History of anaesthesia: Journals & articles

Abstract
The British Journal of Anaesthesia (BJA) celebrates its centenary in 2023, and with it 100 yr of continuous anaesthesia research publication. As an editorially and financially independent journal, the BJA faced a rapidly changing anaesthesia profession, health system, and publishing world without the security of institutional support. In its early days, the Journal was vocal about the challenging conditions faced by anaesthetists before the National Health System was established, and was essential in advocating for the specialty. Although the years after World War II brought improving fortunes for the specialty, the BJA found itself struggling to publish. As the Journal's fortunes began to improve, a new research and healthcare context emerged, radically changing the face of anaesthesia research and practice, to which the Journal needed to adapt. In spite of a range of challenges throughout the years, the BJA has developed into an international, future-focused, well-respected publication. This could not have been achieved without continual transformation, and the willingness to take risks and meet the changing times head on.

Abstract
Pain is both one of the oldest complaints known to medicine and a field for some of medicine's latest breakthroughs and innovations. Pharmacologic treatment of pain is one of the oldest remedies, and opioids have been used since ancient times as an effective pain reliever but with certain specific risks for abuse. Greater knowledge of opioids led to a more thorough understanding of the complexities of pain, which may have any number of mechanisms. A greater understanding of nerve fibers and pain signaling led to the development of more drugs and the more targeted delivery of analgesics using the hollow needle. The hollow needle changed pain treatment and led to percutaneous injections and what would later become interventional pain medicine with regional anesthesia and nerve blocks. Today, imaging can be combined with interventional techniques for more precise localization of nerves for diagnosis and treatment. The role of artificial intelligence in interventional pain medicine, especially in imaging for interventional procedures, remains unknown but will likely become extremely beneficial.

Abstract
This special article briefly discusses the role of women as the new journal Current Researches in Anesthesia and Analgesia (now Anesthesia & Analgesia [A&A]) began in 1922. It was a time of a few women physicians, and they were usually isolated from the world of mainstream medicine and its predominantly male practitioners The journal's founders, Frank McMechan and his wife Laurette of Cincinnati, were committed to developing an organization for everyone, and women physicians were welcomed early on. Three women physicians even served as the presidents of various anesthesia organizations early in the formation of the present national organization. This acceptance of women was to change as medical education and practice evolved to embrace scientific medicine, after the Flexner Report of 1910 documented the deficiencies of American medicine. Mrs McMechan made the most important contributions by a woman because she cared totally for Dr McMechan, after he experienced disabling and very severe arthritis. He became dependent on his wife for most activities, including the simple act of eating. He could not function without her; she kept him going physically for another 27 years after the onset of his very debilitating illness. After her husband's death in 1939, Mrs McMechan served an executive function, keeping the organization going and maintaining production of the journal. This article also briefly discusses the life of the first woman physician to publish an article in A&A, Frances Edith Haines, MD, of Chicago. Haines published several articles in the journal; the first was in 1922, in the second journal issue. She was the president of the Mid-Western Association of Anesthetists, an affiliated organization, in 1926. She also served in World War I as a contract physician anesthetist for the US Army; she was the first woman contract surgeon to go overseas, to Limoges, France. Her adventure-filled and bold life changed as she aged and developed financial problems. She tried, but failed, to get financial help from the government and the military for her war service, and she died in 1966. These women are examples of women physicians involved with the journal, as it began in 1922. As the number of women physicians has increased recently, some past problems, such as difficulty with getting admitted to medical schools, for example, have improved. However, there are still many issues for women in medicine, including in our specialty.

Abstract
Thomas Dent Mütter, a Philadelphia plastic surgeon in the 1840s, boldly championed anesthesia when few physicians were convinced of its virtues. He was an early advocate of handwashing and hygienic wound care and helped pioneer the concept of postoperative recovery units. A leader in education, Mütter used a highly interactive style of teaching and restructured medical school classes to raise the caliber of clinical training. He supplemented his lectures with a myriad of specimens that he amassed over 24 yr. In 1863, this vast collection would serve as the basis for the Mütter Museum, which remains active today. Mütter exemplified expertise by tirelessly pursuing new knowledge and methods for the benefit of his patients and students.

