Dr James Malcolm Graham

Personal Details

Dr James Malcolm Graham MB ChB FFARCS DA

(known as Malcolm)

12/03/1913 to 17/11/1996

Place of birth:  Holmewood, Derbyshire, England

Nationality: British

CRN: 502351

Education and qualifications

Professional life and career

Postgraduate career

After graduation he worked briefly at the Chesterfield Royal Hospital before joining the practice of his general practitioner father, James Graham, in Chesterfield. This was necessary because his father was sick and his assistant left for service in the Second World War. By 1944 Malcolm was appointed temporary Honorary Anaesthetist at Chesterfield Royal Hospital. There he was promoted to Visiting Anaesthetist in 1947 and on the inception of the National Health Service he was appointed a Consultant Anaesthetist at the Royal and Scarsdale Hospitals in Chesterfield. He continued in this post until his retirement in 1974.  

Professional interests and activities

In 1940 Graham accepted a request to administer general anaesthesia once a week at Chesterfield Royal Hospital, and after a while became interested in this as a specialty. Besides reading, he attended a one-week course at the Department of Anaesthetics in Oxford, where he saw a prototype of the Macintosh laryngoscope and promptly ordered one.    

On 13 October 1947 he gave spinal anaesthesia with hypobaric cinchocaine to two patients, who from the first postoperative day had acute myelopathy of the lower spinal cord and developed permanent paraplegia. The method (then common) of sterilizing the exterior of ampoules of local anaesthetic was immersion in phenol for 12 hours so that the gummed labels soaked off; next the unlabelled ampoules were transferred into a jar of weaker phenol coloured pink by dye. The two harmed patients, Cecil Roe and Albert Woolley, sued the Ministry of Health and Graham for damages; writs were issued in July 1949. Court proceedings from October 1953 included questions on the safety of an unlabelled ampoule being used by the anaesthetist. At the end the judge accepted  the opinion of Prof Robert Macintosh that phenol  must have seeped through invisible cracks in the glass, contaminated the cinchocaine and caused the paralysis. It was ruled that in terms of the knowledge available in 1947, there was no negligence, and no compensation was awarded to the plaintiffs. On the advice of Macintosh there was a change to autoclaving spinal instruments, but the publicity of the case contributed to a marked decline in use of spinal anaesthesia in the UK for about 25 years.
At Chesterfield as a consultant anaesthetist, Graham instituted pre-anaesthetic clinics, a postoperative recovery room and drug inquiry forms.

Many anaesthetists including Graham did not believe Macintosh’s phenol theory. In 1990 Dr Chris Hutter re-investigated the ‘Woolley and Roe’ case and published a more plausible explanation: contamination of the spinal needles and syringes by acidic descaler left in the sterilizing pan. This brought some relief to Graham, who had been bothered by his perception that he had been under suspicion of giving the wrong drug.
 

Other biographical information

Malcolm Graham was refused permission to join the Royal Navy in the Second World War because there was no one else to look after the Grahams’ general practice. He married Marjorie Margereson in 1943 and they had one son. In his younger years he played village cricket, social tennis and was a proficient golfer. In later years he took up dinghy sailing. Sadly his last years were marred by incapacitating vascular disease. He was predeceased by his wife, but survived by his son, a merchant banker who worked in Hong Kong and Geneva.

Author and sources

Author:

Dr Alistair MCKenzie

Sources and comments:

[1] Harley DH, Wightman JAK. Obituary. BMJ 1997; 314: 1696.
[2] Medical Registers and Directories.
[3] Cope RW. The Woolley and Roe case. Woolley and Roe versus Ministry of Health and Others. Anaesthesia 1954; 9: 249-70.
[4] Hutter CDD. The Woolley and Roe case: a reassessment. Anaesthesia 1990; 45: 859-64.
[5] Graham JM, Maltby JR. The Woolley and Roe Case. Audiotaped discussion (1983) available at the Association of Anaesthetists.
[6] www.ancestry.co.uk