discovery

The Operating Department Practitioner (ODP)



The work of the ODP, (Operating Department Practitioner), has evolved over the years into what is now, a fully recognized, registered and respected profession. It is now considered an integral part of the theatre team.
Klippy
The 'Klippy' Teanm
(Picture shows a Military theatre team after a charity fund raising event.)

The journey has been slow, difficult and many obstacles have had to be crossed. It has only been formally identified as a profession since 1971.
It has existed under the names of Operating Theatre Technician, Operating Department Assistant and presently, Operating Department Practitioner.

The origins of ODP's and to that matter, theatre nurses are quite complicated, as they never just appeared but came into being because of the needs at the time.
Prior to the “invention” or discovery of modern anaesthesia, the position of surgeon was always looked down upon by the physicians within the medical profession. Strangely, it is anaesthesia that has given surgeons credibility, respect and equality within the medical profession.

Since that October day in 1846, when the first anaesthetic was officially given, surgery has become increasingly more complex, whole industries have been formed to supply the different specialities needs. Whereas before, the surgeon would have operated on all surgical conditions; they now specialise in several areas: in some specialities, i.e. orthopaedics’, they sub-specialise, i.e. hand, or foot specialities.

During Morton’s time, an anaesthetic was given by dentists and ad-hoc assistants; eventually (in the UK) the position was eventually taken over by physicians.
These physicians have struggled over the decades to be given recognition for their speciality. They in decades past could relate their fight for respectful recognition to our (ODP) struggle to be recognised. The danger is that now they have attained near academic equality with surgery, they will lose the empathy they once felt for our profession. We do not want to lose the support of our traditional supporters, the anaesthetists.

However, we have traditionally had problems in being recognised by the surgeons as a viable profession, there were several reasons for this. In the early days, the OTT’s were male, and the OTT was opposed by surgeons because they preferred the female.
The theatre Nurse had established herself at the turn of the 20th century in theatre due to staff shortages (War enlistment) and in some cases, they influenced the surgeon too.
They were cheaper to employ, and as prior to the NHS it was in the interest of the privately funded hospitals to keep costs to a minimum. Surgeons got more for their money.
One might also suggest that the female nurse was easier to control.

Today it is the case that a majority of the ODPs in the country are now women, and this has in some ways improved the image of the ODP, especially where the surgeon is concerned. It is the case that the scrub assistant could be a nurse or an ODP and in some cases, the surgeon has no idea what they are.
It is also the case that today we have far more male nurses working within the theatre environment, so the surgeon is now not surprised to see a male assistant whether scrub assistant or anaesthetic assistant.

We as ODPs and Anaesthetic nurses have now become entwined professionally, we now fulfil focused roles, while in years past the nurse would scrub and the ODP would concentrate on anaesthetics. There are now some nurses (as we have many here), who apart from placements during training have never worked on the ward and have forgotten the ward skills they were taught. They are only suited to theatre. It does not mean they cannot work on the ward or elsewhere, as nurses they have the basic qualification to do so, it is just it will be as alien to them as it would be to myself as an ODP. (Although I spent 3 months on the ward as part of my training).

To become good at what you do requires you to gain experience by working at your chosen profession, nurses are now working in areas that require special skills for that area, if they continue in that area for several years, they do become a little typecast and would require extra training to work elsewhere.
operating theatre
Modern Operating Theatre
I can see theatre practitioners going the same way in time and becoming unskilled at certain specialities in theatre.

Well that is the future, and anything can happen as regards to our development, as it is all based on what the country can afford especially in these times of
ww1 Operating Theatre
WW1 Operating Theatre

financial difficulty for the NHS, all progressions require funding and in the big scheme of things, we do not figure highly.

It would be interesting to see how it develops over the next 20 years. I would like to thank all those sources that have contributed to this book, especially the CODP, Sally Garner, Frank Pyke FIOT, and the BMJ who have provided the basis of the material for the history of the ODP's.

I have referenced all the sources of the material where possible, however there may be some which I have failed to reference, if there are I apologise as it is not intentional.

I also wish to thank all the sources that have provided the images for this, but there are quite a few where it I have been unable to find the holder of the copy-write of the image, this made difficult as the image is widely distributed throughout the world, with some because the copy-write has expired and others because the originator cannot be traced.

