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The Victorian era
- When it comes to scientific advancement, we have a lot to thank the Victorians for: cars, telephones, and electric light bulbs, for example, are all products of the Victorian era (1837-1901).
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The Victorian era
- In addition to inventing such household commodities, the Victorians are also responsible for the discovery of one of the most important features of modern medicine: anaesthetics.
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Pre-Victorian era surgery
- In the early 1800s, surgery was excruciatingly painful and enormously risky. Screaming patients had to be held down by force while the surgeon operated on them.
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High mortality rate
- The chance of dying from an amputation carried out by even the most notoriously successful surgeon, Robert Liston of University College Hospital, London, was one in six.
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Pioneers
- Realizing that something ought to be done about this, particularly since procedures were becoming more complicated, surgeons in the mid-1800s set about trying to find ways to relieve pain.
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Hypnosis
- Early attempts at alleviating the pain of patients on the table involved hypnosis, but these were to no avail. Then came the dentist who experimented with nitrous oxide during a tooth extraction.
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Nitrous oxide
- In 1845 in Boston, dentist Horace Wells publicly conducted a tooth extraction after giving the patient nitrous oxide. The experiment was a categoric failure: a witness reported the patient “screaming with pain.”
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William Morton
- Then in October of the following year another dentist, one William Morton, experimented, again in Boston, with a pain reliever that would prove a lot more promising.
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Ether
- He mixed together a pungent concoction of sulphuric acid and alcohol called “ether,” which he used successfully to put his patient to sleep before pulling out his tooth.
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Catching on
- Within a few weeks word had reached London about ether, the exciting new way to stop pain during surgery. Various procedures were carried out with the patient sleeping thanks to the concoction.
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Catching on
- At the University College Hospital, London, for example, Robert Liston carried out a leg amputation using ether as an anaesthetic. The patient woke up after it was done and asked when he would begin!
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The problem with ether
- Ether was not the perfect solution to the problem, however. Besides being nasty to breathe–it often caused patients to cough or even vomit–it was highly explosive.
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James Simpson
- Midwifery professor James Simpson therefore came up with an alternative to ether. His suggestion for an anaesthetic was a sweet-smelling gas called chloroform.
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Chloroform and its dangers
- For a time, chloroform was surgeons’ preferred anaesthetic, but again the substance had its issues. It proved difficult to establish the correct dose of chloroform, and many fatal doses were administered.
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Chloroform and its dangers
- One particular patient in England went to see surgeon Thomas Meggison to have her toenail removed. She passed out shortly after inhaling chloroform, and a few minutes later she was dead.
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Paradox
- The risks associated with anaesthetics meant that they were not popular with surgeons for several years. Why anaesthetize a patient if doing so was more dangerous than the operation itself?
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John Snow and chloroform
- Even once public health pioneer John Snow had worked out how to correctly dose patients with chloroform, thus eliminating the risk of death, anaesthetics remained unpopular.
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Reasons for unpopularity
- One of the reasons for their unpopularity was that many believed pain was essential to survive surgery. Pain was seen as a sort of stimulant that would keep the body going through the procedure.
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John Snow
- Again, John Snow took steps to advance the cause of anaesthetics: he put forward the argument that pain was risky and anaesthetics would eliminate that risk for patients.
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Audacity
- He even gave Queen Victoria chloroform during the birth of her eighth child in 1853–behavior that landed him in hot water with other medical professionals, who described his actions as “poisonous.”
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After 1860
- By 1860, however, anaesthetics were in much more common use. However, surgeons were still not out of the woods when it came to the risk of mortality during their procedures.
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High infection rate
- Still not much was understood about how wounds became infected, and it wasn’t until the mid-1860s, when antiseptic techniques emerged, that surgery became a lot safer.
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Local anaesthetic
- Around the turn of the 20th century, local anaesthetics made from cocaine were also in use. However, ether and chloroform were still the only forms of general anaesthetic.
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Bye bye, chloroform
- Chloroform eventually fell out of fashion, leaving ether as the only available general anaesthetic. And still today surgeons use anaesthetics that are types of ether.
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The ether of today
- The ether used today is much safer than the ether of days gone by: thanks to the advances of fluoridation chemistry during WWII, scientists now know that adding fluoride to ether renders it inflammable.
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Remaining risks
- Even today anaesthetics are not without risk, of course. They can leave people feeling drowsy for days after an operation, and occasionally people wake up on the table with the operation underway.
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Progress
- But nowadays the chances of dying during a planned surgery are about one in 100,000. When you compare that to the one in six chance of Robert Liston’s day, it’s clear we’ve come a long way.
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Other developments
- However, we must not forget the other medical advancements that have rendered surgery safer. These include the development of equipment to maintain patients’ breathing and track their well-being. See also: Ways Victorian fashion could kill you
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A brief history of anaesthetic
From screaming in pain to sleeping in peace
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Nowadays it is unthinkable that a surgeon would carry out a leg amputation while his patient is awake. Just the thought is enough to make anyone break out in goosebumps!
And yet before the invention of a little substance called anaesthetic, that is exactly how surgery was carried out. Patients were given no pain relief at all, let alone one that would put them to sleep. They had to be held down by assistants called "dressers" while the surgeon went to town.
Clearly we've come a long way since those times. Check out this gallery to learn about the history of the anaesthetic.
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