Acta anaesth. scand. 1975, 19, 341-343
The Norwegian Association of Anaesthesiologists - 25 years BJORN JORGENSEN
Department of Anaesthesia, Ullevil Hospital, Oslo, Norway
Towards the end of the 1930’s, it became awarded a prize from the University of Oslo apparent to Norwegian surgeons that, in for a study on the distribution of a narcotic in order to avoid stagnation in the surgical field, the body. Encouraged by the surgeon Carl it would be necessary to develop anaesthe- Semb, he began a “part-time” practice in siology as a speciality in the way it was anaesthesiology at the U l l c d l Hospital in practised in Britain and in the United States. Oslo. At the end of the war, he got the chance A particularly pressing problem was that to qualify in the speciality while visiting associated with the open pneumonthorax Robert Macintosh and H. G. Epstein at the encountered in thoracic surgery. Progress newly founded Nuffield Department of within this branch of surgery was closely Anaesthetics in Oxford. At the same time, Johan Holst came in associated with advances in modern anaesthesiology. touch with Ivar Lund. As a surgical resident I t is interesting to note the mystery which at the Military Hospital in Oslo during the surrounded the technique of intubation at war, he had also become interested in, and that time. A few ear, nose and throat like Otto Mollestad, had been practising specialists, who had taken up the technique anaesthesiology. After the occupation in 1945, of bronchoscopy, were called upon as “intu- through the help of Johan Holst, he was bators”. Those who mastered the art of offered an unpaid position as Assistant placing a tube in the trachea were regarded Resident at H. K. Beecher’s department at with admiration. Admittedly, in those days Massachusetts General Hospital in Boston. before the advent of curare, intubation was He accepted the position and stayed in Boston not always easy. for 18 months. I n December 1946, the first position for an Surgeons realised that such a system could be nothing more than an emergency measure. anaesthesiologist was established at RikshosI n this country, therefore, as in most other pitalet in Oslo. Otto Mollestad was appointed countries, the initiative for obtaining training and held that post until his death in 1972. facilities for anaesthesiologists was taken by A short time later, in January 1947, Ivar the thoracic surgeons. Little could be done, Lund became the anaesthesiologist at the however, to establish an adequate anaesthesia Ullev2l Hospital. service during the war and the German Mollestad and Lund soon managed to establish anaesthesiology departments at occupation of Norway. Even during the war years, however, two their respective hospitals. These were, for Norwegian doctors had taken an interest in many years, the only centres for training of the field of anaesthesiology and had actually anaesthesiologists in this country, and the started to practice this speciality more or less majority of new positions for anaesthesioloon their own. These two doctors were Otto gists, which were established in Norwegian Mollestad and Ivar Lund, who must be hospitals in the following years, were filled regarded as the first pioneer anaesthesiolo- by doctors who had obtained at least part of gists in Norway. Otto Mollestad had been their training at one of these departments.
