War. He designed a range of equipment, based upon nitrous oxide anaesthesia with carbon dioxide absorption, in order to save on gas. A gas machine without reducing valves (they were in short supply) and newly designed canisters were prepared. The device was robust and portable, as proven by a trip in a tank around the Victorian Alps. New mask valves and a laryngoscope were also developed, as was a simple portable ether vaporiser, for use in field units.
Soon after war was declared in September 1939, Geoffrey Kaye was commissioned into the Australian Army Medical Corps, spending time both in the Middle East and later in New Guinea. He approached matters with his usual enthusiasm and eye for detail. Everywhere he was posted, he set up a workshop for the repair of equipment and trained personnel to do the work. He also enlisted volunteers in setting up a "Hole in the Corner University" where subjects included theory of flight, nature study and Japanese, as well as anaesthesia. Several studies of methods and outcomes were undertaken and in 1942 he prepared a 247 page report for the army on "Impressions of Anaesthesia in a Military Base Hospital". He also conducted and reported on an extensive survey of respiratory complications in injured soldiers.
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In 1943 he returned to Australia, was transferred to the reserve and sent back to Melbourne and to the University. He was engaged on two further projects for the armed forces. One was with a secret section of the army, for whom he was asked to design a miniature oxygen flowmeter with high accuracy at low flows. It was likely that this was to be part of an underwater rebreathing system and was apparently used in attacks on harbour installations. He also developed two training films for the army, with cartoon graphics being drawn by an army colleague.
His wartime exploits also helped with his other interest, the collection of historical apparatus. Many items in the Museum collection that bears his name were collected during his travels.
Geoffrey Kaye had great plans for the establishment of more formal training of specialist anaesthetists. His return to the University in 1943 enabled him to more vigorously pursue his objective. In 1939, he had tried to impress on the then President of the Royal Australasian College of Surgeons, the need for an Australian Diploma in Anaesthetics, similar to the British Diploma. At the time, there was no formal training or qualifying examination. "You simply followed around after senior anaesthetists and copied their tricks as best you could".
What Geoffrey really wanted was a diploma set up conjointly by the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians. Ultimately, such an arrangement was not possible despite much discussion and correspondence. The University of Sydney established a Diploma of Anaesthesia (DA) in 1944, which was followed by a similar arrangement by Melbourne University in 1946. Geoffrey Kaye had desperately wanted the DA to be based in Melbourne and in later years claimed that what he really envisaged was an inaugural College of Anaesthetists. It was not to be, however. What did eventuate was two very different DAs in those two major cities of Australia.
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With the introduction of the DA in Melbourne, Geoffrey resigned as Secretary of the Society to concentrate on his teaching responsibilities at the University, with newly allocated teaching space and areas for a library and museum. At the age of 43, he believed it was time for a "younger man".
1946 also saw the publication of the second Australian textbook on anaesthesia, Anaesthetic Methods, written by Geoffrey Kaye, Robert Orton and Douglas Renton, all from the Alfred Hospital. The book is dedicated to Ralph Waters. This book was much sought after, being a detailed practical guide for both the specialist and non-specialist anaesthetist.
In 1949, Geoffrey headed overseas again, to Scandinavia, Great Britain and North America. This time his major task was to review anaesthesia training in different countries and particularly to seek some parity between the Australian DA, or at least one of them, and the English DA. Of course, the Fellowship of the Faculty of Anaesthetists had been established in 1947 and Geoffrey had already been elected without examination, thus giving him the possible influence to seek some consideration.
His objective view of anaesthesia overseas was that the U.S. led the world in research, but the best clinical anaesthesia was to be seen in Britain. He also claimed that the apparatus used in Australia was the equal of anywhere else. He envisaged the combination of all three elements, in establishing the specialty in Australia.
He wanted a College of Anaesthetists established in Melbourne. He was happy to be part of the negotiations by the Society with the College of Surgeons, on the subject of establishment of an Australasian Faculty, but behind the scenes he was actually seeking out a suitable building to house a 'centre' of anaesthesia.
Renton and Orton, assisted by others on the ASA Executive, proceeded in their negotiations with the College. By mid-1950, Geoffrey had again become Acting Secretary, owing to the illness of the incumbent and was thus again in the centre of negotiations.
In October 1950, the College of Surgeons finally approved the establishment by the Society of an interim Board at the same time as Geoffrey put forward his proposal for the new 'Headquarters' of the Society.
Geoffrey was not to be put off. As the Faculty of Anaesthetists was being established, he proceeded with the establishment of his dream--a centre of excellence for Australian anaesthesia. Geoffrey was a man of vision and incredible optimism!
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He purchased a substantial property and proceeded to renovate it to his own design. He converted the downstairs of the mansion to include a meeting room, library, museum, laboratory and darkroom. He retained the upstairs for his accommodation. The centre was officially opened in March, 1951 by Professor Robert Macintosh.
In 1952, the Faculty of Anaesthetists of the Royal Australasian College of Surgeons was inaugurated on August 25, in the same week as the Australian Society of Anaesthetists Annual General Meeting. The first Dean of the Faculty was his colleague Douglas Renton and Geoffrey was included as one of the Foundation Fellows.
