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“Ether Day 1846” (Warren and Lucia Prosperi): Portrays Dr. John C. Warren doing a procedure with the use of ether at the Massachusetts General Hospital

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Phase of Trial and Error: Techniques Prior to the Discovery of Ether & Chloroform

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Phase of Trial and Error: Techniques Prior to the Discovery of Ether & Chloroform

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Earlier beliefs from primitive cultures (prior to the discovery of anesthesia): attributed pain management to trephination, as they believed that by opening the skull, unwanted spirits could leave the head (they were basically causing the pain)¹.

Without the advanced medical equipment that surgeons use nowadays, it was difficult to predict how long a neurological procedure could have taken. Supposedly, trepanning a single hole took a minimum of thirty minutes¹.

Plants such as coca leaves and daturas were used as a sedative during Peruvian times¹.

Discovering carbon dioxide, hydrogen and nitrogen during the late 18th century  played a vital role in the advancement of anesthesia. However this was not immediately implemented, as, according to Sir Astley Cooper (former consulting surgeon), “liberal quantities of wine” were used to alleviate pain during an operation¹.

Several physicians and dentists utilized nitrous oxide as a form of anesthesia but was held to a stop due to a patient death caused by intoxication. This unfortunate event, however, inspired researchers to experiment with other chemicals¹.

Soon, using ether and chloroform was popularized in the medical community which brings us to the anesthesia we use in our present day.

Sources:
(1) Chivukula, S., Grandhi, R., & Friedlander, R. M. (2014). A brief history of early neuroanesthesia, Neurosurgical Focus FOC, 36(4), E2. Retrieved Apr 5, 2022, from https://thejns.org/focus/view/journals/neurosurg-focus/36/4/article-pE2.xml

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First Public Demonstration of Ether: Dr. T.G. Morton

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First Public Demonstration of Ether: Dr. T.G. Morton

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Although he was not the first to use ether as an anesthetic, Dr. Morton publicized the use of the agent which quickly spread.

Dr. Morton was a dentist when he publicly anesthetized a patient at the Massachusetts General Hospital. He did a surgical procedure to remove a tumor in the jaw. This required close attention to how ether affected the facial nerves³.

Despite how it is reported that during the procedure, the patient, Edward Abbott, shifted a lot and seemed as though he was feeling pain, he claimed that there was no pain although he could still feel something passing through his neck¹.

After the successful procedure, Morton did not reveal ether for a while, and instead termed it “Letheon,” (although this secret was not kept for a long time). It rather sparked up the “ether controversy” for which several physicians stood up to claim priority in discovering this chemical agent².

News spread quickly throughout the states and eventually reached Europe.

Sources:
(1)https://daily.jstor.org/19th-century-anesthesia-and-the-politics-of-pain/

(2)https://hekint.org/2021/06/28/the-ether-controversy/

(3) Chaturvedi, Ravindra, and R L Gogna Retd. “Ether day: an intriguing history.” Medical journal, Armed Forces India vol. 67,4 (2011): 306-8. doi:10.1016/S0377-1237(11)60098-1

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As the demand for ether soared, so was the search for a different method. For instance, chloroform was first used in a procedure done in India early on in 1848. Along with numerous attempts at discovering the best mode of delivering medicine for pain management came a number of deaths caused by it. Several medical institutions were inferring that the deaths caused by chloroform were either because of respiratory or cardiac complications¹.

Today, it is known that incorrectly using chloroform may lead to cardiac arrest².

Major E. Lawrie was one of the elite physicians to insist that chloroform is safe enough to use as an anesthetic. As a matter of fact, it is reported that Lawrie administered this chemical to thousands of patients without losing any¹.

There was a divide amongst physicians regarding the use of chloroform. Some claimed that chloroform can weaken the nervous system and therefore it must be administered with drugs that alleviate it. Others insisted that using stimulants will discard the purpose of using chloroform in the first place. Furthermore, several physicians supported the idea of using ether as the sole source of anesthesia².

Source:
(1) Masson, A H et al. “Edward Lawrie of the Hyderabad Chloroform Commission.” British journal of anaesthesia vol. 41,11 (1969): 1002-11. doi:10.1093/bja/41.11.1002

(2)http://www.pbs.org/mercy-street/blogs/mercy-street-revealed/chloroform-and-the-american-civil-war-the-art-of-practice-and-the-science-of-medicine/

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Introduction to Antisepsis & Progress in Neurosurgical Techniques

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Introduction to Antisepsis & Progress in Neurosurgical Techniques

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Fighting infection was extremely difficult for even the most talented surgeons. During the mid-1800s, surgeons would check to make sure there was minimal infection prior to treating the head and spinal region¹.

