We have just had three visiting American anesthetists lecturing at my hospital
as part of our CME (Continuous Medical Education) requirements. It was
interesting to exchange medical practices between Asia and the US.
One of the visitors, Dr. Tony Tsai, mentioned the history of
anesthesia, so I thought we might look at that, this week. We marvel at the
surgical advances in the past century, but while I take my hat off to the
surgeons, the real praise goes to the anesthetists. Without the advances in
anesthetics, brawny assistants would still be holding patients down while
surgeons attacked with scalpels and saws and the patient lay there screaming.
Yes, that was the way it was up to around the Crimean War 150
years ago. The best surgeons were the quickest surgeons. The incredible searing
pain only had to be endured for a shorter time. The famous surgeon, Dr. Pott,
was able to disarticulate an ankle and dip the soggy end of the lower leg into
boiling pitch in 15 seconds. Bite on the bullet for quarter of a minute! Yes, we
have improved a little since then.
The first anesthetic agent was ether, dribbled on to a mask
to knock the patient out and allow the surgeon to take his time and become
meticulous in his approach. The first public demonstration of ether anesthesia
took place on 16 October 1846, at Massachusetts General Hospital in Boston. The
anesthetist was William Morton and the surgeon was John Warren; and the
operation was the removal of a lump under the jaw of a Gilbert Abbott. Those
three have left their mark in medical history.
While there have been enormous advances since then, I can
remember being a medical student and assisting at an operation in outback
Australia in 1964. The anesthetic was ether, dribbled on to the patient’s gauze
mask by the matron of the public hospital, and it was a Caesarian section for
twins. There was no air-conditioning and it was 43 degrees in the theatre, where
the fumes were making us all woozy. Amazingly everyone survived the ordeal,
mother, twin sons, the local doctor, the matron and me.
Despite outback Australia, anesthesia progressed in the rest
of the world. Chloroform was introduced by James Simpson, the Professor of
Obstetrics in Edinburgh, in November 1847. This was a more potent agent but it
had more severe side effects, including sudden death. However, it worked well
and was easier to use than ether and so, despite its drawbacks, became very
popular.
The next major advance was the introduction of local
anesthesia - cocaine - in 1877. Things definitely did go better with ‘coke’!
Then came local infiltration, nerve blocks and then spinal and epidural
anesthesia, which in the 1900s allowed surgery in a relaxed abdomen, and is
still used today, especially in obstetric anesthesia, where the mother can be
anaesthetized without the baby being affected as well.
The next important innovation was the control of the airways
with the use of tubes placed into the trachea. This permitted control of
breathing and techniques introduced in the 1910s were perfected in the late
1920s and early 1930s. Then came the introduction of intravenous induction
agents. These were barbiturates which enabled the patient to go off to sleep
quickly, smoothly and pleasantly and therefore avoided any unpleasant
inhalational agents. Then in the 1940s and early 1950s, there came the
introduction of muscle relaxants, firstly with curare (the South American Indian
poison, but not administered by native blowpipe) and then agents less dangerous.
In the mid 1950s came halothane, a revolutionary inhalation
agent, which was much easier to use, but now superseded by even more potent, but
less dangerous anesthetic agents.
According to Dr David Wilkinson of the Association of
Anesthetists of Great Britain and Ireland, “Anesthesia is now very safe, with
mortality of less than 1 in 250,000 directly related to anesthesia.
Nevertheless, with today’s sophisticated monitoring systems and a greater
understanding of bodily functions, the anesthetic profession will continue to
strive for improvement over the next 150 years.”
On behalf of all patients requiring surgery in the future,
may I thank Dr. Tony Tsai and his colleagues all over the world. No longer do
they have to bite on a bullet!
