Paediatric anaesthesia in Australia: origins and developments

Dr Ian Hamilton McDonald, MBBS, DA, FANZCA: The evolution of paediatric anaesthesia and intensive care at the Royal Children’s Hospital, Melbourne

“…She was appointed by the Medical Director Dr Vernon Collins, who insisted to hospital management that the only way to improve standards at the Children's Hospital was to pay the medical staff. 2,5,6 Metamorphosis of anaesthesia into a modern specialty…”

“…At the beginning of McDonald's career, intubation was an uncommon occurrence, and anaesthesia for shared airway procedures was via a pharyngeal catheter or a Boyle Davis gag. 2,5 In this 1940s era of ether masks and chloroform, anaesthetic machines were a rarity and novelty:…”

“…' 2 McLeod had been using an Austox nitrous oxide machine, as she feared the effects of frequent, repeat exposures to ether for these children. 2,5 Lorimer Morton, another early honorary anaesthetist in the Children's Hospital, taught McDonald the technique of intubation. McDonald also recalls another of Morton's valuable contributions -his timeless anaesthetic rule:…”

Historical aspects of inhalation anesthesia in children: ether and chloroform

“…Australia was the last to receive scientific knowledge as it took 100 days for a fast ship from England or the east coast of the USA to reach the continent (6). The first report of pediatric anesthesia in Australia was a transcript from Guy's Hospital London published in the Sydney Morning Herald in 1847 and refers to a 12‐year‐old boy who underwent lithotomy under ether anesthesia in May 1847 (7).…”

“…Many factors, such as the mortality rate, the hospital and the autopsy reports and the press, resulted in the progressive reduction of the use of chloroform, which lasted almost 70 years. Two important factors contributed to chloroform's abolition: Dr Edward H. Embley's research, who was the first doctor with a Doctorate in Medicine related to anesthesia in Australia, from the Physiology Department of the University of Melbourne on the subject of chloroform's hepatotoxicity, and the introduction of ethyl chloride which provided rapid, pleasant but also safer induction than chloroform (7).…”