International Congress Series 1242 (2002) 331 – 335

Back to the future: the relevance of the history

of anaesthesia today
C. Mark Harper*
Centre for Anaesthesia, Room 121, 1st Floor Crosspiece, Middlesex Hospital, Mortimer Street, London,
WIT 3AA, UK

Keywords: History; Anaesthesia; Relevance

The interest of anaesthetists in the history of their specialty is probably greater than that
of any other. Indeed, the International Symposium is testament to the fact.
However, I have long thought that history has a value beyond the satisfaction of idle
curiosity and the pleasant passage of quiet hours in the operating theatre. With this in
mind, I set out to discover whether or not I was alone in this opinion and maybe in the
process to rationalise my viewpoint.
I devised a simple questionnaire and distributed it at three anaesthetic meetings to get a
broad, and in one case historically informed, range of views. These meetings were the
North Thames Winter Scientific Meeting (a general meeting attended mainly by con-
sultants), an Association of Anaesthetists History Symposium (the informed, and perhaps
biased, group) and a day-release course for postfellowship anaesthetic trainees in the North
London region.
A total of 54 questionnaires were returned: 19 from the trainee meeting, 7 from the
history symposium and 28 from the North Thames Winter Scientific Meeting.
The findings illustrated in Fig. 1 show that the majority of respondents felt history had a
place in today’s medical environment. Over 70% thought the subject both interesting and
relevant, and more than 80% felt it to be relevant. These figures were similar whether
looked at by meeting or by grade (Fig. 2). Tables 1 –3 summarise the reasons people gave
for their opinions.
It was a bit disappointing, though not entirely surprising, to see that one trainee felt
history was only relevant because it ‘comes up in exams.’ Conversely, other respondents
felt that history remained relevant for its ability to give us a broader social and structural,
rather than simply scientific, perspective.

*
Tel.: +44-20-7485-1434; fax: +44-14-3878-1302.
E-mail address: drmarkharper@hotmail.com (C.M. Harper).

0531-5131/02 D 2002 Elsevier Science B.V. All rights reserved.

PII: S 0 5 3 1 - 5 1 3 1 ( 0 2 ) 0 0 7 0 6 - 9
332 C.M. Harper / International Congress Series 1242 (2002) 331–335

Fig. 1. Percentage of anaesthetists who think that the history of medicine is interesting and/or relevant: by
meeting. NTAM = North Thames Winter Scientific. AA = Association of Anaesthetists History. SpR = day-release
course for postfellowship anesthesiology trainees in the North London region. I = interesting. R = relevant.
U = uninteresting. i = irrelevant.

Amongst the texts considered to be historically important (Table 4) it was particularly

gratifying to see those of John Snow mentioned, as it was his book of 1847 entitled ‘On
the Inhalation of Ether’ [1] that sparked off this project.
The striking thing about this 10-page volume is quite how much of it seems pertinent to
contemporary anaesthetic practice. Many, if not all, of the reasons given regarding the
relevance and interest of medical history can be illustrated from this slim book.

Fig. 2. Percentage of anaesthetists who think that the history of medicine is interesting and/or relevant: by grade.
SpR = trainee (specialist registrar). I = interesting. R = relevant. U = uninteresting. i = irrelevant.
 C.M. Harper / International Congress Series 1242 (2002) 331–335 333

Table 1
Reasons for thinking that the history of medicine is interesting
. It’s a personal thing
. It’s an essential background
. To know the past to understand the present
. It explains why we do things in a certain way/how things have developed/current-practice in context
. I like history
. Interesting to see how things have changed
. How previous generations achieved so much with so little
. Unbelievable what patients used to get put through. . .and what doctors had to cope with
. The way it reflects social history

Snow gives insights into the development of the operating theatre hierarchy: ‘By the
kindness of the surgeons to St. George’s Hospital, I have had the honour of giving the
vapour of ether at thirteen surgical operations—most of them important ones—in the
hospital during the last six weeks, having the valuable advice of the surgeons, and
occasionally one or two of the physicians to the hospital, to aid me giving it.’
In another passage he considers the effect of temperature on the delivery of anaesthesia:
‘It occurred to my mind that by regulating the temperature of the air whilst it is exposed to
the ether, we should have a means of ascertaining and adjusting the quality of the vapour
that will be contained in it.’
That this can give us ‘a perspective of current practice’ or even that ‘one cannot
comprehend the present except by some study of the past’ can be seen by looking at a
recently published paper in Anesthesia and Analgesia. Entitled ‘The effect of temperature
on the solubility of volatile anaesthetics in human tissues’ [2] it reminds us that regulation
of volatile agent delivery and effect does not stop with the bimetallic strip inside our
anaesthetic vaporiser.
Similarly, the importance of clinical assessment of both breathing pattern and
circulation in anaesthetised patients are described. Here, again, there are contemporary
research papers to show the continuing relevance of Snow’s work [3– 5].

