Before anesthesia was a thing

In the 1830s, the surgical theater witnessed a remarkable spectacle as Scottish surgeon Robert Liston prepared to enact a swift and efficient amputation. With medical students poised to assist and onlookers curious to witness, Liston initiated a rapid sequence of movements. The patient's flesh yielded to his blade, and in quick succession, he sawed through the tibia and fibula. In a matter of minutes, the amputation was concluded. Yet, this was an era when surgical interventions were a symphony of suffering, for anesthesia was not yet a ubiquitous ally in the operating room. Patients bore the torment of surgery with consciousness, acutely aware of each cut and sensation. The quest for anesthetics capable of inducing a state of unconsciousness and facilitating meticulous procedures had commenced long before Liston's swift endeavors.

The pursuit of anesthetics that could offer respite from the agony of surgical procedures has a rich historical tapestry, woven across different cultures and eras. As early as 200 CE, Chinese physician Hua Tuo experimented with a blend of alcohol and powdered ingredients to induce anesthesia in patients. Centuries later, in the 13th century, Arab surgeon Ibn al-Quff described patients inhaling anesthetics, likely substances such as cannabis, opium, and mandrake, emanating from saturated sponges. The 18th century witnessed a burgeoning interest in the medical applications of chemistry, kindling a series of advancements in the realm of anesthesia, with three key contenders emerging: nitrous oxide, ether, and chloroform.

In 1799, English chemist Humphry Davy embarked on experiments involving nitrous oxide, colloquially known as laughing gas. Davy ventured to inhale the gas himself and observe its effects on companions. He postulated that its potential to alleviate pain might render it invaluable in surgical contexts. Nevertheless, the full integration of anesthetics into surgical practice was a gradual process, partly owing to reservations harbored by some surgeons and patients concerning the efficacy and safety of these newly emerging pharmacological agents.

An early demonstration of successful anesthesia was recorded in 1804 by Japanese surgeon Seishū Hanaoka, who employed a mixture of medicinal herbs to anesthetize a patient during the removal of a breast tumor. Regrettably, this achievement remained confined within the borders of Japan. Subsequently, ether emerged as a promising candidate, initially formulated centuries before its recreational use became known. The early 1800s witnessed a period known as the "ether frolics," during which an American physician experienced a fall while under the influence of ether and noted the absence of pain. By 1842, ether was utilized in a surgical context when a tumor was successfully excised from a patient's neck under its influence.

In parallel, dentists recognized the potential of nitrous oxide, and despite a setback in 1845 when a patient anesthetized with nitrous oxide screamed during a public tooth extraction, its significance began to be acknowledged. Ether underwent further refinement for dental procedures, culminating in October 1846, when an American dentist facilitated the removal of a neck tumor from an etherized patient, marking a watershed moment. This trend continued with remarkable successes across India, Russia, and beyond. However, ether's journey was not without challenges, including undesirable side effects that dampened its appeal.

The medical community soon became intrigued by another contender: chloroform. Scottish obstetrician James Simpson's curiosity led him to experiment with chloroform in 1847, leading to a surprising outcome when he, along with two colleagues, inadvertently lost consciousness. Subsequently, Simpson administered chloroform during childbirth, and its rapid onset and seemingly minimal side effects catapulted it to prominence. However, our contemporary understanding reveals its harmful and potentially carcinogenic nature.

Amidst these breakthroughs, the understanding of anesthetics remained incomplete, and this lack of comprehension sometimes resulted in fatal consequences. Regrettably, some practitioners held prejudiced beliefs that dictated the provision, or lack thereof, of anesthesia, often influenced by sexist and racist attitudes. For instance, American obstetrician Charles Meigs argued that the pain of childbirth was a divine form of suffering and resisted the notion of medical intervention. Additionally, during the 1840s, American physician James Marion Sims conducted gynecological surgeries on enslaved Black women without pain relief, illuminating a grim chapter in medical history.

By the late 19th century, those fortunate enough to access anesthetics could undergo intricate surgical procedures that were previously inconceivable. Chloroform, while effective, was deemed increasingly risky and toxic, ultimately falling out of favor in the early 1900s. Ether and nitrous oxide, in refined formulations with minimized side effects, still find application today. The meticulous monitoring of a patient's condition allows for surgical procedures that emphasize precision over rapidity, rendering surgery a dreamlike experience rather than a tormenting ordeal. The historical trajectory of anesthetics encapsulates the progression of medical knowledge, societal attitudes, and technological innovation, culminating in a reality where surgery can be a controlled and compassionate process, sparing patients the anguish that once defined the operating room.