The History of Anesthesia

(An Hysterical Perspecitive)

The first recorded use of anesthesia goes back to the ancient Incas; shamans got coked-up cheing
coca leaves and drilled holes in the heads of their patients (to let the bad spirits escape) hile spitting
into the ounds they!d inflicted" The coke-resin-spittle substance numbed the site alloing hours of
drilling# not to mention singing and dancing" The bad humors ere knon to escape and move to
cooler climates"
This same process is still available to some at our better H$%&s" In fact# my psychiatrist as all
e'cited about getting coked-up and spitting at me hen I opted for the more subtle approach of a boot
to the groin# or (gestalt( as it is referred to in the )A Hospital *ystem"
%ur ne't historical reference to anesthesiology stepped into history ith the name +oseph Priestley
ho really anted to be an ordained minister until he met ,en -ranklin and caught a bit of the
science bug" .ontinuing his religious studies# he began to dabble in science despite his none'istent
training in the sub/ect" About the same time that he as ordained he also discovered that graphite
conducted electricity and then spent ay too much time trying to invent the electric pencil"
0iving ne't to a breery he 1uickly discovered alcohol and a gas the breing process gave off called
carbon dio'ide" He as soon leading the charge in the cola ars as he built up his reputation as the
-ather of *oda Pop" Priestly ent on to discover o'ygen# but that as a bit too late since e&d all
been breathing the stuff for thousands of years" Then one night in 2334# hile e'perimenting ith
some of the gasses he&d already discovered# he mi'ed them all up and created a ne gas# nitrous
o'ide# that caused him to see clearer hile feeling lightheaded" He /ust couldn&t stop laughing# so he
called it 0aughing 5as" Priestley ent on to discover other gasses but none of them made very good
colas or tickled him as much as his earlier e'periments# and most of them /ust made him meaner"
Priestley died years before reali6ing his goal of forcing hipped cream from containers ith
compressed nitrous o'ide"
The first really bad e'periment in history as later conducted by an American physician and chemist#
0atham $itchill" He gassed a bunch of animals ith nitrous o'ide# killing the lot" 7r $itchill
immediately proclaimed that nitrous o'ide as not only poisonous but also infectious# and /oined
forces ith the -irst 0ady to start up the (+ust *ay 8o To 8%( (8itrous %'ide) movement"
Apparently he&d forgotten to read up on %ur -riend The %'ygen $olecule# and $itchill left his mark
as the -ather of Asphy'iation"
Then along came Humphry 7avy# a 23 year-old college student# ho# hile looking for a bu66# took
a snootful of nitrous o'ide and did not die# but nearly died laughing" 7avy as a bright boy ho
immediately reali6ed that a bothersome isdom tooth felt /ust fine as he sucked on his laughing gas
and# orking part-time as a surgical assistant# he began theori6ing ho nitrous o'ide could be used to
avoid surgical pain for both the physician and the patient"
It should be noted that a surgical assistant# during this period in history# had to be a strapping young
man ith a firm grip# since it as his /ob to hold the patient don hile the surgeon orked 1uickly"
To dull the pain of minor surgeries# most patients drank copious amounts of alcohol# or smoked
opium or mari/uana" Heroin as a knon painkiller# but /ust didn&t do the trick hen your boels
ere torn open by an intrepid surgeon"
Hoever# do you remember that Priestley as a minister9 :ell# 7avy as a .alvinist" And to the
religious of the period# pain as part of 5od&s plan" -rom childbirth to death# pain as e'pected" It
as the punishment handed don from Adam and ;ve for listening to that snake in the grass"
*o even 7avy# hile cauteri6ing a dog bite ound on his leg# never considered using nitrous o'ide"
<es# he e'perimented# but e'periments ere one thing; relieving pain9 %h come no" :here&s the
fun in that9
7avy as much more interested in getting high than relieving pain" He mi'ed up batches of nitrous
o'ide and inhaled great giggly 1uantities at parties he thre for all his friends" $any celebrities of the
period attended 7avy&s gatherings# including the -amous Peter =oget ho got the idea for his
timeless Thesaurus at one of 7avy&s parties >social gathering# gathering# get-together (informal)#
festivity# revelry# merrymaking# bash# celebration# event# blast (slang)# social# bee# shindig (informal)#
thrash (informal dated? after getting stoned >drugged# high (slang)# into'icated (formal)# da6ed# under
the influence (informal)# euphoric# spaced-out (slang)# drunk# into'icated (formal)# under the
influence (informal)# blit6ed (informal)# plastered (informal)# smashed (informal)# reeling#
so66led (informal)# legless (@A# informal)? indulging in>en/oy# bask in# revel in# relish# make the most
of# take pleasure in# lu'uriate in# glory in# e'ult in# lie in# roll about in# immerse yourself in# indulge
in# delight in? vast 1uantities of nitrous o'ide >0aughing 5as?"
