Country
Date
Contribution
Contributor/manufacturer
Denmark
1950s
Gas analysis
P Astrup; O Siggaard Anderson
1955
Ruben valve; Ambu bag
H Ruben
Sweden
1940s
Gordh-Olovsson needle
T Olovsson; T Gordh
1940s
Lidocaine
N Löfgren, B Lundqvist
1957
Mepivicaine
Bo af Ekenstam
1965
Bupivicaine
Bo af Ekenstam
1996
Ropivacaine
Bo af Ekenstam
1952
Engström ventilator
CG Engström
1971
Servo ventilator
B Jonsson, L Nordstrom; Elema-Schönander
1958
Implanted pacemakers
Å Senning, R Elmqvist; Elema-Schönander
1948
Inkjet ECG printers
R Elmqvist; Mingograph-Elema-Schönander
Norway
1870
Jaw thrust
J Heiberg
1901
First open CPR
K Igelsrud
1961
Resuscitation simulators
B Lind; Asmund Laerdal Industries
Doctors and nurses in Sweden and other Nordic countries recognized Gordh’s great ability as a teacher, and came to train with him. Three additional anesthesia positions in Sweden were established in the 1940s, and given to doctors trained in GB or the US. In Stockholm, Olle Friberg was employed in 1943 at the Sabbatsberg’s hospital, where Crafoord had his cardiothoracic center. In 1945, Eric Nilsson was appointed in Lund, and is remembered for his contributions to intensive care. At the Bispebjergs Hospital in Copenhagen, Nilsson, together with the director Carl Clemmesen, adapted basic anesthesiological principles (open and clear airways, physiotherapy, frequent changes of body positions and careful positioning of the patient; and, if necessary, artificial ventilation and circulatory support) to treat patients with barbiturate intoxication, thereby decreasing the mortality rate from 20 to 1%. This ‘Scandinavian method’ continues as a cornerstone of the treatment of barbiturate intoxication and of intensive care [43].
In 1947, Olle Lundskog was appointed in Malmoe, and in 1949, Karl-Gustav Dhuner received the first position for an anesthetist in Gothenburg’Sweden’s second largest city. Göran Haglund, the first pediatric anesthetist in Sweden and a pioneer in pediatric intensive care, was appointed in 1951. At Uppsala University, Martin Holmdahl, a PhD in physiology and trained in Great Britain, received an independent position in 1954. He developed a prominent research center and produced several academic scientists, including Ake Grenvik.
A Nordic Society
In 1949, Gordh, Mollestad, Turpeinen and Henning Poulsen (Denmark) met in Helsinki to form a Nordic Society (Nordisk Anaesthesiologisk Forening, NAF) and create a Nordic Anaesthesia journal. In 1950, the first congress was held in Oslo and the first bylaws were approved. Subsequently, these congresses have been held every second year, the venue rotating between countries. The president of the current congress also serves as society chairman. A general secretary guarantees continuity.
Acta Anaesthesiologica Scandinavia (AAS) first appeared in 1957. Eric Nilsson in Lund, became the first editor-in-chief, and Poulsen played a pivotal role, acting as a member of the first Editorial board and taking responsibility for publishing the journal. For the first 15 years, the journal was printed in his home town in Denmark’Aarhus [44]. He also became the NAF’s first Secretary General.
1945–60
An expanding surgical work load forced the few existing anesthesiologists to focus on clinical demands. Such pressures precluded research or teaching, and recruitment of doctors into anesthesia. Although the specialty had become indispensable, financial constraints limited the number of new anesthesiologist positions.. Despite these problems, Nordic anesthesiology developed rapidly.
While almost all of the first generation of Nordic anesthetists went to GB or the US for training, domestic centers slowly developed specialty training. Initially, importation of British and Irish colleagues was needed to fill new positions, and some of these doctors stayed and became valuable contributors to the specialty, particularly outside regional centers.
The initial creation of only one anesthesia position per hospital, required anesthesiologists to recruit anesthetic nursing staff to get the work done. But the nurses had worked under the surgeon’s supervision, and both surgeons and nurses sometimes found it difficult to accept physician anesthesia-led departments. Eventually harmonious anesthetic departments were created with teams of nurses (with postgraduate specialty training) directed by anesthesiologists.
This team approach continues to the present. Although the number of doctors progressively increased, a shortage existed early in the history of the specialty, partly because anesthesiologists earned less than most other doctors (they received the same hospital salary but lacked the opportunity to gain income from private outpatients). Mollestad’s successor, Jacob Stovner summarized the situation:‘At the end of the working day we biked homewards in the exhausts from the surgeons ’ limos’!
Anesthesia from 1945–1960 paralleled that in the rest of the western world, a barbiturate induction and maintenance with nitrous oxide and ether. Cyclopropane was sometimes used for pediatric anesthetic induction. The introduction of muscle relaxants was enthusiastically accepted. Although Hunt and Traveau synthesized succinylcholine in Boston in 1906, the Swedes Thesleff, von Dardel, and Holmberg first tested it clinically in 1950 [45]. In the same year, the Swedish ENT surgeon Eric Carlens published experiences with the use of his invention, the double lumen tracheal-bronchial tube for separation of the lungs [46]. a prerequisite for pulmonary surgery.
