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 apparent to Norwegian surgeons that, in order to avoid stagnation in the surgical field, it would be necessary to develop anaesthe- siology as a speciality in the way it was practised in Britain and in the United States.

A particularly pressing problem was that associated with the open pneumonthorax encountered in thoracic surgery. Progress within this branch of surgery was closely associated with advances in modern anaes- thesiology.

I t is interesting to note the mystery which surrounded the technique of intubation at that time. A few ear, nose and throat specialists, who had taken up the technique of bronchoscopy, were called upon as “intu- bators”. Those who mastered the art of placing a tube in the trachea were regarded with admiration. Admittedly, in those days before the advent of curare, intubation was not always easy.

Surgeons realised that such a system could be nothing more than an emergency measure. In this country, therefore, as in most other countries, the initiative for obtaining training facilities for anaesthesiologists was taken by the thoracic surgeons. Little could be done, however, to establish an adequate anaesthesia service during the war and the German occupation of Norway.

Even during the war years, however, two Norwegian doctors had taken an interest in the field of anaesthesiology and had actually started to practice this speciality more or less on their own. These two doctors were Otto Mollestad and Ivar Lund, who must be regarded as the first pioneer anaesthesiolo- gists in Norway. Otto Mollestad had been

awarded a prize from the University of Oslo for a study on the distribution of a narcotic in the body. Encouraged by the surgeon Carl Semb, he began a “part-time” practice in anaesthesiology at the Ullcdl Hospital in Oslo. At the end of the war, he got the chance to qualify in the speciality while visiting Robert Macintosh and H. G. Epstein at the newly founded Nuffield Department of Anaesthetics in Oxford.

At the same time, Johan Holst came in touch with Ivar Lund. As a surgical resident at the Military Hospital in Oslo during the war, he had also become interested in, and like Otto Mollestad, had been practising anaesthesiology. After the occupation in 1945, through the help of Johan Holst, he was offered an unpaid position as Assistant Resident at H. K. Beecher’s department at Massachusetts General Hospital in Boston. He accepted the position and stayed in Boston for 18 months.

In December 1946, the first position for an anaesthesiologist was established at Rikshos- pitalet in Oslo. Otto Mollestad was appointed and held that post until his death in 1972. A short time later, in January 1947, Ivar Lund became the anaesthesiologist at the Ullev2l Hospital.

Mollestad and Lund soon managed to establish anaesthesiology departments at their respective hospitals. These were, for many years, the only centres for training of anaesthesiologists in this country, and the majority of new positions for anaesthesiolo- gists, which were established in Norwegian hospitals in the following years, were filled by doctors who had obtained at least part of their training at one of these departments.

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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 HAX- HOLT & 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 Associa- tion 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 anaesthe- siology 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 develop- ment 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 anaesthe- siology have varied somewhat through the years, but at present comply with the require- ments in the other Scandinavian countries. The Norwegian Association of Anaesthesiol- ogists 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 Anaes- thesiologists was founded in 1949, Otto Mollestad suggested that the first Scandin- avian 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 responsi- bility and burden of work was comparable to that of a surgeon, and that the anaesthe- siologist 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 hospi- tals. The prospects for those who began their specialist training in anaesthesiology were not promising. Consequently, recruitment to the speciality was poor. Anaesthesiologists con- tinued to get a lower salary than other specialists.

I t was unavoidable that problems of this kind had a negative influence on the develop- ment 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 com- mon 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 anaesthe- siology 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 respira- tory failure were the domains of the anaesthe- siologis t.

In 1961, the Norwegian Association of Anaesthesiologists arranged an international conference on resuscitation in Stavanger. Here external cardiac massage was discussed

NORWEGIAN ASSOCIATION OF ANAESTHESIOLOGISTS 343

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 associa- tion has been the organising of professional meetings and postgraduate education courses.

Training of medical students in anaesthe- siology has taken place at the various univer- sity hospitals. Its scope and content are com- parable with all the Scandinavian countries.

Norway was the last of the Scandinavian countries to establish an academic chair in anaesthesiology. In 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 Anaesthe- siologists 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.

The Norwegian Association of Anaesthe- siologists began humbly with only ten mem- bers. Today its membership totals 110. The problems of the pioneering days are over- come. 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 univer- sities 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 Anaesthesi- ology. Acta anaesth. scand. 19, 324.

Address :

Bjsrn Jorgensen, M.D.

Department of Anaesthesia Ullevdl Hospital Oslo Norway