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A Brief History of Anaesthesia

A Brief History of Anaesthesia. Andrew Ronald Consultant Cardiac Anaesthetist Aberdeen Royal Infirmary. Why study the History of Anaesthesia?. An understanding of our past guides our future

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A Brief History of Anaesthesia

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  1. A Brief History of Anaesthesia Andrew Ronald Consultant Cardiac Anaesthetist Aberdeen Royal Infirmary alronald@tiscali.co.uk

  2. Why study the History of Anaesthesia? • An 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 alronald@tiscali.co.uk

  3. alronald@tiscali.co.uk

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  5. History of Anaesthesia • Pre-1846 - the foundations of anaesthesia • 1846 - 1900 - establishment of anaesthesia • 20th Century - consolidation and growth • 21st Century - the future alronald@tiscali.co.uk

  6. Pre-1846 The Foundations of Anaesthesia alronald@tiscali.co.uk

  7. Pre 1846 - The Foundations of Anaesthesia ……..so the Lord God caused him to fall into a deep sleep. While the man was sleeping, the Lord God took out one of his ribs. He closed up the opening that was in his side……... Genesis 2:21 NIrV alronald@tiscali.co.uk

  8. Drug methods Alcohol Opium (poppy) Hyoscine (Mandrake) Cannabis (Hemp) Cocaine (New World) Non-drug methods Cold Concussion Carotid compression Nerve compression Hypnosis Blood letting The Foundations of Anaesthesia alronald@tiscali.co.uk

  9. The Foundations of Anaesthesia • Status of surgery • Barber shop surgeons • Types of surgery • Amputations & dental extractions • No antisepsis • Appalling mortality • Indications • Unbearable pain • Crippling deformity • Imminent death alronald@tiscali.co.uk

  10. “…the case was an interesting one of a white swelling, for which the thigh was to be amputated. The patient was a youth of about fifteen, pale, thin but calm and firm. One professor felt for the femoral artery, had the leg held up for a few moments to ensure the saving of blood, the compress part of the tourniquet was placed upon the artery and the leg held up by an assistant.The white swelling was fearful, frightful. A little wine was given to the lad; he was pale but resolute; his Father supported his head and left hand. A second professor took the long, glittering knife, felt for the bone, thrust the knife carefully but rapidly. The boy screamed terribly; the tears went down the Father’s cheeks. The first cut from the inside was completed, and the bloody blade of the knife issued from the quivering wound, the blood flowed by the pint, the sight was sickening; the screams terrific; the operator calm….” Contemporary description of surgery, 1841 alronald@tiscali.co.uk

  11. What changed? alronald@tiscali.co.uk

  12. alronald@tiscali.co.uk

  13. 1540: synthesis of ether 1628: circulation of blood 1744: ether inhalation suggested to treat pain 1770’s: research on CO2 1771: discovery of O2 1772: “Mesmerism” 1773: discovery of N2O 1794: gas therapy in illness 1709: iron formed from coke 1712: first steam engine 1733: flying shuttle (1745: Battle of Culloden) 1769: water frame 1769: Watt steam engine 1771: cotton mills 1779: first iron bridge (1789: French Revolution) 1801: first steam carriage Industrial and Scientific Revolution alronald@tiscali.co.uk

  14. Industrial and Scientific Revolution • Late 1700’s • lots of new gases identified • attempts to apply gas knowledge to medicine • directed at treatment of existing diseases rather than novel use • Gases of importance • nitrous oxide • ether • carbon dioxide • oxygen alronald@tiscali.co.uk

  15. Gas Therapy in Illness • Pneumatic Institute, Dowry Square, Clifton, Bristol • founded by Thomas Beddoes (1760-1808) in 1794 with equipment designed by James Watt (1736-1819) • attempted to use used gas therapy (incl. oxygen, nitrous oxide & ether) to treat diseases incl. asthma, dropsy, consumption, & venereal disease alronald@tiscali.co.uk

  16. Pneumatic Institute New medical institution.Upper end of Dowry-Square, Hotwells, corner house. Treating incurable diseases.Medical professors at Edinburgh.Many Physicians in England.Consumption, Asthma, Palsy, Dropsy, obstinate Venereal Complaints, Scrophula or King's Evil.Other incurable diseases.Patients treated gratis.Expectation: Considerable portion of cases will be permanently cured.Methods are not hazardous or painful. Attendance will be given from 11 till 1 o'clock by Thomas Beddoes or Humphrey Davy. Subscriptions for support of Institution received by John Savery, Esq., Narrow Wine Street, Bristol. Bristol Gazette March 21 1799 alronald@tiscali.co.uk

