Anaesthetic before ether

[CalMeacham]

The first anaesthetic is reported to be inhaled ether. If you’re from Boston you think that William Morton first came up with this in 1846, demonstrating it in the Ether Dome at Massachusetts General Hospital. If you’re from elsewhere – especially Georgia – you might credit its first use to Crawford W. Long, who employed it four years earlier in 1842, but didn’t properly report it, and lost out on being first credited.

It was supposed to be this breakthrough, along with other innovations in medical care stemming from the Napoleonic wars, that’s credited with the revolution in surgery. Now, it was claimed, surgeons didn’t have to rely on speed in performing amputations, minimizing the suffering of wide awake patients who had to endure the pain.

But why does ether get the credit for this? Ignoring the advances in sterilization and germ theory and just concentrating on the “pain” part – which I;'m sure was paramount in everyone’s minds – didn’t they already have effective ways to render a patient unconscious so they wouldn’t feel the pain of the operation?

Opium has been used since time immemorial. Wouldn’t it, in sufficient dose, cause unconsciousness? And what about plain ethyl alcohol? Why did they have to wait for the discovery that ether could render people unconscious to provide a way to alleviate the pain of operations?

Don’t say that it’s a matter of dosage, and that you could kill the patient. That’s true of all anaesthetics, including ether. For as important a matter as making surgery and amputation more doabl;e, I’m sure they could have worked out the doses needed.

In fact, there does seem to have been use of opium and alcohol in combination, along with ther medical herebs during the Middle Ages and Renaissance:

In the Middle Ages, sedative potions began to standardise around a particular group of plants, usually mixed with opium and alcohol. The English sedative dwale was an alcohol-based mixture containing bile, opium, henbane, hemlock, lettuce and vinegar.

By the 15th century, a mixture of opium, mandragora and henbane was the sedative of choice for surgical procedures such as amputation. Sedatives changed very little until the 19th century.

The art of anaesthesia | Science Museum

See here, too:

ADA522810.pdf

For that matter, nitrous oxide was known before ether was used as an anaesthetic – why not use that?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4608178/#:~:text=several%20years%20later.-,The%20first%20true%20demonstration%20of%20ether%20as%20an%20inhalation%20anesthetic,painful%20dental%20procedures%20[4].

Apparently ether started being used on the battlefield as early as 1847 at the battle of Vera Cruz,. During the Civil War, despite all those depictions of wide-awake amputations you see in media (like Dances with Wolves there were reportedly 80,000 cases of cases where they used ether anaesthesia. Even with the difficulties of supply and demand, then, people used anaesthetic when it became available and well-known.

But the question remains – why didn’t they use other stuff earlier, when they could have?

[TriPolar]

@CalMeacham

In fact, there does seem to have been use of opium and alcohol in combination, along with ther medical herebs during the Middle Ages and Renaissance:

I assumed these were available for a long time. Don’t know why they wouldn’t have been used.

What I don’t know is how often it would have been useful. Cannons created a tremendous need during the US Civil War, and there were plenty of field doctors to perform amputations. But before then how often were amputations or any other kind of operation performed? The cannons were around, but were the field doctors available? Were there other operations commonly performed that would have benefited from anesthesia?

[gnoitall]

@CalMeacham

But the question remains – why didn’t they use other stuff earlier, when they could have?

Partly, because some doctors opposed the idea.

Accepting Pain Over Comfort: Resistance to the Use of Anesthesia in the...

[Jackmannii]

@CalMeacham

Opium has been used since time immemorial. Wouldn’t it, in sufficient dose, cause unconsciousness? And what about plain ethyl alcohol? Why did they have to wait for the discovery that ether could render people unconscious to provide a way to alleviate the pain of operations?

Don’t say that it’s a matter of dosage, and that you could kill the patient. That’s true of all anaesthetics, including ether.