2
7avy began to consider abandoning science as he reali6ed he could turn a handsome profit selling
nitrous o'ide cheaper than alcohol" :ith this reali6ation# the concept of the +unkie as born and
7avy immediately became the -ather of *elling Pharmaceuticals That $ake <ou =eally High" *ome
minor historians believe that later he ent on to build the first meth lab# ride shot-gun in the first
drive-by# and died uttering his famous last ordB fashi666el"
4
Pushing into'icating drugs began catching on as an American medical student# by the name of
5ardner Cuincy .olton# gave his first public demonstration of nitrous o'ide for the sum of DEFE"GG
and 1uickly 1uit medical school to follo his life dream of peddling cheap thrills full time on the
road" He billed himself as 7r .olton and his 0aughing 5as (he kept the title (7octor( because he was
still prescribing)" At one of 7r .olton&s lectures# a dentist attended by the name of Horace :ells ho
itnessed a man by the name of *am .ooly# ho after taking in a lungful of gas# ent a bit berserk
and tore about the room ildly# finally landing ne't to 7r :ells ho immediately noticed *am&s
bleeding leg" :hen he asked *am ho that had happened# *am replied# semi-coherently# (7unno"(
:ells immediately sa the benefits of nitrous o'ide (if you can call having a leg half-torn off hile
cavorting about stoned out of your mind a benefit) and arranged for a general demonstration at
$assachusetts 5eneral Hospital in ,oston here he ould perform the first ever painless tooth
e'traction in the year 2HIE"
*adly# the orld had to ait a bit longer for the first ever painless tooth e'traction# as poor 7octor
:ells did not test his theory" He ran headlong into surgery ith students and administrators looking
on" :ells might not have administered enough gas# for the patient cried out during the procedure#
destroying the good doctor&s reputation" :ells retreated to his home a broken man here he rote
letter after letter to the heads of 7o .hemical accusing them of replacing his nitrous o'ide ith
helium and eventually became a traveling salesman selling canaries and shoer baths" ,ut his first
love# nitrous o'ide and other into'icating chemicals never left him and he began e'perimenting on
himself and eventually became addicted to chloroform" :ells&s life ended in prison# here he
committed suicide (some say# 1uite painlessly)"
F
In :ells&s audience that sunny day of 2HIE as an astute pupil# by the name of :illiam $orton ho#
knoing he could still be called (7octor( by attending a much easier 7ental .ollege# (borroed( the
techni1ue of gassing patients into painlessness and 1uickly populari6ed it"
The era of painless dentistry had begun# and sadists everyhere ould have to find different
professions to occupy themselves# such as an esthetician or a yoga instructor"
;ther# an organic solvent# had been discovered by a *paniard called 0ullius in 243E" 8ot having the
cramped 1uarters of today&s modern dry cleaners# no one reali6ed they could get high from it till the
2HGGs"
I
Thenalong came a 7r .raford :illiamson 0ong from +efferson# 5eorgia ho# hile stoned
on ether fumes at a party# noticed that he had bruised himself but had felt no pain" %n $arch FG#
2HI4# 0ong convinced a patient# +ames )enable# ith to cysts in his neck# to try a bit of ether"
)enable sniffed the ether# passed out# and 0ong operated# removing both cysts and a considerable
portion of his allet" The operation as a successJ
7r 0ong ould have gained a pretty hefty reputation in history books had he published his results#
but he kept e'perimenting for the ne't seven years# and by the time he published in 2HIK# to people#
physician .harles +ackson and our dentist friend# :illiam $orton# had (borroed( his techni1ues too
and in ,oston&s $assachusetts 5eneral Hospital (apparently the $ecca for anesthesiologists) on
%ctober 2L# 2HIL# in front of an audience of famous surgeons and a fe less famous surgeons#
anestheti6ed to patients and then beat the stuffing out of them for the ne't hour" The surgeons truly
en/oyed the performance"
About this time# bitter arguments heated up over ho should be credited as the father of
anesthesiology and even .ongress got into it# and for 2L years dragged its feet in a manner that ould
not be e1ualed till the early 42
st
century hen food safety issues and orker in/ury issues took a back
seat to ta' breaks for the underprivileged ealthy class"
,ut another rench as about to be tossed into this debate (can they do that9) hen chloroform as
used successfully as anesthesia in 2HI3" .hloroform had been around since 2HF2# but again# its
inventors ere too busy getting stoned to really care" It asn&t until everyone else had gotten famous
making other people high that chloroform came into its on"
The donside to anesthesia seems to be that no doctors could take their time" 7id e say
(donside9( <es# because surgeons eren&t 1uite sterile yet (many ore the same surgical scrubbies
they!d orn for years ithout ever ashing them; the blood caked cotton smocks being their red
badge of courage)# and by taking their time# breaking for lunch# tossing -risbees around the surgical
room# and andering into the reception room to feed the fish# patients /ust got septic" $ore and more
patients ere reporting that they felt no pain hatsoever as the coroner placed pennies over their
closed eye lids"
$edical science ould have to ait for a good bottle of 0isterine to be invented and that ould have
to ait for the invention of carbolic acid" It ould also have to ait for doctors to learn to ash their
hands" Then there&s the official time lag in medicine here all the entrenched physicians call the
people ith ne solutions Cuacks" This (Cuack( lag-phase ill be talked about later in our article on
The History of Cuackery"
Today# in ,oston# a statue stands# erected to the -ather of Anesthesiology" If you ever visit there# you
ill note# after alking around the statue# that there is no name listed" 8o one seems to agree on ho
should be credited as the -ather of Anesthesiology"
0et this be a lesson to all of you" If you ant to be famous for inventing something# don!t sit around
for the ne't fe years getting stoned or no one ill ever kno ho really invented it"
And one more thing should be understood from all this research is that the main difference beteen
illegal drugs and legal drugs is that feer people are killed using illegal drugs than using legal drugs"
0egal drugs are those that make lots of money for the pharmaceutical interests" *o# if you&re on a
legal high# you can thank a billionaireJ
2" Than' to Encarta Thesaurus M 4GGG $icrosoft .orporation" All rights reserved" 7eveloped for
$icrosoft by ,loomsbury Publishing Plc" for all the synonyms"
4" 7avy actually settled don and though he as erratic in his focus at times# he ent on to become
one of the top scientists of his time# as instrumental in early ork ith many nely discovered
elements (such as iodine)# named the element aluminum# helped $ichael -araday get started# as
knighted# and married a ealthy ido" In the last years of his life# his late forties# 7avy as very ill#
probably from his (huffing( every substance he discovered# and finally died of a heart attack at the
age of E2"
F" The patient used in the demonstration told :ells afterards that he really did not feel any pain# but
as scared and cried out" :ells spent many months riting letters# but not to 7o .hemicalB he as
trying to resurrect his reputation and establish himself as the -ather of Anesthesiology" The rest of
that paragraph# though seemingly absurd# is all true"
I" *ome historians credit $ichael -araday (the same $ichael -araday 7avy helped get started)# the
-ather of ;lectricity# ith the discovery of ether" Hoever# not being a stoner# he merely dabbled ith
ether as a solvent and ent on to make even greater discoveries than his /unkie friends ho insisted
on testing things till they ere# visibly# blue in the gills"
Articles T%.
