once upon a time, aneshesia - Expo 2025 en

The use of medication or procedures for reducing pain goes back to earliest antiquity.

Inhalation of vegetable substances

The use of cannabis goes back more than 5000 years BC. Indian hemp featured in The dried herb book of the divine cultivator (Sheng – Nung, China 2700 BC). Numerous plants including poppy, hemlock, mandrake, henbane, and datura were known in ancient times and were used sometimes in surgery.
The sponge has been used since mediaeval times for delivery by inhalation. The very first trace of its use in the Western World is to be found in the lX^th century in the Benedictine monasteries (Monte Cassino in Italy and Bamberg in Germany). This technique was repeated with several variations during the succeeding centuries, starting in Salerno in the XI^th century and then in Bologna, Montpellier and Avignon. In 1471, a new edition of the Book of Nicolaus Salernitanus dating from the XI^th century (shown here) gave a recipe for the use of mandrake with other plants to induce sleep and analgesia.
The idea was to prepare a mixture of plants, soak them onto a sponge which was then dried and stored in a closed vase. The sponge was then dampened with hot water before use and the patient inhaled the vapours before surgery. Each convent had its own recipe which could not be used elsewhere since it depended on the quality of the plants used.

Alchemy

Volatile substances were made by alchemists during the Middle Ages with ether and chloroform discovered after the XII^th century. In the XVI^th century Paracelsus (1493 – 1541) prepared ether from sulphuric acid and alcohol and described its analgesic and anaesthetic properties as well as total reversibility of the effects. But there was no apparent application.
At the end of the XVI^th century, the great alchemist Della Porta (1535 – 1615) succeeded in linking the properties of alcohol and vegetable distillates. He did not use a sponge but fashioned ‘apples’ (a form of inhaler) which then caused loss of sensation and immobility.

Blood vessel or nerve compression

The Assyrians (2000 – 800 BC) caused unconsciousness by compression of the carotid blood vessels before circumcision. Ambroise Paré compressed blood vessels to reduce blood loss during amputations (1564). The same procedure was used by Jean-Louis Petit (1718). In 1784, James Carrick Moore advocated nerve compression to produce analgesia during amputations.

Alcohol and regional hypothermia

It was well–known that during acute drunkenness a certain degree of analgesia could be achieved as shown in a XV^th century engraving. In 1646 Marco Aurelio Severino in Italy recommended cold mixtures of ice and snow for surgical anaesthesia. At the battle of Eylau (1807) and during the Russian campaign, Dominique Larrey observed the beneficial effects of cold during surgery.

Hypnotism

Modern use of hypnotism was started by Franz Anton Mesmer (1733 – 1815). He created a hypnotic method in 1780 which he named animal magnetism. We recall the first users of hypnotism: Puységur 1815, Cloquet 1829, Esdaille 1840, Braid 1842 and Hippolyte Bernheim 1884.

Missed opportunities in inhalation anaesthesia

In 1800 Humphry Davy   suggested the used of nitrous oxide for non – haemorrhagic surgical operations.
We recall the sad history of Henry Hill Hickman who, in France in 1824 as in England did not succeed in interesting the medical world in the anaesthetic effects of carbon dioxide and of ‘certain other gases.’

Until the middle of the XIX^th century in Europe, pain was considered to be essential for the process of healing.
‘Avoiding pain during operations is a chimera that would be impossible to accept nowadays’.
In April 1844, in the United States, Dr Garner Quincy Colton formed a travelling circus which had acts where volunteers inhaled laughing gas (nitrous oxide). At the same time ‘frolic parties’ were held with the inhalation of nitrous oxide or ether.

Crawford Williamson Long was a doctor and pharmacist at the town of Jefferson in Georgia and took part in such parties where ether was inhaled and produced a calm sleep. Long used ether for the first time on the 30^th March 1842 for the removal of a neck tumour from his friend James M. Venable. He used the technique seven times in the following years but did not publish the details.

Horace Wells, a dentist at Hartford, Connecticut was present at a circus show put on by Colton. His neighbour, who had inhaled ether had a fall and injured the calf of his leg. At the end of the show Wells asked him if he was in pain and he replied that he had felt nothing. He realised the relation between anaesthesia and analgesia. The following day he had an infected molar removed by his assistant, having inhaled nitrous oxide and felt nothing. He published locally and anaesthetised 15 patients with the same results. Following advice from Morton   in Boston, he gave a demonstration at the Massachusetts General Hospital, but the patient cried out and he was dismissed as a charlatan.

