Anesthesia - History - Early Inhalational Anesthetics

Early Inhalational Anesthetics

Further information: Inhalational anesthetic

Early Arab writings mention anesthesia by inhalation. This idea was the basis of the "soporific sponge" ("sleep sponge"), introduced by the Salerno school of medicine in the late twelfth century and by Ugo Borgognoni (1180-1258) in the thirteenth century. The sponge was promoted and described by Ugo's son and fellow surgeon, Theodoric Borgognoni (1205-1298). In this anesthetic method, a sponge was soaked in a dissolved solution of opium, mandragora, hemlock juice, and other substances. The sponge was then dried and stored; just before surgery the sponge was moistened and then held under the patient's nose. When all went well, the fumes rendered the patient unconscious.

In 1275, Spanish physician Raymond Lullus, while experimenting with chemicals, made a volatile, flammable liquid he called sweet vitriol. Sweet vitriol, or sweet oil of vitriol, was the first inhalational anesthetic used for surgical anesthesia. It is no longer used often because of its flammability. In the 16th century, a Swiss-born physician commonly known as Paracelsus made chickens breathe sweet vitriol and noted that they not only fell asleep but also felt no pain. Like Lullus before him, he did not experiment on humans. In 1730, German chemist Frobenius gave this liquid its present name, ether, which is Greek for “heavenly.” But 112 more years would pass before ether’s anesthetic powers were fully appreciated.

Meanwhile, in 1772, English scientist Joseph Priestley discovered the gas nitrous oxide. Initially, people thought this gas to be lethal, even in small doses. However, in 1799, British chemist and inventor Humphry Davy decided to find out by experimenting on himself. To his astonishment he found that nitrous oxide made him laugh, so he nicknamed it laughing gas. Davy wrote about the potential anesthetic properties of nitrous oxide, but nobody at that time pursued the matter any further.

American physician Crawford W. Long noticed that his friends felt no pain when they injured themselves while staggering around under the influence of ether. He immediately thought of its potential in surgery. Conveniently, a participant in one of those “ether frolics,” a student named James Venable, had two small tumors he wanted excised. But fearing the pain of surgery, Venable kept putting the operation off. Hence, Long suggested that he have his operation while under the influence of ether. Venable agreed, and on 30 March 1842 he underwent a painless operation. However, Long did not announce his discovery until 1849.

William Thomas Green Morton, a Boston dentist, conducted the first public demonstration of the inhalational anesthetic. Morton, who was unaware of Long's previous work, was invited to the Massachusetts General Hospital to demonstrate his new technique for painless surgery. After Morton had induced anesthesia, surgeon John Collins Warren removed a tumor from the neck of Edward Gilbert Abbott. This occurred in the surgical amphitheater now called the Ether Dome. The previously skeptical Warren was impressed and stated "Gentlemen, this is no humbug." In a letter to Morton shortly thereafter, physician and writer Oliver Wendell Holmes, Sr. proposed naming the state produced "anesthesia", and the procedure an "anesthetic".

Morton at first attempted to hide the actual nature of his anesthetic substance, referring to it as Letheon. He received a US patent for his substance, but news of the successful anesthetic spread quickly by late 1846. Respected surgeons in Europe including Liston, Dieffenbach, Pirogov, and Syme, quickly undertook numerous operations with ether. An American-born physician, Boott, encouraged London dentist James Robinson to perform a dental procedure on a Miss Lonsdale. This was the first case of an operator-anesthetist. On the same day, 19 December 1846, in Dumfries Royal Infirmary, Scotland, a Dr. Scott used ether for a surgical procedure. The first use of anesthesia in the Southern Hemisphere took place in Launceston, Tasmania, that same year. Drawbacks with ether such as excessive vomiting and its flammability led to its replacement in England with chloroform.

Discovered in 1831, the use of chloroform in anesthesia is linked to James Young Simpson, who, in a wide-ranging study of organic compounds, found chloroform's efficacy on 4 November 1847. Its use spread quickly and gained royal approval in 1853 when John Snow gave it to Queen Victoria during the birth of Prince Leopold. Unfortunately, chloroform is not as safe an agent as ether, especially when administered by an untrained practitioner (medical students, nurses, and occasionally members of the public were often pressed into giving anesthetics at this time). This led to many deaths from the use of chloroform that (with hindsight) might have been preventable. The first fatality directly attributed to chloroform anesthesia was recorded on 28 January 1848 after the death of Hannah Greener.

John Snow of London published articles from May 1848 onwards "On Narcotism by the Inhalation of Vapours" in the London Medical Gazette. Snow also involved himself in the production of equipment needed for the administration of inhalational anesthetics.