modernisers

Modernisers



James Young Simpson 1811-1870

The question is, who discovered Chloroform, here is the question? Chloroform can also be called trichloro methane and is prepared through the chlorination of methane gas.
James Young Simpson was born at Bathgate, Linlithgowshire, in 1811. The Simpson family had lived there for many years, steady labouring farmer folk. James’s father, David Simpson, happened to be the village baker.
At the age of fourteen he entered the University of Edinburgh as a student of the arts.
Two years later he began his medical studies. At the age of 21 he took his degree of Doctor of Medicine.

simpson
James Young Simpson
Dr John Thomson, who then occupied the chair of pathology in the university, was impressed with Simpson's thesis , "On Death from Inflammation", and he offered him his assistantship.
The offer was accepted, and during the session 1837-1838 he acted as interim lecturer on pathology during the illness of the professor. The following winter he delivered his first course of lectures on obstetric medicine in the extra-academical school.

In February 1840 he was elected to the professorship of medicine and midwifery in the university.196 It is said that the name "Young" in his name represents his achievement as a very "young" Professor as he was not baptised with this middle name. He is quoted as saying:“‘The man laid on an operating table in one of our surgical hospitals was exposed to more chances of death than the English soldier on the field of Waterloo."1

Simpson started to use Ether on January 19, 1847 in Edinburgh, Scotland. He disliked its strong smell and was determined to find a better alternative.

So, who discovered chloroform? Chloroform was first prepared in 1831 by the American chemist Dr Samuel Guthrie, who combined whiskey with chlorinated lime in an attempt to produce a cheap pesticide.

Simpson with two of his assistants continued their search for a better alternative to Ether, and on the advice of Dr Waldie of Liverpool, he experimented with Chloroform.
On the Thursday evening of November 4, 1847, they tested Chloroform. Immediately after testing it, Simpson knew it was remarkable, and that this was what he had been searching for.
On November 15th they gave the first public demonstration of chloroform, and introduced it into his practice in November 1847.

In November 1847 James Simpson proclaimed the new anaesthetic agent, Chloroform, using it first on the 8th in obstetrics’ for the first time.
simpson statue
Simpsonś Statue
James Young Simpson is accredited with discovering the anaesthetic properties of Chloroform and pursued its use in obstetrics.

Simpson, like his American counterparts, used to take part in Ether and Chloroform frolics. Simpson lived in a time when most gentry were Church believers or supporters.
It was difficult at that time to explain the need of pain relief during childbirth as the punishment for the original sin was seen as being compromised by man.
The pastor at the time would quote the book of Genesis which states to the woman he said: “I will greatly increase your pains in childbearing; with pain you will give birth to children. Your desire will be for your husband, and he will rule over you.”2
It was Simpson who quietened these religious voices by reminding them that anaesthesia was inspired by God. “So, the Lord God caused the man to fall into a deep sleep; and while he was sleeping, he took one of the man’s ribs and closed up the place with flesh. “3

Simpson however failed to recognise the dangers associated with chloroform.
James Young Simpson was born the son of a baker, was the first medical man to be knighted for services to medicine. He like Lister was a strong advocate from an early period of preventing hospital infection and insisted his juniors washed their hands in chlorine prior to contact with a patient. He and his wife suffered personal tragedy losing two young daughters to which it has been said that they never ever recovered. Most of his practise was private up until his death. He died in 1870 and to give you an idea of what high esteem he was held in, his funeral route was lined by over 100,000 members of the public.
There is even a monument in Edinburgh for this incredibly talented physician. "All pain is per'se and especially in excess, destructive and ultimately fatal in its nature and effects."1

John Snow 1813-1858

John Snow was born in 1813, at York and was the son of a farmer.
John Snow was by all accounts quite introvert but very studious and he is recognized as the first true anaesthetist. Chloroform use spread rapidly, and Anaesthesia got royal approval when in 1853 Queen Victoria was administered chloroform by John Snow, at the birth of one of her children Prince Leopold on 7th April 1853.

johnsnow
John Snow
John Snow was said to have first observed the administration of Ether by James Robinson. This brilliant but rather shy individual was observing at that time the “Victory over Pain” and unbeknown to him at the time, he would be its first master.

John Snows had a reputation already it was such that he has even had a public house named after him. This was for his public health work. Public health at this time was a big issue; disease in London was rife at the time. Even Queen Victoria’s beloved husband Albert died of typhus. (Although it is suspected it could have been cancer or Crohns disease).

Snow recognised that cholera came from a contaminated water supply that was being pumped from the Broad street apparatus.

