Durham Smith: In 1961, we established a spina bifida clinic. We were about the first group in the world to advocate a selective process of deciding the babies on which we would operate or not, taking account of quality of life issues. In 1964 I visited the Sheffield Children's Hospital where they had an annexe full of spina bifida patients in desperate circumstances because they did not use any selection process. The paediatrician attached to the unit said the annexe was formerly the conservatory of an old home where they grew flowers. But now they "only grew vegetables". It’s a very good example of the use of ethics to help determine policy on treatment in the 1960s and '70s.

Anne Rickards[73] : From 1968 I worked with Dr Bill Kitchen on a multi-disciplinary randomized controlled trial that had started in 1966.[74] It was a longitudinal study that compared the mental and physical development of children who weighed 1000 to 1500 grammes at birth who either received the routine care then given to babies which amounted to devoted nursing care or a more intensive form of care that included intravenous glucose feeding and careful control of electrolytes. It was my job to talk to the children and assess their cognitive development and behaviour using sensitive measures. In two papers published in 1978 and 1979 we showed that there were significantly more survivors in the intensive care group, but they tended to have more handicaps during childhood than those given routine care.[75] In other words, the intensive treatment was helping the more vulnerable ones to survive. I think that had quite a profound effect at the time, causing some hospital nurseries to undertake less aggressive treatment on babies with a very low-birthweight.

Kester Brown: A fascinating piece of history occurred in April 1970 when positive end expiratory pressure ("PEEP") was used at the Children's Hospital for the first time to keep the airways open of a baby with hyaline membrane disease. It happened during the Hospital’s Centenary Meeting after Dr Mary Ellen Avery[76] gave an address about putting positive pressure on the airways to keep the alveoli open. At 10.30am Dr John Stocks,[77] having heard the address, made arrangements for the expiratory gas to be bubbled under water to a depth of 5cm to achieve positive pressure. That was the start of the Hospital’s use of a technique that completely transformed neonatology in my view. It made possible the survival of a whole crowd of babies. Before that, babies in respiratory distress because of a lack of surfactant, were treated with increasing amounts of oxygen to counter their inadequate oxygenation. But most of them died. After this new technique was introduced many more survived.

We had another very interesting problem consequent on that. We didn't realize that 100% oxygen was having a toxic effect on the babies’ lungs. We found that out over lunch in the doctor’s dining room, now long extinct, in a conversation between Alan Williams[78] and me. He said, what are you doing to the babies? It was then that we realised what the problem was and corrected it. There are a lot of fascinating bits of evolution around the babies of that time.

But the question of how far you push a treatment is a terrible ethical problem. If you don't take into consideration the quality of life, I think that’s a great sadness to all concerned.

Garry Warne[79] : I'd like to pick up something that reverberates from Vernon, through to people like John Colebatch. It seems that for some time there was discussion within the profession about ethical matters, but probably not in the community. I just wonder, as a student of the 1960s, to what extent Vernon Collins was effective in speaking to the community about these difficult ethical issues.

Witness to the History of Australian Medicine