A curious case of the “missing” anaesthetist

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Many laurels in surgery rest on the shoulders of Anaesthesia and Antisepsis. Anaesthesia is a science that can make a person stuporous, and withstand pain during surgery. On the other hand antisepsis is a set of practices that reduces chances of an infection during a surgery. While anaesthesia was officially born on 16th October 1846, antisepsis was introduced in operation theatres about twenty years later. Before these developments surgery was crude and painful. Those who survived surgery, succumbed to infection. Surgeons could only sparingly enter inside skull, chest or abdomen.

Birth of Anaesthesia

William TG Morton was a Dentist, who in 1840 started his practice under Horace Wells in Boston. The duo had successfully used Nitrous oxide in their dental practice. However, in 1845 their public demonstration of its effect failed. A person, who had his tooth pulled, screamed in pain, Mortan and Wells were humiliated, and broke their partnership. While Wells moved on, Morton continued with his experiments. He had heard about stupefying effects of sulphuric ether. He succeeded in his experiments, with the famous public demonstration on 16th October 1946. Anesthesia was born.

Sadly, Morton did not get his due in his lifetime. He was ridiculed for his desire to patent his product. In 1846, patents were equated with greed and profit. Moreover, he named this product Letheon, which was soon identified as commonly available sulphuric ether. Further, Wells and his other mentors wanted a share in his discovery. Morton, the discoverer of anaesthesia, died in 1868, broke and bitter.

Anaesthesia is 175 and growing

By December of 1846, news of sulphuric ether compound crossed Atlantic. Dentists in London were using ether for painless tooth-pulling. In 1847, James Simpson an Obstetrician, introduced inhaled chloroform in Obstetric practice. In the coming years, John Snow further popularised chloroform based painless childbirths.

Six years later, in 1853 Charles Pravaz and Alexander Wood invented the the hollow hypodermic needle. This needle could now inject medicines below the skin and inside the blood vessels. About 25 years later, in 1877 we discovered cocaine, a drug that when injected close to nerves would render them senseless. Young surgeons Karl Koller (1857-1944) and William Halsted (1852-1922) first used local anaesthesia in 1884. Koller was operating an eye, and Halstead on a Jaw. By the year 1900 we had anaesthesiology as an academic branch, that had its own research journal, and a separate professional society.

By 1920s, Anaesthetists could control airway by using airway tubes, and manual ventilation. In 1940s they had a muscle relaxant in their armamentarium, followed by various other drugs to control heart rate and blood-pressure. These scientific discoveries, and monitoring technologies have forever changed our operating rooms and range of surgeries than can be safely performed. Today, the speciality has branched out, has a role in almost all invasive medical procedures, with sub-specialisation in various domains. In 2021, right in the middle of Covid pandemic, anaesthesia turned 175. Entire world was witness to scores of anaesthetists engaged in intensive care.

From Antisepsis to Asepsis

Joseph Lister, was a British surgeon who was worried about high infection rates following a surgery. He was influenced and intrigued by his contemporary Louis Pasteur, a French microbiologist who in 1860s had postulated Germ theory of disease. In 1865, Lister started applying carbolic acid on wounds, and they healed better. By 1871, he had developed an antiseptic system of carbolic acid sprays in operation theatre. This was the first infection control system inside an operation heater. We know Lister as father of modern surgery. A popular antiseptic mouthwash – Listerine is also named after him !!

By 1890, world had gained a wider acceptance of Germ theory of disease. Robert Koch had also demonstrated that dry heat and water vapours can also kill bacteria. Thus, sterility in the operating rooms improved. Gustav Neuber (1850-1932) was a German surgeon, who had his own private practice. He had two operation theatres, one for a clean (non-septic) and another for unclean (septic) surgeries. Gustav was the first to use drapes, gloves and masks along with heat sterilisation. He was a pioneer in asepsis, which we practice till date.

Postage stamps on modern day surgeries – and the missing anaesthetist

Modern surgery is not possible, either without an anaesthetist, or asepsis. It takes two to tango. While a team of surgeons operates, anaesthetists keep the patient sedated, relaxed, and pain free. They also ensure that lungs are breathing and heart beats well. Usually seated at the head-end their task is to ensure calm, so that surgeons remain composed. There are only a few postage stamps, that depict an operating room. While these stamps depict asepsis, strangely anaesthetist seems to be missed out !!

Some of these stamps, like the above two are on a surgeons congress, or from a surgeons society. Others, like the bottom two show an organised care by red-cross or a hospital. In all four, we can see drapes, gowns, caps and gloves. We can also see members of the support team.

We depict, what we perceive. To an untrained eye, surgeon is visible right below the bright operating room lighting. If we pierce deep, we can probably find other team members in the background. For instance, lets look at the tiny blown up image below.

Success at last !!!

So, as I was just giving up on the missing anaesthetist, I came across this 2014 postage stamp from India. Bingo !!! this recent stamp has a more modern operation theatre, and person at the head-end of the patient is indeed an anaesthetist – keeping a watchful eye on the patient, as well as on the surgeons.

Modern surgery is a teamwork. Today, in addition to a surgeons and anaesthetists, we also have specialised nurses and technicians in the operating room. This team is assisted by gadgets, to monitor and control almost all organs of our body. I am eagerly looking forward to find more operating room postage stamps, and hopefully without missing out on the anaesthetist !!!

Also read a previous blog on Surgery in the pre-anaesthetic era