342
BJ0RN J0RGENSEN
Some supplemented their anaesthesiology training during the postwar years with shorter or longer periods at departments of anaesthesia abroad. The Anaesthesiology Centre, which was founded in Copenhagen in 1950 (see HAXHOLT & SECHER,1975), also played an important role in the training of Norwegian anaesthesiologists. Many Norwegian doctors were given the opportunity of participating in a 1-year course at this centre. The establishment of a Norwegian Association of Anaesthpsiologists was Otto Mollestad’s idea. The Association was founded on January 28, 1949 with ten members. Its two most important objectives were: 1) to protect the professional interests of its members; 2) to work for the advancement of anaesthesiology as a specialty. An account of the activities of the Norwegian Association of Anaesthesiologists during the 25 years of its existence also gives an idea of the development of the speciality in this country. The Association immediately set out to work for recognition of anaesthesiology as a separate speciality. This was soon achieved. The requirements for training needed in order to qualify as a specialist in anaesthesiology have varied somewhat through the years, but at present comply with the requirements in the other Scandinavian countries. The Norwegian Association of Anaesthesiologists suggested at quite an early date that the specialist should pass an examination in order to be recognised. This proposal has not been accepted by the Norwegian Medical Association. When the Scandinavian Society of Anaesthesiologists was founded in 1949, Otto Mollestad suggested that the first Scandinavian Congress of Anaesthesiology should be held in Oslo during the summer of 1950. The idea was accepted, and the Congress was held in August of that year. It would seem that this event must have taken its toll of energy from the Norwegian organisers, as it was the only activity mentioned in the Association’s annals from 1950. An important issue for the Association in
the years that followed were the difficult negotiations with the authorities regarding the financial status of anaesthesiologists. It was difficult to obtain understanding for the claim that an anaesthesiologist’s responsibility and burden of work was comparable to that of a surgeon, and that the anaesthesiologist should therefore receive the same salary as the surgeon. Only towards the end of the 1960’s was this principle accepted. The 1950’s as a whole were a dificult period for Norwegian anaesthesiology. Few new positions were established at our hospitals. The prospects for those who began their specialist training in anaesthesiology were not promising. Consequently, recruitment to the speciality was poor. Anaesthesiologists continued to get a lower salary than other specialists. I t was unavoidable that problems of this kind had a negative influence on the development of the speciality. At the same time, however, it seemed that anaesthesiology in our neighbouring countries enjoyed a rapid and favourable expansion. I t was during this period that we could observe in the other Scandinavian countries the establishment of an impressive number of intensive care units under the management of competent anaesthesiologists. Many years were to pass before such units became common in Norway. When the establishment of intensive units was finally accomplished, and anaesthesiologists claimed the administrative leadership of these units, this point of view was not altogether and universally accepted by our surgical colleagues. The breakthrough of Norwegian anaesthesiology came in the late 1960’s. It was then that anaesthesiologists really became involved in the many aspects of postoperative and intensive care. I t was generally accepted that resuscitation, treatment of shock and respiratory failure were the domains of the anaesthesiologist. I n 1961, the Norwegian Association of Anaesthesiologists arranged an international conference on resuscitation in Stavanger. Here external cardiac massage was discussed
NORWEGIAN ASSOCIATION OF ANAESTHESIOLOGISTS
for the first time at an international forum. A new conference on resuscitation was held in Oslo in 1967. The most important activity of our association has been the organising of professional meetings and postgraduate education courses. Training of medical students in anaesthesiology has taken place at the various university hospitals. Its scope and content are comparable with all the Scandinavian countries. Norway was the last of the Scandinavian countries to establish an academic chair in anaesthesiology. I n 1973, Jacob Stovner, Otto Mollestad’s successor, became our first and so far only Professor of Anaesthesiology. Academic chairs had then been in existence for many years in the other Scandinavian countries. The Norwegian Association of Anaesthesiologists has established a fund to support and encourage scientific and practical work within anaesthesiology. “A/S Norsli Astra” supplied the original capital and a monetary prize was, for many years, given to a doctor as remuneration for some special service to Norwegian anaesthesiology. Every year, a monitory reward is given for the best paper written by a medical student, intern or anaesthesia resident. This award is paid by Imperial Chemical Industries.
