Overcoming Obstacles: The Legacy of Fidel Pagés, Founder of the Epidural, 100 Years After His Passing.

Fidel Pagés, a Spanish surgeon, tragically died in 1923 at the age of 37, just 2 years after his publication "Anestesia Metamérica," the first description of human thoracolumbar epidural anesthesia. In the intervening 100 years, epidural anesthesia has faced countless obstacles, starting with the dissemination of his initial report, which was not widely read nor appreciated at the time. However, the merits of the technique have fueled innovations to meet these challenges over the years. Even today, while epidural anesthesia is widely embraced, particularly in obstetric and chronic pain medicine, the pressures of the operating room for efficiency and a low tolerance for failure, pose modern-day challenges. Here, we revisit Pagés' original report and highlight the key innovations that have allowed for the evolution of this essential anesthesia technique.

'To see ourselves as others see us'.

Shaw and colleagues, who are medical historians, have published a detailed review of the social history of the British Journal of Anaesthesia (BJA) to celebrate its first 100 years. In this editorial, we note some additional contributions and financial details that are relevant to the development of the BJA into the international high-impact journal it is today.

From mouthpiece of an emerging specialty to voice for high-quality research: the first 100 years of the British Journal of Anaesthesia.

The British Journal of Anaesthesia (BJA) celebrates its centenary in 2023, and with it 100 yr of continuous anaesthesia research publication. As an editorially and financially independent journal, the BJA faced a rapidly changing anaesthesia profession, health system, and publishing world without the security of institutional support. In its early days, the Journal was vocal about the challenging conditions faced by anaesthetists before the National Health System was established, and was essential in advocating for the specialty. Although the years after World War II brought improving fortunes for the specialty, the BJA found itself struggling to publish. As the Journal's fortunes began to improve, a new research and healthcare context emerged, radically changing the face of anaesthesia research and practice, to which the Journal needed to adapt. In spite of a range of challenges throughout the years, the BJA has developed into an international, future-focused, well-respected publication. This could not have been achieved without continual transformation, and the willingness to take risks and meet the changing times head on.

Celebrating the first centenary of the British Journal of Anaesthesia: a century of discovery and dissemination.

In 2023, the British Journal of Anaesthesia commemorates its first century of publishing innovations in anaesthesia, pain, critical care and perioperative medicine. In honour of this special anniversary we outline a number of exciting initiatives to occur over the course of the year to commemorate this important milestone, and to highlight the many contributions that the British Journal of Anaesthesia has made to patient care, medical research, and medical education in our first 100 years.

An anaesthetist who missed a golden opportunity.

Richard Gordon (1921-2017) was a prolific writer of both humorous fiction and historical reviews. He trained in medicine at St Bartholomew's Hospital (Barts) in London and specialised in anaesthesia working at Hill End Hospital, St Albans (where a large proportion of Barts work took place to avoid the impact of the Blitz during the Second World War) and at the Radcliffe Infirmary, Oxford with Robert Macintosh. He published multiple papers and a book on trichlorethylene anaesthesia and edited a textbook of anaesthesia for medical students which ran for 10 editions. His gift for writing and his prominent public persona placed him in a unique position to highlight the importance of the newly emerging speciality of anaesthesia. He did the exact opposite of this and instead created a representation of an uninterested spectator to surgical activity, a representation which still persists in some quarters today.

John Henry Evans, MD: Founding Chairman of the Board of Governors of the International Anesthesia Research Society, and a Forgotten Pioneer of Oxygen Therapy.

The theoretical and practical foundations of modern oxygen therapy were established during the first half of the 20th century. John Henry Evans, MD, inaugural chairman of the Board of Governors of the International Anesthesia Research Society (IARS), was an early pioneer in this field. Challenging the conventional wisdom that high concentrations of oxygen were harmful when inspired over long periods, Evans advocated the continuous and extended administration of 100% oxygen in a wide range of conditions, using special apparatus developed by the Toledo Technical Appliance Company (later, the McKesson Appliance Company), which incorporated a tight-fitting facemask or nasal inhaler. In doing so, Evans became embroiled in a conflict with Alvan Barach of Columbia University College of Physicians and Surgeons, which would take nearly a decade to resolve. Additionally, Evans experimented with the subcutaneous injection and intravenous infusion of oxygen, reporting significant benefits of the former in several acute inflammatory conditions, as well as a variety of chronic ailments. While these contributions have largely been forgotten, Evans expanded the remit of anesthesiology beyond the operating theater and the original charter of the IARS and helped lay the foundations for the rational use of oxygen as a therapeutic agent in all areas of medicine.

Women of the First Anesthesia Journal.

