The document provides a history of anaesthesia from ancient times to the 20th century. It discusses early uses of opium, cannabis, cocaine, and carotid compression for pain relief in ancient civilizations. It then covers key developments like Crawford Long's first use of ether anaesthesia in 1842, Morton's public demonstration of ether anaesthesia at the Ether Dome in 1846, Simpson's introduction of chloroform in 1847, Koller's discovery of cocaine as a local anaesthetic in 1884, and Bier's first spinal anaesthesia in 1898. The 20th century saw advances in airway management and new anaesthetic agents that improved safety and efficacy.

1. HISTORY OF
ANAESTHESIA
Presenter-
Dr Chimi Handique
PGT
Dept of Pharmacology

2. Anaesthesia : A clinical and philosophical concept
It is in the Hippocratic Corpus, that the word ‘anaesthesia’
was used for the first time in a medical context as reversible
loss of sensation and unconsciousness, when Hippocrates
writes:
“For when they [breaths] pass through the flesh and puff it
up, the parts of body affected lose the power of feeling
[‘anaestheta’]”.

3. What was done to a patient before an operation ?
It was the custom then, as for centuries afterward, to bind the patient to
the table with ropes or straps. His screams were disregarded, but if he
struggled too Violently, assistants grasped his arms and legs.

4. • Pain had not prevented surgery in the past, but it had made it
almost an unbearable, excruciating agony.
• In January 1843, George Wilson, a medical student who
underwent surgery to amputate an infected leg, described his
experience of surgery without anaesthesia and analgesia.
• “Of the agony it occasioned, I will say nothing. Suffering so great
as I underwent cannot be expressed in words. ... The particular
pangs are now forgotten;but the black whirlwind of emotion, the
horror of great darkness, and the sense of desertion by God and
man, bordering close upondespair, which swept throughmy
mind and overwhelmed my heart, I can never forget ...”

5. By the early1840s successive cultural and medical changes
basedon newerhumanistic standards had resultedin the view
that physical painis purposeless.
This new concept regardingpain prevention and its relief is the
social scenery for the discovery of modern ‘anaesthesia’ during
the middle of the 19thcentury.

6. • The word “Anaesthesia“ was
coined by Oliver Wendell
Holmes in 1846.
• It originates from the Greek an
- "without” and “aisthēsis”
refers to the inhibition
of sensation.
Oliver Wendell Holmes
(1809–1894)

7. In a letter to William T. G. Morton, the first practitioner
to publicly demonstrate the use of ether during surgery,
he wrote:
"Everybody wants to have a hand in a great
discovery. All I will do is to give a hint or two as to
names—or the name—to be applied to the state
produced and the agent. The state should, I think, be
called 'Anaesthesia.' This signifies insensibility—more
particularly ... to objects of touch.“

8. A Brief Overview

9. • Attempts at producing a state of general anaesthesia can be
traced throughout recorded history.
• The Renaissance saw significant advances
in anatomy and surgical technique. However, despite all this
progress, surgery remained a treatment of last resort.
• An appreciation of the germ theory of disease led rapidly to the
development of antiseptic techniques in surgery reducing the
overall morbidity and mortality of surgery to a far more
acceptable rate.

10. • Concurrent with these developments were the significant
advances in pharmacology and physiology which led to the
development of general anesthesia and the control of pain.
• In the 20th century, the safety and efficacy of general anesthesia
was improved by the routine use of tracheal intubation and other
advanced airway management techniques.
• Significant advances in monitoring and new anesthetic
agents with improved pharmacokinetic and pharmacodynamic
characteristics also contributed to this trend.

11. TIMELINE OF
ANESTHESIA
• Antiquity
• Middle ages and Renaissance
• 18th Century
• 19th Century
• 20th Century
• 21st Century

12. Antiquity
Antiquity saw the dawn of anesthesia.
This era saw the uses of poppy,
mandrake, Indian hemp, cocaine and
carotid compression.

