The first administration of ether anaesthesia in India
was on Monday 22(nd) March, 1847, in the Medical College Hospitals, Calcutta,
under the supervision of Dr. O’Saughnessy, the surgeon. (First ether anaesthesia
in the world was administered on October 16(th) 1846 in Boston, USA). Ether
was used within one week of the news reaching Calcutta in the 2(nd) week of
March, 1847. The first chloroform anaesthesia in India was administered on January
12(th) 1848 (Chloroform was first used by Simpson in Edinburgh UK, on 15(th)
November, 1847). It is interesting to note that David Waldie, a chemist who
has been credited for introducing chloroform in clinical anaesthesia came to
Calcutta in 1853; started his chemical company and lived there till his death
in 1889.
During the first
16 years of chloroform anaesthesia, there were 393 deaths and 48 were reported
due to ether. There was a controversy between two medical schools, the Edinburgh
(Simpson) claiming death due to respiratory failure and London (John Snow) claiming
cardiac failure as the cause of death. The pitish Medical Association appointed
the Glasgow committee in 1880 which concluded that “Chloroform was injurious
to the heart and in comparison more dangerous than ether”. In 1888 Edward Lawrie
in Hyderabad claimed that he had administered chloroform anaesthesia to 40,000
people without a single fatality and formed the “First Hyderabad Chloroform
Commission”. 141 animal experiments were done and it was concluded “Chloroform
may be given with perfect safety and without any fear of accidental death, if
only respiration is carefully attended to”. This was not accepted in England
and so the “Second Hyderabad Chloroform Commission” was formed to which a representative
from Lancet was sent. The Nizam of Hyderabad offered £ 1000 for a commission
consisting of Lauder puntor, F.R.S. U.K., Surgeons Lawrie and Rustomji. Experiments
were carried out on 430 animals (dogs, monkeys, horses, goats, rats, rabbits
and cats) and a clinical study on 54 humans. They concluded that the Edinburgh
School was right. This study was undertaken at the Afzalganj Hospital in Hyderabad
where the Osmania Hospital now stands. Incidentally the first woman anaesthetist
in India and perhaps the world, Roopabai Ferdunji was working under Edward Lawrie
in Hyderabad in 1889; she later went to Edinburgh for further studies.
In 1890 after 20
years of accidents due to chloroform, the world began to discard it in preference
to ether, after strictures by coroners against the use of chloroform. However
in India till 1928, chloroform was the only anaesthetic used. In fact, it became
synonymous with anaesthesia. “Chloroformed” was the popular expression for anaesthesia.
It was cheap, easy to induce and pitish. It was Dr. M. C. Ganguli from Calcutta
who observed the leniency of coroners and Jyoti Prasad of Jodhpur (1928) produced
a classical well documented paper on ether and observed that “Open ether is
practical even in hot weather and at less cost”.
Some Interesting
Case Reports
The first recorded
case of endotracheal insufflation anaesthesia was in 1880 for an osteosarcoma
of the hard palate with a catheter in the trachea by MacReddie for MacEwan’s
procedure (Ind. Med. Gaz. – 1880, 16, 131).
Cayley in 1879 reported
successful removal of a femoral artery aneurysm in a patient with extensive
heart disease, with uneventful recovery (Ind. Med. Gaz. – 1897, 15, 71).
Mahatma Gandhi was
operated upon on 12(th) January, 1925 for an eventful emergency appendicectomy
in Sassoon Hospital, Pune. Dr. Date administered open drop Chloroform. A notable
feature being that electricity failed; a torch was pought in which got fused;
Surgeon Col. Maddock completed the operation in the light of a kerosene lamp
!! (D. G. Tendulkar – Mahatma Gandhi – Vol. 2, Page 76).
J. Frayer, reported
the first case of delayed chloroform poisoning in the world in 1869 in a 27
year old man who was treated for compound fracture of the leg. 24 hours later
he started vomiting, developed jaundice, coma, anuria and died on fourth post
operative day (Ind. Med. Gaz. – 1869, 4, 260). Guthrie’s report on a chloroform
poisoning appeared in Lancet in England appeared in 1894!
