We use a variety of instruments in surgery - most of them eponymous and most of the time we have little idea who invented them or who created them. Tonsillectomy is one of the most common operations we perform as ENTs and the first step in the procedure is to open the mouth and push the tongue down so that we can get to the tonsils. The instrument we use is the Doughty gag, or more precisely the Boyle-Davies gag with the doughty modification. Below is the obituary of Andrew Doughty from this week's BMJ - he seems like a truly remarkable man and I will certainly think of his contribution to ENT next time I ask for a mouth gag at the start of surgery.
Inventor of the Doughty gag and early champion of epidurals in labour
Andrew Doughty is probably best known for the Doughty gag, a piece of kit that he fashioned to enable better access to the throat when performing tonsillectomies.1Doughty split the tongue plate (similar to a tongue depressor) of a Boyle-Davis gag so the patient’s tongue could be held out of the way and an endotracheal tube inserted. The modification meant that the airway was secure, with no blood entering the lungs, and this enabled safer administration of anaesthetic.
“Before the Doughty gag you had to anaesthetise the patient by wafting anaesthetic into the mouth. The patient got some of it and the surgeon and the rest of the theatre staff got a good deal of it. Now, the anaesthetist had complete control and the surgeon didn’t have to breathe in the gas,” says Anna-Maria Rollins, a consultant anaesthetist who interviewed Doughty when he was made an honorary member of the Association of Anaesthetists of Great Britain and Ireland in 1993.
With less risk of blood getting into the lungs the surgeon had more time to operate, and the operation could be performed more safely. The gag is still in use today, although tonsillectomies are performed less often.
“It was a great bit of engineering,” says Rollins. “Many bits of old fashioned medical kit are the result of an anaesthetist sitting and thinking ‘there must be a better way of doing this.’ This was one of the really good bits of thinking,” she says.
Doughty’s professional passion, however, was the use of epidurals in labour. In their early days epidurals were only used in large teaching hospitals. According to his daughter, Catherine, Doughty did not understand why his patients should have to endure the pain of labour when relief was available.
Doughty pioneered the widespread use of epidurals in the UK, becoming one of the founder members of the Obstetric Anaesthetists Association and serving as its president from 1979 to 1981. He trained hundreds of other anaesthetists from around the world in their use. From 1973 he ran intensive two week courses—which were booked up for years in advance—where the trainee would live in Kingston Hospital, escaping only once to have Sunday lunch with the Doughty family. The idea was that the anaesthetist would learn his or her craft from Doughty and then spread their newly acquired knowledge.
Obstetricians were suspicious of epidurals as they thought they slowed down labour and increased the use of forceps deliveries. Doughty’s response in the British Journal of Anaesthesia was that, in his experience of more than 800 deliveries, they did not increase the number of forceps deliveries if a number of conditions were in place. These included that epidurals should be used in both normal as well as abnormal labours, an oxytocin infusion should be administered to strengthen contractions if necessary, and the mother should be given time to deliver “without unduly hasty intervention.” 2
Doughty, the son of a mechanic, was born in Lincolnshire in 1916 during a zeppelin air raid. The family spent a short time in South Africa before returning to the UK and settling in Bexhill-on-Sea in East Sussex. He completed his medical training in 1941 at St Thomas’ Hospital in London. After training in obstetrics he was called up to the Royal Army Medical Corps. He volunteered for an anaesthetics post and was sent to the British General Hospital in Calcutta for training. Here he anaesthetised mice for the typhus research unit.
He returned to St Thomas’ as an anaesthetics registrar, where he met his wife, Peggy, a Nightingale nurse. He was told by his boss to apply for a consultant post at Kingston Hospital, which, on arrival, he described as a “hell hole.” Doughty was determined to change things and he set up both the well known obstetric anaesthetic service and a 10 bed intensive care unit, which still bears his name. He also published an annual report which gave statistical data years before clinical audit became the norm.
On his retirement in 1980 he was able to devote his time to music, his lifelong passion. Singing, particularly Gilbert and Sullivan, had always been an interest. He took singing lessons and regularly performed duets with Hugh Seeley, a retired consultant anaesthetist from St George’s Hospital.
Doughty was a Roman Catholic and—in a quiet and unassuming way—his faith was the cornerstone of his life. Seeley, who only got to know him in retirement but had known of his reputation, says of him: “He was always regarded as a wise counsel and totally and utterly honest.” Doughty also loved canal boats and would have great fun taking his two children on boating holidays.
His wife died in 2008. He leaves a daughter and a son.