343
The Norwegian Association of Anaesthesiologists began humbly with only ten members. Today its membership totals 110. The problems of the pioneering days are overcome. Recruitment is adequate and the majority, if not all, of the hospitals in our long and thinly populated country have a reasonably good anaesthesiological service, where Norwegian anaesthesiologists are much engaged in attention to acute medicine and intensive care. Today there are four universities with medical faculties where training in anaesthesiology for medical students and postgraduate training are given. At the time of our 25th anniversary, anaesthesiology in Norway is well established, although many problems and challenges still remain to be met and solved. REFERENCES HAXHOLDT, B. F. & SECHER,0. (1975) The 25th Anniversary of the Danish Society of Anaesthesiology. Acta anaesth. scand. 19, 324. Address :
Bjsrn Jorgensen, M.D. Department of Anaesthesia Ullevdl Hospital
Oslo Norway
The Norwegian Association of Anaesthesiologists - 25 years BJORN JORGENSEN
Department of Anaesthesia, Ullevil Hospital, Oslo, Norway
Towards the end of the 1930’s, it became awarded a prize from the University of Oslo apparent to Norwegian surgeons that, in for a study on the distribution of a narcotic in order to avoid stagnation in the surgical field, the body. Encouraged by the surgeon Carl it would be necessary to develop anaesthe- Semb, he began a “part-time” practice in siology as a speciality in the way it was anaesthesiology at the U l l c d l Hospital in practised in Britain and in the United States. Oslo. At the end of the war, he got the chance A particularly pressing problem was that to qualify in the speciality while visiting associated with the open pneumonthorax Robert Macintosh and H. G. Epstein at the encountered in thoracic surgery. Progress newly founded Nuffield Department of within this branch of surgery was closely Anaesthetics in Oxford. At the same time, Johan Holst came in associated with advances in modern anaesthesiology. touch with Ivar Lund. As a surgical resident I t is interesting to note the mystery which at the Military Hospital in Oslo during the surrounded the technique of intubation at war, he had also become interested in, and that time. A few ear, nose and throat like Otto Mollestad, had been practising specialists, who had taken up the technique anaesthesiology. After the occupation in 1945, of bronchoscopy, were called upon as “intu- through the help of Johan Holst, he was bators”. Those who mastered the art of offered an unpaid position as Assistant placing a tube in the trachea were regarded Resident at H. K. Beecher’s department at with admiration. Admittedly, in those days Massachusetts General Hospital in Boston. before the advent of curare, intubation was He accepted the position and stayed in Boston not always easy. for 18 months. I n December 1946, the first position for an Surgeons realised that such a system could be nothing more than an emergency measure. anaesthesiologist was established at RikshosI n this country, therefore, as in most other pitalet in Oslo. Otto Mollestad was appointed countries, the initiative for obtaining training and held that post until his death in 1972. facilities for anaesthesiologists was taken by A short time later, in January 1947, Ivar the thoracic surgeons. Little could be done, Lund became the anaesthesiologist at the however, to establish an adequate anaesthesia Ullev2l Hospital. service during the war and the German Mollestad and Lund soon managed to establish anaesthesiology departments at occupation of Norway. Even during the war years, however, two their respective hospitals. These were, for Norwegian doctors had taken an interest in many years, the only centres for training of the field of anaesthesiology and had actually anaesthesiologists in this country, and the started to practice this speciality more or less majority of new positions for anaesthesioloon their own. These two doctors were Otto gists, which were established in Norwegian Mollestad and Ivar Lund, who must be hospitals in the following years, were filled regarded as the first pioneer anaesthesiolo- by doctors who had obtained at least part of gists in Norway. Otto Mollestad had been their training at one of these departments.
