History of anaesthesia: Overview

Abstract
An early administration of anaesthesia for childbirth occurred on 19 January 1847, when Scottish obstetrician James Young Simpson administered diethyl ether to facilitate the delivery of a child to a woman with a deformed pelvis. Simpson advocated for its use to reduce pain both in surgery and in childbirth. Obstetric anaesthesia was controversial for many reasons, and objections came not only from fellow obstetricians, but also from the public and members of the clergy. While James Young Simpson shed light upon religious objections to obstetric anaesthesia, modern scholars have debated whether such objections truly existed. The aim of this study is to determine whether religious objections to obstetric anaesthesia were endorsed by medical professionals in France during the mid-19th century. A search of the Bibliothèque Nationale de France (National Library of France) was conducted. Primary source documents reveal that French physicians were interested in studying the effects of ether and chloroform during labour and delivery. Nevertheless, the introduction of obstetric anaesthesia was controversial for many reasons, including concerns about its effect on natural labour. The evidence suggests that these objections were not endorsed by the medical community. Much of the controversy surrounding obstetric anaesthesia involved the perceived necessity of the practice during low-risk vaginal deliveries. It appears that French physicians were aware of religious objections to the use of anaesthesia in childbirth but did not endorse them. The use of obstetric anaesthesia in France was guided by scientific evidence and clinical experience, without interference from religious leaders.

Abstract
Sleep, dreams, unconsciousness and death are concepts regularly contended with by anaesthetists and their patients. The closely related genealogy of the entities personifying these concepts in ancient Greek mythology highlights a visceral uncertainty about the spectrum of human unconsciousness. Hypnos and Thanatos-Sleep and Death, respectively-commonly feature together in art and literature as twin brothers. Sleep was the more powerful of the two and was feared even by members of the Pantheon immune to death such as Zeus himself, drawing a parallel with the modern knowledge that all living organisms demonstrate susceptibility to anaesthesia. The power to induce sleep was regarded as a divine ability and was thus the domain of the gods. However, some mortals possessed these talents, usually through application of herbs or potions, highlighting an understanding that a state of unconsciousness could be induced by elements from the environment in the hands of a skilled or gifted operator. Through multiple different tales, the ancient Greeks also imply a distinction between physiological and drug-induced sleep, the latter of which is frequently associated with wrath and amnesia. Despite this distinction, sleep is commonly used interchangeably with general anaesthesia in discussions with patients. Though presumably intentioned to provide reassurance, using inaccurate terminology may impact on patients' ability to make an informed decision about receiving an anaesthetic. Perhaps there is a role for artistic and allegorical methods of communication to reflect this distinction to patients as we guide them through an odyssey of their own into a state of controlled unconsciousness.

Abstract
In the second half of the nineteenth century and up to the First World War, anaesthetic practice in Scotland differed markedly from that in England. Chloroform was invariably used in Scotland with apparent disregard for reports of deaths under its influence. By contrast, in England concern about chloroform deaths, which were subject to inquests there, led to ether often being chosen instead. This article examines the different interpretations and handling of chloroform deaths in the two countries, drawing on the medical journals of the period and archived documents. Quite symmetrical claims were made. Whereas in England the danger of chloroform was perceived to be an inherent property of the agent itself, in Scotland the blame was thrown on a timid method of administration. The interpretation in Scotland was supported by a network of doctors who promoted chloroform as effective, safe and easy to administer; manufacturers who had monopoly of its manufacture; and legal practitioners who were uninterested in investigating anaesthetic deaths. Although the reporting of anaesthetic deaths was flawed in England, underreporting was far worse in Scotland. The fear of anaesthetic deaths in England allowed the seeds of specialisation in anaesthesia to germinate, whereas in Scotland the downplaying of anaesthetic risk obviated the notion of such specialisation.