175 Years of Anesthesia and How Childbirth Has Benefited

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Throughout the history of human civilization and the much longer span of prehistory that preceded it, women could count on at least one thing: childbirth was nearly always painful, so painful that so many different cultures boast origin stories seeking to explain how how the pain of childbirth had come to be. But 175 years ago, a new medical technology came on the scene, or at least it was demonstrated for the first time before the eyes of humankind. On October 16, 1846, in the surgical amphitheatre known famously today as the “Etherdome” of Massachussets General Hospital (MGH), in Boston, William T. G. Morton, a dentist of sorts, induced inhalational anesthesia in a patient sufficient for a surgeon, John Warren, to remove a tumor, as the patient lay unconscious, feeling no sensation of pain. Waking up after the procedure, the patient remembered nothing from the moment that the anesthesia had been induced.

It was not the very first anesthesia success. Anecdotes floating around from Middle Ages and earlier have hint of occasional surgeons in bygone eras, in eastern lands, possessing one or another cocktail of medications that enabled painless surgical procedures, even deep within the body. Moreover, in Morton’s own time period, a Georgia surgeon, Crawford W. Long, is generally recognized by historians for anesthetizing patients as much as four years prior to Morton’s MGH demonstration, using the same inhalational anesthetic as Morton, diethyl ether (“ether”), and also another inhalational anesthetic, nitrous oxide. Unlike ether, which is stored as a liquid that volatilizes (evaporates into inhalable fumes), nitrous oxide is a gas. Still used today when only light anesthesia is needed (such as in certain minor procedures), nitrous oxide, a gas that you may know as laughing gas, had been the drug of choice in a test one year early, in the very same surgical amphitheatre at MGH. That earlier test had not gone well, probably because the man administering the nitrous oxide —another dentist, Horace Wells— should have waited just a little longer before proceeding extracting a bad tooth from the patient, a medical student, who had volunteered at the last minute, because the designated patient had run away, fearing the pain of the major surgery for which he’d been scheduled.

That Wells and Morton were both dentists was no coincidence. Above, I called Morton a dentist of sorts, because he lacked formal training and worked as a dentist, only because he had conned Wells into teaching him the trade by claiming to be a partially-trained dentist, forced to drop out of dental school, due to lack of funds. This was following a previous career of swindling people and running from state to state to escape capture and prosecution for fraud. Over time, Morton had swindeled Wells into investing money for various ventures, and finally taken credit for Wells’ idea to utilize nitrous oxide for anesthesia, and finally Morton had stumbled on ether, tested it on his dog, and earned the attention of Warren, a talented and respected Boston surgeon.

If Morton’s origins and motivations were questionable, his demonstration of the effects of ether would soon transform surgery, which over the next year would start making use of ether and nitrous oxide and a third anesthetic, chloroform (trichloromethane). Like ether, chloroform is also a liquid whose fumes produced anesthesia when inhaled. In old movies, chloroform is the notorious agent that is soaked into handkerchiefs placed over the mouth and nose of an unsuspecting victim to render the victim unconscious, but chloroform also claims some credit related to pregnancy. In 1853, during her eight pregnancy, Queen Victoria happily accepted chloroform anesthesia to avoid the pain of giving birth to Prince Leopold. Although used previously, experimentally in some settings, such as during the Mexican American war (1846-47), Queen Victoria gave anesthesia the high dose of publicity needed for it to go viral, and it surely did. Although Hollywood has produced no shortage of horrifying scenes set in the American Civil War (1861-65) of amputations being performed without anesthesia, in reality, especially on the Union side, surgeons made full use of both chloroform and ether.

Although, as noted earlier, nitrous oxide still has some uses, anesthesiology has come a long way in these 175 years from these early anesthetics, each of which has at least one major disadvantage. Nitrous oxide, though fairly safe, does not produce full anesthesia, although it can be combined with other agents for such a purpose. Chloroform is fairly toxic. It can cause heart arrhythmias and is carcinogenic (cancer causing) as well. As for ether —meaning diethyl ether— it can be irritating to mucous membranes, has an unpleasant smell, and can cause excessive salivation and laryngeal spasm, which can interfere with a patient’s ability to breathe, plus it is extremely flammable —which is not a good thing in a modern surgical theatre, where there are a lot of things used that can get quite hot, things like diathermal cutting and cautery instruments and lasers. On top of this, typically, there is a lot of oxygen around during surgery, so flammable agents are no longer used. But modern anesthesia makes use various other agents, safer in many ways, some inhalational others intravenous to produce general anesthesia in which you are asleep, and others to eliminate pain in parts of the body while you are awake.

Today, you can receive anesthesia with no need to worry about toxicity and cancer-causing properties of chloroform and other old agents. Most women get what doctors call neuraxial anesthesia, which means you are awake with no ability to sense pain below a certain point on your body. Usually the type of neuraxial anesthesia for childbirth is epidural anesthesia, which means anesthetic is injected along the dura layer of connective tissue that surrounds your spinal cord. For cesarean birth, your doctors may use epidural, or a slightly deeper type of neuraxial anesthesia called spinal anesthesia, which also allows you to be awake for your child’s birth.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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