Section I - Introduction
Chapter 1
- History of Anesthetic Practice
- Merlin D. Larson
The first anesthetics were given to ameliorate the pain associated
with dental extractions and minor surgery. As the complementary fields of surgery
and anesthesiology matured together, new skills were required of the anesthesiologist,
including expertise in resuscitation, fluid replacement, airway management, oxygen
transport, operative stress reduction, and postoperative pain control. Today, personnel
from the anesthesiology department are scattered in several locations throughout
the hospital, from the ambulatory care center to the intensive care unit. Organizing
the background of these various activities into a coherent historical document is
therefore complicated by the diverse roles that anesthesiologists play in the modern
hospital.
One approach to the history of anesthesiology is to relate in
detail the events surrounding the 1846 public demonstration of ether anesthesia by
William T. G. Morton (1819–1868).[1]
[2]
[3]
[4]
This event
represents the starting point from which anesthesiology emerged as a specialty.
Although the ether demonstration was dramatic and enacted by interesting personalities,
it was just the opening act of the pain control story. Since 1846, there has been
enormous progress and change in the specialty of medicine that has become known as
anesthesiology, and these changes often have occurred in small, incremental steps
that are hardly noteworthy on their own. Most operations in the modern operating
room could not have been performed before the great progress in anesthetic practice
that took place in the years between 1925 and 1960, but historians often overlook
these advances, because they were introduced without the drama and spectacle of previous
developments.
In addition to the advancements of the 20th century, it is necessary
to look prior to mid-19th century to appreciate the groundwork laid by those curious
individuals who sought a scientific understanding of cardiopulmonary physiology and
pain. These fundamental discoveries provide the physiologic foundation for safe
anesthetic practice. A brief survey of these developments is provided in the opening
sections of the following narrative. Dentists, priests, musicians, pediatricians,
engineers, ophthalmologists, neurophysiologists, pharmacologists, urologists, otolaryngologists,
surgeons, ministers, dilettantes, philosophers, physiologists, missionaries, chemists,
South American Indians, and anesthesiologists all had a role in shaping the practice
of contemporary anesthesiology, one of the most fascinating stories in the history
of medicine.
I have attempted to describe and reference the origins of ideas
relating to modern anesthetic practice, but the issue of priority is vague on some
topics and may be open to question by other historians of specific subjects. I have
attempted to verify information from several sources, including original manuscripts
whenever possible. Notably lacking are early references to anesthetic methods in
Asia, because these texts and manuscripts are difficult to obtain. The historical
developments of the subspecialties are not documented, but that information can be
obtained from specialized textbooks. Perhaps Sir William Osler (1849–1919)
expressed the difficulties of the medical historian best when he related the History
of British Medicine in an address to the British Medical Association in
1897.[5]
To trace successfully the evolution of any one of the learned professions would
require the hand of a master—of one who, like Darwin, combined a capacity for
patient observation with philosophic vision. In the case of medicine, the difficulties
are enormously increased by the extraordinary development, which has taken place
during the 19th century. The rate of progress has been too rapid for us to appreciate,
and we stand bewildered and as it were, in a state of intellectual giddiness, when
we attempt to obtain a broad, comprehensive view of the subject.