William Thomas Green Morton  , a dentist in Boston researched ether between 1845 and 1846. You can see a silent film produced in 1936 by the anaesthetic team at Massachusetts General Hospital of the first general anaesthetic given at the hospital. The film highlights the variability of the clinical effects of the products used. His former teacher, Charles Thomas Jackson   directed him to a pharmacy which provided ether which produced constant anaesthetic effects. In the afternoon of the 30^th September 1846 Morton   tried the ether on himself successfully. In the evening of the same day, he successfully removed an infected tooth from Eben Frost under ether inhalation. The next day, he published his discovery in a Boston journal.
Encouraged by his daily results, he contacted Professor John Collins Warren, chief surgeon at the Massachusetts General Hospital to arrange a formal demonstration in the operating theatre, known nowadays as the ‘ether dome.’
On the 16^th October, 1846 the amphitheatre was full. The patient, Edward Gilbert Abbott had a tumour in the neck. He was attached to an armchair. Morton   was late, due to having made some modifications to his apparatus. Warren was about to start the operation when Morton   arrived with Eben Frost who explained to the patient how well things had gone for him a few days earlier. Morton   anaesthetised the patient and Warren operated for 10 to 15 minutes during which time the patient did not cry out. When he awoke, he confirmed that he had felt nothing. There was an ovation in the room after hearing the celebrated comment by Warren
No Gentlemen, this is not a humbug! We are not the object of an hallucination; we have just been present at a major event in the history of surgery. Our craft has been delivered for ever from horror.

News of the technique was sent to London in the middle of December 1846 and anaesthesia was immediately spread to Europe and throughout the world. In France, the first use of ether took place on the 15^th December 1846 delivered by Willis Fischer to Jobert de Lamballe but this was a failure. Malgaigne   repeated the technique and published details of the first anaesthetics in France on the 12^th January 1847. Ten days later Charrière made his first anaesthetic apparatus. In 1847 within six months there were 76 communications sent to the Academy of Medicine and Science in Paris.

James Young Simpson  , a doctor in Edinburgh and two of his colleagues inhaled various compounds in search of a new anaesthetic. One evening, his wife found them in a comatose state having inhaled chloroform. On the 4^th November 1847, Simpson   performed the first anaesthetic with chloroform which would become rival to ether.

The tragic fate of the discoverers

The fight to establish who had discovered anaesthesia continued in America and particularly in Paris at the Institut de France. Jackson  , a celebrated scientist claimed the discovery of ether in a letter to the Institute without mentioning Morton  , a mere dentist. Morton   was defended by Velpeau  . Meanwhile, Wells who had become an antique dealer, came to France and also claimed the discovery. The documents sent by the various protagonists are preserved in the Institut de France. In 1850 the institute delivered its opinion and awarded the Montyon prize for 1847/48 jointly to Jackson   ‘for his observations and experiments on the anaesthetic effects produced by ether and also to Morton   for having introduced the technique in practical surgery following the work of Jackson  .’

Wells languished in New York, addicted to ether and to chloroform. One evening, while suffering the effects of his addiction he threw vitriol at a prostitute who had injured his friend. After the trial, he committed suicide in his cell by cutting his femoral artery while under the effects of chloroform. There is a statue of Wells in the Place des États-Unis à Paris in the 16^e arrondissement.

Morton  , who was attacked incessantly by Jackson   to prevent him receiving the prize of the US Congress, lived in poverty and died following a stroke. His friends created a magnificent monument to him in the cemetery of Mount Auburn, near Boston.

Jackson  , who was addicted to ether and alcohol never recovered from not being recognised as the discoverer of anaesthesia, went mad after seeing the monument to Wells and finished his life in an asylum where he had spent 12 years.

Until 1940 the surgeon performed surgery and anaesthesia at the same time. He operated either in a hospital or a clinic or at home for small procedures.
From 1930 a few surgeons, realizing that French surgery was way behind the anglo saxon countries where anaesthesia had been specialised since 1900, began to work with a doctor who had been trained in anaesthesia.
In 1934 Professor Robert Monod (1884 – 1970) founded the Society for the Study of Anaesthesia and Analgesia with 100 members, of whom four were anaesthetists. The journal Anesthésie et Analgésie first appeared in 1935 and continues to the present day but with a different title.
The Second World War saw the spread of new anaesthetic techniques but in France there were only 23 doctors specialized in anaesthesia in 1946.

