Anaesthesia has a history as old as ancient history and is really as old as civilisation itself. There have been numerous attempts made over the centuries to reduce pain associated with disease, injury, and surgical procedures. Yet, many of these methods were extremely archaic, dangerous, and oftentimes more painful than the injury or disease the patient had.
So, what can we learn about anaesthetic history, and how did it progress over time? Let's dig into anaesthetics!
Anaesthetic Meaning
Anaesthesia is a medical technique that allows patients to undergo procedures like surgery, dentistry, and tests without feeling much or any pain.
Anaesthetic
A substance that is known to lessen sensitivity to pain.
Anaesthetics Causes
During the early 19th century, surgery was not a pleasant experience for anyone involved. Pre-anaesthesia, patients were fully conscious whilst in operations, which weren't fully developed yet either! This lack of anaesthesia and the immense pain that surgery would produce meant that most patients had to be physically restrained during surgery. Surgery used to be traumatic because of these factors, meaning that most people opted out of surgery. This had negative impacts on the following:
- Public Health in Industrial Britain.
- Death rates.
- The growth of Hospitals.
- Developments in science and surgery.
Dismembering is a dreadful Operation; yet necessary.1
- James Cooke, 1685.
Surgery such as amputations caused an immense amount of pain yet were deemed necessary in certain situations to save the patient, as James Cook affirmed in the above quote. Anaesthesia was created to prevent the patient from suffering the full scale of pain that surgeries created. Developments in anaesthesia allowed procedures to save people's lives.
Black period of surgery (1846-70)
After the discovery of more advanced anaesthetics in the 19th century, surgeons could operate on unconscious patients. During this time, surgeons would now take their time in procedures and learn about the deeper parts of the body that they could not operate on before this. However, patients still died as surgeons and doctors neglected to wash their hands as they were unaware of the processes of infection in the 1840-1870s.
Anaesthetic History
The latter half of the 18th century, the time of the "Enlightenment", saw many discoveries that contributed to modern medicine and anaesthetic history.
In the Enlightenment period, gaseous substances, such as oxygen and carbon dioxide, were discovered for the first time. These advances opened up a whole new realm of discovery for scientists and, moreover, offered some exciting opportunities for medical advancements.
Did you know?
It was in the 13th century that diethyl ether was first demonstrated as a successful anaesthetic. The drug was found to be able to induce unconsciousness and produce pain relief in some cases. Despite this, it was not used medically for centuries.
Anaesthetic Timeline
There has been no shortage of attempts to relieve pain throughout scientific history. The timeline below highlights the most influential and important events of the discovery and implementation of anaesthetics in the 19th century and the Industrial Era.
| Date | Development in the History of Anaesthetics |
| Middle Ages | Concoctions consisting of alcohol and natural plants, such as mandrake root, were used. |
| 1799 | Humphrey Davy suggested the use of nitrous oxide to reduce pain. |
| 1824 | Henry Hickman documented that the use of carbon dioxide could produce a loss of consciousness in a patient. |
| 1840 | The use of ether on animals and its side effects were documented by Paracelsus. |
| 1842 | Dr Clark and Dr Long first used ether for general anaesthesia on humans. |
| 1844 | Horace Wells used nitrous oxide in dentistry, specifically for the extraction of teeth. |
| 1846 | The first public demonstration of ether anaesthesia was presented by Dr William Morton. |
| 1847 | The first recorded use of anaesthetics in Australia. |
| 1848 | Chloroform was introduced into science and surgery by James Young Simpson. |
Types of Anaesthetics
There were many early forms of anaesthesia, some natural, some arguably unpolished, and most were underdeveloped. Thus, these types of anaesthetics had major side effects, and most were dangerous enough to cause death!
Herbal Concoctions
Herbal concoctions were typically sourced from oriental areas or Southern Europe since these areas grew plants that often times had anaesthetic properties. It was not uncommon for medieval British texts to mention opium as an anaesthetic.
Fig. 2 - Mandrake Root
Although some of the drugs used in modern anaesthesia are derived from substances found in plants, these early formulations had little to do with the later development of successful drug-induced anaesthesia.
Did you know? Dangerous blows to the head to induce unconsciousness were also used during the early days of anaesthetics, this type of anaesthetic frequently caused the patient to die by causing brain bleeding and brain damage.
Ingestion
The ingestion of substances such as ethanol was another method of anaesthesia. This was extremely hazardous, as ingesting the wrong amount of ethanol could be fatal.