A history of anesthesia or "pain killing" techniques throughout history
Anesthesia, historical background and the the word's origin
Pain# hoever useful as a arning signal designed to keep living organisms from damaging
themselves too badly# becomes useless agony hen operations must be performed" Attempts to
control pain ere many" The use of alcohol or some form of hat came to be called hypnotism as
old" Acupuncture as used in the %rient" The ne chemistry also contributed nitrous o'ide# hich#
hen inhaled# served to suppress the sensation of pain"
As time ent on# substances; such as# diethyl ether (more commonly simply called ether) and
chloroform ere found to cause unconsciousness during hich the sensation of pain disappeared"
;ther came to be use by physicians during operations# the first to do so being an American physician#
.raford :illiamson 0ong (2H2E-2H3H)# ho used it in 2HI4 to remove a tumor" He did not publish
or publici6e his ork# hoever"
An American dentist# :illiam Thomas 5reen $orton (2H2K-2HLH)# used ether on a patient in
*eptember# 2HIL# hile e'tracting a tooth" The patient told about the e'perience to a nespaper# and
$orton as urged to demonstrate the use of ether during an operation at the $assachusetts 5eneral
Hospital"
It as this demonstration that effectively introduced the practice into medicine# so that $orton
usually gets credit for the discovery of this method of suppressing pain during the dental process"
American physician Oliver endell Holmes !"#$%&"#%'( suggested the term anesthesia, from
the )reek words meaning "no sensation"
%liver :endell Holmes# a physician-poet and the father of the *upreme .ourt /ustice of the
same name# rote the folloing on 8ovember 42# 2HILB
N;very body ants to have a hand in a great discovery" All I ill do is to give you a hint or to
as to namesOor the nameOto be applied to the state produced and the agent" The state should# I
think# be called PAnaesthesia& (from the 5reek ord anaisthesia# Plack of sensation&)" This signifies
insensibility " " " The ad/ective ill be PAnaesthetic&" Thus e might say the state of Anaesthesia# or
the anaesthetic state"Q
This citation is taken from a letter to :illiam Thomas 5reen $orton# ho in %ctober of that
year had successfully demonstrated the use of ether at $assachusetts 5eneral Hospital in ,oston"
Althoughanaesthesia is recorded in 8athan ,ailey&s Universal Etymological English Dictionary in
2342# it is clear that Holmes really as responsible for its entry into the language" The Oxford
English Dictionary has several citations for anesthesia and anesthetic in 2HI3 and 2HIH# indicating
that the ords gained rapid acceptance"
O-rom The American Heritage Dictionary of the English anguage#
Frd edition# Houghton $ifflin .ompany# ,oston# 2KK4"
*lysses +impson )rant, ,ommander&in&,hief of the *nion forces during the ,ivil ar and
-resident of the *nited +tates died of throat cancer in "##./
N5rant&s consumption (of cigars) 6oomed to 4G stogies a day# a habit he continued until doctors
ordered him to 1uit in 2HHI" He died of throat cancer in 2HHE# after losing 3G of his 4GG pounds and
becoming addicted to cocaine to ease the pain"Q
O NA *togie :arning# chic-and dangerous#Q !ewswee"# 7ecember 4# 2KKL# p" 3E"
Anesthesia & The 0uture Of Anesthesia
*ince :orld :ar II# many changes have taken place in anesthesiology" Important discoveries have
been made ith such volatile li1uids as halothane and synthetic opiates" The technology of delivery
systems has been greatly improved" ,ut ith all these changes# the basic goal of anesthesia has been
the sameOthe control of a motionless surgical field in the patient" In the ne't EG years it is possible
that the goals of anesthesia ill be idened" The role of anesthesia ill broaden as neer surgical
techni1ues develop in the area of organ transplants" Anesthesia may also be used in the future to treat
acute infectious illness# mental disorders# and different types of heart conditions" There may be a
ide range of ne therapeutic applications for anesthesia"
Anesthesiologists compete strongly for research funds" ,etter trained anesthesiologists need to do
research to gain further knoledge on the effects and mechanisms of anesthesia" *ince understanding
and controlling pain is the central problem of anesthesiology# it ill be necessary to gain more
knoledge about the mechanism of pain and pain control" 8e anesthetics# delivery# and monitoring
systems ill need to be developed to keep up ith the pace of medical development as it moves
closer to noninvasive surgical techni1ues"
1esources
2ooks
2arash, -aul )/, 2ruce 0/ ,ullen, and 1obert 3/ +toelting/ Clinical Anesthesia. -hiladelphia4
5ippincott, "%%6/
$cAenry# 0eda $" and ;velyn *alerno" #osby$s %harmacology in !ursing& PhiladelphiaB $osby#
2KHK"
+ordan P" =ichman
=ead moreB Anesthesia - The -uture %f Anesthesia - *urgical# Pain# 7elivery# $ental# 5ain# and
Anoledge httpBRRscience"/rank"orgRpagesRFL4RAnesthesia-future-anesthesia"htmlSi'662=6T0)G6T
HISTORY OF ANAESTHESIA
Ancient and 7ediaeval times
7rugs available for relief of pain
Alcohol
%pium (Poppy)
Hyoscine ($andrake U others)
.annabis (Hemp)
.ocaine V in 8e :orld only
Non drug methods
.old
.oncussion
.arotid compression
8erve compression
Hypnosis
,lood letting
Leading up to 1846
2E2L action of curare observed
2EIG ether synthesised
2EL4 ParW used nerve compression
2L4H Harvey described circulation of blood
2LLE first I) in/ection V opiate through a 1uill
2334 $esmer V Panimal magnetism&
2333 Priestley prepares 84%
2HG3 0arrey - sno for amputations
2H42 ,rodie gives ether to guinea-pigs;
2HI4 Hickman uses .%4 on animals
2HF2 5uthrie et al - .hloroform synthesised
2HI4 .larke and 0ong used ether for operations; unreported
2HIF -irst -=.* V before both anaesthesia and antisepsisJ
2HII :ells used 84%; public demonstration at $5H Pfailed&; cries of NHumbugQ
2HIE ;sdaile V 3F operations under hypnosis
