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September 1997
Volume 61 |
Number 9
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| John J. Bonica
Makes Obstetric Anesthesia an Academic Concern |
John S. McDonald, M.D.
Fifty plus years ago, a young father was excitedly awaiting the
imminent birth of his first child. However, his excitement soon
changed to horror when, as a physician, he was called upon to
resuscitate his wife who aspirated while receiving open drop ether.
Little did this young physician know that this near tragedy would
mold him to become one of the world's greatest advocates for the
safety of mothers and their babies. John J. Bonica was that father.
Although he was not the first to work in the area of obstetric
anesthesia, this author believes that he was the father of modern
obstetric anesthesia. What Dr. Bonica did is remarkable. He brought
the work being done in this area to the masses. He often said,
and firmly believed, that "passion was the fuel of history."
Throughout his life, he diligently applied his passion to the
pursuit of excellence for two of the most important members of
our society, mothers and their children.
About the same time that Robert A. Hingson, M.D., was promoting
regional anesthesia for obstetrics, not so much for the mother's
benefit but for the fetus, Dr. Bonica recognized its great value
for mothers as well. He vigorously joined in the campaign for
the use of regional anesthesia in childbirth.
At Tacoma General Hospital, he instituted the first Obstetrical
Anesthesiology Service in the United States offering 24-hour,
seven-days-a-week coverage, including regional analgesia. In today's
eyes, that does not seem so impressive, but in the 1950s, it was
unprecedented. The prevailing mood put the care of the pregnant
patient way down on the list of importance. This attitude was
hard for Dr. Bonica to comprehend considering that about one-fourth
of all anesthetics administered were for the relief of childbirth
pain, that obstetric anesthesia is in many cases "emergency"
anesthesia, and that not one but two lives are at stake. He could
not acquiesce to the fact that in many communities this important
function, deserving the skill and devotion of the best specialists,
was often relegated to poorly trained medical and paramedical
personnel. The best, most skilled anesthesiologist would spend
half a day caring for a moribund octogenarian who was doomed,
while in the delivery room, a student anesthetist was giving general
anesthesia, without an endotracheal tube, to a woman who had just
eaten!
When he became Chair of the Department of Anesthesiology at the
University of Washington in 1960, the ball really got rolling.
He could now mold young minds, contribute meaningful research
to the field and participate in the political arena, which set
the tone and tenor for the practice of anesthesiology. And participate
he did! He was a founder of the World Federation of Societies
of Anaesthesiologists, the founder of the International Association
for the Study of Pain, and President of ASA in 1966. Because of
his untiring work, residency programs that had considered obstetrics
a stepchild soon began to provide months of obstetric anesthesia
experience to their residents. Now, of course, a rotation in obstetric
anesthesiology is a requirement for certification by the American
Board of Anesthesiology. He also honed his skills at convincing
hospital administrators that the delivery rooms should not be
the last resting place for obsolete anesthesia equipment.
Dr. Bonica was also one of the leaders in studying the physiology
of pregnant women. He published many articles, especially on changes
in the respiratory and circulatory systems during pregnancy and
parturition.
He authored the first complete textbook on pain treatment, The
Management of Pain, which was published in 1953. His outstanding
book, Principles and Practice of Obstetric Analgesia and Anesthesia,
was published in 1967. For many, many years, this was considered
"the Bible" on the subject. Why did he write this book?
He said, "My motivation in writing this book is an intense
desire to contribute to the prevention of needless deaths and
to contribute to the well being of the mother and her infant."
In his preface, he expounded on his lifelong belief in teamwork
by writing, "It is intended to serve both as a textbook and
reference work for anesthesiologists, anesthesia residents, nurse
anesthetists, obstetricians, obstetric residents, general practitioners,
obstetric nurses, pediatricians and others involved in the care
of the parturient and her newborn." In other words, he knew
and spread the gospel that delivering a baby is a multidisciplinary
endeavor not to be practiced by amateurs.
In 1994, just months before his death, this author was privileged
to co-edit the second edition of this textbook. At that time,
he wrote, "Obstetric anesthesia is finally an established,
and even respected, part of the delivery of anesthesia health
care in today's environment. After so many years of attempting
to be recognized as a valid entity and attempting to recruit interest
from the specialty of anesthesiology, it now is fully accepted
as one of the most vital and vivacious subinterest areas in the
entire specialty."
John J. Bonica was truly a citizen of the world. He was a public
figure who had the ear and the respect of presidents, governors,
corporate heads, professors and even the Pope. In 1956 and 1957,
he worked with his friend, Pope Pius XII, on drafting this statement:
"Man retains the right of control over the forces of nature.
The Christian is never obliged to will suffering for its own sake.
The doctor ... is seeking, in accordance with the ordinance of
the Creator, to bring suffering under man's control." Keep
in mind this was written at a time when many clergy still felt
it was Divine will to let nature take its painful course in childbirth.
Did Dr. Bonica have a hand in changing the Pope's mind?
On behalf of the women and children of the world, we thank Dr. Bonica
and all of the "pioneers" of obstetric anesthesia for
their love and dedication in making childbirth a safe, humane and
happy experience.
John S. McDonald, M.D., is Professor of Anesthesiology
and Obstetrics and Gynecology and Chair of the Department of Anesthesiology
at Ohio State University, Columbus, Ohio.
E-mail the author.
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