The history of anesthesia for thoracic surgery: some remarks.

I t was with great interest that I read the review by J. Brodsky and M.Lemmens on “The history of anesthesia for thoracic surgery”.1 The authors must be credited for presenting physiologically well-founded facts and for providing rare contemporary photographic material. They must also be recognized for discussing clinically deplorable and ill-advised methods of tackling the issue of gas exchange during surgery in the open thorax, like Sauerbruch’s negative pressure chamber. The positive pressure head-box in Figure 2 is erroneously ascribed to the German internist Brauer, and notwithstanding the striking similarity, the device of 1905 must be credited to Murphy.2 In the section discussing positive-pressure ventilation, the authors refer to O’Dwyer’s and Fell’s tubes intended for the delivery of artificial ventilation into the airways as “tracheal tubes.” However, these were actually laryngeal tubes, whose conical tips were intended to provide an airtight fit in the larynx by resting on the false cords. By the mere dimensions of the detachable tips displayed in Figures 3 and 4, the laryngeal tubes could never have been forced to pass beyond the cricoid cartilage and to enter the trachea.2 The authors delineate the evolution of mechanical ventilation from the intensive care ward of the great poliomyelitis epidemic, to the thoracic theatre. The device employed by Björk et al., after successful use in the postoperative ventila-