The History of Anaesthesia!

Recently I undertook some work experience at Leicester Royal Infirmary, where I learned about the roles and duties of not just doctors, but also of the many people that make up a surgical team, and those who accompany consultants in their work. On the first day, I remember the consultant anaesthetist I was shadowing in the MRI scanning unit was very enthusiastic about the field he works in. In fact he was so committed to informing me what exactly anaesthesia is, he gave me a two hour lecture on the history of anaesthesia! After all, MRI scans can take unto 40 minutes which left us plenty of time to discuss aspects of medicine and indeed how anaesthetics came about in today's medical world. I must admit, it was very interesting and I thought it would be fitting to talk a bit more about it here.

Well, fundamentally we need to understand what exactly is an anaesthetic. General anaesthetics are 'medications used to cause a loss of consciousness' according to NHS Choices. It is widely accepted that these drugs interrupt the transmission of signals along the nerves of the body. This explains why during surgery, the presence of an endotracheal tube in the throat fails to initiate a 'chocking' reflex by the patient. Anaesthetic drugs can by administered in one of two main ways: intravenously in a liquid (through a cannula), or as a vapour through a breathing mask. It is generally known that using a needle and giving the anaesthetic by injection is a lot quicker and 'smoother'. However using the vapour is a very suitable option if one is not comfortable around needles or the idea of injection.

In today's medical world, anaesthetists have access to quite a diverse array of anaesthetic drugs such as desflurane and isoflurane (in combination with nitrous oxide). Conversely in the 17th century, between 1835 and 1845, there was evidence that people attempted to use anaesthetic agents. Despite these formulations, these drugs didn't have a significant effect on the medical field at that time. Back then, it was William Morton who administered the first anaesthetic made of ether - this was a medical breakthrough. The patient, Gilbert Abbott received the anaesthetic on the 16th October 1846, for treatment of his jaw where a lump needed to be surgically removed. This took place in the Massachusetts General Hospital, in Boston. After this pivotal event, ether anaesthetics were increasingly becoming used in hospitals for surgeries including amputation and tooth extraction. For surgeons at least, this new revolution was considered a step forward. In those times, the diversity of surgery was quite limited compared to what it is today. Previously, operating on the head for example was especially avoided. Patients were conscious after all, awake if you like. Strapped down to the table, it was known many would faint at knowing their leg would simply be cut off, or at the sight of a newly sharpened knife. I'd like to share one of the terrible stories of early surgery that was originally published in the New York Herald, 21st July 1841. I managed to find this excerpt from The Royal College of Anaesthetists webiste.

"The case was an interesting one of a white swelling, for which the thigh was to be amputated. The patient was a youth of about fifteen, pale, thin but calm and firm. One Professor felt for the femoral artery, had the leg held up for a few moment to ensure the saving of blood, the compress part of the tourniquet was placed upon the artery and the leg held up by an assistant. The white swelling was fearful, frightful. A little wine was given to the lad; he was pale but resolute; his Father supported his head and left hand. A second Professor took the long, glittering knife, felt for the bone, thrust in the knife carefully but rapidly. The boy screamed terribly; the tears went down the Father’s cheeks. The first cut from the inside was completed, and the bloody blade of the knife issued from the quivering wound, the blood flowed by the pint, the sight was sickening; the screams terrific; the operator calm."


Reading this re-emphasises for me how fortunate we are to have access to anaesthetic drugs for surgery - especially very invasive ones. To great appreciation of the surgeon, they could afford to be more accurate, precise and careful when performing operations to get the optimum result. Now the 'doors were opened' to many other parts of the body such as the brain that could now be safely operated on. But surgery improved not only with anaesthetics, but with the introduction of sterile surgery catalysed by Joseph Lister in the 1860's. Lister used methods of cleaning and dressing wounds with a solution of carbolic acid which saw a decrease in patients suffering gangrene post-surgery. Even the idea of surgeons wearing clean gloves was down to Lister as well as the sterilisation of surgical instruments, much like today. 
A year later after the introduction of ether anaesthetics, different agents that could be inhaled were formulated - one example being Chloroform. This was first used by James Simpson, Professor of Obstetrics in Edinburgh. However there were a few known flaws of this particular agents. One surprising effect was that usually in very nervous patients, sudden death could occur (1848 saw the first events). Another was that it could induce late-onset liver damage. Despite this, it proved quite popular due to it's ease of use and effectiveness. 
Soon enough, many different anaesthetic agents were being used, even cocaine became useful as a local anaesthetic from 1877! By the early 1900's, minimally toxic anaesthetic drugs were being used.
It is important to realise however that anaesthesia doesn't just pay attention to the drug that is given to a patient. Whilst on my work experience, I learned that the anaesthetist in the theatre has a very important duty to monitor the patient's holistic condition: their breathing and if they are experiencing any pain are two main examples. Endotracheal tubes that could be placed into the mouth and descend into the windpipe was the next invention that would become increasingly used in the 1920's and 1930's when the techniques became perfected. Furthermore, you may be surprised to hear that intravenous methods of delivering anaesthetic didn't come about until the 1930's - this helped deliver the drug smoother and quicker, as well as being more pleasant for those who detested the more traditional inhalation agents. Even more progression came about when muscle relaxants such as curare (actually a poison!) became more and more useful over the course of the 1940's and 1950's. Despite all these advancements, what anaesthetic that is considered in today's world a revolution is halothane. Apparently much easier to use and therefore more practical, it is probably the most widely used category of anaesthetic. Since the mid-1950's, this group of agents have improved in potency and become safer after years of refinement. 
With the probability of mortality of less than 1 in 250,000 from taking an anaesthetic, it is comforting to patients that anaesthesia in the modern age is considered very safe. This is indeed one area of medicine that I have become so interested in recently - reading about it's history is especially useful as well as knowing how it has evolved as a field over the last 150 years. 


More information on what anaesthesia is can be found on the NHS Choices website here.


Full credit is given to Dr D J Wilkinson, past honorary treasurer of The Royal College of Anaesthetists who gave permission for an article to be published on The Royal College of Anaesthetists website titled "The History of Anaesthesia". To read in more detail about what I have talked about, you can see the original text here.