The Association of Anaesthetists of Great Britain and Ireland 1932–1992 and the Development of the Specialty of Anaesthesia. Sixty Years of Progress and Achievement in the Context of Scientific, Political and Social Change THOMAS B. BOULTON Association of Anaesthetists of Great Britain and Ireland, London WC1 3RA, 1999, 785 pp., indexed, illustrated. ISBN: 09536639 0 6. Price £30.00
This is undoubtedly a formidable work, yet, unlike so many, it is a readable and enjoyable account. The author was for many years the editor of Anaesthesia and has held office as a member of the Council and as President of the Association of Anaesthetists.
This work is, first, a history of the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and it is salutary to read why and how this organization was founded in 1932 in very difficult times. Of course this was before the outbreak of World War II (WWII) in 1939 and the establishment of the National Health Service (NHS) in the UK in 1948. Before the NHS, anaesthesia was a somewhat limited occupation and doctors attended British hospitals on a voluntary sessional basis relying on surgical colleagues in private practice for fees as anaesthetists. Anaesthetists in practice today in the UK have known no other climate than the NHS plus, for some, the option for additional private practice. I was reminded of something Sir Robert Macintosh once told me about his early days in London of a senior colleague ‘…Dr X (a household name in anaesthesia) had no idea what it was like for a young anaesthetist to reach the end of the month without any money’.
The book chronicles the birth and progress of the AAGBI. In so doing we are given insights into many interesting matters, such as the establishment of the two British anaesthetic journals, first the independent British Journal of Anaesthesia and then Anaesthesia the Association’s own journal, the institution of the original two-part Diploma in Anaesthetics and later the FFARCS (Diploma of Fellow in the Faculty of Anaesthetists of the Royal College of Surgeons of England) which has since become the FRCA. The problems surrounding anaesthesia in WWII are outlined. This wartime experience improved the recognition and the development of the specialty. These are fascinating accounts. Particular issues that have dogged anaesthetic practice for years are described and discussed, examples being the problems of providing out-patient dental anaesthesia (usually by peripatetic practitioners), fires and explosions, the provision of anaesthesia for emergency surgery, the development of intensive care, assistance for the anaesthetist, nurse anaesthetists, grades of staffing, fees and salaries, deaths associated with anaesthesia, monitoring in anaesthesia and help for the sick doctor. The occasional thorny interface between academic and purely clinical anaesthesia is touched upon and the reasons for the friction are shown to go back a very long way. Working patterns between anaesthetists and surgeons, and in particular the management of casualties of trauma, are of course inextricably interwoven and it is interesting to see how they have changed over the years.
Boulton’s text is the definitive work on the history of the AAGBI and chronicles every aspect that this innovative organization has touched upon. He deals thoroughly and methodically with the business of the Association, its committees and political activities, its influence on research, development and standards, and its later educational profile. The importance of anniversaries and the commemoration of notable events, e.g. of the introduction of chloroform, nitrous oxide and so on, and important congresses are detailed. This is never a ‘dry’ book. Boulton has the gift of bringing to life everything upon which he writes, so that it is not difficult to imagine being there oneself experiencing the events of the day. This is no ordinary account of a professional organization. Throughout the book, the author provides his own inimitable overview of many of the events that have affected anaesthetists and their specialty. On some occasions he has put on kid gloves, for example his account of the transformation of the Faculty of Anaesthetists into the College of Anaesthetists (later the Royal College of Anaesthetists).
However, the real secret of this book lies in its secondary title, for what Boulton has done is to provide a living account of anaesthesia, and everything that touches upon it, from the early 1930s to almost the present day. Therein lies its added value. His commentaries and descriptions of the changing political climate over the years before the war, the war and the postwar years, and the associated economic fortunes of the UK and its peoples, and how these have affected the practice of medicine and anaesthesia in particular, are quite fascinating and informative. Description of the relationships with the European Union include the origins of the European Academy of Anaesthesiology, together with the European Diploma of Anaesthesiology and the commencement of the European Journal of Anaesthesiology (both in 1984), and, further afield, the origins of the World Federation of Societies of Anaesthesiologists.
The author invited two colleagues to contribute individual chapters at the end of the book. First, Anna-Maria Rollin, a past Vice-President of the AAGBI, details the period from 1993 to mid-1997 and she succinctly describes these years of repeated political upheaval and stress in medicine in the UK. Secondly, Dr E. T. Mathews is responsible for a moving, albeit brief, account of the life of Henry Walter Featherstone who was the founder of the AAGBI. There can be few organizations that have had the good fortune to have been inspired by men such as he and the colleagues he gathered around him in 1932.
This book is a masterly and scholarly work of the events and development of anaesthesia in the British Isles in our own times. It is meticulously researched and beautifully referenced. Where money is mentioned, the author helpfully provides us with both the original sums and with conversions at the 1996 rate thus providing a valuable insight into financial aspects of fees, prices and costs.
So who should buy this book? It is an absolute treasure and anyone who has any feeling at all for his or her specialty should possess a copy. It is the legacy of all anaesthetists in the UK and of many beyond these shores. It will not be long before the AAGBI’s printing is exhausted and copies will be hard to obtain.