Prior to 1850, medicine and anesthesia in Lebanon were mostly practiced by turkish army medical officers or missionary doctors. The majority of the population had to depend on barbers, “Mughrabies” or bone-setters. No major surgery is known to have been performed prior to that time except for the documented extraction of a urinary bladder stone without the use of anesthesia by Dr. Ibrahim Najjar in 1849.
The first reference to the actual use of anesthesia in Lebanon goes back to 1865 when Dr. George Post, an American medical missionary administered what was probably chloroform to a dog in the village of Abey. Together with Drs. Cornelius Van Dyck and Wortabet, he started the medical school of the Syrian Protestant College in 1867, and in 1869, he became the first professor of surgery at this college. Dr. Post rightly deserves the title of the pioneer of anesthesia in Lebanon. He was a dynamic author, and a great deal of credit goes to him, first because of the surgery book he authored “Almisbah al waddah fi sinaat aljarrah” 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 man’s dislocated shoulder. Secondly, Post initiated the publishing of the first Lebanese medical journal written in Arabic in 1874 (Al-Tabib). Dr. Post was responsible for the introduction of new drugs and the teaching of sound anesthesiology knowledge in Lebanon. Even in such early times, he described four stages of anesthesia – “Excitement”, “Drowsiness”, “Anesthesia”, and “Deep Sleep” in the section on general anesthesia of his book. He was also aware of premedication (“opium and arak”), and of the dangers of full stomach (“delay operation 6 hours”) and dealt with cardiac and respiratory arrest.
Between 1874-1912, some of the subjects discussed in “Al-Tabib” were: resuscitation of the newborn, ether, nitrous oxide, asphyxia, local anesthesia, laryngeal obstruction secondary to a foreign body, air embolism, endotracheal intubation, morphine and atropine, tracheostomy, hyperventilation, blood transfusions, ethyl chloride, metabolism of chloroform, shock, pain treatment, spinal analgesia and Caisson’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 “Al Mashrek” 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. In 1902, Dr. M. Hache advocated for 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 completed 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 apparatuses, 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 started practicing 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 a few months later to become the head of the anesthesia service at “Hotel Dieu de France”. 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 and then Dr. Marie-Claire Antakly in 1970.
With the war over, the number of specialized surgeons was increasing and the demand for well-trained anesthesiologists began to be felt. In July 1953, a two-year residency training program was started at the AUB. This program was increased to 3 years in 1958 under the leadership of Dr. Bernard Brandstater who was appointed chairman and professor till his departure to USA in 1969. The years under the chairmanship of Dr. Brandstater 1958-69 witnessed a period of rapid growth and rapid change. The 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 at AUB. His warm leadership, pedagogical capabilities, ability for clinical research, innumerable publications, tenacity and devotion exhibited during the Lebanese civil war, his worldwide travels and the various honorary awards he received, doubtlessly placed the department of Anesthesiology, the American University of Beirut and Lebanon on the “Anesthesia Map of the World”.
A 3-year residency program was started at the French Faculty in 1981 by Dr. Marie-Claire Antakly. At the Lebanese university, this program took started in 1988 with Dr. Nadim Raphael for a period of 4 years and was then increased to 5 years including one year specialization in Critical Care Medicine.
THE LEBANESE SOCIETY OF ANESTHESIOLOGY
The Lebanese Society of Anesthesiology 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 for a four-year term. Dr Adib Abou Haidar (1966), Dr Robert Haddad (1970), Dr Musa Muallem (1974) and Dr Marie Claire Antakly (1994) were subsequently elected presidents of the society. In the early seventies the Lebanese Society of Anesthesiology became an active member of the World Federation of the Societies of Anaesthesiologists, a membership that has been maintained to this day despite the difficulties encountered along the way.