What Did People Do Before Anesthesia

The Era of Robert Liston and the Importance of Surgical Speed

In the 1830s, Scottish surgeon Robert Liston was renowned for his surgical speed. With medical students restraining the patient and onlookers eagerly awaiting, Liston would swiftly cut through his patient’s flesh, saw through their tibia and fibula, and complete an amputation within just a few minutes. This speed was crucial during a time when anesthesia was not widely used, forcing patients to consciously endure every moment of surgery.

The Quest for Anesthetics

The quest for anesthetics that could induce unconsciousness and enable more meticulous surgeries launched long before Liston. Around 200 CE, Chinese physician Hua Tuo described mixing alcohol with a powder of various ingredients to anesthetize patients. In the 13th century, Arab surgeon Ibn al-Quff described patients taking anesthetics, likely inhaling drugs like cannabis, opium, and mandrake, from saturated sponges.

The Advent of Nitrous Oxide, Ether, and Chloroform

By the end of the 1700s, many scientists were pondering chemistry’s medical applications. This led to a profusion of anesthetic advancements involving three main players: nitrous oxide, ether, and chloroform. In 1799, English chemist Humphry Davy began experimenting with nitrous oxide, or laughing gas, inhaling it himself and observing its effects on friends. Davy noted that its pain-relieving abilities might make it useful for surgical operations, but it would be decades before that happened. This was, at least in part, because some surgeons and patients were skeptical of the effectiveness and safety of anesthetic drugs.

Early Successes and Setbacks of Anesthetics

In 1804, Japanese surgeon Seishū Hanaoka successfully removed a breast tumor from a patient anesthetized with a mix of medicinal herbs. However, the news stayed in Japan indefinitely. Meanwhile, ether started garnering medical attention. It was first formulated centuries before then came to be used recreationally. During the so-called “ether frolics” of the early 1800s, an American physician noted that the fall he suffered while using ether was painless. In 1842, he etherized a patient and successfully removed a tumor from his neck.

The Rise and Fall of Chloroform

Scottish obstetrician James Simpson heard about an alternative anesthetic called chloroform. In 1847, he and two colleagues decided to try some themselves and promptly passed out. Soon after, Simpson administered chloroform to one of his patients during childbirth. It quickly gained popularity because it was fast-acting and thought to be side-effect-free, though we now know it’s harmful and probably carcinogenic. Chloroform came to be understood as a riskier, more toxic option and fell out of favor by the early 1900s.

Discrimination in Anesthesia Administration

Because anesthetics weren’t yet fully understood, they sometimes had lethal consequences. And some doctors held sexist and racist beliefs that dictated the amount of anesthesia they’d provide if any at all. American obstetrician Charles Meigs argued that the pain of childbirth was a form of divine suffering and was skeptical that doctors should interfere with it. Throughout the 1840s, American physician James Marion Sims conducted experimental gynecological surgeries without pain relief, primarily upon enslaved Black women.

The Evolution of Anesthetics

By the late 19th century, those who could access anesthetics were undergoing increasingly complex operations, including some that were previously impossible. Alongside newer drugs, ether and nitrous oxide are still used today, but in modified formulations that are safer and produce fewer side effects, while doctors closely monitor the patient’s state. Thanks to these advances, speed is not always of the essence and, instead of acute agony, surgery can feel like just a dream.