Henning Ruben
Anaesthetist who revolutionised the art of resuscitation by the invention, among other things, of the Ruben valve and the Ambu self-inflating bag
Henning Ruben, head of department of anaesthesia, Finsen Institute, 1953; professor of anaesthesia University of Copenhagen 1955-84 (b 20 July 1914; q Copenhagen 1946), d 4 December 2004.
By any standards, Henning Ruben was a remarkable man. During his career he was, at various times, a member of the Danish fencing team, a professional dancer, magician, thought reader, dentist, doctor, and inventor. To these might be added his reputation as a bon viveur and raconteur par excellence. It was, however, for his skill and originality as an inventor that he was best known.
He was born in Copenhagen on 20 July 1914, the eldest son of an orthodox Jewish family. At 19 he entered the Royal Dental College in Copenhagen, combining his studies with the exercise of his other talents. With a well known singer, he toured the halls as a professional dancer, excelling at the tango. He was also an accomplished athlete, becoming a member of the Danish fencing team that won a bronze medal at the world championships in Monte Carlo in 1939. He became a member of the exclusive Danish Magisk Circel.
In 1943 he enrolled as a medical student at the University of Copenhagen. Following the occupation of Denmark by the Nazis and in view of his underground activities and Jewish background, it became urgent for him to leave the country. One night he escaped on a fishing boat bound for Sweden, where he remained for two years, working as a dentist in Stockholm, as well as employing his talents as a magician and thought reader. He returned to Denmark with the Danish Brigade in 1945 and graduated in medicine in January 1946. At that time, anaesthesia was an undeveloped specialty in Denmark but was more advanced in Sweden, where Ruben found the combination of physiology, pharmacology, and physics of great interest, and he decided to become an anaesthetist. However, in the early years after the war, travel was very difficult but fortune came to his aid.
In 1947 he was invited to Sweden by the Swedish Society of Illusionists and, at their meeting in Stockholm, he performed brilliantly to a packed concert hall. During that visit, he introduced himself to the anaesthetists at Sabbatsberg Hospital and St Ericks Hospital. As a result, the following year he was appointed to the Serafimerlasarattet in Stockholm. He was now able to travel and in 1948 he came to England for visits, which included Oxford and Liverpool. He returned to Copenhagen in 1949 and was appointed to the Gentofte Hospital and, later, to the Finsen Institute.
Eager to broaden his experience, in 1951 he negotiated a six month secondment to the University of Iowa to work with Lucien Morris. At this time he met James Elam in Iowa and, finding that they had common interests, a collaboration started, which lasted until both had retired. Back in Copenhagen, he was appointed head of department at the Finsen Institute in 1953. There he began his programme of research and invention that was to have a lasting effect on the practice of anaesthesia and resuscitation. In 1953 he developed a lightweight, foot-operated sucker. This played a significant part in other developments for, in addition to its intrinsic value, it brought Ruben into contact with a Dr Holger Hesse, the founder of Ambu-Testa. The foot-operated sucker, although first marketed by Ambu, was soon copied by other manufacturers. But this was only the start.
The following year, he described and published a simple automatic constant-rate syringe pump for the controlled delivery of drugs. It was driven by a wind-up alarm clock. However, as early as 1948, Ruben had seen a non-rebreathing valve in an American anaesthetic journal. Unable to acquire it quickly, he attempted to make a copy but misinterpreted the drawing. Entirely by chance, he introduced some changes that led, with the help of a watchmaker, to the development of his own non-rebreathing valve—the "Ruben valve"—which made him a household name among anaesthetists round the world. By 1982, over a million Ruben valves had been made. He once described how he was often approached by younger colleagues and asked if the "Ruben" of the valve was his father. Once, a confused anaesthetist addressed him as "Dr Valve."
Curiously, it was a strike by Danish truck drivers in 1954 that led to the next invention. Lorries delivering oxygen were kept off the road and oxygen supplies in Danish hospitals ran very low. Ruben declared that it was this event that led to the development of the self-inflating bag. Ruben went to his bicycle mechanic and got him to weld together four bicycle wheel spokes and then manipulated the spokes into an anaesthesia bag. Ruben described how, with the aid of an attached string, he obtained a globe-shaped frame, which kept the bag expanded. When compression of the bag was released, the spokes regained their curved shape, making the bag self-filling. With his non-rebreathing valve and a valved inlet, the self-inflating bag was born and copied all over the world. In 1964 the self-inflating bag was declared by the American Medical Association to be among the most significant medical advances in anaesthesia of the past 25 years.
In 1957 training in resuscitation (mouth to mouth) became mandatory in many schools in Scandinavia. In the same year Ruben constructed the first manikin on which individuals could be trained in the correct use of the self-inflating bag. Six months later, when mouth to mouth ventilation had become widely accepted, the manikin was in great demand for training. In addition to many medical meetings, it was demonstrated at an international NATO meeting in Copenhagen.
Henning Ruben was a man of prodigious talents, all of which he exploited to the full. He received many honours both in his own country and elsewhere. He was president of the Danish Society of Anaesthetists in 1963-5 and received its prize of honour in 1966. In 1973 he was made a knight of the Order of Danneborg. In addition, he was made an honorary member of the Association of Anaesthetists of Great Britain and Ireland and was elected to the fellowships of the Faculties of Anaesthetists of the Royal Colleges of Surgeons of England and Ireland.
Henning Ruben was a marvellous raconteur, a wit, and enormous fun to be with. I valued his friendship and I feel an acute sense of loss at his death. He leaves his wife, Vera; four children; and seven grandchildren. His death is a great loss to anaesthesia as well as to his family and friends. [John Zorab]