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John Bonica Essay, Research Paper
For almost five decades Dr. John Bonica worked to define pain as a clinical field and a worthwhile subject for multidisciplinary neuroscience. He fought successfully for the establishment of an international, multidisciplinary scientific effort directed at pain and for the creative integration of basic neuroscientists and clinicians in the advancement of the field. He was my mentor, my friend, and an altogether extraordinary human being.
With the passing of Dr. John Bonica on August 15, 1994, the field of pain lost its founding father and its greatest champion. His death followed that of his wife of 52 years, Emma Louise Bonica, by scarcely more than a month. John Bonica was a man of great vision and accomplishment. For more than 50 years he maintained an unflagging dedication to achieving recognition for the importance of pain and its control, to the establishment of a multidisciplinary scientific effort directed at pain, and to the creative integration of basic neuroscientists and clinicians in the advancement of the field. If John Bonica had not been, the field of pain as we know it would not exist.
John Bonica was born on Filicudi, a small island off the coast of Sicily, on February 16, 1917. In 1928 the family emigrated to New York City. Following his father’s death in 1932, he assumed responsibility for the household, shining shoes, hawking newspapers and selling fruits and vegetables in pursuit of his dream to become a physician. He became the youngest Eagle Scout in the history of Brooklyn. .
In high school he took up amateur wrestling and won both city and state championships. He worked his way through college at Long Island University, and then medical school in Milwaukee, Wisconsin, as a professional wrestler, traveling with the carnival during the summers through small towns in the northeastern U.S., taking all on comers.
Ultimately, John Bonica won not only the title of light heavyweight wrestling champion of the world, but also after 6 years of determined courtship, the hand of Emma Louise Baldetti. They were married following his graduation from Marquette University School of Medicine in 1942.
After internship and residency in anesthesiology at St. Vincent’s Hospital in New York City, Dr. Bonica joined the U.S. Army which sent him to Fort Lewis, Washington, where at the age of 27 he became Chief of Anesthesiology at Madigan Hospital. Over the next 3 years, he taught himself the techniques of regional blocks, developing this form of anesthesia for surgery and pioneering pain-relieving techniques that helped the more than 10,000 soldiers under his care who had been wounded in action. Their suffering was the initial stimulus for his lifelong dedication to relieving pain in others.
After Emma nearly died from primitive open drop ether anesthesia during the birth of their first child, John committed himself to his second pioneering effort, regional anesthesia for obstetric pain. For the birth of their second daughter, Emma Bonica was the first woman in the Pacific Northwest to receive the now routinely administered continuous epidural analgesia.
In 1947, John Bonica became Director of the Department of Anesthesiology at Tacoma General Hospital. There he established the first residency training program in anesthesiology in the state of Washington, pursued a productive clinical research program investigating the effects of regional pain relief, and established a record for obstetric techniques of zero mortalities among mothers and newborns.
In 1953, John Bonica produced the first edition of his classic 1,500 page book, The Management of Pain. This book later appeared in several languages and earned a reputation as the Bible of pain diagnosis and therapy. In it, Dr. Bonica drew upon extensive experience with hundreds of patients to characterize acute, chronic and cancer pain problems, review issues, and provide key information on therapeutic options. In addition, he lectured extensively on these topics, produced numerous articles, and carried out extensive consciousness raising efforts.
In 1960, John Bonica founded and chaired the Department of Anesthesiology at the University of Washington School of Medicine in Seattle. During his 18 years as its leader, the department became one of the most prominent in the world with strong, balanced programs in training, research and patient care. Under his leadership, the department advanced regional anesthesia techniques for surgery and obstetrics. At the same time, Dr. Bonica established the world’s first Multidisciplinary Pain Clinic, a model now emulated worldwide.
In 1978, Dr. Bonica retired from the Anesthesiology chair at the University of Washington to devote his energy to promote, worldwide, the research of acute and chronic pain and approaches to improving treatment of pain. His concern, vision, and untiring commitment to sound the alarm, catalyzed current advances in pain research and the heightened international awareness of this fundamental element of human suffering.
John Bonica authored scores of books and several hundred research papers on regional anesthesia and pain. His magnum opus, The Management of Pain, Second Edition, a completely rewritten tome in two volumes, appeared in 1990. An update of a similarly comprehensive work, Principles and Practice of Obstetric Analgesia and Anesthesia, first published in 1967, reached completion only a few weeks before his death. The first international symposium on pain and its management, organized by John Bonica, took place in Seattle in 1973 and led directly to the creation of the International Association for the Study of Pain. The IASP has grown to over 5600 members representing 83 countries and with 45 chapters worldwide.
Through his tireless efforts, John Bonica ignited public and political interest in the immense societal costs of acute and chronic pain. The results encompass increased U.S. government support of pain research and pain management, including the early 1990s cancer pain emphasis by the National Cancer Institute and other NIH institutes.
Among John Bonica’s many worldwide honors are the Distinguished Service Award of the American Society of Anesthesiologists, of which he served as President in 1966; Honorary Fellow of the Faculty of Anaesthetists, Royal College of Surgeons of England; Honorary Doctorate of Science Degrees from the Medical Colleges of Wisconsin and Northwestern University; Honorary Doctorate from Siena University, Italy; Commander and Highest Officer of the Knights of the Order of Merit of the Republic of Italy; and Hereditary Knight, Noble Order of Cingolo Militare with rank of Baronet. Eight lectureships and fellowships around the world bear his name, including the John J. and Emma Bonica Endowed Chair for Anesthesiology and Pain Research at the University of Washington School of Medicine, and the John J. Bonica Trainee Fellowship of the International Association for the Study of Pain.
Throughout his career, and especially near the end of their lives, John Bonica gratefully acknowledged Emma’s sacrifices and contributions, without which he could not have realized his many accomplishments. Emma was well known to everyone who worked in the field of pain since John Bonica rarely traveled without her, and their dedication to one another became legendary. The memory of the two as a couple is a bright part of the Bonica legacy.
Most people describe John Bonica’s life as a series of outstanding clinical, scientific and organizational achievements. And yet, for those of us who knew him well in his last decades of life, his most impressive victories were those that he won in his day-to-day struggles with his own pain. His wrestling career had left him with extensive musculoskeletal problems and a complex, ever evolving pattern of chronic pain punctuated by periodic severe exacerbations. For a man gifted neither with great patience nor the grace to accept what others said he could not change, this pain was a constant vexation as well as a source of fatigue, discomfort and distraction. We watched him grapple with his pain every day, wrestling it to the mat whenever he had a lecture commitment or a deadline. He never let it interfere with his goals or responsibilities, nor did he restrict his outreach and productivity to minimize personal suffering.
The office next to mine, once John Bonica’s, now belongs to Dr. Dennis Turk, who holds the John and Emma Bonica Chair in Anesthesiology and Pain Research. The establishing of this chair is a tangible part of the legacy that Dr. Bonica left. Curiously, many of the intangible aspects of his legacy have stood the test of time. John Bonica’s sense of mission and commitment to pain control are still with me and with all of us who worked closely with him at the University of Washington.
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