History of Anaesthesia: A Hit and Miss Affair Angel Netto, 315727

The management, prevention, and treatment of pain fall under the umbrella term of
anaesthesia, a subfield of medicine. During surgery, a variety of diverse kinds of anaesthetics
can be used. There are three main types: solids, liquids, and gases. Throughout history, a
variety of anaesthetics have been used to alleviate pain during surgical procedures, childbirth,
and other medical procedures.

During the period of 40-90 AD, Pedanius Dioscorides, a Greek physician and
pharmacologist, described as the father of pharmacognosy, endeavoured in the use of opium
and mandragora as anaesthetics but failed as they presented extraordinary risks and did not
always guarantee an analgesic (pain killer) effect. Mandragora officinalis, or more known as
Mandrake is an extremely poisonous Mandrake plant with powerful narcotic and sedative
effects, that when consumed could lead to a potentially life-threatening increase in
temperature. Thus, such treatment methods were considered lethal or ineffective, or both.
Likewise, in the Middle Ages, doctors were able to induce narcosis with a popular method
called Spongia Somnifera or Soporific Sponge. Patients were given a concoction of mulberry
juice, lettuce seed, ivy, hyoscyamine, scopolamine, hemlock, opium, and mandrake re-
constituted using a sea-sponge into a liquid to drink or as a form of inhalation anaesthesia. A
downside to this practise, was that it would not prevent the sleeping patient from vigorously
moving in response to the surgery, thereby indicating a lack of an analgesic and narcotic
effect.

The first known injection to produce anaesthesia is intravenously administered opium to dogs
which resulted in unconsciousness in some, but death in others. Christopher Wren, an
astronomer who later designed St. Paul's Cathedral, wanted to show that drugs would quickly
reach the heart and brain once they entered the bloodstream. In 1656, Wren met the great
chemist Robert Boyle and the physician Thomas Willis. After fastening the dog's legs to the
corners of a table and cutting a vein in its limb, Wren infused opium and wine through a
goose quill connected to a pig bladder that contained the elixir in their most well-known
experiment. The first ever intravenous anaesthetic was administered to the dog, and as soon
as he was let out, he "appeared...stupifi'd" and fell to the ground. Another well-known
anatomical circuit, the arterial "Circle of Willis," was later defined by Wren and Willis via
intravascular injections.

Application of the first local anaesthesia is proposed to have taken place in South America,
by Indigenous people who applied chewed Coca leaves to the area to be operated on.

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However, the full effect of Coca leaves was not produced when uncooked, as raw Coca
leaves lack in the amount of cocaine alkaloids crucial for the required anaesthetic effect. Carl
Kollen used cocaine to anesthetize his eyes in 1847, marking the beginning of the active use
of local anaesthesia. W.S. Halsted used cocaine to anesthetize the nerves in the trunk a year
later.
The most important anaesthetic, Ether, was first created in 1275, by the Raymond Lully. He
did this by adding wine to sulfuric acid to produce Ethyl Ether. Lully called it the Sweet Oil
of Vitriol. However, Lully was the first pharmacologist to display a lack of development on
this substance which would cost future generations the luxury of painless surgery. 3 centuries
afterwards, in 1540 Valerius Cordus and later Theophrastus Bombastus von Hohenheim or
Paracelsus for short, both produced ether and noticed its effects. Cordus, a German botanist
observed ethers anaesthetic effects via inhalation, which he endeavoured to use to enliven his
“ether frolicks,” his recreational parties. Paracelsus described the sweet effect of ether as
such; “ quiets all suffering without any hard, and relieves all pain, and quenches all fevers,
and prevents complications in all illnesses” (Clutton, R. E., 2020). Both died before having
demonstrated the possibility of ether as a potent painkiller and anaesthetic to the medical
society. It is now generally accepted that the dentist William Thomas Green Morton’s
successful public administration of an ether anaesthetic ultimately persuaded the medical
community that anaesthesia could alleviate surficial pain.