  17. Pneumatic Institute Humphrey Davy (1778-1829) • became Superintendant in 1798 • continued Priestley’s and Beddoe’s Work • Nitrous oxide & Ether alronald@tiscali.co.uk

  18. Humphrey Davy & the Pneumatic Institute • Recognised analgesic properties of N2O and christened it “laughing gas” • first tentatively suggested a use during surgery “…as nitrous oxide in its extensive operation appear capable of destroying physical pain it may be used with advantage during surgical operations in which no great effusion of blood takes place …” alronald@tiscali.co.uk

  19. Gas Therapy in Illness Nitrous oxide Ether alronald@tiscali.co.uk

  20. Nitrous oxide • 1800: Davy’s thesis • 1834: Colton “anaesthetised” 6 Red Indians by mistake • 1844: Horace Wells had his own tooth pulled under N2O - “a new era in tooth pulling” • 1845: Wells “failed” to demonstrate N2O at MGH alronald@tiscali.co.uk

  21. 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: research at Pneumatic Institute alronald@tiscali.co.uk

  22. Ether • 1818: Michael Faraday (1791-1867) described “narcotic effects” of ether alronald@tiscali.co.uk

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

  24. Ether • 1842: first use as clinical anaesthetic in USA • 16th October 1846: first public demonstration of ether anaesthesia in Boston, Mass. alronald@tiscali.co.uk

  25. William T G 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.” alronald@tiscali.co.uk

  26. So why no anaesthesia until 1846? • Why did Davy not pursue his work? • no real concept of “anaesthesia” in late 1700’s / early 1800’s  how can you achieve a state which you assume impossible or cannot envisage achieving • Pneumatic Institute concerned with treatment of disease by “Physicians” - surgery did not have same standing and therefore influence • State of surgery - almost inevitably fatal - why encourage them? • General moral / religious beliefs and fear / concerns about animal experimentation alronald@tiscali.co.uk

  27. So why no anaesthesia until 1846? Or wasn’t there? alronald@tiscali.co.uk

  28. Henry Hill Hickman (1800-1830) alronald@tiscali.co.uk

  29. Henry Hill Hickman and carbon dioxide • Born at Lady Halton, Bromfield, Shropshire • matriculated at Edinburgh University 1819 • attended lecture “On Asphyxia” by Henry Goldwyer - “a temporary suspension of the vital functions arising from a deficiency of atmospheric air..” and described reversal using artificial respiration & electrical restarting of heart • admitted as member of RCS London 1820 • set up practice in Ludlow, Shropshire alronald@tiscali.co.uk

  30. Henry Hill Hickman • 1821-1824: series of experiments on small animals to induce “suspended animation” • semi-asphyxiation due to air starvation or by breathing Carbonic Acid (CO2) gas • after unconsciousness was induced Hickman operated on them - amputations, removal of ears, skin incisions - and observed responses to surgery, evidence of pain, amount of bleeding and time to recovery • 1824: attempted to bring work to notice of Royal Society alronald@tiscali.co.uk

  31. Henry Hill Hickman alronald@tiscali.co.uk

  32. Henry Hill Hickman “……there is not an individual who does not shudder at the idea of an operation however skillful the Surgeon or urgent the case, knowing the great pain that the patient must endure, and I have frequently lamented, when performing my own duties as a Surgeon, that something has not been thought of whereby the may be tranquillised and suffering relieved …..I have been induced to make experiments on Animals, endeavouring to ascertain the practicability of such treatment on the human subject……I have witnessed results which show that it may be applied to the animal world , and ultimately I think will be used with perfect safety and success in Surgical operations…..I have never known of a case of a person dying after inhaling Carbonic Acid gas if proper means were taken to restore the animal powers …..” alronald@tiscali.co.uk

  33. Henry Hill Hickman • 1824: moved to Shifnal • 1824: “A Letter on Suspended Animation” (W Smith, Ironbridge, 1824) to TA Knight of Downton Castle alronald@tiscali.co.uk

  34. Henry Hill Hickman • 1825: having failed to attract attention of Knight, Davy and Royal Society wrote to Shrewsbury Chronicle (dated 3rd June) • Anonymous writer (“Antiquack”) responded to “Letter on Suspended Animation” and Shrewsbury Chronicle article in The Lancet 1825 alronald@tiscali.co.uk

