• Oliver Wendell Holmes in 1846 was the first to propose use of the term anesthesia to denote the state that incorporates amnesia, analgesia, and narcosis to make painless surgery possible.
  
• Ether was used for frivolous purposes (“ether frolics”) and was not used as an anesthetic agent in humans until 1842, when Crawford W. Long and William E. Clark independently used it on patients. On October 16, 1846, William T.G. Morton conducted the first publicized demonstration of general anesthesia for surgical operation using ether.
  
• The original application of modern local anesthesia is credited to Carl Koller, at the time a house officer in ophthalmology, who demonstrated topical anesthesia of the eye with cocaine in 1884.
  
• Curare greatly facilitated tracheal intubation and muscle relaxation during surgery. For the first time, operations could be performed on patients without the requirement that relatively deep levels of inhaled general anesthetic be used to produce muscle relaxation.
  
• John Snow, often considered the father of the anesthesia specialty, was the first to scientifically investigate ether and the physiology of general anesthesia.
  
• The “captain of the ship” doctrine, which held the surgeon responsible for every aspect of the patient’s perioperative care (including anesthesia), is no longer a valid notion when an anesthesiologist is present.

The Greek philosopher Dioscorides first used the term anesthesia in the first century AD to describe the narcotic-like effects of the plant mandragora. The term subsequently was defined in Bailey’s An Universal Etymological English Dictionary (1721) as “a defect of sensation” and again in the Encyclopedia Britannica (1771) as “privation of the senses.” Oliver Wendell Holmes in 1846 was the first to propose use of the term to denote the state that incorporates amnesia, analgesia, and narcosis to make painless surgery possible. In the United States, use of the term anesthesiology to denote the practice or study of anesthesia was first proposed in the second decade of the twentieth century to emphasize the growing scientific basis of the specialty.

Although anesthesia now rests on scientific foundations comparable to those of other specialties, the practice of anesthesia remains very much a mixture of science and art. Moreover, the practice has expanded well beyond rendering patients insensible to pain during surgery or obstetric delivery (Table 1-1). The specialty uniquely requires a working familiarity with a long list of other specialties, including surgery and its subspecialties, internal medicine, pediatrics, and obstetrics as well as clinical pharmacology, applied physiology, and biomedical technology. Recent advances in biomedical technology, neuroscience, and pharmacology continue to make anesthesia an intellectually stimulating and rapidly evolving specialty. Many physicians entering residency positions in anesthesiology will already have multiple years of graduate medical education and perhaps even certification in other medical specialties.

This chapter reviews the history of anesthesia, emphasizing its British and American roots, and considers the current scope of the specialty.

The specialty of anesthesia began in the mid-nineteenth century and became firmly established less than six decades ago. Ancient civilizations had used opium poppy, coca leaves, mandrake root, alcohol, and even phlebotomy (to the point of unconsciousness) to allow surgeons to operate. Ancient Egyptians used the combination of opium poppy (containing morphine) and hyoscyamus (containing scopolamine); a similar combination, morphine and scopolamine, has been used parenterally for premedication. What passed for regional anesthesia in ancient times consisted of compression of nerve trunks (nerve ischemia) or the application of cold (cryoanalgesia). The Incas may have practiced local anesthesia as their surgeons chewed coca leaves and applied them to operative wounds, particularly prior to trephining for headache.

The evolution of modern surgery was hampered not only by a poor understanding of disease processes, anatomy, and surgical asepsis but also by the lack of reliable and safe anesthetic techniques. These techniques evolved first with inhalation anesthesia, followed by local and regional anesthesia, and finally intravenous anesthesia. The development of surgical anesthesia is considered one of the most important discoveries in human history.

Inhalation Anesthesia

Because the hypodermic needle was not invented until 1855, the first general anesthetics were destined to be inhalation agents. Diethyl ether (known at the time as “sulfuric ether” because it was produced by a simple chemical reaction between ethyl alcohol and sulfuric acid) was originally prepared in 1540 by Valerius Cordus. Ether was used for frivolous purposes (“ether frolics”), but not as an anesthetic agent in humans until 1842, when Crawford W. Long and William E. Clark independently used it on patients for surgery and dental extraction, respectively. However, they did not publicize their discovery. Four years later, in Boston, on October 16, 1846, William T.G. Morton conducted the first publicized demonstration of general anesthesia for surgical operation using ether. The dramatic success of that exhibition led the operating surgeon to exclaim to a skeptical audience: “Gentlemen, this is no humbug!”

Chloroform was independently prepared by von Leibig, Guthrie, and Soubeiran in 1831. Although first used by Holmes Coote in 1847, chloroform was introduced into clinical practice by the Scot Sir James Simpson, who administered it to his patients to relieve the pain of labor. Ironically, Simpson had almost abandoned his medical practice after witnessing the terrible despair and agony of patients undergoing operations without anesthesia.

Joseph Priestley produced nitrous oxide in 1772, and Humphry Davy first noted its analgesic properties in 1800. Gardner Colton and Horace Wells are credited with having first used nitrous oxide as an anesthetic for dental extractions in humans in 1844. Nitrous oxide’s lack of potency (an 80% nitrous oxide concentration results in analgesia but not surgical anesthesia) led to clinical demonstrations that were less convincing than those with ether.