Anesthesia in the late 1960s at Peter Bent Brigham Hospital, Boston: A case report.

BACKGROUND: Regional and general anesthesia were widely available in the United States in the late 1960s. The risk of permanent neurological sequelae resulting from spinal anesthesia had largely been dismissed. Although many academic departments of anesthesiology had gained independent status, a significant number operated as divisions within the department of surgery. We present a case report from Peter Bent Brigham Hospital to illustrate the state of anesthetic techniques in use during the late 1960s, and the power dynamics vis-à-vis physician anesthesiologists and surgeons. SOURCES: Hospital records and interviews with individuals familiar with the case. FINDINGS: An otherwise healthy patient underwent inguinal hernia repair. The resident anesthesiologist conducted a preoperative assessment the evening prior to surgery with the patient consenting to the spinal anesthesia, a plan agreeable to the faculty anesthesiologist. The attending surgeon was one of the most prominent surgeons in America and the chairman of their department. He disapproved of the planned anesthetic. Subsequent modifications to the anesthetic plans are discussed, as is the fallout from those actions. CONCLUSION: Spinal anesthesia remained a popular anesthetic option during the late 1960s. General anesthesia with ether, halothane, and other agents an alternative. This case highlights various aspects of perioperative management during a period when many American academic departments of anesthesiology existed as divisions within the department of surgery. It also touches upon the careers of two prominent American physicians.

Pathfinders in oncology from the end of the 19th century to the first description of Ewing sarcoma.

During the period 1884 to 1922, the only option in cases of operable cancers was radical surgery, and only a minority of patients were cured. Sporadic attempts were made to treat inoperable cancer patients with bacterial toxins; however, with the discovery of x-ray and radium, the era of radiation treatment as an alternative to surgery began. The discovery of transmissible cancers and experimental growth of cancer cells offered new information and not only led to a better understanding of the cellular composition of cancers but also yielded important information that ultimately paved the way to chemotherapy. These efforts also advanced the understanding of the pathogenesis of tumors and induced new clinical and pathologic classifications and subspecializations. It is important to emphasize that many of the initiatives and discoveries made in Europe in the second half of the 19th century were first put into clinical practice in the United States during the first 2 decades of the 20th century, including the use of x-ray and radium for irradiation and as diagnostic tools. All things considered, the progress made between 1884 and 1922 came about through the hard work of many eminent individuals; however, there were 7 foresighted pathfinders (3 surgeons, 2 pathologists, 1 internist, and 1 physicist) who-despite their widely diverse backgrounds, personalities, and expertise-made remarkable contributions to oncology to an extent that is still felt today.

Recent History of Publication-Based Academic Interest in General Anesthetics.

PURPOSE: The aim of this study was to determine how interest in various general anesthetics among the authors of academic publications changed over the past 50 years. METHODS: Publication-based academic interest were analyzed using specific scientometric indices: popularity index (PI), top journal selectivity index (TJSI), and index of change (IC). Terms used for searches were the names of drugs belonging to two pharmacological classes of general anesthetics - inhaled and intravenous. Only those that had a PI value > 2.0 during at least one of the 10 five-year periods, from 1967 to 2016, were selected. RESULTS: The PI, an index of comparative popularity, reflects a consistent decline in academic interest over time in both classes of general anesthetics. Over the past 25 years, the PI of inhaled anesthetics decreased by 52 %, and that of intravenous anesthetics fell by 32%. At the same time, the PI of anesthesia management increased by 167%. Among individual anesthetics, the most impressive change was a profound decline in halothane's PI, from 22.9 in 1972-1976 to 0.5 in 2012-2016. The interest in halothane was gradually supplanted by that in new agents, initially by enflurane, followed by isoflurane and finally, sevoflurane. The next meaningful change was the gradual rise in sevoflurane's PI to surpass that of isoflurane. The most dramatic change among the PIs of intravenous anesthetics was associated with the introduction of propofol: an increase from 1.8 to its maximum of 13.6. CONCLUSIONS: The study revealed a constant decline over time in academic interest in the pharmacological basis of general anesthesia relative to all fields of anesthesia combined.

Ludwik Bierkowski and the early days of general anaesthesia in the Polish soil in February 1847.

Ludwik Bierkowski belonged to the elite of surgeons of the first half of the 19th century. Educated in an excellent German university, Bierkowski had in-depth and comprehensive knowledge, a wide range of practical skills and was continuously eager to search for new solutions. He introduced cotton wool for wound dressings, experimentally determined the conditions of blood transfusions and published two outstanding anatomo-surgical atlases, which ranks him among the leading physicians of those days. Moreover, he was the first to use ether for effective general anaesthesia in the Polish lands, the procedure that changed the course of the history of medicine. Bierkowski performed ether anaesthesia in less than four months after the first world and in less than two months after the first European demonstration, which rates him among the most modern surgeons of those times. This year we celebrate the 170th anniversary of this event.

Two Japanese Pioneers in Anesthesiology: Seishu Hanaoka and Gendai Kamada.

Seishu Hanaoka and Gendai Kamada are two Japanese pioneers in anesthesiology. Seishu Hanaoka was the world's first surgeon on record to successfully perform surgery under general anesthesia in 1804. Seishu discovered that six medicinal herbs containing Datura, stramonium, and Aconitum had anesthetic properties. From these, he developed Mafutsusan. His fame spread across Japan, and he was inundated with requests from patients and prospective students. He founded a private medical school (Shunrinken) and trained more than 1000 students. Gendai Kamada was an outstanding pupil of Seishu Hanaoka. From the perspective of the history of anesthesiology, three of Gendai's achievements had a global impact. (1) In 1839, he wrote the first textbook of clinical anesthesiology, Mafutsuto-ron; (2) in 1840, he authored Gekakihai-zufu, which included some of the oldest illustrations of surgery under general anesthesia; and (3) he trained Gensei Matsuoka, the world's second anesthesiologist.

