The History of Anesthesia

The history of anesthesia is really the history of humanity's struggle with pain.

Today a patient facing an operation usually worries about the outcome. Two hundred years ago, what people feared was the operation itself.

Because having surgery often meant enduring pain beyond bearing.

Before modern anesthesia, surgery had two great enemies: pain and infection.

Setting aside the patients lost to infection, many went into shock from the pain they experienced during the operation, and some died before the surgery could be completed.

This is why the successful surgeons of that era were often known as the fastest surgeons. Success depended not only on the surgeon's skill, but on how long the patient could endure.

How did people try to reduce pain?

In the centuries before anesthesia, people tried many different methods.

Alcohol, opium, cannabis derivatives and various herbal mixtures were used for hundreds of years.

None of them provided anesthesia in the modern sense. The patient might feel less pain, but they were conscious during the operation and usually remembered it.

For anesthesia in the real sense to appear, chemistry and physiology would first have to develop.

Laughing gas and a failed demonstration

One of the more interesting characters in the story of modern anesthesia is the American dentist Horace Wells.

In 1844 Wells realised that nitrous oxide — the gas commonly known as laughing gas — could reduce pain. He believed the discovery would change medicine.

To show this, he arranged a live demonstration at one of the leading medical centres of the day.

Things did not go as he had planned. The patient was not sufficiently numbed and felt pain during the procedure, and the audience judged the demonstration a failure.

Some even shouted "Humbug!"

An idea now regarded as one of the turning points in the history of anesthesia looked, that day, like a complete failure.

The day modern anesthesia was born

The date regarded as the turning point in medical history is 16 October 1846.

The American dentist William T. G. Morton successfully administered general anesthesia to a patient using ether. The patient felt no pain during the operation.

That demonstration was not merely the introduction of a new drug. It was the birth of modern surgery.

Surgeons could now perform, carefully and methodically, procedures they had previously been forced to finish within minutes. Organ surgery, major tumour operations and more complex procedures became possible for the first time.

Many medical historians regard that day as the beginning of modern surgery.

Anesthesia's new question: how will the patient breathe?

Pain had been brought under control. But a new problem appeared.

Putting a patient into deep sleep could also affect their breathing. With the muscle relaxants introduced later in particular, some patients became unable to breathe on their own.

The development of anesthesia is therefore not only the story of drugs that induce sleep. It is also the story of artificial ventilation and of intensive care.

Vesalius and the first traces of artificial ventilation

Andreas Vesalius, who lived in the 16th century, is regarded as one of the founders of modern anatomy.

One of his observations is striking: he noticed that when air was delivered into the lungs of animals whose breathing had stopped, circulation could resume.

An observation that seems obvious to us now was extraordinary at the time. It is regarded as one of the first scientific foundations of the idea of artificial ventilation.

The iron lung and the polio epidemics

By the 20th century the world faced another problem: epidemics of poliomyelitis.

The polio virus did not affect only the muscles of the arms and legs. In some children it paralysed the respiratory muscles as well, leaving them unable to breathe and unable to survive.

To keep these patients alive, devices known as iron lungs were developed. The patient was placed inside a large metal cylinder, and the device assisted breathing by producing movement of the chest.

The system looks primitive today. At the time it saved thousands of lives.

From artificial ventilation to intensive care

During the polio epidemics, doctors noticed something important: drugs alone were not enough to keep patients alive. Breathing had to be supported as well.

That need drove the development of modern ventilators. The foundations of the mechanical ventilation systems used in intensive care units today were laid in this period.

The birth of modern intensive care cannot be considered separately from the development of anesthesiology. In many countries, anesthesiologists took a leading role in establishing and developing intensive care units.

Anesthesia today

Anesthesia today is beyond comparison with the first applications of the 19th century.

Heart rhythm, blood pressure, oxygen level, breathing and many other physiological parameters are monitored continuously throughout the operation.

Nerve blocks can be performed under ultrasound guidance, pain after surgery can be controlled far more effectively, and intensive care support can be delivered at a far more advanced level.

Beneath all of this progress lies one unchanging purpose: the safety of the patient.

Why does the history of anesthesia matter?

Today we take it for granted that we feel no pain during surgery.

That state of affairs is the result of centuries of scientific work.

The history of anesthesia is not only the history of drugs. It is the history of the human effort to reduce suffering, protect life and build a safer medicine.

Modern surgery, intensive care and pain treatment reached their present level thanks to that long journey.