2H4LVIE at the $ass" 5en"Hosp" there ere only FFF operations over 4G years"
*ocial 8ote
In the 23R2Hth centuriesB public e'ecutions X entertainment"
,efore 2HIL there had been 4E years of peace# rapid industrialisation and rapid groth of tons"
,y 2HFG there as overcroding# not enough clean ater# poor seerage; not enough graveyards"
In 2HFF the -actory Act as passed; 2HI2-IH the $ines Act# Ten Hours Act# Public Health Act"
%ctober 2Lth 2HIL
-irst successful public demonstration of anaesthesia
$assachusetts 5eneral Hospital# ,oston
AnaesthetistB :illiam Thomas 5reen $orton
AgentB 7iethyl ;ther
PatientB 5ilbert Abbott
+ome events after "#'8
2HI3 *impson
2HI3 *no
2HI3 *no
2HIH Heyfelder
2HEI *no
2HLE 0ister
2H3H $aceen
2HHI Aoller
2HK2Tuffier
2HK4 *chleich
2HKI
2HK3
.hloroform
On the 'nhalation of Ether
chloroform regulating inhaler
;thyl chloride used in 5ermany
,road *t pump-handle removed
carbolic spray
first oral ;TT; fle'ible brass# FRH( diam
cocaine
first partial pneumonectomy; no ;TT
infiltration 0A
anaesthetic charts
first death from a motor car
2HKE .orning
2HKH ,ier
2KGI
2KG3
2K4G =obotham
2K42
2KFI
2KF3 $acintosh

spinal anaesthesia for relief of pain
spinal anaesthesia for surgery
procaine V a huge advance
intra-tracheal insufflation (chloroform)
blind nasal intubation ith ide bore tube
lumbar epidurals
cyclopropane# thiopentone
2st ;uropean chair of anaesthesia

2HKE .orning
2HKH ,ier
2KGI
2KG3
2K4G =obotham
2K42
2KFI
2KF3 $acintosh

spinal anaesthesia for relief of pain
spinal anaesthesia for surgery
procaine V a huge advance
intra-tracheal insufflation (chloroform)
blind nasal intubation ith ide bore tube
lumbar epidurals
cyclopropane# thiopentone
2st ;uropean chair of anaesthesia

2KI2
2KI4
2KIL
2KE2
2KE4 Ibsen
2KEL +ohnstone
2KHG onards
Trilene
curare first used in anaesthesia
lignocaine
su'amethonium
IPP= for bulbar poliomyelitis
introduces halothane
use of halothane declines# as ne ethers introduced
TH9 0:1+T )9;91A5 A;A9+TH9T:, :; 21:+TO5
<r 1 eller
.onsultant Anaesthetist# -renchay Hospital# ,ristol

,ristol as among the cities that reported the use of ether as an anaesthetic ithin the first eeks of it
being demonstrated in 0ondon# although there is some doubt about the precise date hen the
operation took place"
The suggested dates of first ether anaesthetic in ,ristolB
FGth 7ecember 2HIL 0ancet
F2st 7ecember 2HIL 0ondon $edical 5a6ette and ,ristol $irror
2st +anuary 2HI3 ,ristol 5a6ette# -eli' -arley!s ,ristol +ournal and The Times
Ith +anuary 2HI3 7evelopment of Inhalational Anaesthesia
F2st August 2HEG *hort History of the ,ristol 5eneral Hospital
The last to dates are clearly rong" *ince no hospital records remain# one is left ith a choice of
three days# FGth 7ecember and F2st 7ecember 2HIL# and 2st +anuary 2HI3" :e can eliminate FGth
7ecember" The only letter referring to this date as ritten to eeks later# appearing in
the l#ancet of 2Lth +anuary"2 It as ritten by the surgeon# + 5 0ansdon# and startedB !*ir# I find#
from 7r -airbrother# that he has sent you a letter respecting the operation I performed on the FGth ult#
hilst the patient as under the influence of ether!
The letter that 7r -airbrother had sent to the 0ancet as acknoledged in an earlier issue4 but as
never published" Hoever# it did appear in the 0ondon $edical 5a6etteF This letter startedB !*urgical
operation ithout painB - Thursday# F2st 7ecember# a young manY 7ated Ith +anuary# this is
obviously better evidence; -airbrother is more likely to have remembered the actual day of the
operation after four days# than 0ansdon after to and a half eeks" The nespapers vary in their
detailed accounts of the procedure as much as they vary in the day they said it occurred" 8ot only do
they disagree about the date# the F2st or the 2st# but compound the disagreement by specifying
Thursday and -riday"
The Place
There is no doubt that the anaesthetic as given at the ,ristol 5eneral Hospital" The hospital
occupied 22# 24 and 2F 5uinea *treet# having been founded in 2HF4" It as e'panded in 2HEH# and
again in 2H3E" A ,ristolian of one hundred and forty years ago ould easily recognise the buildings
that the 8H* inherited# and still occupies today"
The patient
The patient as a young man ho had a left above-knee amputationB !rendered necessary by a hite
selling of three years duration!F As far as can be ascertained# he did ell after his operation# and at
the end of +anuary as !1uite ell# and in a state to leave the hospital; no unfavourable symptoms of
any kind having manifested themselves!I The surgeon# +ames 5oodall 0ansdon as# in 2HIL# the
senior surgeon to the ,ristol 5eneral Hospital" He is dealt ith more fully in 7r ,ennett!s paper (see
comment belo)"

The anaesthetic
The method of administration of the ether# using a common bladder# as described in a letter to The
TimesE ritten by a ell knon ,ristol chemist# :illiam Herapath# and dated 2st +anuary 2HI3B
!8o complicated apparatus is necessary# nor any e'traordinary care in purifying the ether" A common#
but very large# bladder should be fitted ith a collar to hich an ivory mouthpiece ith a very large
bore can be screed ithout the intervention of any stopcock; pour in about an ounce of good
common ether (mis-spelt in The Times as either)# and blo up the bladder ith the mouth till it is
nearly full; place the thumb on the mouthpiece# and agitate the bladder so as to saturate the air in it
ith the vapour; as soon as the patient is ready for the operation# close his nostrils# introduce the
mouthpiece and close the lips around it ith the fingers" He must no breathe into and out of the
bladder# and in about one or to minutes the muscles of his lips in lose their hold" This is the
moment for the first cut to be made" In to or three minutes# the effect ill begin to disappear; the
mouthpiece should again be introduced# and this repeated as often as re1uired" If the pulse should
indicate a sinking of the patient# a little ine ill restore him"!