He was a great experimenter and at one time performed a tracheotomy on a rabbit and passed a tube into the rabbit’s trachea and then anaesthetising the animal with chloroform. This was probably the first endotracheal anaesthetic performed.

broad street
Broad Street Apparatus
John Snow accelerated the acceptance of anaesthesia by publishing two books on the subject; "On the inhalation of the vapour of Ether" and "Chloroform and other anaesthetics".
Chloroform however was not as safe as ether and required more expertise to deliver; several unnecessary deaths were reported from chloroform in the early years as medical students, nurses and the occasional member of the public were pressed into administering the agent. In 1848 a young girl Hannah Greener, aged 15, was the first patient to die while under chloroform anaesthesia. She was having an avulsion of her toenail.
Some have commented on her death as “she died like a shot rabbit” . It has been suggested she died of anaphylaxis due to the drug.

It was as a result of these deaths that Britain required physicians to administer the drug, whereas in the United States of America and Europe a nurse could administer Ether under supervision.

John Snow can be accused of making the art of anaesthesia a science.
This intelligent physician was taken from this world prematurely and was laid to rest at Brompton cemetery.
The following quote is how the established public health committee got it all wrong as eventually Snow was proved right on Cholera : "There is, in our view, an entire failure of proof that the occurrence of any one case could be clearly and unambiguously assigned to water". The reviewer later concludes: "Notwithstanding our opinion that Dr Snow has failed in proving that cholera is communicated in the mode in which he supposes it to be, he deserves the thanks of the profession for endeavouring to solve the mystery. It is only by close analysis of facts and the publication of new views, that we can hope to arrive at the truth".4

Joseph Lister 1827-1912

Joseph Lister was born in Upton Essex, England. As Professor of Surgery at Glasgow University, he was very aware that many people survived the trauma of an operation but died afterwards of what was known as "Ward Fever", its other names were "Hospitalism" or "Hospital Gangrene".

lister
Joseph Lister
He was aware of the work done by the Hungarian doctor, Ignaz Semmelweis in 1865, Lister however was reminded of the work done by Louis Pasteur on how wine was soured, by professor John Anderson. It convinced Lister of Pasteur’s germ theory, i.e. that microbes carried in the air that caused diseases to be spread in wards.

People who had been operated on were especially vulnerable as their bodies were weak and their skin had been cut open so that germs could get into the body with more ease. Lister decided that the wound itself had to be thoroughly cleaned.

In 1865 he treated 11-year-old James Greenlee who had been run over by a cart and sustained an open fracture (Compound) of the shin bone. He then covered the wound with a piece of lint covered in carbolic acid. After 6 weeks the lad was discharged able to walk.
< Prior to this, amputation would have been the only sensible course to save the life of the patient. Death by gangrene was common after such an accident.
He said: "The frequency of disastrous consequences in compound fracture, contrasted with the complete immunity from danger to life or limb in simple fracture, is one of the most striking as well as melancholy facts in surgical practice." 5
He continued to use this treatment on patients who had a compound fracture. This is where the broken bone had penetrated the skin thus leaving a wound that was open to germs.

Lister covered the wound made with lint soaked in carbolic acid. His success rate for survival was very high.
lister carbolic
Joseph Lister and his Carbolic Spray
In 1867, Lister published his study of antiseptics by use of carbolic; it was to become known as the Carbolic Crusade. He used carbolic acid sprays to decontaminate surgical wounds.
The number of patients operated on by Lister, who died, fell dramatically.

This was the beginning of sterilisation and proper asepsis. He experimented and had great success with sutures that he soaked in an aqueous solution of carbolic acid. 6

Add to this the nursing crusade set in motion by Florence Nightingale during the Crimean war, these combined had a tremendous effect on the post- operative results for the patients.

On Anaesthetics he stressed the need for the stomach to be empty, and the need to starve a patient for at least four hours.
His infection rates prior to his antiseptic technique were:

1864-1866 (35 cases) 19 recovered and 16 died. 45%
1867-1870 (40 cases) 34 recovered and 6 died. 15%

Still high but a rapid drop of 30% in mortality rate.
He also recommended a cup of tea up to two hours before surgery. 7 Lister was most likely the first to use wire to fix fractures, he sterilised silver and tied bones together using his well proven anti-septic technique.

Joseph Lister died in 1912 and was accorded in death the rare honour of a funeral service at Westminster Abbey before being interred at Hampstead Cemetery.

Dr August Karl Gustav Bier (1861–1949)

In 1897 the German surgeon, Dr August Bier administered the first spinal anaesthetic.
bier
Dr August Karl Gustav Bier
August Bier subjected himself to a clinical experiment in which he observed the anaesthetic effect of a spinal; He had the local injected into himself, so he could experience its anaesthetic effect. August Bier is known as the father the spinal anaesthesia and intravenous regional neural blockade.

He was however a surgeon although described as unorthodox. It took him only two years to become a senior lecturer in surgery his mentor being the Fig 164 August Karl Gustav Bier surgeon Friedrich von Esmarch. (Of Esmarch bandage fame).

