List the ways in which this patient is in danger

What were the factors that influenced the discovery and acceptance of anaesthetics in surgery?

Until the mid-19th century, surgery was extremely painful and dangerous, so major operations were not possible. Surgeons would give patients a drug like opium or try to get them drunk before an operation, but there were no effective anaesthetics.

In 1799 Humphrey Davy discovered that the gas nitrous oxide ('laughing gas') could dull pain and published a pamphlet to bring attention to this. Unfortunately, most surgeons ignored this discovery. Those that did use it found that it did not work on everyone, so the search continued.

The use of ether was pioneered in the USA by Dr Crawford Long in 1842, who used it to remove a tumor from a man’s neck. In October 1846, a Massachusetts dentist William Thomas Green Morton (1815-68), painlessly removed a tumor from a man's jaw, after giving him ether, a gas which had been recently discovered. News of the operation reached Britain very quickly and by the end of the year, several successful operations had been performed

using it. However, ether was an irritant and caused coughing and vomiting in some patients. It was also highly flammable.

Sir Robert Liston was the first British surgeon to use ether for an operation in December 1846.

In 1847 James Simpson, the professor of midwifery at Edinburgh University discovered chloroform, which was quicker acting than ether and didn't appear to have any side effects. By the start of the 20th century it was realized that chloroform could cause liver and heart damage.

Surprisingly, many people opposed the introduction of anaesthetics. Some religious people thought that it was God's intention for

Five surgeons participating in an amputation before anaesthetic

Early operation with anaesthetic

women to feel pain during childbirth. Others worried that surgeons would not have the experience to give the right dose, and people sometimes did die from overdoses of ether and chloroform. It worried other people that they wouldn't know what the surgeon was doing to them while they were unconscious.

The death of Hannah Greener in 1848 from a chloroform overdose provided those who argued against its use with powerful ammunition.

However, little opposition remained after Queen Victoria was given chloroform for the birth of her eighth child Prince Leopold, in 1853 and Princess Beatrice in 1857. In addition, positive press reports did much to combat people’s fears. Chloroform remained the most popular anaesthetic until the 1900s, when it was realised that it could damage the liver.

Think about this:

Discovery is often the result of a chain of experimentation

Royal approval helped bring about the acceptance of anaesthesia

The administration of anaesthesia required expertise.

A device invented by Dr John Snow for inhaling chloroform

Queen Victoria and Prince Albert with some of their children.

'An Operation in 1846' Information SheetThis account describes an operation carried out by Sir Robert Liston on 21

December1846 at University College Hospital, London:  'He then takes from his long

narrow case one of the straight amputating knives of his own invention. It is evidently a favourite instrument, for on the handle are little notches showing the number of times he had used it before. His house Surgeon, Ransome, puts the saw and the artery forceps onto the chair close by, then threads a wisp of well waxed hemp ligature through his own buttonhole

...... the porters are waiting just outside, and the patient (Frederick Churchill, a butler) is carried in on a stretcher and laid on the table..... Liston stands by, trying the edge of his knife against his thumbnail, and the tension increases...

Ransome holds the limb. "Now gentlemen, time me," says Liston to the students.

The huge left hand grasps the thigh, a thrust of the long straight knife, two or three rapid sawing movement(s) and the upper flap (of skin) is made. Half a dozen strokes and Ransome places the limb in the sawdust.

"Twenty - eight seconds!" says William Squires. The femoral artery is tied with two stout ligatures, a strip of wet lint placed between the flaps and the stump raised'.

 

An Operation in 1846

Sir Robert Liston’s operation was the first operation in England to be carried out using anaesthetic. The patient had been put to sleep with ether.

1. Do you think that the patient felt any pain during the operation?

2. Why do you think the surgeon worked so quickly?

3. What sort of equipment did the surgeon use?

4. Why do you think that the amputated leg was placed in sawdust?

James Simpson (1811-1870)

In the early 19th century, patients dreaded surgical operations. Effective anaesthetics were not discovered until 1842, so patients had to endure excruciating pain. In an amputation, the patient would be held down while the surgeon cut through all the soft tissue and bone. The horror of pain forced surgeons to work quickly, often leading to mistakes and a low survival rate. The first successful steps in the conquest of pain were taken by James Simpson.

Who was James Simpson? Simpson was the youngest son of a Scottish village baker. He trained as a doctor and became Professor of Midwifery at Edinburgh University. Simpson wanted to cut down the suffering of his patients in childbirth. He often used ether, but disliked it because of its strong smell which made his patients cough.

How did he become well known? In 1847, Simpson and two assistants experimented with a new anaesthetic, chloroform, which had none of the side effects of ether. Within a month he had used it successfully on over 50 patients.

Was there any opposition to Simpson's ideas? Unfortunately, the use of chloroform was not without risks. Some doctors did not know how to use it properly and in 1848, Hannah Greener, aged 15, died from an overdose of chloroform. There was opposition from those who saw chloroform as unnatural and members of the Calvinist Church of Scotland claimed its use was forbidden in the bible.

Why was chloroform accepted? In 1853 Queen Victoria was successfully anaesthetised during the birth of her eight child. This turned the tide and from then on chloroform became widely accepted. However, its effects sometimes meant that surgeons spent too long on operations and patients could still die from blood loss and infection as more complicated operations were attempted.

What was Simpson's legacy to medicine? Although his name is always mentioned in books as the developer of anaesthetics, chloroform was only used until around 1900 when it was discovered that it could damage the liver. From then on surgeons returned to using ether. Today, surgeons use a complex mix of drugs administered by a qualified anaesthetist. Simpson's use of chloroform helped to gain popular

support for the use of anaesthetics and removed one of the obstacles in the development of safer surgery.

James Simpson and his assistants having

inhaled chloroform

Improvements in 19th Century Surgery

What were the advantages and disadvantages of the following anaesthetics?

Advantages Anaesthetic Disadvantages

Nitrous oxide1799

Ether1842

Chloroform1847

How have operations improved by the end of the 1860s?