When did podiatrists first use local anaesthetic?
The story of when podiatrists first used local anaesthetic was published here at ConsultingFootPain in August 2018. I have updated this to reflect a recent article in the January 2021 edition of The Podiatrist– ‘rising from the ranks’, which has provided more information worth highlighting (Potter, M). Additionally I go behind the scenes in my latest book, Podiatrist on a Mission. The Genesis of a New Profession (Tollafield 2021) where I have asserted that podiatry really only came about because of access to anaesthetics. My autobiographical account however is a bit more gritty, less academic and depicts a scene where two students are having an emotional interaction. Everyone likes the human element! The value, the importance and the opportunity that arose has underpinned podiatry since 1974.
The Medicine’s Act 1968
Podiatrists started to first use local anaesthetic before it was included in the Medicine’s Act that was then modified from 1968 but excluded podiatrists from using the prescription only medicine. The Podiatry Association was established to overturn some of the older legislation left over from the 1938 Board of Registration of Medical Auxiliaries, which shackled the development of the then profession of chiropody. Most podiatrists would agree that the advent of local anaesthetic, that is the ability to produce numbness in and around a painful part of the foot, impacted on the profession of podiatry significantly. Today all podiatrists can offer essential care with this pain relieving medication legally. However it was not something that just happened overnight. The profession of podiatry actually fought against itself at one point which seems bizarre by today’s attitudes of doing the right thing for the patient. This historical fact was uncovered in a PhD thesis by Dr Alan Borthwick.
Introduced into schools of podiatry late 70’s
In 1978 schools of chiropody (as they were called before the term podiatry) introduced the local anaesthetic certificate as part of the three-year diploma course (DPodM). This has now been replaced by the BSc (Podiatry) degree, but ’78 was a momentous occasion for me, not that we as students quite realised we were the first cohort at London Foot Hospital to acquire this skill formally. The year before, I recall, a good friend (and best man at my wedding) had to come back after qualifying to take the course as an add-on… and pay for it out of his own pocket. How lucky we were. Soon after, Part A (theory), then Part B practical local anaesthetic courses were run to allow previously qualified podiatrists to upgrade. It may seem strange that we started with the toe block as shown. Thankfully, today, podiatrists can offer patients a range of different methods of treating without pain.
The introduction of Independent Prescribing has become an important addition to the treatment and management of patient pain, inflammatory conditions and managing infection. The development arose from the former practice of patient group directives which I covered in another article – The Dawning of the Patient Group Directive (Tollafield 2018).
History and Podiatry
Martin Harvey comments
Digging back into my memory and library, LeRossignol and Holiday in a ‘pharmacopoeia for chiropodists’ (1937) refer to Benzocaina and Orthocaina in the Schedule 1 poisons list, which under the terms of the Pharmacy and Poisons Act 1933 a Chiropodist can “purchase by attending and signing the poisons register of a chemist to whom he is personally known” (notice the word “he”) they group these into a diverse and large set of other schedule one medications which include creosote, iodidum rubrum as well as nitric and perchloric acids!. They also observe that anaesthesia is rarely required in chiropody and that puts me in mind of the famous statement by the principal of a school who claimed one only needed a “sharp scalpel and a keen eye” a few decades later when discussing LA. Winograd or neurectomy with a leather strap between the teeth and a quick dollop of perchloric acid anyone? Sam Pitts, Chair of the Institute of Chiropodists (now the IOC & Podiatrists) in the 1960’s wrote that “many chiropody courses in the 1930’s adverted to local anaesthesia and it was certainly in ‘ad hoc’ use in the 1950’s according to our archives. There was no national agreement on its use as far as I can see from the Institutes’ archives, indeed some opposed it. Its probable that such ad hoc use depended on the local medical landscape, co-operation with local doctors etc. Naturally the 1968 medicines act then came along and everything changed.
I qualified from the London Foot Hospital in June 1970. It was a Diploma course in chiropody, there were no podiatrists except as an address. The Telegraphic address of the Society of Chiropodists was ‘Podiatrist, London’. How this originated I have no idea. It would be interesting to know if some far sighted individual chose the address with hope for the future. Graham,R B 2017
A new era, a new in-house journal
It is wonderful that Morwenna Potter (Jan-Feb 2021) has published her article in the first UK journal-magazine called ‘The Podiatrist’ which was formally ‘Podiatry Now’. This is available from the College of Podiatry or free to members as an on-line download.
Published by Busypencilcase Reflective Communication
Published originally in Aug 2018 and updated 1 Feb 2021