Abstract
At the outbreak of World War II (WWII), anesthesiology was struggling to establish itself as a medical specialty. The battlefield abruptly exposed this young specialty to the formidable challenge of mass casualties, with an urgent need to provide proper fluid resuscitation, airway management, mechanical ventilation, and analgesia to thousands. But while Europe was suffering under the Nazi boot, anesthesia was preparing to rise to the challenge posed by the impending war. While war brings death and destruction, it also opens the way to medical advances. The aim of this study is to measure the evolution of anesthesia owing to WWII. We conducted a retrospective observational bibliometric study involving a quantitative and statistical analysis of publications. The following 7 journals were selected to cover European and North American anesthesia-related publications: Anesthesia & Analgesia, the British Journal of Anaesthesia, Anesthesiology, Schmerz-Narkose-Anaesthesie, Surgery, La Presse Médicale, and The Military Surgeon (later Military Medicine). Attention was focused on journal volumes published between 1920 and 1965. After reviewing the literature, we selected 12 keywords representing important advances in anesthesiology since 1920: "anesthesia," "balanced anesthesia," "barbiturates," "d-tubocurarine," "endotracheal intubation," "ether," "lidocaine," "morphine," "spinal anesthesia," "thiopental," "transfusion," and "trichloroethylene." Titles of original articles from all selected journals editions between 1920 and 1965 were screened for the occurrence of 1 of the 12 keywords. A total of 26,132 original article titles were screened for the occurrence of the keywords. A total of 1815 keywords were found. Whereas Anesthesia & Analgesia had the highest keyword occurrence (493 citations), Schmerz-Narkose-Anaesthesie had the lowest (38 citations). The number of publications of the 12 keywords was significantly higher in the postwar than in the prewar period (65% and 35%, respectively; P < .001). Not surprisingly, the anesthesiology journals have a higher occurrence of keywords than those journals covering other specialties. The overall occurrence of keywords also showed peaks during other major conflicts, namely the Spanish Civil War (1936-1939), the Korean War (1950-1953), and the Vietnam War (1955-1975). For the first time, this study demonstrates statistically the impact of WWII on the progress of anesthesiology. It also offers an objective record of the chronology of the major advances in anesthesiology before and after the conflict. While the war arguably helped to enhance anesthesiology as a specialty, in return anesthesiology helped to heal the wounds of war.

Abstract
In 2023, the British Journal of Anaesthesia commemorates its first century of publishing innovations in anaesthesia, pain, critical care and perioperative medicine. In honour of this special anniversary we outline a number of exciting initiatives to occur over the course of the year to commemorate this important milestone, and to highlight the many contributions that the British Journal of Anaesthesia has made to patient care, medical research, and medical education in our first 100 years.

Abstract
Relying on original, primary source documentation from the National Archives, we describe the practice of anesthesia in mobile army surgical hospital (MASH) units and the 171st Evacuation Hospital during the latter part of the Korean War in 1953. Values were scaled and reported as percentages. These Essential Technical Medical Data Sheets reveal a surprising proportion (12.9%) of men received spinal anesthetics, despite official recommendations to the contrary. Still, the majority (69.2%) of the wounded underwent general anesthesia, most commonly through a mixture of thiopental and nitrous oxide. Despite data from World War II demonstrating the advantages of endotracheal intubation in these patients, few patients (20.6%) were intubated. Six percent benefited from the new curare-based drugs. This is the first English-language article that describes the practice of anesthesia during the Korean War. Utilizing primary source documentation, we found that general anesthesia was the most common type utilized. Newer techniques were not as commonly adopted, despite official recommendations and data from the time. The care provided closely resembled that delivered in the Second World War but inspired a series of technological and pedagogical reforms through the 1950s to improve military anesthesia for the next conflict.