As you know, the margin for error is much narrower with opium and alcohol. The dose necessary to cause unconsciousness is uncomfortably close to that which fatallly suppresses respiration. Add in the stress on the body due to an operation, and you’d be killing far more patients than with ether (or chloroform, another early anesthetic).

[Johnny_Bravo]

Required dosages of alcohol and opiates are also wildly variable. What puts me to sleep isn’t necessarily what puts thee to sleep, and falling asleep from too much alcohol is not the same as being rendered unconscious. How do you know when somebody has had enough booze that that won’t wake up screaming when you start cutting?

Modern anesthetics can be reliably dosed by body weight with little need to worry about tolerance. They also take effect nearly instantly, unlike alcohol.

The breakthrough with modern anesthetics is the combination of reliability and consistency, not in figuring out a new substance that can knock somebody out.

[crowmanyclouds]

@Johnny_Bravo

The breakthrough with modern anesthetics is the combination of reliability and consistency, not in figuring out a new substance that can knock somebody out.

And, probably more important, the ability to reliably and consistently un-knock somebody out.

[CalMeacham]

@Jackmannii

As you know, the margin for error is much narrower with opium and alcohol. The dose necessary to cause unconsciousness is uncomfortably close to that which fatallly suppresses respiration. Add in the stress on the body due to an operation, and you’d be killing far more patients than with ether (or chloroform, another early anesthetic).

It’s a tough call. The stress on the body of operation without anaesthetic is enough to cause severe stress, as well

Surgery and Emotion: The Era Before Anaesthesia

It seems to me that in a lot of cases the risk of using opium/alcohol/whatever would hav e been more than justified.

[TriPolar]

@Johnny_Bravo

The breakthrough with modern anesthetics is the combination of reliability and consistency, not in figuring out a new substance that can knock somebody out.

Perhaps dosage control prevented reliably using opium and alcohol to knock someone out entirely, but they certainly could have been used within safe limits to reduce the pain during the operation and afterwards.

[Jackmannii]

Other reasons to avoid ethanol as an anesthetic include its deleterious effect on cardiovascular function, including reduced cardiac output.

Anyone interested in the history of surgery would be well advised not to delve too deeply into early efforts to remove bladder stones, which led to Hippocrates’ Oath calling for most physicians to avoid the practice of “cutting for stone”, which nevertheless persisted as a quack pastime.

During the medieval period in Europe (1096–1438) there was little activity in the management of stone disease [10, 11]. In this era lithotomists were essentially commercial travelers moving from town to town looking for business and cutting all who came their way [7]. Often uneducated and occasionally dishonest, some were great showmen. The procedure was generally performed in the public without anaesthesia and generally lasted a few minutes [7].

The History of Urinary Stones: In Parallel with Civilization

[Johnny_Bravo]

Yes, definitely: reliability and consistency across the entire perioperative spectrum.

@TriPolar

but they certainly could have been used within safe limits to reduce the pain during the operation and afterwards.

Sure, and they still are, though there’s a big push to find ways to limit the use of opioids as much as possible.

But bear in mind that anesthesia isn’t just about limiting pain: a fully insensate patient isn’t just not hurting, they aren’t reacting at all. That means steady heart rate, respiration, no sudden physical movements that could interrupt procedures, etc.

The ability to reliably and safely “separate” the patient from the procedure is a huge deal.

[Kent_Clark]

Here’s an interesting (and occasionally graphic) paper about the effects of surgery without anesthetic on both the patient and the physician.

Surgery and Emotion: The Era Before Anaesthesia - The Palgrave Handbook of the History of Surgery - NCBI Bookshelf.

[Chronos]

@Jackmannii

Anyone interested in the history of surgery would be well advised not to delve too deeply into early efforts to remove bladder stones, which led to Hippocrates’ Oath calling for most physicians to avoid the practice of “cutting for stone”, which nevertheless persisted as a quack pastime.

And despite the huge fatality rate (I’ve seen figures as high as 50%), stones could be so painful that people would choose to roll the dice, anyway. The prohibition wouldn’t have been necessary if there weren’t the demand.