Modern Anesthesia Is Developed

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Modern Anesthesia Is Developed

Overview

The discovery and development of anesthesia is one of the most important medical discoveries of the nineteenth century. It not only relieved pain, it also allowed doctors to perform life-saving surgical procedures, thereby increasing a person's lifespan and quality of life.

Background

Although pain was always assumed to be inevitable during surgery, many substances and concoctions were used to relieve pain over the centuries. Most frequently various plant extracts such as opium or preparations containing alcohol were used as anesthetics. Sometimes these substances, along with the speed of a skillful surgeon, helped the patient survive painful procedures. Yet such methods of pain relief were inconsistent at best.

Events leading to modern surgical pain relief began in England in the 1770s. Joseph Priestley (1733-1804), a minister, author, and scientist, isolated several gases, including oxygen and nitrous oxide, or "laughing gas." In one of his publications Priestley expressed his hope that there might be medical uses for these gases. By the early 1780s several physicians, including Thomas Beddoes (1760-1808) in Bristol, were researching such uses. In 1799 Beddoes opened the Pneumatic Medical Institute to study the gases, and hired a young man named Humphry Davy (1778-1829) as Research Director. Davy and others did extensive research on nitrous oxide and in a book about their research (published in 1800) Davy suggested that inhalation of the gas might relieve pain during certain types of surgery. Beddoes and Davy also noticed that breathing nitrous oxide relieved the pain of a toothache.

In 1823 English physician Henry Hill Hickman began a deliberate search for an anesthetic. He used high doses of carbon dioxide during surgeries in mice and dogs. In his published account Hickman noted the lack of response to an incision in these animals. Hickman had indeed discovered inhalation anesthesia, yet he was ignored by other physicians and scientists of his day.

In the United States in the small town of Jefferson, Georgia, physician Crawford Long (1815-1878) performed several surgeries beginning in March 1842 using ether vapor as an anesthetic. Ether had been known since the sixteenth century, and its vapor was often inhaled at "ether frolics" or parties to produce a brief feeling of euphoria. Long had received excellent medical training for his day, graduating from the prestigious University of Pennsylvania Medical School at a time when most physicians in America were trained by apprenticeship to other physicians. Yet Long failed to report or publicize his monumental achievement until years later. Apparently, since surgery was so rare in his practice, Long did not immediately realize the importance of what he had discovered.

Impact

Finally, in 1845 and 1846, two American dentists brought anesthesia to mainstream medical practice. Horace Wells had a successful practice in Hartford, Connecticut, when he attended a nitrous oxide demonstration on the night of December 10, 1844. At that time various showmen toured England and the United States giving public exhibitions of the exhilarating or intoxicating effects of breathing this gas. On that night Gardner Qunicy Colton invited audience members to join him onstage and breath nitrous oxide. One young man who did so, Samuel Cooley, injured himself in the excitement but apparently felt no pain. Wells immediately realized the potential of nitrous oxide in medical practice. The next day Wells invited Colton to give him the gas while John Riggs, Wells's former pupil, pulled a wisdom tooth. Wells felt no pain, and began to use the gas in his practice.

In January 1845, Wells traveled to Boston to demonstrate this new method of pain relief at the Massachusetts General Hospital. Wells appeared before the surgery class of John Collins Warren, one of America's best-known surgeons, and attempted a tooth extraction on a patient who had breathed nitrous oxide. Unfortunately, the patient cried out in apparent pain, and Wells's demonstration was considered a failure.

William Thomas Green Morton (1819-1868), a Boston dentist and former pupil and business associate of Wells's, correctly decided that Wells had the right idea but the wrong gas. With the help of a Harvard Medical School professor named Charles T. Jackson, Morton began experiments with another gas, sulfuric ether. After successful attempts on various animals and dental patients, Morton was ready for a surgical patient. Despite the earlier failure of Wells, Warren allowed Morton to demonstrate his method at the hospital in front of staff physicians and medical students. On October 16, 1846, a young man named Edward Gilbert Abbott had a tumor removed from his neck. Morton let Abbott breath the gas from a small apparatus; after four or five minutes, he told Warren the patient was ready. Although Abbott cried out and moved during the surgery, afterward he denied feeling any pain. The next day a tumor removal on another patient under ether was successful. In the following months word of this procedure spread around the world. By the end of 1847 books and pamphlets about ether anesthesia appeared in the United States and many countries in Europe.

Although anesthesia made a great contribution to medicine, medical practice during the rest of the nineteenth century changed slowly. Surgical mortality, or deaths, remained high until late in the century, due primarily to the slow acceptance of the germ theory and the need for cleanliness in operating rooms and hospitals. Some physicians were also reluctant to use anesthesia due to fears of possible side effects.

During the second half of the century, anesthetic practice slowly improved and expanded. A Scottish obstetrician named James Young Simpson (1811-1870) tried using ether to relieve his patient's pain during childbirth. Unhappy with ether's smell and its lengthy period of action, Simpson experimented with a number of other substances and finally discovered the anesthetic properties of chloroform. He quickly introduced this gas into his practice, and soon chloroform was being used in surgery as well. Ether and chloroform remained in common use around the world until the 1950s, when use of halothane, a synthetic gas, became widespread.

Englishman John Snow (1813-1858) is often called the first anesthesiologist—a physician whose practice consists of giving anesthesia in the operating room and monitoring the patient's vital signs. Snow never actually limited his practice to anesthesia; few physicians in either England or the United States could support themselves that way until well into the twentieth century. Yet Snow was considered a superb physician whose interest in anesthesia included a desire to understand how the gases affected the body. Snow did extensive research and left many published accounts of his work. After Snow's death in 1858, Joseph T. Clover (1825-1882) became one of the best-known figures in England associated with anesthesia. Clover designed a portable machine to administer gases that remained in use decades after his death. Another Englishman, Frederick Hewitt (1857-1916), designed an early anesthesia machine to administer variable portions of nitrous oxide and oxygen, a combination used widely for dental procedures and short surgeries from the late nineteenth century until today.

Regional and local anesthesia, forms of pain relief and prevention that do not require the patient to be unconscious, as with general anesthesia, were also discovered during the nineteenth century. In the 1880s Carl Koller (1857-1944), an associate of Sigmund Freud's (1856-1939) in Vienna, discovered in their work with cocaine that the drug made his tongue numb. Koller quickly attempted experiments on animals and realized that use of cocaine prevented pain. After a friend reported Koller's results at a medical conference in Germany, word quickly spread around Europe and the United States. Over the next few years numerous physicians used injections of cocaine in the eye, mouth, and other areas of the body to block nerve impulses. By the end of the century, cocaine was used for spinal anesthesia by August Bier in Germany. Since 1900 many other drugs have been developed to replace cocaine. Today regional and local anesthesia are frequently used during surgeries and after surgeries to manage pain.

Another nineteenth-century innovation related to anesthesia is intubation. This procedure, in which a flexible breathing tube is inserted through the mouth into the windpipe, assists the anesthesiologist by creating a dependable airway during an operation. Scottish surgeon William Macewan first used this procedure in July 1878. However, interest by Macewan and others in this procedure was sporadic until an American physician, Joseph O'Dwyer, began using it on children with diphtheria to assist their breathing. O'Dwyer designed several tubes that were soon adopted by New Orleans surgeon Rudolph Matas. However, several decades would pass before intubation would become a standard technique.

The discovery and development of anesthesia is one of several important medical developments of the nineteenth century. Pain, a constant for most of human existence, can now be controlled and prevented in many situations.

A.J. WRIGHT