13. Origin of Opium

14. Opium, is a very popular ancient pain relieving and euphoria
inducing remedy.
It is first said to have been cultivated in lower mesopotamia
(Southwest Asia) in 3400 BC.
Sumerians referred it as “hul-gil” which means “joy plant”
Sumerians passed this “miracle drug” to the Assyrians who in
turn passed opium to the Babylonians and then to the
Egyptians.
3400 BC

15. • The knowledge and use of opium
passed on from Egypt across
Mediterranean Sea trade routes to
various civilizations including the
Phoenicians and the Greeks.
• Later, around 330 BC, Alexander the
Great and his armies introduced
opium to the people of India, Persia
and other eastern and Middle Eastern
kingdoms.

16. Prior to the introduction of opium to ancient India and China,
these civilizations pioneered the use of cannabis incense and
aconitum. By the 8th century AD, Arab traders had brought
opiumto India and China.

17. • Pictographs showing practice of
Acupuncture in China on bone
and Tortoise shells with
inscriptions dating from the time
of Shang dynasty have been
found, and it is thought that
these were used for divination in
the art of healing.
1600 BC

18. • Sushruta in Sushruta
Samhita advocated the use of
wine with incense
of cannabis for anaesthesia.
• The use of henbane and
of Sammohini and Sanjivani
are reported at a later period
600 BC

19. • Assyrians and Egyptians used
carotid compression to produce
brief unconsciousness before
circumcision or cataract surgery.
• In a passage in
History of Animals, Aristotle says of the jugular veins: “If these
veins are pressed externally, men, though not actually choked,
become insensible, shut their eyes, and fall flat on the ground."
400 BC

20. • Pedanius Dioscorides, a Greek
surgeon in the Roman army of
Emperor Nero, recommended
mandrake boiled in wine to
"cause the insensibility of those
who are to be cut or cauterized.”
in his writings in De Materia
Medica
C. 64 BC

21. • Hua Tuo of China used to perform surgery
under anesthesia using a formula he had
developed and called mafeisan.
• The word mafeisan probably means
something like "cannabis boil powder".
• The exact composition of mafeisan, similar to all of Hua Tuo's clinical
knowledge, was lost when he burned his manuscripts, just before his
death.
CA 160

22. &

23. History of Ether

24. Origin
• The compound may have been created by Jābir ibn Hayyān in
the 8th century .
• Alchemist Ramon Llull has also been credited with
discovering diethyl ether in 1275, althoughthere is no
contemporary evidence of this.

25. • Paracelsus (1493–1541) isolated
substances that resulted from interaction of
alcohol and vitriol and demonstrated its
action in chickens.
• He noted chickens enjoy sweet vitriol
[ether] - after which they "undergo
prolonged sleep, awake unharmed".
• However, he did not extend this discovery
from farm animals to people.
1525

26. • German physician Valerius Cordus
(1515–1544), is widely credited
with developing a method for
synthesizing ether.
• He synthesized diethyl ether by
distilling ethanol and sulphuric acid
into what he called by the poetic
Latin name oleum dulci vitrioli, or
"sweet oil of vitriol”
1540

27. • The name ether was given to the substance in 1729 by August
Sigmund Frobenius.
• WilliamT. G. Morton was First in the worldto publicly and
successfully demonstrate the use of ether anesthesia for
surgery.

28. Developments in 18th century

29. History of Nitrous oxide

30. • Joseph Priestley (1733–1804) was an
English chemist who discovered nitrous
oxide (1772), nitric oxide, ammonia,
hydrogen chloride and oxygen(1774).
• He originally named nitrous oxide as "nitrous air, diminished”,
on account of his preparative method of allowing NO to
standing in contact with moist iron filing
.
1771-1786

31. Priestley’s apparatus Priestley’s Experiment

32. • Priestley was clearly perplexed as to the nature of his diminished
nitrous air.
• A candle burnt with an increased brightness in the gas. When
mice were placed in a bell-jar of N2O their liveliness was
reduced and they soon died.
• In contrast they seemed livelier if they respired oxygen, which
Priestley subsequently discovered.(1774).
• But general anaesthesia by the inhalation of nitrous oxide wasn't
demonstrated for over 40 years till December 1844 by US
dentist Horace Wells.