Alexander Crombie
of the Presidency General Hospital, Calcutta, started using hypodermic morphine
in 1880 for smoother course of chloroform anaesthesia; this is the first documented
report of premedication in the world, confirmed by Gwathmey and Rene. F. Miller
of U.S.A. (Ind. Med. Gaz. 1888, 23, 34).
Chloroform and ether
continued to be used till mid – fifties in many hospitals. Trilene was introduced
in the late 1940’s and is still in use and Halothane appeared on the scene in
1960. We reported the first case of Halothane hepatitis in 1972. Enflurane trials
were made in 1975 but it was not made available. Isoflurane is now used introduced
in 1992.
Regional Anaesthesia
Cocaine 4% was first
reported as a local anaesthetic in 1894 for removal of a facial tumour. Spinal
anaesthesia was first reported by Capt. A Chalmers of Trichinopoly with hyperbaric
stovaine. The first death under spinal anaesthesia was reported by W. Gabbett
of Madras, He gave 3 c.c. of distilled water containing 1 mgm strychnine and
1 dg of Novocaine at T11 and T12. The patient had dyspnoea and died (Ind. Med.
Gaz. – 1910, 44, 54).
Spinal analgesia
in children was reported by Rutter Williamson (1915) from Madras. He preferred
stovaine from Saidapet Madras to that from London (Ind. Med. Gaz. – 1915, 50,
156). Stovaine was discarded in 1933. Later spinocaine and Percaine were used;
a report on herniorrhaphies by J. C. Drummond was published.(Ind. Med. Gaz.
– 1933, 68, 699).
Lumbar and caudal
extadural analgesia were reported by Dr. G. R. Kokatnur (Belgaum, Karnataka).
He had been doing that since 1925 with 40–60 c.c. of 1% Novocaine with no risk
in over 400 cases (J. Ind. Med. Assoc. – 1946, 15, 342). Dr Hari Rao of Vizagpatnam
published a study of a series of 970 cases of caudal extradural anaesthesia
and 6 patients who were given lumbar epidurals (J. Ind. Med. Assoc. – 1941,
10, 448).
Total spinal for
controlled hypotension was introduced in 1954 (Dr. G. S. Ambardekar). Nupercaine
1% heavy and 1:1500 hypobaric were commonly used in this decade. Though regional
anaesthesia was discarded for several years in U.K., it was the most popular
here, because of economics, simplicity and good operative conditions. Labour
analgesia was also practised routinely in some centres.
Intravenous Anaesthesia
Thiopentone was
introduced in early 1940s by Dr. M. M. Desai and Dr. B. N. Sircar (Bombay) at
the G. S. Medical College. Dr. Desai had the misfortune of being the first and
perhaps the only anaesthetists to die in a dental chair following thiropentone,
given by his own resident!
Relaxants
d-tubo curarine
was introduced in 1949 and subsequently gallamine and scoline in the late fifties.
Pancuronium was in use sine 1975, Norcuron in 1979 – 1990.
The first mitral
commisurotomy was performed in 1952 (G. S. Medical College); hypothermia for
atrial septal defect in 1953. At about the same time blind intubations were
in practice.
Neurosurgery as
a speciality started in 1941 and open heart surgery (1961) was started at B.Y.L.
Nair Hospital, Bombay, using an indigenous reusable bubble oxyenator! We were
not for behind in transplant surgery, the first kidney transplant was performed
at Vellore in the early 70’s, heart transplant attempted at Bombay in late 1960’s.
Recently cadaver transplants have been performed in Hyderabad, Madras, Bombay
and Delhi. The stage is set for liver transplants.
Critical Care
A two–bedded ICCU
was started in K.E.M. Hospital, Bombay (1962). The first documentation of an
Intensive Care Unit was in 1963, in the Army Hospital, Delhi by Col. Ramarao.
At this time there were units at AIIMS (Dr. Tandon) and at Safdarjung Hospital
(Dr. Bhattacharya). Now there are ICCUs in every town and ICUs in all major
hospitals and specialities, where anaesthesiologists play an important role.