  35. Henry Hill Hickman • “…can he for a moment suppose that any medical man of sense and judgement will be so far led away by a proposal so utterly at variance with all he has ever heard, saw, or read, of the deleterious effects of respiring the fixed air to believe that that this letter was published with any intention of benefiting mankind... intended to serve as a decoy by which credulous may be induced to give up their senses as well their cash to men…” • “…an open and downright quack is superior to a plausible quacking physician… “ alronald@tiscali.co.uk

  36. Henry Hill Hickman • “…I sincerely hope, and believe, for the credit of the profession, be utterly impossible to find any surgeon so great a fool, and so unwarrantably bold as to undertake that operation on such terms..” • “…I do fervently hope that the letter itself may be a complete hoax, and not written by Dr Hickman; for, in this age of science and gentlemanly acquirement, I feel assured, that no man who has any claim to the honourable appellation of a Doctor of Physic would so far disgrace both his profession and himself by writing such a tissue of quackery, which he himself, and every medical man must know is (to say the least) humbug” signed Antiquack, The Lancet 1825 alronald@tiscali.co.uk

  37. Henry Hill Hickman • 1828: appeal to Charles X of France - referral to Royal Academy of Medicine in Paris • 1829: returned to practice in Tenbury Wells, Shropshire alronald@tiscali.co.uk

  38. Henry Hill Hickman • 1830: died; buried in Bromyard churchyard alronald@tiscali.co.uk

  39. Henry Hill Hickman • 1847: letters in Lancet by Thomas Dudley of Kingswinford identifying Hickman’s work with reports of “the Letheon” • 1912: first modern reference to Hickman Thompson CJS. Brit Med Jour 1912 ; i: 843-845 • 1930: plaque erected by Section of Anaesthetists of RSM alronald@tiscali.co.uk

  40. 1846-1900 The Establishment of Anaesthesia alronald@tiscali.co.uk

  41. General Anaesthesia Ether spread to Europe Nitrous oxide Chloroform James Young Simpson John Snow Local Anaesthesia anaesthesia without sleep New techniques early landmarks 1846-1900 alronald@tiscali.co.uk

  42. Ether • 16th October 1846: first public demonstration of ether anaesthesia in Boston, Mass. • “Gentlemen this is no humbug. We have seen something today that will go round the world” alronald@tiscali.co.uk

  43. Ether - the news spreads • Letter and other papers from Jacob Bigelow (description of his daughters surgery under ether and relevant copy of Boston Daily Adveriser) sent to Francis Boott in London • News carried by Cunard paddle steamer “Acadia” leaving Boston 3rd Dec 1846 and arriving Liverpool 16th Dec 1846 alronald@tiscali.co.uk

  44. Ether - the news spreads • 17th Dec 1846: Boott received letter and arranged with dentist James Robinson to experiment with ether inhalation • 19th Dec 1846: ether administered by James Robinson to a Miss Lonsdale for molar extraction at Boott’s home • 21st Dec 1846: Robert Liston, Professor of Surgery at University of London publicly amputated the leg of Frederick Churchill at UCH - “This Yankee dodge beats mesmerism hollow” alronald@tiscali.co.uk

  45. Ether - the Dumfries connection • William Fraser • Cunard Ship’s surgeon • 19th December 1946 • ? 1st European use of Ether anaesthesia • What case? • probably an amputation of a leg in a patient run over by a cart - patient died alronald@tiscali.co.uk

  46. Ether - the news spreads • 1847: arrival of Ether Anaesthesia announced in first edition of “The Lancet” of 1847 • Letter from Francis Boott • Letter to Boott from Henry Bigelow • Paper from Boston Medical and Surgical Journal • Robert Liston’s own experiences alronald@tiscali.co.uk

  47. Ether - the news spreads • 1847: Liston became an increasingly important supporter of ether in the following months at a time when many surgeons tried, then abandoned its use returning to practice without anaesthesia • Reasons for possible abandonment • attempts to “patent” anaesthesia and so limit its use • inadequate anaesthesia • excessive secretions • vomiting patients • risk of explosion and fire (candlelight!) • perceived “risks” of rendering patient unconscious for surgery alronald@tiscali.co.uk

  48. Nitrous oxide • 1847: Horace Wells published paper “A History of the Discovery of the Application of Nitrous Oxide Gas, Ether and Other Vapours to Surgical Operations” • 1863: Colton “reintroduced” N2O, primarily for dental surgery • 1865: N2O cylinders available in London • 1881 pain relief in labour • 1887 Hewitt “gas and oxygen machine” alronald@tiscali.co.uk

  49. 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 alronald@tiscali.co.uk

  50. 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 alronald@tiscali.co.uk

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