BOOK REVIEW |
Innovation in Pain Management: Wellcome Witnesses to Twentieth Century Medicine—Volume 21. L. A. Reynolds and E. M. Tansey (editors). Published by the Wellcome Trust Centre for the History of Medicine at UCL, London. Pp. 120. Price £6.00 (hardcopy) or free download from www.ucl.ac.uk/histmed/witness.html. ISBN 0-85484-097-4
E-mail: Douglas.Justins{at}gstt.sthames.nhs.ukIn 1990 the Wellcome Trust created a History of Twentieth Century Medicine Group and one of the formats that they have employed to address issues of recent medical history is the Witness Seminar. For each Witness Seminar several individuals associated with the topic in question are ‘invited to come together to discuss, debate, and agree or disagree about their memories’. Using these Seminars they have examined about 40 subjects ranging from the common cold, to the rise and fall of the peptic ulcer, and onwards to environmental toxicology and neonatal intensive care. Details of other volumes in the series can be found at: www.ucl.ac.uk/histmed/witness.html
The Witness Seminar on Innovation in Pain Management was held in December 2002. Consideration of the fate of some of the actual or potential contributors demonstrates how important it is to get the people who were there at the time to record their views on what happened before their memories are lost forever. One of the invited participants, Peter Nathan (Neurologist, Queens Square) died just days before the meeting. Mark Swerdlow died 10 weeks after the meeting and Dame Cicely Saunders has just died in July 2005. The man who did as much for pain as anyone in the last fifty years, Professor Patrick Wall, had died in August 2001 but the book contains a wonderful bonus in the form of an extract from an annotated Physiological Society interview conducted with him in February 1999.
Amongst the participants in the Seminar were Professor Sir Michael Bond (President of the International Association for the Study of Pain), Dr Jan Stjernsward (Chief of Cancer at WHO from 1980 to 1996), Dame Cicely Saunders (founder of St Christopher's Hospice), Robert Twycross (palliative care physician, Oxford), Mark Swerdlow (anaesthetist and pioneer pain specialsist, Salford) and Suresh Kumar (a young anaesthetist and palliative care physician who initiated a ground breaking community care programme in Kerala, India).
The proceedings of the Witness Seminars are transcribed from a recording and subjected to what appears to be minimal editing so as to turn the transcript into ‘readable text’. Unstructured sentences, grammatical meanderings and syntactical errors are all included. This may be quite distracting for some readers although, like Hansard, it does deliver all the flavour of a live debate.
Some of the revelations are startling and there are tales that have real resonance with present problems such as supplying affordable anti-retroviral medication to developing countries. One contributor remarked: ‘Human greed has to be controlled before we can control pain’. It is salutary to learn about the battles that were fought, during the very recent past, to overcome strongly entrenched attitudes to the management of cancer pain and the availability of opioids. It is astonishing to learn that in 1953, when Pat Wall moved to MIT (Massachusetts Institute of Technology), all the mathematical calculations were performed in a room with about 40 women working on hand calculators. In addition the people who provided the launch pad for his discoveries about the spinal cord were military engineers, physicists and electronic engineers.
This is fascinating history related by the people who were the front line players. It does not pretend to be a comprehensive history of the period but it allows the reader to gain some understanding of the giant strides that have been taken in pain management during the last 50 years. In 120 pages there are stirring stories of innovation, genius, perseverance in the face of adversity, serendipity, and for every one of the participants, the overwhelming desire to improve the management of pain for the benefit of patients.
London, UK
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