Historic Perspectives for Modern Practitioners
By Rosalind S. Fournier
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An operating room of the late 1800s or early 1900s, location unknown, showing an anesthesiologist at work. Anesthesiologists of that time used ether to prepare patients for surgery. Photo courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, Illinois.
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According to noted UAB anesthesiology professor Maurice Albin, M.D., the past is always present. Take, for example, a potential complication of neurosurgery: When patients sit upright for a procedure, the risk of venous air embolism can occur while the patient is anesthetized. Many specialists had considered this to be a relatively new problem, Albin says, but an air-embolism fatality was reported as far back as 1821—and he recently came across a paper on the subject written in 1864, in the midst of the Civil War. “There’s actually a lot of information out there about ways to address this,” Albin says. “So if you don’t think about looking at the history, you’re going to get kicked in the rear end.”
Learning from the past is the mission of the David Hill Chestnut, M.D., Section on the History of Anesthesia, part of UAB’s Department of Anesthesiology and named for a former chair. A.J. Wright, M.L.S., the section’s director and an associate professor in the department, says the history section is emblematic of a growing movement among medical schools to incorporate what are commonly known as the “medical humanities”—a broad term referring to other areas of study that overlap with health care, including literature, ethics, religion, sociology, and history.
First of Its Kind
The UAB anesthesia history section, founded in 2002, is the first academic unit of its kind, Wright says. It includes a library that serves as a valuable research tool to acquaint medical students, residents, faculty, and practicing anesthesiologists with the history of anesthesia and the field’s contributions to modern medicine. Beyond that, the section also regularly presents exhibits on historical topics and invites visiting professors to speak about specific areas of anesthesia history. Six members of UAB’s anesthesiology faculty—Wright and Albin; Mark Mandabach, M.D.; Jason McKeown, M.D.; Antonio Aldrete, M.D.; and Raymond DeFalque, M.D.—are associated with the section.
One important benefit of having all of that history on hand, Wright notes, is that students and others can learn from the experiences of their predecessors. “We have a fair amount of correspondence from the department dating back to the late 1940s, when it was founded,” Wright says. “And if you read about the problems that the staff faced then, in terms of issues like work overload and how to deal with this question or that, you’ll see that a lot of it is the same stuff people deal with now,” he explains. “Not only may it give you hints about how people resolved problems in the past, but it helps to put things in perspective as well.”
Albin shares Wright’s belief that teaching perspective is a critical element of medical education. As the veteran of admission committees at three different medical schools, Albin has interviewed countless prospective students over the years, and he takes a different tack in his questioning to gauge the breadth of their knowledge. “I take for granted that they’re all smart, and they all know the science,” explains Albin, who is considered a pioneer in the field of neuroanesthesia. “Instead, I ask them questions like, ‘How do you think the United States ranks in infant mortality? How many uninsured people do we have in this country, and why are they uninsured?’ It broadens their horizon if you can encourage them to see that medicine is more than just medicine. It’s human beings. It’s culture and ethics.”
World History
While Albin and Wright agree that the history of medicine in general is an important subject, they find it difficult to pinpoint why anesthesia history in particular has become such a popular area of study—not only within the university but internationally as well. A group of anesthesiologists formed the Anesthesia History Association (of which both Albin and Wright are past presidents) in the early 1980s, Wright notes. Around the same time, the first International Symposium on the History of Anesthesia was held in the Netherlands; the event continues to convene every four years in different locations around the world. Wright adds that each year at the School of Medicine, a handful of anesthesia residents choose to do a historical research study to meet their requirement for an extracurricular academic project—something that wouldn’t be possible without the resources of the history section.
“Anesthesia has a lot of areas that appeal to people,” Wright notes. “You can look at the history of the drugs and the history of the equipment and how it has evolved, and then you can look at the people—there are a lot of interesting individuals who have been very important in anesthesia over the years.
“If you’re attracted to neat, strange, and interesting stories,” Wright continues, “then anesthesia certainly has those.”