History of Cape Anaesthetics Pty Ltd.

(formerly Dr B Solomons and partners)

Previous Partners

History of the Structure of the “Cape Anaesthetics Pty Ltd.” Group of Anaesthetists : 

1960 – 1995:
After the post-war development of an Anaesthetic Department at Groote Schuur Hospital and training of doctors in anaesthesia, the first private hospital Medipark was built in Cape Town on the Foreshore in the 1950’s (near the present location of the Artscape theatre). Predictably several operating theatres were also included with the need for some Private Practice Anaesthetists. Amongst the first pioneers before and after the Second World War in Cape Town were George Bampfylde-Daniels, Roydon Muir, Jack Abelson and Lindsay Van Der Spuy, then Peter Jenkins, Norman Smiedt, Heyman Samson, Edgar Hacking, Basil Solomon and Cecil Moss. It was soon realised that partnerships were more efficient in providing a comprehensive anaesthetic service and the first such Partnership was created by Basil Solomon and Cecil Moss in 1960 who were soon joined by the enthusiastic and young Peter Horrigan. It was named “Dr B Solomon and Partners”. Cecil Moss returned to Groote Schuur in 1966, but other gentlemen of the day such as Chris Wicht, Guy Currie, Jack Jacobson, Yvic Bosman and Sandy Collie joined the burgeoning “B Solomon Practice” at regular intervals through the 1960’s and 1970’s. June Hagen, Tessa Lopez and recently retired Professor Arthur Bull provided extra part-time (associate) cover when necessary and the Practice grew from strength to strength. As the original Partners started to retire into the 1980’s, so the second generation of Anaesthetists replaced the first, and Geoff Bax, Andre Louw, David Schlugman, Brian Lewer and Clive Nussbaum started their careers on a sound footing. The 1990’s saw more growth in numbers as Piers Harington, Martin Brossy, Colin McClarty, Alan Chesterton, Spencer Burke, Greg Torr and Ian Seggie joined the ranks. In recent years the Practice has maintained the policy of growing from beneath and every few years a young graduate is invited to join to encourage new ideas and retain a close link with current academics. Enter the new millennium anaesthetists such as Patrick Purcell, Steve Cohen, Will Lee and then recently Caroline Corbett and Mia Barbieri.

1995 – 2000: As surgical lists grew longer and Partners needed time with their families , so the late night workers were rewarded for their efforts and dedication and the after-hours fees accrued directly to the Anaesthetist doing the work. We became a “Partnership” in-hours, and “Association” after-hours (still called “Dr B Solomon and Partners”).

2000 – date: Soon the benefits and fairness of “association” became apparent and the Partnership was changed to an Association which was renamed “Cape Anaesthetics Inc.”, partly after the Cape Anaesthetic Clinic and partly because the practice is the original Anaesthetic Practice of Cape Town (and as such has the longest and proudest history of any Western Cape practice). “Cape Anaesthetics Inc.” replaced “Dr B Solomon and Partners” as an entity in 2000 as the Partnership transformed into an Association of Anaesthetists but retained the same central billing structure of the “B Solomon & ptnrs” single practice number. The Association is soon to become a group of solo Anaesthetic practices with different individual practice numbers still working together and providing the same anaesthetic services as before (merely a change of financial/tax entity).

Cape Anaesthetics staff: The cornerstone of any business is the quality of the staff…. The Cape Anaesthetic Clinic (CAC) was fortunate to have staff as faithful and capable as any, such as Sisters Daphne Parry, Joan Lewthwaite, Leslie Martin, Joan Nash, Pam Bailey, Lynn Fraser and others. These were nurses who could care for patients, do administrative duties, fix equipment, help doctors, in fact do just about anything !! The Anaesthetists of the Cape Anaesthetics Partnership and Association have equally been lucky enough to grow with dedicated, dependable and charming secretaries Charlene Williams, Leatitia Bruintjies, Sharon Swail and Deborah Solomons under the very capable leadership of the Office Manager Ruwayda Peck. This office staff has been virtually unchanged in 20 years which indicates a real sense of family and strong bonds between staff and anaesthetists throughout the workings of the Clinic and the Partnership. This has obviously fostered a friendly working relationship and healthy, happy environment, which is a hall mark of the “Cape Anaesthetics“ group.

