Monday, 12 October 2015

Anaesthesia Heritage Centre

The Association of Anaesthetists of Great Britain and Ireland
21 Portland Place

Thursday October 8th 2015

Followers of the blog may have noticed that we tried to visit this august  body (fine building – colonnaded porch, exemplary ornamental flowers) some weeks ago but a flood in the basement had closed them down. In spite of heavy rain again this week the heritage centre, located in the building’s basement was open and a young woman escorted us downstairs. We assume the rest of the building is occupied with issues of professional development, research and membership; also there are rooms for meetings.

The area is shared with a library and is small, partly a reflection of the fact that anaesthesia, as we know it, has a very short history compared to most other branches of medicine which have been going since Greek times. The library and exhibits give credit to the collectors Thomas King and J. Alfred with the Foundation starting in 1932. Rather puzzlingly there is a (silent) film of a man floating face down in the sea, tethered we presumed, to some oxygen but without a commentary it was a bit difficult to establish where this figured in the evolution of safe anaesthesia.
There were plenty of examples of both surgery and even more wincingly dentistry taking place WITHOUT either anaesthesia or pain relief – the main methods of operating being to hold the patient down or give him a  hefty tot of alcohol. The Enlightenment saw scientists pursuing a more methodical and rigorous approach to experimentation rather than relying on magic or belief systems…  The pictures reproduced made us devoutly grateful that pain relief was so much better nowadays. The experimenters looked at what was already there and evaluated the effectiveness, and after effects of the various methods, usually trialing on themselves.

 I guess pain relief was the start of total anaesthesia and the early practitioners used herbs ( mandrake roots as featured in some detective fiction; it is also known, more poetically as Mandragora as in ‘Charmian, give me to drink mandragora’ says Cleopatra unhappy without her Anthony).
Further east acupuncture has long been used for pain relief.

In the Thirties ‘bright young things’ (‘twas ever thus) were using nitrous oxide as part of their ‘ether frolics’ and gradually dentists began to use variants to help with their work. Anaesthesia in dentistry is of course more complex as you need to keep the mouth open in order to complete the work. After 2001 dentists were no longer permitted to be their own anaesthetists and most out- patient pain relief is via local injections.   Where possible this is also the current practice for minor surgery.

There are ample examples of the apparatus used to deliver pain relief/total anaesthesia both in the vitrines and the drawers below and these include a range of face masks, needles etc. Apparently two metal syringes were discovered on the  'Mary Rose'.

Chloroform was another early agent of pain relief and interestingly it was Dr.John Snow, who not only deduced the source of the cholera outbreak in London but also developed pain relief for women in childbirth – including Queen Victoria. A man of many talents. 

From 1912 the use of anaesthesia became part of the curriculum of medical education n and in 1935 the Diploma in Anaesthetics was introduced. Nowadays anaesthetists can lead Intensive care units and have  a much higher profiles.

The exhibition ends with a display featuring the work of anaesthetists working on the front during World War 1. Apparently ’shock’ was as much a threat to life as the actual injuries and though recognised  it took some time for those treating the injured to understand, and out into practice replacing fluids  (via saline or blood) as the best relief for ‘shock’.

This is a display clearly designed to appeal and inform the practitioners. We would have welcomed some more basic explanations –

What exactly is the difference between ether, which has been around since 1275, and chloroform (1830s) and whatever is used nowadays. There is no mention of the effects on the brain – I contend that having anaesthetic is NOT like being asleep – it is complete nothingness presumably like being dead – where of course they ‘bring you back’..  Nor are the after effects of anaesthesia referred to in any detail. The other omission is the role played by anaesthetists working in palliative care and hospices where their skills are used to manage a more pain free exit from life.   

The best thing is the association's coat of arms upheld by two peacefully 'sleeping' patients...

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