Airway Command from 1700 to 1846: An Historical Review

PLEASE peruse this month’s issue of Anesthesiology for “An Anesthesiologist’s Perspective on the History of Basic Airway Management: The ‘Preanesthetic’ Era—1700 to 1846.”¹  This historical review article by Adrian A. Matioc, M.D., sweeps the reader along 146-plus years of the historical timeline on managing airways. As an inventor of face masks, an academic physician, and a Veterans Administration Medical Center Staff Anesthesiologist, Matioc has a fascinating perspective on the history of basic airway management.

In preparing the reader for his targeted 1700 to 1846 time period, Matioc reviews “The Rise of Modern Medical Sciences.” This introduction initially explores how classical humoral balance was achieved by therapies centered on eliminating fluids. Next, he cites treatments that, rather than eliminating, added something … stimulation. Then, Matioc discusses therapeutics that promoted organ sympathy. And finally, he explores the researchers’ efforts in understanding asphyxia and in using the discoveries of carbon dioxide and of oxygen.

In Matioc’s discussion of “The Pre-Humane Societies Period,” he bifurcates the discussion between resuscitating infants and reviving adults. Infant resuscitation discovers the “Midwives’ Secret” of mouth-to-mouth ventilation and contributions by Italy’s Cangiamila and England’s Pugh. “Adult Resuscitation” investigates the roles of France’s de Réaumur and of Scotland’s Tossach, Fothergill, and Buchan.

In Europe, the Enlightenment fostered the national humane societies that supplied logistics and literature for resuscitating victims of drowning. The time period from 1767 to 1800 witnessed a decline in resorting to mouth-to-mouth ventilation and a rise in artificially ventilating with bellows. Then from 1800 to 1826, there was a perception of limits on positive-pressure ventilation. Finally, from 1827 to 1846, there was a true decline in positive-pressure ventilation and a rise in negative-pressure ventilation.

So, why are reviews such as Matioc’s so valuable? After all, history does not consist of neatly organized events falling along a timeline; rather, history explodes in three dimensions with interconnections that are difficult to understand retrospectively. Facts undersupplied may have to be interpolated along the timeline. Oversupplied facts beg organization and understanding. When a reader peruses an historical review from a new perspective (e.g., the one advanced by the author of an historical review), the reader may reach new understanding and may glimpse that most elusive prize: historical truth.

I congratulate 2013 Paul M. Wood Fellow Adrian A. Matioc for not choking the reader with too many details … and for not needing to support the reader’s airway from obstructing with ennui. Most readers will be fascinated by Matioc’s historical accounts of resuscitation attempted with bellows to patients’ noses or smoke up their recta (“fumigation”). I highly recommend reading this issue’s “An Anesthesiologist’s Perspective on the History of Basic Airway Management: The ‘Preanesthetic’ Era—1700 to 1846.”¹