Anesthesia
From The Art and Popular Culture Encyclopedia
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Some of the meaning of aesthetic as an adjective can be illuminated by comparing it to anaesthetic, which is by construction an antonym of aesthetic. If something is anaesthetic, it tends to dull the senses, cause sleepiness and induce boredom. In contrast, aesthetic may be thought of as anything that tends to enliven or invigorate or wake one up. --Sholem Stein |
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Anesthesia or anaesthesia (see spelling differences; from Greek αν- an- “without” + αἲσθησις aisthesis “sensation”) has traditionally meant the condition of having the feeling of pain and other sensations blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846. Another definition is a "reversible lack of awareness", whether this is a total lack of awareness (e.g. a general anaesthestic) or a lack of awareness of a part of a the body such as a spinal anaesthetic or another nerve block would cause.
Today, the term general anesthesia in its most general form can include:
- Analgesia: blocking the conscious sensation of pain;
- Hypnosis: producing unconsciousness;
- Amnesia: preventing memory formation;
- Paralysis: preventing unwanted movement or muscle tone;
- Obtundation of reflexes, preventing exaggerated autonomic reflexes.
Early gases and vapours
The works of Greek authors such as Dioscorides were well-known among physicians in the Islamic Empire, and Arab and Persian physicians such as Muhammad ibn Zakarīya Rāzi (Rhazes), Avicenna (Ibn Sina) and Abu al-Qasim al-Zahrawi wrote medical textbooks of great importance in the development of medicine in Europe and the Middle East. Arabic and Iranian anesthesiologists were the first to utilize oral as well as inhalant anesthetics. In Islamic Spain, Abulcasis and Ibn Zuhr (Avenzoar), among other Muslim surgeons, performed hundreds of surgeries under inhalant anesthesia with the use of narcotic-soaked sponges. Abulcasis and Avicenna wrote about anesthesia in their influential medical encyclopaedias, the Al-Tasrif and The Canon of Medicine. These were the precursors to the true narcotic derivatives, now known as general anesthesia or general anesthetics, which were not produced until Dr. Janssen developed narcotics, except morphine, in the past 50 years.
In the West, the development of effective anesthetics in the 19th century was, with Listerian techniques, one of the keys to successful surgery. Henry Hill Hickman experimented with carbon dioxide in the 1820s. The anesthetic qualities of nitrous oxide (isolated in 1773 by Joseph Priestley) were discovered by the British chemist Humphry Davy about 1799 when he was an assistant to Thomas Beddoes, and reported in a paper in 1800. But initially the medical uses of this so-called "laughing gas" were limited — its main role was in entertainment. It was used on 30 September 1846 for painless tooth extraction upon patient Eben Frost by American dentist William Thomas Green Morton. Horace Wells of Connecticut, a traveling dentist, had demonstrated it the previous year 1845 at Massachusetts General Hospital. Wells made a mistake in choosing a particularly sturdy male volunteer, and the patient suffered considerable pain. This lost the colorful Wells any support. Later the patient told Wells he screamed in shock and not in pain. A subsequently drunk Wells died in jail, by cutting his femoral artery, after allegedly assaulting a prostitute with sulfuric acid.
Another dentist, William E. Clarke, performed an extraction in January 1842 using a different chemical, diethyl ether (discovered by Valerius Cordus in 1540). In March 1842 in Danielsville, Georgia, Dr. Crawford Long was the first to use anaesthesia during an operation, giving it to his friend, who was also a school teacher (James M. Venable) before excising a cyst from his neck. Long got the idea to do this from his observations at ether frolics. He noted that participants experienced bumps and bruises but afterward had no recall of what had happened. He did not publicize this information until 1849.
On October 16, 1846, dentist William Thomas Green Morton, invited to the Massachusetts General Hospital, performed the first public demonstration of diethyl ether (then called sulfuric ether) as an anesthetic agent, for a patient (Edward Gilbert Abbott) undergoing an excision of a vascular tumor from his neck. In a letter to Morton shortly thereafter, Oliver Wendell Holmes, Sr. proposed naming the procedure anæsthesia.
Despite Morton's efforts to keep "his" compound a secret, which he named "Letheon" and for which he received a US patent, the news of the discovery and the nature of the compound spread very quickly to Europe in late 1846. Here, respected surgeons—including Liston, Dieffenbach, Pirogoff, and Syme—undertook numerous operations with ether. An American-born physician, Boott—who had traveled to London—encouraged a leading dentist, Mr James Robinson, to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anesthetist. On the same day, 19 December 1846 in Dumfries Royal Infirmary, Scotland, a Dr. Scott used ether for a surgical procedure. The first use of anesthesia in the Southern Hemisphere took place in Launceston, Tasmania, that same year. Ether has a number of drawbacks, such as its tendency to induce vomiting and its flammability. In England it was quickly replaced with chloroform.
Discovered in 1831, the use of chloroform in anesthesia is usually linked to James Young Simpson, who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847. Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold. Unfortunately, chloroform is not as safe an agent as ether, especially when administered by an untrained practitioner (medical students, nurses, and occasionally members of the public were often pressed into giving anesthetics at this time). This led to many deaths from the use of chloroform that (with hindsight) might have been preventable. The first fatality directly attributed to chloroform anesthesia (Hannah Greener) was recorded on 28 January 1848.
John Snow of London published articles from May 1848 onwards 'On Narcotism by the Inhalation of Vapours' in the London Medical Gazette. Snow also involved himself in the production of equipment needed for inhalational anesthesia.
The surgical amphitheatre at Massachusetts General Hospital, or "ether dome," still exists today, although it is used for lectures and not surgery. The public can visit the amphitheater on weekdays when it is not in use.
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