After vaccination, the most important medical event of the century is
the discovery of anæsthesia. While there were some prior attempts at
anæsthesia, practically it dates from October 16, 1846, when Dr. John
C. Warren, in the Massachusetts General Hospital, first performed a
major surgical operation, without inflicting the slightest pain. I
cannot enter into the merits of the various claimants for the credit
of first using an anæsthetic, but ether was then for the first time
publicly administered by Morton, and the very sponge which was then
used is now a precious trophy of the Massachusetts General Hospital.
I may, perhaps, quote from an address which I delivered before the
Medical and Chirurgical Faculty of the State of Maryland, at their
centennial anniversary, in April, 1899, the following in relation to
anæsthesia:
“The news went like wildfire, and anæsthesia was soon introduced
into every clinic and at almost every operation throughout
the civilized world. Prior to that time a surgical operation
was attended with horrors which those who live in these days
cannot appreciate. He was the best surgeon who could perform any
operation in the least possible time. The whole object of new
methods of operating was to shorten the period of frightful agony
which every patient had to endure. Every second of suffering
saved was an incalculable boon. To submit to any operation
required then a heroism and an endurance which is almost
incomprehensible to us now. All of the more modern, deliberate,
careful, painstaking operations, involving minute dissection,
amid nerves and blood-vessels, when life or death depends on the
accuracy of almost every touch of the knife, were absolutely
impossible. It was beyond human endurance quietly to submit one’s
self for an hour, for an hour and a half, for two hours, or even
longer, to such physical agony.
“It is a striking commentary on the immediate results of
anæsthesia to learn that, in five years before the introduction
of ether, only one hundred and eighty-four persons were
willing to submit themselves to such a dreadful ordeal in the
Massachusetts General Hospital—an average of thirty-seven
operations per annum, or three per month.... During the last
year, in the same hospital—a Mecca for every surgeon the world
over—over thirty-seven hundred operations were performed. It is
not an uncommon thing at the present day for any one of the more
active surgeons of this country to do as many as four or five
hundred operations in a year. I have known as many as nineteen
operations to be done in the Jefferson Medical College Hospital
in a single day—equalling six months’ work in Boston before the
introduction of ether.”
The next year, 1847, witnessed the introduction of chloroform by Sir
James Y. Simpson, of Edinburgh. Until I became acquainted with the
striking figures just quoted, I had often wondered at the hospital
scene in that most touching story, _Rab and His Friends_, by the late
gifted and well-beloved physician, Dr. John Brown, of Edinburgh.
Nowadays students do not rush into the surgical amphitheatre when they
learn that an operation is to be done, but it is taken as a matter of
course, for practically every day many operations are done in most of
our large hospitals. But, at the time when Rab’s mistress was operated
upon, an operation, as has been stated, was a very rare event. Few had
the fortitude to endure its dreadful pangs. Now, thanks to the blessed
sleep of anæsthesia, sufferers from even the most dreadful disorders
can have long and difficult operations done, accurate and tedious
dissections made, and yet feel not a twinge of pain.
Besides general anæsthesia by ether, chloroform, and a few other
agents, there have been introduced several means for producing “local
anæsthesia,” _i.e._, agents which destroy the sensibility of the part
of the body to be operated upon while not producing unconsciousness.
Freezing the part by ice and salt, or by a quickly evaporating spray
of rhigolene or chloride of ethyl, are sometimes used. But cocaine
and a somewhat similar substance, eucaine, have of late been more
extensively used on man, after their harmlessness had been first shown
by experiments on animals. In 1885 Corning, of New York, injected a
solution of cocaine as near to the spinal cord as was possible, and
produced insensibility of all the body below the point of injection
by the effect of the cocaine upon the spinal cord. A few years ago
Quincke, of Kiel, in Germany, devised a means of puncturing the spinal
canal itself in the lumbar region (the lowest part of the small
of the back) for the purpose of drawing off some of the fluid for
examination. This suggested to Bier, then of Kiel, who was apparently
ignorant of Corning’s work, that cocaine could be injected through a
hollow needle inserted into the spinal canal by “lumbar puncture” and
so produce anæsthesia of all the body below this point. This method
was published by him in 1899, and was soon repeated in America. In
France, however, it has been practised more than elsewhere, Tupper,
of Paris, having successfully done over two hundred operations by
“spinal anæsthesia.” All of the body below the diaphragm can thus be
deprived of sensibility. The method will probably never replace ether
and chloroform, but in many cases is a valuable aid to the surgeon.
But it has its dangers and its inconveniences. The ideal anæsthetic
is not that which destroys sensibility and yet leaves the patient
perfectly conscious, as spinal anæsthesia does. A patient to whom I
recently proposed it for certain special reasons rejected it, saying,
with probable truth, that she could never bear the strain of lying on
the table perfectly conscious of all that was being done and frightened
by any surgical emergency which might easily arise in such a long,
difficult, and dangerous operation. The ideal anæsthetic is that
which will abolish pain and consciousness without danger to life. The
twentieth century will undoubtedly see the discovery of this safe and
efficient anæsthetic.