33. Developments in 19th Century

34. JULY, 1800
Even though N2O was discovered by
Joseph Priestley it Humphry Davy who
spotted its medical potential
In 1798, Humphry Davy was appointed
laboratory superintendent of the Pneumatic
Institute in Bristol, UK. This was an
establishment founded on the belief that
the recently discovered gases might have
curative applications

35. • Curiously, the use of this gas in therapy is barely mentioned: a
couple of accounts of its use on paralysed patients, and that's about
the extent.
• It is at the end of this book “the history, chemistry, physiology and
recreational use of nitrous oxide” that he makes his off-repeated
statement about the possible use of nitrous oxide in surgery:
"As nitrous oxide in its extensive operation appears capable of
destroying physical pain, it may probably be used with advantage
during surgical operations in which no great effusion of blood takes
place."

36. • Henry Hill Hickman (1800–1830)
experimented with the use of carbon
dioxide as an anesthetic in the 1820s.
• He would make the animal insensible,
effectively via almost suffocating it
with carbon dioxide, then determine
the effects of the gas by amputating
one of its limbs.
.
1824

37. • In 1824, Hickman submitted the results of his research to
the Royal Society in a short treatise entitled Letter on
suspended animation: with the view of ascertaining its
probable utility in surgical operations on human subjects.
• The response was an 1826 article in The Lancet titled
'Surgical Humbug' that ruthlessly criticized his work.
• Hickman died four years later at age 30. Though he was
unappreciated at the time of his death, his work has since been
positively reappraised and he is now recognized as one of the
fathers of anesthesia

38. • Crawford W. Long had observed in the
ether frolics gatherings, that some
participants experienced bumps and
bruises, but afterward had no recall of
what had happened.
• He postulated that that diethyl ether
produced pharmacologic effects similar to
those of nitrous oxide.
• On 30 March 1842, he administered
diethyl ether by inhalation to a man named
James Venable, in order to remove a cysts
from the man's neck.
1842

39. • Dr. Horace Wells (1815-1848) volunteered to inhale nitrous
oxide for his own dental extraction back in December of 1844.
• Wells then began to administer nitrous oxide to his patients,
successfully performing several dental extractions over the next
couple of weeks.
1845

40. • In spite of these convincing results being reported by Wells to the
medical society in Boston already in December 1844, this new
method was not immediately adopted by other dentists.
• The reason for this was most likely that Wells, in January 1845 at
his first public demonstration to the medical faculty in Boston, had
been partly unsuccessful, leaving his colleagues doubtful
regarding its efficacy and safety the partial anesthetic was judged
as a "humbug."

41. HISTORY OF ETHER DOME

42. • On October 16,1846 William T. G. Morton (1819-1868)
became first in the world to publicly and successfully
demonstrate the use of ether anesthesia for surgery. This occurred
at what came to be called "The Ether Dome," at Massachusetts
General Hospital.
1846

43. The Ether Dome is a surgical operating amphitheater in
the Bulfinch Building at Massachusetts General
Hospital in Boston.
It was the site of the first public demonstration of the use of
inhaled ether as a surgical anesthetic on 16 October 1846.

44. • Crawford Long, had previously administered ether in 1842,
but this went unpublished until 1849.
• The Ether Dome event occurred when William T. G. Morton,
used ether to anesthetize Edward Gilbert Abbott.
• John Collins Warren, the first dean of Harvard Medical
School, then painlessly removed part of a tumor from Abbott's
neck.
• After Warren had finished, and Abbott regained consciousness,
Warren asked the patient how he felt.

45. • Reportedly, Abbott said, "Feels as if my neck's been
scratched". Warren then turned to his medical audience and
uttered "Gentlemen, this is no Humbug".
• This was presumably a reference to the unsuccessful
demonstration of nitrous oxide anesthesia by Horace Wells in
the same theater the previous year, which was ended by cries
of "Humbug!" after the patient groaned with pain..

