Patients and Pain: A Brief History of Anesthesia

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(Photo Credit: Crucial Interventions)

Let us begin this conversation with an exercise. Imagine yourself laying on a wooden operating table. The bloody residue from past victims..(er patients) is still visible. A crowd of people are seated around the room and all are eager to witness the upcoming spectacle. An infected compound tibia got you into this mess and now the only option is to undergo the amputation or die. Your body trembles and beads of anxious sweat drip down your face. The surgeon, tools in hand, nods to the audience that he is about to begin. You lay there, held in place by his assistants, as he cuts and saws away at your flesh and bone. The operation only takes 30 seconds to complete but every last tidbit of it will be imprinted into your memory; a traumatizing event that leaves you forever altered. Surgery before reliable anesthetics was a grim sight. It was not uncommon for patients to flee the operating rooms; more willing to die than to undergo the pain of the procedure. Imagining surgery without anesthesia is a hard task for most people living in the 21st century. Today we will tip our hats to the individuals whose discoveries forever changed how people experience healthcare.

In Agony:

Various remedies were used throughout time as a means of removing the burdens that pain caused.  For example, Arab doctors in the medieval period soaked sponges in aromatics in an attempt to lessen their patient’s level of consciousness during procedures (Parker 128). Snow anesthesia was another method that became popular in many preoperative routines. One of the most famous users of snow in amputations was the French surgeon, Dominique Larrey, who participated in the 1807 Battle of Eylau in Prussia as a medic (Pickover 152). Hippocrates even noted the benefits of using cold water on an area of the body that was about to be manipulated in an uncomfortable way. The 1770’s saw another unconventional means of alleviating procedural pain and it was referred to as mesmerism. Mesmerism, developed by the German physician, Anton Mesmer, involved the physician hypnotizing their patients so that they sat still during operations and were not consciously present to recall the discomforts that their bodies endured (Parker 128). The first formally recognized painless operation took place in 1846 with the use of ether but there are earlier examples of people being rendered insensible with the use of mesmerism (Barnett 64). For instance, in 1842 W. Squire Ward used mesmerism to remove the leg of a Mr. J. Wombell (Barnett 64). It was noted that Mr. Wombell seemed completely unaware of the events that went on around him (Barnett 64). The use of hypnotism is a curious treatment indeed, but once ether and chloroform entered the medical sphere such methods quickly became obsolete.

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(Photo Credit: Crucial Interventions)

Ether:

The person credited with the development of ether, the first reliable surgical anesthetic, was the American dentist, William T. G. Morton, who first demonstrated it’s promising abilities in 1846. It is hard to believe then that nitrous oxide, or laughing gas as it is commonly referred to as, had actually existed since 1772! That year, Joseph Priestley prepared the potion and by 1795, Humphry Davy was experimenting with it in Bristol, but failed to see its potential with the public (Barnett 65). He later wrote that inhaling nitrous oxide could relieve pain from a bad tooth ache, and that it could potentially be a useful advancement in operations, but it was years until something ever came out of the theory (Barnett 66). How could this be!? Why was nitrous oxide not taken up an a formal anesthetic right then and there? First of all, it was originally used as an unsuccessful treatment for consumption (Tuberculosis), so it had developed a reputation as a failed drug (Barnett 66). Secondly, Some physicians believed that pain was a trial from God and that a person had no chance of recovering properly without remaining completely aware of it (Barnett 66). Also, surgeons had to become indifferent to the sufferings of their clients, otherwise there was no hope of completing a procedure (Barnett 65). Those examples had a lot to do with why laughing gas remained distanced from the physician’s tool bag. In fact, during the late 18th century and early 19th century, laughing gas was used more often as a party favor than as a medicine.

