The Deadly History of Anaesthesia

by Read Listen Learn

The History of Anaesthesia

We know that in the twelfth century in Europe and Asia, people used the Solanum plant species, mixed with other ingredients including alcohol, to make people fall asleep so that they could have operations without feeling any pain. In Italy in the thirteenth century, for instance, Theodoric Borgognoni used Solanum with opium in surgery. On the other side of the world, native Americans used coca leaves to cause unconsciousness and to clean cuts in operations on the head. They spat the mixture into the patients’ wounds to clean them.

The only difficulty with these early mixtures of natural anaesthetic plants was that if they used too little, they had no effect and, if they used too much, the patient never woke up.

As people knew about these anaesthetic plants in Europe and America so many centuries ago, it is surprising that doctors performed most operations until the late eighteenth century without any anaesthetic at all, except for alcohol – which is not very effective in reducing pain. We know that surgeons on British ships, for example, routinely cut off limbs after giving patients a few mouthfuls of brandy and putting wood into their mouths so that they would not bite their tongues off. The surgeon’s assistants held patients still so that they could not move too much while the operation was going on. Obviously, many people died of shock caused by the extreme pain.

There were two reasons why doctors did not use anaesthesia for so long. First, they thought that pain kept the patient’s body working and so reduced the chances of death. Next, and more importantly, people believed it was good for a Christian to suffer pain, as this was something given to us by God. Of course, it was also manly not to scream or cry when you were in pain.

However, Thomas Sydenham (1624 – 1689), the greatest doctor of his age, created laudanum towards the end of his life. This was opium mixed with a kind of wine, called sherry, as well as cinnamon, saffron and cloves. It stopped headaches, toothaches and many other everyday aches and pains and, of course, it tasted great. In a few decades, British imports of the opium needed to make laudanum had increased hugely and so we can be fairly sure that people were using it to reduce the pain of many physical illnesses and for problems like sleeplessness, depression and worry.

We also know from their memoirs that some well-known authors became addicted to opium in the late eighteenth century just from the pleasure of using it. We can be sure that they were not the only ones. The question is, of course, why did it take so long for laudanum to become popular?

The answer is not a medical one, but more about social acceptance of unnecessary pain. The late eighteenth and early nineteenth centuries saw many new laws and movements to reduce human and animal suffering.

The British Parliament limited the number of hours children could work and then stopped this completely; slavery was abolished; new rules were introduced to make factories safer; the Royal Society for the Prevention of Cruelty to Animals was set up in 1827; aristocrats slept in prisons for a night or two to see for themselves the terrible living conditions there and improve them; children could no longer be hanged for stealing a handkerchief and adults were transported to Australia – not executed – for stealing; and so on.

It seemed people no longer accepted that pain was a necessary part of living. At the same time, there was more interest in medicine and science too. In the case of Humphry Davy (1778 – 1829), the chemist who increased our understanding of alkaline and discovered iodine and chlorine among many other elements, his discovery of the anaesthetic characteristics of nitrous oxide (often known as laughing gas) happened by chance.

Like many scientists in his day, Davy used to test chemicals on himself and noticed with nitrous oxide that he could not stop laughing and also that his toothache disappeared. In fact, Davy liked nitrous oxide so much that he used it three, even four or five times a day for the rest of his life and eventually died of it. So, if he knew that this gas could stop toothache, why didn’t he tell anyone about it?

For doctors at the time Davy was working, the body was a holistic system. All the different parts needed to work in harmony for the whole to function well. Medicine was, therefore, bringing badly functioning organisms back to equilibrium. As eighteenth century medicine focussed on the nervous system, Davy was worried about giving alcohol or opium to patients as he felt these would excite the patient and so throw the body off balance. He also believed – and, of course, personally proved – that nitrous oxide could be addictive and kill the patient. For many years, then, nitrous oxide was used largely by students to have a good time, rather than for medical reasons.

The next time we know nitrous oxide was used as an anaesthetic was in the USA, when in 1844 Horace Wells, a young dentist, experimented with the gas on himself and his patients. At this time, dentists were not seen as true doctors and often removed teeth at fairs as entertainment for the public.