I have outlined the origins of the theatre assistants in the next pages. I am grateful to the CODP website for the bulk of the material on the ODP's origins.

Handlers

It is surprising to know that in the centuries prior to the twentieth, the position of surgeon and surgical assistant was in nearly all cases undertaken by men.
handlers
Handlers
The reason behind this was simply because the surgeon needed to be physically strong.
The surgeon also required several assistants during the procedure, (prior to anaesthesia) who were powerful enough to hold down and restrain the patient; these assistants were called Handlers. 1

There is recorded in one of the London Hospital journals, that a bell was rung to assemble the Handlers to hold down the patient prior to surgery. On hearing this bell, a cold shiver would run down the spines of some patients on the ward, knowing that some unfortunate individual, who was about to be operated upon, was shortly going to suffer excruciating pain; they themselves having gone through the self-same tortuous experience. 2

Edward Morris wrote in his book The London Hospital: “The introduction of anaesthetics is undoubtedly one of the two most important factors contributing to the advance of surgery, the other being the introduction of antiseptics. The great abdominal operations were impossible when patients had to be strapped to the table, or held down by volunteers, while the surgeon did his awful work. The patient's inability to bear unlimited pain and the surgeon’s inability to inflict unlimited pain— for, strange as it may appear, some surgeons shrank from this part of their work and would never perform any large operation—entirely prevented advancement in surgery beyond a certain point. There are still ghastly relics in the Hospital of these terrible days: the great wooden operating table with its straps; the bell which was sounded before an operation to call assistants to hold down the patient—a bell whose dreadful clank could be heard by every shivering patient in the building, including the patient, often a little child; a bell with a voice loud enough and harsh enough to make all Whitechapel shudder.”3
The term "Dressers" and "Porters" were also given to the people who were expected to handle the patients and stop them moving. The use of blindfolds and straps were common, gags were also used to null the screams of the patient. The view that all the patients that undertook surgery, writhed and screamed was in fact untrue as there were those who never murmured but gritted their teeth and bore all.

Hoo Loo

One of the most famous of pre-anaesthetic operations to be undertaken was on a Chinese (Hong Kong) national who travelled all the way to London to have a very large tumour removed from his groin (25kg in weight). His passage was paid by the East India company and he arrived in London in 1831. 1
hooloo
Hoo Loo


The gentleman had the colourful name of Hoo Loo, and he was to be operated on by Aston Key assisted by Ashley Cooper, a renowned surgeon at Guys Hospital in London. Because of the size of the tumour to be removed, the proposed operation attracted a lot of attention, so much so that the operation was moved to a larger anatomical theatre; there were said to be a thousand spectators crammed in to watch the proposed operation.

Key had Cooper and three surgeons to assist him, plus the usual array of handlers. Hoo Loo was strapped onto the table and the surgery commenced. The operation lasted about 45 minutes. It was sad that he died through loss of blood, in agony, his final words translated were: "I can bear no more unloose me."
How must the audience, handlers and surgeons have felt when he died?

At the Post Mortem it was written: "Hoo Loo, in the arms of death, possesses a countenance remarkable for its placidity, and good humour; qualities which the poor fellow possessed, in an eminent degree, when living."

For some days prior to the operation, Hoo Loo appeared to have some fearful forebodings as to the result. The following event; however, tended not only to raise his spirits, but to give him full confidence in the universally acknowledged talents and experienced skill of Mr. Key, and to cause him anxiously to look forward to the day which was to rid him of his unwieldy burden, and transform him into a "perfect man".4

Key Reported to The Lancet later: "The poor patient, however, did not only lose his penis, but his life as well, death being ascribed to haemorrhage: Complete syncope occurred twice, and during the whole of the later steps of the operation he was in a state of fainting. The quantity of blood lost was variously estimated by those who assisted, and though certainly not large, it was the operators own impression that the haemorrhage was the immediate cause of death."5

The thought of even trying to excise a tumour of that size without an anaesthetic is horrendous, the chances of survival even if there was some form of anaesthetic would have been very little, what with loss of blood and the strongest possibility, because of the size of the audience and the length of time it took, infection would have been certain.

