History and Significance of Anesthesia in Modern Medicine

Introduction to Anesthesia

Anesthesia means the temporary loss of sensation, including pain. It is a Greek word that literally means "to negate sensation" (Silver, 1957). The primary significance of anesthesia lies in its ability to provide painless surgical procedures by producing analgesia, unconsciousness, and amnesia in patients; it also results in the suppression and relaxation of muscles. Combinations of drugs are required to achieve these effects quickly and effectively. Until the discovery of anesthesia, performing surgery and tooth extraction was an extremely painful ordeal.

The significance of anesthesia is therefore to relieve anxiety and stress in patients and to make them comfortable for surgery. Pain is an undesirable symptom that tells the body something is wrong. Over time, several efforts were made to eliminate this symptom. The Chinese were known to use acupuncture, while Greeks and Romans promoted the use of alcohol. Herbs were used in other parts of the world, and these efforts eventually led to the discovery of anesthesia.

Before the discovery of anesthesia, medical professionals were generally not held in high regard. Anesthesia played a significant role in giving medical practitioners their due place in society. Previously, techniques for pain management were crude and brutal. Oliver Wendell Holmes, an American physician and poet, was the first person to give the name "Anesthesia" to the phenomenon, in 1846. The respect and honor that physicians and surgeons receive today — the title of Healers — did not exist in ancient times. Anesthesia is preferred over other drugs partly due to its fat-soluble property, which allows drugs easy and quick passage through the cell membrane, producing effects rapidly and making surgery a quicker and safer procedure.

Pre-Anesthesia Pain Management and Surgical Practice

Attempting to administer pain-free surgery has been a dream as old as the ancient world itself. Pre-anesthetic pain management techniques were crude attempts to fulfill the dream of a painless surgical procedure. According to Celsus, a Roman physician in 100 AD, the pain of surgery was akin to torture: "Now a surgeon should be youthful or at any rate nearer youth than age; with a strong and steady hand which never trembles, and ready use the left hand as well as the right; with vision sharp and clear, spirit undaunted; filled with pity, so that he wishes to cure his patient, yet is not moved by his cries, to go too fast, or cut less than necessary; but he does everything just as if the cries of pain cause him no emotion."

The process of surgery and tooth extraction was considered brutal, and surgeons were regarded as heartless individuals who needed to be strong enough to handle patients in extreme pain. In older times, several strong men were required to hold the patient steady, and the surgeon had to appeal to the patient for cooperation before quickly conducting the procedure. Due to pain, the process became very difficult, and patients often aspirated vomit into their lungs, causing aspiration pneumonia. Even after inducing heavy doses of ether, the process remained very difficult and painful.

Ether is a small molecule first discovered in 1275 by a Spanish chemist who named it "sweet vitriol." Later, in 1730, the name was changed to "ether" by the German scientist W.G. Frobenius, and this name was retained until the early 1800s (Blatner, 2009). One elderly Boston physician could only compare the experience of surgery before anesthetics to the Spanish Inquisition. It was not until the 18th century that some major advances in medicine took place. Surgery was an extremely painful procedure and was often abandoned by patients, resulting in death from diseases that could otherwise have been cured surgically. Surgeons in older times used herbs and plant derivatives such as marijuana, belladonna, jimsonweed, and opium; some preferred alcohol, and others used a blow to the head to cause unconsciousness. These methods were not successful and did not produce the anesthetic effect required to carry out a surgical procedure.

Before anesthesia, surgery was performed only rarely. According to the annual report of Massachusetts General Hospital from 1821 to 1846, records show a total of 333 surgeries — roughly one surgery per month (Sullivan, 1996). Surgery was considered simply the last resort of treatment. The English scientist Joseph Priestley (1733–1804) discovered that nitric oxide might relieve pain. Some practitioners used carbon dioxide, while others injected cocaine into the mouth, eyes, and other parts of the body to block nerve impulses.

During the 19th century, most medical practices took place privately in homes, which increased the risk of infection and sepsis. Doctors at that time had limited knowledge of how disease spread, and hospitals — despite being large — were considered unhygienic, which harmed patients during their stays. Early forms of anesthesia, such as chloroform and ether, carried the danger of asphyxiation. There was also an increased risk of infection, as antiseptics were not widely adopted in the United States until the end of the century (19th Century Doctor within the U.S., 2009, Rose Melnick Medical Museum). As a result, patients and their families preferred to call doctors to their homes. In older times, a doctor was expected to treat everything from a toothache to a tumor, but with time, doctors began to focus on excelling in specific fields of medicine and surgery.