Bier had a tremendous impact on surgery and anaesthesia. He was the co- author of a surgical textbook, Chirurgische Operationslehre (Operative Surgery).
In 1908, he pioneered the use of intravenous procaine analgesia. He was also responsible for the invention the M1916 army helmet used by the Germans during the First World War, this familiar shaped helmet was the design the Germans kept and gave them the nickname Fig 165 German Helmet "square heads".

helmet
German Helmet
He has been portrayed by many as a supporter of Adolf Hitler third Reich, this might have been true in the frenzied instant before Hitler’s true intentions were revealed as the majority of the country’s population were carried away into deception by that evil man in the thirties. However, this was never established as truth, as even his wife was confined and questioned in regard to the attempt on Hitler’s life in 1944. The term “Biers Block” is commonly used by some anaesthetists when they perform a regional block on a limb. The substance used nowadays would be Prilocaine, however, this particular block is not very widespread in today’s hospitals. He retired in 1932 and died in 1949.

He stated, "A professor is a gentleman with a different point of view.” 8

Sir Frederick Treves

Frederick Treves was born 8, Cornhill, Dorchester, Dorset to William and Jane Treves. His father was an Upholsterer with his own business.

treves
Sir Frederick Treves
He was at first educated at William Barnes school in South Street. William Barnes was a local Poet who taught at that school. His father unfortunately died in 1867 when he was 14 and a couple of months later his mother sold the family business and moved to London.

In 1871, he enrolled into the University College London’s medical school at the London hospital to Fig 166 Sir Frederick Treves pursue a career in medicine. After a stint in Derbyshire he returned to The London Hospital to take up a post as a registrar in Surgery. During his early years as a surgeon, he like many went to war, in his case the Boer war. Treves was the commanding officer of 4 field hospital and also wrote a book about his experiences with the military. He proposed a lot of radical changes to the way field surgical teams operate. He also pointed out that “The Military Hospitals do not come up to the standards of the Workhouse Infirmaries”

Frederick Treves is remembered most as the surgeon in the film the Elephant man as he was the Surgeon who consulted to Joseph Merrick.
However, he is also renowned as the surgeon who delayed the coronation of King Edward VII, by removing successfully, his appendix on Tuesday June 24th, 1902, just three days before the planned event, causing enormous inconvenience to world leaders and also the Kings and Queens of Europe.

It was Treves opinion and that of Joseph Lister (but not every other surgeon who was consulted) that the procedure should be carried out without delay. The King suggested that he would be crowned in his present condition and Treves replied, “Then sire you will go as a corpse.”
Treves operated at Buckingham Palace and Dr Frederick Hewitt gave the anaesthetic. 9

Even today, the most common of emergencies is an appendectomy (Laparoscopic) and each hospital will see a couple a week at least.
It also has to be remembered that 170 years earlier, Queen Caroline (the wife of George II) died as a result of a strangulated umbilical hernia.
This is a straight forward procedure today. To be fair however she was known to be obese and a general anaesthetic was not available then.

Frederick Treves was also an excellent water colourist and has painted many excellent landscape paintings along with anatomical drawings of both men and animals.

water colour
Treves Watercolour
He was known to be a keen yachtsman and was friends with the likes of Thomas Hardy the author, he retired at fifty and went on his travels and wrote many an article about this.

He died at the age of 70 on 20th April 1934 in Lausanne, Switzerland ironically of peritonitis believed to have been bought on by a burst infected gall bladder.
He was cremated in Switzerland and his ashes were buried in Dorset.
Treves said: “Don't worry about genius. Don't worry about being clever. Trust to hard work, perseverance and determination. And the best motto for a long march is: Don't grumble. Plug on!"

James Leonard Corning 1855-1923

James Leonard Corning was born in Stamford, Connecticut in 1855. The son of James and Sarah Ellen Corning. At the outbreak of the American Civil war, his family moved to Germany.
corning
James Leonard Corning
Corning studied chemistry at the Stuttgart Polytechnic Institute under Hermann von Fehling. He received his medical education at Wurzburg University, which was also where Wilhelm Conrad Roentgen of X-Ray fame was educated.

In 1878, he left Germany and eventually returned to the United States. There are several writers who say that Corning then a Neurologist performed the first spinal anaesthetic in 1885 inadvertently.

This first spinal anaesthetic was carried out by accident. He observed that subcutaneous injection of cocaine was associated with both vasoconstriction and local anaesthesia.

Corning reasoned that injecting cocaine solution into the subcutaneous tissues between two contiguous spinal processes would result in its uptake by the "minute ramifications of the veins" and (the anaesthetic) "being transported in the blood to the substance of the cord" resulting in anaesthesia of the sensory and perhaps also the motor tracts.

He wrote: "I hoped to produce artificially a temporary condition of things analogous in its physiological consequences to the effects observed in transverse myelitis or after total section of the cord". 10

It is said he was experimenting with the action of 2% cocaine solution between two inferior dorsal vertebrae of a dog, causing paralysis of the hindquarters, and hence inadvertently performed the first spinal anaesthetic.
It is disputed though as no Cerebral spinal fluid was seen, so most academics suggest he performed an epidural. Whatever the dispute it is considered that Bier performed the first planned Spinal anaesthesia, certainly on a human.