Volatile anaesthetics

At that time the volatile agents used were ether and chloroform. The latter was preferred by surgeons, except in Lyon because of the rapidity of action but its use required great care. It caused a number of fatalities, which took more than 50 years to be explained.
During the 1860s nitrous oxide returned to widespread use, first in dentistry but also in general surgery after the work of Paul Bert   in 1878. He demonstrated that to be effective the gas had to be given at a concentration of 100 percent but that it caused asphyxia. He proposed the use of hyperbaric chambers with a pressure of 1.3 atmospheres which allowed the addition of oxygen. A mobile operating theatre was constructed by Dr Fontaine and hyperbaric chambers for dentists. However, this technique was not developed due to the complexity of the installations. Anaesthesia using nitrous oxide and oxygen was used in 1930s and 40s.
In 1894 a new volatile anaesthetic , ethyl chloride was discovered which had a very rapid but short duration of action. It was not used in France until 1946.

The discovery of intravenous anaesthesia

Between 1873 and 1875 Pierre Cyprien Oré  , in Bordeaux invented intravenous anaesthesia by injecting chloral hydrate. The duration of action was between 8 and 12 hours! This technique was rapidly abandoned in France due to the risks of phlebitis at the point of injection and pulmonary embolism.
It was not until after 1905 that other intravenous anaesthetics were discovered: Hédonal (1905), Somnifen (1921), Pernoston (1932), Évipan (1932) et Pentothal (1934). Their use in France was rare at that time. Pentothal became the most used agent after 1946.

The contribution of French physiologists

Anaesthesia was the subject of studies by many French physiologists. Claude Bernard   studied muscle relaxants and was the first to recommend premedication with morphine before general anaesthesia
Paul Bert  , apart from his hyperbaric work, studied nitrous oxide and did research on effective and lethal concentrations of anaesthetics which followed the use of mixtures titrated for individual anaesthesia. This work was not recognized and employed until the XX^th century.

The evolution of anaesthetic techniques

These exhibits show the evolution of general anaesthesia. Originally only simple techniques were used such as a cloth soaked with the anaesthetic (where the patient was half awake and the anaesthetist half asleep!), simple masks and gauze. Anaesthetic apparatus delivering measured quantities of agents did not appear until after 1900.
To avoid respiratory complications during anaesthesia a number of accessories were invented, such as mouth gags (to keep the mouth open, tongue forceps and oropharyngeal cannulae). The use of oxygen in anaesthesia dates from this period, particularly for thoracic surgery. Endotracheal intubation was also developed.

Books describing techniques appeared regularly, written by surgeons.

During the middle of the 19^th century local anaesthesia was used rarely, being limited to the application of cold. At first, mixtures of ice and salt water were used and after 1858, evaporation of ether or ethyl chloride.

Chewed coca leaves, used by South American Indians were known for their anaesthetic properties. Alfred Niemann isolated cocaine in 1854 and noted its local anaesthetic effect on the edge of the tongue. Karl Koller, in 1884 was encouraged by the head of his department to find a method of producing local anaesthesia. Koller was a friend of Sigmund Freud who was working on cocaine but mainly to investigate its stimulant effects. Freud gave Koller a little cocaine to test who noted an anaesthetic effect on the edge of his tongue. Koller went into his laboratory and put a few drops of cocaine into the eye of a frog, a guinea pig and finally into his own eye and that of his assistant, noting the insensitivity produced to contact with a needle. He operated on cataracts on the 19^th September 1884 and presented his findings to a congress in Heidelberg. This was truly a bolt from the blue and within a few months cocaine local anaesthesia was being used around the world. The technique was simple and consisted of just infiltrating with cocaine solution.

In 1906, August Bier   invented regional intravenous anaesthesia which consisted of injecting the anaesthetic into veins of the arm or leg from which the blood flow had been interrupted using a tourniquet. In 1898 Bier   invented subdural spinal anaesthesia of the lower part of the body. But it was really François Tuffier   who perfected the technique. The French anaesthetists Fernand Cathelin and Jean Marie Athenase Sicard suggested anaesthetising nerve roots in the epidural space by injection through the sacro–coccygeal (caudal) canal. The idea of injecting into the epidural space but at a higher level in the lumbar region dates from the beginning of the 20^th century.

