3 - History of Anaesthesia Society

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Griffith, well imderstood the imprtance of respiratory assistance and even controlled ventilation. The surgeon, bwen, insisted on refusing to achwledge anaesthesia as a medical subspeciaIty until after the second lJorld War. Clinical manifestations of tetanus were described by FLippocratss, and for centuries after him only a Few new ideas about this disease were introduced. Dcninique Larrey observed different ~OLTLIS of the disease but its origin remined unknown; it ms generslly accepted as being a muscle disease. Vulpian and his successors proposed a nervous system origin for tetanic crises, but it iuas Simpson (1354) who established this. Carle and Ratton (1F!G4) induced the first tetanic infection ln laboratory animals., In 1885 Nicolaier showed that the injection of earth provoked tetanus and establishfd that this was due to a bacillus. The action of curare on respiratory muscles and the survival of artificially ventilated animals were observed by Sir Benjamin Collins Brodie and Edward Bancroft in 1811. Subsequently, Brodie informed the Academy of Sciences in Paris of his proposal to treat animals with tetanus with curare. He mentioned his plans tpo_gllse curare for a tetanus patient in a latter he sent to Flourens in 1811. Guyane Indians blew air into birds injured with arrow poisons in order to keep Cnem alive. Knowing this, Charles lrlaterton successfully used artificial ventilation to keep curarised an 1s alive. His friend Francis Bilron later used the same method on horse2 he same technique was also used by Snell, an hglish veterinary practitioner, in 1837.~ In 1856, the analogy between strychnine intoxication and tetanus was made by George Harley. Working on this hypothesis, he performed exper nts with horses using strychnine and mare for tile treatment of tetanus.pTherapeutic use of curare in a patient with facial paralysis was reported by Thibaut de Nantes in 'LVUnion Medicale', in 1856. The same author was one of the first to use curare in the treatment of tetanus, referring, as did others, to the article by Vulpian on: 'The use of curare as strychnine antidote and as treatment of tetanusg published in 1857.' (h?e year later, Manec and Vulpian used curare in a tetanus ptient at the Charite Hospital, Paris. The drug was first applied to the mund as a solution and therafter us4 subcutan~o -1y. No improvement was ohserved and the patient died of tetanus. 4f' Sayres and surul applied civare to the wound of a tetanus patient in the same year in New York, ht without success. Although early arplications failed, French doctors persisted with trials. They had more occasions for its use during the war in Italy. Vella used curare on three wounded sol-liers with tatanus in the French Hospital in Turin. He reported cossation of the convulsions after 45 minutes. The treatment ryls repeated many times as the convulsions reapared shortly aftenuards. Rvo of the ,utients died but the thlrd one W o had been seriously wounded u, the battle of Magenta, rec~vered.~~~~~-'~ Mother success wis reported by Slr Thonns awncar in 1863. He treated twelve patients the same way and three of them surv~ved.~
In France, the trials conducted by Follin in Paris and Gintrac in Bordeaux failed. A discussion took place at the Academy of Sciences in Paris. Another discussion followed at the Academy of Medicine. Velpeau especially criticised the reports of Vella and Gintrac, copring the results obtained with the llorrnal evolution of the disease. In othsr words, he was looking at a control group. Claude Bernard w3s especially astonished by the hypothesis of an eventual refractory state to the action of cutare. In 1959, 13 comnunications on this s~ibject were published in French journals, four in Anglo-Saxon literature and four in Germany. nuenty-one patients were treated in hospitals in Milan and Pavia by Parravicino, Gherini, Monti, Cuesta, Moroni, dell8Acqua and Gualla between 1859 and 1861. Four of these patients survived. meso data were published in 1864 in the French language in 'Gazette Medicd d'Orientl(I~t?nbul), Vella's work tms also published in the same journal and referred to in an article on the same subject in 'L'Union Medicale'(Paris). Retween 1853 and 1873 Wme reported D mng 22 cases and Busch reprted 6 survivals mng 11 patients. 4, 5':"fi"-PS From 1880 on, no publications apared abut the use of curare in tetanus patients tmtil 1925 when West, from Scotland, started experiments with a plrified product. The turning point was in 1952, when Lassen ventiLated for prolonged periods patients with respiratory muscle paralysis during a poliomyelitis epidemic. This made the administration of a paralysing dose of curare possible in the treatment of tetanus. Final*, rlollarst from the Claude Bernard Hospital, Paris, first reported successful results with d- tubocurarine. The early use of curare more than a century ago ia tetanus patients, both subcutaneously and as locally spplied solutions, is interesting. This method had little effect in improving the prcgnosis of the disease but was successful in some cases in stopping convulsions for a limited period. References Bernard C. Etudes physiologiques sur quelcpes poisons americains. Revue de Deax Wmdes 1864; 53: 164-190. Bevan DR. ett al. Muscle relx~ants in clinical anesthesia. Year Book Med. Pub. 1988; 1-2. Davidson I.W. The Evolution of Anaesthesia. John Sherratt & Son 1965; 154-158. Gazette Medical dlOrient. Istanbul. 1860; 10: 178-190. Lee JA, Atkinson RS. A Synopsis of Anaesthesia. John Wright 1973. Vellard. Les curares indiens. Anesth.Analg.Reanim.1973; 20:2. Vulpian EF. De llemploi du mare come antidote de la strychnine et come traitmnt du tetanou. LrUnion Itedicale 1357; 11: 25-26. Cazette Mdic41 de Orient. Istanhl 1864; 2: 17-22. Gazette iMiz,3le doOrient. Istanbul 1859; 7: 143. Kern E. TR 'curare en anesthesie. I.Qsson 1950. LILhion :,ledicale 1959; 49: 817-825. Sykes !E. Essays on the First Himdred Years of Anaesthesia. John Wright 1973. L'Union Medic3le 1859; 140: 401-404.
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3 - History of Anaesthesia Society

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