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September 2000
Volume 64 |
Number 9
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| Anesthesiology,
Anesthesiologist, Anesthetics and Anesthetist: The Emerging
Professionalism of a Medical Specialty |
Patrick P. Sim, Librarian
William Thomas Green Morton made history on Friday, October 16,
1846, by unequivocally demonstrating an effective means of pain
control for surgical operations. The goal for surgical preparation,
true since time immemorial, has been to diminish or destroy the
state of consciousness during surgical operations.1
Morton's act was simply pioneering at the time, requiring a fair
amount of entrepreneurial spirit that engendered an equal amount
of courage. Yet such acts were requisite for all breakthroughs
in anesthesia, surgery and medicine in the ensuing century and
a half. Anesthesia has since become second nature to surgery,
just as breathing is second nature to living. The term chosen
to identify this blessing to humanity has never been a curiosity
in people’s mind. Indeed, the word "anesthesia" did
not even occur in the literature during the first month of its
introduction. The newly discovered method of pain control was
meant to enhance surgery; it was never considered a vital function
in the practice of medicine. The origin of the term describing
pain control, and its subsequent development to become a special
branch of medical science, should be of interest.
"Anaesthesia" Seeps Into Public Consciousness
The ancient Greeks were always concerned about physical pain,
regardless of the origins of infliction. Not known for their expertise
in alleviating physical pain, they tried philosophically and psychologically
to solve this form of human suffering. The roots of the words
of Greek origin, relative to pain relief or pain control, were
mostly shades of escapism. The most obvious words of such nature
are Lethe and Hypnos. Lethe was the silent stream of oblivion
that flowed in the lower world. It was believed that a drink from
Lethe would make one forget the sorrow and pain of real life.
This was what the ancient Greeks could offer: trying to forget
sorrow and pain without the means to alleviate or abolish it.
The Greeks also promoted Hypnos, the god of sleep, the fatherless
child of night and the twin brother of death. He was welcomed
by those suffering and in pain, as sleep and artificial death
obviate pain.2 Hypnotism for pain relief had preceded
chemical anesthesia. Of Greek origin, this word is carried to
modern day medical and psychological terminology.
Pain relief by hypnotism indeed had been tried in India by Scottish
surgeons prior to Morton's discovery of ether to alleviate surgical
pain in 1846. The great gift to render surgery painless by chemical
means during the frenzied early days following Morton’s discovery
was frequently referred to as "Dr. Morton's preparation,"
his discovery, etherization or ethereal inhalation. However, the
Greek terms describing the relief of physical pain soon came to
the minds of the medical men present at Morton's discovery. His
physician friends August Addison Gould, Henry Jacob Bigelow and
Oliver Wendell Holmes named his discovery Letheon, alluding to
the Lethe River of Oblivion; again, myth was applied to block
the harsh reality of pain. Dr. Holmes, however, was dissatisfied
with the term. By November 21, 1846, he arrived at another Greek
word, anaesthesia, which he interpreted as an altered physiological
state rendering the body insensible to pain. For this altered
state of painlessness, he used the term anaesthetic. He predicted
that these terms for the new discovery would soon be widely accepted
in the civilized world.3 In the ensuing year, however,
Dr. Holmes’ new terms did not appear in the literature at all
until Sir James Young Simpson introduced chloroform as an anesthetic
in Edinburgh in 1847.4 He referred to chloroform as
an anaesthetic agent and an anesthetic. In February 1848, Bigelow,
who was the most important messenger in bringing Morton’s discovery
to the world, discussed the clinical application of ether and
chloroform and called this process of pain relief etherization.
For the effects brought about by such application on the patient,
he graded them in terms of the degrees of narcotism and labeled
such effects the anesthetic state. He too predicted that anesthesia
would soon be such a standard procedure for surgery that no surgeons
would perform major surgery without it.5 Two decades
later in June 1868, on the occasion of the dedication of the Ether
Monument at the Boston Public Garden, Bigelow again affirmed the
efficacy of etherization and called it "an inevitable, complete
and safe anaesthesia."6 The term coined by Holmes
gradually emerged in medicine. It was, however, still primarily
regarded as a method of pain control.
In the last decade of the 19th century, the terms anesthesia,
anesthetics and anesthetist began to acquire a new and expanded
connotation when professionalism of a medical discipline on pain
control began to develop. In Great Britain, the Society of Anaesthetists
was formed in 1893.7 Defining the term anaesthetist
in its membership qualification statement, that Society required
the specialist to be a duly qualified medical practitioner who
held office in a public institution or in private practice.
