EVOLUTION OF THE SPECIALTY
Following its first public demonstration
in the United States, ether anesthesia quickly was adoptedin England. John
Snow, often considered the father of the anesthesia specialty, was the
firstphysician to take a full-time interest in this new anesthetic. He was the
first to scientifically investi-gate ether and the physiology of general
anesthesia. Of course, Snow was also a pioneer in epidemiol-ogy. He helped stop
a cholera epidemic in London by proving that the causative agent was
transmitted by ingestion of contaminated well water rather than by inhalation.
In 1847, Snow published the first book on general anesthesia, On the Inhalationof Ether. When the
anesthetic properties of chloro-form were made known, he quickly investigated
and developed an inhaler for that agent as well. He believed that an inhaler
should be used in adminis-tering ether or chloroform to control the dose of the
anesthetic. His second book, On
Chloroformand Other Anaesthetics, was published posthu-mously in 1858.
After Snow’s death, Dr. Joseph T. Clover
took his place as England’s leading anesthetist. Clover emphasized continuously
monitoring the patient’s pulse during anesthesia, a practice that was not yet
standard at the time. He was the first to use the jaw-thrust maneuver for
relieving airway obstruc-tion, the first to insist that resuscitation equipment
always be available during anesthesia, and the first to use a cricothyroid
cannula (to save a patient with an oral tumor who developed complete air-way
obstruction). After Clover, Sir Frederic Hewitt became England’s foremost
anesthetist at the turn of the last century. He was responsible for many
inven-tions, including the oral airway. Hewitt also wrote what many consider to
be the first true textbook ofanesthesia, which went through five editions.
Snow, Clover, and Hewitt established the tradition of phy-sician anesthetists
in England. In 1893, the first organization of physician specialists in
anesthesia, the London Society of Anaesthetists, was formed in England by J.F. Silk.
The first elective tracheal intubations
during anesthesia were performed in the late nineteenth century by surgeons Sir
William MacEwen in Scot-land, Joseph O’Dwyer in the United States, and Franz
Kuhn in Germany. Tracheal intubation during anesthesia was popularized in
England by Sir Ivan Magill and Stanley Rowbotham in the 1920s.
In the United States, only a few
physicians had spe-cialized in anesthesia by 1900. The task of provid-ing
general anesthesia was often delegated to junior surgical house officers or
medical students, if they were available.
The first organization of physician
anesthetists in the United States was the Long Island Society of Anesthetists
formed in 1905, which, as it grew, was renamed the New York Society of Anesthetists
in 1911. The International Anesthesia Research Soci-ety (IARS) was founded in
1922, and in that same year the IARS-sponsored scientific journal CurrentResearches in Anesthesia and
Analgesia (now called Anesthesia and
Analgesia) began publication. In1936, the New York Society of Anesthetists
became the American Society of Anesthetists, and later, in 1945, the American
Society of Anesthesiologists (ASA). The scientific journal Anesthesiology was first published in 1940.
Four physicians stand out in the early
devel-opment of anesthesia in the United States after 1900: F.H. McMechan,
Arthur E. Guedel, Ralph M. Waters, and John S. Lundy. McMechan was the driving
force behind both the IARS and Cur-rent
Researches in Anesthesia and Analgesia, andtirelessly organized physicians
specializing in anesthesia into national and international orga-nizations until
his death in 1939. Guedel was the first to describe the signs and stages of
general anesthesia. He advocated cuffed tracheal tubes and introduced artificial
ventilation during ether anesthesia (later termed controlled respiration byWaters). Ralph Waters made a long list of
contribu-tions to the specialty, probably the most important of which was his
insistence on the proper educa-tion of specialists in anesthesia. Waters
developed the first academic department of anesthesiology at the University of
Wisconsin in Madison. Lundy was instrumental in the formation of the American
Board of Anesthesiology and chaired the American Medical Association’s Section
on Anesthesiology for 17 years.
Because of the scarcity of physicians
specializ-ing in anesthesia in the United States and the per-ceived relative
safety of ether anesthesia, surgeons at both the Mayo Clinic and Cleveland
Clinic began training and employing nurses as anesthetists in the early 1900s.
As the numbers of nurse anesthetists increased, a national organization (now
called the American Association of Nurse Anesthetists) was incorporated in
1932. The AANA first offered a certification examination in 1945. In 1969 two
Anesthesiology Assistant programs began accept-ing students, and in 1989 the
first certification examinations for AAs were administered. Certified
Registered Nurse Anesthetists and Anesthesiolo-gist Assistants represent
important members of the anesthesia workforce in the United States and in other
countries.
In 1889 Henry Isaiah Dorr, a dentist,
was appointed Professor of the Practice of Dentistry, Anaesthet-ics and
Anaesthesia at the Philadelphia College of Dentistry. Thus he was the first
known professor of anesthesia worldwide. Thomas D. Buchanan, of the New York
Medical College, was the first physician to be appointed Professor of
Anesthesia (in 1905). When the American Board of Anesthesiology was established
in 1938, Dr. Buchanan served as its first president. In England, the first
examination for the Diploma in Anaesthetics took place in 1935, and the first
Chair in Anaesthetics was awarded to Sir Rob-ert Macintosh in 1937 at Oxford
University. Anes-thesia became an officially recognized specialty in England
only in 1947, when the Royal College of Surgeons established its Faculty of
Anaesthetists. In 1992 an independent Royal College of Anaesthetists was
granted its charter.
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