title: Notable Australian contributions to the management of ventilatory failure of acute poliomyelitis: with special reference to the Both respirator and Dr. John A. Forbes.
abstract: When Australia's 1937 epidemic of poliomyelitis created an urgent need for extra ventilating machines to compensate for respiratory paralysis, Edward Both, an innovative Adelaide biomedical engineer, invented a wooden-cabinet respirator capable of being made relatively quickly in sufficient quantity. His device, here called "the Both", alleviated the problem at Adelaide's Northfield Infectious Diseases Hospital and others, and in late 1938 was introduced into England when Both was visiting there. Appreciating its merits, Lord Nuffield financed assembly-line production at the Morris motor works in Cowley, Oxford. Then, through the Nuffield Department of Anaesthetics in Oxford's Radcliffe Infirmary, he had the Both distributed Commonwealth-wide, as a gift for treating ventilatory failure in polio - especially in children. For the 1937 epidemic in Victoria, and to the design of Melbourne University's Professor of Engineering, Aubrey Burstall, nearly 200 of another wooden-cabinet respirator were ultimately built. Some were installed at the Acute Respiratory Unit of the Infectious Diseases Hospital at Fairfield, then others "all over Australia". However, by the early 1950s, the Both had replaced Fairfield Hospital's "Burstall", which had functioned as Victoria's favoured respirator since 1937. Dr John Forbes at Fairfield became the foremost Australian clinician for expertise with the Both. Before the advent of intermittent positive pressure ventilation, the Both's usefulness had seen it tried for ventilatory failure in some non-polio conditions, but uptake of that application was limited. Nonetheless, Nuffield's philanthropy with the (Nuffield-)Both ultimately furthered progress along the 20th century pathway to intensive care medicine.
authors.affiliation: Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand. rvt.met@pl.net
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Trubuhovich
mesh_terms: D000208:Acute Disease; D001315:Australia; D049673:History, 20th Century; D006801:Humans; D011051:Poliomyelitis / Q000150:complications / Q000266:history* / Q000628:therapy; D011175:Positive-Pressure Respiration / Q000266:history; D012133:Respiratory Paralysis / Q000209:etiology / Q000266:history* / Q000628:therapy; D012122:Ventilators, Mechanical / Q000266:history*; D015919:Ventilators, Negative-Pressure / Q000266:history