Although Geoffrey continued to arrange scientific meetings and invite overseas speakers, the ASA Headquarters became simply a venue for the monthly meeting of the Victorian Section of the Society, with Geoffrey doing all the work in the library, museum and producing the Society newsletter single-handedly. He wrote some 15 papers for the newsletter for distribution to all members, including subjects such as explosions, oesophageal thermometry and anaesthesia for reptiles. He encouraged young anaesthetists to learn engineering skills and had them help in the sectioning of apparatus for teaching purposes.
The experiment came to an abrupt end in 1955 when he withdrew the lease, lamenting to his colleague Harry Daly, "our own members, who tread cigarette ends into the carpets, burn holes in the linoleum, ignore the washing up and generally leave the place a pigsty when they depart".
He later wrote: "In backing the experiment at '49' (49 Mathoura Road, Toorak), I was gambling in 'anaesthesia futures' for heavy stakes. The premises, and their rebuilding for the Society's purposes, cost me 12,000 [pounds sterling], my entire fluid capital. The scientific equipment which I put into the pool was the collection of years, assembled for such a purpose. The upkeep of house and grounds has absorbed my surplus income for five years, abolishing all freedom of movement. Finally, the Society appeared to hold itself entitled to a blank cheque upon my physical energy".
Why did his dream fail? He was years ahead of his time and did not understand the situation of the ordinary anaesthetist. This was the time when the specialty was at its beginning, in the immediate post-war period, with new specialists trying to make their way in a new environment, with young families to support. Having achieved their qualifications and specialist status, their goals and ideals were to make a living and did not include further scientific development.
Geoffrey, on the other hand was unmarried and had an independent private income set up by his father. He didn't participate in private practice, as he "hated it". He didn't comprehend the real needs of the new breed of specialists of the time.
Having withdrawn the lease, he sold "49" and severed his relationship with anaesthesia. The museum and library were gifted to the Faculty of Anaesthetists at the College of Surgeons in Melbourne.
In 1955 he joined the Department of Electrical Engineering at Melbourne University, under Professor David Dewhurst, where he set about designing and developing electrometrical equipment. He spent the next 10 years designing many monitoring and teaching devices, as well as building a car for Dewhurst's disabled son!
His most ambitious project was the construction of a "Patient Watching Machine". This was to be a device capable of monitoring multiple parameters, and was reputedly the size of a large refrigerator. Eventually in 1965, the university refused to continue funding the project and, having put $16,000 of his own money into it, he was forced to abandon it.
Also during this time he began to concentrate on his other passion, that of collecting objets d'art.
In 1965, just as the university was withdrawing its funding, his own financial status came under threat as some investments failed. He was forced to go and work for a salary and he spent several years working in development with Commonwealth Industrial Gases, the Australian equivalent of British Oxygen. This was at the age of 62.
Ultimately, his financial status improved and he was able to continue his collecting, establishing a substantial collection of artwork, decorative arts, furniture and tableware. He documented all items meticulously and was clearly an expert in several of his areas of collection interest. He published articles on "Old English Glass" (1960), "Chinese Monochromes of the 18th Century" (1962) and gave an opening address at the National Gallery of Victoria on 'Antique English Silver" in 1961.
His collecting gives a different insight into Geoffrey Kaye. It reflects the style of collecting of an English Gentleman of significant means. He appears to have been particularly fond of the Georgian period. He also appreciated the aesthetics and design of the objects, and many of them were in everyday use in his house. Indeed, dinner guests became accustomed to sipping his lethal cocktails from precious antique crystal and eating from fine china with Georgian silver.
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Most of his collection was donated, some before his death, and the majority upon his death. Various individual items were donated to organisations, individuals and the National Gallery of Victoria. The decorative arts, some 160 pieces in all, were donated to the Ian Potter Museum of Melbourne University.
He also maintained his enthusiasm for work in his engineering workshop and embraced pewter and silversmithing, often presenting pewterware gifts to close friends. He became interested in computers and became a proficient programmer.
Throughout his life, he maintained a prodigious correspondence with people all over the world and, although he shunned any relationship with anaesthesia after 1955, he was accorded a number of accolades in recognition of his achievements. He returned to the Society when he presented a short address at the 50-year anniversary meeting of the ASA in Sydney in 1984.
Schooled in the classics and languages, Geoffrey Kaye claimed knowledge of French, German, Latin, Swedish, Japanese, Arabic and High Dutch. He learnt to fly, but was grounded on the basis of his poor eyesight. He epitomised the life of the English gentry of the late 19th century in taste and culture, but embraced the new science of the 20th century. He was a man both before his time and ahead of his time.
Geoffrey Kaye was a complex man. Difficult to know and difficult to get close to, he nevertheless had a profound influence on Australian anaesthesia and Australian anaesthetists. He left many legacies, the most obvious being the museum which bears his name, now housed at the Australian and New Zealand College of Anaesthetists in Melbourne.
In typical self-effacing fashion, he was once asked if he had any hobbies. His reply was "No, I never had time for them"!
Geoffrey Kaye died on October 28, 1986 at the age of 83.
Accepted for publication on February 13, 2007.
R. N. WESTHORPE *
Geoffrey Kaye Museum of Anaesthetic History, Australian and New Zealand College of Anaesthetists, Melbourne, Victoria,
First delivered at the sixth International Symposium of Anaesthesia History, Cambridge, U.K., 2005 and published in the Proceedings of that meeting. Reproduced here with kind permission.
* F.R.C.A., F.A.N.Z.C.A., Deputy Director, Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Victoria.
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|Publication:||Anaesthesia and Intensive Care|
|Date:||Jun 1, 2007|
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