Pain, a Burden to be Borne

In the 1800s, most people expected to experience pain in their lives and relied on religion or personal fortitude to help them endure it. Pain was one of God's punishments for the wicked and purifying trials for the good; for the woman in labor, pain was the spiritual experience that would transform her into a self-sacrificing mother. Many doctors shared these views! Other physicians were concerned about the ethics of operating on a comatose patient and many were concerned about the potential risk of death from an overdose of anesthetic.

Nitrous Oxide

Humphrey Davy (1778-1829) suggested that the pain and shock of surgical operations might be relieved if patients inhaled nitrous oxide, a gaseous compound discovered by Joseph Priestly (who was also the first to isolate oxygen).

Ether

	Recipe for toothache using ether from a manuscript book of recipes and prescription, c. 1800

Ether, whose starting materials are sulfuric acid and alcohol, had long been known. It was used as a sedative in the treatment of tuberculosis, asthma and whooping cough, and as a remedy for toothache. Its anesthetic potential had never been exploited.

William Thomas Green Morton
Morton was a dentist receptive to new ideas. He became intrigued when he heard of a recipe including ether that relieved toothaches.

The Demonstration of Surgical Anesthesia

	William T.G. Morton (From: The Semi-Centennial of Anesthesia. Boston, 1897)

In 1846, William T. G. Morton (1819-1868) revolutionized surgery and medical practice with his demonstration of surgery under ether anesthesia at the Massachusetts General Hospital. Although many scientists had experimented with anesthetic compounds such as ether and nitrous oxide, only Morton and a few others had tried these drugs in clinical practice.The use of anesthesia enabled surgeons to develop finer skills and life-saving procedures. But the practice became common only gradually: many physicians were accustomed to relying on "the healing power of pain" and were wary of the ethics of operating on an insensate patient.

James Young Simpson

	James Young Simpson

James Young Simpson (1811-1870), a Professor of Midwifery at Edinburgh wanted to find an alternative to ether ". . . in order to avoid, if possible, some of the inconveniences and objections pertained to sulphuric ether, - (particularly its disagreeable and very persistent smell. . . and the large quantity of it occasionally required to be used, more especially in protracted cases of labour.)"

Simpson experimented with various compounds and found chloroform to be efficacious and reasonably safe. He began using it to relieve the pains of childbirth and incurred the wrath of those holding to the Biblical view that "In sorrow thou shalt bring forth children." After Queen Victoria chose to be anesthetized in 1853 for the birth of Prince Leopold and again in 1857 for the birth of Princess Beatrice, however, the practice became common among the upper and middle classes.

	Anesthetic apparatus

	Operating room used at Johns Hopkins from 1892 to 1927.

By the 1880s anesthesia, with aseptic technique, was standard practice in American and European surgical theaters. Middle-class patients, used to receiving medical care at home, found themselves seeking admission to hospitals for operations; hospitals were transformed from charitable asylums for the poor into consumer-oriented service institutions. While the surgeon's prestige and power soared, the anesthetist was a mere assistant-a nurse, intern or medical student. The development of the independent medical specialty of anesthesiology would not occur until the early 20th century.