Specialty Emerges From Concept of Pain Control
In this early era of professionalism, physicians who did not
practice anesthesia, but were especially interested in the subject
of anesthetics, were also qualified for its membership.8
Thus a new profession in medicine had emerged from a concept of
pain control. Efforts were made by the British Society to petition
the official medical authority, the General Medical Council in
England, to include anesthetic administration in the medical education
curriculum. It was, however, rejected as being inexpedient. Nevertheless,
the hospital anaesthetists in London pressed on to introduce the
same issue and were successful in encouraging the Royal College
of Physicians and Surgeons to require adequate instruction in
anesthetics for, and satisfactory demonstration of practical skill
by, candidates participating in qualifying examinations.9
Describing the duties of the anaesthetist, British medical authorities
in 1909 required this medical specialist to direct the preparation
of the surgical patient, select anesthetic drugs, give undivided
attention to safety, attend to any emergencies during surgery
and provide postsurgical recovery care. Under any circumstance,
the anaesthetist was always a medical practitioner.10
Professionalism in American anesthesia formally began in 1905,
half a century after its introduction, when nine physicians who
had devoted full-time practice to anesthesia gathered to form
the Long Island Society of Anesthetists in New York. Membership
for this group was limited to qualified physicians for the purpose
of promoting the art and science of anesthetics. This society
evolved to become the American Society of Anesthesiologists as
it stands today.11 Such evolution of anesthesia, from
a medical method to a medical specialty, has fulfilled the prophecy
of Oliver Wendell Holmes in 1847 and Henry Jacob Bigelow in 1848.
The process of its development was slow in America. Leroy D. Vandam,
M.D., offered a theory for this, distinguishing early medical
practitioners of anesthesia between the urban elite, as in the
case of Great Britain and large American cities and the rural
practitioners, mostly in America at the time. Dr. Vandam observed
that training requirements, service orientation, and cultural
and geographical isolation of these physicians in rural America
engendered a fairly strong sense of sectionalism that in turn
nurtured a free spirit and an attitude of independence from the
so-called established authorities in anesthesia. Such factors
eventually caused a retarding effect on the professional development
in American anesthesia.12 Nevertheless, professionalism
in anesthesia was inevitable.
In the early days of professional anesthesia, the term anesthetist
naturally was designated to the physician practitioner who administered
anesthetics. The terms anesthesiology and anesthesiologist emerged
in the 1940s, reflecting the maturation of a bona fide medical
specialty through its history in a century. Central to this etymological
evolution was Chicago surgeon M. J. Seifert, M.D. [Figure 1],
who in early 1938 wrote to Paul M. Wood, M.D., Secretary of ASA
in New York, and coined the terms to further differentiate between
a medical authority and a technician in the management of pain
control, which after a century had become a clinical science of
medicine [Figure 2].
Dr. Seifert defined anesthesiology as a branch of medical science
involved in engendering insensibility for medical and surgical
purposes and further designated the scientific authority in this
branch of medical science to the anesthesiologist, who is a physician.
He considered the hitherto accepted term of medical specialist
in pain control, the anesthetist, a technician. With this pronouncement,
he revolutionized the common perception of the budding medical
specialist in pain control from the status of a technician to
its rightful place in the world of medicine. This was indicative
of an evolving medical discipline that required a new definition
for its medical specialist, relegating the formerly accepted term
to a new category of nonphysician technical operator. In March
of 1944, Dr. Wood took up this advice and proposed to the Society
a change of its corporate name to "The American Society of
Anesthesiology." This proposal was accepted with a wise modification
of the word Anesthesiology to Anesthesiologists, indicating that
it was an association of medical specialists devoted to the branch
of medicine in pain control for surgery. By November of the same
year, the name change of the Society was approved by its membership.
In April 1945, the state of New York granted this corporate name
change for a fee of $100.13
Who was this Dr. Seifert who helped redefine an important concept
in medicine as it had matured to a full-fledged medical science?
Chicago physician-surgeon Mathias Joseph Seifert, M.D., (1866-1947)
was a model Midwesterner in early 20th century medicine, as described
by Dr. Vandam.13,14 Dr. Seifert’s medical career was
preceded by an equally successful career in music and education.
He had graduated from the Chicago Musical College and attended
the Normal School of St. Francis in Wisconsin. His early education
was followed by a multifaceted career in music as an organist,
pianist, choir master and orchestral conductor in the years 1885-96.