342
BJ0RN J0RGENSEN
Some supplemented their anaesthesiology training during the postwar years with shorter or longer periods at departments of anaesthesia abroad. The Anaesthesiology Centre, which was founded in Copenhagen in 1950 (see HAXHOLT & SECHER,1975), also played an important role in the training of Norwegian anaesthesiologists. Many Norwegian doctors were given the opportunity of participating in a 1-year course at this centre. The establishment of a Norwegian Association of Anaesthpsiologists was Otto Mollestad’s idea. The Association was founded on January 28, 1949 with ten members. Its two most important objectives were: 1) to protect the professional interests of its members; 2) to work for the advancement of anaesthesiology as a specialty. An account of the activities of the Norwegian Association of Anaesthesiologists during the 25 years of its existence also gives an idea of the development of the speciality in this country. The Association immediately set out to work for recognition of anaesthesiology as a separate speciality. This was soon achieved. The requirements for training needed in order to qualify as a specialist in anaesthesiology have varied somewhat through the years, but at present comply with the requirements in the other Scandinavian countries. The Norwegian Association of Anaesthesiologists suggested at quite an early date that the specialist should pass an examination in order to be recognised. This proposal has not been accepted by the Norwegian Medical Association. When the Scandinavian Society of Anaesthesiologists was founded in 1949, Otto Mollestad suggested that the first Scandinavian Congress of Anaesthesiology should be held in Oslo during the summer of 1950. The idea was accepted, and the Congress was held in August of that year. It would seem that this event must have taken its toll of energy from the Norwegian organisers, as it was the only activity mentioned in the Association’s annals from 1950. An important issue for the Association in
the years that followed were the difficult negotiations with the authorities regarding the financial status of anaesthesiologists. It was difficult to obtain understanding for the claim that an anaesthesiologist’s responsibility and burden of work was comparable to that of a surgeon, and that the anaesthesiologist should therefore receive the same salary as the surgeon. Only towards the end of the 1960’s was this principle accepted. The 1950’s as a whole were a dificult period for Norwegian anaesthesiology. Few new positions were established at our hospitals. The prospects for those who began their specialist training in anaesthesiology were not promising. Consequently, recruitment to the speciality was poor. Anaesthesiologists continued to get a lower salary than other specialists. I t was unavoidable that problems of this kind had a negative influence on the development of the speciality. At the same time, however, it seemed that anaesthesiology in our neighbouring countries enjoyed a rapid and favourable expansion. I t was during this period that we could observe in the other Scandinavian countries the establishment of an impressive number of intensive care units under the management of competent anaesthesiologists. Many years were to pass before such units became common in Norway. When the establishment of intensive units was finally accomplished, and anaesthesiologists claimed the administrative leadership of these units, this point of view was not altogether and universally accepted by our surgical colleagues. The breakthrough of Norwegian anaesthesiology came in the late 1960’s. It was then that anaesthesiologists really became involved in the many aspects of postoperative and intensive care. I t was generally accepted that resuscitation, treatment of shock and respiratory failure were the domains of the anaesthesiologist. I n 1961, the Norwegian Association of Anaesthesiologists arranged an international conference on resuscitation in Stavanger. Here external cardiac massage was discussed
NORWEGIAN ASSOCIATION OF ANAESTHESIOLOGISTS
for the first time at an international forum. A new conference on resuscitation was held in Oslo in 1967. The most important activity of our association has been the organising of professional meetings and postgraduate education courses. Training of medical students in anaesthesiology has taken place at the various university hospitals. Its scope and content are comparable with all the Scandinavian countries. Norway was the last of the Scandinavian countries to establish an academic chair in anaesthesiology. I n 1973, Jacob Stovner, Otto Mollestad’s successor, became our first and so far only Professor of Anaesthesiology. Academic chairs had then been in existence for many years in the other Scandinavian countries. The Norwegian Association of Anaesthesiologists has established a fund to support and encourage scientific and practical work within anaesthesiology. “A/S Norsli Astra” supplied the original capital and a monetary prize was, for many years, given to a doctor as remuneration for some special service to Norwegian anaesthesiology. Every year, a monitory reward is given for the best paper written by a medical student, intern or anaesthesia resident. This award is paid by Imperial Chemical Industries.
343
The Norwegian Association of Anaesthesiologists began humbly with only ten members. Today its membership totals 110. The problems of the pioneering days are overcome. Recruitment is adequate and the majority, if not all, of the hospitals in our long and thinly populated country have a reasonably good anaesthesiological service, where Norwegian anaesthesiologists are much engaged in attention to acute medicine and intensive care. Today there are four universities with medical faculties where training in anaesthesiology for medical students and postgraduate training are given. At the time of our 25th anniversary, anaesthesiology in Norway is well established, although many problems and challenges still remain to be met and solved. REFERENCES HAXHOLDT, B. F. & SECHER,0. (1975) The 25th Anniversary of the Danish Society of Anaesthesiology. Acta anaesth. scand. 19, 324. Address :
Bjsrn Jorgensen, M.D. Department of Anaesthesia Ullevdl Hospital
Oslo Norway