This special article briefly discusses the role of women as the new journal Current Researches in Anesthesia and Analgesia (now Anesthesia & Analgesia [A&A]) began in 1922. It was a time of a few women physicians, and they were usually isolated from the world of mainstream medicine and its predominantly male practitioners The journal's founders, Frank McMechan and his wife Laurette of Cincinnati, were committed to developing an organization for everyone, and women physicians were welcomed early on. Three women physicians even served as the presidents of various anesthesia organizations early in the formation of the present national organization. This acceptance of women was to change as medical education and practice evolved to embrace scientific medicine, after the Flexner Report of 1910 documented the deficiencies of American medicine. Mrs McMechan made the most important contributions by a woman because she cared totally for Dr McMechan, after he experienced disabling and very severe arthritis. He became dependent on his wife for most activities, including the simple act of eating. He could not function without her; she kept him going physically for another 27 years after the onset of his very debilitating illness. After her husband's death in 1939, Mrs McMechan served an executive function, keeping the organization going and maintaining production of the journal. This article also briefly discusses the life of the first woman physician to publish an article in A&A, Frances Edith Haines, MD, of Chicago. Haines published several articles in the journal; the first was in 1922, in the second journal issue. She was the president of the Mid-Western Association of Anesthetists, an affiliated organization, in 1926. She also served in World War I as a contract physician anesthetist for the US Army; she was the first woman contract surgeon to go overseas, to Limoges, France. Her adventure-filled and bold life changed as she aged and developed financial problems. She tried, but failed, to get financial help from the government and the military for her war service, and she died in 1966. These women are examples of women physicians involved with the journal, as it began in 1922. As the number of women physicians has increased recently, some past problems, such as difficulty with getting admitted to medical schools, for example, have improved. However, there are still many issues for women in medicine, including in our specialty.

100 Years of Pediatric Anesthesia With Anesthesia & Analgesia: Growing Together.

As the practice of pediatric anesthesiology grew in the early 20th century, Anesthesia & Analgesia (A&A) became the most important practical resource of pediatric fundamentals for general anesthesiologists. With continued growth in the mid-20th century, focus then shifted to complex cases performed by dedicated pediatric anesthesiologists. To this day, A&A continues to serve as a crucial forum for our subspecialty as it matures. The International Anesthesia Research Society (IARS) also remains pivotal in addressing the crucial questions of modern practice, such as the recent founding of the SmartTots initiative to investigate the potential neurotoxicity of anesthetics in children. While A&A celebrates 100 years of publication, we reflect upon pediatric anesthesiology's evolution and the impact of the IARS and A&A on pediatric anesthesiology's scholarship, clinical practice, and professionalization.

A Century of Technology in Anesthesia & Analgesia.

Technological innovation has been closely intertwined with the growth of modern anesthesiology as a medical and scientific discipline. Anesthesia & Analgesia, the longest-running physician anesthesiology journal in the world, has documented key technological developments in the specialty over the past 100 years. What began as a focus on the fundamental tools needed for effective anesthetic delivery has evolved over the century into an increasing emphasis on automation, portability, and machine intelligence to improve the quality, safety, and efficiency of patient care.

The Editors-in-Chief of Anesthesia & Analgesia Over 100 Years: Creating the Voice of the Global Anesthesiology Community.

The year 2022 marks the 100th anniversary of Anesthesia & Analgesia, the longest-running anesthesiology publication in the world. Founded in 1922 as Current Researches in Anesthesia & Analgesia by the visionary and charismatic Francis McMechan, MD, the journal served as a reliable mirror for the key scientific and political issues facing the nascent specialty of anesthesiology. Under the leadership of 6 subsequent Editors-in-Chief over the ensuing century-Howard Dittrick, MD; T. Harry Seldon, MD; Nicholas M. Greene, MD; Ronald D. Miller, MD; Steven L. Shafer, MD; and Jean-Francois Pittet, MD-Anesthesia & Analgesia has grown in size, circulation, and impact. Today, it remains a formidable voice in the global anesthesia community.

[The Stadium analgeticum - Historical Highlights on the Ether Rush]. / Das Stadium analgeticum ­ historische Streiflichter zum Ätherrausch.

For decades, the term ether rush was synonymous with the practice of short-term anaesthesia, among patients and doctors. The term was first used shortly after the discovery of the anaesthetic properties of ether by Hamburg-based physician Elias Salomon Nathan in an article about the newly discovered ether anaesthesia. Decades later, the surgeon Paul Sudeck, who also worked in Hamburg, also described an anaesthetic technique he practiced as an ether rush and met with great approval from his surgical colleagues, as well as for his anaesthetic mask developed for carrying out the ether rush and the anaesthetic dropper, specified for this purpose.Sudeck did not want to be regarded as the inventor of the special anaesthetic technique and repeatedly pointed out that his procedure had already been described and applied before him, but was forgotten again. Nevertheless, Sudeck's ether rush remained a well-known, widespread analgesic method in German-speaking countries until the end of the 1940s, and it proved its worth many times during the World War. After 1945, when ether lost its pre-dominant role as an inhalation anaesthetic and was replaced by other, new agents and short-acting i. v. administered analgesics, the ether rush was also fell into oblivion and was no longer used.Against the background of the first successfully performed ether anaesthesia on October 16th, 1846 - 175 years ago - at the Massachusetts General Hospital in Boston, the description of the ether rush should be recalled in this context.

