I 00 YEARS OF ANAESTHETICS
By OUR MEDICAL CORRESPONDENT
EVERY major discovery in medicine, as in most of the arts and sciences, has had its various tributaries. Observations and experiments—sometimes made long before and almost forgotten —discoveries in other and apparently quite unrelated fields have all contributed ; and this is true of anaesthesia. The relief of pain and the production of artificial sleep by the use of drugs, " poppy and mandragora," have a legendary past both in Europe and Asia. But if they were employed to alleviate suffering due to wounds or surgical operations, it was only sporadically. The vast majority of our forebears had to endure ordeals without their aid, such as it may have been. And it would be substantially true to say that anaesthesia, in the modern sense of the word—which was coined by Oliver Wendell Holmes—was the gift to humanity of America, and that the year of its advent was 1846.
Earlier than that, in 1799, Humphrey Davey in England had noted the temporary pain-destroying effects of inhaled nitrous oxide or laughing gas, and Michael Faraday, in 1815, had made similar observations in respect of ether. But neither of these great men seems to have envisaged, or at any rate followed up, the prospects thus suggested in the field of surgery. It was not until some years later that an obscure Shropshire doctor, Henry Hickman, of Ludlow, made such a suggestion. In publishing the results of some ex- periments he had made of inducing temporary unconsciousness in animals by means of the inhalation of carbon dioxide and nitrous oxide gases, he pointed out what seemed to him the implied possi- bilities for human surgery. But his work met with no response.
Then, in 1842, a country doctor in America, Crawford Long,
actually removed without pain a tumour from a boy patient to whom he had administered ether. But Crawford Long, although he did several more such operations, did not publish his results—either through caution or his distance from any medical centre or because he had not fully realised their import—till the year 1849. Mean- while, a Connecticut dentist, Horace Wells, in 1844 successfully and painlessly removed a tooth under nitrous oxide. But a public demonstration of his technique failed, and he became both dis- credited and disheartened. His partner, William Thomas Morton, however, who had moved to Boston, continued to explore the possi- bilities of pain-abolition in dentistry, and, on the suggestion of Dr. Charles Jackson, turned his attention to ether. Trials on him- self and a patient were so satisfactory that he persuaded Dr. J. C. Warren, a surgeon at Massachusetts General Hospital, to let him demonstrate his method at an operation in the presence of the local doctors. This took place in October, 1846, and Morton was Impressively successful. A month later Warren did an amputation under the new anaesthetic, and it was then manifest that another era in surgery had begun.
Unfortunately, Morton, who was not himself a qualified medical nun, tried to keep his agent a secret and to ensure it by a patent. To the medical men of America this was subversive of all their accepted ethics, and it was soon made evident that the operative factor was • just ether. Then there followed a rather sordid and
never finally resolved argument about priority. But while the laurels were in dispute the news of what had happened had spread across the world. Before the end of the year, Robert Liston, the great Scottish surgeon—still commemorated in the splint that bears his name—had performed the first major operation under an anaesthetic in England, at University College Hospital, London, the future Lord Lister being present as a nineteen-year-old student.
Looking back, one finds it hard to realise that anaesthesia, as we know it today, is only just a century old. It is still more difficult to understand the battles that had yet to be fought for its full
acceptance, at any rate in this country. In these the chief protagonist was James Young Simpson, or " Jamie " as he was affectionately— though in some cases rather acidly—referred to in Edinburgh. And it would have been difficult to find a more doughty apostle. Born in a little four-roomed baker's premises at Bathgate, on the Edinburgh-Glasgow road, he was the youngest of a family of eight, of whom six were still living ; and the total financial resources of the family at the time of his birth were eight shillings and ninepence. But thanks to the self-sacrificing devotion of the family, his own fidelity to them, genius and unconquerable determination, he had battled his way, by the age of twenty-one, to the degree of M.D. of Edinburgh University. At the age of twenty-nine, after an embittered contest—in which his youth and lowly origin were among the trump cards of his opponents—he was elected, by a majority of one vote, to the University Chair of Midwifery ; and by 1846, at the age of thirty-five, he had become the leading gynaecologist and accoucheur in Scotland, if not in the British Isles, and had just been appointed physician to Queen Victoria in Scotland. " But I am far less interested in it," he wrote to his brother Sandy, " than in having delivered a woman this week without pain when inhaling sulphuric ether."
Ether, however, was in many ways unsuitable for Simpson's particular work, and it was this that led him, after various inquiries and experiments, to the adoption of chloroform, in the use of which, both as an anaesthetic for general surgery and in childbirth, he was the pioneer. His first pamphlet describing his results sold in tens of thousands, and it was then that the opposition began to rear its head. Pain was defended as a tonic. The inducing of artificial unconsciousness was described as an unwarrantable assault on man's diviner part. Above all, " Jamie " was written and thundered against in Press and pulpit for interfering in childbirth with the primal curse, whereby it had been ordained that women should bring forth children in sorrow. But he was more than a match for his assailants. To recalcitrant doctors he pointed out that anaesthesia had already reduced the mortality due to amputations by a third. To the theologians—himself a stalwart Free Churchman—he suggested that the Hebrew word for sorrow did not mean pain ; and anyway the primal curse, if there had been one, had occurred under the old dispensation, Which had been succeeded by another. To perform an operation without an anaesthetic would, in future, he declaimed, be " a piece of deliberate and cold-blooded cruelty." And when, a few years later, it became known that Queen Victoria had received chloroform at the birth of Prince Leopold, it was generally recognised that the battle had been won.
In its own technical sphere there were, of course, controversies to come as to the relative merits of this or that agent. For a very long time—and naturally far longer in Scotland—chloroform held the field against ether, because of the convenience with which it could be administered and because it was perhaps 'more pleasant for the patient. But the popularity of ether, alone or in various combinations, was destined, partly on account of its greater safety, gradually to wax again. Nitrous oxide, often in combination with oxygen, was to be revived and become the most widely used general anaesthetic in dentistry. And as well as the large number of ways of inducing local anaesthesia while preserving general consciousness, rivals have recently entered the field in the shape of drugs that can produce almost instant general anaesthesia when injected into a vein,
Of the major discoveries of the nineteenth century, anaesthesia and antisepsis (including asepsis), it is perhaps arguable which has been the greater boon to mankind. But on a general, and not merely a professional, vote there is probably little doubt which would be the winner.
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