Abstract
Richard Gordon (1921-2017) was a prolific writer of both humorous fiction and historical reviews. He trained in medicine at St Bartholomew's Hospital (Barts) in London and specialised in anaesthesia working at Hill End Hospital, St Albans (where a large proportion of Barts work took place to avoid the impact of the Blitz during the Second World War) and at the Radcliffe Infirmary, Oxford with Robert Macintosh. He published multiple papers and a book on trichlorethylene anaesthesia and edited a textbook of anaesthesia for medical students which ran for 10 editions. His gift for writing and his prominent public persona placed him in a unique position to highlight the importance of the newly emerging speciality of anaesthesia. He did the exact opposite of this and instead created a representation of an uninterested spectator to surgical activity, a representation which still persists in some quarters today.

Papua New Guinea is a Pacific country that remains an enigma to the world at large. Despite massive geographical challenges due to mountainous terrain, remote islands, poverty, and with 80% of the population of over eight million living in rural villages, Papua New Guinea has managed to develop national medical and postgraduate specialty training. The first recorded anaesthetic was administered in Papua New Guinea in 1880 and the first anaesthetist trained in 1968. The University of Papua New Guinea graduated its first diploma in anaesthesia candidate in 1986 and its first master of medicine candidate in anaesthesiology in 1991. As of December 2021, there have been 82 diplomas and 40 masters of medicine awarded. We review the factors and influences bearing on the development of physician anaesthesia training in Papua New Guinea over this period. Many of the people involved have contributed information used in this article.

The Presidential Address of the outgoing President of the Australian Society of Anaesthetists (ASA) was renamed the Geoffrey Kaye Oration in 1986 after the first and longest serving Secretary of the Society.1 The development of the specialty of anaesthesia in Australia benefitted from his ‘unique talents in research, teaching and organisation’, which were accompanied by his ‘dedication and capacity for hard and unremitting work’.2
On 19 January 1934, Geoffrey Kaye (1903–1986) and six other men stepped away from the Fourth Australasian Medical Congress of the British Medical Association to Hadley’s Hotel in Hobart and founded the ASA. This was undoubtedly a challenging time for the specialty but very much a cherished moment. This event created the fourth medical organisation in Australia and a split from the British Medical Association. Anaesthesia had been overlooked and not included in the initial scientific program of the Congress. This step, of forming a separate anaesthesia organisation, marked in Australia that anaesthesia, ‘for so long merely the handmaiden of surgery, was now itself a science and an art and for its practice there must be training and teaching’ and it would be the newly formed ASA which would steer this course.2
Since that day in 1934, the Annual General Meeting of the ASA has almost always been held in conjunction with the National Scientific Congress (NSC). Annual General Meetings and Congresses mark time for organisations such as ours. Whilst reflecting on the Congresses that have marked my time as President, there are two moments that I would like to share with you today.
The first is the 2019 NSC in Sydney, convened by Dr Anne Jaumees. During the NSC a colleague asked me what number female President of the ASA I would be. As I had been in an Acting President role for a good part of the year, I was embarrassed that I didn’t know the answer, but I quickly looked it up. Five. I am the fifth woman to be President of the Australian Society of Anaesthetists and the 46th President.

In April 1915, a 34-year-old sergeant in the British Army was among the thousands of allied troops attacked with chlorine gas during the second Battle of Ypres. While he survived, and ‘expected to recover in a day or two’, the previously healthy infantryman, who ‘had done heavy work all his life, and was a good athlete, having rowed and swum in races’, was left with persistent breathlessness, tightness.

