Lives of the fellows

Gordon Jackson Rees

b.8 December 1918 d.19 January 2001
MB ChB Liverpl(1942) DA(1946) FFARCS(1951) Hon FFARACS(1964) Hon FFARCSI(1980) Hon MD Uruguay(1983) FRCP(1994) Hon FRCPCH(1994)

Gordon Jackson Rees, a world renowned anaesthetist, was born in Oswestry, Shropshire, the younger of two sons of Thomas Archibald Rees, a marine engineer who joined the RNR with the rank of lieutenant commander. His mother, Mary Ethel née Jackson, also came from the Oswestry district.

Like his father he went to Oswestry School and then Jack - as he was widely known - entered Liverpool University to read medicine. After qualification in 1942 he was appointed RMO at Liverpool's Sefton General Hospital.

Rees joined the RAF in the Second World War and served in north Africa where probably he became interested in anaesthesia. After the war he returned home, took the DA in 1946, was demobilized and appointed anaesthetic registrar to the Liverpool Royal Southern Teaching Hospital in 1947. Supported by the head of the University's new department of anaesthesia he was appointed to the University post of demonstrator in anaesthesia in 1949.

At that time anaesthesia for children was not as developed as it was for adults. Alder Hey Children's Hospital's senior surgeon, Isabella Forshall, FRCS, was frustrated by the lack of development in anaesthesia necessary for operations on babies with major congenital defects. She asked the reader in anaesthesia to find an anaesthetist ready to devote his time fully to the development of paediatric infant anaesthesia. Rees was recommended by the reader and head of the department and approached. After a little hesitation and encouragement, he accepted the challenge and immediately was appointed consultant anaesthetist to Alder Hey Children's Hospital in 1949.

A methodical researcher, Rees immediately started by studying in detail the anatomy and physiology of the newborn baby. In his first publication, he wrote 'The newborn infant differs so greatly from the adult in his anatomy and physiology that the approach to anaesthesia in the two groups must be quite different. In the past there has been a tendency to adapt to infants those methods of anaesthesia which have proved to be of value in adults. The time has come to consider the problem of anaesthetizing the newborn in relation to their peculiar physiology' (BMJ,1950:2:1419).

He went on to compare the efficiency of an area of the newborn baby's lung with that of the same area of an adult lung and noted the inefficiency of the bronchioles and the effect of hyperventilation used frequently in adult anaesthesia. His observations in this paper are fundamental for anaesthesia.

Rees had noted the differences between the rib cages of the adult and in the newborn which affected the efficiency of the baby's respiration. His research into rates of flow through the trachea and bronchioles and the effect of hyperventilation, used frequently in adult anaesthesia, is a model of its kind. He decided to use the same principles and drugs which had proved so successful in adult anaesthesia, namely, light narcosis with nitrous oxide and oxygen and a muscle relaxant to ensure good surgical conditions and a rapid recovery (the Liverpool technique).

Rees devised 'the Jackson Rees T-piece', a simple piece of equipment for manually ventilating the lungs of babies and small children. It consists simply of a T-piece fitted to the endotracheal tube with one limb of the T-piece connected to a tube delivering a fresh gas flow and the other limb connected to a light tube with a small reservoir bag at its end which fits comfortably in the hand of the anaesthetist so that he or she can gently ventilate the lungs. The bag has a small diameter outlet easily controlled by the anaesthetist should the tension in the bag rise too high. This Rees T-piece may also be used for prolonged assisted pulmonary ventilation when necessary as, for example, in an ICU. The results obtained using this technique were outstanding and the unit and its director with his assistants became universally acclaimed and made it possible to repair congenital deformities such as tracheo-oesophageal fistulae, cardiac and other neonatal anomalies.

A small but important advance was Rees' skillful technique for venous puncture into the tiny anterior veins in the wrists of babies and small children: his unit effectively became a school of paediatric anaesthesia and Liverpool University awarded him the title of director of paediatric anaesthesia in 1955.

Rees was completely dedicated to his small patients: they always came first and no other duty was allowed to come between them and him. For a long time he was loathe to accept professional responsibilities no matter how prestigious, as they would interfere with his clinical work. Later, when he had Rees-trained assistants who, like him, were totally competent and reliable, he was able to travel and accept demanding commitments at home and overseas.

Friendships with Rees were for life and he kept in touch with fellow students in his qualifying year and his postgraduate trainees. After qualification, he married one of them, Elizabeth (Betty) Schofield, who became a distinguished consultant in genito-urinary medicine. They soon had a family, three sons and a daughter. The eldest son was appointed Aberdeen University's Regius professor of medicine in 1994. Indeed, the Rees genes were outstanding: his nephew, Martin, a Cambridge professor of astronomy, was in 1995 chosen to be the Astronomer Royal.

Jackson Rees retired in 1982, enjoyed an active social life and, until his final illness, attended professional meetings and functions at home and abroad on a regular basis. In 1983 the Erasmus University of Rotterdam invited him for a year as guest professor of paediatric anaesthesia to stimulate teaching and research at Rotterdam's Sophia Children's Hospital: he accepted and was honoured by the inception of biennial Jackson Rees lectures.

By nature Rees was a very sociable and clubable man with a fine sense of humour. He loved a party. He was an inveterate cigarette smoker which led to his untimely death. He faced his last illness with enormous courage: up to a very short time before his death he received and welcomed guests and until late in his illness he successfully hid any sign of it.

T C Gray

(Volume XI, page 472)

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