The History of Anesthesia
Although most human civilizations evolved some method for diminishing patient discomfort, anesthesia, in its modern and effective meaning, is a comparatively recent discovery with traceable origins dating back 160 years. (An epitaph on a monument to William T. G. Morton, one of the founders of anesthesia, reads: “Before whom in all time Surgery was Agony.”) (Jacob AK, Kopp SL, Bacon DR, Smith HM. The history of anesthesia. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Ortega R, Stock MC, eds. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2013: 1–27.)
I. Anesthesia Before Ether
In addition to limitations in technical knowledge, cultural attitudes toward pain are often cited as reasons humans endured centuries of surgery without effective anesthesia.
Early Analgesics and Soporifics (Table 1-1)
Almost Discovery: Clarke, Long, and Wells
In January 1842, William E. Clarke, a medical student, may have given the first ether anesthetic in Rochester, NY, for a dental extraction.
Crawford Williamson Long administered ether for surgical anesthesia to James M. Venable on March 30, 1842, in Jefferson, GA, for the removal of a tumor on his neck. Long did not report his success until 1849 when ether anesthesia was already well known.
Horace Wells observed the “analgesic effects” of nitrous oxide when he attended a lecture exhibition by an itinerant “scientist,” Gardner Quincy Colton. A few weeks later, in January 1845, Wells attempted a public demonstration in Boston at the Harvard Medical School, but the experience was judged a failure.
Table 1-1 Early Analgesics and Soporifics
Mandragora (soporific sponge)
Alcohol
Diethyl ether (known in the 16th century and perhaps as early as the 8th century)
Nitrous oxide (prepared by Joseph Priestly in 1773)
Public Demonstration of Ether Anesthesia. William Thomas Morton Green was responsible for the first successful public demonstration of ether anesthesia. This demonstration, which took place in the Bullfinch Amphitheater of the Massachusetts General Hospital on October 16, 1846, is memorialized by the surgeon’s statement to his audience at the end of the procedure: “Gentlemen, this is no humbug.”
Chloroform and Obstetrics
James Young Simpson, a successful obstetrician of Edinburgh, Scotland, was among the first to use ether for the pain relief in obstetrics. He became dissatisfied with ether and encouraged the use of chloroform.
Queen Victoria’s endorsement of obstetric anesthesia resulted in acceptance of the use of anesthesia in labor.
John Snow took an interest in anesthetic practice soon after the news of ether anesthesia reached England in December 1846. Snow developed a mask that closely resembles a modern facemask and introduced a chloroform inhaler.
II. Anesthesia Principles, Equipment, and Standards
Control of the Airway
Definitive control of the airway, a skill anesthesiologists now consider paramount, developed only after many harrowing and apneic episodes spurred the development of safer airway management techniques.
Joseph Clover, an Englishman, was the first person to recommend the now universal practice of thrusting the patient’s jaw forward to overcome obstruction of the upper airway by the tongue.
Tracheal Intubation
The development of techniques and instruments for intubation ranks among the major advances in the history of anesthesiology.Related posts:
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