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| Alastair A. Spence, C.B.E., M.D., F.R.C.A. |
Lewis H.
Wright Memorial Lecture
“The Scottish Enlightenment: A Hotbed
of Genius”
Tuesday, October 17, 2006, from 12:50
p.m. to 1:50 p.m. at McCormick Place, Room E450A.
he Lewis H. Wright Memorial Lecture is sponsored annually
by the Wood Library-Museum of Anesthesiology (WLM)
and honors its namesake, who was a pioneer in American
anesthesiology. Dr. Wright was committed to enhancing
the stature of anesthesiology as a clinical science
and as an advanced medical specialty. He was a founding
member of the WLM Board of Trustees and later served
as its President Emeritus. In 1973, the New York State
Society of Anesthesiologists endowed this lectureship
to honor Dr. Wright, who died in 1974.
This year’s distinguished speaker is Alastair
A. Spence, C.B.E., M.D., F.R.C.A., Professor Emeritus,
University of Edinburgh, and Past President of the
Royal College of Anaesthetists, 1991-94.
Dr. Spence grew up along the Ayrshire Coast in Scotland;
he came from a family of paper merchants based in
nearby Glasgow. In 1960 he graduated from Glasgow
University Medical School, one of the largest medical
schools in the United Kingdom. Professor Spence earned
cash on vacations as the official beach photographer
at Ayr; his peak income was 6 pounds for a six-day
week, plus bonuses! While in medical school, Dr. Spence
spent six months in the clinics of Dr. Ian Donald
(1910-1987), Regius Professor of Midwifery. The echo
techniques used by the Royal Navy intrigued Dr. Donald,
and he saw an application in medicine. To this day,
Professor Spence is still proud to have witnessed
some of the earliest obstetric ultrasound images.
Dr. Spence originally intended to pursue a career
in medicine and neurology; the senior registrar in
his medicine residency at Glasgow Royal Infirmary
was a neurologist and Dr. Spence’s role model.
His change of heart was the result of both ambition
and pragmatism. Dr. Spence recognized that training
in medicine might not lead anywhere, as consultants’
positions were limited. Anesthesiology was a burgeoning
specialty with demand ahead of supply. He was appointed
to the Fellowship of the Faculty of the Anaesthetists
of the Royal College of Surgeons of England (F.F.A.R.C.S.)
at the Western Infirmary, one of the leading teaching
hospitals of Glasgow. This was a well-structured clinical
training program with weekly departmental seminars.
After clinical training, Dr. Spence received an 18-month
research fellowship in the laboratory that investigated
hyperbaric oxygen. The leading physiologists who visited
this laboratory included John W. Severinghaus, M.D.,
and Hermann Rahn, M.D. (1912-1990), and Dr. Spence
recalls this time as “a great opportunity to
learn techniques of clinical measurement.”
John F. Nunn, M.D., Professor of Anaesthesia at the
University of Leeds and one of the premier anesthesiology
academicians in the United Kingdom, also visited the
Glasgow laboratory. In September 1966, Dr. Spence
was recruited to Leeds where his research focused
on postoperative pain, which was an extension of his
Glasgow work on lung function. His query was, “Which
operations caused significant discomfort?” and
his method was “to access by spirometry their
effect on lung function.” He established a visible
role on the ward and, in this capacity, was an early
perioperative anesthesiologist. Dr. Spence observed
that right paramedian incisions for gallbladder or
peptic ulcer surgery were very painful, especially
in the first 48 hours postoperatively. These patients
had both reduced vital capacities and expiratory reserve
volumes. From here he suggested using epidural anesthesia
for 48 hours postoperatively after upper-abdominal
surgery. A lucky break occurred when a senior doctor
was admitted with bronchiectasis; he could not cough
because of the pain. Dr. Spence placed an epidural
catheter, and the doctor could cough. Dr. Spence “was
king for a day!” He followed all of his epidural
catheters for 48 hours and noted “bedside research
often needs a heavy time commitment.”
He returned to Glasgow in 1969 as chair of the anesthesia
department at the Western Campus. His Glasgow days
were marked by his appointment in 1973 as editor of
the British Journal of Anaesthesia (BJA),
a position he held until 1983. Under his guidance,
the BJA became a well-respected academic publication
and a financially profitable endeavor. In 1984, Dr.
