A BRIEF HISTORY OF ANAESTHESIA.
The development of anaesthesia since its introduction in 1846 has been erratic.
Anaesthesia as we know it today was first used by W.T.G.Morton of Boston in the United States, who gave ether to Gilbert Abbott, at the Massachusetts General Hospital on the 16th October 1846.
C.W.Long of Georgia had given some of this agent on several occasions in 1842, but had failed to report his work.
Ether was administered by Robert Liston, a Surgeon trained in the United States, but working in London on a patient named Frederick Churchill, the operation was for an amputation through the thigh of the patient. This was performed at the University College Hospital, London on the 21st December 1846.
The technical difficulties associated with the use of ether were partly overcome by the substitution of chloroform, by James Young Simpson, professor of midwifery at Edinburgh University in 1847. He poured drops of this newer agent onto gauze held near the face of the patient, thus avoiding the use of the inhalers used for ether. Chloroform tended to be used more in Scotland than in England because of the accidents and deaths associated with it during anaesthesia.
Chloroform was also used widely in the greater part of Europe, and in the southern states of America, while ether remained the favourite agent in England and the northern states of America. There was much controversy as to which was the safer agent, but eventually ether won the day.
In 1858, John Snow, who was England's leading Physician/Anaesthetist died, and his place was taken by J.T.Glover. Between these two men, and partly due to their influence, the administration of anaesthetics in the United Kingdom has always been in the hands of medical men and, as time passed, it was to be in the hands of Doctors who were specialists in anaesthesia.
During this period of history nitrous oxide had been in use in the United States, and in 1863 G.Q.Colton endeavoured to popularize the gas. Its disadvantages were difficulty in administration and evidence of asphyxia during its use. The latter was partly overcome by Edmund Andrews of Chicago, who, in1868, gave it with 20% oxygen. Paul Bert of Paris gave it under pressure (compressed) ten years later in 1878.
The first major war in which anaesthetics were used was the Crimean War 1854-1855. It is a fact that twenty five years after Morton first used ether during surgery, operations were still in the main being performed without any form of anaesthesia.
During the next forty to fifty years there were few significant changes in anaesthesia, but in the nineteen twenties the pace of progress quickened. In the nineteen twenties ether and chloroform were the main agents used, but ethyl Chloride and Nitrous Oxide were often used for induction.
Simpsons open drop method was the most popular, and the first Boyle machine appeared in 1917. Before the nineteen thirties, the Anaesthetist administered one or two volatile agents to produce a state of unconsciousness, muscle relaxation and also deafferentation. This gave rise to so called techniques of balanced anaesthesia. The amount of toxic drugs given to a patient was reduced therefore the hazards of general anaesthesia were also reduced.
In the nineteen thirties Magill and Rowbotham introduced endotracheal techniques, and with the appearance of Bromethol (Avetin), Divinyl Ether, Cyclopropane and Trichloroethylene, and the induction of anaesthesia by intravenous barbiturates, were innovations of this period. Because of the difficulty of obtaining relaxation of the jaw and larynx with ether, blind naso-tracheal intubation became popular.
Controlled respiration was used with cyclopropane, so that when curare was first tried out by Harold Griffith in Montreal in 1942, the way to deal with hypoventilation and apnoea was well established, and very soon Intermittent Positive Pressure Ventilation ( I.P.P.V.) became common practice.
This period in the history of anaesthesia could be said to have been the forerunner of the present day sophisticated anaesthetic techniques, for it produced many innovative ideas that were tried and introduced by many exiting and forward looking pioneers of medicine.