Today we take anaesthesia and pain relief for granted. However, before the introduction of anaesthesia in the 1840s, the terrible pain suffered from surgery was vividly recorded by diarists such as Samuel Pepys in 1658, for the removal of a bladder stone, and Fanny Burney in 1811, for a mastectomy.
Although practitioners had always sought to alleviate suffering, pain was widely thought to be of physiological and moral value. In surgery, pain was the stimulant that preserved life in the body during the stress of the operation. The discovery of anaesthesia therefore challenged Victorian understandings of pain at the most fundamental level and by the end of the nineteenth century anaesthesia had become a routine part of surgery.
This well-written and informative book charts the discovery of the anaesthetic properties of ether, chloroform and nitrous oxide, and the debates about their risks in surgery, in childbirth, and – for chloroform – both on the battlefield and in crime cases, including murder. Later the story moves into the twentieth century and beyond with the discovery of newer drugs, such as muscle relaxants, short-acting intravenous barbiturates, and safer agents such as Halothane (the first designer anaesthetic), as well as the introduction of modern anaesthetic equipment such as mouthpieces, endotracheal tubes and ventilators.
The early pioneers of anaesthesia included American dentists Horace Wells, Charles Jackson and William Morton, who discovered the pain-killing properties of nitrous oxide (which became the mainstay for dentistry) and ether in the 1840s. However, it was John Snow, a London general practitioner (whose other claim to fame was showing that cholera was transmitted by contaminated water from the Broad Street pump in Soho) who was the architect of the scientific principles of anaesthesia and champion of anaesthetic inhalers. Later, in 1847, James Young Simpson discovered the anaesthetic properties of chloroform, and was a supporter of administering chloroform using the ‘simple hanky’ method. When Charles Dickens’s wife successfully gave birth with chloroform anaesthesia in 1849, the author declared: ‘I am convinced that it is safe in its administration, as it is miraculous and merciful in its effects’. Chloroform was administered to Queen Victoria in 1853 during the birth of Prince Leopold, and this finally put the seal of respectability on childbirth anaesthesia, aptly called ‘chloroform à la reine’.
However, deaths from anaesthetics were common and minimizing the risks involved with anaesthesia occupied doctors’ thoughts for the remainder of the nineteenth century and beyond. With ether, for example, the pungent odour, tendency to irritate the throat and nasal passages, and propensity for causing initial excitement was offensive to doctors and patients alike. During surgery bleeding intensified (we now know that it relaxes and dilates the blood vessels) and wounds healed more slowly. Its vapour seemed to exacerbate existing respiratory disease; in some patients it appeared to cause convulsions, paralysis and inflammation and even changed the appearance of the blood. More worrying was the fact that ether was highly flammable, bringing the risk of an explosion.
Under ether, states of life and death appeared to mingle. It was impossible for onlookers observing an unconscious, pale and insensible patient to know whether he or she was still alive: death appeared too close for comfort. It was Snow, however, in his paper ‘On the Inhalation of Ether in Surgical Operations’, who first described the process of ether anaesthesia as five identifiable degrees, which are still recognized in modern anaesthesia today. Later the popularity of ether was quickly upstaged by the discovery of chloroform, with its pleasant odour and ease of administration, which later received royal approval even though it was the riskiest of the three anaesthetics.
Deaths under anaesthesia were also the subject of coroners’ inquests. However, in Britain, during the nineteenth century, no doctor was charged with anaesthetic malpractice after a chloroform fatality. The patient’s fear of pain outstripped any worries of dying under chloroform and fatalities were tolerated as a worrying though inherent risk of anaesthesia. Things were very different across the Atlantic however, especially in the Northern cities such as Boston, where patients’ litigious predilections meant that malpractice suits against surgeons were common, especially if chloroform was used in favour of ether, in which case they could not be defended.
By the early 1850s anaesthesia had proved itself to be beneficial in wartime operations, though surgeons remained wary about its use. For example, in the Crimean War (1854–6) controversies about the risks and benefits of anaesthesia on severely wounded soldiers raged, although the use of chloroform was often curtailed more through lack of supplies than by theoretical arguments. Anaesthesia also became a new weapon in a different battle. This was with military malingering. It was Snow, in 1847, who showed a gathering of military officers that under ether it was not possible to feign disabilities or deformity.
From its humble beginnings in the 1840s anaesthesia has developed into the largest single hospital specialty in the NHS today and the element that binds anaesthesia most tightly to its origins is the absence of definitive explanations in matters of mechanism and process.