William Stewart Halsted 1852-1922

One (dark and stormy) night in 1882, a critically ill 70-year-old woman was at the verge of death at her daughter’s home, suffering from fever, crippling pain, nausea, and an inflamed abdominal mass. At 2 AM, a courageous surgeon put her on the kitchen table and performed the first known operation to remove gallstones. The patient recovered uneventfully. The patient was the surgeon’s own mother. 11

William Stewart Halsted
William Stewart Halsted
Halsted was born in New York City to William Mills and Mary Louisa Haines Halsted on September 23, 1852. Halsted's father was the president of a textile-importing firm, Halsted, Haines and Co. 12

Halsted was educated at home by tutors until 1862, when he was sent to boarding school in Monson, Massachusetts.
At Yale, Halsted was captain of the football team, played baseball and rowed crew. Upon graduation from Yale in 1874, Halsted entered Columbia University College of Physicians and Surgeons. He graduated in 1877 with a Doctor of Medicine degree. Though raised a Presbyterian, Halsted was an agnostic by adulthood.

Most in theatre know of Halsted for his artery forceps, but his major achievement was to introduce new preventative methods such as rubber gloves into operating practice in 1890. 13

A scrub nurse by the name of Caroline Hampton developed a serious form of dermatitis, which was in part due to the cleaning solutions they used. Initially these gloves were to protect Caroline Hampton (his future wife) but it was found that the use of gloves reduced the incidence of infection.

The Goodyear tyre company made the first surgical gloves, which differed from others in that they were thin.
caroline
Caroline Hampton
Eye surgeons continued however not to use gloves up until the 1970s when super-sensitive gloves were developed.
Because of the success of the rubber gloves, it stimulated him to make asepsis his main concern.
He was methodical in the sterilization of all medical equipment. William Halsted went on to develop surgical gowns and hats.

Halsted's Team
Halsted's Team
You will notice from the picture that masks were still not used. He said, “the only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is haemorrhage”.

In 1886, Halsted after experimenting with cocaine for use with eye surgery became addicted, and this caused his surgical abilities to become dangerously unreliable, and his medical career was nearly destroyed by the time he was forced to leave New York City.
However, he overcame this addiction and went on to become one of the founder professors of the Johns Hopkins Medical School.
In 1919, he recovered from an operation to remove gallstones.
He failed to recover from a second gallstone operation, however, and died in 1922.12
"The public blabbers about preventative medicine but will neither appreciate nor pay for it. You get paid for what."14

Sir Alexander Fleming 1881-1955

It was a sad fact that infection was one of the biggest killers of surgical patients.
fleming
Sir Alexander Fleming
Antibiotics were not yet discovered during the First World War, however the condition that is the cause of infection was starting to be fully understood. Antibiotic gets its name from antibiotics which is effectively when one life destroys the life of another, as to preserve its own life.

During WW1 a Scottish doctor called Alexander Fleming was working at St. Mary's Hospital London. He had previously been the one to point out that the Iodine that the soldiers carried on the front to apply to wounds, was too strong and caused more harm than good.

Fleming was to go on with his research and eventually discover penicillin in 1928, it has to be said, by accident, on the morning of September 3rd, 1928, Professor Alexander Fleming was having a clear up of his cluttered laboratory.
florey
Howard Florey
Fleming was sorting through a number of glass plates which had previously been coated with staphylococcus bacteria as part of research Fleming was doing. One of the plates had mould on it. The mould was in the shape of a ring and the area around the ring seemed to be free of the bacteria staphylococcus. The mould was penicillin notatum.

chain
Ernest Chain
Fleming had a lifelong interest in ways of killing off bacteria and he concluded that the bacteria on the plate around the ring had been killed off by some substance that had come from the mould. That which was Howard Florey eventually put together as a suitable antibiotic in 1941 when Dr Howard Florey, Ernst Boris Chain managed to produce a suitable substance.

Andrew J. Moyer an American found the key to mass-producing the antibiotic while working as the director of the USDA’s Northern Research Laboratory. An expert on the nutrition of moulds, Moyer found he was able to increase yields
moyer
Andrew Moyer
tenfold when penicillin mould was cultured in a broth of corn steep liquor and lactose. The process known as industrial fermentation was the first use of corn steep liquor to grow micro-organisms.

Moyer also discovered that the production rate could be sped up when the improved medium underwent continuous shaking. Moyer’s innovation facilitated the mass production of penicillin, saving the lives of an estimated 12 to 15 per cent of Allied soldiers wounded in World War II. 15

This first antibiotic became ready for D. Day in mass quantities thanks to an American drug company. It has saved many lives and prevented the amputation of thousands of limbs.

nobel
Nobel Award For Medicine
This wonder drug is one of the main reasons why surgery has progressed over the last 60 years, without it very few of the major orthopaedic, vascular and plastic surgical procedures would be attempted. Sir Alexander Fleming, Ernst Boris Chain, Sir Howard Walter Florey were later in 1945 to receive the Nobel Prize for medicine. “I have been trying to point out Nobel Award for Medicine that in our lives chance may have an astonishing influence and, if I may offer advice to the young laboratory worker, it would be this - never to neglect an extraordinary appearance or happening”.