*ignificantly# Herapath then addedB
!2 have no doubt but the inspiration of nitrous o'ide (laughing gas) ould have a similar effect upon
the nerves of sensation as the vapour of ether# as I have noticed that persons under its influence are
totally insensitive to pain# but I do not think it ould be advisable to use it in surgical cases# from its
fre1uently producing an ungovernable disposition to muscular e'ertion# hich ould render the
patient unsteady# and embarrass the operator"!
The anaesthetist
There are to candidates for the honour of giving the first anaesthetic in ,ristol" They have both been
mentioned already - 7r Ale'ander -airbrother and $r :illiam Herapath" As ith the date# the
evidence differs as to hom the honour is due" Three sources# the 0ondon $edical
5a6etteF# the ,ristol $irrorL and -eli' -arley!s ,ristol +ournal3use the same ordingB
!At the suggestion of 7r -airbrother# the senior physician to the hospital# $r 0ansdon# the operating
surgeon# as induced to try the effect upon the patient of the inhalation of the vapour of sulphuric
ether" ,y this mode# the patient is thron into a state of utter insensibility# by means of the bladder
used in imparting the laughing gas# into hich $r Herapath introduced the ether# and caused the
patient to inhale the vapour" After one minute and a half the patient as unconscious; the surgeon
then commenced his incision" After the lapse of to or three minutes# 7r -airbrother again
administered the vapour# keeping his fingers on the patient!s pulse# and atching his breathing"!

-rom this it ould seem that $r Herapath induced anaesthesia# and 7r -airbrother then took over and
maintained it" The ord !again! in !7r -airbrother again administered the vapour! must refer to the
administration# and not the administrator" The Times reportE is identical# e'cept that by omitting the
sentence !by this mode Y" inhale the vapour!# all mention of Herapath administering the ether is also
omitted" This is compensated for by the long letter from Herapath on the method of administration
hich then folloed" The ,rislol 5a6etteH under the headingsB !Painless *urgical %perations! and
!*uccessful application in ,ristol! gives 7r -airbrother the honour of suggesting the use of ether# but
$r Herapath the sole honour o(the administration" It seems relevant to compare the careers of these
to protagonists# to see hich as the more likely to have had the foresight to recognise the huge
ne net ho am not anything outside of the ne discovery of ether as employed in 0ondon# and then
the courage to use it in ,ristol"
7r Ale'ander -airbrother
-airbrother as born in 2HGK# graduating at ;dinburgh in 2HFL" He as appointed Physician to the
,ristol 5eneral Hospital in 2HFH and held the post until 2HEF" He must either and ending on the line
have read the reports of the use of ether in the 0ancet# or heard by ord of mouth" In his letter to
the I"ondon $edical 5a6ette#F he first describes the events and then makes a fe comments" After
citing the temporary insensibility produced by the America authorities# he statesB
!In the present case# by keeping my fingers upon the pulse# and closely atching his respiration#
varying the process by giving ine (leaving off at intervals all the means# and alloing him to
breathe the atmospheric air)# he as kept e'actly in that state of unconsciousness that as desired#
from hich he aoke directly after the operation as completed and the man appeared as though he
had suffered no pain" I should not hesitate to superintend a case re1uiring a longer duration of the
application than the present# hich occupied from fifteen to tenty minutes"!
I leave -airbrother also to 7r hile this but if he really as the instigator of the use of ether in
,ristol# surely the authors of his various obituaries# both medical and lay# ould have recorded the
fact# as they did the interest in the sub/ect shon by + 5 0ansdon"
$r :illiam Herapath
:illiam Herapath as a man of rare distinction# ho rose from a very humble background to follo
to very separate but e1ually important careers" He as born in ,ristol in 23KL# his father being a
maltster in the *t Phillip!s area of the city" Initially# he /oined the family business but soon became
more interested in chemistry# and it as in this field that he achieved national fame" In 2H4H# he
started to give lectures at the ,ristol $edical and *urgical *chool# hich had been started by Henry
.lark in 2H4L" The Apothecaries! Hall recognised these lectures immediately# hile the .ollege of
*urgeons aited until 2HF2" He Z)a#[ thus one of the founding professors of the $edical *chool#
holding the post of Professor of .hemistry and To'icology from 2H4H until his death" His lectures
ere regularly advertised In the local press# and ere open to the public" A series of public lectures
during the autumn of 2HFL ere particularly popular# so much so that they had to be repeated tice"
These have been described beforeK so I ill limit myself to to 1uotations" :ith respect to nitrous
o'ide# on 2L 8ovember 2HFL heB
""" e'patiated on its discovery# and more particularly on the fact that in our native city the discovery of
its laughable properties as first discovered by *ir Humphry 7avy# hilst ith 7r ,eddoes# hose
ork ritten at the time on this important discovery he recommended all present to read"!