Spence assumed the chairmanship at the University
of Edinburgh — a decision he never regretted.
Edinburgh is the youngest of the four Scottish medical
schools (Glasgow, St. Andrew’s, Aberdeen), but
Spence was able to recruit senior academic anesthesiologists.
Eventually he and his colleagues established Edinburgh
as the premier Scottish center for clinical anesthesiology
training and research. Professor Spence served as
Chairman of the Department of Anaesthesia at Edinburgh
at the Royal Infirmary of Edinburgh until 1998. His
accomplishments in the advancement of Scottish medicine
were recognized formally when he received the distinction
of “Commander of the British Empire” in
1992.
Along the way, Dr. Spence developed an interest in
the Scottish Enlightenment, that period of creativity
when brilliant minds moved Scotland forward by leaps
and bounds. This intense movement produced contributions
to science, philosophy, literature and art and also
influenced the American and French Revolutions. The
Enlightenment began around 1740 and was encapsulated
by the poet and songwriter Robert Burns (1759-1796),
who was born in Alloway, south of Ayr, the childhood
town of Professor Spence. Burns was known as the “Bard
of Scotland,” and his ballads convey the hopes
and dreams of the common man. During the Enlightenment,
Adam Smith (1723-1790) gave us theories of economics,
James Watt (1736-1819) engineered a better steam engine,
David Hume (1711-1776) promoted moral philosophy,
James Hutton (1726-1797) made discoveries in geology
and Joseph Black (1728-1799) described the caloric
theory of heat. The core theme of the Scottish Enlightenment
was a belief that both science and the humanities
were on equal ground; an enlightened man should embrace
each discipline with fervor.
Edinburgh and Glasgow were the touchstones of medicine
and surgery during the Enlightenment. In Glasgow the
Gregory family led the way. In Edinburgh, the three
Monroes (Primus, Secundus and Tertius) established
a legacy by holding the Chair of Anatomy for 126 years.
William Cullen (1710-1790) was a major force in chemistry
and medicine. Professor Cullen held the chair of the
Institute of Medicine and founded the Royal Medical
Society of Edinburgh Society. Professor Cullen attracted
the best minds from Europe and the United States.
Our own Benjamin Franklin appreciated the success
of the Edinburgh school; he sent William Shippen (1712-1801),
physician and founder of the University of Pennsylvania,
and John Morgan (1735-1789), a great innovator in
American medical education, to work under William
Cullen. Dr. Joseph Lister proposed the practice of
antisepsis in 1865 while a surgeon at the Royal Infirmary
of Glasgow, and he made his way to Edinburgh, as did
James Young Simpson, M.D. (1811-1870), who introduced
anesthesia for childbirth at the Royal Infirmary of
Edinburgh. Charles Darwin (1809-1882) began graduate
education at the medical school in Edinburgh. His
father, grandfather and brother were all trained at
the university and were physicians in the city. Darwin
could not tolerate the anatomy sessions; he watched
two operations without anesthesia and never returned
to the surgical amphitheater.
For this year’s lecture, Professor Alistair
A. Spence will discuss “The Scottish Enlightenment:
A Hotbed of Genius.” In this talk, he will focus
upon the achievements made in medicine and science.
He will highlight the successes of the Scottish school
and show how its leaders advanced the concept of a
discrete disease state and a formal approach to its
diagnosis.
The Wood Library-Museum is honored to have Professor
Alastair A. Spence as the 2006 Lewis H. Wright Memorial
Lecturer. His research in lung function and postoperative
analgesia has helped us to improve strategies for
surgical pain relief. Under his leadership at the
University of Edinburgh and the Royal Infirmary of
Edinburgh, scores of physicians received superb anesthesiology
clinical training. We thank him for sharing his perspective
on the Scottish Enlightenment and for illustrating
again that science and history are inseparable.
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Susan A. Vassallo, M.D., is Anesthetist and
Assistant Professor of Anesthesia, Massachusetts
General Hospital and Harvard Medical School,
Boston, Massachusetts. |
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