A Gradual Expansion
Denmark is more densely populated than Finland, Iceland, Norway or Sweden, but all have metropolitan areas where a majority of the inhabitants live. In Iceland and Norway, the population is concentrated in coastal areas. These conditions led to differences in the development of anesthesiology. Hence separate descriptions are necessary for each country. We rely on the bookScandinavian Anaesthesia during 150 years. (Nordisk anestesiologisk forening), to describe these differences.
Denmark [47]
In Denmark, development after Lippmann and Mørch was slow. Willy Dam (1914–1990) assumed the first position as an anesthetist, created in 1944 at Bisbebjergs Hospital in Copenhagen (within the department of surgery). In 1948, Erik Andersen was employed at Gentofte hospital, where he provided anesthesia services to three different surgical departments. He was later given the first independent anesthetic position.
Poulsen and Ole Secher started their careers after the end of World War II. Secher worked at the major state hospital’Rigshospitalet’where in 1953, he received an academic position as a lecturer. Poulsen initially worked in Copenhagen, soon moving to Aarhus where he created a university department. As noted, in 1949, he started the Danish Society for Anaesthesiologists and was a founder of the Nordic association.
Around 1950, the state recognized anesthesiology as an independent specialty and anesthesia development expanded throughout Denmark. The World Health Organization started a one-year international course in anesthesiology (the Anesthesiology Centre) in Copenhagen, with the initial faculty including Henry Beecher, Harry Churchill-Davidson, Stuart Cullen, Francis Foldes, Emmanuel Papper, John Severinghaus and Jackson Rees. The course was repeated 23 times in the ensuing two decades. In 1953, the first independent anesthetic departments were created under Secher and Henning Ruben (famous for the development of the Ruben valve and the self filling ventilating bag, Table 32.1).
In 1952, a lethal poliomyelitis epidemic in Copenhagen led to the development of Intensive Care Units (ICUs). The epidemic prompted professor HCA Lassen to form an expert group charged with finding a strategy for treatment of cases with severe respiratory insufficiency. The free-lancing anesthetist, Bjørn Ibsen, (who had earlier spent a year in Boston with Beecher) with physiologist Poul Astrup, convinced this group that the patients had to receive intermittent positive pressure ventilation (IPPV). Physiologist Poul Astrup helped guide the ventilation by pioneering a new method of blood:gas analysis. Volunteer doctors, nurses and students performed this radical treatment, manually squeezing reservoir bags attached to tracheotomy tubes. Mortality decreased from 87 to 37 per cent, a remarkable achievement. Ibsen established a permanent ICU in the city hospital (Kommunehospitalet), in April 1954. Two Danish anesthesiologists, Henrik Bendixen and Henning Pontoppidan, emigrated to the US in the 1950s, becoming pioneers of ICU medicine at the Massachusetts General Hospital.
Finland [48]
Immediately after World War II, severe shortages of medical equipment, and the absence of positions for anesthesiologists, hindered development of anesthesia. Some conservative surgeons claimed that “ether anesthesia administered by a nurse was quite sufficient” (a well-known point of view). The first positions were created in the county hospital in Lahti in 1950, for Sakkari Pelttari and Jorma Airaksinen. As mentioned before, the pioneers Turpeinen and Aro had to wait until 1950 and 1953 before obtaining positions. Turpeinen, Aro and their colleagues worked diligently to establish the specialty. Turpeinen was one of the 1949 founding fathers of the Nordic Society. In 1952, he and three colleagues founded a national society, promoting the spread of the specialty in Finland. The Society focused on the need for education and training of doctors in anesthesia, and the creation of independent departments and positions for specialists.
The WHO anesthesiology centre in Copenhagen provided an important educational resource, attended by 22 Finnish anesthetists between 1950 and 1967. Others gained training in the UK. A domestic training program began in 1957–1958, requiring three years of anesthesiology, and one year of surgery, internal medicine, otology or basic sciences. The Society proposed establishment of university departments in Helsinki and Turku (Åbo), a dream realized in 1969–1970.
During this period, the Finnish Society of Anesthesiologists successfully negotiated for new positions and salaries. However, recruitment remained difficult and several measures were taken to improve the situation. A three-month compulsory training course in anesthesia for all surgical residents was implemented, and at their own request medical students were approached by the Society regarding careers in anesthesiology at several meetings. How much these measures affected recruitment is unclear, but the number of specialist members in the Finnish Society of Anesthesiologists steadily increased to reach 300 in 1980.
Iceland [49]
Jon Sigurdson observed that
“In Iceland as in all neighboring countries the development from 1950 was gigantic… When the specialty anesthesiology took its first steps it was not highly valued by other specialists. Less experienced colleagues, medical students, nurses and even unqualified staff members were entrusted to perform anesthetics. Anyone could do it!”Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
