Forbes McGain[46]: Well, I didn't throw any paper darts. I remember him entering the lecture hall and all two hundred and thirty of us watching him closely. A lot of people didn't know who he was. And he arrived wearing a bow tie. And of course naturally everyone said, "It's an obstetrician, it's an obstetrician". He looked somewhat different from the usual pharmacology type. And, of course, we pretty soon realised he wasn't an obstetrician.

Figure 10 Forbes McGain
Photograph courtesy of Ann Westmore

He probably gave two or three lectures out of the whole series of the pharmacology course. They were quite enthralling, and certainly he kept the paper darts to a minimum. Most of all, he stirred the imagination.

Ken Winkel: Thanks Forbes. Perhaps John [Pearn] might want to talk about how first aid and the management of bites and stings were taught as you recall it pre-Struan Sutherland.

John Pearn: As many of those here today remember, until the 1970s, the standard reference for first aid teaching in Australia was the small black book of the St. John Ambulance. Still in the 1970s, the major reference text was an English based book. The book had first been written in 1879 as First Aid to the Injured by a young Surgeon-Major, Peter Shepherd, from Britain.[47] And that book had gone into its 33rd or 34th edition with changes. But none of those changes that were made to the doctrine of first aid was based on what we today call evidence-based medicine. In all the areas of biological science and its practical application, I think the area of first aid has been the one where dogma and tradition have been most slavishly followed.

Up to the 1950s and 1960s there were five bodies teaching first aid in Australia. They were predominantly the St John Ambulance Association, the Australian Red Cross, the Surf Life Saving Association of Australia, the Royal Life Saving Society here in Australia and, fifthly, various state ambulance services. But, in essence, the one text-book was used.

Order was brought to this dichotomy by the establishment in 1976 of the Australian Resuscitation Council. Because of the dogma inherent in first aid teaching, and people vigorously defending their own beliefs and "turf", there was an evolutionary tendency for each body to go off by itself.

Sanity was brought to bear by the establishment of one overall body to co-ordinate first aid teaching, under the initial advocacy of a wonderful anaesthetist called Roger Bennett,[48] together with a neurosurgeon, the late Kenneth Jamieson.[49] The body, based at the Royal Australasian College of Surgeons in Melbourne, continues and, I would just say in parenthesis, it now consists of seventeen of the major bodies teaching first aid in Australia. But currently, as we meet here today, there are more than one hundred and seventy bodies, private firms and so on, teaching first aid in Australia. Everybody works very hard to try to hold the line and keep at least some sort of commonality of teaching.

It was against this background that Struan's essentially evidence-based approach to the management, particularly of the snake-bitten patient, brought some cohesion and eventually major change in the teaching of first aid. In the 1950s and, indeed, until the early 1960s, the formal teaching of first aid for the snake bitten in Australia was to apply an arterial tourniquet with what was called a Spanish windlass. That is, one put a ligature of some sort around a limb, made another little loop and placed a stick or a pencil under it, and wound that up - the so-called Spanish windlass - and then re-tied that and tied down the arm of the lever of the windlass by a second ligature to stop it spinning, and then excised the wound and applied Condy's crystals[50]. I am sure there are many here who would remember the beautiful little pencil-like containers which had at one end the wooden-turned cap with its little wooden screw where there was a lancet and at the other end there were some Condy's crystals. Now that had developed, as I said earlier on, perhaps from Aboriginal lore or traditional teaching: It had no evidence base in medicine at all. But that continued as the standard into the 1960s. The incision, and the use of any topical agent, specifically Condy's crystals, was taken out of the teaching in the early 1960s. But the ligature and maintenance of life support measures and monitoring for the patient was the formal first aid doctrine until 1979.

Struan's work, as I would perceive it at CSL at the time, was really one example of toxinology research that was being conducted in relatively isolated centres throughout Australia, that is, by small islands of devoted individuals - in Brisbane, by Bob Endean, a senior lecturer with his work particularly on marine toxinology and Ann Cameron[51] working with him particularly on scorpenoid fishes, stone fish envenomation, bull-routs and those sorts of fish; Charlie Tanner with his very pragmatic approach from his venom collection unit in the little house which he built himself twelve kilometres up the Endeavour River outside Cooktown;[52] John Tonge,[53] the forensic pathologist in Brisbane who first introduced the knowledge of the risk of ciguatera[54] in Australia in a paper in the late 1960s,[55] now realised to be a major cause of poisoning in Australia with perhaps as many as two thousand cases of poisoning each year. Then there was Colin Limpus from Armadale and his work on seasnakes;[56]my own venom research laboratory at the Royal Children's Hospital in Brisbane; and there was the tradition still of Charles Campbell working in Alice Springs.[57] So there were a number of disparate areas.[58]

But my perspective is that a whole quantum leap of professionalism was established at CSL with the team that included Struan, who I visited in his lab in the early 1970s, Alan Coulter who's here with us today, and Allen Broad as well.[59] So I see then, an evolution in the practical aspects of Struan's work coming from initial states of dogma, a movement towards commonality of teaching, and then this quantum leap to what today we call an evidence-based approach.

Witness to the History of Australian Medicine