Surgery before anesthesia
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.
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 Heys 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.