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Professor Frank Pantridge (died 26 December 2004)

(The Guardian, by Bill Duff, Thursday January 6, 2005 )

Professor Frank Pantridge, who has died aged 88, made a significant contribution to medicine in general and cardiology in particular.

Since the mid-1950s it was known that thousands of deaths occurred after a coronary attack due to ventricular fibrillation, a total disorganisation of the heart's normal rhythm. This could be corrected via the application of a short but massive electric shock to the heart, and many hospitals equipped themselves with mains defibrillators. Pantridge pointed out that since two-thirds of deaths occurred in the first hour after the onset of an attack, it would make more sense to take the defibrillator to the patient by way of a specialist "heart ambulance".

So in the winter of 1965, at the Royal Victoria hospital (RVH), Belfast, Pantridge, with colleagues Alfred Mawhinney, a technician, and John Geddes, a senior house officer, converted a mains defibrillator to operate from two car batteries in the back of an old ambulance. Thus was born the world's first mobile defibrillator, although, from the beginning, Pantridge was convinced that it could be reduced in size and made truly hand portable. This it eventually was.

Amazingly, the reaction of the British medical establishment consisted for the most part of disbelief, ridicule and even hostility. It was to be 16 years before the concept of taking the care to the patient was fully accepted. The reaction in America was totally different, and the creation of mobile units was both swift and comprehensive.

Pantridge's contribution to cardiology, however, was far from finished. In the aftermath of a heart attack, depending upon where exactly the attack has occurred, the heart either speeds up or slows down; muscle damage continues to accrue; and blood pressure problems present themselves. Pantridge was first to point out that damage could be minimised and blood pressure stabilised if remedial action was taken as soon as possible to normalise the patient's heart rate. This discovery led to higher survival rates and better quality of life for countless patients ever since.

Pantridge was born in Northern Ireland, on a farm on the outskirts of Hillsborough, Co Down. His father died when he was 10 and his early school days were troubled. He was several times expelled. He completed his secondary education at Friends School, Lisburn, and went up to Queens University, Belfast in 1934. Again his education was marked by trouble with authority, but he graduated very near the top of his year and thus gain a coveted job as a house officer at the RVH.

Almost immediately afterwards, war was declared and Pantridge immediately volunteered. Within days of his arrival in Singapore with the RAMC, Pantridge had fallen out with his superior at the military hospital and was posted to the second battalion of the Gordon Highlanders, then at Changi. When the Japanese attacked, the Gordons were sent north into Malaya, where they conducted a fighting withdrawal all the way back to Singapore. Casualties in the Gordons and a nearby Gurkha unit for whom he also acted as medical officer were heavy and evacuation always difficult, sometimes impossible. Pantridge, in common with other medical officers, ensured that those so severely wounded that they could not be evacuated would never see the enemy.
 
During the retreat in Johore, Pantridge was wounded and awarded a Military Cross, his citation saying he was "cool under the heaviest fire". Back on Singapore Island, he was devastated when the order to surrender came through. He had been appalled at the incompetence of the civil and military leadership before and during the campaign, but he had fully expected a fight to almost the last man.

Pantridge was incarcerated at Changi before moving north to work on the infamous Burma Siam railway. Of his group of 7,000, only a few hundred survived. Pantridge himself suffered from prolonged and near fatal cardiac beriberi but was possessed of a fanatical will to live. He never forgave the Japanese for what he saw them do to soldiers and civilians alike. Chronic ill health was to dog him for the rest of his life.

Back in Belfast he had to resume his career. Jobs were not easy to come by, but research into cardiac beriberi won him a scholarship to the University of Michigan. When he returned in 1949, he introduced surgeons to the operation of mitral valvotomy, from which over 2,500 patients benefited. In 1951, he was appointed consultant physician at the RVH and developed a large and reputable cardiac unit. He remained there until his retirement in 1984.

Frank Pantridge was both a simple and a complex man. Unquestionably focused and brilliant, he brought about unique advances in cardiology. He could be cantankerous, gruff, even rude, and yet witty and generous. For him to like someone he had to respect them, and he could then be a very loyal friend.

That he was not rewarded with a knighthood was probably due to his refusal to conform and his ability to fall out with anyone in authority. The title of his 1989 autobiography, An Unquiet Life, was entirely appropriate, and he did not marry. Apart from his native Northern Ireland, his greatest recognition came from the US, where he was showered with awards.

James Frank Pantridge, doctor, born October 3 1916; died December 26 2004.

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(The Daily Telegraph, by Susan Sontag)

Professor Frank Pantridge, the cardiologist who died on Boxing Day aged 88, developed the portable defibrillator, which has saved the lives of countless cardiac patients over the past 40 years.

In the 1950s it was said that coronary heart disease had reached epidemic proportions, and in the early 1960s hospital care units were initiated in North America. Pantridge, who was based at the Royal Victoria Hospital in Belfast, doubted the value of these, since epidemiological data had shown that the majority of coronary deaths were sudden, and thus occurred outside hospital.

It was known that most coronary deaths resulted from ventricular defibrillation, a disturbance of the heart rhythm which might be corrected by the application of an electric shock of momentary duration across the chest.