[Hosetsu Namba and the First General Anesthesia for a Pregnant Woman in the World].

Hosetsu Namba (1760-1859), a practitioner at Kanagawa, Bizen (presently Okayama Prefecture) and a disciple of Rokujo Hanaoka, described in his Taisan Shinsho three cases of general anesthesia with Mafu- tsusan. They are breast cancer tumor excisions in two patients in 7 and 3 months of pregnancy, respectively, and anal fistulectomy in a patient in 3 months of preg- nancy. Their postoperative courses were uneventful, and all of them had smooth deliveries. Although Namba did not provide the exact dates of these opera- tions, it is highly likely that the patient with breast cancer in 7 months of pregnancy received the tumor excision during a period between 1815 and 1830. To the best of our knowledge, this is considered the first general anesthesia for surgery in a pregnant woman to be documented in the world literature.

[History of anesthesia : "From narcosis to perioperative homeostasis"]. / Geschichte der Anästhesie : "Vom Narkotiseur zum perioperativen Homöostatiker".

In the western World 16 October 1846 is often called "Ether Day", marking the beginning of anesthesia. Before that date, for physicians there was only a struggle against pain. In the following 170 years all fields of general anesthesia as well as regional and local anesthesia were continuously developed. Pharmacological developments and technical innovations made this evolution possible. The complexity of this field of medicine requires a specialist: the anesthesiologist, whose selection of the most suitable form of anesthesia for the patient makes the surgical intervention painless. In addition, the history of anesthesia was characterized by personalities who were responsible for the progress of this medical field. Anesthesia is one part of the discipline of anesthesiology, which also includes resuscitation, intensive care medicine, emergency medicine and pain therapy.

Meandering Musings by Linus Pauling: "American Scientists and the Spirit of the Frontier".

Hoping to raise funds in 1975 for his namesake institute, Linus Pauling submitted to Esquire magazine a 32-page handwritten manuscript, "American Scientists and the Spirit of the Frontier." Angered when his submission for publication was declined, Pauling eventually gifted the original manuscript in 1986 to his friend, Linus Pauling Institute fundraiser Stephen Maddox, who would sell it in 2004 to the Wood Library-Museum of Anesthesiology. Published accurately here for the first time, the manuscript captures not only Pauling's sweeping metaphor of scientists as frontiersmen but also the creative process by which Pauling formulated his hydrate microcrystal theory of general anesthesia.

[The Origins of the Words : Zenshin Masui and Kyokusho Masui.]

In 1850, Seikei Sugita coined the word "Masui" to describe a physical condition induced by ether inhala- tion. Therefore, the word"Masui"initially meant general anesthesia. After physical methods to produce local numbness were introduced to Japan, it was necessary to make a new phrase to express the methods and the physical condition produced by them, and "Kyokusho Masui" was made, in which "kyokusho" means local. Then,"Zenshin Masui", indicating general anesthesia, was made to form a set of "Kyokusho Masui" and "Zenshin Masui". It was 1876 when Tadanori Ishiguro published "Geka Tsujutsu", in which he described a clear definition of "Kyokusho Masui" and "Zenshin Masui". This is one of the earliest uses of "Kyokusho Masui" together with "Zenshin Masui" in Japan.

Development of Mafutsusan by Seishu Hanaoka and General Anesthetics in the Very Early Part of the 19th Century in Japan.

Seishu Hanaoka's medicine is famed for its breast cancer surgery. Hanaoka, who,was motivated by Dokushoan Nagatomi's Man-yu zakki, published in 1771, had the idea to excise a breast cancer tumor and not to perform a breast amputation. Because he recognized that general anesthesia was indispensable for performing a surgical operation of the breast, he developed a general anesthetic and surmounted various difficulties: selection of an anesthetic method, anesthetic ingredients, determination of the opti- mal dosage, administration methods, indications and contra-indications, evaluation of the depth of anesthesia, facilitation of the smooth emergence from anesthesia, and postoperative care. I reviewed previous articles on these subjects and, using several unpublished manuscripts, provided new information on disseminated general anesthetics in Japan during the decade after the first general anesthesia for Kan Aiya in 1804.

Ryozo Chiba's Ben-nyugansho narabini Chiho Soko and Nyuganbensho or Nyuganben: The Practice of Hanaoka's Breast Cancer Surgery in 1811.

In 1811, Ryozo Chiba (1789-1861) from Sendai Province enrolled in a private school of Shunrinken, presided by Seishu Hanaoka and wrote up a manuscript titled Nanki Seishu Sensei Nyugan Chyutu Koju (the title on the first page is Ben-nyugansho narabini Chiho Soko) in August 1811, only 6 months after enrollment. The manuscript describes Hanaoka's teachings about breast cancer surgery; signs and symptoms of breast cancer, differential diagnosis, preoperative care, administration of Mafutsusan, operative procedures, hemostatic techniques, wound suture; wound dressing, recovery from anesthesia with Mafutsusan, postoperative care, and prescriptions of drugs for internal and external use. After repeated transcriptions and the addition of various papers on other subjects, the title of the manuscript changed to Nyuganbenshio or Nyuganben. Chiba's original manuscript is considered important because the transcriber and the year of transcription of the manuscript are identified, and it unfolds the practice of Hanaoka's breast canicer surgery as of 1811.