The more I read about this disaster, the more I see two surgeons who wish to highlight their profile by attempting a procedure that brought a (some say) thousand people to watch.
It is also interesting to note that the patient was given some blood from a member of the audience; there is a distinct possibility that a reaction could have taken place.
Today, these surgeons would be arrested and put up on a manslaughter or murder charge, they would have been dismissed from the profession and locked up. Handlers existed right up to the turn of the 20th century and in countries where Anaesthesia was not commonly available, well into the 20th century. If you look at some of the oldest hospitals in the UK, look out for the bell tower, thanks to anaesthesia you will not hear it ring to summon handlers.

This position of handler is probably the oldest of the surgical assistant positions. There are ancient Egyptian writings and drawings that show the Handlers restraining those being circumcised.

Box Man

This title was given to the individual employed to carry the surgeon’s instruments, (In the early days of surgery they
Amputation Instruments
Amputation Instruments
had to purchase their own) they were known as “ Box Boys” or "Box Man" and they existed prior to the Second World War.1

These could be required to attend three of the surgeons at the hospital, and according to E.S Pope, were recruited at times from the patients in the hospital who were paid 3d (3 old pennies) for every patient who was “bled”. Pope goes on to say however that this stopped at around 1813 when the surgeons appointed their own Box Carriers.

The Box Man would be required, as part of his duties, to ensure that the instruments were kept clean, and in good condition. In the case of saws, knives and scissors, it was his duty to keep them sharp! They had various other duties especially prior to the discovery of anaesthesia that is to act as an extra handler when the need arose.
It was also the tradition that the Box carrier used to carry the surgeon’s instruments onto the ward so that lesser operations could be carried out.

This task was also taken at one time by his "Dresser", his junior assistant. It enabled the Dresser to have a front row view of the operation to be undertaken, and thus help him in his studies. The practise of sharpening instruments carried on into the very early eighties.

Fred Wheedon MBE was first appointed as Box Boy at the Lambeth Hospital sometime during the late 1930s and soon afterwards he convened to the role of theatre attendant. Fred Wheedon was the Membership Secretary of BAODA until just before his death in 1989.

Sally Garner, were a lot of this information comes from, replaced him. 6

Surgical Beadle

The word Beadle comes from the middle English word Be-del that means messenger. Beadles were town criers and were also employed in the Parish workhouses and hospitals.
Typical Beadle
Typical Beadle


They were initially employed earning less than a porter, and their duties involved the clearing beggars and the sick from the streets of London.

The healthy beggars were sent to a correction institution and the sick to St Thomas's or Bart’s.
They were akin to policemen and ambulance-men rolled into one. They also wore Blue Coats like the one in the drawing. (Mr Bumble of Oliver Twist fame is a fictional example) A beadle can also be a verger at a church.

Eventually the Surgical Beadle was employed specifically for theatre work. This Beadle would act as a surgical assistant amongst other duties such as security and ambulance man.

St Thomas Beadle
St Thomas Beadle


In 1850, the average wage was 3/6p per week, which was at that time a generous wage. One of their duties as a surgical beadle was to ensure the cautery rod and brazier was correctly positioned, and was at the right temperature when it was needed.

In the twentieth century the beadles were as common as head porters at hospitals and other government institutions.
The word Porter itself is representative of what they were initially formed to do which was to open the gates of the hospitals to let the "Poor In and Out".

The picture shows the Beadle (Head Porter) Mr Streeton at St Thomas's Hospital been given a task by one of the nurses. This photograph was taken in 1960 when the Beadles were effectively the head porter of the hospital. 7

Josiah Rampley Surgical Beadle

The most famous hospital Beadle of all, was Josiah Rampley, he was referred to as the “Grand old man of the London Hospital”. He was associated with their theatre from 1871 for 30 years.
Rampley
Josiah Rampley


Josiah Rampley was born in 1845 to Joseph Wright Rampley and Sarah Rampley at Wordwell, Suffolk in 1844. He was one of ten children who I presume came from a Christian family as the names of most of his siblings are or contain a biblical character. Not much is known about his early life but what we do know is that he joined the London Hospital as a Post Mortem Porter in or around 1868/9, and he stayed in that post for 2 years.