History of the Cape Anaesthetic Clinic (CAC) :
1964 – 2002 The first “Day Hospital” in South Africa called Cape Anaesthetic Clinic (CAC) was started by Basil Solomons and Peter Horrigan about 1964 and operated with 3 theatres on the 4th floor of Fountain Medical Centre , c/o Adderley and Riebeeck Streets, Heerengracht, Cape Town city centre. This was a fairly revolutionary concept at the time when admission was always the day-before and discharge often the following day or two after every operation . The Cape Anaesthetic Clinic recognised the benefits of same-day admission and earlier return to home for patients whilst maintaining the same safety standards. Obviously costs were greatly reduced and patients embraced the shorter admission time and quicker re-establishment of normal home and working life. The “CAC” clinic thrived and operated at full capacity in the 1970’s and 1980’s until Medical Aids reduced and then abolished benefits for Dentistry under General Anaesthesia in the 1990’s. Partners were obviously chosen as the Anaesthetists for the “CAC” Clinic and the Dr B Solomon group of Anaesthetists was also known as “CAC”. The Cape Anaesthetic Clinic Day Hospital venture wound up in 2002 and was sold to and taken over by Presmed and soon after that by Life / Afrox who transferred the theatre licences to Life Health Care Vincent Pallotti Hospital. The partnership worked under the Practice Number of Dr B Solomon, which number still exists today (causing confusion !) although Dr Solomon has long since passed away. The associates are currently procuring their own personal Practice numbers as the Practice keeps up with modern trends.

1964 – 2002 The original Anaesthetists also owned the premises of Cape Anaesthetic Clinic (CAC) being the 4th floor of the Fountain Medical Centre and which was rented by the Clinic. The 4th floor was also sold by the senior Anaesthetists when the Cape Anaesthetic Clinic wound up in 2002.

The creation of the Anaesthetic College in South Africa :
Before and after World War 2 (WW2), Anaesthetists fell under the governance of the College of Medicine and Surgery (as a “Faculty”) and were doctors with a keen interest and knowledge of anaesthesia for surgical procedures and operations, which needed specialised doctors to improve safety and reliability of anaesthesia peri-operatively. During and after the WW2 various special interest Colleges became independent of the Colleges of Medicine and Surgery (which were the initial two large groupings of doctors in the first half of the 20th century). In the 1940’s and 50’s other major groups of doctors split off such as Anaesthetists, Paediatricians, Radiologists, Obstetricians and Gynaecologists, Pathologists, Psychiatrists, and so on. The Colleges of Medicine and Surgery likewise sub-divided into many different specific sub-specialities under their umbrella groups.

The Royal College of Anaesthetists of Great Britain and Ireland (RCA) in the UK and the American Society of Anesthesiologists (ASA) were formed just prior to WW2 and in 1943 the South African Society of Anaesthetists (SASA) was created and soon became an independent organisation (1956) under the auspices of the College of Medicine of South Africa (CMSA) itself created in 1954. Up to the early 1950’s, doctors like Basil Solomon had to specialise in the UK (or USA) and return to South Africa as specialists. These solo Private Practitioners in Anaesthesia had to transport all their own drugs, vaporizers, equipment, tubes, sterilising agents and monitors by hand in one or two suitcases to the hospitals where only oxygen and nitrous oxide gas was provided. From the late 1950’s the South African Faculty of Anaesthetists trained their own Specialist Anaesthetists (Fellow of the Faculty of Anaesthetists (FFA (SA)),to international standards equivalent to and readily accepted by the American, British, European and Australasian Colleges. The South African College of Anaesthetists only eventually became totally separated from the College of Surgery in 1995. In the new millennium, international nomenclature for Anaesthetists changed and Specialists were formally known as “Anaesthesiologists” to differentiate them from GP Anaesthetists (with / without a Diploma in Anaesthesia (DA)), who usually work in rural areas and small towns. However in Commonwealth countries the “Anaesthetist” title generally prevails for specialists.

