Surgery, Pain, and Anaesthetics

At the beginning of the 19th century, surgery was typically performed on conscious patients. However, through the discoveries made by Humphry Davy, William Morton, and James Simpson, effective anaesthetics were routinely used by the end of the century, transforming the field of surgery.

Surgery in the Early 19th Century

In the early 1800s, surgery faced three major challenges:

• Pain
• Infection
• Blood loss

These problems meant that surgical procedures had to be carried out as quickly as possible, often under challenging conditions. High mortality rates were common, as many patients died of infections, even if they survived the operation itself.

Robert Liston, a renowned surgeon in the 1840s, famously performed a leg amputation in under 40 seconds. Speed was vital because there were no anaesthetics to keep the patient still, and prolonged surgeries increased the risk of fatal blood loss.

Humphry Davy and Nitrous Oxide

In 1799, the British chemist and surgeon Humphry Davy discovered that nitrous oxide, often referred to as "laughing gas," could serve as an effective local anaesthetic. Davy noted its potential for use in surgery, but his findings were not fully realised until after his death.

American surgeon Horace Wells tried to use nitrous oxide in a public demonstration to extract a tooth. Unfortunately, the patient wasn’t given a sufficient dose, resulting in the patient making noise during the procedure, which led to the widespread belief that nitrous oxide was ineffective for anaesthesia.

William Morton and Ether

Horace Wells later collaborated with fellow surgeon William Morton, who experimented with using ether as an anaesthetic. Ether was found to effectively prevent pain during surgery, and its use quickly became widespread among surgeons, particularly in England.

However, ether had several drawbacks. It was highly flammable, which required careful handling and storage. Moreover, patients often complained of side effects such as sore throats or nausea after being administered ether.

James Simpson and Chloroform

In 1847, Scottish doctor James Simpson, along with some friends, experimented with chloroform and discovered that it was an effective general anaesthetic. Chloroform soon replaced ether as the most popular anaesthetic used in surgery. Its use meant that patients could remain still and pain-free during an operation, allowing surgeons to consider more complex procedures. This breakthrough significantly advanced the field of surgery.

Opposition to Anaesthetics

Despite the clear advantages of anaesthetics, their use in surgery faced significant opposition for various reasons:

Religious objections: Some people in the Church believed that pain, especially during childbirth, was a punishment or test sent by God. They argued that using anaesthetics during labour interfered with God’s will.

Concerns about safety: Anaesthetics could be dangerous if not used correctly. A notable example was the case of 15-year-old Hannah Greener, who died during a procedure to remove an ingrown toenail because she was administered an excessive dose of chloroform.

Military resistance: The British Army initially banned the use of chloroform. Some military surgeons argued that the pain experienced by awake patients helped them gauge their condition and respond to their needs.

How Opposition to Anaesthetics Was Overcome

In the 1850s, the anaesthetist John Snow developed a chloroform inhaler. Prior to this innovation, chloroform was applied to a cloth and held over the patient's mouth and nose, which made it difficult to control the dosage. The inhaler allowed doctors to regulate the amount of chloroform administered to the patient, significantly improving safety.

In 1853, Queen Victoria gave birth to her eighth child with the assistance of chloroform, administered by John Snow. She later described the experience as a ‘blessed chloroform,’ praising its ability to relieve the pain of childbirth. This high-profile endorsement helped reassure the public about the safety and effectiveness of chloroform, overcoming much of the previous opposition to its use.

By the end of the 19th century, anaesthetics had become a routine part of surgery, and they played a crucial role in making surgical procedures safer and less traumatic for patients.