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Early 1800s: The Early Use of Nitrous Oxide

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Early 1800s: The Early Use of Nitrous Oxide

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From the late 1790s to the early 1800s, scientists conducted multiple experiments on the use and effectiveness of Nitrous Oxide, or what is more commonly known today as Laughing Gas.

Humphry Davy, a British chemist, was known for experimenting with the compound on himself. One of his most notable experiments took place outside Bristol in 1799, where he saturated his system with nitrate of ammonia and then recorded his feelings - his findings were similar to what one may experience on Laughing Gas: euphoria, a general absence of self-awareness and pain, and numbness.

At first, the use of this compound was not actually used in surgery. Instead, it was a commodity of sorts, with people volunteering to undergo the sensation if Davy were allowed to research their reactions. Over time, the commodity wore off but Davy's findings were incredibly significant as he found Nitrous oxide could essentially eliminate pain for a period of time. This finding would prove incredibly applicable to the future of pain management and surgery.

(1): https://www.open.edu/openlearn/history-the-arts/history-science-technology-medicine/humphry-davy-laughing-gas-and-the-era-self-experimentation

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Humphry Davy, laughing gas and the era of self-experimentation

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When Humphry Davy wanted to explore the properties of nitrous oxide, he decided the best way would be to experiment upon himself.

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March 1842: The First Surgical Use of Anesthesia

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March 1842: The First Surgical Use of Anesthesia

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In March 1842, Crawford Long administered the first surgical anesthetic. As noted previously, the use of compounds such as Nitrous oxide and ether had been studied and used prior to Long's significant usage in 1842, but never had they been used to administer surgery successfully.

Long administered the anesthetic in Georgia to James Venable to remove two small tumors on the back of his neck. At the time, ethyr was inhaled via a towel pressed over the patient's face and was inhaled multiple times throughout the procedure.

Long repeatedly used ether throughout the 1840s to operate on patients and began to learn that longer operations needed more ether, or a more powerful compound, as it had an end point.

(1): https://ugapress.manifoldapp.org/system/actioncallout/4f2530c4-f089-41d7-8792-6c36684adec5/attachment/original-cd5145bfc144430dc06aa43ebf01eead.pdf

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October 1846: Wide-Spread Ether Approval in the Ether Dome

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October 1846: Wide-Spread Ether Approval in the Ether Dome

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Prior to this event, the usage of ether in surgery was still relatively new and used by only a handful of physicians.

In October 1846, the first surgery under ether was performed publicly in Massachusetts General Hospital (MGH) in Boston, Mass., by Dr. John Collins Warren. Warren successfully removed a tumor from William Morton without pain. This event marked the first public usage, and since then, administering ether in a surgical capacity became more frequent.

This usage, however, also expanded into other fields such as neurobiology, prompting many scientists to research other compounds and their impact on pain. receptors throughout the body. Morton's success post-surgery and Dr. Warren's successful operation accelerated research on pain reception and blocks.

(1): https://www.massgeneral.org/assets/MGH/images/museum/ether-dome.jpg

(2): https://www.massgeneral.org/museum/exhibits/ether-dome

(3): https://ugapress.manifoldapp.org/system/actioncallout/4f2530c4-f089-41d7-8792-6c36684adec5/attachment/original-cd5145bfc144430dc06aa43ebf01eead.pdf

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The Ether Dome at Mass General

William T.G. Morton made history on October 16, 1846 in Massachusetts General Hospital's surgical amphitheater, now known as the Ether Dome, when he demonstrated the first public surgery using anesthetic (ether).

Between 1821 and 1868, more than 8,000 operations were performed in the Ether Dome. Today it is a teaching amphitheater and historical landmark. Visitors can explore the unique architecture and a small collection of artifacts, including an oil painting of the famous first surgery, an Egyptian mummy and early surgical tools.

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William T.G. Morton made history on October 16, 1846 in Massachusetts General Hospital's surgical amphitheater, now known as the Ether Dome, when he demonstrated the first public surgery using anesthetic (ether).

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Throughout the early 1800's the use of chloroform had grown in popularity for women in childbirth to reduce their pain. However, it did not become widely used or administered until Queen Victoria utilized it during her 8th birth in 1853.

On April 7, 1853, in Buckingham Palace, Dr. John Snow administered chloroform to the queen to which she expressed "great relief" upon its usage. The chloroform was administered via a light handkerchief and most notably, the queen did not appear out of sorts or loopy, like how Davy had appeared under the usage of Nitrous Oxide. This use of "light sedation" was groundbreaking in pain management as it enabled an individual to reduce pain without fully reducing consciousness.