Ingestion
The action of taking food, drink, or another substance into the body by swallowing.
Hypnotism
This form of anaesthesia was not very effective; it worked for some, but not all, especially as societies developed over time.
Fig. 3 - Hypnotic séance painting by Swedish artist Richard Bergh
Did you know? Another early form of Anaesthetics was the compression of arteries to cut off the circulation of blood to the head. This type of anaesthetic was extremely dangerous and often led to brain damage.
The Founders of Anaesthetics
Let's take a closer look at some of the founders of modern anaesthetics.
Humphrey Davy
Humphrey Davy investigated nitrous oxide and found that two important properties occurred when it was inhaled.
It caused euphoria or uncontrollable laughter, which is why nitrous oxide is also known as laughing gas.
Nitrous oxide could numb the body.
From this discovery, Davy suggested that the gas should be used in medical procedures and surgeries, but this suggestion was ignored, much like the 13th-century discovery. In fact, the gas was largely used for recreational purposes such as parties.
Did you know? Despite the numerous people who administered anaesthetic agents between 1835-1845, these agents were not widely known and did not have an impact on general medical practice.
Gardner Quincy Colton and Horace Wells
In 1844, Gardner Quincy Colton, an American travelling showman, demonstrated the inhalation of nitrous oxide. Among the audience was Horace Wells, a prominent local dentist who specialised in making dentures but wanted to find a way to ease the discomfort of removing the patient's rotten teeth.
During the show, Wells noticed the man who had inhaled the gas had damaged his shin but appeared to be in no obvious pain. An experiment was conducted the next day, in which Horace Wells had one of his own teeth removed after Gardner Quincy Colton administered the gas. Horace Wells experienced no pain during the procedure and decided to learn how to make nitrous oxide to use in his surgeries.
Fig. 4 - Illustration of 1846 Wells operation in which the patient felt pain
Did you know? However, when Wells attempted to demonstrate the procedure in front of an audience with a volunteer, the volunteer experienced pain during the tooth extraction.
William Morton
Morton conducted experiments with ether. He first experimented on animals and then on patients. In front of a large audience, Morton gave patient Gilbert Abbot some ether and had his colleague John Warren remove a tumour from his neck. Gilbert Abbott experienced no pain, and the tumour was removed successfully.
Robert Liston
During his travels to America, Robert Liston, a leading amputation surgeon from London, saw the potential of ether as an anaesthesia. Following this, Robert Liston brought anaesthesia to England in 1846 and attempted an amputation using ether.
Consequently, general anaesthesia entered Britain's medical practice.
Did you know? Dr Robert Liston, despite being renowned as the fastest surgeon of his time, performed with a 300% mortality rate.
Anaesthetics side effects
The side effects of general anaesthesia in the modern world are very different to their earlier forms. The overview below outlines what scientists now know about anaesthesia and its side effects on patients.
- Side effects of general anaesthesia can include nausea and vomiting.
- A sore throat is a common side effect of general anaesthesia, as the tube that is used to help you breathe whilst unconscious causes discomfort.
- Postoperative delirium is common after the use of general anaesthesia; in simpler terms, it is confusion and disorientation.
- Physical side effects include muscle aches, itching, chills, and shivering.
- Some more serious side effects include cognitive dysfunction (memory loss) and Malignant hyperthermia, a dangerous reaction to anaesthesia.
So what have we learned about anaesthesia since doctors and scientists in the Industrial Era?
Ether
When used as an anaesthetic, the side effects of ether are dose-dependent. Doctors during the early 19th century were unaware of the side effects, yet its use was reduced during the 1860s as it was replaced. Symptoms can consist of the following:
- Drowsiness.
- Bradycardia.
- Hypothermia.
- Dizziness.
- Laryngospasm.
- Unconsciousness.
- Death.
Because of these possible side effects and the development of more effective and safe use of inhalation anaesthetics, the usage of ether and chloroform declined during the 20th century and are very rarely used in surgery today in the developed world.
Fig. 5 - Ether being used during an amputation
Nitrous Oxide
Used to treat pain, nitrous oxide also functions as a sedative. Therefore, nitrous oxide is sometimes used before dental procedures to minimise anxiety or increase relaxation. Side effects of nitrous oxide include:
- Dizziness.
- Disorientation.
- Impaired memory and cognition.
- Weakness in the legs.
- Loss of balance.
- Dissociation.
