Anaesthesia and the Practice of Medicine: Historical Perspectives

Abstract

This is a delightful volume written by two retired anaesthetists, one a Cambridge graduate and the other a graduate from Harvard. Both worked together at the Massachusetts General Hospital in 1954–55. The book is divided into five parts. Part 1 deals with the origins of anaesthetic drugs. The first use of anaesthetics is open to considerable doubt but excluding alcohol, hemlock, hemp and laudanum, the earliest recorded soporific effects of ether were described as far back as 1540. Nitrous oxide, discovered by a clergyman, Joseph Priestley, started off as a recreational drug and as a cure for tuberculosis and other respiratory illnesses. Beddoes and Humphrey Davy identified its pain relieving properties and in 1800 proposed its use in surgery. It was not until 44 years later that nitrous oxide was used to relieve pain during surgical procedures. Volatile anaesthetics ether and chloroform also started off as recreational drugs and cocaine, the first effective local anaesthetic, continues in that role. Cocaine was initially used to anaesthetise the cornea in eye surgery but as far back as 1889 it was used by the German surgeon August Bier to produce spinal anaesthesia. The last chapter in this section deals with the mechanical aspects of anaesthetics and their development – ventilators, heart-lung machine, and various types of anaesthetic apparatus. Part 2 identifies the impact of a number of historical events, notably the Second World War, and the individuals who helped to establish anaesthetics as an important scientific and clinical discipline. The section concludes with three chapters on curare and neuromuscular blockade reflecting the enormous contribution of these drugs to modern day anaesthesia and the strong research interest of the authors. Part 3 deals with the extension of anaesthesia into other areas of medical practice – maintenance of respiration in poliomyelitis and other diseases requiring respiratory intensive care, cardiac bypass for open heart surgery, cardio-pulmonary resuscitation and the development of short-acting anaesthetic agents for day surgery. Halothane hepatitis and the safety of anaesthetic agents are also discussed. Part 4 discusses the role of the anaesthetist in childbirth and in the care of the newborn. Opposition to pain relief during Victorian times was largely silenced by Queen Victoria'a pronouncement, “We are going to have this baby and we are going to have chloroform”. The important contribution of Virginia Apgar to neonatal intensive care is also discussed. She introduced her Apgar score in 1953, which is probably the most famous eponymous acronym in medicine – Appearance, Pulse, Grimace, Activity, Respiration. The final section concludes on a less optimistic note. This chapter concludes that anaesthetics, like a number of other medical academic disciplines, faces two major problems: the impact of the European Working Time Directive on clinical services and training, and the erosion of the academic base that is essential for the future development of the discipline. Together Keith Sykes and John Bunker have built up a wonderful and engaging story of anaesthesia over the last two centuries from laughing gas parties and ether frolics to the targeted use of local and general anaesthetics used today. The volume clearly details how the skills that were developed in the operating room have been increasingly applied to many other diseases and disciplines within medicine. Anaesthetists, surgeons, those involved in pain management and intensive care and those interested in medical history will be enthralled and captivated by this book.