History of anaesthesia

A Brief History
of Anaesthesia
BY
DR PARTH SHAH
DR DIVYA KHESKANI
alronald@tiscali.co.uk

Why study the History of Anaesthesia?
 Understanding of our past guides our future
 The history of surgery is inextricably linked to
the development of appropriate anaesthetic
techniques and so the history of surgery
follows the history of anaesthesia
 We are all part of it

“Pre-history”
 The Roman writer Celsius encouraged
“pitilessness” as an essential characteristic
of the surgeon
 Authors of leading surgical texts often
ignored surgical pain as a topic of discussion
 In Liston's time, as in the countless ages
before, pain was considered primarily a
symptom of importance

Despite this sentiment, many different
agents were used to achieve anesthesia.
 A physician from the first century
A.D., commented upon mandragora.
 He stated that the plant substance
could be boiled in wine and strained,
and used “in the case of persons . . .
about to be cut or cauterized, when
they wish to produce anesthesia.”
 Mandragora was still being used to
anesthetize patients as late as the
17th century.

History of Anaesthesia
 Pre-1846 - the foundations of anaesthesia
 1846 - 1900 - establishment of anaesthesia
 20th Century - consolidation and growth
 21st Century - the future

The Foundations of Anaesthesia

Pre 1846 - The Foundations of
Anaesthesia
 Drug methods
 Alcohol
 Opium (poppy)
 Hyoscine (Mandrake)
 Cannabis (Hemp)
 Cocaine (New World)

The Foundations of Anaesthesia
 Non-drug methods
 Cold
 Concussion
 Carotid compression
 Nerve compression
 Hypnosis
 Blood letting

Henry Hill Hickman (1800-1830)
•Attended lecture “on asphyxia”
by henry goldwyer - “a temporary
suspension of the vital functions
arising from a deficiency of
atmospheric air..”.
•he studied & described reversal
using artificial respiration &
electrical restarting of heart

Ether
 1540: synthesised and named “sweet oil of vitriol” by
Valerius Cordus
 renamed “ether” by Frobenius
 1744: Matthew Turner published essay suggesting its
inhalation in certain types of pain
 late 1790’s: researched at Pneumatic Institute started &
clinical use of ether was experimented

Ether
 Michael Faraday
(1791-1867)
 1818: described
“narcotic effects”of
ether

Ether
 Benjamin Brodie (1783-1862)
 1821: demonstrated to Royal
College of Surgeons that ether
inhalation could induce
insensibility in a guinea pig
 “….ether acted like a narcotic
poison……”

Ether
 1842: first use as
clinical anaesthetic
in USA
 16th October
1846: first public
demonstration of
ether anaesthesia
in Boston, Mass.

Ether - the news spreads
1847: arrival of Ether Anaesthesia announced in first edition of “The
Lancet” of 1847

William T. Morton
 Inventor and Revealer of
Inhalational Anaesthesia:
 Before Whom, in All Time,
Surgery was Agony;
 By Whom, Pain in Surgery
was Averted and Annulled;
Since Whom, Science has
Control of Pain.”

 Before the invention of the hollow needle and an
awareness of aseptic technique, the only class of
potential anesthetics that could offer a prompt,
profound, and temporary action were the inhaled
drugs.
Morton's ether inhaler (1846)

Joseph Clover
 Clover was the first anaesthetist to administer
chloroform in known concentrations through the
Clover bag.
 After 1870, Clover favored a nitrous oxide–ether
sequence. The portable anesthesia machines that
he designed were in popular use for decades
after his death.
 He was the first Englishman to urge the now
universal practice of thrusting the patient's jaw
forward to overcome obstruction of the upper
airway by the tongue.

Joseph Clover
 Joseph Clover (1825–1882) became the leading
anaesthetist of London after the death of John
Snow in 1858.
•Joseph Clover anesthetizing a patient with chloroform
and air passing through a flexible tube from a Clover bag.

John Snow: The First
Anesthesiologist
John Snow was already a respected physician who had
presented papers on physiologic subjects when the news
of ether anesthesia reached England in December 1846.
He took an interest in anesthetic practice and was
soon invited to work with many of the leading surgeons
of the day.
•He was not only facile at
providing anesthesia but was
also a remarkably keen
observer.
•His innovative description of
the stages or degreesof ether
anesthesia
•based on the patient's
responsiveness was not improved
upon for 70 years.