He was working under a very well-respected Pathologist, Dr Henry Gawen Sutton, who was born near where I live, in Middlesbrough, Rampley speaks very highly of this man who died in 1891.

After two years Rampley was offered the post as theatre assistant but he was required to also fulfil his duties as a Post Mortem assistant. In his early days in theatre (Prior to diathermy) one of his responsibilities was to keep the iron red hot just in case it was needed to arrest bleeding.

He also had to ensure that the ice was readily available which followed the cauterisation of a vessel. One of the junior Surgeons he worked with, was to go on to be one of the most famous surgeons in the world at the time, that was Frederick (Freddie) Treves.

It is thought that he was appointed surgery beadle in 1893, because his predecessor, Henry Peter Stuckey, was dismissed for not having the stomach pump ready for the surgeon, but to be honest, I found that Rampley was in place, definitely in 1881 and although the dismissal of Stuckey is possibly correct, I could not find a trace of him in the 1881/91 census.

Stuckey was employed as the Surgical “Boadler” according to the 1861 census which I presume is the miss-spelt Beadle.
In the 1871 census he was listed correctly as the Surgical Beadle and living in Whitechapel. So, in all likelihood, Rampley took up his position in 1873.

Rowing Club
The Rowing Club of the London Hospital with Treves and Rampley 1898
8


What makes Josiah Rampley so special is not that he was a surgical Beadle, not also that his working career in theatres paralleled Frederick Treves, no, it was his commitment to his job, he lived and breathed the London hospital; it has been said that he was perpetually on call throughout his service. He never married because he was already married, to the London Hospital.

Most people know him today because of the Rampley’s sponge holding forceps which are the most common instrument seen on a basic surgical tray, even today.
Sponge Holder
Rampleyś Sponge Holder


As a Beadle, another of his duties in his early days was to recruit nurses and other servants when required.
I mentioned that the word Beadle comes from the "middle" English word Be-dal which means messenger. Prior to our technological bleeps, telephones and other communication devices, the Beadle would in effect be the Bleep of the day.

Josiah retired in 1900 and over 72 “Londoners” turned up at his farewell dinner, at the Hotel Metropole on December 12th, 1900, with even the great Frederick Treves giving a speech on “Ramps” contribution to the hospital and the love and respect that all had for him. 7

He always kept an association with the London Hospital up till his death in on 20th April 1934 at his home in Willesden, where he had lodged with the Parkinson family when he retired.

He was Cremated on the 25th April and many “Londoners” were present at his funeral. On his coffin was written the words of Christ. What fitting final words they are, on who I consider to be the father of our profession, Josiah Rampley. The words were: “Well done good and Faithful servant”.

The Needs of the Times

During the Great War of 1914-18, thousands of casualties were evacuated to the UK from the field hospitals close to the battlefield areas of the Flanders fields. English hospitals were working flat out, especially in the surgical wings, to cope with the workload.
ww1 Hospital Ward
WW1 Hospital Ward


There were not enough box boys or Surgical Beadles as most had volunteered or were recruited into the Armed Forces to serve in the Field Surgical Teams.

So female nurses were recruited to fill the gap left in the theatres by the men who went to serve in the armed forces. They were given basic training, but there was not much in the way of formal training, as you would see today, just on the job training. This training was however far better than what was given say in the early years of Rampley and Treves, when all that would be required is having the ability to read and write.

Rampley described them as the "Sarah Gamp's" which is a reference to a Dickens character from Martin Chuzzlewit", i.e. drunken nurses.9

However, the legacy of Florence Nightingale paid dividends at this critical period in the history of Britain. The nurses coped with the workload of the hospitals on the mainland, in the theatres and on the wards.
Strangely, before the Great War, the belief was, that Operating theatres were not a pleasant place for women to work. The establishment at pre-war Britain felt that women working in such a bloody and cruel environment would not be able to cope with the stress, the blood and the heavy workload.
WW1 Operating Theatre
WW1 Operating Theatre


It however turned out that the women coped quite well, the WW1 women were used to hard work and suffering. As regards with the physical aspect of the job, they managed because all the theatre team generally helped out with the patient transfers and other heavy work.

