Modern historians of medicine believe that the first methods of anesthesia emerged at the dawn of human development. Of course, back then it was common to act simply and crudely: for example, until the XVIII century the general anesthesia was given to the patient by a strong blow on the head with a baton; after he lost consciousness, the doctor could proceed to surgery.
Narcotic preparations have been used as local anesthesia since ancient times. One of the oldest medical manuscripts (Egypt, around 1500 B.C.) recommends giving opium-based drugs to patients as an anesthetic.
Opium was unknown in China and India for a long time, but the miraculous properties of marijuana were discovered quite early there. In the 2nd century A.D., the famous Chinese doctor Hua To gave his patients a mixture of wine and crushed cannabis powder he invented as an anaesthetic during surgeries.
Meanwhile, in the Americas, not yet discovered by Columbus, local Indians actively used cocaine from the leaves of the coca plant as an anesthesia. It is well known that the Incas in the high Andes used coca for local anesthesia: the local medicine man chewed the leaves and then dripped saliva saturated with the juice on the patient’s wound to relieve his pain.
On rare occasions, doctors tried to use the power of suggestion as anesthesia, for example, by putting patients into a hypnotic sleep. A modern follower of this practice was the notorious psychotherapist Anatoly Kashpirovsky, who in March 1988, during a special teleconference, arranged anesthesia for a woman who had a tumor cut out of her breast in another city without anesthesia. However, there were no successors to his cause.
Who was the first to use gas?
More familiar to modern man methods of anesthesia were developed only in the middle of the XIX century. In the 1820s, the English surgeon Henry Hickman experimented on animals, trying to amputate their limbs using carbon dioxide as an anesthetic.
However, nitrous oxide, also known as “laughing gas”, which was discovered in 1799, turned out to be much more suitable as an anesthetic.
For a long time, people did not know that it could be used for anesthesia. This property was first discovered by the American magician Gardner Colton, who used “laughing gas” during his shows in a traveling circus. On December 10, 1844, during one of his performances in the small town of Hartford, Colton called a volunteer to the stage to demonstrate the effect of the unusual gas on him. A man in the audience, inhaling it, laughed so hard that he fell and seriously injured his leg. However, Colton noticed that the volunteer felt no pain at all – he was under anesthesia.
This unusual property of nitrous oxide was noticed not only by the magician himself, but also by his audience. Among them was local dentist Horace Wells, who quickly realized how useful the magic gas could be in his work. After the performance, he approached Colton, asked him to demonstrate the properties of the gas once more, and then arranged to purchase it. Beginning to use the “laughing gas” in his practice, Wells appreciated its effectiveness, but did not patent his discovery, deciding that the new universal anesthetic should be available “like air.”
In 1845, Horace Wells decided to demonstrate his discovery to the general public. At a Boston hospital, he promised to pull a sick tooth in front of an audience, using nitrous oxide as anesthesia. The volunteer was a strong adult male who appeared to be able to tolerate the extraction without anesthesia. However, when the operation began, the patient began screaming violently. The medical students present in the room began to jeer at Wells and, shouting “Quack, quack, quack!” left the room. Wells later discovered that the patient had not felt pain during the surgery, but had been screaming in fear, but the situation could not be changed, his reputation had already been ruined.
Abandoning dental treatment, Wells made a living as an itinerant trader for several years, then returned to experimenting in the field of anesthesia. However, they did him no good, the former dentist became addicted to sniffing chloroform and once, in a state of severe intoxication, spilled sulfuric acid on the clothes of two street prostitutes. He was arrested for this act; when he sobered up and realized the horror of what he had done, Horace Wells committed suicide. Before slitting his wrists, he inhaled chloroform to induce anesthesia.
A moment of glory and years of oblivion
Among those who attended Horace Wells’ unsuccessful demonstration in 1845 was his former pupil and colleague William Morton. It was to him that the fame of the chief inventor of anesthesia went.
On September 30, 1846, he performed an operation to remove a tooth from a patient, using ether as an anesthetic. However, history is made of his later operation, on October 16, 1846, in the same Boston hospital where his teacher had been mocked, William Morton publicly removed a tumor on the patient’s neck, while he was under the influence of ether vapor. The operation was successful; the patient felt no pain.