John Snow (1813-1858)
 Born in York in 1813
 became interested in
anaesthesia via work in
toxicology
 Researched in Newcastle,
then worked in London 1836-
1858 until his death
 acknowledged as “first full-
time” anaesthetist developing
ways to improve methods of
ether and chloroform
administration(4000 no)

John Snow's face mask
(1847).
The expiratory valve
can be
tilted to the side to
allow the
patient to breathe air.
John Snow's ether inhaler (1847).
The ether chamber (B) contained a
spiral coil so that the air entering
through the brass tube (D) was saturated
by ether before ascending the flexible
tube (F) to the face mask (G).
The ether chamber rested in a bath
of warm water (A).
John Snow: The First
Anesthesiologist

Nitrous oxide
 Nitrous oxide was first prepared in 1773
by Joseph Priestley, an English clergyman
and scientist, who ranks among the great
pioneers of chemistry.
 Like ether, nitrous oxide was known for
its ability to induce lightheadedness and
was often inhaled by those seeking a
thrill.
 It was not used as frequently as was
ether because it was more complex to
prepare and awkward to store.

Nitrous oxide
 Humphry Davy (1778–1829)
was a young man of ability and
drive.
 He performed a brilliant series
of investigations of several
gases but focused much of his
attention on nitrous oxide,
which he and his associates
inhaled through face masks
designed for the Institute by
James Watt, the distinguished
inventor of the steam engine
 1834: Colton “anaesthetised” 6
Red Indians by mistake

The Establishment of
Anaesthesia

1846-1900
 General Anaesthesia
 Ether
○ spread to Europe
 Nitrous oxide
 Chloroform
○ James Young
Simpson
○ John Snow
 Local Anaesthesia
 anaesthesia without
sleep
 New techniques
 early landmarks

James Young Simpson (1811-1870)
 Professor of Midwifery in
Edinburgh from 1840
 Tried chloroform on
himself and friends at
suggestion of David
Waldie, a chemist
 Secured and popularised
chloroform as clinical
anaesthetic, esp. in
Obstetrics

Chloroform
 1831: Chloroform synthesised
 1833: Cynthia Guthrie accidentally anaesthetised
herself!
 1847: Anaesthetic properties recognised
 1847: First clinical use, St Barts, London
 1847: James Young Simpson used chloroform for
obstetric anaesthesia

Chloroform
 1847: John Snow’s regulating
inhaler
 1847/48: Chloroform eclipses
ether
 1848: Hannah Greener - first
anaesthetic death
 1858: John Snow “On
Chloroform and other
anaesthetics”

The Discovery of Regional
Anesthesia in the 19 Century
 Cocaine, an extract of the coca leaf, was the first
effective local anesthetic.
 In 1884, Koller's friend, Sigmund Freud, became
interested in the cerebral-stimulating effects of cocaine
and gave him a small sample in an envelope, which he
placed in his pocket.
 When the envelope leaked, a few grains of cocaine stuck
to Koller's finger, which he casually licked with his
tongue.
It became numb.
 At that moment, Koller realized that he had found the
object of his search. He dashed to the laboratory and
made a suspension of cocaine crystals

 He and Gustav Gartner, a
laboratory associate, observed its
anesthetic effect on the eyes of a
frog, a rabbit, and a dog before
they dropped the solution onto
their own corneas.
 To their amazement, their eyes
were insensitive to the touch of a
pin.
The Discovery of Regional
Anesthesia in the 19 Century

Spinal anesthesia
 The term spinal anesthesia was
coined in 1885 by Leonard
Corning, a neurologist who had
observed Hall and Halsted.
 Corning wanted to assess the
action of cocaine as a specific
therapy for neurologic problems..”

 An intravenous regional technique with
procaine was reported in 1908 by August
Bier, the surgeon who had pioneered
spinal anesthesia.
 Bier injected procaine into a vein of the
upper limb between two tourniquets.
 Even though the technique is termed the
Bier block, it was not used for many
decades until it was reintroduced 55
years later by Mackinnon Holmes.
 Holmes used lidocaine, the very
successful amide local anesthetic
synthesized in 1943 by Lofgren and
Lundquist of Sweden.
Regional Anesthesia

Other 19th century Landmarks
 1865: Lister introduced “Carbolic spray” - antisepsis
 1878: first oral ETT - flexible brass, 0.95cm diam
 1891: first partial pneumonectomy; no ETT
 1894: first anaesthetic charts

Anaesthetic Equipment
 1908: Rotameters
 1917: Boyles machine (Plenum flow)
 1914-18: “Flagg can”

 1926: McKesson demand machine (intermittent flow)
 1938: Artificial respiration via ventilator
 1940: Oxford vaporiser

 1954: classification of breathing circuits
 1961: Manley ventilator
 1972: Bain circuit
 1976: Lack circuit

Anaesthesia in the 21st Century
The future of Anaesthesia is bright -
but we may see our roles and how we
practice might change

History of anaesthesia

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Semelhante a History of anaesthesia

Semelhante a History of anaesthesia (20)

Último

Último (20)

History of anaesthesia