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Nitrous Oxide OUTPATIENT ANAESTHESIA with particular reference to Nitrous Oxide by William Denis Ashley Smith VOLUME THREE VOLUME THREE APPENDIX F; A HISTORY OF NITROUS OXIDE AND OXYGEN ANAESTHESIA - COLLECTED REPRINTS Part I? Joseph Priestley to Humphry Davy Brit. J.Anaesth. (1965), 37, 790. Part II: Davy's researches in relation to inhalation anaesthesia. Brit. J.Anaeoth. (1965), 37, 871. Part Hit Parsons Shaw, Doctor Syntax and Nitrous Oxide. Brit. J.Anaesth. (1965), 37, 958. Part IV: Hickman and the "Introduction of certain gases into the lungs". Brit.J.Anaesth. (1966), 38, 58. Part V: The crucial experiment, its eclipse and its revival. Brit. J.Anaesth., (1966), 38, 143. Part VI: Henry Turton, William Lloyd Poundall and Hallam. Brit.J.Anaesth. (1966), 38, 212. Part VII: 1868 - nitrous oxide anaesthesia takes root in Great Britain. Brit.J.Anaesth. (1966), 38, 551. Part VIII; Twenty years of nitrous oxide anaesthesia in Great Britain. Brit.J.Anaesth. (1966). 38, 831. Part IX • The introduction of nitrous oxide and oxygen anaesthesia. Brit. J.Anaesth. (1966), 38, 950. Part X; The early manufacture, storage and purity of nitrous oxide. Brit. J.Anaesth. (1967), 39, 351. Reprinted from the British Journal of Anaesthesia Volume XXXVII, No. 10, October 1965 A HISTORY OF NITROUS OXIDE AND OXYGEN ANAESTHESIA PART I: JOSEPH PRIESTLEY TO HUMPHRY DAVY BY W. D. A. SMITH ALTRINCHAM JOHN SHERRATT AND SON Brit J. Anaesth. (1965), 37, 790 A HISTORY OF NITROUS OXIDE AND OXYGEN ANAESTHESIA PART I: JOSEPH PRIESTLEY TO HUMPHRY DAVY BY W. D. A. SMITH Department of Anaesthesia, Leeds University, England "An historical review may be useful as offering a nitrous air contracted when allowed to stand in kind of a map of the science and of the roads by contact with a paste of iron filings and brimstone. which it has been explored." Some of the thrill of this discovery is communi- (Humphry Davy 1810; cated in his description of it: cited John Davy 1839) The diminution of common air by a mixture of nitrous air, is not so extraordinary as the diminution Towards the end of the eighteenth century which nitrous air itself is subject to from a mixture of iron filings and brimstone, made into a paste with water. increasing knowledge of "different kinds of air", This mixture, as I have already observed, diminishes and of respiration, led to the inhalation of gases for common air between one fifth and one fourth . but medicinal purposes. Inhalation anaesthesia when it is put into a quantity of nitrous air, it diminishes it so much that no more than one fourth of the original emerged from this background of "Pneumatic quantity be left. The effect of this process is generally Medicine", although not quite as soon as it might perceived in five or six hours, about which time the visible effervescence of the mixture begins; and in a very have done. A long-suffering acceptance of pain, short time it advances so rapidly, that in about an hour and of the improbability of its relief during surgical almost the whole effect will have taken place. If it be operations, probably contributed to the delay. suffered to stand a day or two longer, the air will still be diminished farther, but only a very little farther, in The first attempts to introduce nitrous oxide as proportion to the first diminution. The glass jar, in an anaesthetic were short-lived. It was temporarily which the air and this mixture have been confined, has generally been so much heated in this process, that I supplanted by ether and chloroform, even for have not been able to touch it. anaesthesia in the ambulant patient. When it was revived, many of the later improvements in anaes- The remaining air supported combustion and it thetic technique were considered, at least in smelled more like common air than like nitrous air. embryonic form, but their development had to He named it "dephlogisticated air". In his own await the accumulation of experience and basic words (Priestley, 1786): "Dephlogisticated nitrous knowledge, new discoveries and advances in air is the term by which I first distinguished this technology. species of air, because it admitted a candle to burn in it." This is now known as nitrous oxide. The isolation of nitrous oxide and oxygen. Although he did not realize it at the time, "The word 'discovery' is often ambiguous in Priestley first liberated oxygen from saltpetre Science and leads to misunderstandings." Those (potassium nitrate) in 1771 (Hartog, 1933). He words could have been applied appropriately to the obtained it again in 1774 by focusing sunlight on "discovery" of anaesthesia, but they were written mercurius calcinatas (mercuric oxide), having just by Hartog (1941) in relation to the allied subject procured a lens of 12 inches diameter (Priestley, of