James Watt, of Steam Engine Fame, Offered Inhaled Carbon Monoxide for Putative Therapeutic Action

James Watt (1736-1819) is remembered as a steam engine innovator and industrial magnate. A polymath, he was also a hands-on contributor to the Medical Pneumatic Institution of Thomas Beddoes. Watt recruited Humphry Davy, who there discovered analgesic action of inhaled nitrous oxide in 1799. Watt also built pneumatic equipment, and he introduced a gas mixture, dubbed hydro-carbonate, as a medical tonic. The bioactive component was carbon monoxide, a readily-lethal inhibitor of the transport and utilization of respiratory oxygen. Despite appreciable toxicity, carbon monoxide is an endogenous product of heme catabolism, and low doses of the gas are under laboratory investigation for therapeutic purposes. However, Watt's hydro-carbonate constituted a setback in the development of pharmacologically useful gases.

Oxygen Was Almost Named Nitrogen

In his Tractatus Quinque Medico-Physici of 1674, John Mayow wrote that a fifth of atmospheric air is comprised of nitro-aerial spirit. That so-called spirit participates in both respiration and combustion. The etymology of "nitro-aerial spirit" stems from a mineral long called niter and now specified as potassium nitrate. Niter mixed with sulfur and carbon is gunpowder, developed in the ninth century in China. Mayow appreciated that niter was the oxidant in the energy-yielding reaction of gunpowder. The word "oxygen," eventually prompting the word oxidant, was coined a century later by Antoine Lavoisier.

Henry Jacob Bigelow Inhaled Nitrous Oxide While an Undergraduate at Harvard College

When teenaged Henry Jacob Bigelow was an undergraduate at Harvard College in 1833-1837, he prepared nitrous oxide gas for demonstrations to other students. Bigelow's son, William Sturgis Bigelow, related the claim, and there is an eyewitness account from Augustus Goddard Peabody, a fellow Harvard undergraduate with Bigelow. Peabody wrote to Henry David Thoreau about a nitrous frolic. College chemistry primed Bigelow to support the concept of inhaled surgical anesthesia when the idea came to Boston in 1845-1846. Bigelow's chemistry professor was John White Webster. According to Harvard alumnus Edward Everett Hale, in addition to demonstrating effects of nitrous oxide, Webster presciently treated two cases of carbon monoxide poisoning with copious volumes of synthetic oxygen gas. The career of Webster was inhibited by financial difficulties that were suspected to be contributory when he was convicted of the 1849 murder of physician George Parkman at the Harvard Medical School, then adjacent to Massachusetts General Hospital and its Ether Dome. Webster suffered the death penalty in 1850.

Kety-Schmidt Application of Nitrous Oxide to Determine Cerebral Blood Flow

In the 1940s, Seymour S. Kety and Carl F. Schmidt measured cerebral blood flow in awake humans by means of subanesthetic doses of inhaled nitrous oxide. The inhalation route obviated the need for an arterial injection of the indicator, and nitrous oxide had virtues of metabolic inertness, rapid diffusion through the blood-brain barrier, comparable blood and brain solubility, and ease of analytical detection. The technique was also applied to the heart. Follow-up work by Kety contributed to the development of brain scanning methods.

Thunberg's Barospirator, a Fully Encasing Predecessor of the Iron Lung

Used as a ventilator for assisting victims of polio, the barospirator was described by Swedish physician-scientist Torsten Thunberg in 1924. An immediate predecessor of the iron lung of Philip Drinker, the barospirator fully encased the entire body. Cyclic air-pressure changes within the chamber achieved ventilation during equilibrations of intrapulmonary and ambient pressures. Pulmonary medicine innovator Alvan Leroy Barach used a modified barospirator for lung rest as a treatment of tuberculosis in the 1940s. Adverse effects included damage to patients' tympanic membranes. Despite its limited clinical success, the barospirator was successfully used by one of Drinker's competitors, John H. Emerson, to invalidate Drinker's US patent filings.