In 1920, the Spanish anaesthetist Fidel Pagès described segmental regional anaesthesia but died in an accident and it was the Italian Achille Mario Doglliotti who, in 1931 became the champion of the technique.
In 1884, the American surgeon William Halstedt injected cocaine around the nerve endings of an area controlled by a specific nerve. George Washington Crile anaesthetised wider areas by injecting around major nerve trunks such as the brachial plexus, and the sciatic nerve after exposing them during surgery.

In 1911, Herchel and Kulenkampff would develop the technique with the use of sometimes complicated observations: confirmation of the correct positioning of the injecting needle was done by the patient noticing a small electric shock. To improve this development, neurostimulation using small electric currents allowed identification of the muscle response of the nerve being sought. This technique was perfected after 1912 by George Perthes but was never developed at the time. It would not be until 1970 that electronic developments allowed the use of more reliable and manageable stimulators. The technique was widely – used until being replaced at the beginning of the 21^st century by echography.

The adoption of different local anaesthetic techniques was facilitated by the publication of large volumes about regional anaesthesia. The first was that of Heinrich Braun in 1905 but the most important was that of the Frenchman Victor Pauchet   which was followed by his pupil in America Louis Labat before being adopted by John Adriani Cavinini, a major player in the development of local anaesthesia. However, its deleterious and toxic side effects, sometimes causing fatalities during operation became apparent. The search for substitutes started at the beginning of the 20^th century.
The French doctor Ernest Fourneau produced Stovaine, the first truly synthetic local anaesthetic in 1903. Two years later, the German chemist Alfred Einhorn synthesised procaine, a far less toxic compound and opened the door for a new class of local anaesthetic agents, the amino esters. It would not be until 1948 that Xylocaine (lidocaine) appeared synthesised by the Swedish Nils Löfgren which remains the most widely – used local anaesthetic in the world. It also led to the development of a new class of agents, the amino – amides which were more powerful and manageable and, importantly had a near zero risk of allergic reaction.

The Second World War proved to several surgeons that modern anaesthesia had to be medicalised.

The battle against the ‘Almighty Surgeon’ and gain recognition for the anaesthetists would be bitter, as much for teaching as for the Social Security, the Ordre de Médecins (the French medical registration authority), hospitals and the universities.
Formal anaesthetic teaching started in 1947 with a course for doctors and nurses, lasting 6 weeks with a 6 months attachment. It was reserved only for doctors in 1948, with an examination. In 1949 a special certificate of training in anaesthesia was introduced. (the CESA). In 1966 this was altered to the CESAR to accommodate the addition of resuscitation to anaesthesia. In 1982, anaesthesia – resuscitation moved into specialist training with a period of 4 years (now 5 years) making a total of 11 years for specialist training with a basic medical degree.
From the Social Security, only surgeons received fees, one tenth of which was paid to the anaesthetist. The anaesthetists at that time were known as ten percent doctors. In 1947 anaesthesia delivered by a specialist was remunerated separately but subjected to the discretion of the social security! It was not until 1953 that all patients could benefit from modern anaesthesia. Finally in 1960 anaesthesia was separated from surgical interventions (K) with a specific designation (Kar).
In 1947, article 42 (or 45 in 1955 of the Ordre des Médecins) stated that the surgeon had the right to choose his operating assistants including the anaesthetist. In 1950 a Commission for qualification in anaesthesia was created becoming, in 1970 Specialist in Anaesthesia and Resuscitation. It was not until 1979 that article 45 was rescinded finally giving the anaesthetist total responsibility for his actions.

Hospitals

In 1947, a competition for 15 unpaid posts of Hospital Assistant was held in Paris as a temporary measure. The anaesthetist worked for nothing in the hospital during the morning and earned a living in the afternoon by working in private clinics delivering general anaesthesia.
In 1958, the hospital reforms of Robert Debré created full time posts of departmental heads, but it was not until 1960 that anaesthesia became organised into two bodies: university hospital and hospital.
In the university sector, the first professors of anaesthesia were created in 1961 and in 1963 the first established chairs were created. By 1970, the battle to establish the speciality had been won.

The evolution of anaesthetic techniques from 1946 to the present day

This display only concerns general anaesthesia. Local and regional anaesthesia is covered in the previous display.

Modern general anaesthesia uses three types of essential agents: hypnotics, analgesics and muscle relaxants (the ‘triangle’ of balanced anaesthesia). Techniques have evolved with the discovery of new products and the development of physiological theory.