the "discovery" of oxygen. He continued: "In 1776, p. 33). He discovered that a candle burned in dealing with experiments and observations like it with a remarkably vigorous flame. He wrote those of Priestley and Scheele on Oxygen, I prefer (Priestley, 1776, p. 33): to say that they 'isolated and recognised' or 'identi- But what surprised me more than I can well express, fied' rather than that they 'discovered' oxygen." was, that a candle burned in this air with a remarkably Priestley (1733-1804) isolated both nitrous oxide vigorous flame, very much like that enlarged flame with which a candle burns in nitrous air exposed to iron or and oxygen during the course of his Experiments liver of sulphur; but as I had got nothing like this re- and Observations on different kinds of Air. markable appearance from any kind of air besides this Priestley gave the name "nitrous air" to what is particular modification of nitrous air, and I knew no nitrous acid was used in the preparation of mercurius now known as nitric oxide. In 1772 he found that calcinatas, I was utterly at a loss how to account for it. A HISTORY OF NITROUS OXIDE AND OXYGEN ANAESTHESIA—III 959 In the following year he found that a mouse respiration while the other would support neither. would live longer in this new air than in an equal The former—dcphlogisticatcd air—he renamed volume of common air (pp 33-34). He concluded "oxygen". Their proportions he found to be about that it was better than common air (p. 45) and he 25 parts to 75 parts (Duncum, 1947, pp. 56-57). called it dcphlogisticated air. He breathed it: Humphry Davy's experiments with nitrons oxide. The feeling of it to my lungs was not sensibly different from that of common air; but I fancicd that my breast Twenty-six years after the first isolation of felt peculiarly light and easy for some time afterwards. nitrous oxide, Humphry Davy (1778-1829) was Who can tell that, in time, this pure air may become a appointed Superintendent of the Medical Pneu- fashionable article in luxury. Plitherto only two mice and myself have had the privilege of breathing it. matic Institution which had been set up by Dr. Bcddoes (1760-1808) in Clifton, Bristol. Davy was Patterson (cited Fulton, 1935) has drawn atten- then 21 years old and his status was approximately tion to the fact that as early as 1660 Boyle had equivalent to that of a house surgeon (Cartwright, already committed himself to Paracelsus' earlier 1952, p. 100). conjecture that there is in the air "a little quin- Beddoes was one of the leading authorities on tessence . which serves to the refreshment and pneumatic medicine, which was concerned with restoration of our vital spirits, for which the the administration of medicinal "airs". He was an grosser and incomparably greater part of the Air enthusiast and he so impressed his friends that being unserviceable, it need not seem strange that they encouraged him to set up the Institution and an animal stands in need of almost incessantly provided him with the necessary funds. Its purpose drawing in fresh air". In the same work Boyle calls was to ascertain the effects of the inhalation of attention to the fact that the flame of a lamp is put gases in various diseases, and to discover the out by removal of air just as the life of an animal is best means of applying them. Apparatus for pro- extinguished (cited Fulton, 1935). Priestley saw ducing and receiving the various "airs" had already that there was a similarity between the processes of been designed by James Watt (1736-1819) in combustion and respiration, but his appreciation collaboration with Beddoes (Beddoes and Watt, of the significance of his new gas was hindered by 1796, 2, p. 184). Davy thus had an exceptional his belief in the phlogiston theory. Phlogiston was start to his career. thought to be the inflammable part of any body Nitrous oxide was chosen for particular study, and to escape upon combustion. It was also thought and Davy set about investigating its physical, to take part in respiration. Priestley considered chemical and biological properties. Within a little that the new gas owed its properties to a capacity over a year he had carried out numerous experi- for absorbing phlogiston, and therefore that it ments and written them up in his Researches, initially contained less phlogiston than common Chemical and Philosophical; chiefly concerning air—hence "dephlogisticated air". nitrous oxide, or dephlogisticated nitrous air} and its It was Antoine Laurent Lavoisier (1742-94) who respiration (Davy, 1800b) from which the quota- paved the way to a fuller understanding of the ions given below have been taken. nature of dephlogisticated air. He also discredited Although Davy experimented with the prepara- the Phlogiston Theory.
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