The advances in Anesthesiology is the single most important development, in the last century in medical field, which has become a boon to the patients undergoing procedures. This has helped in eliminating mankind’s greatest fears, i.e. pain of surgery. The quest of finding an agent and technique to relieve pain while doing procedures was the direct result of anesthesiologists being unhappy with and needing better tools to properly and safely anesthetizing patients. Let’s delve deep into the history to know and understand, how it has advanced from a mere chance finding to a fully developed medical specialty.
Modern and effective anesthesia has its origins in the mid-nineteenth century but the search for an anesthetic agent/technique is going on, since last five thousand years. Our ancestors tried nerve compression, cold water-ice combination, hypnosis, and even alcohol to relieve surgical pain. But to their dismay, nothing worked even close to their expectations.
Neither Humphrey Davy’s exclusive work and a well researched 580-page book Nitrous Oxide in 1800, nor English surgeon Henry Hill Hickman’s attempt of using high concentration of carbon dioxide in 1824, could discover surgical anesthesia.
Ether comes in picture-
Diethyl ether was certainly known in the sixteenth century in Europe. But for the next three centuries, its routine use was an inexpensive recreational drug among the poor of Britain and Ireland. Even the distinguished British scientists Robert Boyle, Isaac Newton and Michael Faraday did not show interest and could not make conceptual link to surgical anesthesia.
Real breakthrough came in January 1842, when William E. Clarke, a medical student from Rochester, New York, administered ether from a towel, to a young woman for her tooth extraction. However, it was assumed that her unconsciousness was due to hysteria and Clarke was advised to conduct no further anesthetic experiments. Two months later, on March 30 1842 Crawford Williamson Long, administered ether with a towel in Jefferson, Georgia. He removed two small tumors on the neck of the patient successfully and charged $ 2.00 as the first fee for anesthesia and surgery.
Horace Wells, a dentist from Hartford, Connecticut developed interest in Nitrous Oxide but unfortunately his first public demonstration of its efficacy as a complete surgical anesthetic failed. Ironically, the credit of first successful public demonstration of anesthesia goes to his small time student WTG Morton, from New England, on the historical day of October 16, 1846 at Massachusetts General Hospital. On this day, a vascular lesion on the neck of a patient was removed after being given ‘Letheon”, which was simply diethyl ether.
Chloroform makes its entry-
James Young Simpson, an obstetrician from Edinburgh, Scotland first published about Chloroform in ‘The Lancet” in November 1847. Chloroform gained popularity after John Snow used it to deliver the last two children of Queen Victoria. When the Queen endorsed obstetric anesthesia saying “the effect was soothing, quieting and delightful beyond measure”, religious debate over the practice of labor analgesia ended soon. In 1848, Snow introduced Chloroform inhaler. He published two remarkable books, on the inhalation of the vapor and ether  and on Chloroform and other Anesthetics .
The first elective use of oral intubation for an anesthetic was undertaken by Scottish surgeon William Macewan in 1878. An American surgeon Joseph O’Dwyer is remembered for his extraordinary dedication to the advancement of tracheal intubation. In 1888, his metal laryngeal tubes with conical tip along with the bellows and T-piece designed by George Fell, the Fell-O’Dwyer apparatus was used during thoracic surgery. After O’Dwyer’s death, a German surgeon Franz Kuhn did outstanding work on tracheal intubation. He described techniques of oral and nasal intubation and even monitored the patient’s breath sounds continuously through a monaural earpiece.
The first direct vision laryngoscope was devised by Alfred Kirstein in Berlin in 1895. Although it was not used by anesthesiologists, it was the forerunner of all modern laryngoscope. The design is useful even today!
The most distinguished innovator in tracheal intubation was the self-trained British anesthetist Sir Ivan Magill. He, while serving the Royal army, along with Stanley Rowbotthom , gained expertise in blind nasal intubation in 1920, Magill devised an aid to manipulating the catheter tip ,the “Magill angulated forceps”’ which continues to be manufactured even after 100 years. Robert Miller in the USA and Robert Macintosh in England, created their respectively named blades within an interval of two years in the 1940’s.
This memoir would be incomplete without the mention of Dr Archie Brain, who revolutionized airway management by devising Laryngeal Mask Airway in 1983.
Carl Koller, a Viennese surgical intern, first recognized the utility of Cocaine as an effective local anesthetic. His article presented in Germany on September 15 1884, revolutionized ophthalmic surgery and other surgical disciplines. In December 1884, two young surgeons, William Halsted and Richard Hall, described blocks of the sensory nerves of the face and arm.
The term spinal anesthesia was coined by a neurologist Leonard Corning in 1885, who ended up giving cocaine extradurally. Since August bier described authentic spinal anesthesia, with the mention of CSF, he got the credit of introducing spinal anesthesia. He even reported intravenous regional anesthesia technique in 1908, known today popularly as Bier’s block. Heinrich Quincke of Kiel, Germany in 1899, made a breakthrough observation that it was most safely performed between third and fourth lumbar inters-pace because entry here was below the termination of spinal cord.
Thus, the discovery of anesthesia is a saga of many hits and misses. There are many unsung heroes whose painstaking work failed to impress and make an impact in the progress of anesthesia. Techniques and drugs, once popular, were later on criticized and labelled dangerous by subsequent researchers. Important findings were sometimes ignored until they were studied again several decades later.
- Barasch PG et al. Clinical Anesthesia (2014) Seventh edition.
- Miller RD et al. Miller’s anesthesia (2010) Seventh edition
By Dr Sachin M Sadawarte
MD, DNB (Anesthesiology)
Consultant Anesthesiologist, Nagpur