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 XXth 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.