The structure of BACO has changed dramatically since the first conference in 1963, but the fundamental elements of academic excellence, instructional sessions and social events have been common threads. Andrew Freeland, who worked with Ronald Macbeth, the instigator of BACO, gives us a history of the man and the conference.

Ronald Macbeth, MA, DM, FRCS(Edin & Eng), 1903-1992 was a truly remarkable man, an eminent ENT surgeon, the founder of the ENT Department at the Radcliffe Infirmary, Oxford, a brilliant organiser and administrator as well as being an incisive prolific writer and speaker.

Ronald G Macbeth.

Much of what I write is gleaned from personal communication with ‘RGM’, as he was known at the Radcliffe, albeit after his official retirement in July 1968. The untimely death of Gavin Livingstone his great friend and colleague in December 1968, a month after I started my own ENT career at the Radcliffe brought Macbeth back as a locum and I think I probably became his last SHO and then Registrar. I also spent many hours with him asking about his life in ENT shortly before his death in his 90th year. So the facts as presented here are probably correct!

Before I move on to Macbeth ‘s involvement in BACO it is worth recounting some of his outstanding achievements as they give insight into his energy and enthusiasm without which BACO would probably not have been born.

A scholar of Oriel College, Oxford where he gained a cross-country half blue in 1924/5, he then went on to study medicine at Kings College, London where he was taught by Sir Victor Negus. Even at this stage he wanted to know what was going on in the field of ENT in the rest of the world, especially Europe, where English was not spoken much and journals were printed in their own languages. He was awarded the Herbert Hunt travelling scholarship and in 1930 embarked on a four month tour of Berlin, Dresden, Prague, Vienna, Munich and Frankfurt. His beautifully kept diary exists and he introduced many new ideas into the UK.

“Macbeth had huge drive and was particularly interested in teaching and exchange of knowledge.”

This was the beginning of his lifelong interest in international exchange and the beginning of his thoughts that led onto BACO. He quickly realised that two things were missing from British ENT; one was that there was little international exchange and secondly, although British surgery was advanced, the specialty had a much better image in Germany, Austria and the USA, largely because teaching and investigational work were better organised. He was appointed the first ENT surgeon to the Radcliffe Infirmary in 1932 and was told by the board of governors that he would be expected to form a full department. He had one house surgeon and 16 beds scattered throughout the hospital. In 1935 there was a serious haemstrep outbreak in Oxford and Macbeth recalls doing five acute cortical mastoid operations in the primitive conditions of a school sanatorium one night, and his house surgeon did 60 acute mastoids in his six month appointment! By 1937 he had formed a fully equipped department with its own operating theatres and 12 male, 12 female and 10 children’s beds in the centre of the hospital. International exchange, especially with Australia and New Zealand, was already beginning. This helped him and his single house surgeon cope with the clinical workload. Gavin Livingstone joined him in 1940 and more trainees were appointed.

Gavin Livingstone and Ronald Macbeth, 1943.

He was particularly proud of his part in the penicillin story and later his association with Esme Hadfield and woodworkers adenocarcinoma in the High Wycombe area. His name is still associated with the osteoplastic frontal sinus operation. He wrote countless papers, was President of the Otology section of the RSM in 1959, Vice President of RCS Edin, and Master of BACO in 1971, amongst many other honours at home and abroad.


As a friend of Howard Florey, later Baron Florey of Adelaide, Macbeth was asked in 1941 to try some penicillin, which was too impure to use systemically, by infusing it into infected mastoid cavities in the Radcliffe Infirmary. Remarkable recoveries were made by the penicillin group compared with those not treated. This was the first ever use of penicillin in ENT surgery. He presented the first 50 cases to the RSM in 1942, but for security reasons it was not published until 1945 [1].


From the above it can be seen that Macbeth had huge drive and was particularly interested in teaching and exchange of knowledge. It was a time when medical meetings in Europe were held in their own language and therefore not accessible to most UK surgeons and the cost of attending meetings in the USA was prohibitive. So in 1959 Macbeth put his ideas of a major British meeting to some of the most eminent figures in the specialty. A small committee was set up consisting of Leslie Salmon, Norman Crabtree, Ken Harrison, Douglas Ranger and of course Ronald Macbeth. It seems there were many misgivings amongst the ENT community especially about the cost and the risk of failure to attract an international audience. The committee were enthusiastic however, and eventually managed to gain the support of much of the specialty. However none of the existing ENT societies in the UK were willing to help finance or undertake any of the organisation!

The committee pressed on and with Macbeth’s extensive knowledge of overseas training, organisation and contacts it was formulated that the conferences would be held four yearly and consist of many and multiple instructional sessions as well as plenary lectures. The instructional session idea turned out to be highly popular and oversold, and is still a major feature of BACO. Funding and underwriting such a major venture continued to be a major headache, but the President of the Royal College of Surgeons of England, the future Lord Porritt came to the rescue by not only personally supporting this venture but suggesting it should be held for free at the college. The other Royal Colleges all then asked to be represented. The first meeting was arranged for the summer of 1963 at the College after the original ideas men met in 1961 to formulate how this and future conferences were to be organised. A look at the 1963 programme shows how a general committee to include the Royal Colleges, the ENT societies, an academic committee and an executive committee was formed. (The original five kept a very close eye on the organisation!)

Opening programme of the first day of the first BACO, 1963. Note the number and quality of the Instructional Sessions.

Banquet menu at the Guildhall, all for £3.2.6d..

Funding was likely to be a major issue, but from memory, Macbeth thought most of the UK ENT surgeons stumped up about £10 to help set the ball rolling. Registration was set as £11 assuming 250 would register. Nearly double that number came so although the accounts do not apparently show the profit it is assumed it at least broke even!

On June 16th 1963 Macbeth’s dream came to fruition. HRH the Duke of Edinburgh became Patron, Sir Arthur, later Lord, Porritt gave the opening address and as a New Zealander was thrilled by the number of Commonwealth delegates, many of whom had passed through Macbeth’s hands at the Radcliffe. Ian Simson Hall from Edinburgh was installed as the first Master. Space does not allow the full programme to be published here but the opening day shows how important the instructional sessions were to Macbeth, and the organisers and a truly international field gave the instruction.

The banquet was held at the Guildhall for the princely sum of £3.2.6d including drink. An amazing amount of work must have gone into the seating plan attached to the menu but it caused a fair bit of unhappiness and has remained an unpopular job! TG Wilson from Dublin designed the Master’s badge and his words describe the design, “The Greek tripod in the centre denotes wisdom and may also be taken to refer to the triple nature of our specialty. The palms above were in classical times placed on the tripod when the sybil vacated it. Unfortunately the Greeks had no symbols for the special senses but it is hoped the lyre and the amphora, being connected with hearing and smell, will make adequate substitutes.”

The first conference was a huge success and the second was planned for Oxford in 1967. Macbeth was installed as Master in Edinburgh in 1971. This was a true accolade of his founding vision and one he was immensely proud of, and the rest, as they say, is history.


Master’s badge designed by T G Wilson (Dublin). Ronald Macbeth’s installation as Master of the 3rd BACO in Edinburgh, 1971.



1. Macbeth RG. A series of 50 cases of acute and subacute masoiditis treated by wound closure and perfusion with penicillin. Journal of Laryngology and Otology 1945;Vol LX:16-23.
2. Harrison D, Harrison A. British Academic Conferences. Unpublished; 1991.


Declaration of Competing Interests: None declared.


These are links to features on some of the former ‘greats’ in the ENT field, whose contribution we are honoured to remember:
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Andrew Freeland

John Radcliffe Hospital, Oxford, UK.

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