Lidwill, Mark C

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MD ad eundem gradum 1911 MB ChB Hons (Melb) MD (Melb)

In 1913 Mark Lidwill was the first Lecturer in Anaesthetics in the Faculty of Medicine, and became the first Honorary Director of Anaesthetics at Royal Prince Alfred Hospital in 1930. He designed and patented the ‘Lidwill Anaesthetic machine for insufflation anaesthesia’, and carried out the first successful pacing of the heart using an insulated needle in 1926.

Mark (known to his friends as ‘Bunny’ was born in England in 1878 and migrated to Melbourne with his parents in 1894. He graduated with honours from the University of Melbourne in 1902, and gained his Doctorate in Medicine in 1905. Soon after, he moved to Sydney, first entering general practice and later becoming a specialist physician. He gained his MD from the University of Sydney in 1911.

In 1913 he was appointed to Royal Prince Alfred Hospital as Honorary Assistant Physician and, in the same year, became the first Lecturer in Anaesthetics in the Faculty of Medicine and the first Tutor in Anaesthetics at the Hospital. During this time, he designed the ‘Lidwill Anaesthetic Machine for insufflational endotracheal and endopharyngeal ether anaesthesia’, an apparatus which was extensively used throughout Sydney for the next 30 years. His machine was patented in 1921 (Australian Patent No. 1593/21) and produced and sold by Elliot Brothers, Sydney. Barry Baker, in his history of Anaesthesia at Royal Prince Alfred Hospital, states that the “surgeons of the day were most impressed because this innovation allowed them continuous access to the patient for operations on the face and pharynx, when previously they had an episodic mask/operation/mask/operation sequence”.[1] Mark describes a typical induction sequence for his method:

The patient is anaesthetised as with ether given by the open method, ethyl chloride being sprayed on the mask until he is unable to answer questions put to him. Thereupon the anaesthetic is quickly changed to ether and a thin stream of this drug is poured more or less continuously on the mask, the object being to get the patient under the influence of ether before the effects of the ethyl chloride have worn off. If this is successfully accomplished there will be no coughing, but if coughing arises and becomes troublesome, a few minims of chloroform dropped upon the mask will immediately dissipate the cough, when the administration of ether may be resumed. Continue the administration of ether until the jaws are completely relaxed and pass a Belfast linen catheter into the trachea and connect the catheter with the machine. You proceed then as in intratracheal anaesthesia.[1]

As both a physician and anaesthetist, Mark was interested in cardiac causes of death. He knew that cardiac muscle could be made to contract either by using intracardiac adrenaline or through electrical stimulation. With this in mind, he began designing an “electrical device with the objective of resuscitating patients in whom the conducting system had failed”.[1] He commenced work with Major Booth at the University of Sydney and set about designing a variety of machines, one of which was portable. In 1926 Mark carried out the first successful pacing of the heart (transcutaneous, using an insulated needle and mains electricity) in a neonate. Whilst his early models of the ‘pacemaker’ were difficult and complex to use, the portable machine was user-friendly. Mond, Sloman and Edwards give this description:

This portable machine was plugged into a lighting point… One pole was applied to a skin pad soaked with strong salt solution. The other pole, like Hyman’s apparatus, consisted of a needle insulated except at its point and was plunged into the appropriate cardiac chamber and the machine started. A switch was incorporated to alter the polarity. The pacemaker rate was variable from about 80 to 120 pulses per minute and likewise the voltage also variable from 1.5 to 120 volts.[1]

In her history of anaesthesia in Australia, Gwen Wilson observes Mark’s demonstration of the portable version of his invention at the Australasian Medical Congress Third Session of 1929 and gives Mark’s description:[1]

My attention has been drawn to the failure of the neuro-muscular mechanism when watching a patient die and at the same time taking electrocardiographic tracings. The sino-auricular node first ceased to act. Then Tawarra’s node ceased and the heart kept on beating by means of extra systoles. I also notice that in certain toxaemias, one of the signs of cardiac failure was impairment of the conductivity or functioning of portions of the neuro-muscular mechanism, because, on careful microscopical examination, the muscle itself seems quite able to carry on the circulation. Then one considers the causation of the cessation of ordinary muscle to reaction from nerve impulses and, as you know, it is found that the nerve endings become fatigued and cease to act long before the muscle itself ceases to act. The muscle can still be stimulated by electrical means and will contract long after the nerve endings have ceased to act. I then thought that if I designed some means of stimulating the heart after the sino-auricular node and other portions of the system had cease to act, life might be carried on and it might be possible to revive patients from time to time.

In 1930 Mark was appointed the first Honorary Director of Anaesthetics at Royal Prince Alfred Hospital whilst still an Honorary Physician. He held that position and the Lectureship at the University of Sydney until 1933. He remained Honorary Physician until 1938, when he retired from the active staff of the hospital, aged 60. Barry Baker states, however, that Mark’s influence “should be seen as extending from his first appointment in 1913”.[1] His long term colleague and friend, Ivor Hotten described Mark as a person with an “air of jollity and friendliness which radiated from his portly person topped by a shiny pate and a childlike smiling countenance which endeared him to patients and students alike”.[1]

Aside from these medical achievements, in 1913 Dr Mark Lidwill made the first verified recreational capture of a marlin on rod and reel in Australian waters. His catch was a black marlin weighing 70 pounds (32kg) caught off Port Stephens. He donated the fish to the Australian Museum, where its skeleton is still on public display in the downstairs Skeleton Room.

Citation: Mellor, Lise (2008) Lidwill, Mark C. Faculty of Medicine Online Museum and Archive, University of Sydney.

An alternate version appears in: Mellor, L. 150 Years, 150 Firsts: The People of the Faculty of Medicine (2006) Sydney, Sydney University Press.