Journal of Anesthesia History最新文献

Purpose

One of the most interesting signs of growth in a medical specialty is the addition of pain medicine as a clinical subspecialty to it. The aim of this study was to analyze publication-based academic interest in pain medicine among clinical specialties with long-standing involvement in pain management.

Methods

We assessed the activity within several specialties in the development of an academic foundation for pain medicine by measuring the frequency of the most common pain topics (1998-2017) in academic journals representing such specialties. The selection of materials for the analysis of publication-based academic interest associated with the development of pain medicine followed a three-step process: (1) Medical specialties, limited to those with accredited fellowship training in pain medicine for more than 20 years – anesthesiology, neurology, physiatry, and psychiatry; (2) Pain topics, based on the degree of topic association with the work of pain clinics – a total of 34 topics; (3) Specialty journals, mostly official journals of societies publishing articles representing all aspects of a specialty – four journals per specialty. Specialty-related academic interest was characterized in two dimensions: its breadth (the number of different topics of interest with distinctly high shares of publications) and its intensity (maximal number of publications on a particular topic).

Results

According to the number of topics with a distinctly high share of articles per topic (≥ 5%), the rank order of specialties was as follows (of 34 topics): anesthesiology (22), physiatry (20), neurology (10), and psychiatry (0). Regarding comparative intensity of interest, anesthesiology has prevailing interest in 16 topics (especially in postoperative pain and pharmacologic pain treatment), physiatry in 13 topics (especially in physical methods of pain therapy), and neurology in one topic (headache disorders).

Conclusion

Publication-based academic interest in pain management was most intensive in two specialties, anesthesiology and physiatry, with anesthesiology being somewhat more multifaceted, especially in the methods of pain treatment.

Milton Antony (1789-1839), an apprenticed trained physician, began educating medical apprentices in 1826 and helped to establish the Medical College of Georgia (MCG) in 1829. Antony recruited additional faculty, Louis Dugas (anatomy and physiology), and Paul Eve (surgery), and together they worked to promote the dissemination of new medical knowledge and enhance and reform medical education. As a result of their efforts, the Southern Medical and Surgical Journal (SMSJ) was established in 1836. The SMSJ became the most successful and widely read regional medical journal. Unfortunately, upon the death of Milton Antony because of the Augusta yellow fever epidemic, the SMSJ ceased publication in 1839. Paul Eve then became Dean of MCG and revived the SMSJ in 1844.

Crawford Long (1815-1878) administered ether anesthesia for surgical removal of a neck tumor to James Venable in 1842. For several possible reasons, he did not publish his experience with ether until after Morton’s demonstration of ether in Boston in 1846. Crawford Long did meet with Paul Eve, in Augusta at MCG, and was encouraged to publish his experiences with ether in the revived SMSJ, which he did in 1849.

It is quite possible that if Milton Antony had lived, and the SMSJ had been continuously published, that Crawford Long may have published his use of ether well in advance of Morton’s ether demonstration in 1846. Had that occurred, the great controversy during the mid-nineteenth century over who first used ether for surgical anesthesia would not have existed, and Crawford Long would have received appropriate credit during his lifetime.

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.

Leo Fabian played a role in many anesthesia firsts: the first halothane anesthetics in the United States, the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. As was common for men of his generation, Fabian’s first taste of medicine came during World War II, as a pharmacist’s mate aboard the U.S.S. Bountiful. Afterward, he pursued his medical education before joining Dr. C. Ronald Stephen and the anesthesiology department at Duke. There he helped to create one of the first inhalers for halothane, the Fabian Newton Stephen (F-N-S) Fluothane Vaporizer. Fabian left Duke for the University of Mississippi Medical Center, where he consistently worked with the chair of surgery, Dr. James Hardy. Together they performed the first American electrical anesthetic, the first lung allotransplant, and the first heart xenotransplant. By the end of his time at Mississippi, Fabian and Hardy had several philosophical disagreements, and Fabian ultimately left for Washington University in St. Louis, where he rejoined Dr. Stephen. He served as Stephen’s right-hand man and would oversee the department when Stephen was away. Fabian spent the final years of his career as chair of the department before his own health forced him to step down.

