Anaesthesia and the Practice of Medicine: Historical Perspectives. By Keith Sykes, F.R.C.A., F.A.N.Z.C.A., F.C.A. (S.A.), and John Bunker, M.D., Contributing Editor. London, The Royal Society of Medicine Press, 2007. Pages: 303. Price: $35.00.
Anesthesia and the Practice of Medicine: Historical Perspectives represents a welcome addition to the limited literature outlining the evolution of anesthesiology as a distinct specialty. From the contested discovery of ether to current academic practice, Anesthesia explores the rich transatlantic traditions of scientific inquiry, technical advancement, and professional organization that have come to characterize the field. The stories, people, and personalities that shaped anesthesia practice are described in rich detail and with genuine clinical wisdom. That this wisdom should pervade the text is not surprising, given its foundations in the practical experience and decorated careers of Keith Sykes and John Bunker over a period of more than 50 yr.
Part 1 provides a tour through the discoveries of volatile and local anesthetics, airway management, vascular access, and muscle relaxants. The discussion is organized topically, and although individual contributions are included, this section manages to avoid becoming a series of biographical essays. The second part explores the pioneering efforts that forged anesthesia-based research, literature, and a system of education. Specific influences of the World Wars are considered in light of the physiologic understanding of shock and pain management, and the rise of emergency medical and military anesthesia services. Part 3 explores the rise of intensive care medicine, cardiac anesthesia, ambulatory surgery, and anesthesia’s enduring pursuit of safety. Part 4 describes the origins of obstetric anesthesia, including the introduction of inhalation and neuraxial techniques for the relief of labor pain, as well as the contributions of American anesthesiologist Virginia Apgar (1909–1974) in the assessment of newborns. The final section provides a brief glance at the past, present, and future, with focus on the working demographics of anesthesia providers and the staffing crisis.
This book succeeds in reminding us of lessons hard learned: the tragedies linked to the delivery of curare in the absence of mechanical ventilation, the administration of thiopental to hypovolemic soldiers, and the improper connection of early anesthesia breathing circuits. At the same time, the book pays tribute to the triumphs in medical science and technology that today enable safe anesthetics and freedom from surgical pain.
The authors should be congratulated on creating a work that is both readable and entertaining. Concerned with citing evidence and contextual accuracy, some historians arrange facts on paper in correct but tiresome fashion. By contrast, this work moves from topic to topic, sweeping through the advances in anesthesia while including the human (and often more interesting) stories that breathe life into the past. The result is an interesting and compelling read, valuable to the lay person as well as the anesthesia provider.
Worthy of comment is the book’s unique collection of photos, illustrations, and figures, which supplement concise descriptions of the physiology and anesthetic management concerns that drove innovation and discovery. A photograph of pioneering American anesthesiologist Henry K. Beecher (1904–1976), for example, treating a wounded soldier in a military “shock tent,” reveals a cot elevated on a wooden crate to produce Trendelenburg positioning. Such images depict the stark reality of battlefield conditions, the early understanding of circulatory collapse, and the origin of physiology-based volume management.
Another unique feature of this book is the physician–historian authorship which affords the reader the knowledge and clinical insights of experienced practitioners. This is analogous to a sports commentator who has played at the professional level and who can offer unparalleled observations and perspectives. In Anesthesia , explanations of clinical issues are offered with the simplicity and clarity that only an experienced practitioner could provide. A passage on thoracic anesthesia, for example, contains the following explanation: “whereas the inflated lung looks like a pink sponge, the collapsed lung looks like a piece of liver. To keep the patient alive, the anesthetist must prevent lung collapse and also maintain the normal ventilation of the lungs so that oxygen and carbon dioxide are exchanged normally.” Such glimpses into the understanding of physiologic challenges daily facing the anesthetist are thus made accessible to the lay reader. This book may be recommended to any and all with an interest in anesthesia and the stories behind the developments that shaped modern practice.
Mayo Clinic, Rochester, Minnesota. smith.hugh2@mayo.edu
