Introduction of Anaesthesia

Today it is difficult to imagine undergoing surgery without anaesthetic, but up to the mid-19^th century this was the only choice for people who required surgical treatment. It was not until 16^th October 1846 that Boston dentist William Thomas Green Morton successfully and publicly demonstrated the use of ether for surgery. This case received a great deal of publicity and news soon spread across the Atlantic and physicians, surgeons, and dentists in London and beyond began experimenting with anaesthesia. There are reports of anaesthesia being used as early as 1842, but these cases were not publicly reported and didn’t receive the same level of interest and so it is Morton’s demonstration that is generally often accepted as being its first successful use.

James Young Simpson, the famous Professor of Midwifery at the University of Edinburgh, quickly embraced the idea of anaesthesia and is acknowledged as being the first person to use ether for childbirth on 19^th January 1847, in the case of a woman with a deformed pelvis.  Anaesthesia was not without its controversies, particularly where childbirth was concerned, but by 1853 when Queen Victoria was anaesthetised for the birth of Prince Leopold the practice became much more accepted.

Shortly after the completion of his medical studies in 1847/8, the Manchester based surgeon Edward Lund took a tour of Edinburgh, Glasgow, and London visiting the Universities, a number of hospitals, the various Royal Colleges, and a number of medical associations to witness the work of some notable practitioners, and the manuscript recording his experiences survives within the Manchester Medical Manuscripts Collection (MMM/11/2).  He first visited Edinburgh where he met with Simpson and notes:

“In August 1847, I was at Edinburgh and was introduced to Professor Simpson by Dr Lever. He showed me several cases in which he employed ether during operations, he generally gave it by sprinkling it upon a large sponge cut into the shape of a large mask which he placed all over the patient’s face. He has invented a very simple tin apparatus for administering it during labour, which he takes with him to almost every confinement case.” 

In the short time since first demonstrating its use in childbirth, it’s clear that Simpson had adopted anaesthesia as part of his general practice. At this point Simpson was using ether, and whilst he favoured its use he encountered some technical difficulties which he wished to overcome. Simpson and his two assistants experimented at home inhaling various vapours, when in November 1847 they came across chloroform, which soon became his anaesthetic of choice.

By following Lund’s medical tour into 1848, at which point he was visiting the London hospitals, we see from his various accounts of the surgeries he witnessed that chloroform was being more widely used than ether. On 6^th February 1848 he describes one case as such:

“I witnessed the reduction of a dislocation of the femur into the obturator foramen of the right side, in a girl aged 20 years; it had been done 16 hours. She was put under the influence of chloroform and the reduction was most easy.”

This differs greatly to the experiences of Dr John Shepherd Fletcher just four years earlier in the Manchester Royal Infirmary, when he describes the case of a 44 year old man who also had a dislocation of the femur. Three failed attempts at reducing the dislocation were made during the day, and the fourth and final attempt was described as follows:

“He was placed upon the table & extension again commenced in the same manner as before & continued for about 20 minutes when the bone slipped back into its place, but without any audible snap.  About 5 minutes before it was reduced he began to complain most bitterly of the extension, wanting it relaxed & when this was declined he was very violent, struggled & called out most violently, in fact he seemed quite delirious, a circumstance which I think facilitated the reduction by directing his attention away from the injured part.” (MMM/9/1)

Also within the collection are a series of tables compiled by Thomas Radford bringing together the details of all published caesarean cases he could find in addition to those reported to him privately (MMM/13/1/1). These span 1738-1864, and from late 1847 onwards the use of chloroform becomes a regular occurrence. Caesareans had up to this point been highly controversial; with a high mortality rate and little or no pain relief it was seen by some to be pure butchery. The introduction of anaesthesia did not change attitudes or practices overnight but was quite evidently a major turning point in surgical practice.

Sources:

Caton, D. What a Blessing She Had Chloroform: The Medical and Social Response to the Pain of Childbirth from 1800 to the Present (New Haven: Yale University Press, 1999)

Rushman, G.B, Davies, N.J.H., & Atkinson, R.S. A Short History of Anaesthesia (Oxford: Butterworth-Heinemann, 1996)

Thatcher, V.S. History of Anaesthesia (New York: Garland Publishing, 1984)