The complicated history of modified electroconvulsive therapy (ECT) started back before anesthesia was incorporated when unmodified electroconvulsive therapy was not considered humane. When anesthesiologists started working with psychiatrists, ECT gradually regained acceptance by decreasing the obstacles inherent to this therapy despite the complexities of the anesthetics. However, the sociopolitical and medicolegal factors negatively impacted the use of modified ECT leading to a period of time when it was banned from use in the United States. Fortunately, as advances in anesthesia and technology continued to develop, anesthesiologists helped ECT regain widespread usage improving the safety profile, cost effectiveness, quicker onset of seizures, and ease of control despite its stained past. This allowed more accessibility, especially for high-risk medical patients, to a relatively safe and effective treatment for psychiatric diseases.

The most recent estimates, published in 2016, have indicated that around 70% of anaesthesia providers in Papua New Guinea are non-physician anaesthetic providers and that they administer over 90% of anaesthetics, with a significant number unsupervised by a physician anaesthetist. Papua New Guinea has a physician anaesthetist ratio estimated to be 0.25 per 100,000 population, while Australia and New Zealand have a ratio of 19 physician anaesthetists per 100,000, which is 75 times that of Papua New Guinea. To reach a ratio of seven per 100,000, recommended as the minimum acceptable by the Lancet Commission in 2016, there will need to be over 35 practitioners trained per annum until 2030, at a time when the average annual numbers of recent years are less than three physicians and less than five non-physician anaesthetic providers. We review the development of anaesthesia administered by non-physician indigenous staff and the stages of development from heil tultuls, dokta bois, liklik doktas, native medical assistants, aid post orderlies, and Anaesthetic Technical Officers up to the current Anaesthetic Scientific Officers having attained the Diploma in Anaesthetic Science from the University of Papua New Guinea.

A number of Charles Darwin's biographies record the administration of chloroform by Darwin to his wife Emma, during her labour and delivery of her eighth child, Leonard. This occurred on 15 January 1850, a little over two years after James Young Simpson in Edinburgh described the analgesic action of inhaled chloroform. An online search of more than 9000 items of Darwin's correspondence at Cambridge University and other sources revealed that he was an active proponent and user of chloroform in midwifery, for euthanising animals he studied, as well as in botanical studies of carnivorous plants. He also discovered that the concurrent inhalation of chloroform, during its administration to his wife, alleviated his distressing anxiety which he suffered when present at her earlier confinements.

The lack of radio navigational aids in early Royal Flying Doctor Service aircraft in Australia occasionally resulted in aircraft being stranded at a remote site with a critically injured patient due to weather and other conditions. For a brief period in the 1950s, at least one Royal Flying Doctor Service pilot was trained to administer anaesthesia to critically ill patients who could not be immediately evacuated. The aim of this paper is to describe the circumstances in which this arose and how it worked in practice. This is based largely on the recollections of pilot anaesthetist Captain Keith Galloway, who shared his recollections during interviews with the authors.

Pandemics have ravaged human civilization at regular intervals for the past 2000 years killing millions of people worldwide [1]. With each pandemic, healthcare workers and hospital systems have borne the brunt of these outbreaks fulfilling their moral responsibility to treat and give a healing touch to already distressed situations. Each outbreak has tested the exceptionally very high level of skill, expertise as well as the professional commitment of healthcare workers.

Anesthesiology reflections from the Wood Library-Museum.

When Thomas Trotter retired from his long career as physician to the Channel Fleet in 1804, he published his earlier MD thesis—an essay on drunkenness. While Trotter was not the first to recognise the problem of addiction, or to suggest potential treatments, his manuscript was the first book-length discussion on the subject—and the first to suggest that addiction was ‘a disease of the mind’. His seminal work probably had little impact at the time—the medical profession, and the general public, were more supportive of the moralistic tone promoted by Benjamin Rush in his 1785 pamphlet ‘Ardent Spirits’.