46. History of Chloroform

47. • Chloroform was discovered independently
in 1831 by the USA's Samuel Guthrie,
France's Eugène Soubeiran, and
Germany's Justus von Liebig.
• Prof. James Y. Simpson (1811-1870)-
Scottish obstetrician begins administering
chloroform to women for pain during
childbirth.
• Chloroform quickly became a popular
anesthetic for surgery and dental
procedures as well.
1847

48. • Dr. John Snow (1813-1858) who was a
fulltime anesthetist since 1847,
popularized obstetric anesthesia by
chloroforming Queen Victoria for the
birth of Prince Leopold (1853) and
Princess Beatrice (1857).
1853 & 1857

49. • Knowledge of the narcotic effect of chloroform spread rapidly,
but very soon reports of sudden deaths mounted.
• The first fatality was a 15-year-old girl called Hannah Greener,
who died on January 28, 1848.
• Between 1864 and 1910 numerous commissions in UK studied
chloroform, but failed to come to any clear conclusions.
• The reservations about chloroform could not halt its soaring
popularity. Between about 1865 and 1920, chloroform was
used in 80 to 95% of all narcoses performed in UK and
German-speaking countries.

50. History of Cocaine

51. • Dr. Karl Koller (1857-1944)-Viennese
ophthalmologist and colleague of
Sigmund Freud, introduced cocaine as
an anesthetic for eye surgery.
• Koller recognized its tissue-numbing capabilities, and in 1884
demonstrated its potential as a local anaesthetic to the medical
community.
1884

52. • Koller's findings were a medical
breakthrough. Prior to his discovery,
performing eye surgery was difficult
because the involuntary reflex
motions of the eye to respond to the
slightest stimuli.
• Later, cocaine was also used as a
local anaesthetic in other medical
fields such as dentistry

53. • Dr. August Bier (1861-1949) was a
German surgeon.
• On 16 August 1898, Bier performed
the first operation under spinal anesthesia at the Royal Surgical
Hospital of the University of Kiel.
• The subject was scheduled to undergo segmental resection of
his left ankle, which was severely infected with tuberculosis.
1898

54. • But Bier dreaded the prospect of general anesthesia because he had
suffered severe adverse side effects during multiple previous
operations. Therefore, Bier suggested "cocainization" of the spinal
cord as an alternative to general anesthesia.
• Bier injected 15 mg of cocaine intrathecally, which was sufficient
to allow him to perform the operation. The subject was fully
conscious during the operation, but felt no pain.

55. • Two hours after the operation, the subject complained
of nausea, vomiting, severe headache, and pain in his back and
ankle.
• The vomiting, back and leg pain improved by the following day,
but the headache was still present.
• Bier performed spinal anesthetics on five more subjects for
lower extremity surgery, using a similar technique and achieving
similar results

56. 20th
C
E
N
T
U
R
y

57. The 20thcentury saw the transformation of the practices of
tracheotomy, endoscopy and non-surgical tracheal intubation
fromrarelyemployed procedures to essential componentsof the
practices of anesthesia, critical care medicine, emergency
medicine, gastroenterology, pulmonology and surgery.

59. In 1902, Hermann
Emil Fischer (1852–
1919) and Joseph von
Mering (1849–1908)
discovered that
diethylbarbituric
acid was an
effective hypnotic
agent.

60. • Also called barbital or Veronal, the trade name assigned to it
by Bayer Pharmaceuticals, this new drug became the first
commercially marketed barbiturate.
• It was used as a treatment for insomnia from 1903 until the
mid-1950s.

61. • Barbitone was prepared by
condensing diethylmalonic ester
with urea in the presence of sodium
ethoxide, and then by adding at least
two molar equivalents of ethyl iodide
to the silver salt of malonylurea or
possibly to a basic solution of the
acid. The result was an odorless,
slightly bitter, white crystalline
powder.

62. • Alfred Einhorn (1857-1917)-
German chemist develops
procaine and names the substance
"Novocain.“ from the Latin nov-
(meaning new) and -caine, a
common ending for alkaloids used
as anesthetics.
• It was introduced into medical use
by surgeon Heinrich Braun.
1905

63. • Arthur Guedel publishes his eye signs of
Ether anesthesia in the American Journal of
Surgery.
• He also described 4 stages of ether anaesthesia dividing the
stage III into 4 planes
• His Guedel (oral) airway is still used today.
• He has been memorialized by the Arthur E. Guedel Memorial
Anesthesia Center, San Francisco.
1920

64. HISTORY OF SODIUM THIOPENTAL

65. • Sodium thiopental, the 1st IV
anesthetic, was synthesized in
1934 by Ernest H. Volwiler &
Donalee L. Tabern , working
for Abbott Laboratories.
• In the mid 1930s, Volwiler and Tabern spent three years
screening over 200 candidate compounds in search of a
substance which could be injected directly into the blood
stream to produce unconsciousness

66. •It was first used in humans on
8 March 1934 by Ralph M. Waters in
an investigation of its properties,
which were short-term anesthesia and
surprisingly little analgesia.
•Three months later, John Silas Lundy started a clinical trial of
thiopental at the Mayo Clinic at the request of Abbott
Laboratories.