The use of antisepsis during operations was initiated around this time. This technique allowed surgeons to proceed surgical procedures regarding the brain with a well reduced risk of spreading the infection¹.

Up until the introduction of antisepsis, neurosurgery was not considered a separate field of surgery. However, as neurosurgical pioneers made remarkable discoveries (such as localization), surgical techniques that are unique to neurosurgery were developed¹.

An example of this would be when neurologist Alexander Hughs Bennet advised Sir Rickman Godlee to remove a brain tumor of a patient who has been having seizures. Bennet based this information off of his evaluation of how the seizures started to spread from the face throughout the limbs. Godlee was able to successfully remove the tumor via a cortical incision¹.

Source:
(1) Goodrich, J. T. (2012). Landmarks in the history of neurosurgery. In Principles of Neurological Surgery (pp. 3-36). Elsevier Inc.. https://doi.org/10.1016/B978-1-4377-0701-4.00001-4

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Anesthesia during the Civil War

Prior to the Civil War, forms of inhalation anesthesia were used by Sir James Young Simpson during the Mexican-American War¹.

According to Samual Gross, a military surgeon, chloroform was widely used in other countries that were in war during the such as Britain and France. By the mid-1800s, chloroform was considered to be a typical supply used by military physicians¹.

The American Civil War was when the majority of physicians grew fond of using the agent during procedures. Only 0.3% of the procedures used anesthesia¹.

The reason chloroform was more widely used than ether was due to the fact that it took less time to take its full effect. Procedures were done by covering the patient’s nose and mouth with a piece of cloth dampened in chloroform¹.

Source:
(1) http://www.pbs.org/mercy-street/blogs/mercy-street-revealed/chloroform-and-the-american-civil-war-the-art-of-practice-and-the-science-of-medicine/

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Joseph Lister is a British surgeon who came up with the antisepsis system. Lister quickly realized how detrimental infections are to a patient’s pathway to recovery. Despite how many operations were considered successful, once infected the patient’s life was at risk¹.

Prior to becoming a surgeon, Lister worked as a surgical dresser. During this time, he was able to closely examine various wounds. He dedicated much of his time researching the nature of what caused patients to get infected. He would conduct clinical trials to further his work1.

Dr. Lister based his research on Louis Pasteur’s Germ Theory of Disease which concerned the nature of microorganisms and its effect on the human body¹.

In the end, he was able to come up with the idea of creating a chemical layer between the wound and possible infectious germs using carbolic acid. This acid helped eliminate germs that contacted the barrier¹.

Furthermore, Dr. Lister created an anti-bacterial hand wash for surgical teams, and came up with ways to sterilize surgical instruments. With his inventions, infection rates went down and death rates plummeted².

Sources:
(1)https://www.sciencemuseum.org.uk/objects-and-stories/medicine/listers-antisepsis-system#:~:text=Antisepsis%20is%20the%20method%20of,wounds%20during%20and%20after%20surgery.

(2)https://www.bbc.co.uk/bitesize/guides/zwkm97h/revision/5#:~:text=This%20began%20to%20change%20in,20%20solution%20of%20carbolic%20acid.

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Patient playing a guitar during an awake brain surgery (MD Anderson Cancer Center)

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Awake Craniotomy allows the surgeon to maximize the removal of tumor without causing physiological complications. This option is preferred for patients with tumors located near or within the cortex. Patients  experience less difficulty (e.g., nausea) when comparing their surgical experience to general anesthesia. Overall, this procedure helps maintain the patient’s motor control¹.

Prior to the operation, a surgical team will examine the patient’s airway to prepare for any potential issues that may come up during the procedure¹.

Some of the most commonly used anesthetic methods are monitored anesthesia care and asleep-awake-asleep¹.

With monitored anesthesia care (MAC), the patient will be accompanied by a specialist who will administer specific anesthetics unique to the individual. An advantage for this type of anesthesia is patients are able to discharge sooner².

Asleep-awake-asleep (AAA) allows surgeons to map the brain. As the name suggests, the patient is first asleep while an incision on their head. The patient is then woken up for monitoring purposes as well as mapping. Then the individual re-enters the “asleep” phase for the rest of the procedure³.

Sources:
(1)Kim, Seung Hyun, and Seung Ho Choi. “Anesthetic considerations for awake craniotomy.” Anesthesia and pain medicine vol. 15,3 (2020): 269-274. doi:10.17085/apm.20050

(2)Ghisi, D et al. “Monitored anesthesia care.” Minerva anestesiologica vol. 71,9 (2005): 533-8.

(3)https://www.clinicalpainadvisor.com/decision-support-in-medicine/anesthesiology/awake-craniotomy/