Anaesthetic Fees in South Africa over the years :
In the 1940 – 50’s, Anaesthetists were paid as (a small !!) part of the surgical fee package, usually “3 guineas” for a long operation and “1 – 2 guineas” for a shorter operations !! (The guinea was a residual monetary unit of the British Empire with the equivalence of 21 shillings, when 1 GB pound was 20 shillings). When the Republic of South Africa was formed in 1961, the “South African Rand” (ZAR) became currency and was worth 10 shillings (2 Rand = 1 GB Pound). A more comprehensive set of payments for Anaesthetists and indeed all Specialities and doctors was established at the time, which was further developed in the 1970’s into a nationwide standard set of tariffs. The base fee for a short 01 – 30 minute anaesthetic at that time was R11.20 !! At the same time Medical Aids started up as businesses which helped simplify the finances for patients and doctors alike. Although the fees were agreed initially, Medical Aids soon eroded the payments to doctors stealthily every year until disputes had to be declared as the “Cost of Living” rose markedly in the Apartheid years. Today the base rate payment by Medical aids to Doctors has been reduced to about 20% of the agreed tariffs in the 1970’s, hence Medical Aids now have several schemes of repayment with higher premiums which cover most or all of the Medical fee. A system of “co-payment” has also come into being whereby the patient’s bill (for the cheaper schemes) is part settled by the Medical Aid and part by the patient.

The amazing improvement in Anaesthetic Safety, Monitoring, Drugs and Equipment :
Like all aspects of life, times during and after the World War 2 were tough; rationing existed for certain items for up to 10 years afterwards and medical equipment and drugs were still simple and limited. Anaesthesia was no exception as ether and chloroform had only recently been phased out with essential drugs like thiopentone, suxamethonium, curare, morphine, halothane vapour and nitrous oxide in oxygen being the mainstay of the early Anaesthetist. Monitoring was rudimentary (but dedicated) and consisted of manual blood pressure monitoring, a “finger on the pulse”, a “stethoscope on the chest”, a keen appreciation of clinical signs and close attention to colour and movement !! The early Anaesthetist was literally connected to the patient throughout the operation and often used clinical intuition to prevent and solve problems. The basis of pain relief for women in labour was inhalation of nitrous oxide until the introduction of epidurals in about 1970. Imagine our revered Prof Joseph Ozinsky during his very successful anaesthesia for Prof Christiaan Barnard’s first heart transplant in Groote Schuur Hospital in 1967.These early years and the improvement in anaesthetic methods saw the expansion of surgery to include major joint replacements, complicated surgeries such as total prostatectomies and major abdominal and chest surgery and improved blood transfusion services.

Electrocardiograms were invented to monitor the heartbeat and function, followed by temperature measurement, pulse plethysmography, oxygen analysers and soon the full array of gas measurements, capnography, pulse oximeters, ventilation pressures and characteristics, nerve stimulators, and many other more automated monitors and machines were rapidly developed. Positive pressure ventilators replaced the draw-over breathing systems and “Iron Lungs” (used for polio patients) and the medical equipment and drug industry grew exponentially. The reliability, potency and accuracy of both drugs and monitors also dramatically improved with the years.

Anaesthetic machines now resemble cockpits of jumbo jets and our sophisticated alarm systems have significantly helped reduce mortality and morbidity in anaesthesia. The growth in Local and Regional Anaesthesia, Intensive Care, Pain Clinics and Total Intravenous Anaesthesia are amongst the most significant advances in Anaesthetic world. The profession is progressing slowly towards a remote control and automated discipline of evidence–based medicine with even more safety checks . Research in anaesthesia has expanded, protocols have been developed and are regularly revised. Continuing Medical Education and Continuing Professional Development (CPD) is a way of life for the modern-day Anaesthetist to keep up to date and is actually a legal requirement. Thus all Cape Anaesthetics Inc. Anaesthetists are registered Medical Practitioners with the Health Professions Council of South Africa (HPCSA), all are members of the South African Society of Anaesthetists (SASA), all carry Medical Indemnity with Medical Protection Society (MPS), and most are also members of the Medical Association of South Africa (MASA) and other organisations . Regular Audit, Journal Club, and Morbidity and Mortality meetings, both privately and organised by SASA, are held to learn from other’s experiences and constantly review and scrutinise current practice.
Anaesthetic drugs have been modified to hugely improve their function and safety; auxiliary medical equipment is a massive industry as all sorts of aids are used to help strive towards and ensure a pain-free, safe and comfortable anaesthetic for each and every patient. This is the de facto mission statement of the working Anaesthetist and is foremost in the minds of all Anaesthetists in our practice.