Thiopentone (Pentothal) was the leading short acting hypnotic agent of choice until 1970. From 1956 – 1987 20 different similar agents were developed with shorter or longer durations of action. Nowadays, only five or six products are used, with volatile agents being phased out due to environmental considerations.
Morphine and pethidine (Dolosal) were used up to 1956, but from that time new analgesics appeared which changed the face of anaesthesia. The last of these, remifentanil (1974) had a very short duration of action and could therefore be used in continuous infusion.
The first use of muscle relaxants by Griffiths in Canada was in 1942. This allowed the surgeon to operate without muscle contraction. But the use of relaxants required the use of artificial ventilation. The degree of relaxation was measured using a nerve stimulator.

Anaesthetic monitoring and safety

Before 1965, monitoring during anaesthesia was purely clinical by checking the pulse, blood pressure, and respiration (frequency, auscultation of airways, colour of the face and mucous membranes) as well as observation of the corneal and pupillary reflexes.

From 1965, monitoring developments permitted the detection of developing problems and thus avoiding accidents. This display presents the arrival of various monitoring devices.
Some interesting figures: while the number of anaesthetics given in 1970 was around two millions, the Social Security system estimated the figure at thirteen millions in 2022, due to an increasingly ageing population affected by a wide range of pathologies.

The number of specialist anaesthetists increased from 169 in 1960 to 9930 in 2022. This improvement was due, in no small way to the quality of anaesthesia required and to the appearance of a Decree which required and anaesthetic consultation more than 24 hours before an operation and another less than 24 hours before the start of surgery. It also required suitable equipment and monitoring to be available during the operation and especially for the patient to go to a recovery room if consciousness had not been regained by the end of the procedure.

In this showcase we see several pieces of anaesthetic equipment invented in France. (The Charrière device is missing since it is part of another exhibition in the museum of the Assistance Publique - Hôpitaux de Paris – the Paris hospital service. However, the brochure, kept in the University library is shown here.)
All the manufacturers in the major French cities (Paris, Lyon Marseille and Strasbourg created their own anaesthetic apparatus after1847. The introduction of chloroform would complete the range of devices.

As we have seen in the showcase of the origins of anaesthesia, various masks were employed. As a replacement for the mask, the ‘cornet’ was used by the French Army and Navy, notably during the Crimean War (1853-1856).

The first real French innovation appeared in 1855 with the arrival of the Raphael Dubois   apparatus which permitted control of concentrations of chloroform during anaesthesia.
Dubois made a device that automatically mixed chloroform and air at predetermined concentrations so that the anaesthetist could control delivery without exceeding the lethal dose. At that time the technique was criticised because the apparatus was too cumbersome for the surgeons! It was not adopted until the 20^th century.

From 1900 onwards, anaesthetic devices were created that allowed the delivery of controlled concentrations of agent.

In 1902 Braun invented the ‘Narko’ system which could combine ether and chloroform.

In 1908, Professor Nélaton asked his assistant, Louis Ombrédanne to construct a safe ether anaesthetic device. This he did, with the aid of his chauffeur. The prototype is shown here (but without the English modification which allowed the addition of ether). The prototypes were produced by the Collin factory in Paris. All these devices are still numbered. It was simple to use. By moving the cursor, the concentration of ether could be varied. At zero concentration, the patient inspired only air and exhaled carbon dioxide. At level 8 he inspired only ether and expired air. The device produced a degree of safety.
Nevertheless, it had a considerable world – wide success since more than 70,000 units were sold. It continued in use world – wide until 1970!

Other devices were also produced including the Ricard   device for chloroform (1913).

In 1920 the Dupuy de Frenelle   device appeared which allowed the mixture of three agents (ether, chloroform and ethyl chloride) followed by the Dufaut   apparatus in 1922 with two agents employed, followed by several others.
The introduction of cyclopropane, a highly explosive agent led to the use of closed-circuit devices with a CO2 absorber but these were not used in France until after 1940.

In 1759, the chemist Francois Rouelle discovered ethyl chloride, but it was not produced for scientific studies until after 1801. In 1847, Marie-Jean-Pierre Flourens   carried out the first anaesthetic studies on a dog. In 1890 Camille Redard in Geneva used the agent as a local anaesthetic, given its volatility and production of cold. In 1894, H. Carlsson rediscovered the anaesthetic properties of ethyl chloride by inhalation. The agent is a very short-acting anaesthetic and was used both in hospital and domestic practice for tonsillectomy, dental extractions and short surgical procedures.