Methoxyflurane was an inhaled agent commonly used for general anesthesia in the 1960s, but its clinical role gradually decreased in the 1970s because of reports of dose-dependent nephrotoxicity. In 1999 its manufacturer, Abbott Laboratories, discontinued distribution of methoxyflurane in the United States and Canada. Outside of North America, however, methoxyflurane has been reborn as an inhaled analgesic used for pain relief in the prehospital setting and for minor surgical procedures. First used in Australia and New Zealand, and subsequently in over thirty-seven other countries, low concentrations of methoxyflurane are administered with a hand-held inhaler which provides conscious sedation, so that patients can self-assess their level of pain and control the amount of inhaled agent. The Penthrox inhaler, originally developed in Australia after several other hand-held vaporizers were tried, is currently being used worldwide as a portable and disposable self-administered agent delivery system. Methoxyflurane-induced nephrotoxicity continues to be a major concern, but with cautious administration of recommended doses methoxyflurane has been established as a remarkably safe analgesic agent with minimal side effects for patients in need of rapid and potent pain relief.

The name of Keizo Uenaka has not been documented in textbooks. However, Uenaka was the scientist who worked on ephedrine and played a practical role in the purification and crystallization of adrenaline. His handwritten memorandum, “On Adrenaline, Memorandum, July to December, 1900” is now stored in a Buddhist temple, Kyougyou-ji in Nashio, Japan.

In the present report, we compared Uenaka's original description and Jokichi Takamine's published scientific reports, and examined how each statement in four documents are related to each other in terms of successful adrenaline crystallization.

Uenaka's memorandum contained precise procedures and experimental tips for successful purification. The experimental steps were considered to transcribed in the first published document in The American Journal of Pharmacy by Takamine in 1901, and summarized in another document in ``Journal of Physiology'' in 1901. A Japanese version was published in ``Yakugakuzasshi'' in 1903 by translating the English paper in the American Journal of Pharmacy published in 1901.

Reading Uenaka's memorandum, we realized that he tirelessly and diligently undertook routine experiments that to some of us might seem boring and laborious. Although the name of Uenaka is not globally well known, he was the main scientist who did the actual work of purifying adrenaline.

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.

Sunday February 24, 1957 was a pivotal day in the history of anesthesiology and pain medicine. The leader of the Roman Catholic Church, Pope Pius XII met with anesthesiologists attending an international symposium sponsored by the Italian Society of Anesthesiologists entitled, “Anesthesia and the Human Personality”. The purpose of this audience was to seek clarification about the use of opioids at the end of life to reduce suffering. Three questions had been formulated from the previous year’s Italian Congress of Anesthesiologists and sent to the Holy See on this specific issue. The Pope responded during this audience remarking that there was no moral obligation to withhold pain medication that could elevate suffering. He further remarked that the suppression of consciousness that can occur with opioids was consistent with the spirit of the Christian gospels. Finally, he also stated that it was not morally objectionable to administer opioids even if it might shorten life. The moral philosophy behind these answers is the doctrine of double effect. In essence, administering medications to relieve pain, the primary effect, may also hasten death, the unintended secondary effect. In seeking answers to these questions, the Italian anesthesiologists were at the forefront of a larger and ongoing debate. As new therapies are developed that may have unintended consequences, when it is morally permissible to use them?

For 12 days in April 1944, a hastily constituted force of British and Indian combat troops held at bay 10 times their number of the seemingly invincible Japanese Imperial Army. The story of the siege of Kohima is one of courage, determination, and leadership. The Burma campaign and, indeed, the Asian theater of World War II as a whole are often overlooked other than by those with a special interest; this article is intended to inform and perhaps inspire a wider readership. The article describes the situation in North Eastern India, prior to and during the siege, from both military and medical points of view. It highlights some of the qualities of leadership that led to the garrison’s survival and describes the remarkable performance, against all odds, of the medical staff who cared for the many casualties.

In 1758, Benjamin Franklin froze water by means of the evaporation of diethyl ether. Diethyl ether became the coolant in early mechanical refrigerators and ice makers. Refrigeration advances by Carl von Linde and others provide medical oxygen from the air, liquid nitrogen for cryopreservation and cryoablation, xenon for inhaled anesthesia, and liquid helium for supercooling of magnetic resonance image scanners.