The Story Of Anaesthesia

Surgeries could evolve tremendously and effectively only after the birth of anaesthesia, says Dr Ushadevi R

In the modern era, the minutest and the innermost part of the human body is accessible and amenable to surgical therapy during safe and reversible anesthesia-induced unconsciousness and/ or paralysis with plain relief. Today, the surgeon at the operating table takes consent from the attending anaesthesiologist to start the surgery. The latter in turn assures that the patient is adequately anesthetised and ensures safety of the patient's vital parameters. The parameters include proper functioning of his brain, heart lungs, both intra, post-operatively in the operation theatre, and in the immediate recovery room.

However, there was a time in the history of mankind when surgery was rare, mostly superficial, brutal and often fatal being done on a screaming, struggling patient with utter disregard to his pain or the welfare of his vital organs. Though there is definite proof that trephining (creating a hole) of the skull was practiced on human beings as early as the Neolithic period of 2000 BC, probably to ward off evil spirits presumed to be the cause of headache and epilepsy, there is no evidence of satisfactory anaesthesia up to the middle of 19th Century at which point of time various attempts of the human race at pain relief surfaced and culminated in the birth of anesthesia.

In medicine, the concept of injecting drugs into a patient could take off only after the early 1850s when Prawaz and Alexander Wood invented hypodermic syringe and hollow needle. Until then, medicine had to be applied externally, taken orally or inhaled in the form of vapours.

The gases - oxygen and nitrous oxide which are used extensively in anaesthesia to this day were discovered by an English clergyman scientist - JB Priestley in the 18th Century. Priestley was later forced to leave England after his home, research material, and books were burnt by an angry mob to punish him for his sympathies for the French revolution. The gas invented by Priestley was named ‘oxygen’ by a French chemist, Levoisier, who showed the role of the gas in respiration. He was soon imprisoned on flimsy charges and guillotined in 1794 AD when Robespierre, President of the tribunal, is said to have remarked - 'The Republic has no need for chemists'.

Diethyl ether or ether, the earliest inhalational anaesthetic agent was definitely known in the 16th Century, having been prepared by Valerius Cordus, a 25-year-old Prussian botonist. However, the potential or nitrous oxide and ether as anesthetic agents for surgery remained unknown and unharvested for centuries.

Nitrous oxide was reputed to be poisonous. But Humphry Davy, an English chemist, used it on animals, men and on himself when he had a toothache, discovered its analgesic property and called it as 'Laughing Gas'. A little later, a young English practitioner called Henry Hilary Hickman tried to create insensibility in animals by carbon-di-oxide inhalation - an original idea but with a wrong gas. He died in an unrecognisable state at the age of 30.

A dentist named Horace Wells tried to demonstrate the use of nitrous oxide for tooth extraction in 1845, but because of his short experience and primitive nature of equipment, he failed . Wells was hooted by the audience. Hurt and frustrated he became an addict. He was later jailed, became insane and committed suicide at the age of 33.

WTG Morton, a partner of Wells, then thought of stronger agent, ether, and gave the first dramatically successful public demonstration of ether as anesthetic agent in Massachusetts General Hospital, Boston, America on October 16, 1846 to remove a tumor painlessly from a patient before a learned audience in a era of non believers. Within a short time, the news of it caught the attention of the whole world. The term anaesthesia meaning insensibility was coined by Oliver Wendell Holmes. A breath taking medical discovery of universal importance created a controversy and rivalry among the people involved. Frustration borne out of frequent quarrels, denial of his claims and financial worries let to Morton's death due to cerebral hemorrhage at the age of 49.

Soon after, a Scottish obstetrician James Simpson, used chloroform on himself and others to induce unconsciousness successfully. His contribution to anaesthesia lies in his hard hitting battle with the obstinate clergy and others who opposed it on religious grounds. Queen Victoria had chloroform administered to her during child birth, resulting anaesthesia gaining respect.

The earliest anaesthetists were surgeons themselves but gradually with the realisation that permanent mental or physical disability and even death could occur due to improper usage of the equipment, techniques or potent drugs paved way for the establishment of the field of Anesthesiology in its own right. Today, this specialty of the 'silent men of medicine' has emerged as a highly skilled one. Ether and chloroform usage is dead and in their place, extremely evolved agents and equipment are available for patient administration, making surgery to grow in leaps and bounds. Trauma, intensive care, pain clinic are some of the extensions of operation theatre which are in-charge of the anaesthetists.

In the Indian scenario though, Sushruta- a renowned ancient Indian surgeon-is quoted world over. Till date, the story of effective anaesthesia began only on March 22, 1847 when ether was used as an agent in the Medical College Hospital, Kolkata. The early anaesthetists were called chloroformists, later they became known as anesthesiologists. A central body - Indian Society of Anaesthesiologists was founded in 1947 to act as network between the specialists all over India. It can thus be seen that surgery, though thousands of years old, could evolve tremendously and effectively only after the birth of anaesthesia about 160 years ago.

The writer is with the Indian Society of Anesthesiologists, Mysore