The Anaesthesia
Instruments
In 1929, the FLAGG’s
can was modified into a bottle! (The K.E.M. Bottle). On 22(nd) January, 1935,
the first Boyle’s Apparatus arrived in Calcutta by ship, it had “Fine adjustment
valves (no pressure reducing valves!) and water sight feed bottle for ether,
a 2–way stop cock, for re–peathing / non-repeathing and shipways CO(2) absorption
apparatus, 4 cylinders of 100 gallons for O(2) and N(2)O”. The cost of this
including custom duty and delivery charges was Rs. 645/-
The first O(2) plants
were installed in Calcutta in 1935 and N(2)O plant in 1962. Now there are Regional
Centres in most areas. The pipe–line supply was first installed in Vellore (1954)
and by 1979 over 150 centre and now every major hospital has it. Liquid Oxyugen
has now been introduced a decade ago (Mid 80’s).
The first indigenous
“Boyle F” rolled out of IOL, Calcutta in 1950, with imported parts. By 1956
it was entirely manufactured in India except the cylinders. At present machines
with all the latest safety guards have been incorporated. During the 1(st) Indo-Pak
war the Porta-Boyle was developed, as well as an Air–Trilene apparatus for inaccessible
areas. Currently there are several companies manufacturing anaesthesia apparatus
(Bombay, Delhi and Calcutta).
In the early 40’s
Lord Nuffield of Oxford, a car magnate and benefactor to anaesthetists, donated
“iron lungs” (drinker’s apparatus) to the Armed Forces and Metro Cities in India.
The 1950’s saw “Dog–Pumps” later the Beaver and Bird – MK 7. In the late Sixties
electromechanical anaesthesia ventilators were indigenously manufactured but
till today Triggered Ventilators are yet to be indigenously made. However a
plethora of sophisticated multimod ventilators are being imported.
Monitoring has
also come of age, cardioscopes were introduced in 1960 for cardiac surgery,
now it is universally used and indigenously manufactured too. Pulse oximeters
were first introduced by Omeda in the mid–eighties; now the market is flooded
with oximeters. End tidal carbondioxide monitor is also used in major centres.
Neuromuscular monitoring is also catching up, first introduced in 1968 by wellcome
laboratories, now computerised versions are available with several modes. Temperature
monitoring is not yet universal or mandatory.
Fifty Years of
ISA – The Golden Jubilee Year
On October 16(th)
1946, a centenary celepation of “Ether – Anaesthesia” was held at the G. S.
Medical College in Bombay; Dr. S. K. Bakshi (Delhi) Dr. B. N. Sircar. Dr. G.
S. Talwalkar, Dr. M. N. Desai (Bombay); Mukteshwar Prasad (Patna) and F. Saher
conceived the Indian Society of Anaesthetists (ISA). Dr. Saher; in charge of
the correspondence for opinions, died soon after following an operation! Dr.
B. B. Sircar of Seth G. S. Medical College, Bombay took over and the society
was established in 1947.
On 23(rd) and 24(th)
December, 1949, during the Annual Surgeons Conference, the first meeting of
the ISA was held at the Seth G. S. Medical College. Dr. M. N. Desai was the
chairman of the Reception Committee and Dr. J. R. Jagase (Bombay) was the President.
The following delegates were present Drs. G. S. Ambardekar, Awalegaokar, G.
S. Talwalkar (Treasurer), B. N. Sircar, V. Bhargav, K. M. Bakshi, I. Iqbal,
W. P. Thatte, R. B. Redkar, R. P. Parulkar, Jadhav V. V., Hari Rao (Vizag),
Gwenda Lewis (Vellore), Satyendra Singh (Delhi), P. D. Dhameja (Delhi), Mukteshwar
Prasad (Patna) and A. T. Gokhale (Pune). Thereafter the society continued to
meet yearly under the umpella of the Association of Surgeons of India (ASI).
In 1964 the silver
jubilee year of the Association of Surgeons of India it was decided after a
lot of deliberation to separate out ISA as an independent association. The first
independent conference of ISA was held in Hyderabad under the Chairmanship of
Prof. Venkatrao and Presidentship of DR. R. P. Parulkar of Baroda. Two illustrious
anaesthetists, Prof. Macintosh and Prof. Cecil Gray were present on the occasion.
Silver Jubilee of ISA was celepated at Madras organised by Dr. T. Srinivasan.