(1): https://www.ogmagazine.org.au/18/1-18/victorias-secret-chloroform-acceptability-analgesia-birth/

(2): https://pbs.twimg.com/media/GFdjEiWa4AAbF9k.jpg

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Victoria’s secret: chloroform and the acceptability of analgesia for birth – O&G Magazine

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Among the crimes of Agnes Sampson, a midwife and the first woman to be burned at the stake for witchcraft in Scotland, in 1591, was that she had used her supernatural skills to relieve the pain of labour. The dominant (in other words, male) view throughout Europe was that such interventions were potentially dangerous –…

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1884: Cocaine and Localized Pain Management

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1884: Cocaine and Localized Pain Management

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In 1884, Dr. Carl Koller revolutionized the history of local pain management through the use of cocaine on a patient.

Dr. Koller was an ophthalmologist from Vienna and a colleague of Sigmund Freud. It is said that Freud "quietly revolutionized eye surgery by suggesting to the ophthalmologist Carl Koller that cocaine could be used as an anaesthetic." And, like the quotation, that is exactly what Koller did. He placed a cocaine solution in the cornea of a patient in Austria, and witnessed how it only reduced pain in the area applied, rather than the entire body (which inhaling ether and chloroform did).

Although incredibly controversial, its findings cannot go unnoticed. Koller was the first known to reduce pain in a specific region, introducing the beginnings of nerve/pain blocks.

(1): https://pubmed.ncbi.nlm.nih.gov/22531385/

(2): https://academic.oup.com/brain/article-abstract/147/9/e62/7682512?redirectedFrom=fulltext

(3): https://wcsa.world/Userfiles/Upload/images/12656202324_bccb585d3e_z.jpg

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Abstract

Modern-day local anesthesia began in 1884 with a discovery by a young unknown ophthalmologist from Vienna named Carl Koller, who placed a cocaine solution on the cornea, thus producing insensibility. The news of his discovery spread throughout the world in less than a month. "Not surprisingly," a controversial priority discussion emerged. There is little information about this "dark side" of Koller's discovery and only sparse data about the personalities involved in this controversy. In addition, Carl Koller's decision to leave Vienna is also surrounded in secrecy. The story surrounding the revelation of the local anesthetic effect of cocaine and the personalities involved is fascinating and relatively unknown.

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national center for biotechnology information

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Carl Koller, cocaine, and local anesthesia: some less known and forgotten facts - PubMed

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Modern-day local anesthesia began in 1884 with a discovery by a young unknown ophthalmologist from Vienna named Carl Koller, who placed a cocaine solution on the cornea, thus producing insensibility. The news of his discovery spread throughout the world in less than a month. "Not surprisingly," a co ...

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Contemporary Entry: BIS Monitors and Anesthesia Regulation

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Contemporary Entry: BIS Monitors and Anesthesia Regulation

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Contemporary Entry

As previously seen, anesthesia in the 1800s was used relatively unregulated - the only way to know if a patient felt pain was for them to announce it, and it was administered most commonly through inhalation from a towel placed over the mouth.

Now, modern anesthesiologists utilize technology like a Biospectral Index (BIS) monitor to track a patient's level of consciousness throughout the surgery. This prevents the patient from waking up mid-operation and experiencing pain, and allows the anesthesiologist to put the patient under heavy, light, or no sedation.

BIS mintors utilize a numerical scale of 0-100 which is constantly changing depending on the stage of consciousness the patient is in. These monitors were not introduced until the mid 1900s, however they have quickly become widely used and instrumental in streamlinging surgeries.

The usage of BIS in the modern day represents just how far we have come as a society in not only the administration of anesthesia but also the science of consciousness and sleep-like states.

(1): https://www.ncbi.nlm.nih.gov/books/NBK539809/

(2): https://pmc.ncbi.nlm.nih.gov/articles/PMC3387745/

(3): https://upload.wikimedia.org/wikipedia/commons/a/a9/BIS_JPN.jpg

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Monitoring the depth of anesthesia is very important during any procedure. Anesthesia that’s too deep can cause hemodynamic changes, and anesthesia that is too light carries the risk of recall or awareness during anesthesia.[1] Awareness during anesthesia is a very serious complication with potential long-term psychological sequelae such as anxiety and posttraumatic stress disorder.[2] When the bispectral index (BIS) value is maintained below 60, it decreases the incidence of anesthesia awareness.[2] Several neuro monitors based on the processed electroencephalogram or evoked potentials have been developed to evaluate the anesthetic depth. The BIS monitor is the first FDA-approved method to assess the hypnotic effects of drugs.[3]

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Docent Entry

I would pick Dr. Crawford Long, as discussed in entry #2 to be the guide for this mini-museum.

Long was Georgia born and raised, and performed his groundbreaking ether surgery March 30, 1842. Although ether was not widely used until the surgery done at MGH in 1846, that surgery would not have been done if it were not for Dr. Long and his successes in Georgia!

Dr. Crawford Long would provide incredibly insight in guiding this exhibit as all subsequent usages of anesthesia and research really would not have been possible without him. He redfinied the world of pain, consciousness, and surgical possibilities by doing something no one was willing to do at the time. He bridged the gap between theory and guesswork to actual application.

(1): https://www.med.upenn.edu/psom/assets/image-cache/user-content/images/portraits/jmb-longcw-laheyr.5c68ae01.jpg