Anesthetic Agents: A Brief History

1840s: Patients needing surgery (ie. Amputation of a limb) were given laudanum (opium mixed with wine) which would cause drowsiness, but was not a genuine anesthetic and did little to dull the pain. In operations at this time, speed was key because long surgeries would result in a blood rush to the limb being operated upon, causing shock and a blood deficit to the brain. Prolonged shock would cause death. Thus, without anesthetics, patients could not receive operations involving internal organs or complicated procedures.


Boston dentists, Morton and Wells, experimented with nitrous oxide (discovered by Humphrey Davie), which was discovered to be a laughing gas. Nitrous oxide was the first general anesthetic, and was not predictable because the effective dosage varies from patient to patient, and its effects vary from patient to patient. Wells attempted to spread the use of nitrous oxide as an anesthetic to the medical profession, and so lectured to a skeptical Dr. Warren (a prominent Boston physician) and his students, and was ridiculed. Morton continued to experiment with alternate anesthetics, and in 1846 discovered that purified ether worked as an anesthetic. Ether could also be used as a laughing gas, which would cause the medical community to be skeptical, so Morton decided to add a red dye to his purified ether and re-name it lipion (spelling?). On October 16 1846 at the Massachusetts general hospital, Morton uses his anesthesia to remove a small tumor from the neck of a patient, Gilbert Abbott. It is the most important occasion in the history of anesthesia. The surgeon is the revered Dr. Warren, and so it is Dr. Warren who transmits the discovery through the New England Journal of Surgery to the medical world. It is hailed as successful and widely used in the great medical centers of London, Paris, and Berlin.


James Young Simpson, an obstetrician in Edinburgh, Scotland, used ether to deal with childbirth pain. Ether was used as an analgesic in childbirth, not an anesthetic, to moderate the pain but not stop it. Ether, though, could cause nausea so severe that a patient could suffocate. Gaseous anesthetics are effective by being inhaled, then reaching the bloodstream and the brain. The church and much of the local medical profession opposed ether on the grounds that it was unnatural. Simpson and some of his assistants experimented with different chemicals attempting to find new anesthetics, and almost died from inhalation of “Dutch oil”, a poison.


On November 4, 1847, chloroform was discovered by Dr. Simpson to work as a laughing gas and anesthetic. Chloroform is denser than ether and so easier to transport. The trouble with chloroform was that it, too, was hard to predict with respect to the correct dosage needed per patient. Indeed, for untrained New England country doctor Mr. Micheson (spelling?), chloroform therapy killed a patient when it was used as an anesthetic for the removal of a toenail—although there is still debate as to whether it was the chloroform or the brandy used in attempts to wake her, that suffocated the patient. Horace Wells, the dentist involved with some of the original work with nitrous oxide as an anesthetic, later in life became addicted to chloroform and committed suicide after being incarcerated for throwing acid in the face of a prostitute while high on the drug. Indeed, addiction was not understood by the pioneers of anesthetics, which lead to the abuse of experimental chemicals and drugs by many of the very innovators who brought them into public medicinal usage.


With the advent of many more complicated surgeries brought about by the introduction of anesthesia, infection killed many of those operated upon because not enough was known or believed about microscopic germs.


In the 1880s, it was discovered that cocaine could cause local anesthesia in the eye or tip of the tongue due to the fact that there was no thick external skin to prevent the absorption of the drug into the tissue. It was later found by Dr. William Holstead that when cocaine was injected into tissues it was effective at blocking nerves (when administered within a millimeter or two of the targeted nerve). Holstead then, was a pioneer of regional anesthetic. He also found that injected cocaine could allow him to go for days without sleep, and became addicted… he eventually overcame his cocaine addiction by substituting morphine and went on to become the father of modern surgery due to his ability to proceed slowly—an innovation made available by the use of anesthesia on his patients.

Category: Pharmacology Notes