The membership of the society has grown from 19 members in 1947 to 100 in (1955),
2500 (1979) and to over 8000 at present. Life membership was introduced in 1985.
Sub-specialities such as in pain, cardiac anaesthesia, neuroanaesthesia, clinical
pharmacology, and Anaesthesia Practitioners Forum were proposed at Vishkhapatnam
in 1986; all these sub-specialities are flourishing in their respective group
meetings. At present most major cities, towns and states have a panch of ISA.
The Armed Forces Anaesthetists Forum and the All India Railway Anaesthetists
Forum have their annual conferences too.
The first official
journal of the society was published in July 1953. Dr. M. C. Ganguli was the
first editor.
In 1956 ISA joined
the World Federation of the Societies of Anaesthesiologists (WFSA) as a founder
member and hosted the V Asia-Australasian Regional Congress (AACA) at Delhi
in September 1978 organised by Dr. G. R. Gode.
A South Asian Confederation
of Anaesthesiologists (SACA) of SAARC countries was conceived in New Delhi in
November 1991 and the first SACA congress was held in Dhaka (1993) with Dr.
(Mrs.) V. M. Divekar as the Founder President.
Anaesthesia Education
and Academics
In 1890 in Hyderabad
Medical School, 2 students were deputed for all cases that were to be given
chloroform anaesthesia, one person administering anaesthesia and the other taking
detailed notes – the earliest anaesthesia records in the country! These trained
anesthetists were called “ Chloroformists” (Ind. Med. Gaz. P. Heir – 1893; 27,
80).
The Indian Medical
Gazette in 1941 advertised a post of “One Paid Anaesthetist” for the Mayo Hospital,
Calcutta and Sassoon Hospital, Poona. Dr. Jyotindranath Mukherjee L.M.S. was
appointed on September 1(st), 1914 on a salary of Rs. 50/- per month!
Lectures on anaesthesia
for undergraduates were first started officially in Calcutta University in 1906.
Incidentally in Great pitain it started in 1918 (Scurr). In two medical schools
before independence there were teachers in anaesthesia in Bombay (S. G. Talwalkar),
Calcutta (M. C. Ganguli), Lucknow (R. Pramanik) Madras (P. V. Francis and T.
G. Baganath) Delhi (E. Soundaravalli). Lahore and Patna did not have teachers.
Now, there are over 150 Medical Colleges each with departments of anaesthesiology.
Tutorials and 8- 10 didactic lectures, certain basic skills in anaesthesia and
CPR are compulsory, as well as half to one month internship.
Postgraduate teaching
and training: A post independence phenomenon started with the Diploma in Anaesthesia
in Bombay in 1946 and D. A. of College of Physicians and Surgeons in 1948. The
first degree course, M. S. in Anaesthesia was started in Muzaffarpur and Darbhanga.
Currently most university and post graduate institutes have M.D./M. S. in Anaesthesia.
The National Academy of Medical Sciences started the Diplomate of National Board
of Examinations in the 70s. The students whoh took these exams have increased
from 5 to approximately 70 students per year at present. The quality of education
in anaesthesia is of a high order by the reports our students ping in during
their foreign assignments and of course the reduction in mortality and morbidity.
Ph.D. in anaesthesia is also offered at some centres, the first student was
Dr. J. R. Mitra of Calcutta under Dr. Barat.
Dr. Bhojraj, Dr.
Bhattacharya and Dr. Pramanik were the first to receive F.F.A.R.C.S. in 1953.
Armed forces had
a spurt in anaesthesiologists during the World War II. After 28 days of training,
the specialist was let loose! The Indian Specialist took over in 1947, this
is also the Golden Jubilee year of the Indian Armed Forces Anaesthetists. There
is at present intensive training at the AFMC (Pune) and after 5 years of training
they are classified specialists including Super Specialities.
Therefore, the
science of anaesthesia is just about 150 years young as compared to the thousand
years old well-established surgical faculties. It is truly an applied medical
science of all the medical faculties, and has proved to be one of the three
“A”s – Anaesthesia, Asepsis and Antibiotics – a millennium contribution for
the tremendous advances made by the medicine, surgery intensive care and pain
management.
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2001 - Journal of Postgraduate Medicine
