Anaesthesia

2. Development of Anaesthesia

2. Development of Anaesthesia The wor d 'anaesthesia ' i s derive d fro m th e Gree k an d mean s 'withou t feeling' . Dioscorides, the Greek surgeon in the army of the Roman Emperor Nero, first used it in A D 60. I t wa s introduce d int o genera l usuag e i n 184 7 b y th e famou s America n thinker Olive r Wende l Holmes . I t wa s believed tha t th e first docto r t o us e diethyl ether wa s Crawfor d Williamso n Lon g i n 184 2 in th e U.S.A. , bu t i t ha s sinc e bee n discovered tha t nearl y 10 0 year s befor e him , anothe r surgeo n b y th e nam e o f M. Turner advocated the inhalation of ether to relieve pain. Dr McEwen of Glasgow is credited with being the first to use, in 1883 , metal endotracheal tube s passed, wit h the ai d o f touch , throug h th e mouth . However , alread y 30 0 year s befor e that , Vesalius mentioned endotracheal insufflatio n an d resuscitation . D r Marc o Severin o is credited wit h using, in 1646 , a freezing mixtur e of ice for surgica l local analgesia . However, again , alread y 60 0 year s befor e him , Avicenn a (wh o compounde d hi s famous Cano n a s wel l a s describin g carcinom a o f oesophagus ) ha d similarl y de scribed the use of snow and ice. We are inclined to think that extradural and cauda l analgesia, as practised today, are some new developments, but in 1901 , Cathelin an d Sicard wer e advocatin g an d practisin g thes e methods . Anaesthetist s nowaday s ar e greatly concerne d wit h metabolic effects o f anaesthetic agents. However, Lavoisier , the famous French chemist, had already called attention to body chemistry and C0 2 formation. Unfortunately , h e wa s guillotine d durin g th e Frenc h Revolutio n a s a 'useless aristocrat'. The histor y o f anaesthesi a ma y b e divided int o tw o periods : th e pre-anaestheti c and th e anaesthetic . Th e forme r end s an d th e latte r begin s wit h th e first us e o f diethylether to alleviate the pain of surgical operations in 1842 and its general acceptance in 1846. The Pre-anaesthetic Period The exact beginning of the use of anaesthesia is not known. The earliest evidence of surgery was found i n the paleolithic caves in Spain, where fingers were discovered t o have been amputated i n ritual ceremonies as early as 20,000-25,000 BC . Much later , trephining operations were practised by the ancient Incas. These are thought to have started first a s ritua l rite s an d late r a s therapeuti c measure s t o 'le t of f evi l spirits' . They ma y hav e bee n attempt s a t decompressio n o f increase d intracrania l pressur e caused by expanding intracranial lesions, possibly even cerebral tumours. The repute d ancien t Chines e surgeon , Hau-to , i s sai d t o hav e carrie d ou t suc h Development of Anaesthesia 15 varied procedures as venesections, resections of spleen, liver and intestine s and acu puncture . Al l ancien t script s o n surger y deal t mainl y wit h th e car e o f injuries , traumatic as well as those sustained in battles. What i s considered t o be an early reference t o general anaesthesia i s found i n th e Book of Genesis, chapter 2 , starting at verse 21: 'And th e Lord Go d cause d a dee p sleep to fall upon Adam and he slept; and he took on e of his ribs and close d up th e flesh thereof.' Ther e ar e othe r reference s suggestin g tha t narcotic s ma y hav e bee n used in pre-anaesthetic times. For example: (1) Homer , i n The Odyssey, says : 'Helen dropped int o th e wine of the soldier s "a n antidote to grief and pain" including oblivion to all ills.' (2) Herodotus , i...