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(Photo Credit: The Medical Book)

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(Photo Credit: Dreadful Diseases and Terrible Treatments)

After William T. G. Morton’s experiments with ether, the surgeon, Crawford W. Long decided to attempt to successfully remove an arterial tumor from a gentleman’s neck without him crying out (Gerald 102). Physicians everywhere heard the news and had become desperately eager to try ether out for themselves. One of the most famous experimental surgeries preformed using ether inhalation was conducted by the Scottish surgeon, Robert Liston. Frederick Churchill, a 25 year old man had osteomyelitis of the tibia and needed his leg amputated right away (Fitzharris 15). After he came to, he turned to Liston and asked if he had even started! What a success! Wrapped up in the excitement, Liston exclaimed, “This Yankee dodge, gentlemen, beats mesmerism hollow” (Fitzharris 15). Ether, as groundbreaking as it was, did have its drawbacks. The chemical was slow to take effect, caused severe nausea and vomiting (not good during an operation), had a tendency to irritate the mouth and lungs, was discovered by a Yankee, and was highly flammable (Hollingham 69). Another severe drawback was the fact that many people were mysteriously dying from it. They would walk into the hospital alive and well and then die from congestion of the lung before the operation was complete. John Snow, an English Physician, solved the problem by creating an ether inhaler in 1847 that made it easier to control dosage. He also drew up tables in order to assist physicians in calculating correct dosages based on the size of the individuals being treated (Hollingham 76).

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(19th Century Ether Inhaler. Photo Credit: Medicine: The Definitive Illustrated History)

Chloroform:

Scottish physician, James Simpson, wanted to find a means of relieving the agonies of childbirth. Ether’s side-effects did not seem to make it a likely candidate, and so, he set out to find something even better. In his lab, he discovered chloroform, a colorless liquid made up of alcohol and chlorinated lime (Hollingham 71). His early experiments involved him and his colleagues inhaling the vapors in order to see what effect it had on them (Kang 197). The drug left them feeling disoriented and numb and it was not long until it began popping up as a popular pharmaceutical in the 19th century (Kang 198-199). In 1853, chloroform was even administered to Queen Victoria, who was in labor with her eighth child, King Leopold (Gerald 104). Many women after that decided that if chloroform was good enough to be used by the queen, then surely it was good enough for them (Gerald 104). Chloroform, although still dangerous if overdosed on, was quicker at taking effect and did not cause as much nausea (although it did smell terrible), which led to its instant popularity among surgeons.

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(James Simpson and colleagues. Photo Credit: Quackery)

Hip Hip Hooray for Anesthesia:

To put it simply, we are all incredibly lucky to be living in a time where surgery and other medical procedures are not endured in their rawest forms in most circumstances. Hospitals are supplied with anesthesiologists, whose job it is to ensure that you don’t feel a thing. Reliable anesthesia has not been around that long, and so, studying it’s past helps to put everything into perspective. This is one medical breakthrough that is absolutely invaluable. I’ll leave you with a quote by Johann Friedrich, a 19th century plastic surgeon. He said, “The wonderful dream that pain has been taken away from us has become reality. Pain, the highest consciousness of our earthly existence, the most distinct sensation of the imperfect of our body, must bow before the power of the human mind (Pickover 174).

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(Photo Credit: The Drug Book)

(If that didn’t make you thankful for modern medicine, then I don’t know what will!)

Until Next Time-

N.F.

 

Sources:

  • Barnett, Richard. “The Yankee Dodge: Anesthesia.” Crucial Interventions: An Illustrated Treatise on Nineteenth Century Surgery. London: Thames and Hudson, 2015.
  • Fitzharris, Lindsey. The Butchering Art. New York: Scientific American, 2017.
  • Gerald, Michael. The Drug Book. New York: Sterling Publishing, 2013.
  • Hollingham, Richard. Blood and Guts: A History of Surgery. New York: St. Martin’s Press, 2008.
  • Kang, Lydia and Pedersen, Nate. Quackery: A Brief History of the Worst Ways to Cure Everything. New York: Workman Publishing, 2017.
  • Moore, Jonathan. Dreadful Diseases and Terrible Treatments. Alabama: Salt Water Press, 2017.
  • Parker, Steve. Medicine: The Definitive Illustrated History. New York: DK Publishing, 2016.
  • Pickover, Clifford. The Medical Book. New York: Sterling Publishing, 2012.

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