The development of anaesthesia - but at what cost?

Adam Manning uncovers the dark history of general anaesthesia in surgery.

Surgery is a common, not always wanted, 21st century medical procedure performed by trained professionals. Thanks to our increased understanding of human physiology and sterile or aseptic practice, surgery is generally considered to be very safe. However, this hasn’t always been the case. In the Middle Ages, operations were often performed by “barber-surgeons” rather than physicians as barbers already had access to the sharp objects needed for both grooming and surgery. They routinely performed procedures like pulling teeth, amputations, and bloodletting. In fact, this is the reason why the famous barber’s pole remains red and white to this day, to symbolise the blood and bandages they were associated with.

Surgery was dangerous to undergo during pre-Victorian times. It was used only as a last resort because patients were likely to die from infection and blood loss. The patients were also conscious, consequently they would be in an incredible amount of pain throughout. Therefore, surgeons would race against the clock to finish their procedures as quickly as possible. Members of the public and medical associations would come and marvel at these live surgeries for entertainment, which is why surgery is performed in an operating ‘theatre’.

Many surgeons wanted to ease the pain that their patients experienced during surgery. One such person was Seishu Hanaoka, a Japanese surgeon who studied surgical techniques along with classical Japanese, Chinese, and Western medicine. Hanaoka invented a general anaesthetic called tsūsensan, made of six different plants and administered orally. Tsūsensan was used to remove a woman’s breast cancer for the first time in 1804, which became the first recorded historic use of a general anaesthetic in surgery. Unfortunately, his ideas didn’t spread out of Japan.

The first general anaesthetic used in Western surgery was diethyl ether, commonly now known as ether. In 1846, William T.G. Morton demonstrated its use in front of a large audience in Massachusetts General Hospital, Boston. Whilst Morton was not the first to investigate ether as an anaesthetic, his demonstration gained international fame and helped popularise its use. A year later, British doctor James Simpson discovered that chloroform had similar sedating effects and could also be used as an anaesthetic.

Anaesthetics were commonly used after their discovery. In the 1850s, Queen Victoria used chloroform when giving birth to her children, further strengthening its popularity. However, these anaesthetics weren’t without risk. If administered incorrectly, anaesthesia can be toxic to the point of fatal. Chloroform especially became obsolete because it was very easy to overdose with it, killing the recipient. Doctors had limited knowledge of physiology at the time, making it difficult to establish the correct dose to give. In one case, Hannah Greener, a healthy 15-year-old girl, died on January 28th 1848, after receiving chloroform for surgery to remove her toenail. Ether, whilst highly flammable, was safer in terms of this problem and became more favourable despite the invention of a chloroform dosage mask.

Anaesthesia had an immediate impact on surgeries, but counterintuitively, the number of deaths actually increased in what would become known as the ‘Black Period of Surgery’. Anaesthetics allowed surgeons to slow down and conduct more invasive surgeries, but they did nothing to prevent infection or fatal blood loss. Without effective aseptic working conditions, antiseptics and blood transfusions, many died. It wouldn’t be until the 1900s, with the combination of multiple discoveries in regard to these problems, that the high mortality rate would begin to go down.

The invention of anaesthesia was a major breakthrough that helped to bring surgery into the modern era. However, its dark journey to become the safe procedure we know it as today shows that not all innovations are as clear-cut as good or bad. Anaesthetics did indeed revolutionise surgery, but at the cost of the lives of many people. The breakthrough emphasises the indirect consequences that life-changing revolutions can have. Ultimately, it teaches us that it is our responsibility to be mindful of such consequences when developing future medical innovations.

From Issue 21