From 1892, Dr Bengué and the Rhone chemical company consortium saw the discovery of Kélène® by Drs Gilliart, Monnet and Cartier. The Woolwich Elliot chemical company in Sydney, Australia also developed preparations for local anaesthetic use.

Ampoules or bottles of general anaesthetic agent were produced by the Rhone consortium (Kélène®), the American company Squibb, The Belgian Chemical Association (Chlorène®) as well as the Woolwich Elliot Company. These ampoules could be emptied onto a gauze swab or used in a vaporiser. This display shows various anaesthetic devices used for short duration surgical or dental practice.

An anecdote: ethyl chloride was used as a propellent to disperse perfume during the Rio Carnaval for over 70 years but was banned in 1961 due to the unconsciousness it produced!

In 1960 the arrival of new halogenated anaesthetic agents led to the abandonment of former agents such as ether, chloroform, ethyl chloride and cyclopropane over the following years. The Fluoxair machine (1967) was a compact, portable self – contained open circuit device allowing the administration of halothane, air and oxygen. The patient could either breathe spontaneously or be given assisted ventilation manually using a bag. Commercially, the device could be adapted for use with chloroform. The original machine, built by the British company Cyprane Ltd was distributed by the LSA company in France which no longer exists.

The Dräger Fabius anaesthetic machine (Luebeck, Germany) 1956

Created initially for the Army, this portable anaesthetic system could be used in a closed or open circuit configuration, using air or gas bottles. The exhibit shown here is the portable model with a CO2 absorber, vaporiser, oxygen, nitrous oxide and cyclopropane. The flow charts of the different circuits are also shown.

Rosenstiel – Pesty – Richard – a ventilator with adjustable pausing. RPR – the acronym that ventilated France for more than 30 years.

In 1956 Raymond Pesty took up an invention by Rosenstiel and produced the RPR ventilator, with advice from Professor Maurice Cara. The device was manufactured by the Richard company. The first two models appeared in 1956 and 1957.
1962 saw the appearance of the definitive version – the RPR 3.
The RPR was a pneumatic, volume preset device driven by compressed oxygen, nitrous oxide or air.
The simple idea of being volume - preset reveals the complexity of the device. The frequency and inspiration/expiration ratio depended on the fresh gas flow, the set tidal volume and airway resistance.
The control was set by an abacus – like device. Monitoring of function was only by a manometer and a spirometer.

Clinical observation was always therefore essential, particularly during the transport of ventilator - dependent patients and during anaesthesia.
The RPR was much – used in paediatric resuscitation as a paediatric version – the RPRN. The anaesthetic version had a vaporiser in the circuit.

The RPR was widely – used in operating theatres throughout France up to the beginning of the 1990s.
Later, it was still used in veterinary practice.

The discoverers of oxygen were: Carl Wilhelm Scheele in 1772, whom he called “fire air”; Joseph Priestley in 1774, with his theory of “dephlogized air” (phlogiston from the Greek word for flammable, consumed by flame), which was later rectified by Antoine Laurent Lavoisier, who identified oxygen and its properties, and gave it its name in 1777: “acid generator” or “oxy-gene” (derived from the Greek word for acid).
As early as 1783, it was used clinically to treat respiratory insufficiency, and was studied at Bristol’s Pneumatic Institute (1799-1802). These uses were sporadic and mostly ineffective.
In 1837, it was included in the French pharmacopoeia, and it was in 1866 that surgeon Jean Nicolas Demarquay had tanks built to administer oxygen. Stanislas Limousin, a pharmacist, followed in his footsteps and is credited with being the father of oxygen therapy, with oxygen prepared at the patient’s bedside. Prescriptions at the time were to inhale 5 to 10 liters of oxygen twice a day!
In 1877, the discovery of oxygen liquefaction made it easy to transport, but it was mainly used for industrial purposes. The big national compressed gas distribution companies were born around 1900.

In 1900, “nascent” oxygen generators were invented, in which sodium dioxide combined with water released oxygen. This led to the industrial development of Oxylithe® by Jaubert. These techniques were used not only in medicine, but also on submarines and in the 14/18 war to treat gassed soldiers.
Aberrant uses of oxygen emerged in the 1920s: subcutaneous or intravenous oxygen, some examples of which you can see in this showcase: oxygen ampoules, Dr Bayeux’s apparatus...
It wasn’t until 1917 that John Scott Haldane set out the modern principles of oxygen therapy: “intermittent oxygen therapy is like bringing a drowning man to the surface of the water from time to time”. It will evolve into our current practices.
Oxygen therapy in anesthesia-intensive care began to be used in the 1900s, but only became systematic after 1940.