William Morton was not altruistic; he wanted not only fame, but also money. For this reason, he did not admit during the operation that he used ordinary medical ether for anesthesia, but claimed that it was a gas he had invented, “letheon” (from the word “Leta”, the river of oblivion). Morton obtained a patent for his invention, but it did him no good. Pretty quickly it turned out that the main component of Letheon was ether, which was not covered by the patent. On both sides of the ocean, doctors began to use medical ether for anesthesia; Morton tried to assert his rights in court, but he never received any money. But he won fame; he is commonly referred to as the creator of anesthesia.
In fact, however, it was the American surgeon Crawford Long who first used ether as an anesthesia. On March 30, 1842 (four years earlier than Morton), he performed the same operation – he removed a tumor from the patient’s neck under general anesthesia. He subsequently used ether many times in his practice, but did not invite spectators to these operations, and he did not publish a scientific article about his experiments until six years later – in 1848. In the end he got neither money nor fame. But Dr. Crawford Long lived a long and happy life.
The use of chloroform in anesthesia began in 1847 and rapidly gained popularity. In 1853, English physician John Snow used chloroform as a general anesthetic during the delivery of Queen Victoria. However, it quickly became clear that the toxicity of the substance often caused complications in patients, so chloroform is no longer used for anesthesia.
Anesthesia by Dr. Freud
Both ether and chloroform were used for general anesthesia, but doctors dreamed of developing a drug that would work effectively as a local anesthetic. The breakthrough came at the turn of the 1870s and 1880s, and the long-awaited wonder drug was… cocaine.
German chemist Albert Niemann first isolated cocaine from coca leaves in 1859. For a long time, however, cocaine was of little interest to researchers. For the first time, the possibility of its use for local anesthesia was discovered by a doctor Vasily Anrep, who, according to the scientific tradition of the time, did some experiments on himself and in 1879 published an article about the effect of cocaine on nerve endings. Unfortunately, at the time, it was almost ignored.
Instead, a series of scientific articles about cocaine written by the young psychiatrist Sigmund Freud became a sensation. Freud tried cocaine for the first time in 1884 and was struck by its effect: the use of this substance cured him of depression and gave him self-confidence. In the same year, the young scientist wrote an article “On Cocaine”, in which he strongly recommended the use of cocaine as a local anesthetic, as well as a cure for asthma, digestive disorders, depression, neurosis.
Freud’s research in this area was actively supported by pharmaceutical firms, which anticipated huge profits. The future father of psychoanalysis published as many as 8 articles about the properties of cocaine, but in his later works on the subject he wrote less enthusiastically about the substance. There is nothing surprising, because Freud’s close friend Ernst von Fleischl died of cocaine abuse.
Although the anesthetic effect of cocaine was already known from the works of Anrep and Freud, the ophthalmologist Karl Koller was famous as the discoverer of local anesthesia. This young doctor, like Sigmund Freud, worked at the Vienna General Hospital and lived on the same floor as him. When Freud told him about his experiments with cocaine, Koller decided to see if this substance could be used as a local anesthetic for eye surgery. Experiments showed its efficacy, and in 1884 Koller reported the results of his research to a meeting of the Vienna Medical Society.
Almost immediately Koller’s discovery began to be used in literally all fields of medicine. Cocaine was used not only by doctors, but also by all comers, it was freely sold in all pharmacies and enjoyed almost the same popularity as aspirin today. Grocery stores sold wine with cocaine and a carbonated drink called Coca Cola, which contained cocaine in its composition until 1903.
The cocaine boom of the 1880s and 1890s cost the lives of many ordinary people, so the substance gradually fell under prohibition in the early 20th century. The only area where cocaine use was long tolerated was in local anesthesia. Carl Koller, to whom cocaine brought fame, later ashamed of his discovery, and did not even mention it in his autobiography. For the rest of his life, his colleagues called him Koka Koller behind his back, alluding to his role in introducing cocaine into medical practice.
In the XX century in anesthesiology cocaine was replaced by safer drugs: procaine, novocaine, lidocaine. Thus anesthesiology finally became not only effective but also safe.