Pantridge suggested that, if the problem lay outside hospital, ventricular defibrillation should be corrected where it occurred, in the workplace, the home, the street or in an ambulance. However, removal of ventricular defibrillation required a defibrillator; and the available machines operated only in hospital from the mains electricity supply.

In 1965 he produced the first "portable" defibrillator. It operated from car batteries and weighed 70 kilos. Descendants of that clumsy contraption are now used countless times daily throughout the world saving many lives.

Pantridge installed the portable defibrillator in an ambulance, thus creating the pre-hospital coronary care unit known as the Pantridge Plan. This plan was used to manage President Lyndon Johnson when he suffered a heart attack while on a visit to Virginia in 1972.

Pantridge was labelled the "father of emergency medicine" and his Plan was rapidly adopted in America and elsewhere. An exception was the United Kingdom, even though an editorial in the Lancet in 1957 had stated that Pantridge and his colleague at the Royal Victoria Hospital, Belfast, John Geddes, had revolutionised emergency medicine.

In 1990, nearly 25 years after Pantridge had installed a defibrillator in an ambulance in Belfast, Kenneth Clarke, the then Secretary of State for Health, announced that £38 million was to be made available to equip all front-line ambulances in England with defibrillators. The number of unnecessary deaths during the 24 years' delay elicited no comment.

James Francis Pantridge (always known as Frank) was born on October 3 1916 on the outskirts of the village of Hillsborough, Co Down. His forebears were small landowners. He was educated at the local Friends School and graduated in Medicine from The Queen's University of Belfast in 1939.

On the declaration of war, he immediately reported to the recruiting office (there was no conscription in Northern Ireland), and was posted to the Far East where he became medical officer of an infantry battalion. During the battle that preceded the fall of Singapore, he received an immediate award of the Military Cross; the citation stated that "this officer worked unceasingly under the most adverse conditions of continuous bombing and shelling and was an inspiring example to all with whom he came in contact. He was absolutely cool under the heaviest fire ".

Captured at the fall of Singapore, Pantridge spent much of his captivity in the slave labour camps on the Siam-Burma Railway, including some months in the notorious "death camp", Tanbaya, on the Siam-Burma border. He survived the usually fatal cardiac beriberi, an experience which may have initiated his special interest in heart disease. The fall of Singapore, the impregnable fortress, left its mark. He was to say that never again would he have any confidence in those who were in control of affairs, and the only politician for whom he had any regard was Harry S Truman; he believed that Truman's decision to drop the atomic bomb in August 1945 undoubtedly saved the lives of the POWs.

Back in Belfast at the end of 1945, the only appointment he could obtain was that of part-time supernumerary lecturer in the university's department of pathology. However, he obtained a scholarship to the University of Michigan, where he worked with F N Wilson, then the world authority on electrocardiography.

Pantridge returned to Belfast in 1950, and was appointed Physician to the Royal Victoria Hospital, where he remained until his retirement in 1982. He quickly established an internationally acclaimed cardiology unit, recognised not only in the erudite medical journals but also in the North American lay press; there were articles in Time magazine and the New York Times. Mouth-to-mouth ventilation, with chest compression to maintain the circulation (the technique known as cardiopulmonary resuscitation, or CPR), aroused much interest in the North American lay press in the 1960s.

While Pantridge supported CPR he was well aware of its limitations, knowing that the longer ventricular fibrillation had been present, the less likely long-term survival would result from its removal. The aim, he insisted, should be immediate correction of ventricular fibrillation.

He also maintained that any lay individual who could perform CPR was capable of using a defibrillator; and a defibrillator should be beside every fire extinguisher since life was more important than property. He was aware that the size of the apparatus had to be reduced, and, using a miniature capacitor manufactured for Nasa, in 1968 he designed an instrument weighing only 3 kilos.

It was argued that a defibrillator in the hands of a lay individual might be used when not necessary; the citizen who had fainted or was drunk might be given a potentially dangerous shock. Thus, Pantridge suggested that the miniature defibrillator should incorporate a fail-safe mechanism like the safety catch on a pistol. This would ensure that the instrument would not deliver a shock unless the lethal arrhythmia, ventricular fibrillation, was present.

The defibrillator for implantation in the chest developed by Mirowski, in Baltimore, had just such characteristics. Pantridge thought that a similar circuit should operate from the chest surface, and he discussed this with Mirowski on a train journey between Ghent and Amsterdam in 1976. Mirowski was adamant that it was impossible, but Pantridge persisted, and eventually the automatic external defibrillator (AED) emerged.

One of the important dividends of a pre-hospital coronary care unit was the observation that, in the very early phases of the coronary attack, there was a high incidence of abnormalities of the heart rate and blood pressure. The correction of these abnormalities resulted in a much lower incidence of cardiogenic shock and failure of the heart as a pump. In 1970 Pantridge postulated that early appropriate treatment would limit the extent of heart muscle damage. This proved to be so: in 1985 Charlie Wilson, also in Northern Ireland, found that, among patients under 65, the early initiation of treatment reduced mortality by 38 per cent.

Frank Pantridge was appointed CBE in 1978. He was the author of The Acute Coronary Attack (1975), and a volume of autobiography, An Unquiet Life (1989). His hobby was salmon fishing.

He was unmarried.

(29/12/2004)

 

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