It was the case then that all the fears that were put in place were as a result of the “Pre-anaesthesia “ thinking, but the humane methods used now, (Anaesthesia) to prevent pain with also the use of porters to help move patients was to nullify this argument.

It was this success that nurses claimed in coping with the workload of the war wounded, and dealing with the duties previously undertaken by the men, which led the hospitals to abandon their pre-conceived ideas about women in Theatres, and keep them on post war.

No Title
Unemployment


At the end of the war, the returning soldiers found it hard to return to their jobs, there was no job protection as there is today. It was also the case that some posts like the Surgical Beadles, ceased to exist in the operating theatre, (most were given porter Jobs but were still called Beadles up until the early 70's) and most of the theatre places were filled by nurses.

There where vast changes made to the way theatres were run, instrumentation had altered to suit the needs of the specially.
The way patients were looked after post op changed. In short, nurses were seen to cope very well without the Beadles, Box Boys and surgical assistants post war.

There were some hospitals that continued to use these mainly in London, but the majority withdrew their post from the department.
The Beadles continued in some hospitals as head Porter.

The Cinderella Profession

Life however was a continued struggle; the Theatre Technician was in general limited to the anaesthetic aspect of theatre. There were many reasons for this, one was that in those early days the patient, in many cases was “gassed” down, and as you know when the patient goes into stage two of unconsciousness they tend to fight, the man’s superior strength was needed to restrain the patient at that point.

It must be said though, the main reason is, what I call the Loo syndrome ; ODPs go to the Gents and nurses go to the Ladies. The Anaesthetic room was the Gents and the Scrub side was the ladies.
It was the case also those patients were transferred to the operating table by stretcher, and with limited staff the OTT was a great asset.
As a result, it was nearly always the case to see a man in the role as OTT.
There were many Doctors who supported the wider use of OTTs, several of them are very well known globally; for instance the extracts from a letter below from the BMJ in Feb 1951, is from Alfred Lee who was the co-author of "A synopsis of Anaesthesia".
He worked at the Southend hospital (which I myself worked about ten years ago and worked alongside another of the authors of the Synopsis, Rushman).

The letter read "Operating Theatre Technicians : Sir, we heartily endorse the views expressed in the annotation (January 13, p. 80) dealing with the aims, objects. And scope of work of operating theatre technicians. It is high time that the facts concerning these men were more widely known and that the widespread wholly erroneous belief that they are merely theatre orderlies was corrected".
It goes on to say: "Surely theatre technicians deserve better than to be classed by the Whitley Council with theatre porters and domestic workers, and surely by now a satisfactory decision concerning their status and wage claims should have been reached."10
He was not the only eminent anaesthetist to support the OTTs plight, there were several others, and many of them are known historically as the great pioneers and modernisers of Anaesthetics.

But on the other side there were those who were vehemently opposed us.
Below is an extract taken from a letter from David Aitkin, taken from the BMJ in reply to Alfred Lees letter, it would probably sum up the attitude towards OTTs from most surgeons, the support we got was in the main from anaesthetists, and this ignorant and most likely arrogant surgeon from Sheffield was what they were up against.
OTT Scored
OTT being Scorned by the Surgeon


The letter also sums up the divide between the North of the country where most theatres were dominated entirely by female Nurses, using men just as porters to put the patients on the table and help position them and the London and big city hospitals that have employed men in a more technical role for years.
"Operating Theatre Technicians : Sir, I strongly oppose the introduction of operating theatre technicians except at small outlying hospitals which cannot attract sufficient suitable nursing personnel." It goes on to say: "What will the position of the theatre sister become? A theatre sister worth her salt will not tolerate this intrusion on her rights." And I suppose his main reason: "Give me the pleasant female nursing staff any time in preference to male".11 If you read into his letter it seems his argument is against men working in theatre, maybe he feels that he would not be able to bully the staff if they were men.

It is interesting to note that a reply was given by several people to his letter (none in support of his views) but I will show one on the next page in particular, from a senior theatre sister from St Thomas's, one of the biggest hospitals in the world at the time.

Apart from being completely sexist by saying that only women should work in the operating theatre (which could still a silent wish of a lot of surgeons) It is quite ironic that the letter states that teaching hospitals could well avoid the OTT.