!In the ma/ority of those ho took the 5as it occasioned a pugnacious tendency """" it as a matter of
congratulation that a magistrate as present to prevent a breach of the peace" The scene as# in fact#
as truly comic as can ell be conceived - one dancing ith the greatest enthusiasm# another boing
ith the most perfect grace# a third standing in !solemn silence!" 8ot the least amusing e'hibition as
that ofa gentleman ho on taking the gas as sei6ed ith a fit of the most e'cessive politeness#
several times thanking $r Herapath for his kindness# and accosting everyone ith hom he came in
contact ith the most polite thanks for some supposed act of civility" It is impossible to depict the
varied effects of this singular gas as displayed that evening" To form any correct idea of the effect e
ould recommend our readers to visit the $echanics Institution on :ednesday# the FGth instant#
hen $r Herapath# at the re1uest of the .ompany and ith a vie to benefit the funds# has kindly
consented to repeat the e'periments at the conclusion of his fifth and last lecture"!
%n 44 7ecember 2HFL# it as noted ho HerapathB
Proasted a piece of beef eighing nine pounds# a couple of fols# a plum pudding# and boiled some
potatoes by means of a gas apparatus" The viands ere pronounced by the company# ho all partook
of them# to be e'cellently ell done# and from ere long gas fires ill be found in the house of all
grate economists# as gastronomy be# as it should# the science of cooking by gas" %n -riday ne't# the
0aughing 5as is to be administered to several happy youths home for the holidays!
As a forensic e'pert# he came to prominence after his evidence at the trial of $rs ,urdock in 2HFE"
*he had used arsenic to poison her lodger# a $rs *mith# and as hanged# largely as a result of
Herapath!s chemical e'amination of the corpse# e'humed fourteen months after burial" After that# he
as asked to make analyses in all the great poisoning causes celebres culminating in 2HEL in the case
of :illiam Palmer# the notorious =ugeley poisoner" %n this occasion he appeared for the defence#
hich lost"
It as in the role of local politics that he as best knon to the population of ,ristol" He held# from
his youth# e'treme liberal vies" 2HF2 found him as )ice-President of the ,ristol Political @nion# a
strongly radical club# actively orking for the 5reat =eform ,ill" :hen# on 4K %ctober# the ,ristol
=iots broke out# it as noted that hile the posters of the authorities# urging the crods to disperse#
ere torn don# Herapath!s ere left up" Indeed# the many reactionary Tory elements in the ton
blamed his organisation for much of the trouble" After the $unicipal =efonn Act became la in
2HFE# Herapath as among the fe liberals ho ere elected to the reformed .ouncil# and he held
various seats until 2HLF" Hoever# his pretensions to public office# and the fading of his radical
vies# gradually lost him much of his support" He had a strong interest in the ,ristol 5eneral
Hospital" He as present and spoke at a public meeting calling for its formation# held on 42
*eptember 2HF2" 2G His connection ith the radical element in the city# though# meant that hen the
election of the committee to run the hospital took place# an event actually postponed by the riots# he
as not chosen"
%ur main interest# hoever# is in his brief involvement ith anaesthesia# hich as not confined to
the hospital" Having induced the first general anaesthetic in ,ristol# Herapath did not entirely
ithdra from the sceneB
!%n Tuesday (i"e 22th +anuary)# a young lady from *toke ,ishop# ho for some time has been
suffering from toothache# as induced to try the e'pedient of inhaling ether# and $r Herapath kindly
undertook to administer it" *he ent to $r 5ordon!s# in Park *treet# and being rendered insensible to
pain# the operation of e'traction as successfully performed ithout the least pain to the lady"! 22
:illiam Herapath died on 2F -ebruary 2HLH# at his home# the @* $anor House# %ld Park# aged 32#
and is buried in Amos )ale .emetery" ,ristol has not entirely forgotten Herapath" A rather scruffy
street in the ,arton Hill area of the city is named after him"
=eferences
2" 0ansdon +5" ,ristol 5eneral Hospital" 0ancet 2HI3; 2B3K"
4" .orrespondence" 0ancet 2HI3; 2BEI"
F" -airbrother A" Painless surgical operations" 0ondon $edical 5a6ette 2HI3; IBH2"
I" -airbrother A" =emarks on Inhalation of the )apour of ;ther" 0ondon $edical 5a6ette 2HI3;
IBFLI"
E" The Times" 2HI3; Ith +anuary
L" ,ristol $irror and 5eneral Advertiser 2HI3; 4nd +anuary"
3" -eli' -arley!s ,ristol +ournal 2HI3; 4nd +anuary"
H" ,ristol 5a6ette and Public Advertiser 2HI3; 3th +anuary"
K" :eller =$" 8itrous o'ide in ,ristol in 2HFL" Anaesthesia 2KHF; FHBL3H-LH4"
2G" ,ristol 5a6ette 2HF2; 44nd *eptember"
22" ,ristol $irror 2HI3; 2Lth +anuary"


Anesthesia
Anesthesia# or anaesthesia (see spelling differences; from 5reek \]-# an(# (ithout(;
and \^_`^ab# aisth)sis# (sensation()# traditionally meant the condition of having sensation (including
the feeling of pain) blocked or temporarily taken aay" It is a pharmacologically induced and
reversible state of amnesia# analgesia# loss of responsiveness# loss of skeletal muscle refle'es or
decreased stress response# or all simultaneously" This allos patients to undergo surgery and other
procedures ithout the distress and pain they ould otherise e'perience" An alternative definition is
a (reversible lack of aareness#( including a total lack of aareness (e"g" a general anesthetic) or a
lack of aareness of a part of the body such as a spinal anesthetic" The ord anesthesia as coined
by %liver :endell Holmes# *r" in 2HIL"
>2?
Types of anesthesia include local anesthesia# regional anesthesia# general anesthesia# and dissociative
anesthesia" 0ocal anesthesia inhibitssensory perception ithin a specific location on the body# such as
a tooth or the urinary bladder" =egional anesthesia renders a larger area of the body insensate by
blocking transmission of nerve impulses beteen a part of the body and the spinal cord" To
fre1uently used types of regional anesthesia are spinal anesthesia and epidural anesthesia" 5eneral
anesthesia refers to inhibition of sensory# motor and sympathetic nerve transmission at the level of the
brain# resulting in unconsciousness and lack of sensation"
>4?
