Surgery: Anesthesia and Ether Surgical operations have been performed since before the Neolithic age, and

4.3.1 Surgery: Anesthesia and Ether Surgical operations have been performed since before the Neolithic age, and

involved the endurance of excruciating pain in exchange for the chance of recovery.

132 CHAPTER 4 HEALTH, REPRODUCTION

Many surgical instruments were invented and recorded in history to perform such early tasks as the removal of tumors, defective organs or foreign bodies such as arrows; and the repair of broken parts such as bone fractures. More modern surgical instruments have been developed to unblock blood vessels and to transplant or replace joints, kidneys, and hearts.

Advances in surgery would not have been possible without the development of the field of anesthesia. Early on, the problem of alleviating the pain of surgery was accomplished by the use of plants such as hemlock, mandrake, or the opium poppy. Whisky, hypnotism, and acupuncture were also used for surgery or child- birth. In 1799, Humphry Davy published a book about the properties of the recently discovered gas nitrous oxide, to which he gave the name “laughing gas.” He found that he could make himself unconscious by inhaling nitrous oxide vapor, and sug- gested that it could be used to block pain in surgery. Many of his society friends allowed themselves to be tested as intoxicated human guinea pigs, including such luminary poets as Samuel Taylor Coleridge and Robert Southey. Davy’s apprentice, Michael Faraday, published similar observations in 1818 concerning the effects of sulfuric ether. During the first half of the nineteenth century, nitrous oxide and ether were widely used for recreation by stylish British and American partygoers. A flask of ether or a bag of nitrous oxide could provide exhilaration, emotional release, and unconsciousness. Despite the efforts of Davy and Faraday, the use of laughing gas or ether for easing pain in surgery did not come into common use in clinical practice for many more decades.

Crawford Long was a country doctor in Georgia who had access to ether. He and his friends participated in ether-driven frolics in which they banged into things but did not notice any pain, bruising, or scrapes until the ether had worn off. Long realized the potential of ether for surgical pain. He first tried using the ether thera- peutically before operating on his friend James Venable to remove a neck tumor in 1842. He poured ether on a towel, had his friend breathe the fumes till he appeared insensible, then excised the tumor. Venable awoke a few minutes later having felt no pain. Incredibly, despite this success, Long did not publish a paper on his ether trial till 1849, and apparently never used it again. So he was the first to use ether for surgical pain, but by not sharing his findings right away, his work did not change the world of surgery.

Horace Wells was a dentist in Hartford, Connecticut who attended a travel- ing nitrous oxide show and noticed that an injured audience member appeared to have no pain while under its influence. In 1844, Wells himself inhaled nitrous oxide from a leather bag till he nodded off, during which time his student removed his sore wisdom tooth. When he awoke a few minutes later he was elated. He asked his former student William Morton to approach John Warren, the head of surgery at Massachusetts General Hospital in Boston, about perform- ing a demonstration with the nitrous oxide. Warren approved a public lecture and demonstration in January 1845. Wells administered what he thought would

be an adequate dose of nitrous oxide and proceeded to extract the tooth. How- ever, as the tooth came free, the young man groaned and cried out. The audience laughed and jeered with shouts of “Humbug!” The demonstration was not deemed a success.

133 Undaunted after Wells’ failed demonstration, Morton continued to experi-

4.3 THERAPY

ment. He consulted with Charles Jackson, a Harvard Medical School graduate, who apparently suggested that ether would be easier to administer in liquid form. Warren was willing to try again, and scheduled a second demonstration on October 16, 1846 at the Massachusetts General Hospital. Morton poured ether onto a young man with a tumor in his neck and jaw, and within a few minutes the young man was deeply asleep. Morton stepped aside and Warren operated with speed during which time the patient did not stir. When the operation was over, Warren turned to the audience and announced “Gentlemen, this is no Humbug.” The operating room at the Massachusetts General Hospital is named the “Ether Dome” in honor of this historic event. After that the use of ether for anesthesia spread with amazing speed. Oddly, there were initial objections to its use in childbirth, as some felt that God had cursed Eve with labor pains as punishment for eating the forbidden fruit: “In sorrow thou shalt bring forth children.” However when Queen Victoria herself used ether for her delivery, it silenced many opponents.

The field of modern anesthesia is divided between central nervous system depressants that induce unconsciousness, such as ether and halothane; and local anesthetics such as lidocaine, which work on a limited area of tissue such as a tooth or a finger, while the patient remains awake. Anesthetics act by blocking the signal of pain generated at nerve endings from reaching the brain. There is frequently a narrow margin between a dosage high enough to stop pain, yet low enough to avoid severe damage or death. Because of this, malpractice insurance for anesthesiologists in the United States has become very expensive. Anesthesi- ologists must be highly trained physicians, and have to carry very high insurance against malpractice suits.