From Agony to Anesthesia

PRIOR to the 1840’s, patients did not go into an operating room feeling anxious. They were terrified! Why? Because there was no anesthesia. In his book “We Have Conquered Pain,” Dennis Fradin says: “Surgeons were known to enter the operating room with a bottle of whiskey in each hand—one for the patient and the other for the doctor so that he could endure his patient’s screams.”

Getting the Patient Drunk or “High”!

Doctors, dentists, and patients would try almost anything to reduce the pain of surgery. Chinese and Indian doctors used marijuana and hashish. Opium was also widely used in various parts of the world, as was alcohol. Ancient Greek physician Dioscorides—the first person known to have used the word “anesthesia”—attributed anesthetic powers to potions made from mandrakes and wine. In later times some doctors even experimented with hypnotism.

Yet, pain relief was far from satisfactory. Hence, surgeons and dentists worked as fast as they could; in fact, they were rated according to their speed. But the fastest could still inflict enormous suffering. As a result, people commonly preferred to endure all manner of ills, from tumors to a mouth full of rotting teeth, rather than face the agony of surgery or tooth extraction.

Sweet Vitriol and Laughing Gas

In 1275, Spanish physician Raymond Lullus, while experimenting with chemicals, made a volatile, flammable liquid he called sweet vitriol. In the 16th century, a Swiss-born physician commonly known as Paracelsus made chickens breathe sweet vitriol and noted that they not only fell asleep but also felt no pain. Like Lullus before him, he did not experiment on humans. In 1730, German chemist Frobenius gave this liquid its present name, ether, which is Greek for “heavenly.” But 112 more years would pass before ether’s anesthetic powers were fully appreciated.

Meanwhile, in 1772, English scientist Joseph Priestley discovered the gas nitrous oxide. Initially, people thought this gas to be lethal, even in small doses. However, in 1799, British chemist and inventor Humphry Davy decided to find out by experimenting on himself. To his astonishment he found that nitrous oxide made him laugh, so  he nicknamed it laughing gas. Davy wrote about the potential anesthetic properties of nitrous oxide, but nobody at that time pursued the matter any further.

Ether and Laughing-Gas Parties

Davy’s antics while under the influence of laughing gas—to which he became temporarily addicted—became well-known. Soon breathing it for fun caught on. Even traveling showmen, as part of their programs, had volunteers from the audience step onto the stage and take their turn at breathing nitrous oxide. The gas melted inhibitions, and soon the unrestrained antics of the volunteers had audiences in the grip of laughter.

About the same time, the recreational use of ether also became popular. One day, however, a young American physician named Crawford W. Long noticed that his friends felt no pain when they injured themselves while staggering around under the influence of ether. He immediately thought of its potential in surgery. Conveniently, a participant in one of those “ether frolics,” a student named James Venable, had two small tumors he wanted excised. But fearing the pain of surgery, Venable kept putting the operation off. Hence, Long suggested that he have his operation while under the influence of ether. Venable agreed, and on March 30, 1842, he had a painless operation. However, Long did not announce his discovery until 1849.

Dentists Also Discover Anesthesia

In December 1844, a U.S. dentist named Horace Wells attended a traveling show where a certain Gardner Colton demonstrated nitrous oxide. Wells volunteered to try the gas but retained sufficient presence of mind to notice that another participant dashed his legs against a hard bench but felt no pain, even though he was bleeding. That night Wells made a decision to try nitrous oxide in his dental practice—but after he first tried it on himself. He arranged for Colton to supply the gas and for fellow dentist John Riggs to extract a troublesome wisdom tooth. The extraction was a success.

Wells decided to make his discovery public by demonstrating it before his peers. However, he was extremely nervous and administered insufficient gas, so that the patient cried out when the tooth was pulled. Immediately Wells’ audience jeered him. But they should have questioned the patient, for later he confessed to Wells that although he cried out, he felt little pain.

On September 30, 1846, fellow American dentist William Morton performed a painless tooth extraction on a patient who submitted to ether—the same compound  used by Long in 1842. Morton prepared his ether with the assistance of eminent chemist Charles Thomas Jackson. Unlike Long, Morton arranged for a public demonstration of ether’s anesthetic properties on a patient undergoing surgery. In Boston, Massachusetts, on October 16, 1846, Morton anesthetized the patient. Then the surgeon, a Dr. Warren, performed the operation—the removal of a growth from under the patient’s jaw. The operation was a signal success. Word soon spread like wildfire across the United States and Europe.

Further Discoveries

In the wake of these thrilling discoveries, experiments with various vapors continued. Chloroform, discovered in 1831, was used with success in 1847. In some places it quickly became the preferred anesthetic. Soon chloroform was given to women in childbirth, including Queen Victoria of England, in April 1853.

Sadly, the history of general anesthesia has been somewhat tarnished. A heated dispute erupted over who—Long, Wells, Morton, or Jackson, the eminent chemist who assisted Morton—should get foremost credit for the discovery of anesthesia (not, of course, of the chemical compounds themselves). No consensus has ever been reached, but with the calmness of hindsight, many acknowledge the contribution of all four men.

Meantime, advancements were being made in the field of local anesthesia, often referred to as regional anesthesia. Anesthetics are used that allow patients to remain lucid while one region of their body is made anesthetic, without feeling. Nowadays, dental surgeons commonly use local anesthetics when working on teeth and gums, and physicians use them for minor operations and trauma repair. Anesthesiologists commonly administer local anesthetics to women giving birth.

Over time, anesthesiology has developed into a medical specialty in its own right. Modern anesthesiologists participate in preparing patients for surgery. They induce anesthesia using sophisticated equipment and complex anesthetics that are mixtures of a number of chemical agents, along with oxygen. In fact, many patients may not even be aware that their doctor has used anesthetic gases because these are often administered only after initial anesthesia has been established by intravenous means. The anesthesiologist is also involved with pain management after surgery.

So if you should require surgery someday, try not to become too anxious. Imagine yourself lying on a crude operating table about two centuries ago. The door opens and in walks your surgeon carrying two bottles of whiskey. Suddenly the modern anesthesiologist’s sophisticated equipment looks almost friendly, does it not?

[Box on page 22]

ACUPUNCTURE—Pain Relief From the East

Acupuncture is an ancient Chinese therapy that is said to relieve pain. Practitioners insert needles at specific points on the body, often distant from the area being treated. Once inserted, the needles may be twirled or connected to a low-voltage electric current. Encyclopædia Britannica says that acupuncture “is routinely used in China as an anesthetic during surgery. Western visitors have witnessed ambitious (and ordinarily painful) surgical operations carried out on fully conscious Chinese patients locally anesthetized only by acupuncture.”

Acupuncture should only be practiced by a skilled, medically trained therapist. According to the Encyclopedia Americana, “serious accidents have occurred when acupuncture needles have pierced the heart or the lungs, and hepatitis, local infection, and similar complications may occur when unsterilized needles are used.” Of course, the use of general anesthesia also carries risks, as do operations themselves—whichever form of anesthesia is used.

[Picture on page 23]

Anesthesiology has become a medical specialty

[Credit Line]

Courtesy of Departments of Anesthesia and Bloodless Medicine and Surgery, Bridgeport Hospital-CT

[Picture Credit Line on page 21]

Pages 2 and 21: Reproduced from Medicine and the Artist (Ars Medica) by permission of the Philadelphia Museum of Art/Carl Zigrosser/Dover Publications, Inc.