7issociative anesthesia uses agents that
inhibit transmission of nerve impulses beteen higher centers of the brain (such as the cerebral
corte') and the loer centers# such as those found ithin the limbic system"
History
#ain article* History of general anesthesia
-lant derivatives
Throughout ;urope# Asia# and the Americas a variety of +olanum species containing potent tropane
alkaloids ere used# such as mandrake#henbane# 7atura metel# and 7atura ino'ia" Ancient 5reek and
=oman medical te'ts by Hippocrates# Theophrastus# Aulus .ornelius .elsus#Pedanius 7ioscorides#
and Pliny the ;lder discussed the use of opium and +olanum species" In 2Fth century Italy# Theodoric
,orgognoniused similar mi'tures along ith opiates to induce unconsciousness# and treatment ith
the combined alkaloids proved a mainstay of anesthesia until the nineteenth century" In the
Americas coca as also an important anesthetic used in trephining operations" Incan shamans cheed
coca leaves and performed operations on the skull hile spitting into the ounds they had inflicted to
anestheti6e the site"
>citation needed?
Alcohol as also used# its vasodilatory properties being unknon"
Ancient herbal anesthetics have variously been calledsoporifics# anodynes# and narcotics# depending
on hether the emphasis is on producing unconsciousness or relieving pain"
The use of herbal anesthesia had a crucial draback compared to modern practiceOas lamented
by -allopius# (:hen soporifics are eak# they are useless# and hen strong# they kill"( To overcome
this# production as typically standardi6ed as much as feasible# ith production occurring from
specific locations (such as opium from the fields of Thebes in ancient ;gypt)" Anesthetics ere
sometimes administered in the (spongia somnifera(# a sponge into hich a large 1uantity of drug as
alloed to dry# from hich a saturated solution could be trickled into the nose of the patient" At least
in more recent centuries# trade as often highly standardi6ed# ith the drying and packing
of opium in standard chests# for e'ample" In the 2Kth century# varying aconitum alkaloids from a
variety of species ere standardi6ed by testing ithguinea pigs" Trumping this method as the
discovery of morphine# a purified alkaloid that could be in/ected by hypodermic needle for a
consistent dosage" The enthusiastic reception of morphine led to the foundation of the modern
pharmaceutical industry"
>citation needed?
The first effective local anesthetic as cocaine" Isolated in 2HEK# it as first used by Aarl Aoller# at
the suggestion of *igmund -reud# in eye surgery in 2HHI"
>2?
5erman surgeon August ,ier (2HL2V
2KIK) as the first to use cocaine for intrathecal anesthesia in 2HKH"
>F?
=omanian surgeon 8icolae
=acoviceanu-Pitecti (2HLGV2KI4) as the first to use opioids for intrathecal analgesia; he presented
his e'perience in Paris in 2KG2"
>F?
A number of neer local anesthetic agents# many of them
derivatives of cocaine# ere synthesi6ed in the 4Gth century#
includingeucaine (2KGG)# amylocaine (2KGI)# procaine (2KGE)# and lidocaine (2KIF)"
9arly inhalational anesthetics
,urther information* 'nhalational anaesthetic
Anesthesia pioneer .raford :" 0ong
.ontemporary re-enactment of $orton!s %ctober 2L#
2HIL# ether operation;daguerrotype by *outhorth d Haes
The first physician to use diethyl ether as an anesthetic as .raford 0ong# ho administered it on
FG $arch 2HI4 during a surgical procedure to remove a tumor from a patient" He subse1uently used
it on multiple occasions afterard# but did not publish anything regarding the trials until 2HIK"
>I?
:illiam Thomas 5reen $orton# a ,oston dentist# conducted the first public demonstration of the
inhalational anesthetic" $orton# ho as unaare of 0ong!s previous ork# as invited to the
$assachusetts 5eneral Hospital to demonstrate his ne techni1ue for painless surgery" After $orton
had induced anesthesia# surgeon +ohn .ollins :arren removed a tumor from the neck of ;dard
5ilbert Abbott" This occurred in the surgical amphitheater no called the ;ther 7ome" The
previously skeptical 7r" :arren as impressed and stated (5entlemen# this is no humbug"( In a letter
to $orton shortly thereafter# physician and riter %liver :endell Holmes# *r" proposed naming the
state produced (anesthesia(# and the procedure an (anesthetic("
>E?
$orton at first attempted to hide the actual nature of his anesthetic substance# referring to it as
0etheon" He received a @* patent for his substance# but nes of the successful anesthetic spread
1uickly by late 2HIL" =espected surgeons in ;urope including 0iston# 7ieffenbach# Pirogov#
and *yme# 1uickly undertook numerous operations ith ether" An American-born physician# ,oott#
encouraged 0ondon dentist +ames =obinson to perform a dental procedure on a $iss 0onsdale" This
as the first case of an operator-anesthetist" %n the same day# 2K 7ecember 2HIL# in 7umfries =oyal
Infirmary# *cotland# a 7r" *cott used ether for a surgical procedure"
>citation needed?
The first use of
anesthesia in the *outhern Hemisphere took place in0aunceston# Tasmania# that same year"
7rabacks ith ether such as e'cessive vomiting and its flammability led to its replacement in
;ngland ith chloroform"
7iscovered in 2HF2# the use of chloroform in anesthesia is linked to +ames <oung *impson# ho# in a
ide-ranging study of organic compounds# found chloroform!s efficacy on I 8ovember 2HI3" Its use
spread 1uickly and gained royal approval in 2HEF hen +ohn *no gave it to Cueen )ictoria during
the birth of Prince 0eopold" @nfortunately# chloroform is not as safe an agent as ether# especially
hen administered by an untrained practitioner (medical students# nurses# and occasionally members
of the public ere often pressed into giving anesthetics at this time)" This led to many deaths from the
use of chloroform that (ith hindsight) might have been preventable" The first fatality directly
attributed to chloroform anesthesia as recorded on 4H +anuary 2HIH after the death of Hannah
5reener"
>citation needed?
