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Harvey Cushing (1869-1939), recognized as the pioneer of neuroanesthesia, would be the best person to guide you through this museum (1). Cushing is an American neurosurgeon from Ohio who made significant contributions to anesthesia, including introducing blood pressure measurement during anesthesia. Noting that patients needed to be monitored full-time during surgeries by a doctor, Cushing had asked one of his colleagues to be his constant “etherizer”, who was essentially the first neuroanesthetist. He provided specific and complete instructions for the full-time neuroanesthetist and introduced the neuroanesthesia subspecialty (1). As a significant contributor to the field, Harvey Cushing would be able to discuss the history of anesthesia and the rise of neuroanesthesiology.

Sources:

(1) https://link.springer.com/article/10.1007/s00540-008-0652-0

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On October 16th, 1846, Dentist William Morton demonstrated the first public surgery using an anesthetic in the Massachusetts General Hospital’s surgical amphitheater. Morton used ether as the anesthetic and administered it to a patient with a tumor in their jaw, Edward Abbot. Once Abbot was unconscious from the anesthetic, Dr. Warren completed the tumor removal procedure. What was most fascinating for the audience was that Abbot never winced or cried in pain. This was the first time in public that a doctor performed surgery using ether as an anesthetic (1).

The surgical amphitheater is now referred to as the “Ether Dome” because of this demonstration, and is now considered a historical landmark and place for teaching. The artifact above is a painting of the procedure by Warren and Lucia Prosperi. Both painters restaged the surgery to best capture the scene. This painting was considered a gift to the hospital and commemorates this innovative surgery (1). This demonstration was vital in displaying the beginnings of using substances to alter brain circuits that aid both patients and healthcare teams with painful but necessary medical procedures.

Sources:

(1) https://www.massgeneral.org/museum/exhibits/ether-dome/creating-the-ether-dome-painting

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Only a few months after Morton’s demonstration, James Young Simpson introduced ether anesthesia into the field of obstetrics on January 9th, 1847 (1). However, noting the drawbacks of ether for his patient, he sought a safer and more effective anesthetic as an alternative. Through his research, including Simpson and his friends testing it themselves, he demonstrated the anesthetic properties of chloroform on humans. The artifact above was an excerpt from the memoir of Simpson detailing the first use of chloroform anesthesia on November 8th, 1847 in Edinburgh (1). This excerpt emphasizes the “awe” factor surrounding the mother’s inability to feel the pain of labor due to the use of chloroform. Around this time and within a few years of his discoveries, the use of chloroform as an anesthetic was largely debated because of the improper administration of chloroform and the belief that labor pains are helpful for giving birth (2). Simpson dissolved many of these misconceptions and was highly honored for his groundbreaking contributions to the progression of anesthetics and the future of obstetrics. His investigations of chloroform have helped mothers relieve their pain as an early anesthetic and paved the way for safer and more effective anesthetics used in surgery today.

Sources:

(1) https://fn.bmj.com/content/86/3/F207#ref-5

(2) https://embryo.asu.edu/pages/james-young-simpson-1811-1870

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Victor Horsley was the first neurosurgeon appointed in a hospital in Queen Square of London. He experimented on himself and animals from 1883-1885 with ether, chloroform, and morphine to better understand their intracranial effects. In doing so, he found that ether had many disadvantages that would not permit its use in neurosurgery, such as hypertension, bleeding, and vomiting (1). When testing morphine, he found that it increased cerebral blood flow and controlled hemorrhage (1). Thus, Horsley initially suggested that a combination of morphine and chloroform narcosis be used as an anesthetic, and then switched to small amounts of chloroform after learning of the respiratory depression effects of the opioid (2). The artifact above is a picture of Horsley performing neurosurgery at the National Hospital for Neurology in London (3). As a pioneer of neurological surgery, not only did Horsley contribute many of the “firsts” in procedures of the brain, but Horsley also made great strides in research for the best anesthetics specific to neurosurgery and their effects on the brain.