“It is the lone worker who makes the first advance in a subject; the details may be worked out by a team, but the prime idea is due to enterprise, thought, and perception of an individual. “ 16

Henry Edmund Gaskin Boyle (1875-1941)

Henry Boyle was a pioneering anaesthetist. He was born on 2 April 1875 at Bannatyne, Barbados,
boyle
Henry Edmund Gaskin Boyle
the only child of Henry Eudolphus Boyle and Elizabeth. He was educated at Harrison College, Barbados, and then moved to London and studied at St Bartholomew's Hospital.

As a student, he was president of the Abernethian Society, he qualified MRCS LRCP from St Bart's Hospital.
Known as "Cocky" to his friends, he is best remembered for the development of early anaesthetic machines.
Vaporiser
Boyles Vaporiser
Always more interested in the practical rather than the purely scientific side of his speciality, he was quick to see how each new advance could best be put to practical service.
At first, he used the American Gwathmey machine, but he found that they kept breaking down. He went about designing his own version of the machine and his continuous flow machines included cylinders for the gases.
It has been suggested that Boyle borrowed drawings from Geoffrey Marshall another pioneer of anaesthetic machines for the design of the Boyle anaesthetic machine. 17

machine
Boyles Machine
Even until recently, an anaesthesia machine for administering general anaesthesia would often be referred to as a “Boyle’s Machine” in honour of his contribution in this field. His design included not only cylinders for medical oxygen, but nitrous oxide and a “Boyle’s Bottle” to vaporize diethyl ether.

His other contribution to Anaesthesia included the "Boyle-Davis gag", which is still used today during tonsillectomy operations. He died at the age of 66, at the end of a long and particularly distressing illness.

I always wondered why the controls were on the left on today’s machines it is because Boyle was left-handed, as a result, anaesthetic machines available all over the world are designed with controls and switches meant for a left-handed user. 18

Sir Ivan Whiteside Magill KCVO, DSc, MB, BCh, BAO, FRCS, FFARCS (Hon), FFARCSI (Hon), DA, (1888-1986).

Sir Ivan Magill was born on 23rd July 1888 at 4 Barnhill Terrace (now 10 Curran Road), Larne, Co. Antrim, Northern Ireland.
magill
Sir Ivan Whiteside Magill
He was one of five children. His father Samuel Magill was a prominent businessman, councillor, Presbyterian and Freemason of Larne, and his mother was Sara.
He was educated at Larne Grammar School from 1900 to 1906 and he graduated from Queen's University, Belfast in 1913. 19

I thought I would put in full the titles awarded to Sir Ivan Whiteside Magill, he is my hero, simply because when I was doing my vive exams has an OTT in the British Army. I was asked one question by a senior consultant anaesthetist, “How old is Magill?” to
90th
Magill 90th Birthday Celebration
which I answered. "I don’t really know; I presume he must be dead." The anaesthetist then looked at me in horror and said to me. "Dead, Dead! I hope not. I’m attending his 90th birthday party next week," to which I replied. "You must be honoured Sir, to be invited to a birthday party of such a famous inventive anaesthetist."

The anaesthetist concerned who was Brigadier Saunders, smirked and then gave a wry smile, as he must at that point considered what I said. The one word honoured must have struck a note on his ego. He then spent the rest of my viva session not questioning me but detailing the life of Sir Ivan Magill.
I believe that’s what first got me interested in seeking the history of anaesthesia and surgery.

His Birthday party was held at the Royal Society of Medicine on the 9th July 1978. This was attended by over 200 members and guests in Barnes Hall It was noted that 11 ex-presidents were in attendance, for some of which this was their first attendance for many years. Magill’s connection with the Royal Society of Medicine spanned over 57 years and this was the audience to many of his papers.

Magill was first appointed as an anaesthetist at the Queen’s Hospital, Sidcup in 1919. He worked alongside
ltcol
Lt. Col Magill
the famous plastic surgeon Harold Gillies.
It was here that he got the idea to develop the endotracheal tube because of the airway problems of anaesthetising patients with major facial injuries.
He eventually was appointed to the Westminster and Brompton Hospitals in London. It was at this hospital that he developed the ET tube between the war years.
Magill visited the American Anaesthetic pioneer Waters in 1930. He taught him blind nasal intubation.
Originally, they were cut from a rubber hose; Magill developed his own metal adapters.

