The Awakening of Anesthesia

hewitt mixed gas

Frederick Hewitt's mixed gas anesthesia machine

Abdominal surgery was severely limited by the limitations of pain and exposure, and was largely confined to enormous ovarian pathology until the development of anesthesia caught up to surgery. The anesthetic properties of Nitrous oxide were first described in 1800, but this agent was expensive to make and difficult to transport, so the first real use of inhalational anesthesia was delayed until March 30, 1832 when Crawford Long used diethyl ether as anesthesia in order to remove a tumor from the neck of James Venable in Jefferson, Georgia.

Diethyl ether has remarkable anesthetic powers, as the dose increases, not only is stupor obtained, rendering the patient insensate of pain, but eventually induces muscle relaxation. In addition, ether is easy to make and to store as a volatile liquid in cans. Ether anesthesia could be induced by placing ether on a piece of cloth and having the patient breath through the cloth. This was refined over time into a mask attached to an inverted cone filled with cotton, called the ether cone.

Ether quickly became widely used as an anesthetic, and it allowed increasingly aggressive abdominal surgeries to be performed over the latter half of the nineteenth century. Ether presented some significant difficulties, the leading one of which was dose control, which is in two parts: first, how to achieve a safe level of anesthesia without going too far into apnea and coma?, and the second of which is how to confine the ether to the patient and limit exposure to the operating room personnel?

Sir Frederic William Hewitt was born in 1857 in London. He was educated at the Merchant Taylors’ School and the Royal School of Mines, but then moved to Christ’s College, Cambridge where he studied Natural Science. Sir Frederic then attended the medical school at St. George’s Hospital in London. He was made a Fellow of the Royal College of Surgeons in 1882, and, unusually for the times, received his MD degree in 1886. After qualifying as a surgeon Dr. Hewitt had developed a retinal disorder which led to significant visual problems. He decided to scientifically study anesthesia, becoming the first physician “anesthetist.” A post was created for him at London Hospital, where he would work closely with Frederick Treves.(Edwards)

The Mayo Brothers provided a telling description of anesthesia practices around 1883:

(speaking of young Dr. Charles Mayo, around 18 years old)

Since anesthesia was still new enough for the layman to fear it, it was the custom to have some physician of established reputation give the anesthetic, and on this occasion Dr. Mayo’s anesthetist was a doctor well known in Rochester, a homeopath of wide practice and experience. He was a surgeon and had served as coroner for Olmsted County, but obviously he was not accustomed to major operations on a breathing, pulsing body.

Dr. Mayo (the father, William Worrell Mayo) made a small incision, inserted a trocar into the tumor, and as the fluid contents drained out caught them in a tub at hand for the purpose. Then by means of clamps worked by thumbscrews he began to pull the tissue of the growth out through the incision. The base of the tumor was pulled back and forth in the process, producing a peculiar sucking noise like that made “by a cow’s foot in the mud.” This was too much for the nerves of the anesthetist and he fainted.

After a quick survey of the possibilities, Dr. Mayo kicked over a cracker box at the end of the sofa and said, “Here, Charlie, you stand on this and give the anesthetic.”

“He did it well, with perfect composure,” said Will (Charlie’s brother, Dr. William James Mayo), both Charlie added a few details: “When she stopped wiggling Father would tell me to stop, and when she started again I would drop some more (ether). I did fine, but like doctors called in to help another, I was looking at the operation and paying no attention to the patient.”(Clapsattle)

Frederick Hewitt, with his sole concentration on the anesthetized patient, instituted a sea change in the care of the patient. He invented the machine to provide mixed gases, multiple anesthetic agents and oxygen, to patients to provide more even anesthesia. With modifications, Hewitt’s machine is still in use today. He also developed the standard methods for monitoring the patient’s level of anesthesia, and established the link between hypoxia, low blood oxygen levels, and anesthetic related complications and death. He invented methods of airway control, developed the first oral airways and endotracheal tubes, as well as the methods for improving the airway with relaxation, such as the jaw thrust maneuver he performed on the King when he turned blue under anesthesia.