'SLEEPING BEAUTY'

The important thing to remember with nearly all surgical procedures today, is that they would not be possible if it had not been for the introduction of ‘anaesthesia.’

One of the earliest forms of anaesthesia was chloroform, however, even this was discovered by accident during a dinner party in ----.

The means of application around this time were, to say the least, primitive. Initially it was simply a cloth soaked in the anaesthetic substance which was held over the patients face, fortunately this was soon developed into more controllable forms

One such development came in the 1800’s. It was in the form of a mask called the ‘schimmelbusch mask’. This pretty basic instrument worked on the same principle as the cloth held over the face but had somewhat more control by its design.

This was a small cage, which opened up into two halves. Then a piece of lint was placed over the lower half of the cage, this was held in place by the other half of the cage and then placed over the patients nose and mouth, the anaesthetic was then carefully dripped onto the mask and so was inhaled by the patient.

If we look at more recent developments in this field, one of the major changes was in 1936 when Lord Nuffield established the chair of anaesthesia at the university of oxford as part of a 2 million pound gift to the university. At this time anasthesia was regarded as a rather limited subject when compared with other specialties and its attraction to medical students was certainly limited. At this time the anaesthetic agents and means of administration where restricted to: -

Inhalation

ether

chloroform

nitrous oxide

ethyl chloride

cyclopropane

Intravenous

barbiturates

evipan (hexobarbitone)

pentothal (thiopentone)

Rectal

avertin

Local

cocaine + related drugs-

procaine

novocaine

(taken from: -‘a History of the Nuffield department of anaesthetics oxford 1937-1987 by Jennifer Beinart 1987)

The first person to occupy the seat of anaesthesia at oxford was Robert R. Macintosh he was the first professor of anaesthetics in the country. The reason i mention his name is because he developed one of the most successful anaesthetics units still in use today.

The `Epstein Macintosh Oxford ` Anaesthetic Unit (E.M.O. for short) works on a `draw over` method, by this i mean that the when the patient inhales through the mask they draw air (or oxygen) over the vaporising unit which contains water and ether, this also has a selector switch which the operator pre- sets to the percentage of ether vapour the patient is to receive - the maximum of which is only 20%.

Should the patient be unable to breath for themselves then this is not a problem, the E.M.O. is assisted by the addition of the `Oxford Inflating Bellows` which allows the operator to breath for the patient and so anaesthatise them.

Despite the fact that the E.M.O. is over 68 years old it is still the unit most commonly sold to third world and developing countries?

With the introduction of anaesthesia brought with it the opportunity to perform previously impossible procedures, including dental surgery. One of the anaesthetic machines for use in this field was manufactured by the British Oxygen Company (B.O.C.). It was called the ‘Walton Five’.

This unit stood about 5 feet tall, it had four ports, two on each side, these were for the two oxygen cylinders and two Entanox (50% Nitrous Oxide & 50% oxygen) cylinders. The flow from these were controlled by dual selector switches set on the front of the machine, one was a slider switch, the other is a dial. There was a third option available, should the need arise, this was a single button located on the top of the machine, if this was pressed then the system was purged with oxygen.

The Walton Five was a fairly portable unit and certainly not as cumbersome as its more modern counterparts, however it should be pointed out that it does not have the monitoring facilities that the modern anaesthetic carts have.

Dentistry was not the only specialty to have an anaesthetic equipment designed especially for it. Obstetrics had a machine designed for it in 1932, its name was the ’Minnit Apparatus’ designed by a consultant anaesthatist at the David Lewis memorial hospital in Liverpool, his name was Dr R.J.Minnit. The designer of the Stephenson's Minuteman mentioned earlier.

The machine worked on the principal of delivering a mixture of nitrous oxygen and air.

It was developed under the auspices of the national birthday trust fund in 1932-3. Midwives as well as doctors intended it for use, however, due to lack of training and the problems of transporting a rather cumbersome piece of equipment meant that its use in the community was limited. In fact after the second world war, when almost 50% of all births were at home, only 20% of mothers received analgesia of which 2/3 were given chloroform by a G.P.

'SLEEPING BEAUTY'

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