The Anesthesia Records of Harvey Cushing and Ernest Codman

Bulletin of Anesthesia History, 2013

The absence of a recognized formal curriculum in anesthesia history means that many of us have known and unknown gaps in our knowledge. These gaps limit our ability to understand how things came to be, how things may become and how we can affect the future. I have asked Dr. Manisha Desai and Dr. Sukumar Desai to provide a primer on the history of medicine and anesthesia history. The goals of this primer are to educate and to help individuals target future study. Below is the second article in a continuing series.

The anesthesiology profession may one day serve as a cautionary tale of how power, politics and privilege can perturb science and progress. Previous anesthesia practitioners possessed a superior understanding of physiology and pharmacology, but overenthusiastic CO2 supplementation with inadequate monitors and machines caused asphyxiation disasters that were improperly attributed to CO2 toxicity. Dr. Ralph Waters founded the anesthesiology profession on the basis of a practical new anesthetic tech- nique that introduced elective intubation and hyperventilation to eliminate CO2 toxicity, but mechanical hyperventilation dangerously depletes CO2 tissue reserves and exag- gerates morbidity and mortality. The bene ts of CO2 supplementation were forgotten, and consequent CO2 confusion has derailed research, discouraged opioid treatment, damaged patient safety, and disrupted professional progress. Anesthesiologists can no longer claim to provide superior service, and hospital administrators are replacing them with nurses. Professional membership is in decline, and professional survival is in ques- tion. Modern machines have eliminated asphyxiation, and modern monitoring enables safe and bene cial hypercarbia that complements opioid treatment and minimizes sur- gical morbidity and mortality. CO2 reform promises revolutionary advance but faces formidable opposition.

Mending Bodies, Saving Souls: A History of Hospitals, 1999

This chapter depicts the “discovery” of ether anesthesia at the Massachusetts General Hospital within the context of Boston medicine, surgery and dentistry, discussing the local struggles for professional and cultural identity within an environment of sectarianism and professional secrecy. For this purpose, the narrative uses the story of Alice Mohan who actually became the first patient submitting to full ether inhalation for the amputation of her right leg. Mohan’s successful major surgery, performed on November 7, 1846, followed a prior, famous but brief attempt to remove Gilbert Abbott’s congenital neck tumor that forever put Boston and America on the list of pioneering surgical achievements. More than Abbott’s case, Mohan’s long pre-operative hospitalization and botched treatments provide a rare view into the state of contemporary medical therapeutics and the evolution of the Massachusetts General Hospital.

Current Opinion in Anaesthesiology, 2012

Purpose of review Anesthesia for ambulatory surgery has come a long way since 1842 when James Venable underwent surgery for removal of a neck mass with Crawford W. Long administering ether and also being the surgeon. We examine major advances over the past century and a half. Recent findings The development of anesthesia as a medical specialty is perhaps the single most important improvement that has enabled advances in the surgical specialties. Moreover, improved equipment, monitoring, training, evaluation of patients, discovery of better anesthetic agents, pain control, and the evolution of perioperative care are the main reasons why ambulatory anesthesia remains so safe in modern times. The development of less invasive surgical techniques, economic factors, and patient preferences provided addition impetus to the popularity of ambulatory surgery. Summary Beyond the discovery in the mid-19th century that ether and nitrous oxide could be used to render patients unconscious during surgical procedures, subsequent developments in our specialty have added modestly, in a stepwise manner, to reduce mortality and morbidity associated with its use. These improvements have allowed us to safely meet the steadily increasing demand for ambulatory surgery.

Tennessee medicine : journal of the Tennessee Medical Association, 2005

++Title Slide++# 1 I administered my very first human anesthesia in 1956, and I continuously practiced anesthesiology forty five years, beginning July 1, l958. I have been asked dozen of times why I chose anesthesiology, and why I stayed in the specialty. The answer to the first question is easy-"to avoid destroyer duty." You see I was in the Navy. The Navy needed either destroyer doctors or anesthesiology residents and of course, the choice was easy. ++Slide of young Smith and Navy destroyer ship++#2 However, I eventually made my way onto several destroyers on special duty…but that's a story for another day! I have often avoided answering the second question. As a wise man once said: "When you are up to your waist in alligators, it is difficult to objectively review your decision to drain the swamp" [Carnes]#. As I now emerge from that swamp, I can at last offer a hindsight answer: I am unabashedly proud to have been an anesthesiologist these forty five years. I'm not only proud of the medical details of our everyday practice, but I'm proud of my anesthesiology colleagues. I am proud of your talents; proud of the thousands of personal sacrifices I have seen you make for your patients; and I am proud of the gifts that you and your forebears have contributed to Mankind. As I look back on the multiple and varied accomplishments of Anesthesiology, not only just in my own professional lifetime, but throughout our existence the picture emerges of a dedicated group struggling toward the achievement of the status of "professionalism" in anesthesiology. In 1940, on the very first page of the first issue of our now highly respected journal "Anesthesiology", Howard W. Haggard deeply explored many of the problems in professionality facing clinical practitioners of anesthesiology. Sadly, many of his observations are distressingly familiar and unsolved even today 1940 [Haggard]! Admitting that, I nontheless believe that, although the struggle continues, we in anesthesiology have realized many amazing victories. I intend to point out a sampling of these successes to you today, and to try to convince you that the attainment of "professionalism" in anesthesiology is an ongoing struggle which is not only worthwhile, but one to which you each have a duty to contribute. 2 ++Slide: Defining Professionalism"++#3 What IS "professionalism", and why do I value it so highly? Recently Dr. Mark Lema, former editor of the ASA Newsletter, suggested a comprehensive list of many characteristics of professional behavior in anesthesiology [Lema]. Dr. John Steinhaus, my friend and former ASA President, uses an entire chapter of his book "Medical Care Divided", to attempt to describe "professionalism" in anesthesiology [Steinhaus]. Dr. Norig Ellison, another past ASA president has contributed yet another good discussion [Ellison].

