Anaesthesia in the 1920s.

At the time of publication of the first issue of the British Journal of Anaesthesia in July 1923, there were not many whole-time anaesthetists in this country, and these were confined to university teaching hospitals. Blomfield (1922) stated that there were 27 specialists at 12 teaching hospitals in London, and a similar situation existed in the provinces. In the peripheral hospitals, anaesthesia was administered by general practitioners with part-time contracts and a special interest in the subject. But in many cases, emergencies devolved to house officers with very little experience. Woolmer, the first Professor of the Faculty of Anaesthetists, has described his first administration of an anaesthetic (open drop chloroform) in an x-ray department in the dark, given within 1 h of arriving to take up a new appointment. Any medical practitioner was considered competent to give an anaesthetic on qualification, a situation which concerned Buxton. The General Medical Council had required, since 1911, that every doctor, on qualification, should provide evidence of instruction in anaesthesia, but Buxton felt that only the minimum was being done to comply with this requirement. Undoubtedly, many anaesthetics were given by an occasional administrator in a domestic setting or in a surgery. General anaesthesia was also required in the dental chair and many anaesthetics were given by dentists. The Dentists Act of 1921 admitted a few hundred experienced but unqualified people to the Dental Register. A particular feature of the history of anaesthesia in this country is that, since its earliest days it has been largely in the hands of the medical profession, a fact admired by colleagues in the USA and Europe. In many parts of the USA it was considered to be a nurse’s job. No doubt in places the service was excellent but in the 1920s the situation was evolving and, on both sides of the Atlantic, extremely able doctors were emerging who considered anaesthesia to be worthy of a physician’s full time attention. This process was postponed in Europe, where surgeons continued to dominate the management of anaesthesia by employing junior assistants, and making widespread use of local and regional techniques. One reason why specialist anaesthetists were not a common feature was financial. At teaching hospitals, a small payment was usually made in recognition of