Obituary - Dr Charles McKinnon (Mack) Holmes MB ChB (Otago) FFARACS, FFARCS

11 June 1935 – 26 March 2020

Dr Mack Holmes died peacefully in Dunedin Hospital on 26th March 2020 after a brief illness arising from renal failure. He was born in Dunedin on 11th June 1935 and educated in part at Harrow after WW2, following his father's wartime service as an agricultural advisor for the British government. In 1949 the family returned to Dunedin, when his father was appointed the founding Superintendent of the Invermay Agricultural Research Station. Mack completed his education at Otago Boys' High School before entering Otago Medical School, graduating MB ChB in 1958. After two years in resident positions in Dunedin Hospital, he commenced his anaesthetic training in 1961 as an anaesthetic registrar in the department in Dunedin and was only the second such registrar from the Dunedin Department to be awarded a prestigious Nuffield Clinical Assistantship to continue postgraduate studies in the Nuffield Department of Anaesthetics in Oxford.

When Mack arrived in Oxford with his family to take up the scholarship in early 1962, the Nuffield Department had been undertaking ongoing studies on post-operative pain with which Mack became involved resulting in several publications. However before he left Dunedin, Mack had recently re-discovered the so-called Bier's block, and while in Oxford, with the newer safer local analgesic agents then available he was able to investigate the technique and re-popularised it as a very simple method of providing anaesthesia for hand and arm procedures. The technique of intravenous regional analgesia immediately caught on and led to several publications and speaking engagements for Mack. His 1963 landmark paper in the Lancet gave worldwide publicity to the technique, which soon became generally used by non-anaesthetists as well and is still accepted as the modern-day revitalisation of the technique. Mack completed his English fellowship in in Oxford in 1963, before returning to Dunedin in 1965 to a position as specialist anaesthetist at Dunedin Hospital and Lecturer in Anaesthesia at the Otago Medical School.

Mack's analytical mind and innovative approach resulted in a change from traditional techniques to the eventual avoidance of nitrous oxide and various vapour supplements to very low flow systems and wholly intravenous narcotic techniques, about which he published widely. Simultaneously he championed the undesirability of pollution in the operating theatre and contributed to establishing a passive scavenging system in the Dunedin operating theatres early 1973–74. In 1972 with the proposed introduction of a cardiac surgery unit for the South Island, he was responsible along with Dr Trevor Dobbinson and Professor Pat Molloy for setting up the cardiac theatre and post-operative cardiac care unit. In 1969 he was elected Fellow of the Faculty of Anaesthetics of the Royal Australasian College of Surgeons and in 1970 promoted to Senior Lecturer.

Mack's regular attendance at New Zealand and overseas anaesthetic meetings and his popularity as a speaker soon lead to an appreciation of his innovative and discerning mind, and that his audience could always guarantee to be educated and entertained. His repertoire of humorous anecdotes was legend. He was the author or co-author of more than 30 papers, as well as an excellent monograph on the story of Sir Robert Macintosh, A Famous New Zealander, who occupied the foundation Chair of Anaesthesia in the Nuffield Department of Anaesthesia, University of Oxford, the first such chair in the UK.

Mack was elected to the New Zealand regional committee of the Faculty of Anaesthetists of the Royal Australasian College of Surgeons in the 1970s, becoming Faculty Chairman in 1978. In 1982 he was elected to the Board of Faculty and appointed honorary librarian there from 1982 to 90, chairman of the education committee 1985, and until 1987 both a Primary examiner for 12 years and occasional Final examiner, retiring from the Board of Faculty in 1990. The New Zealand Society of Anaesthetists honoured him with life membership in 2009. He also had a love for languages and was fluent in conversational French with a good working knowledge and understanding of Russian which he learned at a University of Otago summer school before visiting the Soviet Union in 1976, as well as Italian, German and Mandarin (also from a Summer School).

Outside of medicine his life was more than full, with a growing family of four sons and their demands. He was a competent sailor and a qualified private pilot. His love of aviation led him to become an aviation medical examiner and a life member of the Otago Aero Club. Mack's first wife had died suddenly in 1978 and he married Lyn in 1981. He enjoyed the outdoor life and loved exploring Otago's scenery from the Strath Taieri to the Southern Alps, and even at the age of 80 went tramping with the family. In retirement he qualified as a scuba-diver and reported with great glee an encounter with a friendly seal whilst diving off the Mole at the entrance to Otago Harbour.

He retired from his Dunedin Hospital position in 1992 to take up full-time private practice at the Mercy Hospital where he had been in part-time private practice since the mid-1970s. Following retirement from anaesthetic practice in 2007, he continued for a time working as a medical officer doing locums in some of the provincial hospitals. In his complete retirement there was plenty to keep him occupied; he became a volunteer and active member of the Dunedin gasworks museum and a volunteer on the Taieri Gorge Railway.

Mack Holmes will be remembered as a talented dedicated anaesthetist who took a strong interest in teaching registrars and mentoring them for their future roles. He will be sadly missed by friends, colleagues, and family alike. He is survived by his wife Lyn, four sons, a stepdaughter and six grandchildren, one of whom he had only a few months earlier seen become a member of the fourth generation of Holmes to attend the University of Otago.