Sir Ivan was knighted in 1960 by the Queen for his contribution to advancement of medical science he died in his 99th year in 1986. 220
“Ten minutes of genuine belly laughter had an anaesthetic effect and would give me at least two hours of pain-free sleep”21
In 2010, a plaque marking his birthplace was unveiled in the town of Larne, Northern Ireland.

Edgar Stanley Rowbotham 1890-1979

Edgar Stanley Rowbotham was born in Clapham, London on 8 May 1890.
At the outbreak of the First World War he was a medical student and a member of the OTC and was immediately called up and sent to France, where he served in an
rowbotham
Edgar Stanley Rowbotham
infantry regiment.
On the advice of his commanding officer he returned to complete his medical training and qualified with a conjoint diploma in 1915.
In 1915 he qualified from Charing Cross Hospital, as his father, Edgar Joseph and grandfather had done.

It was later in that year that he married Edith May on Nov 6th, 1915 at the Holy Trinity in Clapham their home town.

He returned to service as a doctor and spent his next years with the Royal Army Medical Corps during this Great War.22
rowvap
Rowbotham Vaporiser
He worked alongside Ivan Magill and Harold Gillies in Sidcup. Like Magill, Rowbotham was determined to improve the conditions for the surgeon when operating on neck and facial disfigurements, and pioneered in collaboration with Sir Ivan Magill, of wide-bore endotracheal intubation and "Blind’ nasal intubation" He also pioneered the use of local and intravenous analgesia.
He was a Consultant Anaesthetist at Charing Cross Hospital, London and he served in the Royal Army Medical Corps 1914-18 and also 1939-45.

He was responsible for the introduction of Cyclopropane into this country.
Rowbotham, Magill and the surgeon Harold Gillies advanced Plastic surgery and anaesthesia tremendously during their lifetimes. “Marriage is the operation by which a woman's vanity and a man's egotism are extracted without an anaesthetic.” 23
He retired to Madeira and that is where he passed away in Velho Da Ajuda, and was buried in Funcal, Madeira.

Thomas Phillip Ayre MRCS, LRCP, FFARCS (1902-1980)

Dr Philip Ayre, was a brilliant pioneering anaesthetist. He was born in Fulham,
ayre
Thomas Phillip Ayre
London in 1902 to Dr F. J. Ayre and Dorothea Ayre.
His father moved to Glamorgan in Wales to take up his position as a General Practitioner. He had two sisters Katherine and Mary, and studied at Epsom College, moving on to St Bartholomew’s in London to study medicine.

It is said that he had already administered about 2,000 anaesthetics before he qualified in 1933 in London.
He joined the staff of Newcastle General Hospital in 1934 as an SHO in anaesthetics. Here he anaesthetised for W. Wardill, to whom Sir James Spence sent all his paediatric surgical cases, which included hair lip and cleft palate deformities. Paediatric anaesthesia in those days was for those typical cases, to put it in Dr Ayres’s own words, “Paediatric anaesthesia in those days was a protracted and sanguine battle between surgeon and anaesthetist with the poor unfortunate baby as the battlefield."

tpiece
Ayreś T-Piece
In 1937 he invented a technique which revolutionised the practice of anaesthesia for babies and children, and the "Ayres’s T-piece" is still universally used in paediatrics.
He headed the Department of Anaesthetics at Newcastle General Hospital and the Newcastle Hospital for Babies in 1950, posts that he held until his retirement in 1966.

He spent all his working life in the Newcastle region, and for over 45 years anaesthetised at most of the city's hospitals.
The kids loved his approach, as he played on his speech impediment caused through a cleft pallet. He also suffered from alopecia and he would make fun of his red wig with the children on the ward.
Thomas Philip Ayre will long be remembered in the North-east.24

Sir Robert Reynolds Macintosh (1897-1989)

Robert Macintosh was baptised with the Maori name, RewiRawhiti. He was the youngest son of Charles Nicholson Macintosh,
macintosh
Sir Robert Reynolds Macintosh
newspaper editor and mayor of Timaru in 1901, and his wife, Lydia Beatrice Thompson.

McIntosh spent part of his childhood in Argentina but returned to New Zealand when he was thirteen years old. He was educated at Waitaki Boys' High School, where he was head of school and excelled academically and athletically. In December 1915 he travelled to Britain and was commissioned in the Royal Scots Fusiliers, soon transferring to the Royal Flying Corps.

He was shot down behind enemy lines on 26 May 1917 and taken prisoner, escaping several times.19

Sir Robert Macintosh initial intention was to be a surgeon, but soon after qualifying he developed an interest in the field of anaesthesia. Macintosh became the first professor of anaesthetics at Oxford although the university was at first against the appointment.

laryngoscopes
Macintosh Laryngoscopes
It was Lord Nuffield a friend of Macintosh who ensured that he was appointed by withholding funding. He recruited the scientist’s Dr Kurt Mendelssohn and Dr H G Epstein and together they designed and built the Oxford vaporiser, a simple, portable, and accurate means of delivering varying concentrations of Ether, 25 which was to see service in the second world war and where more complicated apparatus could only be a liability.

