Anesthesia: Making Surgery More Bearable

In the modern world, we expect every surgery procedure to begin with anesthesia. Those who are fans of spy and counter-terror dramas like “24” and “Alias” know that the symbol of torture is a metal tray of medical instruments wheeled in front of a struggling captive. One glimpse of scalpels, scissors and saws tells the viewer life is about to get ugly for whoever is tied, chained or strapped down. Torture for us is surgery without anesthesia — what passed for the normal medicine for people living before widespread use of ether.

Easily one of the greatest medical innovations in history: ether, chloroform and the compounds developed later spared countless patients from intense suffering for more than 150 years. In the mid-1840s, the use of ether quickly changed the practice of surgery. Before ether, every patient faced a horrible choice between the pain of the illness or injury and the literal torture of the cure.

On both sides of the Atlantic, both in England and America, anesthesia went into widespread use within a year of its invention. Ether was immediately hailed as a merciful, a boon to suffering mankind. Patients everywhere sang the praises of anesthesia.

But after the initial passions cooled and anesthesia began to be an expected part of surgery, medical professionals began to consider the very real risk involved in being put into an artificial sleep. The greatest risk was that the patient in the ether-induced sleep would never wake up. Anesthetic death was rare even in the 1840s, but it did happen and every surgical patient had to consider that possibility. Should the patient be anesthetized for a tooth extraction? For the removal of a toe-nail? In 1854, The Lancet published the following commentary after a patient died from anesthesia during surgery for removal of an ulcerated leg:

“Was the intensity or duration of the pain in an amputation of the leg sufficient to justify the risk in such a subject? Or can it be said that insensibility was essential to the surgeon’s proceedings? Surely not. There are those who will agree with us in thinking that it were better that a thousand individuals should each bear, when necessary, the pain of amputation, than that one of the thousand should die in an attempt to remove this momentary suffering.”

I am sure the current editorial staff of The Lancet would encourage anesthesia, even for the momentary pain of an arm or leg amputation.

Recently, the subject of surgery went from academic to actual for me in just a moment. On May 9, I touched wheels with another rider in a downhill bicycle race just as we passed 50 mph. I flipped to the road, landing headfirst. The next thing I remember is taking off in a helicopter. Sometime later, I remember hearing what turned out to be a plastic surgeon reattaching a piece of my forehead that peeled away when I hit the road. He was smiling and said, “This is going to look good.” He did do a great job.

Later, I remember hearing someone say, “You can have surgery or we can put you in a halo cast for a year, but we don’t know if that will work.” At the time I did not understand what kind of surgery, but I understood halo cast. I said, “Surgery!” The someone was the neurosurgeon who would replace the shattered seventh vertebra in my neck with one from a cadaver. I fractured the first two vertebrae in my neck also, but they needed no repair. The surgeon was young, but had lots of trauma experience. His last practice was in Baghdad.

Would I have said “Surgery!” in a world without anesthesia? I don’t know for sure, because I have trouble imagining surgery without anesthesia. I suppose a year with screws in my skull would seem a lot better if I had to compare it to an operation through my neck with me wide awake. I also broke my shoulder blade, collarbone and four ribs on my right side, so I am very glad I could choose the surgery and start recovering as soon as possible.

My injuries are healed well. Many of us with an interest in history wish we could travel in time and meet Boyle, Priestley, Lavoisier, Dalton and other greats of early chemistry. But when I think of the medical care available when they were alive, I prefer to have them travel to our time.

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This article was originally published under the title "We're History" in the August 2007 edition of Chemical Engineering Progress magazine. This article is based on chapter three of the book, “The Risks of Medical Innovation: Risk Perception and Assessment in Historical Context” edited by Thomas Schlich and Ulrich Tröhler. Chapter three is: “Anaesthesia and the evaluation of surgical risk in mid-nineteenth-century Britain” by Ian Burney. This article was prepared by Neil Gussman, communications manager for the Chemical Heritage Foundation.