+ohn *no of 0ondon published articles from $ay 2HIH onards (%n 8arcotism by the Inhalation of
)apours( in the 0ondon $edical 5a6ette" *no also involved himself in the production of e1uipment
needed for the administration of inhalational anesthetics"
Anesthesia providers
7octors speciali6ing in perioperative care# development of an anesthetic plan# and the administration
of anesthetics are knon in the @nited *tates as anesthesiologists and in the @nited Aingdom and
.anada as anaesthetists or anaesthesiologists" All anaesthetics in the @A# Australia# 8e Tealand#
Hong Aong and +apan are administered by doctors" 8urse anesthetists also administer anesthesia in
2GK nations"
>L?
In the @*# FEe of anesthetics are provided by physicians in solo practice# about EEe
are provided by anesthesia care teams (A.Ts) ith anesthesiologists medically directing
anesthesiologist assistants or certified registered nurse anesthetists (.=8As)# and about 2Ge are
provided by .=8As in solo practice"
>3?>H?>K?>2G?>22?
-hysicians
#ain article* Anesthesiologist
Anesthesia students training ith a patient simulator
In the strict sense# the term anesthetist refers to any individual ho administers anesthesia" Hoever#
in the @* the term is most commonly employed to refer to registered nurses ho have completed
speciali6ed education and training in anesthesia to become certified registered nurse anesthetists
(.=8As)" In the @* and .anada# medical doctors ho speciali6e in anesthesiology are
called anesthesiologists" *uch physicians in the @nited Aingdom (@A)# Australia and 8e Tealand
are called anaesthetists"
In the @*# a physician speciali6ing in anesthesiology typically completes I years of college# I years
of medical school# and four years of postgraduate medical training or residency
>24?
According to
the American *ociety of Anesthesiologists# anesthesiologists provide or participate in more than KG
percent of the IG million anesthetics delivered annually"
>2F?
In the @A# this training lasts a minimum
of seven years after the aarding of a medical degree and to years of basic residency# and takes
place under the supervision of the =oyal .ollege of Anaesthetists"
>citation needed?
In Australia and 8e
Tealand# it lasts five years after the aarding of a medical degree and to years of basic residency#
under the supervision of the Australian and 8e Tealand .ollege of Anaesthetists"
>2I?
%ther countries
have similar systems# including Ireland (the -aculty of Anaesthetists of the =oyal .ollege of
*urgeons in Ireland)# .anada and *outh Africa (the .ollege of Anaesthetists of *outh Africa)"
In the @*# satisfactory completion of the ritten and oral ,oard e'aminations allos an
anesthesiologist to be called a (7iplomate( of the American ,oard of Anesthesiology (or of the
American %steopathic ,oard of Anesthesiology# for osteopathic physicians)" This is often referred to
collo1uially as being (,oard .ertified(" In the @A# -elloship of the =oyal .ollege of Anaesthetists
(-=.A) is conferred upon medical doctors folloing satisfactory completion of the ritten and oral
parts of the =oyal .ollege!s e'amination"
The role of the anesthesiologist is no longer limited to the operation itself O $any anesthesiologists
function as perioperative physicians# ensuring optimal analgesia and maintenance of
physiologic homeostasis throughout the preoperative# intraoperative# and postoperative periods"
Anesthesiologists may elect to subspeciali6e in anesthesia for particular types of surgery
(cardiothoracic# obstetrical# neurosurgical# pediatric)# regional anesthesia# acute or chronic pain
medicine# or Intensive .are $edicine"
Anesthesia providers are often trained using full scale human simulators" The field as an early
adopter of this technology and has used it to train students and practitioners at all levels for the past
several decades" 8otable centers in the @nited *tates can be found at the +ohns Hopkins $edicine
*imulation .enter#
>2E?
Harvard!s .enter for $edical *imulation#
>2L?
*tanford#
>23?
The $ount *inai
*chool of $edicine H;0P* .enter in 8e <ork#
>2H?
and 7uke @niversity"
>2K?
=edit>;urse anesthetists
#ain article* !urse anesthetist
In the @nited *tates# advanced practice nurses speciali6ing in the provision of anesthesia care are
knon as .ertified =egistered 8urse anesthetists (.=8As)" According to the American Association
of 8urse Anesthetists# the FK#GGG .=8As in the @* administer appro'imately FG million anesthetics
each year# roughly to thirds of the @* total"
>4G?
FIe of nurse anesthetists practice in communities of
less than EG#GGG" .=8As start school ith a bachelors degree and at least 2 year of acute care nursing
e'perience#
>42?
and gain a masters degree in nurse anesthesia before passing the mandatory
.ertification ;'am" $asters-level .=8A training programs range in length from 4I to FL months"
.=8As may ork ith podiatrists# dentists# anesthesiologists# surgeons# obstetricians and other
professionals re1uiring their services" .=8As administer anesthesia in all types of surgical cases# and
are able to apply all the accepted anesthetic techni1uesOgeneral# regional# local# or sedation" FI
states re1uire physician supervision of a .=8A!s practice# and hospitals can regulate hat .=8As
can or can not do based on local las"
>44?
In the @nited *tates# the .enters for $edicare and $edicaid *ervices (.$*)# a federal agency ithin
the @nited *tates 7epartment of Health and Human *ervices# determines the conditions for payment
for all anesthesia services provided under the $edicare# $edicaid# and *tate .hildren!s Health
Insurance Program (*.HIP) programs" -or the purposes of payment for anesthesiology services#
.$* defines ananesthesia practitioner as a physician ho performs the anesthesia service alone# a
.=8A ho is not medically directed# or a .=8A or AA ho is medically directed"
>4F?
@nder
the -. Anesthesia .laims $odifier# .$* allos payment to a .=8A for anesthesiology services
provided under these programs ithout medical direction by a physician"
>4F?
-urthermore# under .$*
regulations# anesthesia must be administered only byB