A descendant of the vaporiser was used in the Falklands conflict and Gulf wars and is still part of the military's field anaesthetic equipment today.
The common "Laryngoscope blade" today is his curved design.

Sir Robert Macintosh died in Radcliffe Infirmary after sustaining injuries from a fall at home in Oxford on the 28th of August 1989, at the age of 91.

Thiopentone Sodium

The thirties saw the introduction of Thiopentone Sodium after clinical trials by Lundy in 1934.
volwiler
Ernest H. Volwiler


Ernest H. Volwiler (1893-1992) and Donalee L. Tabern (1900-1974) working for Abbott Laboratories discovered the general anaesthetic Pentothal, one of the most important agents in modern medicine. Volwiler and Tabern discovered Pentothal to induce unconsciousness.26

tabern
Donalee L.Tabern
It was first used on human beings on March 8, 1934, by Dr Ralph M. Waters (It was rumoured to have been overused at Pearl Harbour and responsible for many deaths. This is now known to be an exaggeration).

In the 1940s, psychiatrists started using Sodium Pentothal in a form of treatment called narcotherapy. It is a kind of drug-induced substitute for hypnosis, which doesn’t work in many people. Narcotherapy involves giving a person a dose of Sodium Pentothal too small to cause unconsciousness, but just enough to make the individual relax completely.

In that anxiety-free state, patients are more susceptible to suggestion and psychiatrists think it’s possible to uncover repressed memories and feelings that may be contributing to psychological problems.

Sodium Pentothal got the name, Truth Serum, because patients under its influence, and guided by a skilful psychiatrist, lose some inhibitions and may talk freely about topics they might never otherwise discuss. They tell the truth about such topics, but only if they want to.

Narcotherapy patients, just like individuals who are hypnotized, don’t lose all self-control and blabber out answers to every question. If a person wouldn’t disclose damaging information when fully conscious, he probably wouldn’t do it when under the effects of Truth Serum.27

Thiopentone is still used today although not as extensively as it was 30 years ago, in the NHS, and it is a credit to their ingenuity that the substance is still in use today.

Cyclopropane was discovered in 1881 by August Freund. Cyclopropane had no commercial application until Henderson and Lucas discovered its anaesthetic properties in 1929. Industrial production had begun by 1936. 28
Cyclopropane and other drugs gave more control to the anaesthetist.
Thiopentone has had bad press of late as it is one of the cocktail of drugs that the American Correction services used to execute convicted killers.

curare
Curare
In 1942 Curare or Tubocurarine was used by the Canadian Anaesthetist, Harold Griffiths. This particular substance was first mentioned by Peter Angherius (1516): It was 80 years later that Sir Walter Raleigh made mention of this poison.
waterton
Charles Waterton


Curare as it was called and properly named Tubocurarine; was sent from South America initially packed in tubes to keep it fresh, (Hence the name Tubo) and it came from the vine and leaves of the plant Strychnos Chondodendron and Chondodendron tomentosum.

In the 1940s, IPPV was being used more frequently because of the introduction of this drug Curare.
Today we have several types of muscle relaxant that we can use.

In 1812, a British adventurer Charles Waterton travelled to South America. Waterton wrote that one of the main aims of this journey in 1812 was “To collect a quantity of the strongest wourali poison”. This was made by the South American Indians from ingredients taken from the forest and used by them to tip their arrows for both the blowpipe and the bow. 29
It was used to capture monkeys and other wildlife and also as a self-defence weapon.

Curare is no longer used as it has been replaced by synthetic drugs with lesser side effects “Vision in a shroud, the effects of curare”. 30

Propofol

The insertion of a company is not what I would expect to place within this website, but ICI (now Astra Zenica) deserved to be mentioned because of this one development by them that has changed the face of day surgery.

Propofol along with the invention of the Laryngeal Mask Airway have been the two greatest anaesthetic developments in the last 30 years.
propofol
Propofol
Patients, who at one time had operations that kept them in overnight because of the induction agents and post-operative airway management, now are released because of these two items, on the same day. Propofol was discovered in the Biology Department at ICI Pharmaceuticals Division in the UK.
Over a ten-year period more than 5,000 compounds were tested as potential new anaesthetics.31

The clinical trials followed in 1977, the drug was then solubilised in cremophor which produced anaphylactic reactions as it did with the drug it replaced, Althesin.
It was discovered that by emulsifying it in soya oil and water it was not as reactive. It was launched in 1986 under the brand name Diprivan.
A new form of this drug has been launched since, a water-soluble form that is less painful on injection and is said to be broken down even quicker.32
Day surgery is now the norm because of this wonderful induction agent. It is also widely used for patients who suffer from post op nausea and vomiting (PONV) or anyone who is at risk of malignant hyperthermia using a technique called Total Intravenous Anaesthetic (TIVA), no gases are given. Sadly, "Michael Jacksons" death was attributed to this drug when it was misused"

Dr Archie Brain

By far the most impressive and useful modern-day equipment contribution to
brain
Dr Archie Brain
anaesthetics is the invention is the "Laryngeal Mask Airway (LMA)".