There are no known long-term side effects, but it is believed that toxic exposure can lead to anaemia or a vitamin B-12 deficiency. Vitamin B-12 deficiencies can cause nerve damage, resulting in increased tingling or numbness in your fingers and limbs. It is because of these dangerous risks that dentists and scientists are decreasingly using nitrous oxide as anaesthesia.
Chloroform
Chloroform was commonly used during wartime to reduce the pain of surgeries. It was also introduced to childbirth procedures during the 19th century, notably by Professor James Simpson.
Professor James Simpson
Many doctors in Britain experimented with different gaseous substances after the practice arrived, which led Professor James Simpson to encourage these drugs to be used in childbirth. In 1847, Simpson pioneered the use of gaseous substances, particularly chloroform, to help pain during childbirth. However, at the time, this was quite controversial.
Fig. 6 - Portrait of Professor James Simpson
Although these advancements were extremely progressive because of the time, there were still some issues with administering the gases in safe amounts and a lack of awareness of anaesthesia side effects.
Chloroform was discontinued because of its many hazardous and deadly side effects:
- Deaths due to respiratory failure and cardiac arrhythmias.
- Nausea.
- Hyperthermia.
- Jaundice.
- Vomiting.
- Coma due to hepatic dysfunction.
The clinical use of chloroform ended in 1976 with the publication of the second edition of V. J. Collins' textbook.2
Did you know?
From 1865 to 1920, chloroform was used in 80-95% of all sedations for operations performed in the UK and German-speaking countries.
The Importance and Impact of Anaesthetics
Today, it is difficult to comprehend how significant these advancements were. Before the many discoveries that the Industrial era saw, surgery was an often deadly last-ditch effort to save a life. Very few operations could be performed. Surgery carried out externally accounted for the majority of surgeries, while internal surgery was almost impossible.
The discovery of gaseous anaesthesia revolutionised the medical world. It was now possible for surgeries to be performed internally, and they could be performed in a more precise and intricate manner. Anaesthesia was crucial to the development of surgery as it allowed doctors to be more explorative.
Did you know?
By 1853, Dr John Snow, a London doctor who specialised in anaesthesia, and his work became so well respected that he was able to administer anaesthesia to Queen Victoria! He published 'On the Inhalation of the Vapour of Ether', an educational document on how to safely administer anaesthesia gas, on 19 March 1847.
Historian Maxwell David Melin discusses how anaesthetics affected Industrial Britain, the Industrial Revolution, and vice versa. Melin comments on how anaesthetics played a key role in an increased survival rate yet did not make a dent in the vast numbers of medical and surgical deaths.
Although the introduction of anaesthesia made surgery a much less gruesome ordeal, patients still died at an alarming rate. In fact, the mortality rate for a simple amputation still approached 30% in many cases.[...] The educational advancements that came during the Industrial Revolution created an environment where new surgical students could learn more effectively and practicing surgeons could more easily share their work.3
Merlin goes on to discuss how the poor working conditions that were at their peak during the industrial revolution due to the overcrowding of the unsanitary workhouse and cities was causing an "explosion of disease". It would not be until the discovery of Germ Theory that they could explain these deaths.
Germ Theory
The accepted scientific theory for most diseases theorised and proven by Louis Pasteur in 1861. It says that germs, or microorganisms, can lead to infection or disease.
Anaesthetics - Key takeaways
The development of an effective anaesthetic was a long and extensive process which attempted to find ways to ease pain during medical procedures.
The earliest form of anaesthetics was herbal concoctions, which usually consisted of plants and herbs sourced from oriental areas and south Europe, such as opium. Other methods were tested, for example: Blows to the head to induce unconsciousness, hypnotism, and more.
In the Enlightenment period, gases were discovered, such as oxygen, carbon dioxide, and nitrogen. This led to the scientific experimentation of the inhalation of gases and the advance of medicine, especially anaesthetics.
Humphrey Davy investigated nitrous oxide and found that two important properties occurred when it was inhaled. The first was that it had numbing (anaesthetist) qualities, and the second was that it induced laughter or a feeling of euphoria.
Developments with anaesthesia arrived in Britain after Robert Liston travelled to America and saw its effectiveness.
References
- James Cooke quoted in Sam Shuster, 'Painless amputation: historyof a discovery that wasn't made', British Medical Journal, Volume 339, (2009), pg 1418.
- Vincent J Collins, Principles of Anesthesiology, (1976).
- Maxwell David Melin, The Industrial Revolution and the Advent of Modern Surgery, (2016), pg. 4.
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