However, that was Sheffield, in reply to the letter from Aitkin, a Senior Theatre Sister from St Thomas’s hospital in London, which is also one of the most famous teaching hospitals in the world and smack bang in the centre of London, replies to his letter with: "Operating Theatre Technician: As senior theatre sister at St. Thomas's Hospital, with many years of experience, I find they are essential to the smooth working of a busy operating unit in a large hospital".12
It surprised some but not too many who worked in the capital hospitals that a senior nurse should write in support of the OTT, it did not surprise the OTT in London because they were recognised for what they did by all the nursing and anaesthetic staff.

So, history shows that the Theatre Technician struggled to gain recognition as a serious group within the theatre environment, and certainly had the Cinderella image as a profession within the theatre team. This was mostly due to the growing influence of the nurse (with the backing of the surgeon) within the theatre environment who was resisting any incursion into what they now saw as their domain.

It was in 1970 that Lewin pointed out the lack of identity of this group of Theatre Practitioners in the theatre environment and made known that the OTTs skills was being wasted by just working on the anaesthetic side of theatre work.13
This resulted in a name change, to clear any previous identity problems, to the Operating Department Assistant, with the City & Guilds qualification 752 being the formalised training programme that all could relate to.

The ODA started to be recognised in some if not most areas of the country; however, they were still mainly used for anaesthetics. The anaesthetist that introduced Halothane into use Michael Johnstone was a great champion of the Theatre Technician and was influential in the setting up of the recognised City and Guilds course.

There was a change of training techniques in the 80's and the National Vocational Qualification (NVQ) was put into place this incurred yet another name change, this time to Operating Department Practitioner which it still used today.

Bevan reported in 1989 and urged the system to consider ODP's for all roles in theatres but recommended that they be subject to the same registration system as their nursing colleagues. 14
There was a voluntary registration system in place since 2000 but that has now been taken over (2004) by the Health Professional Council (HPC) who now control registration for all ODP's. The Operating Department practitioner now undertakes a two-year diploma course at university.

In the future, a full-time degree course will almost certainly replace this qualification. The future is looking better for the ODP's as there is now a wide acceptance of them in the majority of trusts up and down the country.

There are still those hospitals that still look upon ODP's as a lesser entity in theatre and go all out to protect the hierarchy ensuring the nurse will always be on top. There are several ODP theatre managers and senior staff in Trusts up and down the country. However, there are still far too many trusts who do not Trust (pun intended) ODPs and will prefer nurses, especially in theatre management.

As Operating Department Practitioners and Theatre Nurses, we are valued members of a surgical team. Our main aim is to ensure that the patient gets the best possible treatment while in our care, within the operating theatre department.

Our aim is achieved by giving technical assistance to the surgeon, anaesthetist and other physicians. It also requires us to directly treat patients, as one example, in the recovery room by administering pain prevention medication and anti-emetics. We are required to maintain our professional development, keep up to date with current thinking on medicine in the theatre environment, and accumulate a great deal of knowledge with regards to the wide range of equipment that is employed within today’s operating theatres, anaesthetic rooms and recovery suites.

We need to be able to adjust quickly to the changes brought about by the development of new complex equipment, new surgical procedures and coping with the ever-changing Clinical Governance issues that are brought in.

Improving efficiency in the Operating theatre is on-going and reliant on the wealth of expertise gained from those individuals who work within the department.

Patient care issues are now addressed at regular audits, and data collection at those audits, help to increase understanding.
When acted upon, this in turn improves the competence of all those who work with patients within the department. It is the duty of everybody to sound out how procedures could be improved for the benefit of the patient.
We as ODP's and Nurses need to fine-tune our skills to a new higher level to ensure maximum safety and efficiently for both patient and staff.

Surgery that historically is described as the art and practise of treating injuries, deformities and other disorders by manual and instrumental means is advancing rapidly and we have to keep up with the developments.

There is a greater awareness of the need for infection control to be maintained by the minute within the theatre suite, and where there is patient contact.

