General anaesthesia

Until the mid-19th century such surgery as was possible had to be undertaken at tremendous speed. Surgeons did their best for terrified patients by using alcohol, opium, hyoscine,1 or cannabis. With the introduction of general anaesthesia, surgeons could operate for the first time with careful deliberation. The problem of inducing quick, safe and easily reversible unconsciousness for any desired length of time in man only began to be solved in the 1840s when the long-known substances nitrous oxide, ether, and chloroform were introduced in rapid succession.

The details surrounding the first use of surgical anaesthesia were submerged in bitter disputes on priority following an attempt to take out a patent for ether. The key events around this time were:

• 1842 — W. E. Clarke of Rochester, New York, administered for a dental extraction. However, this event was not made widely known at the time.

• 1844 — Horace Wells, a dentist in Hartford, Connecticut, introduced nitrous oxide to produce anaesthesia during dental extraction.

• 1846 — On October 16 William Morton, a Boston dentist, successfully demonstrated the anaesthetic properties of ether.

• 1846 — On December 21 Robert Liston performed the first surgical operation in England under ether anaesthesia.2

1A Japanese pioneer of about 1800 wished to test the anaesthetic efficacy of a herbal mixture including solanaceous plants (hyoscine-type alkaloids). His elderly mother volunteered as subject since she was anyway expected to die soon. But the pioneer administered it to his wife for, 'as all three agreed, he could find another wife, but could never get another mother' (Journal of the American Medical Association 1966197:10).

• 1847 — James Y. Simpson, professor of midwifery at the University of Edinburgh, introduced chloroform for the relief of labour pain.

The next important developments in anaesthesia were in the 20th century when the appearance of new drugs both as primary general anaesthetics and as adjuvants (muscle relaxants), new apparatus, and clinical expertise in rendering prolonged anaesthesia safe, enabled surgeons to increase their range. No longer was the duration and type of surgery determined by patients' capacity to endure pain.

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