Volume 7 - History of Anaesthesia Society

1ME EARLY WYS OF CARDIAC
I was involved with cardiac anaesthesia from 1949 to 1980, but feel I
ought to mention sane of the more important events prior to these dates,
because the developnents in cardiac surgery and anaesthesia were closely
related.
'he first operation on the heart took place in 1896 when the cardiac
muscle was sutured following injury. In 1901 the first two successful
cases of cardiac massage occurred - each by diEferent routes. Arbuthnot
Lane in this country was operating on a man of 65 for appendicitis under
ether anaesthesia when arrest occurred. He massaged the heart through
the abdomen without opening the diaphragm. In the same year a surgeon
in Norway was carrying out a hysterectomy on a 38 year old women under
chloroform anaesthesia when she arrested. He made an intercostal
incision and massaged the heart under direct vision.
In 1929 Cutler and ~eck' reported 12 cases worldwide of operations on
heart valves with only two successful results. The first two were in
Paris in 1913 and 1914 when Doyen operated on a pulmonary valve and
Tuffier on an aortic. The other ten were mitrals. All these patients
breathed spontaneously and anaesthesia varied from open ether on a
Schimnelbusch mask to nitrous oxide, oxygen, ether either with a face
mask or insufflation through an intratracheal catheter as described by
Kelly in 1912. Souttar's case, which was included in the series, was
slightly different.
On 6 May 1925 at the London Hospital, Henry Souttar operated on a girl
of 14 with a diagnosis of severe mitral stenosis. He carried out the
first transauricular approach to the mitral valve and the patient
survived a further 7 years. Maurice ~am~bell,~ a cardiologist writing
in the British Heart Journal in 1965 stated that the patient's survival
was probably largely due to the skill of the young anaesthetist - John
Challis. Until 1975 most people believed this, but in that year, to
celeb ate the Eiftieth anniversary of Souttar' S operation, Dr Richard
Ellis' of St Bartholomew's Hospital published in 4naesthesis1 a
detailed account of the case. From the original notes it was quite
clear that no anaesthetist was involved! In fact, the anaesthetic was
administered by i-4~ Lindsay, a surgical colleague of Souttar's, assist&
by a surgical registrar. 'he patient was prsmedicated with morphia and
atropine, and induced with an A.C.E. (absolute aLcohol, chloroform,
ether) mixture on a Schimnelbusch mask. Anaesthesia was deepened with
ether, an intratracheal catheter inserted, and this connected to a
shiPay4 apparatus, which delivered by insuEfLation a mixture of warm
air and ether. The patient, of course, breathed spontaneously
throughout. Shipway produced his original apparatus in 1916, but on his
Latest model insufflation pressure could be varied - no doubt, a help
with the open chest.