Abstract
Dr Himson Tamur Mulas was born on the Gazelle Peninsula of East New Britain, New Guinea, on 13 March 1934. After finishing his schooling, he was selected to go to Fiji to undertake a medical course at Fiji Central Medical School in 1953, returning to New Guinea in 1958. He successfully completed residency posts and after a period of training in anaesthesia in Port Moresby, was sent to the Alfred Hospital in Melbourne, Australia, in 1966-1967 to further his anaesthetic career. After returning to New Guinea he undertook several administrative posts as well as continuing his anaesthetic career before settling at Nonga Hospital in Rabaul, East New Britain Province. He was first registered as a specialist anaesthetist in 1972. He went on to complete a Diploma in Public Health in New Zealand in 1974, and in 1976 completed a Diploma in Tropical Health and Hygiene at the University of Sydney. He left public hospital anaesthetic practice in 1980. He is recognised as the first New Guinean to be a specialist anaesthetist. He died on 28 July 2000 aged 66 years.

Abstract
In April 2018, a statue commemorating J Marion Sims was removed from Central Park, New York, and relocated to Green-Wood Cemetery in Brooklyn, where he is buried. In 1849, Sims developed a repeatable surgical solution for obstetric fistula, a debilitating condition caused by prolonged, obstructed labour, which damages the vaginal wall, resulting in permanent leakage via the vagina from either the bowel or bladder and sometimes both. Initially, Sims appears worthy of widespread adulation. There are several commemorative statues of him, he has been afforded the title of the 'father of modern gynaecology', and for 37 years, the American Urogynecological Society held an annual eponymous lecture, among other honours. Obstetric fistula rendered women social pariahs, unable to engage fully in either domestic or public life. Sims was able to create a reliably repeatable surgical solution but did so through ongoing experimentation on enslaved women. One of these women, Anarcha, was operated on at least 30 times without the use of anaesthesia over a four-year period, despite the availability of anaesthesia for the majority of the experimentation period. Over 170 years later, Sims' story retains its relevance because it represents a clear point at which race, gender and class intersect with medicine. This paper will use Sims' own account to drive the narrative, then examine matters of agency, ethics and consent that come from it, to show that his work, and subsequent renown, were only possible because of the inherent violence of chattel slavery and other systemic forms of oppression.

Abstract
On 8 March 2018, the Geoffrey Kaye Museum of Anaesthetic History launched its latest exhibition in an online format, The Rare Privilege of Medicine: Women Anaesthetists in Australia and New Zealand. The launch was deliberately timed to coincide with International Women's Day which carried the theme of "Press for Progress." These women's stories reveal them to have been champions for progress, as well as having the potential to be inspirational beacons of progress for the future, thereby fitting easily into the theme. This article highlights the stories of Dr. Janet Greig and Dr. Lily Jörgensen, two women featured within the exhibition. Other women are also represented, as their stories provide some degree of context to the two featured women, even though there is no evidence to suggest that they did significant work in anesthesia practice. However, this article should not be considered biographical in nature. Instead, it operates within a distinct theoretical perspective, examining the way in which historians research and interpret the past. It also considers the exhibition research, and the exhibition itself, to be a launch point for more nuanced work in this area.

The Journal of Anesthesia History is an international peer-reviewed journal dedicated to advancing the study of anesthesia history and related disciplines. The Journal addresses anesthesia history from antiquity to the present. Its wide scope includes the history of perioperative care, pain medicine, critical care medicine, physician and nurse practices of anesthesia, equipment, drugs, and prominent individuals. The Journal serves a diverse audience of physicians, nurses, dentists, clinicians, historians, educators, researchers and academicians.

Medical History is a refereed journal devoted to all aspects of the history of medicine, health and related sciences, with the goal of broadening and deepening the understanding of the field, in the widest sense, by historical studies of the highest quality. It is associated with the Asian Society for the History of Medicine. The membership of the Editorial Board reflects the commitment to the finest international standards in refereeing of submitted papers and the reviewing of books