Morton applied for a patent on the use of ether to lessen surgical pain on October 1, 1846. He
offered a license to surgeons and doctors to use the vapor, which he sold under the name
Letheon and for which he would receive royalties once the patent was granted. Lethe, one of
the five mythological rivers of the Greek underworld, was the source of the name. Memory
loss occurs when souls consume the waters of Lethe. On October 16, 1846, Morton
successfully demonstrated ether anaesthesia for surgery for the very first time. The following
day, he went back to Massachusetts General Hospital (MGH) to anesthetize another patient.
Additionally, he sought the advice of instrument makers Nathan B. Chamberlain and Joseph
M. Wightman in the design of an appropriate device for administering the vapor. He also
added tincture of orange to mask the ether's odour and make it unique. Thomas Beddoes gave
ether, the analgesic agent, to young woman was a painful mastitis. Dr James Darrach was the
first anaesthetist to administer ether during a surgical procedure (leg amputation). Even
though the patent was officially granted, surgeons at MGH demanded to know the agent's

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composition on November 17, 1846. Morton lost his patent claim when it was discovered that
orange tincture had been added to ether by January 1847.

A Pneumatic Institution was set up in Bristol, England, to primarily relieve the symptoms of
pulmonary tuberculosis with the use of various gases, such as nitrous oxide. Joseph Priestly,
an English ministry man is credited for the discovery of different gases in 1772, among them
the narcotic gas, nitrous oxide. Priestly heated nitrous acid in the presence of zinc to produce
a colourless gas which he called dephlostigated nitrous air. Apart from publishing his
findings in his papers, 3 years later in 1775, Priestly did not further investigate on the
significant effect of this new gas. Humphry Davy, a student scientist conducted his own
experiments on dephlostigated nitrous air, renamed the gas nitrous oxide. He demonstrated its
emetogenic and anaesthetic prosperities, mainly administering it to himself as the prime
subject. Humphry Davy is an early example of how anaesthetics can produce addiction. Davy
compiled his findings in a 588-page monograph entitled Researches, Chemical and
Philosophical, Chiefly Concerning nitrous oxide which included measurements on the uptake
and solubility of nitrous oxide. He wrote: “As nitrous oxide in its extensive operation appears
capable of destroying physical pain, it may probably be used with advantage during surgical
operations” (Huang, C., & Johnson, N., 2016). Davy discontinued his work at the Pneumatic
Institute as well as his research on nitrous oxide when he turned his attention to the field of
electrochemistry at the Royal Society. Horace Wells, a dentist in Connecticut, introduces
nitrous oxide as an anaesthetic to the medical community. His first attempt to make a public
demonstration of his discovery in January 1845, in front of students at Massachusetts Medical
College in a public hall in Boston, was a partial failure due to an insufficient dosage of the
gas. However, it was not until twenty years after its discovery that its anaesthetic properties
were used in general surgery. An intermittent flow of nitrous oxide and oxygen anaesthetic
gas machine was developed in 1910 as a result of nitrous oxide’s dependence on oxygen
during an operation. DR. E. I. McKessen is credited with the first successful use of the gas
machine and nitrous oxide in surgery.

The stupefacient method of action of nitrous oxide is based on the activation of opioid
receptors. These receptors could be desensitized after overstimulation caused by repeated
administration of nitrous oxide. The patient could develop tolerance to nitrous oxide which
could result in enhanced pain on recovery. Samuel Lathan Mitchill described the anaesthetic
effect along with the toxic effect produced through the inhalation of nitrous oxide on animals.

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James Y. Simpson, a young professor of midwifery at the University of Edinburgh (born

1811–1870), introduces chloroform, an inhalation gas with greater potency that ether, as one
of the first anaesthetics to the medical community. On November 4, 1847, Simpson
endeavoured in the inhalation of chloroform along with two colleagues and a few family
members in his dining room at 42 Queen Street, Edinburgh, when he discovered that it had
analgesic properties. He used chloroform for a few minor operations four days later, and on
November 9, he participated in his first delivery. After John Snow, the first specialist
anaesthetist, had administered chloroform to Queen Victoria during the birth of Prince
Leopold in, chloroform became particularly popular during this time.

Hannah Greener of Winlaton, died on January 28, 1848, after receiving a chloroform
anaesthetic to remove a toenail. Miss Greener was a 15-year-old girl who had, several months
prior, successfully undergone a similar removal of a toenail but with an anaesthetic
containing diethyl ether. Her death was the first attributed to the use anaesthesia for the relief
of surgical pain. Her death has been attributed by a number of authors to either an overdose
of anaesthetic, aspiration of the water and brandy that were used to try to revive her, or some
combination of secondary complications that will never be identified.