A Brief History of Obstetric anaesthesia before the epidural

On the 19^th January 1847 James Simpson  , a renowned obstetrician in Edinburgh, Scotland used ether for the first time to facilitate a manipulation during a delivery. A few months later, on the 20^th October 1847 he carried out a delivery with the aid of chloroform. Similar reports were presented in February 1847 at the Academy of Medicine in Paris.
For a long time in the UK, USA and France the use of anaesthetics to relive pain during childbirth remained very controversial. The dictum in the book of Genesis ‘in pain shall you be born’ was always the response of those opposed to the use of ether, either through dogma or religious conviction.
Slowly, however most of them came around to understanding the value of small doses of chloroform to relieve pain during delivery. The decision by Queen Victoria to have small doses of chloroform during the birth of her eighth child on the 7^th April 1853 led John Snow   to call this technique ‘the anaesthesia of the Queen.’
Use of chloroform continued for a long time before being replaced by nitrous oxide in 1930 - an agent known for a long time as ‘laughing gas’ which carried a serious risk of hypoxia if used alone. It was not until 1940 that a reliable and safe mixture of the gas with oxygen became available. This is still used in maternity units up to the present day as Entonox® or MEOPA®.

Techniques of mixed anaesthesia has been known since the time of Claude Bernard   which sought to produce ‘twilight sleep’ using subcutaneous injections of morphine and scopolamine and later barbiturates in small doses which were thought to be less dangerous for both mother and child. The 1930s saw the revival of so – called ‘natural’ methods of pain relief (or psychoprophylactic methods), based on controlled breathing, variation of positions and the use of antispasmodic drugs. But these techniques rapidly revealed their limitations.
At the same time, the concept of obstetric auto–anaesthesia was developed, where the mother inhaled of trilene or methoxyflurane via a Trilene or Cyprane inhaler, both lightweight hand – held devices.

Around 1970 similar devices (the Penthrane oxylator and the Penthrane analgiser) were available to deliver Penthrane on demand. Overall, the results were mixed, with a continuing risk of loss of consciousness.

From 1980, epidural anaesthesia would be progressively adopted for analgesia during labour in all the maternity units in France.

The Oxford vaporiser was originally conceived by the British anaesthetists Robert W. Macintosh and H.G. Epstein.
The object of the device was to produce a constant and reliable concentration of ether. To do this it was necessary to ensure that the ether was always kept at a constant temperature below its boiling point. The vaporiser consisted of three concentric chambers. The central one held hot water, the middle anhydrous calcium chloride and the outer the ether. Hot water poured into the central chamber fed through to the calcium chloride which dissolved producing the constant source of latent heat needed for the vaporisation of ether in the outer chamber for about one hour. After refilling the water chamber the heat source could rapidly be restored.

Conceived in 1941 for use in war conditions, the Oxford inhaler was an extremely practical device requiring only the addition of hot water. Being extremely portable and compact, it was used by the British Army throughout the Second World War.

Muscle relaxation, together with sleep and analgesia is fundamental to modern anaesthesia. Curare had been known since the first explorations of South America and was studied scientifically from the end of the 18^th century. It was used in medicine after 1850, but it was not until a century later that d–tubocurarine, the purified form was used in general anaesthesia. Claude Bernard   established curare as a muscle relaxant and Alfred Vulpian localised its action to the neuromuscular junction.

The used of curare medically was rare until 1942 because the preparation was not purified which made accurate dosage difficult. It was however used in the treatment of tetanus. In 1942, the Canadian H.R. Griffith, at the request of the Squibb pharmaceutical company used Intocostrine during general anaesthesia and published the results of 25 cases. News of this spread rapidly to England and America and soon curare would become one of the indispensable elements of anaesthesia. The muscle paralysis it produced necessitated the use of artificial ventilation.

In this display, we see several plants from which curare was extracted : gourd, pot and tube curare and even the so–called curare used by Claude Bernard  .

Modern forms of non–depolarizing muscle relaxants are synthetic. (translators note: the word ‘curare’ in French is used generally to translate any muscle relaxant, both depolarizing and non- depolarizing).

Muscle relaxants used at the present time are essentially synthetic. They require monitoring to measure the degree of paralysis during operation and also during recovery to ensure that their action is terminated.

Ensuring breathing during anaesthesia has been an obsession since the beginning.