Anyway, he was so pleased with the results that he arranged a public demonstration but, on this occasion, the drug did not work, the patient screamed and Wells was laughed at. He gave up being a dentist but only after he watched his old partner, William Morton, become rich from using exactly the same drug and methods that had not worked for him. Wells now travelled the country selling canaries and became addicted to chloroform. (At the time, people did not realise that ether, chloroform or nitrous oxide were addictive.) He experimented with chloroform on himself for a month and became more and more unstable, until one day he ran into the street and threw sulphuric acid at two prostitutes. When the effects of the chloroform wore off, he called the police, asked them to visit his house before going to the police station, and, after taking more chloroform to ease the pain, cut the artery in his leg and so committed suicide.

Twenty-six year old Morton, another fairground dentist more interested in money than science and a friend of Wells’, had more success at his public demonstration of nitrous oxide. He had experimented with this and with ether on himself and his pet, forcing the dog to smell the liquid until it became unconscious. The success of ether quickly meant that it crossed the Atlantic Ocean to Britain, where Robert Liston, a surgeon famous for the speed with which he could amputate limbs, used it for the first time in an operation.

Speed may not be the characteristic that we think most important these days for a surgeon, but in Liston’s time, it was essential. Although he was known to have a few accidents with his knife, once cutting off a patient’s testicles with his leg by mistake and, on another occasion, his assistant’s fingers, Liston operated quickly because there was a good chance that his patients would die of shock from the pain, as there was no anaesthetic.

In other words, the faster the better. (Actually, many patients died anyway, as doctors never washed their hands before or after an operation. Hygiene in hospitals was also very poor and so many patients got infections after surgery and died, including Liston’s assistant who lost his fingers.) So, it was clear why anaesthetic might be useful.

James Simpson, a Scottish obstetrician with an excellent reputation, experimented with anaesthetics at dinner parties given for his students. In most middle class homes, gentlemen and their male guests drank port, a strong wine, and brandy after dinner. It was not like that in Simpson’s house. He insisted that they smelt anaesthetic gasses, whether they wanted to or not. One evening when their wives returned to the dining room – gentlemen did not share their port or brandy with ladies – they found Simpson and his assistants unconscious on the floor. That was how the anaesthetic effects of chloroform were discovered.

Chloroform was a major advance for surgery, but it was not accepted easily. First, the British Parliament was worried about criminals using it to rob or kidnap people in the streets. Next, there were no clinical tests to prove its effectiveness. As we have seen, Wells and Davy died of anaesthetic drugs and Morton and Simpson tested them on animals and guests. Dr. John Snow, the doctor who identified that the cholera epidemic in London was caused by contaminated water from a particular pump, was worried about some of the side effects of chloroform, especially its unpleasant smell and the difficulty of using the correct amount. So that it had anaesthetic effects without killing the patient and did not cause congestion in the lungs. He experimented on animals and noticed that the temperature of both ether and chloroform affected their power. This meant that he could regulate the strength of the dose by keeping them in water at certain temperatures. Snow then wrote very clear guidelines on how the drugs should be given to patients.

Now that Snow had established clear rules for the use of ether and chloroform, doctors were less concerned about hurting their patients. Queen Victoria became interested in the drugs and wrote to ladies she knew who used it when they were giving birth to ask about its effects. When the Queen was about to give birth in 1853, she called John Snow to her bedside, who gave her enough chloroform to act as a painkiller, but not to put her to sleep. As she was the Head of the Church of England, any idea that pain was a Christian necessity was soon forgotten and chloroform and ether became part of the surgeon’s standard weapons to fight disease. As it also made speed a less important factor in operations, surgery could now become more exploratory. Until then, most operations had been to remove limbs; now, all that changed.

Chloroform quickly replaced ether as the main anaesthetic in use, as ether caused many patients to vomit again and again. However, chloroform had its drawbacks too: it needed trained staff, as it could easily cause death – and did! In a few years though, the deaths stopped and more innovative surgery took place … painlessly.