Surgery before anesthesia
by John T. Sullivan, MD MGH anesthesiology resident

Elective surgery was performed very infrequently prior to the advent of effective anesthesia. From 1821 to 1846, the annual reports of the MGH recorded 333 surgeries, representing barely more than one case per month. Surgery was a last and desperate resort. Reminiscing in 1897 about preanesthesia surgery, one elderly Boston physician could only compare it to the Spanish Inquisition. He recalled “yells and screams, most horrible in my memory now, after an interval of so many years.” Over the centuries, numerous techniques had been used to dull sensation for surgery. Soporifics [sleep-inducing and awareness-dulling agents] and narcotics were prepared from a wide range of plants, including marijuana, belladonna and jimsonweed. Healers attempted to induce a psychological state of anesthesia by mesmerism or hypnosis. Distraction could be provided by rubbing the patient with counterirritants such as stinging nettles. A direct but crude way of inducing a state of insensitivity was to knock the patient unconscious with a blow to the jaw. But by 1846, “opium and alcohol were the only agents which continued to be regarded as of practical value in diminishing the pain of operations.” Unfortunately, the large doses of alcohol needed to produce stupefaction were likely to cause nausea, vomiting and death instead of sleep. Opium, while a strong analgesic, had significant side effects itself and was typically not powerful enough to completely blunt a surgical stimulus.

The fact that a half century passed between the discovery of the anesthetic effects of the inhalational drugs and their widespread clinical use is remarkable and tragic. The accounts and recollections of surgery before the days of effective anesthesia are gruesome. Remarkably, they were reality only a few generations ago. Today, it is easy to forget the burden of surgical pain. On this 150th anniversary of the first public demonstration of anesthesia, we can reflect proudly on the achievement of Morton and others like him who have advanced the art and science of [anesthesiology]. l

The Hey’s saw, used to make an aperture in the skull to relieve pressure on the brain, was a stock item in most surgical field kits for years before the advent of effective anesthesia.

"Surgery before anesthesia" was excerpted with permission from the American Society of Anesthesiologists newsletter, Sptember, 1996, Vol. 60, No. 9, Pages 8-10.