Surgery- Anaesthetics and Antiseptics

Surgery in the early 19th century is dangerous and painful. There is no way to relieve the pain felt by patients during operations. Surgeons do not yet know how to control blood loss or infection, and operating theatres are dirty and dangerous places to be. Some surgeons superstitiously prefer to wear their ‘lucky’ coat in the operating theatre – a coat worn during a successful operation in the past. They do not wash their ‘lucky’ coat between operations in case this breaks their run of luck. The operating table is often blood-stained.

The ? oor around it is sprinkled with sawdust to stop the surgeon from slipping on blood and other waste as he speeds around the table, carrying out his operation at breakneck speed! Surgery is usually a last resort, and the most common operations are amputations, which can be completed quickly. Robert Liston amputated a leg in two and a half minutes. Unfortunately, such was his haste that he cut off the patient’s testicles as well. Patients are lucky to survive operations without any harmful side effects. After Modern operating theatres are clean and safe.

State-of-the-art equipment helps surgeons to perform delicate and intricate operations using techniques like keyhole surgery. Some surgeons are experimenting with robotic parts to help them carry out operations. Hightechnology scanners enable surgeons to probe deep inside parts of the body. Surgeons today can carry out operations that could only have been dreamt of 40 to 50 years ago. Although the ? rst human heart transplant only took place in 1967, heart transplants are carried out quite frequently now. Transplants of other body organs are common.

Many people agree to donate their organs when they die so that they can be used for transplants, helping other people to recover from illness and to stay alive. Some medical scientists hope that it will become possible to clone human organs for transplants. The problem of pain Surgeons had long had to face the problems of pain, infection and bleeding. This was still true in the early 19th century. There were no effective anaesthetics. To help numb the pain during an operation, surgeons gave their patients drugs like opium and mandrake, or tried to get them drunk.

A few surgeons used ‘mesmerism’ (hypnosis), hoping this would lead the patient to ignore the pain. Surgery had to be quick. Deep internal operations were out of the question. Most surgery was limited to removing growths or amputating limbs. Even so, many patients died from the trauma of the excruciating pain. During the late 18th century the science of chemistry had made some progress. In 1772 Joseph Priestley (1733–1804), an English chemist, discovered that oxygen was a gas. Other chemists were also investigating the properties of different substances.

In 1799 Humphrey Davy (1778–1829) discovered that pain could be relieved by inhaling nitrous oxide (‘laughing gas’). He wrote a pamphlet saying that nitrous oxide might be successfully used by surgeons as an anaesthetic. The medical profession ignored his suggestion. Early successes During the early 1840s a number of experiments were made to find an effective anaesthetic. In 1842 an American doctor, Crawford Long, found that ether was a useful anaesthetic, but he did not publicly announce his discovery.

On 10 December 1845 an American dentist, Horace Wells (1815–48), watched people inhaling nitrous oxide as an amusement at a fair. He noticed that, under the infl uence of the gas, they could injure themselves and feel no pain. The next day, Wells had a tooth painlessly taken out after inhaling the gas. He tried to demonstrate painless tooth extraction to some medical students at a hospital in Boston, USA. What he did not know was that some people are not affected by nitrous oxide. Wells’ volunteer yelled as the tooth was taken out and the students left the demonstration shouting ‘Humbug! Humbug!

’On 16 October 1846 William Thomas Green Morton (1819–68) persuaded John Warren, the head surgeon at Boston Hospital, to carry out an operation in public, using ether as an anaesthetic. Morton gave the ether through an inhaler to the patient, Gilbert Abbott. Then Warren removed a tumour painlessly from Abbott’s neck. Warren turned to his audience and announced, ‘Gentlemen, this is no humbug! ’News of Warren’s success spread quickly to Europe. By 18 October, Dr Bigelow, who had seen the operation, had published an article about it. On 3 December a steamship carried a letter from Bigelow to Dr Boot in London.

By 19 December Dr Boot had extracted a tooth using ether – and had written an article about this. On 21 December the surgeon Robert Liston successfully amputated the leg of Frederick Churchill (a butler), using ether as an anaesthetic. Liston removed the leg in 26 seconds! With the leg already on the floor, Churchill raised his head and asked Liston when he was going to begin the operation. James simpson and chloroform James Young Simpson (1811–70), Professor of Midwifery at Edinburgh University, wanted to fi nd something to relieve women’s pain during childbirth.

He disliked ether because it was flammable, had a pungent smell and irritated the lungs when it was inhaled, making the patient cough. He began to test the effects of different chemicals. On 4 November 1847 Simpson and two other doctors discovered the effects of chloroform. Simpson found chloroform easier to administer than ether. Less of it was needed and it appeared to take effect more quickly. By the end of November 1847 he had given chloroform to more than 50 patients and he declared himself pleased with the outcome.

Opposition to anaesthetics The first anaesthetics meant painless operations, but they were not welcomed by everyone. • Some people worried that surgeons were inexperienced in using the anaesthetics, and therefore unsure about the correct amount to give and about any side effects the drugs could have. There were even instances of explosions in operating theatres caused by the use of ether. Such fears appeared to be realised when, in 1848, 15-year-old Hannah Green died from an overdose of chloroform. Deaths also occurred from the overuse of ether.

• Members of the Calvinist Church in Scotland were outraged at the use of chloroform in childbirth. They pointed to the book of Genesis in the Bible, where God says to Eve: ‘In sorrow shalt thou bring forth children. ’ To them, this meant that God intended women to bear pain when giving birth. • Some people worried that anaesthetics placed patients under the total control of the surgeons. What if a surgeon did something against the patient’s will? • In the army, some officers regarded the use of anaesthetics as ‘soft’.

In 1854 John Hall, Chief of Medical Staff in the Crimea, told his team of doctors: ‘A good hand on the knife is stimulating. It is much better to hear a fellow shouting with all his might than to see him sink quietly into his grave. ’ The royal seal of approval Some of the opposition to anaesthetics disappeared after Queen Victoria was given chloroform during the birth of her eighth child, Prince Leopold, on 7 April 1853. The anaesthetist was Dr John Snow (1813–58), who later did vital research into cholera. The Queen wrote in her journal that chloroform was ‘soothing, quietening and delightful beyond measure.

’ As a result of her experience, chloroform became socially more acceptable. It became the most popular anaesthetic until about 1900, when it was realised that it could damage the liver. Surgeons then returned to using ether. Anaesthetics from the late 19th century to the present day Anaesthetics became accepted but problems remained in using them. Massive amounts were often needed, not to prevent pain, but to relax the muscles. Patients became saturated and slept for hours, even days. Recovery was slow and there were frequent complications.

From the end of the 19th century, anaesthetists became specialists. New substances were discovered and put into use. In 1884 cocaine was first used as a local anaesthetic, numbing one part of the body while the patient remained conscious. In Germany, in 1905, novocaine was proved to be more effective than cocaine. In 1942 curare, a South American poison, was frst used as a muscle relaxant during operations; it remains in use today. A skilled anaesthetist is now a crucial member of every surgical team, responsible for monitoring the patient’s well-being during operations.

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