Table 2
Reasons for thinking that the history of medicine is relevant
. Comes up in exams
. Understanding today’s techniques
. Perspective of current practice
. Understanding of technical development
. Understanding of our place in society
. Organisation of the NHS and current management structure
. Knowledge of the history of medicine and anaesthesia is an essential background to understanding and
practising them
. Learning from the past helps future development
. Permits old ideas to be ‘reborn’ at a more appropriate time
. I cannot see how one can comprehend the present except by some study of the past
. Stops us rediscovering techniques that have failed
. ‘Those who cannot remember the past are condemned to fulfill it.’
334 C.M. Harper / International Congress Series 1242 (2002) 331–335

Table 3
Reasons for thinking that the history of medicine is irrelevant
. Competence depends on three factors: training, personal experience and keeping up to date
. The specialty has changed so rapidly that the way it was done 30 years ago is not going to alter your
practice today
. Things have changed so much
. There is information overload already

Although I am extremely grateful that my anaesthetic career has been in the age of
capnography and pulse-oximetry, I sometimes feel that technology is threatening to
overwhelm us and undermine our clinical judgement.
Furthermore, and contrary to the opinion of respondent who suggested that history
merely adds to medical information ‘overload,’ I think that Snow’s book exemplifies the
ability of history to clarify both the present and the future. This is, I think, for three
reasons.
First, it demonstrates that which was important to the physician when he had to rely
solely on direct contact with the patient, thereby emphasising the physical signs of vital
importance: vital not only in the ‘crucial’ sense of the word, but also in the sense of
‘pertaining to life’.
Second, it creates a picture and a context, both of which are particularly important to
someone as factually incontinent as myself.
Third, my feeling is that the study of the history of medicine gives us a ‘proper
perspective,’ not only for ‘a broad estimation of the present state of development of the
medical sciences,’ but also of the centrality of the patient in medical care. From here, we
also gain perspective of our position relative to the patient, and in the medical system and
society as a whole.
The future does not and should not rest solely in the future. Although we should strive
to take our profession forwards, we need to look backwards as we do so. It’s not so much
about seeing the wood for the trees as seeing the patient for the monitors.

Table 4
Texts people considered interesting and/or important in the history of anaesthesia
. Rushman and Atkins—‘A Short History if Anaesthesia’
. Duncum—‘The Development of Inhalational Anaesthesia’
. Bergman—‘The Origins of Surgical Anaesthesia’
. Ostlere and Bryce-Smith—‘Anaesthetics for Medical Students’
. MacQuity—‘The Battle for Oblivion’
. Smith WDA—‘Under the Influence’
. ‘Lee’s Synopsis of Anaesthesia’
. Journals, textbooks, the lot
. I haven’t written it yet
. John Snow’s texts
 C.M. Harper / International Congress Series 1242 (2002) 331–335 335

References

[1] J. Snow, On the Inhalation of the Vapour of Ether, Wilson and Ogilvy, London, 1847 (note that an 87-page
volume with a similar title was also published by Snow in 1847).
[2] J.-X. Zhou, J. Liu, The effect of temperature on solubility of volatile anesthetics in human tissues, Anesth.
Analg. 93 (2001) 234 – 238.
[3] F. Stéphan, A. Flahault, N. Dieudonné, J. Hollande, F. Paillard, F. Bonnet, Clinical evaluation of circulating
blood volume in critically ill patients, Br. J. Anaesth. 86 (2001) 754 – 762.
[4] M. Palazzo, Circulating volume and clinical assessment of the circulation, Br. J. Anaesth. 86 (2001) 743 –
746.
[5] T.L. Strickland, G.B. Drummond, Comparison of pattern of breathing with other measures of induction of
anaesthesia, using propofol, methohexital, and sevoflurane, Br. J. Anaesth. 86 (2001) 639 – 644.