Archie Ian Jeremy Brain was born in Kobe, Japan to a British diplomat family. He won a scholarship to the University of Oxford and eventually decided to attend medical school, also at Oxford, with clinical training at St. Bartholomew's Hospital in London.
After obtaining a diploma in anaesthetics, he worked in Holland and the Seychelles, returning to the UK in 1980 to accept a post at the Royal London Hospital. Brain worked on several research projects, one of them being the prototype laryngeal mask airway, for which he received a patent in 1982.33 It did not however become a common use item until Propofol became widely available, as it depressed the gag reflex better than thiopentone.

So, the Laryngeal Mask Airway (LMA) was invented by Dr Archie I.J. Brain in the East End of London in 1981. Dr Brain identified the need for better safety, reliability, and the ease of insertion of airway management devices.
mask
Laryngeal Mask Airway


He has gone on to modify this invention and produced different variations to deal with different anaesthetic conditions.

They were at first, produced as multi-usable re-sterilisable items. They are now, however, developed as a single use and are disposable.
His view of the airway is: "It is a novel device that fills the gap in airway management between endotracheal intubation and in the use of face mask".
Archie Brains invention has taken hold throughout the world and now comes in different forms, like the "I Gel".

Laparoscopic Surgery

Laparoscopic Surgery has been the way forward for the last 3-4 decades. It has allowed patients to be admitted, operated upon and to be discharged the same day,
jacobaeus
Christian Jacobaeus
whereas if they had been operated upon in the conventional way, they would have stayed in hospital longer.
It is difficult to credit any one individual with the pioneering prize of introducing the Laparoscopic approach.

In 1901 Georg Kelling, of Dresden, Germany performed the first Laparoscopic procedure in dogs, so he could be considered the first, however he did not publish his research at the time. It was however in 1910 that Hans Christian Jacobaeus of Sweden performed the first Laparoscopic operation in humans.
He performed a thoracoscopy using a cystoscope to successfully diagnose a medical condition. 34
It is the case however that the widespread use of the Laparoscope was mainly performed by gynaecologists prior to 1990, it can be said that today, most specialities use this technique in one way or another, this because of the vast improvement of the equipment that is now available.

References:

1 Sir James Young Simpson
2 Gen 3:16 KJV
3 Genesis 2:21 King James Version
4 London Medical Gazette, 1849
5 'On a New Method of Treating Compound Fracture, Abscesses, etc: With Observations on the Conditions of Supperation', Part I, The Lancet (1867), 326
6 Antiseptic Principle Of The Practice Of Surgery, 1867 Joseph Lister
7 http://www.victorianweb.org/science/health/lister1.html
8 Dr August Bier
9 The London Hospital E.W Morris 1930
10 https://pdfs.semanticscholar.org/27ee/7da1b1952ee0a204ad50c52201a3f8e1dd88.pdf
11 https://sciencebasedmedicine.org/halsted-the-father-of-science-based-surgery/
12 http://biography.yourdictionary.com/william-halsted#Azo5zU1agthhACFB.99
13 http://en.wikipedia.org/wiki/William_Stewart_Halsted
14 www.quotegarden.com/medical.html
15 http://indianapublicmedia.org/momentofindianahistory/saving-lives-grand-scale/
16 Alexander Fleming
17 https://www.aagbi.org/news/great-war-pioneers-anaesthesia-and-pain-relief-honoured-new-exhibition
18 http://www.histansoc.org.uk/timeline.html
19 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2604469/
20 Ulster Med J 2008; 77 (3) 146-152 Gail McLachlan 2008
21 http://thinkexist.com/quotation/ten_minutes_of_genuine_belly_laughter _had_an/174929.html
22 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1599575/pdf/brmedj00073-0053.pdf
23 http://thinkexist.com/quotation/marriage_is_the_operation_by_which_a_ woman-s/256174.html
24 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1600235/pdf/brmedj00002-0064.pdf
25 http://en.wikipedia.org/wiki/Robert_Reynolds_Macintosh
26 http://www.invent.org/hall_of_fame/142.html
27 http://www.heartlandscience.org/medhs/anesthesia
28 http://en.wikipedia.org/wiki/Cyclopropane
29 Essays on the first hundred years of anaesthesia vol 1 W Stanley Sykes p89
30 http://www.oldielyrics.com/lyrics/benediction/vision_in_the_shroud.html
31 http://www.sivauk.com/joom/images/stories/york/abstracts/Propofol.pdf
32 http://en.wikipedia.org/wiki/Propofol
33 http://en.wikipedia.org/wiki/Archie_Brain
34 https://en.wikipedia.org/wiki/Laparoscopic_surgery


Ken True ODP
Author
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