He then entered medicine and graduated from the University of
Illinois College of Medicine in 1901 at age 36. Dr. Seifert’s
medical career was also multidimensional, involving obstetrics
and gynecology, general surgery, nursing education, medical journalism,
pharmacy and academic dentistry. His closest association with
anesthesiology was his appointment as professor of physical diagnosis
and anesthesiology at the dental department of the University
of Illinois from 1901, the year he graduated from medical school,
to 1909. His reference to anesthesiology in 1902 matched the time
frame of his appointment as a professor of anesthesiology teaching
dental students. Dr. Seifert reported only a few of his own clinical
experiences in journals and wrote ephemeral manuals for allied
health practitioners. He otherwise left few traces of his contributions.
A typical Midwestern physician at the turn of the century and
a Renaissance man in his own way, Dr. Seifert contributed to the
terminology of a branch of medicine and elaborately explained
its growth from a surgical preparation to a vital discipline of
medical practice. His suggestion was a catalyst in defining a
medical specialty a century after the introduction of anesthesia.
When the national association of anesthesia practitioners changed
its corporate name to American Society of Anesthesiologists, it
properly explained its nature and its mission in medicine. Dr.
Seifert’s suggestion was pivotal.
Will We Evolve to Become "Metesthesiologists"?
The continued exponential growth of anesthesiology within medicine
and surgery in the second half of the 20th century, involving
itself in research and expanding its horizon in health care, certainly
exceeded what Oliver Wendell Holmes and Henry Jacob Bigelow had
envisioned. Although intraoperative care of surgical patients
remains the focus of anesthesiology, more recently Yale anesthesiologist
Nicholas M. Greene, M.D., realized that other involvement of the
specialty demands a re-examination of its term. He pointed out
that the word of Greek origin, esthesia, was joined by the prefix
an to form the word, anesthesia, which means "without sensation."
To better reflect the new reality of the specialty, Dr. Greene
proposed a new prefix, met, meaning "beyond," to replace
"an" and to create a new word, metesthesiology, to carry
the specialty beyond its past 150 years into a new millennium.15
He asserted that the specialty is no longer young, and its maturity
will be appropriately reflected by the etymological evolution
of the Greek word originally coined by Oliver Wendell Holmes,
as witnessed by the growth of the medical specialty.
Patrick P. Sim, M.L.S., has served
as Librarian of the Wood Library-Museum of Anesthesiology for
29 years.
References:
- Flagg JF. The inhalation of an ethereal vapor to prevent
sensibility to pain during surgical operations. Boston Med &
Surg J. 1846; 35(18):356-359.
- Robinson V. Victory Over Pain; a History of Anesthesia. New
York: Henry Schuman; 1946:15-16.
- Miller AH. The origin of the word anaesthesia. Boston Med
& Surg J. 1927; 197(26):1218-1222.
- Simpson JY. Anaesthetic and Other Therapeutic Properties
of Chloroform. Edinburgh: Sutherland & Knox; 1847.
- Bigelow HJ. The use of ether and chloroform. Boston Med &
Surg J. 1848; 38(5):101-103.
- Bigelow HJ. Address at the presentation of the ether monument
to the city of Boston. Boston Med & Surg J. 1868; 1(22); July
2:351-353.
- Transactions of the Society of Anaesthetists, vol. II, 1899.
- Transactions of the Society of Anaesthetists, vol. III, 1900.
Laws and Regulations.
- Transactions of the Society of Anaesthetists, vol.V, 1903.
Report of Council.
- Collum RW. The Practice of Anaesthetics. In: James Cantlie,
ed. The Medico-Chirurgical Series No. 1. New York: William Wood
& Co; 1909:2-6.
- Betcher AM, Ciliberti BJ, Wood PM, Wright LH. The jubilee
year of organized anesthesia. Anesthesiology. 1956; 17:226-264.
- Vandam LD. Early American anesthetists: The origins of professionalism
in anesthesia. Anesthesiology. 1973; 38(3):264-274.
- ASA Board of Directors Meetings, March 30, 1944; February
9, 1945; April 13, 1945. ASA Archives; 1944, 1945.
- Seifert MJ. Biographical information collected from "Who's
Who in America." Located at: The University of Illinois
Health Sciences Library Special Collection and the National
Genealogical Society.
- Vandam LD. Early American anesthetists: The origins of professionalism
in anesthesia. Anesthesiology. 1973; 38(3):264-274.
- Greene NM. The Changing Horizons in Anesthesiology: The 31st
Rovenstine Lecture. Anesthesiology. 1993; 79:164-170.
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