67. • Volwiler and Tabern were awarded U.S. Patent No. 2,153,729 in
1939 for the discovery of thiopental, and they were inducted into
the National Inventors Hall of Fame in 1986.
• The popularity of thiopental-as a swift-onset intravenous agent
for inducing general anesthesia- paved the way for other totally
unrelated intravenous induction agents, such as ketamine,
etomidate, and propofol.

68. • On 23 January 1942 Griffith and his resident Enid Johnson
administered curare to a young man undergoing
appendicectomy..
Dr. Harold Griffith (1894-1985) & Enid Johnson (1909-2001)
1942

69. The credit for introducing curare to anaesthetics belongs to Griffith.
Griffith and Johnson reported their use of curare in July 1942, and
the introduction to their report is memorable: ‘Every anaesthetist
has wished at times that he might be able to produce rapid and
complete muscular relaxation in resistant patients under general
anaesthesia”

70. • Many new intravenous and inhalational
anesthetics were developed and brought
into clinical use during the second half of
the 20th century.
• Paul Janssen (1926–2003), the founder of Janssen Pharmaceutica, is
credited with the development of over 80 pharmaceutical
compounds.
• Janssen synthesized nearly all of the butyrophenone class
of antipsychotic agents, beginning with haloperidol (1958)
and droperidol (1961).

71. • These agents were rapidly integrated into the practice of
anesthesia.
• In 1960, Janssen's team synthesized fentanyl, the first of
the piperidinone-derived opioids.
• Fentanyl was followed by sufentanil (1974), alfentanil
(1976), carfentanil (1976), and lofentanil (1980). Janssen and
his team also developed etomidate (1964),a potent intravenous
anesthetic induction agent.

72. 1956 - UK's Dr. Michael Johnstone clinically introduces
halothane, the first modern-day brominated general
anesthetic.
1963 - Dr. Edmond I. Eger, II described minimum alveolar
concentration (MAC), later characterized as "the
concentration of inhaled anesthetic producing immobility in
50% of patients subjected to a noxious stimulus."

73. 1964- Dr. Günter Corssen et al. begin human trials of the
dissociative intravenous anesthetic ketamine.
1966- Dr. Robert Virtue et al. begin human trials of the inhalational
anesthetic enflurane.
1972- Isoflurane is clinically introduced as an inhalational
anesthetic.
1992- Desflurane is clinically introduced as an inhalational
anesthetic.
1994- Sevoflurane is clinically introduced as an inhalational
anesthetic.

74. 21ST CENTURY
21st Century: Age of Digital Revolution

75. • Among the most widely used drugs are Propofol, Etomidate,
Barbiturates such as methohexital and thiopentone,
Benzodiazepines such as midazolam and Ketamine.
• The "digital revolution“ of the 21st century has brought newer
technology to the art and science of tracheal intubation.
• Several manufacturers have developed video laryngoscopes

76. • Xenon has been used as a general anesthetic. Although it is
expensive, anesthesia machines that can deliver xenon are
about to appear on the European market, because advances in
recovery and recycling of xenon have made it economically
viable.
• New agents based on benzodiazepine, etomidate, and propofol
structures are being developed.

77. Conclusion
• Surgery learned many lessons through the ages, but never was
it able to banish Pain.
• More than a century ago, a vapor in the operating-room of the
Massachusetts General Hospital blotted out sufferrings from
surgery.
• It was the most beneficent change in the history of surgery,
and has since been one of the greatest gift to mankind.
• However, the history of anaesthetics will remain an unfinished
work, until some one is able to synthesize a drug that will have
all of the desirable properties of the ideal anaesthetic.

79. THANK YOU