Prior to 1855, medicine and anesthesia in Lebanon were mostly practiced by some Turkish army medical officers or missionary doctors. The majority of the population had to depend on barbers, â€œMughrabiesâ€ or bone-setters. No major surgery is known to have been performed. One documented evidence exists, however, that around 1849 extraction of a urinary bladder stone was performed without the use of anesthesia by Dr. Ibrahim Najjar.
The first reference of the actual use of anesthesia in Lebanon was given by Dr. George Post and happened to be administered to a dog in the year 1865 at the village of Abey.Â The agent used was most probably Chloroform. Dr. Post had arrived to Beirut as American medical missionary in 1863. Together with Drs. Cornelius Van Dyck and Wortabet, he started the medical school of the Syrian Protestant College in 1867. In 1869, he became the first professor of surgery at this college. Dr. Post the surgeon rightly deserves the title of the first pioneer of anesthesia in Lebanon. He was a dynamic author and a great deal of credit goes to him, in the first place because of his book on surgery â€œAlmisbah al waddah fi sinaat aljarrahâ€ published in Beirut in 1873, in which for the first time he gave evidence of the use of chloroform at the Johanniter Hospital (Prussian Hospital) to reduce a dislocated shoulder of a man. Secondly, Post initiated the publishing of the first Lebanese medical journal written in Arabic in 1874 (Al-Tabib). Dr. Post was for many years behind the introduction of new drugs and the teaching of sound knowledge of anesthesia in Lebanon. In the section on General Anesthesia of his book, he describes four stages of anesthesia â€“ â€œExcitementâ€, â€œDrowsinessâ€, â€œAnesthesiaâ€, and â€œDeep Sleepâ€.Â Post was aware of premedication (â€œopium and arakâ€), and of the dangers of full stomach (â€œdelay operation 6 hoursâ€). He also dealt with cardiac and respiratory arrest.Â
Between 1874-1912, some of the subjects discussed in â€œAl-Tabib â€œ were: resuscitation of the newborn, ether, nitrous oxide, asphyxia, local anesthesia, foreign body laryngeal obstruction, air embolism, endotracheal intubation, morphine and atropine, tracheostomy, hyperventilation, blood transfusions, ethyl chloride, metabolism of chloroform , shock, pain treatment, spinal analgesia and Caissonâ€™s disease.
In 1883, the French Faculty of Medicine was founded by Father Lucien Cattin. The first hospital affiliated to the faculty was Sacre-coeur Hospital in Khandak El Ghamik built in 1847. In 1899, Dr. S. Abourousse a graduate from the French Medical School published an article in the journal â€œAl Mashrekâ€ about the dangers of Chloroform. Following this, ether returned to the stage with the Ombredanne inhaler technique used until the end of World War II.Â In 1902, Dr. M. Hache advocated the use of ethyl chloride. Dr. George Arbli preferred the use of nitrous oxide for dental extractions in 1906.
The Syrian Protestant College founded by Daniel Bliss in 1866 became known as The American University of Beirut in 1920. Miss Alice Osborn was the first nurse anesthetist that was sent to Beirut in 1922. She worked at the American University Hospital and remained there until 1936 when she was replaced by Miss Rena Myers. Throughout this period and until 1947, anesthesia in Lebanon was administered by surgeons, interns and nurse anesthetists. After that time, Dr. Veronica Bakamjian, an AUB graduate who had taken a one-year training in America was appointed as the director of the anesthesiology service in AUB in 1947. With the end of the World War II, it became gradually possible to obtain more funds and materials from America like gas apparatus, laryngoscopes and ET tubes.
In 1948, Dr. Albert Salomon used the Heidbrink apparatus for 4 gases (Oxygen, nitrous oxide, ethylene and cyclopropane). In 1949, Dr. Raymond Asmar, a French specialist in anesthesia, hematology and transfusion was a pioneer in this field. He practiced in many private hospitals using the Ombredanne inhaler and the Heidbrink apparatus. During the same year, Dr. Raymond Johanny, a dermatologist, got specialized in anesthesia in France and returned to Lebanon after few months to become the head of the anesthesia service at â€œHotel Dieu de Franceâ€. He was involved in training nurse-anesthetists, introduced short-acting barbiturates, curare and tracheal intubation. Dr. R. Johanny went back to dermatology practice in 1952 leaving the anesthesia service under the care of Dr. Robert Haddad then Dr. Marie-Claire Antakly in 1970.Â
With the war over, the number of specialized surgeons was increasing and the demand for well trained MD anesthesiologists began to be felt. In July 1953, a two-year residency training program was started at AUB. This program was increased to 3 years in 1958 under the leadership of Dr. Bernard Brandstater. He was appointed chairman and professor till his departure to USA in 1969. The years under the Chairmanship of Dr. B. Brandstater 1958-69 witnessed a period of rapid growth and rapid change. Elaboration of a specialized inhalational and respiratory therapy department with the help of Dr. Musa Muallem took place in 1959. The era of positive pressure ventilation and the practice of epidural analgesia for painless delivery were introduced during this period. In 1966, Dr. Brandstater founded the Middle East Journal of Anesthesiology and was its first editor-in-chief. In 1972, Dr. Anis Baraka was appointed chairman of the anesthesia department. His warm leadership, pedagogical capabilities, ability of clinical research, voluminous publications, tenacity and devotion exhibited during the Lebanese civil war, and his world wide travels and the various honorary awards he received, doubtless placed the department of Anesthesiology, the American University of Beirut and Lebanon on the â€œAnesthesia Map of the World.
A 3-year residency program was started at the French Faculty in 1981 with Dr. Marie-Claire Antakly. At the Lebanese university, this program took place in 1988 with Dr. Nadim Raphael for a period of 4 years which has been then increased to 5 years including one year specialization in Critical Care Medicine.
The Lebanese society of anesthesia was created in 1962 and included 21 members. During their first meeting on the 12th of April, the members elected the first president of the society, Dr Raymond Asmar. Dr Adib Abou Haidar (1968), Dr Musa Muallem (1972) and Dr Marie Claire Antakly (1994) were subsequently elected presidents of the society.