It is also noteworthy that the two most likely scenarios were brought up for discussion shortly
after the patient's death, despite the lack of sophisticated diagnostic equipment and
knowledge of anaesthetic action. Pulmonary aspiration was favoured by Simpson as the cause
of death. Even though a fatal arrhythmia may have already caused Hannah to die, Simpson
was right to be concerned about the methods used to bring her back to life. She was not
helped by these efforts, and it is possible that they were the direct cause of her death. Snow at
first concurred with the anaesthetic overdose explanation for her death. Snow concluded that
Hannah's death was a primary cardiac event after changing his mind. Beecher reiterated this
idea nearly a century later, and the diagnosis of a fatal arrhythmia event continues to appear
to be the most probable cause of Miss Greener's rapid death. It is possible to use Simpson and
Snow's remarkable observational and deductive reasoning skills as strong examples for every
physician currently practicing anaesthesia.

South American natives slathered the tarry toxin on arrow tips to kill enemies and prey after
extracting it from vines like Chondrodendron tomentosum. D-tubocurarine was the scientific
name for the active ingredient, which was used to hold the arrows in the bamboo tubes.
French mathematician Charles Marie de La Condamine was the first to investigate curare. He

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said at the time that respiratory muscle paralysis was the cause of a hen that had been given
curare and died. Charles Waterton, an English naturalist, and his colleagues used artificial
ventilation to keep a curarized donkey alive in a well-known experiment from 1814 where
Curare’s anodyne effects when ventilated was demonstrated by two veterinary surgeons,
Brodie and Sewell. However, the use of curare in anaesthetics did not begin until 1938, when
North American explorer Richard Gill brought 12 kilograms of curare from Ecuador to treat
his own muscle spasms. Former anaesthesiologist and Squibb advisor Lewis H. Wright
provided the drug to Canadian anaesthesiologist Harold Griffith after E. R. Squibb & Sons
acquired Gill's supply and purified it into Intocostrin. The latter soon published in
Anaesthesiology his experience using Intocostrin to induce rapid muscle relaxation in 25
patients who were only lightly anesthetized (1942). The disadvantages of deep anaesthesia—
cardiac depression, explosion risk, severe nausea, and prolonged emergence—could finally
be mitigated through a revolution.

In order to advance general anaesthesia in the 20th century, it was necessary to develop a
device that could add ether or chloroform to a mixture of oxygen and nitrous oxide in order to
control the concentration of the volatile agent more precisely. Second, a method for securing
an airtight connection to the patient's lungs was required so that the gas mixture could be
administered to the patient undiluted by room air.

Thirdly, the anaesthetist had to learn how to keep the patient's lungs ventilated when the
patient stopped breathing. Fourthly, if the surgeon wanted to operate in the chest, the
anaesthetist had to produce a way to prevent the lungs from collapsing. Control of the airway,
assisted, controlled, and facilitated ventilation, as well as the development of carbon dioxide
absorption breathing systems made it possible for thoracic surgery, were all made possible by
the invention of tracheal tubes in the 1920s. Then, the introduction of intravenous thiopental
anaesthesia and muscle relaxation with curare led to a significant shift in the practice of
anaesthesia.

From 1990 to 2000, advances in anaesthesia included desflurane and sevoflurane, two new
short-acting inhalation agents, which are now commonly used in day surgery. Anaesthesia is
also a specialty that encompasses four principal areas: anaesthesia, intensive care medicine,
services for acute and chronic pain, and emergency medicine.

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Borghi, L. (2015). The Monuments Men: In the History of Anesthesia,

Too. Anesthesiology, 122(3), 521-523.Borghi2015TheMonumentsMenAnesthesiology.pdf

Clinical Anesthesia. (2011). (n.p.): Wolters Kluwer Health. https://aneskey.com/the-history-

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Clutton, R. E. (2020). An anglocentric history of anaesthetics and analgesics in the

refinement of animal experiments. Animals, 10(10), 1933.
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