Anesthesiology Clinics, 2009

Delivery of the spectrum of anesthesia from sedation to general anesthesia for patients undergoing procedures outside of the operating room (OR) poses several problems not encountered in the OR. These include limited time to assess the patient and often no time to obtain consultations for medical conditions that may be outside of the usual purview of an anesthesiologist, such as initial management of infections, diabetic ketoacidosis or hyperosmotic hyperglycemic state, inadequately managed cardiovascular disease, and toxic ingestions. Anesthesiologists trained in critical care usually have more experience with the initial assessment and management of patients with such conditions. Some of these conditions, however, also draw on training in internal medicine that is usually not provided in the continuum of anesthesiology residencies or anesthesiology critical care fellowships. Consequently, it can be argued that because procedures performed outside of the OR are becoming more common, the curriculum for anesthesia residencies should be modified to provide more training in conditions typically assessed and managed by internists or medical subspecialists. Many anesthesiologists have written about expanding anesthesia into the perioperative arena, usually referring not only to increasing the role of anesthesiologists in the already established programs in pain management and critical care but also expanding into the relatively less formalized roles in the preoperative and postoperative assessment and in-hospital management of surgical patients. 1-9 One arena that has received relatively little attention is the increasing number and complexity of patients undergoing procedures outside of the OR who often have multiple medical problems,

Canadian Anaesthetists’ Society Journal, 1973

Association agreed to the formation of a committee whose duty it was to collect information about anaesthetic and operative deaths occurring in the province at that time. This committee has made an annual report, except for the years 1956 to 1957, since then. My purpose is to describe the activities of this committee in the context of the evolution of medical care in Alberta. The original committee consisted of an anaesthetist, a pathologist, and a surgeon, but it has expanded and now consists of a pathologist, two anaesthetists and two surgeons. The term of service on the committee has been variable, usually two or three years, so over the years a considerable number of physicians have been associated with the committee's activities. Such a committee is useless if it has no sources of information and indeed there were two years when it was denied access to relevant data. However, hospitals in the province are bound by law to submit the complete hospital records of patients that die to the Department of Public Health. The committee has access to these records on condition that they are returned to the Department of Public Health as soon as possible and that they are not removed from the College of Physicians and Surgeons, photocopied, or circulated to physicians outside the committee. Strict attention is paid to the confidentiality of all information obtained from these hospital records. The committee concerned itself with the records of patients that had died within seventy-two hours of anaesthesia or surgery. Each record was scrutinized by a member of the committee and if it was believed to merit further discussion with other members the record or an abstract was used for this purpose. At times quite elaborate classifications have been used to categorize the data obtained, but over the years each death has been classified according to whether death was believed to be "inevitable," "fortuitous," "possibly preventable" or "unassessable." An inevitable death was one in which the initial state of the patient precluded the likelihood of life saving treatment. A fortuitous death was one in which the appropriate use of established techniques of medical care failed to be associated with the recovery of the patient. A possibly preventable death was a classification made with the benefit of hindsight and not necessarily implying blame. The available details of the situation indicated that appropriate techniques of medical care might not have been applied. A case was not classified as possibly preventable unless either the documented medical care was clearly inappropriate or if the records did not contain evidence of the application of such medical care as

Regional Anesthesia and Pain Medicine, 1999

Masters Thesis, 2023

Access to the interior of the living body had always been difficult in medicine. Physicians longed for the opportunity to explore it but the emotionality and mobility of the patient during surgery had weighed on their conscience. Central to this experience was pain, and consciousness was the agent that allowed the perception of it. It would not be until the middle of the nineteenth century that such an opportunity had finally, allowed surgeons that access—to the Living Interior of the human body. Anesthesia negated pain by disconnecting consciousness from the lived experience of surgery. This had silenced patients and provided surgeons access to the Living Interior unrestricted by time and emotionality. Surgeons perceived the unconscious patient laid out on the surgical table much like how cadavers laid upon the dissection table under their knife and scrutiny. Anesthesia, they thought, blurred the line between the living and the dead, and this had aided in the objectification of the patient. They perceived the anesthetized patient as dead, still and unmoving, much like a corpse; yet alive. The anesthetized patient I contend, was transformed into a Living Corpse. And this reduction of the patient during surgery in the nineteenth century in America and Britain had a profound effect on the relationship between physicians and the surgical body ever since. In order investigate the effect that inhalation anesthesia had on surgery in the mid-19th century, I focused on physicians and surgeons practicing at the time of its discovery. I explored their academic letters, autobiographies, and published reflections on the state of their craft.