Sources:

(1) https://aneskey.com/a-history-of-neuroanesthesia/

(2) https://thejns.org/focus/downloadpdf/journals/neurosurg-focus/36/4/article-pE2.pdf?pdfJsInlineViewToken=2129576550&inlineView=true

(3) https://thejns.org/view/journals/j-neurosurg/130/2/article-p639.xml

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While anesthetics have now been used in various fields, including the discussed neurosurgery and obstetrics, eye surgery at the time was extremely difficult due to the involuntary reflex movements in the eyes (1). Carl Koller, an ophthalmologist from Vienna, was the first to introduce local anesthesia for eye surgery in 1884 (2). While a student, Koller had tested a variety of substances in his eyes and other animals. He had tested chloral hydrate, bromide, and morphine in animals with no success, and then tested a cocaine solution on his cornea. Koller found that a few drops of cocaine solution had tissue-numbing properties and also causes pupil dilation. The artifact above is an 1885 newspaper clipping of a story displaying Dr. Koller’s cocaine discovery from the [Terre Haute] Saturday Evening Mail (3). Cocaine-induced local anesthesia spread quickly to other fields of medical practice, especially in those where general anesthesia would be an unnecessary risk for patients (1) Dr. Koller’s discoveries were crucial in advancing anesthesia from general to local in various medical fields, benefiting both doctors and patients in surgical treatment.

Sources:

(1) https://www.erythroxylum-coca.com/karl-koller/index.html

(2) https://pubmed.ncbi.nlm.nih.gov/22531385/#:~:text=Modern%2Dday%20local%20anesthesia%20began,in%20less%20than%20a%20month.

(3) https://blog.newspapers.library.in.gov/eyesurgery1884/

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August Karl Gustav Bier was a German surgeon who studied spinal cord anesthesia, later known as a spinal block (1). He found that parts of the human body could be numbed at various levels depending on the amount of anesthesia in the spinal cord. In August 1898, Bier injected a cocaine solution in a 34-year-old patient who had tuberculosis in the lower leg, requiring partial leg amputation. He injected the solution into the patient’s spinal canal before completing the amputation. The patient reported that during the operation, he could not feel the lower half of his body, did not feel any pain, and could not move any limbs despite remaining conscious (1).

Bier repeated the operation on five other patients, all of which reported headaches and vomiting a week after receiving the anesthetic. Brier believed that the side effects of the cocaine anesthetic were from circulatory trauma to the CNS or excessive CSF loss (1). The artifact above shows Brier performing a spinal anesthetic just as all of the other procedures he conducted (2). As the first to perform spinal anesthesia, his contributions led to significant growth in the way surgery was conducted.

Sources:

(1) https://embryo.asu.edu/pages/august-karl-gustav-bier-1861-1949

(2) https://litfl.com/august-bier/

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Neuroanesthesiology is a medical subspecialty of anesthesia that involves the integration of anesthetics, neurosurgical procedures, and critical care. The goal for neurosurgical anesthetics are to regulate cerebral perfusion and oxygen delivery to the CNS duing surgery (1). In doing so, neuroanesthesiologists achieve the best conditions for the neurosurgeon while also ensuring adequate brain blood flow and oxygen levels (2). The artifact above is a diagram of an awake craniotomy, a brain surgery where a patient has lower sedation for part of the procedure to perform simple tasks required for brain mapping (3). Such surgery requires lots of communication between a neuroanethesiologist, a neurosurgeon, and a neurologist who work as a team to ensure a smooth procedure. Without anesthesia, an awake craniotomy would be detrimentally painful or nearly impossible. Seeing the field today, it is truly fascinating to see how much anesthesia has progressed to the point that physicians are training in this specialized field to specifically focus on anesthesia care for neurological cases.

Sources:

(1) https://www.sciencedirect.com/science/article/abs/pii/B9780702040887001061?via%3Dihub

(2) https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/anesthesiology-and-critical-care/anesthesia-care-what-to-expect/neuroanesthesia

(3) https://www.aaroncohen-gadol.com/patients/craniotomy/awake-craniotomy