Association of Operating Theatre Technicians

So, it was then that the male theatre assistants started to disappear after the Great War, but never the less, quite a good proportion were still in employment; this was because a good proportion of the female nurses returned to home life, and had children, and there was no maternity pay then.
FST at WORK
FST AT Work


It was the case however that the surgeon had got used to the gentle submissive character of the nurse in theatres, and some preferred them for that reason. It is also true to say that the women were less costly to employ, and in the pre-NHS world that was a large bargaining factor for the women.

Then the depression hit the world, the great stock exchange crash of the late 20s put many out of employment. Then the Second World War was upon us, and the military recruited in huge numbers soldiers to train as Operating Theatre Technicians. The women you see were not required to go into the forward hospitals and field surgical teams, just the base hospitals.

Post war there were a lot of these OTTs who returned to civilian jobs, and especially in the big hospitals of the capital and South East, they were welcomed as an asset to the anaesthetic role that required you not only to assist the anaesthetist but also help in many other areas, the training received in the services was far better than most civilian nurses or doctors expected.

It was on the advice of the pioneering anaesthetist Ivan Magill to an OTT who worked at the UCH called Stan Warner, when he said that:"It’s time you lot got together and produced a training programme so that anaesthetists where ever they went can get the same standard of assistants where ever they go"15

That statement led to five OTTs discuss and form the Institute of Operating Department Technicians, in a pub, in London.

A couple of years ago now I had a very long discussion with Frank Pyke who I probably met when I worked at the Brook hospital in 1978.
He told me how the feeling was at the end of the war; OTTs were being discharged from the military, although trained to work in the theatre environment they found it difficult to find employment for what they were trained to do, and especially in the North, being offered jobs as porters at best.

The basis of the problem was that in general apart from the service personnel who left and joined a hospital after the war, the theatre attendant (as the male worker in theatre was known at that time) was basically self-taught, and there was no formal training to speak of.16

So, the Association was formed, and a training programme was set in place, although they trained for all aspects of theatre work, they concentrated their main efforts on the then developing anaesthetic side of the profession. The committee then wrote to the BMJ with support from many areas to ask them to recognise the OTT.

A couple of years after the formation Stan Warner wrote for support from the BMJ for the Association of Operating Theatre Technicians. Part of it read: 24 May 1947, Association of Operating Theatre Technicians, Now a body of men with many years' experience in. theatre work have formed an association under the heading of the “Association of Operating Theatre Technicians,”7 Part of the BMJ response after deliberation with their various committees: “Anaesthetists Group Committee of the Association lately received a deputation from the Association of Operating Theatre Technicians, who desire to establish themselves as a recognized auxiliary, The Anaesthetists Group Committee feel that the time is appropriate officially to recognize this auxiliary occupation, and this view has been endorsed by the Consultants and Specialists Committee of the Association."9

References:

1 College Of Operating Department Practitioners
2 http://www.bartsandthelondon.nhs.uk/about-us/our-history/history-ofmodern-medicine-and-timelines/the-history-of-the-royal-london-hospital/ (Bell)  
3 The London Hospital E.W Morris 1930  
4 http://www.whonamedit.com/doctor.cfm/2003.html (Key Hoo Loo)  
5 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)93645-7/abstract 
6 Sally Garner COPD 
7 http://www.guysandstthomas.nhs.uk/about/organisation/nhs_60th_years_im age_gallery.aspx  
8 Courtesy of The Royal London Hospital Archives & Museum. 
9 ampley at Home, The London Hospital Gazette, No31, December 1898 
10 J. Alfred Lee, T. C. Thorne Br Med J 1951;1:417 doi:10.1136/bmj.1.4703.417c (Published 24 February 1951) (Ref) Lee  
11 Br Med J1951;1:820 doi:10.1136/bmj.1.4710.820-a (Published 14 April 1951)Aitkin  
12 Br Med J 1951;1:1330 doi:10.1136/bmj.1.4718.1330-a (Published 9 June 1951)Nixon  
13 Lewin Report Organisation and Staffing Of Operating Departments. London: HMSO, 1970  
14 Bevan Report Staffing and Utilisation of Operating Theatres: A Study Conducted Under the Guidance of a Steering Group. Leeds: NHS Management 
15 Br Med J 1947;1:741 doi:10.1136/bmj.1.4507.741-c (Published 24 May 1947) (Warner)  
16 Frank Pyke FIOT 


Ken True ODP
Author
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