Frank Pantridge
Patient Perspective Paper 6
These notes follow a visit to Lisburn in Northern Ireland, where I was surprised to find a statue to Frank Partridge, the inventor
of the external defibrillator - the forerunner of the ICD.
I must emphasise once again that notes such as these are very much my personal interpretation and I apologise
but take no responsibility for any inaccuracy..
Professor Pantridge.
He was born on the outskirts of Hillsborough in 1916 and he went to Friend’s School in Lisburn. He entered Queen’s University, Belfast
in 1934 to read medicine. Up to that time he had thought all doctors to be kind and genial but his experience in catching diphtheria
and not being tested for cardiovascular collapse made him realise that some were incompetent and arrogant – this was confirmed when he
had to appeal against a failure rating in his final exam for not recognising pneumonia, when he had stated that a patient had water on the lung.
To prove his point he had to secretly take a sample to the professor of the faculty. He never lost this view for the rest of his life.
However he graduated in medicine in 1939.
He immediately joined the army as a medical officer and received the military cross for his work in the battle of Singapore. He was captured,
when the city fell to the Japanese and spent much of his captivity experiencing the horrors of working on the Siam-Burma railway. Eventually
he returned to Singapore and was known by the title “The Doctor” by his fellow prisoners. He was rescued by a fellow student of his university
days, who reported that that there was little flesh on him but his blue eyes blazed with defiance and his spirit was unbroken.
On his return to Belfast at the end of the war, he completed his house physician job at the Royal Victoria Hospital (RVH) at a wage of £1 per
week but the only appointment he could get was an appointment as a supernumerary lecturer at Queen’s in pathology. His experiences in the
Far East gave him a deep contempt for those in authority or in charge of affairs who made decisions which might affect him personally.
His unconventional approach, where he even brought pigs into the pathology laboratory did not endear him to those in charge.
He decided to research into the mechanism of sudden death from cardiac beriberi. He came to the conclusion that his research was of little
value but it did give him the opportunity to win a scholarship to the University of Michigan, where he worked with FN Wilson, the world
authority on electrocardiology of the time.
He returned to Belfast in 1950 to be appointed Physician at the Royal Victoria Hospital, where he remained until he retired in 1982.
During that time he established an internationally renowned cardiology unit. He received the CBE in 1978 and was honoured by being
made a Freeman of the City of Lisburn. In his spare time he loved salmon fishing. He died in 2004.
His interest in cardiology.
His medical start in pathology did not inspire him but somehow he got through the final examination for membership of the College of Physicians
in 1947. Soon afterwards he secured a scholarship in the USA in 1948 to work with Frank Wilson. He moved on to be with Abildeskov,
a remarkable electro physiologist, who was to become a life-long friend. Together they wrote an important paper on spatial vectorcardiography.
By 1951 electrocardiograms were widely used but often misinterpreted. Pantridge observed that an “abnormal” reading could be produced by
the drinking of two glasses of ice-cold water. This led to neurotic but well people being incapacitated by a Harley Street “fat cat”.
Throughout his life he campaigned, sometimes unsuccessfully, for careful analysis of all ECGs. He moved into clinical medicine and
he was the first to use a noradrenalin drip in a surgical operation to control the blood pressure in its post-operative fall.
His work between 1951 and 1976 was concentrated in mitral valvotomy to correct the stenosis. The next big leap forward in cardiology
was the introduction of open heart surgery when it was discovered that a heart-lung machine could take over the action of heart and lungs
for a period of four hours or more.
In the 70s he had battles with junior doctors. They first of all threatened to work emergencies only. Pantridge got them round a table
and convinced them that hospital patients were by definition an “emergency”; otherwise they wouldn’t be there in the first place! Outpatients
were also an emergency, because, until they were examined, it would not be known whether they were seriously ill or not. Hence the doctors
had to admit to working “normally” and there was no strike! He also had to deal with a kitchen strike in 1980 by going to tell the cooks
that diabetic patients who had received insulin would go into a coma, if they did not get their food. He said that he would ring the Director
of Public Prosecutions, if they did not get their food. The strike ended and the food went out in 15 minutes!
Electrocardiography.
By the time he returned to Belfast, coronary heart disease had reached enormous proportions striking more at younger people.
In the 50s it had been established that sudden death was often caused by ventricular fibrillation, a disorganisation of the heart rhythm.
It had already been discovered that the disturbance could be stopped by an electric shock to the heart. By the end of the 50s,
coronary care units were established in major hospitals.
Frank Pantridge believed that since some two thirds of premature deaths from the coronary attack occurred within one hour and usually
outside the hospital, a unit in a hospital was of little value. He conceived the brilliant idea of taking the treatment to the patient:
he found an old ambulance and installed in it a standard hospital defibrillator run off the battery using a static inverter. The ambulance
carried coronary drugs and the personnel were especially trained.
By 1966 this mobile unit in Belfast had done one complete year and a report on its success was presented to the 1967 annual meeting of the
prestigious Association of Physicians. To his surprise and disappointment, it did not receive the standing ovation his work deserved but
instead he was heavily criticised. At that time it was thought that sudden death was caused by a simple stoppage of heart unrelated to
electrical chaos. Fellow physicians refused to believe the evidence from Pantridge’s pioneering unit. It was some 20 years later in 1986
before the Department of Health at last acknowledged and adopted the concept of pre-hospital coronary care. Even then in 1990, more than
24 years after Pantridge installed a defibrillator in an ambulance, his contribution was not even mentioned when it was announced that
£3.8 million would be made available by the UK government to equip over 2350 ambulances in the UK with defibrillators.
The original ambulance defibrillator was adapted from a normal hospital one. The apparatus weighed some 70 kgms so could hardly be
described as portable! In spite of the evidence that early shock treatment would limit the amount of heart damage, these results were
only reluctantly received in the UK. However they were enthusiastically received in the USA: so much so that President Johnson had his
personal aeroplane, Airforce One, fitted with a defibrillator. A second article in the Lancet led to the eventual development of the
defibrillator as we know it today, as a box some 9 inches square and then, of course, to the ICD that is in our chests.
What a man! Do read his autobiography – An Unquiet Life. It is readable and fascinating.
GCS/24.07.08
Geoff Shaw