In praise of anaesthetics


I had a small medical procedure under local anaesthetic yesterday; around half an hour lying under a sterile cloth with a hole cut in it so the surgeon could work on the bit of flesh she wanted. We were chatting for much of that time about the difference that anaesthesia makes. Much as I love history, I wouldn’t want to live there. My surgeon said she’d had a similar discussion with the previous patient, this time about geography. Yes; there are places I wouldn’t want to live, too.

For most of history, surgery has been a last, and extremely painful, resort. Opium and alcohol were both used from ancient times, but both had unpleasant side effects and neither entirely blocked the pain. Knocking someone out with a blow to the head ensured they didn’t feel the surgery, but timing was a problem, and the blow could cause its own problems. The same applied to pressing on the carotid artery; the person would pass out, but recover quickly, and repeating the process was dangerous.

Surgeons relied on speed and strong helpers. The first to get the procedure over as quickly as possible, the second to hold the patient still.  In the eighteenth century, the record for the fastest amputation at the thigh was nine seconds, start to finish, including sawing through the bone. Are you impressed yet? Even the average, thirty seconds, was pretty damned fast.

Fanny Burney, the English novelist, describes her mastectomy thus:

When the dreadful steel was plunged into the breast … I needed no injunctions not to restrain my cries. I began a scream that lasted unintermittently during the whole time of the incision … so excruciating was the agony … I then felt the Knife [rack]ling against the breast bone – scraping it.

Ether was the first successful general anaesthesia, and it was first used in 1842. Think about that. Just over 170 years, and before that thousands of years of pain when surgery was the only option to save a life (or possibly two, in the case of caesarean section — more about that another time). Chloroform was introduced in 1847, followed closely by the first person to suffer sudden heart failure under anaesthesia. Both ether and chloroform have since been replaced by much safer agents.

And in 1884, came the first use of local anaesthesia — the nerves blocked by cocaine isolated from the coca plant.

We’ve come a long way since.

For more on the history of anaesthetics, see this timeline: