Our links with the past: the value of knowing our history

Abstract

For the greater part of the past century and a half the hazards and problems of anaesthesia loomed large. They were serious and frequent enough for Dr. Wesley Bourne to suggest that the anaesthetist of that era was holding his patient over an open grave. ~ However, particularly in the past 25 years, advances have made anaesthesia relatively safe and straightforward and relatively free of hazard and stress. From our perspective today it is therefore difficult to visualize our predecessors' problems and the solutions they applied. A backward look is not entirely academic because some of the basic problems (e.g., control of the airway, preservation of homeostasis and provision of analgesia and muscle relaxation) of their day are not dissimilar to ours, while the keys to solving them, then as now, have always been cut from a continuing commitment to self-education. This is nicely illustrated in the autobiographical review left to us by the late Dr. Nicholas Hill. Besides broadening our perspective through a knowledge of history, his account merits our attention for several other reasons. Dr. N.P. Hill practised in St. Catharines, Ontario, from the mid-1920s to the early 1970s. The title of his narrative, Fifty Years in Anaesthesia, suggests one reason why his account is of interest. The experience he gained as extraordinary and exciting advances shaped and reshaped the practice of anaesthesia during that time enabled him to write a first-hand summary of what happened. He witnessed the following advances in both drugs and techniques: - the original inhalational agents (ether and chloroform and later ethyl chloride) through cyclopropane and trichlorethylene yielded primacy to halothane, fluroxene, methoxyflurane, which in turn gave way to isoflurane. - the early intravenous barbiturate hypnotics (e.g., sodium amytal) were superseded by hexobarbital, sodium pentothal and methohexital, which were augmented later by a variety of other agents (e.g., the steroid hydroxydione [Althesin], ketamine, Etomidate, benzodiazepines) and then propofol.