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Pain and cleanliness

Carbolic steam spray used by Joseph Lister England, 1866-1870

Carbolic steam spray used by Joseph Lister England, 1866-1870

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Pain before the 1800s

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Until the 1800s one of the biggest problems a patient undergoing surgery had to face was unimaginable pain. Before the development of modern anaesthetics, patients would be sedated with herbs or alcohol in order to reduce - but never eliminate - the horrific ordeal of surgery. Assyrian surgeons even went so far as to restrict children’s airways, causing unconsciousness before the child underwent circumcision. By the 1400s a mixture of opiummandragora and henbane might be administered to the would-be patient and there was not much change in these methods until the 1800s.

Nitrous oxide - preventing pain

In 1799 nitrous oxide was first used by Sir Humphry Davy. It was not used for surgery as its effects were unreliable, but in the early 1800s it became popular with dentists who used it to prevent pain during extraction. It was also used as a recreational drug at parties - often by doctors.

Seishu Hanaoka: early anaesthetic in the 1800s

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The earliest general anaesthetic was developed in the 1800s by Seishu Hanaoka in Japan and was a combination of herbs based on Traditional Chinese Medicine. It could cause unconsciousness for between 6 and 24 hours, depending on its potency.

Ether (gas anaesthetic): the rise and fall

The first gas anaesthetic to be used in Western surgery was ether. William Morton, a Boston dentist, demonstrated its usefulness in an 1846 operation. It rendered the patient unconscious, allowing surgeons to perform more complicated surgery. Morton tried to patent the discovery, but others had already performed surgery with ether and its use spread quickly across North America and Europe. Unfortunately ether was flammable and irritated the lungs, so a replacement was sought. Chloroform followed and was used in childbirth from the late 1840s - Queen Victoria popularised it when she used it in 1853 and 1857.

Safer injectable anaesthetics in the 1900s

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New, safer injectable anaesthetics were developed in the 1900s and computerised systems were designed to ensure safe monitoring during surgery. More complex combinations of drugs are now given, and the patient is monitored carefully both with computerised systems and by the anaesthetist, who specialises in the administration of anaesthetics. But very disturbing problems, although rare, can still occur, such as ‘anaesthetic awareness’, where the patient is aware of the surgical procedure. In ‘Under the Knife’, a short story by H G Wells written in 1896, the main character undergoes surgery with chloroform as an anaesthetic and has a strange dream-like out-of-body experience.

The control of infection from ancient times to the Middle Ages

While anaesthetics improved, patients were still at grave risk from infection until relatively recently. Turpentine and vinegar were used as methods of infection control in ancient times; these were followed in the Middle Ages by cauterisation.

Germ theory and the prevention of infection

Hungarian doctor Ignaz Semmelweis introduced hand-washing in 1847, which saved the lives of many patients. But no effective method for the prevention of infection in surgery was developed until 1867. This was partly because the existence of germs, or germ theory, was not recognised until 1861.

Reducing infection

Joseph Lister, a Glaswegian surgeon, designed a carbolic spray that was misted onto the wound, which was then bandaged. This method reduced infection and was followed by the use of a carbolic spray in the operating theatre. This was called antisepsis, where infection is prevented by the destruction of bacteria using a disinfectant. Later, the aseptic method was developed, where contamination is prevented by removing contact between the patient and any infective agents. All germs were eliminated from the operating theatre and the surgeon performed the familiar ‘scrubbing up’ procedure that is still practised today.

The continued threat of infection

Even with asepsis methods, infection still occurred and it was not until the regular use of antibiotics from the late 1940s that the danger of internal infection was reduced. But antibiotic-resistant strains of staphylococcus had appeared by 1947 and even today deaths continue to be caused by MRSA and other antibiotic-resistant bacteria.

Bibliography

J Anderson, `Greenhouses and bodysuits: the challenge to knowledge in early hip replacement surgery, 1960-1982', in C Timmermann and J Anderson (eds), Devices and Designs: Medical Technologies in Historical Perspectives (Basingstoke: Palgrave, 2006)

G AJ Ayliffe and Mary P English, Hospital Infection: From Miasmas to MRSA (Cambridge: CUP, 2003)

R Bud, Penicillin: Triumph and Tragedy (Oxford: OUP, 2007)

R B. Fisher, Joseph Lister 1827-1912 (London: MacDonald and Jane, 1977)

F Nightingale, Notes on Nursing: What it is and What it is Not (New York: D Appleton and Company, 1860)

S Nuland, The Doctor's Plague: Germs, Childbed Fever and the Strange Story of Ignaz Semmelweiss (New York: WW Norton, 2004)

S J Snow, Blessed Days of Anaesthesia: How Anaesthetics Changed the World (Oxford: OUP, 2008)

L Stratman, Chloroform: The Quest for Oblivion (Stroud: Sutton, 2003)

Glossary:

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