Thomas Drysdale Buchanan, MD, and the Birth of Academic Anesthesiology.

Thomas Drysdale Buchanan, MD (1876-1940), founding president of the American Board of Anesthesiology, was the first person in the United States to hold the title "Professor of Anesthesiology" in a medical school faculty position dedicated exclusively to the specialty. An 1897 graduate of New York Medical College, Dr Buchanan joined the faculty of his alma mater in 1902 in response to demands by medical students and recent graduates for a dedicated instructor in anesthesia. Within a decade, the instructorship had become a professorship, and Dr Buchanan was on his way to distinction as one of the founders of academic anesthesiology. This chapter in Dr Buchanan's early career illustrates how anesthesiology took shape as a distinct body of knowledge during the formative decades of modern medical education at the turn of the century, laying the groundwork for its recognition 30 years later as a specialty in its own right.

William T. G. Morton's English Patent for Etherization: Patently Pointless?

Boston dentist William T. G. Morton secured a provisional English patent for etherization in December 1846. The full patent specification was submitted 6 months later, and the patent was sealed on June 18, 1847. The enrolled copies of the provisional and full patents, which are held in The National Archives, London, have not been previously documented in the anesthesia literature. We review the communications between Boston and London regarding the patent for etherization, the possibility that preliminary discussions and trials of etherization may have been conducted in London before the earliest known application of the discovery for a dental extraction on December 19, 1846, and the role of the American lawyer James Augustus Dorr, who was Morton's agent in the United Kingdom.

Anesthesia and World War II: When the Battlefield Becomes a Research Field-A Bibliometric Analysis of the Influence of World War II on the Development of Anesthesiology.

At the outbreak of World War II (WWII), anesthesiology was struggling to establish itself as a medical specialty. The battlefield abruptly exposed this young specialty to the formidable challenge of mass casualties, with an urgent need to provide proper fluid resuscitation, airway management, mechanical ventilation, and analgesia to thousands. But while Europe was suffering under the Nazi boot, anesthesia was preparing to rise to the challenge posed by the impending war. While war brings death and destruction, it also opens the way to medical advances. The aim of this study is to measure the evolution of anesthesia owing to WWII. We conducted a retrospective observational bibliometric study involving a quantitative and statistical analysis of publications. The following 7 journals were selected to cover European and North American anesthesia-related publications: Anesthesia & Analgesia, the British Journal of Anaesthesia, Anesthesiology, Schmerz-Narkose-Anaesthesie, Surgery, La Presse Médicale, and The Military Surgeon (later Military Medicine). Attention was focused on journal volumes published between 1920 and 1965. After reviewing the literature, we selected 12 keywords representing important advances in anesthesiology since 1920: "anesthesia," "balanced anesthesia," "barbiturates," "d-tubocurarine," "endotracheal intubation," "ether," "lidocaine," "morphine," "spinal anesthesia," "thiopental," "transfusion," and "trichloroethylene." Titles of original articles from all selected journals editions between 1920 and 1965 were screened for the occurrence of 1 of the 12 keywords. A total of 26,132 original article titles were screened for the occurrence of the keywords. A total of 1815 keywords were found. Whereas Anesthesia & Analgesia had the highest keyword occurrence (493 citations), Schmerz-Narkose-Anaesthesie had the lowest (38 citations). The number of publications of the 12 keywords was significantly higher in the postwar than in the prewar period (65% and 35%, respectively; P < .001). Not surprisingly, the anesthesiology journals have a higher occurrence of keywords than those journals covering other specialties. The overall occurrence of keywords also showed peaks during other major conflicts, namely the Spanish Civil War (1936-1939), the Korean War (1950-1953), and the Vietnam War (1955-1975). For the first time, this study demonstrates statistically the impact of WWII on the progress of anesthesiology. It also offers an objective record of the chronology of the major advances in anesthesiology before and after the conflict. While the war arguably helped to enhance anesthesiology as a specialty, in return anesthesiology helped to heal the wounds of war.

A Commitment to Quality: The History of Nurse Anesthesia Accreditation Part Two: 1983-2019.

In 1934, Gertrude Fife, President of the National Association of Nurse Anesthetists (NANA) sought to elevate the standards of anesthesia practice and standardize the education of nurse anesthetists. NANA members located schools, developed education standards and a school approval process, that eventually led to creation of the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) in 1975. Examination of historical documents demonstrated that COA developed into a well-known accreditation agency recognized by both governmental and non-governmental organizations, enhancing the standards of anesthesia education and promoting high-quality educational programs. Note: See the April 2020 issue of AANA Journal for Part One of this article.