Dick Birks, our current chairman, qualified in Sheffield in 1973 and was appointed to the post of Consultant Anaesthetist at the Jessop and Royal Hallamshire Hospitals in 1983, specialising in obstetric anaesthesia. He led a distinguished career, not only as a practising anaesthetist, but as an Examiner at the Royal College of Anaesthetists, then elected President of the Association of Anaesthetists of Great Britain and Ireland (2008 to 2010).
Dick was instrumental in the introduction of paramedics in the Yorkshire Air Ambulance Service and served as Medical Officer for the British Grand Prix, treating Michael Schumacher when he broke his leg and Sir Jackie Stewart’s team when Jackie’s son was racing in France and Spain.
General anaesthesia (GA) involves unconsciousness, analgesia and muscle relaxation. Anaesthetic agents are delivered either by intravenous injection or inhalation via a mask or tube connecting with the larynx and lungs beyond. These drugs are circulated by the heart to the brain to render the patient unconscious. The exact mechanism of losing consciousness is not yet fully understood.
The main purpose of anaesthesia is to facilitate surgery, by obliterating pain and temporarily paralysing the patient, particularly for abdominal procedures using muscle relaxants. Surgery has been around for millennia in ancient Egypt, Greece, the Roman Empire and China. Opium, mandrake, stinking and deadly nightshade and hemlock were used for pain relief. The Chinese developed a sedative concoction of cannabis, datura and wine. The Arabs acquired these surgical and anaesthetic skills, bringing them to Europe in the Renaissance.
Paracelsus (1454-1493) was the Swiss father of toxicology and discovered ether. Hanaoka (1760-1835), a Japanese surgeon, studied ancient Chinese herbal medicine and removed a breast lump achieving a state of “general anaesthesia” from a sedative drink. Early methods of anaesthesia were achieved by opium, plant extracts, nerve compression (e.g. tourniquet), alcohol, cooling and mesmerism (similar to hypnosis). The blogger’s grandfather-in-law used sherry trifle as a pre-med in children at Great Ormond Street early in the 20th century.
Nitrous oxide (laughing gas and latterly a recreational drug) was discovered by Joseph Priestley in 1772. There’s a fine statue of him in Birstall, Leeds, where flowers were lain after Jo Cox’s death. Davy (of Davy lamp fame) discovered the pain reducing potential of nitrous oxide in 1800. Horace Wells, inventor of the toothbrush and a chloroform addict, was the first to give nitrous oxide for a dental extraction in 1844.
Slightly earlier, in 1842, Clarke and Williamson failed to publish their groundbreaking use of ether for tooth extraction. Paracelsus had already written about ether’s hypnotic effects in the 15th century. William Morton gave the first public demonstration of ether anaesthesia in 1846 in Massachusetts General Hospital in Boston USA. News spread rapidly and, later in the same year, ether was first given in London.
Painless amputation became possible. Joseph Lister (1827-1912) was a pioneer in antisepsis. His work reduced surgical mortality from 45 to 15 per cent in just four years.
John Snow (1813-1858) was the first specialist anaesthetist in Britain. Pain relief during labour became acceptable because of his chloroform assisted deliveries of two of Queen Victoria’s children.
Vaporisers for inhalation of anaesthetic agents, such as ether and chloroform, became ever more sophisticated. Some of us remember the rather unsophisticated anaesthetic machines in use even as late as the 1960s.
Opioids were first used in the early 19th century. Morphine was produced commercially in 1827, followed by diamorphine (heroin) in 1898. Others, such as pethidine and fentanyl, followed rapidly.
Cocaine was introduced in 1884 as a topical anaesthetic for the eye and mouth, then systemically by injection, and first used by the American surgeon Halstead, who was famous for introducing the operation of radical mastectomy for breast cancer.
Spinal anaesthesia using cocaine was introduced in 1898 by Bier in Germany. Procaine (1905) was a safer and non-addictive local anaesthetic, superseded by lidocaine (1943), which was faster acting and even safer.
Some Probus members will have had an epidural or spinal anaesthetic for hip or knee replacement. First introduced in 1921, it’s now very commonly used in conjunction with sedation or modern safe general anaesthesia. Alexander Wood 1817-1884 was the first to use a hypodermic syringe. Regional blocks can anaesthetise a whole or part of a limb without the need for a GA. Magill introduced the endotracheal tube. A big challenge is to avoid regurgitation of stomach contents and inhalation into the lungs, with the potential for severe pneumonia and even death, and achieved by an array of tubular devices that block off the entry to the gullet and stomach beyond, separating them from the airways for safe anaesthesia to take place. A particularly large endotracheal tube shown to us was one that Magill developed to put a horse to sleep.
Viscount Nuffield, the car manufacturer, endowed three academic chairs at Oxford University in 1937, including an anaesthetic chair, leading to the development of the iron lung for poliomyelitis in 1938. Its negative pressure forces the chest and lungs to expand to normalise air entry into the lungs.
Positive pressure ventilators are now used instead. One of the first ventilators, specifically for infants, was invented by our own distinguished Stumperlowe Probus member Dr Murray Wilson at Sheffield Children’s Hospital in the 1970s.
Muscle relaxants were introduced in 1942, a major advance supplementing general anaesthesia, allowing the abdominal surgeon to work unimpeded by tense musculature. Curare was the basic ingredient, first used as a South American arrow poison for hunting and brought back to Europe in 1596 by Sir Walter Raleigh.
Recent developments in anaesthesia include the inhalation agent halothane, first used in Manchester, intensive care in the 1950s, heart-lung machines for open heart surgery, many other inhalation agents, and propofol (1977). Patient controlled analgesia (1971) allows the patient to regulate the amount according to need, without the risk of overdosing. The laryngeal mask, invented by Dr Archie Brain in 1981, is easier to insert than an endotracheal tube and is routinely used nowadays for anaesthesia and by paramedics.
Patients undergoing surgery in the 19th century were noted by some astute Probus members to be upright and surely not without risk. In 1862 John Clover noted the importance of pulse monitoring. Respiratory rate checks followed. The first blood pressure recording was in 1901, then ECGs in 1893.
Carbon dioxide measurement in exhaled breath was used to ensure free air passage and blood flow in the lungs. More recent developments are pulse oximetry, depth of anaesthesia monitoring and the “Lifebox” for safer surgery in the third world.
It was a fine talk, followed by a lively discussion