Divine's CO2 Absorber of 1867

Chemist and inventor Silas R. Divine (1838-1912) sold ammonium nitrate and other anesthesia supplies in New York City. He offered a carbon dioxide absorber for the purpose of rebreathing nitrous oxide. Like his colleague Gardner Q. Colton, he denied the need for nitrous oxide to be supplemented with O₂ gas.

The role of multimodal analgesia in preventing the development of chronic postsurgical pain and reducing postoperative opioid use

Chronic postsurgical pain (CPSP) is a possible complication of various surgical procedures, which can impair patients' quality of life while also contributing to chronic opioid use. Multiple biopsychosocial factors put patients at risk for CPSP. Multimodal analgesia with the use of various pharmacologic and regional anesthetic techniques can help reduce the incidence and severity of CPSP. However, the relationship between various perioperative analgesic strategies and the development of CPSP is not fully understood. Although the use of multimodal analgesia will not automatically prevent CPSP and/or prolonged opioid consumption, there is potential to do so, especially by means of regional techniques.

George Washington Frost Mellen and Resuscitation with Nitrous Oxide in 1847

In The Boston Medical and Surgical Journal of 1847 (later to be called The New England Journal of Medicine), Boston chemist George Washington Frost Mellen claimed that inhaled nitrous oxide gas supports human life in the manner of oxygen gas, and he proposed the use of nitrous oxide in resuscitation from drowning and from carbon monoxide poisoning. The claim was reprinted in at least one dental journal and was long cited as justification for the use of 100% nitrous oxide for inhaled anesthesia. Advocates included anesthesia pioneer and painless dentist Gardner Quincy Colton. Though misguided as to nitrous oxide, Mellen was a prominent member of the Boston community for the abolition of slavery.

The Perfect and Famous Anesthetic Known as Methyl in Boston in 1895

Extravagant claims were made for proprietary dental anesthetics in Boston, MA, in the late 1800s. For instance, in 1883, Urial K. Mayo introduced an inhaled Vegetable Anaesthetic comprised of nitrous oxide that had been uselessly pretreated with botanical material. This misguided concept may have been inspired by homeopathy, but it was also in line with the earlier false belief of Elton R. Smilie, Charles T. Jackson, and William T.G. Morton that sulfuric ether could volatilize opium at room temperature. In 1895, the Dental Methyl Company advertised an agent they called Methyl, a supposedly perfect topical anesthetic for painless dental extraction. The active ingredient was probably chloroform. Anesthetic humbug did not cease in Boston on Ether Day of October 16, 1846.

John Snow and the First Second-Gas Effect

In 1847, British anesthesia pioneer John Snow (1813-1858) observed that patients did not manifest cyanosis during induction with hypoxic mixtures of ether vapor in air. He hypothesized a molecular mechanism that would be understood over a century later as the second gas effect.

John Collins Warren, Surgeon of Ether Day, Entered Sulphuric Ether into The Pharmacopoeia of the Massachusetts Medical Society in 1808

John Collins Warren, the surgeon of Ether Day in 1846 at Massachusetts General Hospital, entered sulphuric ether into the nationally recognized Massachusetts pharmacopeia of 1808.

Noteworthy Chemistry of Chloroform

Inhaled chloroform anesthesia was introduced in 1847. Soon thereafter, the chemical reactivity of aerobically heated chloroform permitted John Snow and Claude Bernard to do seminal experiments in the assay of drug levels and drug metabolism. However, it was not widely appreciated until a clinical mishap in 1899 that thermal decomposition generated significant levels of toxic phosgene from air-polluting quantities of chloroform in poorly ventilated operating rooms that were illuminated by flames. Phosgene is also generated metabolically from chloroform. A clue appeared in the 1950s when subanesthetic traces of inhaled chloroform proved accidentally lethal to strains of male mice spontaneously expressing high levels of chloroform-metabolizing enzymes. Furthermore, in microbial experiments of 1967, the reactive chloroform molecule was inadvertently discovered to selectively inactivate vitamin B12-dependent enzymes. Chloroform can also activate enzymes. As a solvent, it was serendipitously found in 1903 to activate what is now known as plasminogen to plasmin.

