Of all milestones and achievements in medicine, conquering pain must be one of the very few that has potentially affected every human being in the world. It was in 1846 that one of mankind's greatest fears, the pain of surgery, was eliminated. This historical review article describes how the various elements of anesthesiology (gasses, laryngoscopes, endotracheal tubes, intravenous medications, masks, and delivery systems) were discovered and how some brilliant entrepreneurs and physicians of the past two centuries have delivered them to humanity. One name stands out amongst all others when the founder of modern anesthesia is discussed, William T.G. Morton (1819-1868). A young Boston Dentist, Dr. Morton had been in the search for a better agent than what had been used by many dentists: nitrous oxide. With Dr. Morton's tenacity driven by enthusiasm and discovery, he and renowned surgeon at Massachusetts General Hospital, John Collins Warren (1778-1856) made history on October 16, 1846 with the first successful surgical procedure performed with anesthesia. Dr. Morton had single-handedly proven to the world that ether is a gas that when inhaled in the proper dose, provided safe and effective anesthesia. One of the first accounts of an endotracheal tube being used for an airway comes from the pediatrician Joseph O'Dwyer (1841-1898). He used the metal "O'dwyer" tubes in diphtheria cases and passed them into the trachea blindly. Adding a cuff to the tube is credited to Arthur Guedel (1883-1956) and Ralph M. Waters (1883-1979) in 1932. This addition suddenly gave the practitioner the ability to provide positive pressure ventilation. The anesthesiologist Chevalier Jackson (1865-1958) promoted his handheld laryngoscope for the insertion of endotracheal tubes and its popularity quickly caught hold. Sir Robert Reynolds Macintosh's (1897-1989) breakthrough technique of direct laryngoscopy came after being appointed Nuffield professor of anesthetics at the University of Oxford in 1937. He was the first to describe the routinely placing of the tip of his newly re-designed laryngoscope in the epiglottic vallecula which is attached to the base of the tongue, thus when lifted exposed the entire larynx. Macintosh was genuinely astonished at what a great view he could achieve with his new blade and technique. The use of barbiturates as an intravenous anesthetic began in 1932. Sodium thiopental gained popularity after its use was described in detail by a Dr. John Lundy (1894-1973) of the Mayo Clinic. Other I.V. medications were tried over the past seventy years, but the newest induction drug which provided for a substantially shorter recovery period and seemed to actually suppress laryngeal reflexes has brought with it many benefits. Propofol, introduced clinically in 1977, demonstrated many positive effects even as an anti-emetic compound. Before October of 1846, surgery and pain were synonymous but not thereafter. As we entered the information age where the infrastructure of evidence based medicine and newer fields of genetics, transplantation, imaging radiology and even stem cells became quickly integrated into mainstream medicine, we can predict an excellent future on the progress to be made in anesthesia.

Historical Development of Modern Anesthesia

Alcohol, customary drinking behavior, and pain.

Years after his transition from man of letters to man of science, George Henry Lewes brought his experience with neurophysiology to bear on contemporary fiction. In his 1872 essay “Dickens in Relation to Criticism,” Lewes tries to provide a balanced assessment of the strengths and shortcomings of the novelist, who had died two years before. Largely because of two unusual scientific comparisons, however, many readers regarded his article as an attack on Dickens, with whom Lewes had in fact been friendly—despite their public feud over the scientific verisimilitude of Mr. Krook’s spontaneous combustion in Bleak House (1852-53). First Lewes compares the “vividness of imagination” in the novelist’s work to the intensity of “hallucinations,” a trait Lewes has found in “no other perfectly sane mind.”1 Later, Lewes considers the problem of character and caricature in Dickens and produces an even more peculiar— and to many friends of Dickens peculiarly offensive—comparison:

Fiction as Vivisection: G. H. Lewes and George Eliot

The work of the Hippocratic physicians led to the understanding that pain was due to physical disease rather than super­ natural punishment. Thus, pharmacologi­ cal attempts to relieve pain became legiti­ mate goals. The earliest anodynes were derived from plants, and included mandrake, alcohol, cannabis, hyoscyamus, and opium. The de­ velopment of these analgesics and their use in modern medicine are reviewed. Only opium and its derivatives continue to be widely used as analgesics. This article has been peer-reviewed.

https://www.anesthesiahistoryjournal.org/article/S1522-8649(00)50022-5/pdf

Mandrake to Morphine: Anodynes of Antiquity

List of illustrations Acknowledgments Introduction 1. When travellers swarm forth: antebellum urban aesthetics and the contours of the political 2. In 'the thick of the stream': Henry James and the public sphere 3. A 'gorgeous neutrality': social justice and Stephen Crane's documentary anaesthetics 4. Vicious gregariousness: white city, the nation form and the souls of lynched folk 5. A 'moving mosaic': Harlem, primitivism and Nella Larsen's Quicksand 6. Breaking the waves: mass immigration, trauma and ethno-political consciousness in Cahan, Yezierska and Roth Notes Bibliography Index.

http://catdir.loc.gov/catdir/samples/cam033/2002031369.pdf

The aesthetics and politics of the crowd in American literature

The history of surgical anesthesia

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The history of surgical anesthesia