“Surgical anaesthesia is like marriage – an honourable estate instituted by God.”
Terence Steen, 1968
The first successful public demonstration of inhalation anaesthesia was at the Massachusetts General Hospital in Boston USA on October 16, 1846. The patient was Gilbert Abbott, a young man with a vascular tumour under his jaw. The anaesthetist was a dentist, Dr William Morton. The anaesthetic was diethyl ether. The surgeon was Dr John Collins Warren.
There are already many books on the history of anaesthesia, but this one is altogether more egocentric. It approaches the subject from an autobiographical point of view, tracing my life from conception to retirement and beyond, and it highlights the many connections I have had with anaesthetic agents throughout my life, including the 38 years I worked in the National Health Service as a full-time anaesthetist. Some of these agents are gases and some are volatile liquids; the gases are nitrous oxide (laughing gas), cyclopropane, ethylene and xenon, the liquids are ethyl chloride, trichloroethylene, halothane and various ethers. Many of them are now obsolete. All of them played a major part in my life. The story will show how much the practice of anaesthesia changed during the second half of the 20th century.
Although alcohol is not inhaled as a vapour to produce anaesthesia like the volatile liquids above, many of you will know from personal experience that if it is drunk in sufficient quantity it will produce all the stages of anaesthesia. (The role alcohol has played in my life is the subject of a separate book.)
The first stage of intoxication (anaesthesia) with alcohol is the dizzy and delightful, when you lose your highest faculty, that of self-criticism. Smalltalk comes readily, you feel clever and witty and after-dinner speeches become easy. Clouded judgement may lead you do to show off and do something silly, such as driving a car, which may do you serious harm. This too is the stage of increasing analgesia and amnesia. When you wake up the next morning and find a bruise on your shin you may vaguely remember banging into a chair but not of it hurting at the time.
The second stage is the drunk and disorderly, when you react in an uninhibited and exaggerated fashion to outside stimuli, such as starting a fight when someone comments on your tie or struggling violently as you are forcibly held down while a casualty officer stitches up your lacerated scalp. Even if no local anaesthetic is used, you will remember nothing next day and certainly no pain.
The third is the dead drunk, when you are in true surgical anaesthesia, lying still if a policeman kicks you or a surgeon cuts you. You can die from obstruction of your airway, inhaling your vomit, or by being run over by a car.
The fourth is the dangerously deep, when your life is at risk specifically from depression of the vital centres in your brainstem. You will need your airway protected, your respiration supported and intravenous fluids to prevent dehydration. 6
Alcohol is prepared by the fermentation of sugars and since cells like yeast have been around for more than a billion years, it seems likely alcohol too is as old. In ancient times soporific potions for relief of pain were prepared using psychoactive drugs from plants such as opium from the poppy, scopolamine from mandrake and henbane, cannabis from hemp, psilocybin from magic mushrooms, mescaline from cacti and many others. Of these only alcohol and opium are truly pain-relieving before consciousness is lost, though cannabis may relieve pain from muscle spasm. In ancient times soporific potions produced from plants and fungi often contained some opium and were mixed with wine.
The book also discusses some gases, such as hydrogen, helium, nitrogen and argon, which are not strictly anaesthetic agents but which are of some interest in an anaesthetic context, and two gases which play a vital role in our lives, namely oxygen and carbon dioxide. It also mentions other forms of anaesthesia such as the application of cold and hypnosis.
Events within each chapter are told in chronological order and is told as truthfully as fickle memory will allow, although some changes have been made to protect patient confidentiality.
The final chapter is about my first year in anaesthesia and is a compilation and extension of material already seen in the previous chapters. It provides a clear demostration6 of how different things were in 1959 when compared with modern practice.