Control of the tongue falling backwards during unconsciousness led to the use of mouth gags and tongue retractors between 1847 and 1920

Oropharyngeal cannulae date from the beginning of the 20^th century (Hewitt, 1908, O’Connell 1913, Lumbord 1915, Miller 1918 and Guedel 1933). At the present, the Guedel airway is an exact copy of the original device: only the materials used in manufacture have changed.

Tracheostomy is a technique known since Antiquity for the management of rare cases of acute obstructive asphyxia. It was developed for the management of dipheritic laryngitis (croup) during the 19^th century. It is used now for artificial ventilation in some cases of resuscitation and for long term ventilation in the intensive care unit.

Endotracheal intubation had been used in neonatal resuscitation since the begging of the 19^th century by Desault, Chaussier, Depaul and Ribemont. Placing a tube in the glottis was introduced by Bouchut during a diptheria epidemic in 1858 but was challenged by his peers. O’Dwyer revived the procedure in 1896 and improved it. Development of intubation progressed with the invention of the laryngoscope by Chevalier Jackson   which allowed a clear view of the glottis and introduction of a cuffed or non- cuffed tube. Various models were developed subsequently.

Use of intubation became standard in anaesthesia and in resuscitation for assisted ventilation.

The laryngeal mask airway (LMA) a supraglottic device developed by the English anaesthetist Archie Brain during the 1980s, overcame many of the problems associated with difficult endotracheal intubation.

Syringes

The first hypodermic syringes appeared simultaneously in 1853 made by Charles Wood in Scotland and Charles Pravaz   in France. The Pravaz   syringe would enjoy a great success in France, at first by subcutaneous and later, by intravenous injection. The maker, Charrière improved the device and importantly, invented the bevelled hollow needle. The modern glass hypodermic syringe was made by Fournier, a French glassblower in 1894. Finally, syringes could be sterilised but interchangeability of the piston and the body was not achieved until 1934 by Beckton – Dickinson which then became the standard device. Disposable plastic syringes appeared after the Second World War but were not widely – used until the 1970s.

Hypodermic needles

Different needles were invented for specific applications including subcutaneous, intramuscular, intravenous, olive – shaped and epicranial for paediatric use (1965). Here are a few examples.

Infusion bottles

These were initially glass tulips with a cover that allowed filling with a sterilised liquid. Later, in 1940 prefilled glass bottles appeared. Bottles prefilled under a vacuum were not used in France until 1946. Finally, plastic infusion bags appeared in the 1980s. Infusion tubing was initially made of sterilisable rubber and later disposable plastic.

Infusion pumps and syringe drivers

The precision and safety of infusion and injection were improved by the development of infusion pumps and syringe – drivers which allowed the delivery of medications for all clinical situations.

Opening times

Monday to Saturday (closed Thursday);
2pm to 5:30pm (last admission at 5pm);
Closed on public holidays.

Access

UFR de Médecine, site Cordeliers
12 rue de l’École de Médecine, 75006 Paris

On the second floor of the Université Paris Cité headquarters, in a room built in 1905, you’ll find the Museum of the History of Medicine.

Lien Géportail

Services

Cloakroom : yes
Photography allowed yes
Wifi

Join CHAR

Many thanks

Université Paris Cité : Christophe Pérales, directeur, Agathe Sanjuan, Andréa Barbe-Hulmann, Stéphanie Charreaux, Lucie Fléjou, Sonja Poncet, Agnès Sandras, Marina Zborowski. Le Club de l’Histoire de l’Anesthésie et de la Réanimation : Dominique Simon, président. Société Française d’Anesthésie et de Réanimation : Jean-Michel Constantin, président. Comité scientifique : David Baker, Jean-Bernard Cazalaà, Louis-Jean Dupré, Jean-Pierre Haberer, Jacques Hotton, Frédérique Servin, Dominique Simon. Les prêteurs : Musée de l’Histoire de la Médecine de Paris, Collection Pierre Viars (Département d’Anesthésie-Réanimation du CHU Pitié-Salpêtrière), Bibliothèques BIU-Santé Université Paris Cité, Société Française d’Anesthésie et de Réanimation, Musée François Tillequin (Faculté de pharmacie de Paris), Musée du Conseil de l’Ordre des Pharmaciens, Dräger France, Musée dentaire de Lyon (Faculté d’odontologie), Collections privées : Jean-Bernard Cazalaà, Louis-Jean Dupré, Jacques Hotton Conception diffusion numérique : William Fourché.