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
Deadly 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 focused 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 if he could
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, 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.
If you want to watch some videos on this topic, you can click on the links to YouTube videos below.
If you want to answer questions on this article to test how much you understand, you can click on the green box: Finished Reading?
Videos :
1. How does Anesthesia Work? (4:56)
3. Humphry Davy and Nitrous Oxide (5:01)
4. The Tragedy of Horace Wells (8:28)
5. Robert Liston the Fastest Knife (3:16)
6. Ether for Anesthesia (19:00)
7. James Simpson and Chloroform (7:26)
8. Was Queen of Britain a Drug User? (2:14)