Obstetric and Other Uses of Ether Before Ether Day, According to the Boston Medical and Surgical Journal of 1828-1846

From the inception of the Boston Medical and Surgical Journal in 1828 until the prominent public demonstration of surgical anesthesia on Ether Day of 1846, ether was often mentioned in the journal. Many of the examples were related to obstetrics. Because molecular structures were not available in the early 1800s, diverse volatile liquids were termed ethers. In addition to sulphuric ether, so-called ethers included cyanide-releasing propionitrile and ethanolic solutions of chloroform and of the potent vasodilator ethyl nitrite. Familiarity with anesthetically unsuitable ethers may have long deterred consideration of inhaled sulphuric ether for analgesia and anesthesia.

George Bernard Shaw on Anesthesia

Recipient of the 1925 Nobel Prize in Literature, George Bernard Shaw (1856-1950) was an influential critic of the health care establishment in the United Kingdom. Although skeptical of many medical and surgical procedures of the early 20th century, he respected the value of anesthesia, and he advocated its administration by Frederick W. Axham, a medical doctor whose registration was suspended as punishment for providing anesthesia for a bonesetting procedure. In 1924, when a friend needed surgery, Shaw offered to pay the extra fee for the optional anesthesia.

Effect of the daguerreotype process on Morton's part in history

Because daguerreotype photographs are usually reversed laterally from actuality, images of W.TG. Morton falsely suggest that he sometimes changed the side of the part in his hair. Because of daguerreotype image reversal, a statue of Apollo in the Ether Dome at the Massachusetts General Hospital appears to have been moved for the 50th anniversary of Ether Day.

Early misconceptions about nitrous oxide, an "invigorating" asphyxiant

Well into the twentieth century, nitrous oxide was often suspected to support life in the manner of oxygen. Authorities contributing to that life-threatening misimpression include Humphry Davy, Gardner Q. Colton, and George W. Crile. Concomitantly, deprivation of oxygen was long touted as a requisite for nitrous oxide anesthesia.

Commonly used eponyms in anesthesia

Names with eponym status in present-day anesthesia include Apgar, Bier, Bovie, Esmarch, Fick, Foley, Ganz, Hofmann, Huber, Joule, Luer, Macintosh, Magill, Mallampati, Miller, Ovassapian, Pascal, Ringer, Seldinger, Sellick, Swan, Trendelenburg, Tuohy, Valsalva, and Yankauer. A discussion of the people behind the eponyms, which may make these commonly used terms more interesting and provides a sense of the history of the specialty of anesthesia, is presented.

Liquor made quicker: alcohol as a synthetic reagent for molecules in anesthesia

Ethanol was an early anesthetic, and chemists transformed it into better ones. Hypnotic/anesthetic/analgesic molecules prepared from ethanol include barbiturates, benzocaine, chloral hydrate, chloroform, diethyl ether, ethyl chloride, ethylene, etomidate, meperidine, paraldehyde, phenacetin, procaine, tribromoethanol, and urethane. Ethanol was sometimes mixed deliberately with the other anesthetics, and John Snow's inhaled amylene came from the "fusel oil" fraction of rotgut whisky.

Lipmann and Anfinsen: Nobel biochemists of Beecher's anesthesia laboratory

Henry K. Beecher performed blood pH and gas analysis on patients in the 1940s, though the biochemical technology was not widely available until the 1950s. Two of Beecher's biochemist coworkers, Fritz Lipmann and Christian B. Anfinsen, went on to earn Nobel Prizes.

Nitrous or nitric? Same difference. Molecular formulas in the 1840s

The molecular formulas given by James Y. Simpson for nitrous oxide, diethyl ether, and chloroform are difficult to interpret today. The organic formulas are "incorrect" today because Jean Dumas (the influential chemist who was one of the discoverers of chloroform) used John Dalton's presumption of molecular simplicity. That is, water was long presumed to be HO. The nitrous oxide formula was incorrect owing to confusion with Dalton's nitrous gas, now termed nitric oxide. The Simpson formulas illustrate that inhaled anesthesia arrived at the time of a cusp in the history of chemistry.