Pain, a Burden to be Borne
In the 1800s, most people expected to experience pain in their lives and relied on religion or personal fortitude to help them endure it. Pain was one of God's punishments for the wicked and purifying trials for the good; for the woman in labor, pain was the spiritual experience that would transform her into a self-sacrificing mother. Many doctors shared these views! Other physicians were concerned about the ethics of operating on a comatose patient and many were concerned about the potential risk of death from an overdose of anesthetic.
Nitrous Oxide
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| | Portrait of Humphrey
Davy | |
Humphrey Davy (1778-1829) suggested that the pain and shock of surgical operations might be relieved if patients inhaled nitrous oxide, a gaseous compound discovered by Joseph Priestley (who was also the first to isolate oxygen).
Ether
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Recipe for toothache using ether, from
a manuscript book of recipes and
prescriptions, c. 1800 |
Ether, whose starting materials are sulfuric acid and alcohol, had long been known. It was used as a sedative in the treatment of tuberculosis, asthma and whooping cough, and as a remedy for toothache. Its anesthetic potential had never been exploited.
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| Portrait of Horace Wells |
Crawford Long (1815-1878), a Georgia surgeon, and Horace Wells (1815-1848), a New England dentist, experimented with anesthetics in the early 1840s. But Long delayed in publishing his work with ether and Wells' attempt at a public demonstration of nitrous oxide anesthesia failed, humiliating him. Wells' colleague, William T. G. Morton (1819-1868), was intrigued by the idea and began his own experiments with ether.
The Demonstration of Surgical Anesthesia
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The first public demonstration of surgical
anesthesia, Boston, October 16, 1846 (From:
Massachusetts General Hospital. The Semi-
Centennial of Anaesthesia. Boston, 1897) |
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Portrait of William T.G.
Morton
(From: Massachusetts General
Hospital. The Semi-Centennial
of Anaesthesia. Boston, 1897) |
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In 1846, Morton made his famous demonstration of surgical anesthesia at the Massachusetts General Hospital, using a hastily rigged apparatus to deliver ether to the patient. The new technique was to revolutionize practice, enabling surgeons to develop finer skills and life-saving invasive procedures. But the use of anesthesia became common only gradually: many physicians were accustomed to relying on "the healing power of pain" and were wary of the ethics of operating on an insensate patient.
James Young Simpson
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| | Portrait of James Young
Simpson | |
James Young Simpson (1811-1870), a Professor of Midwifery at Edinburgh, wanted to find an alternative to ether " . . . in order to avoid, if possible, some of the inconveniences and objections pertained to sulphuric ether, - (particularly its disagreeable and very persistent smell. . . and the large quantity of it occasionally required to be used, more especially in protracted cases of labour.)"
Simpson experimented with various compounds and found chloroform to be efficacious and reasonably safe. He began using it to relieve the pains of childbirth and incurred the wrath of those holding to the Biblical view that "In sorrow thou shalt bring forth children." After Queen Victoria chose to be anesthetized in 1853 for the birth of Prince Leopold and again in 1857 for the birth of Princess Beatrice, however, the practice became common among the upper and middle classes.
By the 1880s anesthesia, with aseptic technique, was standard practice in American and European surgical theaters. Middle-class patients, used to receiving medical care at home, found themselves seeking admission to hospitals for operations; hospitals were transformed from charitable asylums for the poor into consumer-oriented service institutions. While the surgeon's prestige and power soared, the anesthetist was a mere assistant--a nurse, intern or medical student. The development of the independent medical specialty of anesthesiology would not occur until the early 20th century. |
