Genesis

The Genesis of Surgery and Anaesthesia


Anaesthesia and Surgery has been around for centuries, why according to Genesis: “The Lord God caused a deep sleep to fall upon Adam, and while he slept took one of his ribs and closed its place with flesh"1. So, you can say that the Lord God performed the very first operation under anaesthesia, and not the Americans: Of course, the Americans would dispute this, as a Christian however, I would not.
Now in today’s world we still cannot induce anaesthesia without the aid of one drug or another and we use synthetic fibres such as nylon, vicryl and prolene to close the surgical wound.

Morton's Success
Morton's Success

Since the good Lord created woman from the rib of man, humankind has had to rely upon alcohol, opium, mandrake, and other less effective means of inducing anaesthesia. It was not until the nineteenth century that modern anaesthesia, as we know it today was born.
The breakthrough came on the 16th October 1846 at Boston University Hospital Massachusetts where William Thomas Green Morton successfully anaesthetised Edward Gilbert Abbott, a Printer. The operation was to remove a vascular tumour from below the mandible.
J.C Warren the eminent surgeon, who carried out the surgical procedure was led to exclaim, “ Gentlemen this is no Humbug.“   This statement referred to Horace Wells whose attempt failed a year earlier.
The drug Morton used that day was Diethyl Ether.
Following that demonstration, Morton had been accused of trying to hide the identity of the substance Abbott had inhaled (Ether). He referred to it as “Letheon." It was said that he had intentions to patent the substance and profit highly from its use. However, the Letheon” contained a masking agent.

Mortons Inhaler
Morton's Inhaler
It was known however that Morton did offer free rights to the technique to charitable institutions.
Having had surgery in his younger days he was committed to the eradication of suffering during surgery.
Morton received a patent for Letheon in the USA, but he never received any royalties, as he died prematurely.

Morton's legacy was overshadowed by the medical professions accusations of dishonesty and profiteering, given the patent, so Morton's achievements we not afforded full recognition before his death.
The surgical Ether Dome at Massachusetts General Hospital still exists today, although it is used for lectures and not surgery. The public can still visit the amphitheatre when it’s not in use.
We must however not dispute the fact that modern anaesthesia owes its official discovery to Morton. He has rightly been accredited to the very first publicized demonstration. On his graveside monument is inscribed
“Inventor and Revealer of inhalation Anaesthesia; before whom in all time, Surgery was agony; by whom Pain was averted and annulled; since whom, Science has control of Pain”

My opinion is that Morton had revealed the fantastic effects of Ether to the world. With regard to the word “inventor”! This I challenge, the word inventor describes the main creator.
Morton had made use of a substance which had been known for centuries, so "revealer"   may be a more appropriate word.
It is not my intention to play down Morton’s contribution to the discovery of anaesthesia, just to highlight the facts that led to his successful demonstration, which involved many people from many nations.

Europe, Asia and then America produced the pioneers who prepared the ground for this momentous advancement in Anaesthesia.
This in my view is the one greatest advancements that the scientific world has produced, it has relieved the world of a great deal of suffering, it has allowed surgeons over time to extend the lifespan of many people.
Today we are only restricted from operating on patients because of the weighing up factor i.e. if it is likely that the patient would die or suffer greater physical or mental damage as a result of an anaesthetic or operative procedure, the anaesthetist and surgeon would agree to either resuscitate the patient before surgery and then operate when the patient’s condition improves or make a decision not to do the procedure at all.

However, there are emergencies which will take precedence over a medical condition when the certain outcome is death without intervention e.g. an Abdominal Aortic Aneurysm (AAA) or a patient that has suffered a head injury and needs a craniotomy to remove the clots.
It is the case that even these are also subject to a medical filter especially when the consultants decide that the outcome will be, with or without the procedure, death.

Apart from these obvious restrictions, surgery today has few limitations given these advancements in Anaesthesia.

Before General Anaesthesia, surgery had strict limitations, and was carried out on the wounded following a battle on land or sea.
This was due, to the nature of the injuries obtained during war, all these wounds were dirty wounds and when a limb was involved, the likelihood of the affected area to become gangrenous was so great that it meant the amputation of that limb, which was necessary to save the serviceman's life.

There were surgical procedures carried out in peacetime, but this was a rare occurrence.

Even in times of peace, a patient unfortunate enough to have been injured by machinery, or perhaps run over by a carriage would most likely have suffered an amputation.
There were high mortality rates resulting from a number of factors;

• The excruciating pain of the procedure,
• The postoperative infection
• Shock
• The patients had few reserves of strength, due to loss of blood pre/during and post-surgery.
• The poor fitness of the patient. (The soldier’s survival rate was higher as he was young and fit)

Afghanistan War Surgery
Afghanistan War Surgery
It was also important to be aware that prior to Anaesthesia, Surgery had to be quick, and was quick. Intricate procedures would not be attempted unless it was lifesaving, although there are some surgeons who did attempt a procedure that was too complex and could not be carried out safely at speed, so the patient died in agony usually owing to the pain or shock due to a blood loss.
In the 19th century, Robert Liston, who carried out the first amputation under a general anaesthetic in this country, on a cold Monday December 21st, 1846. He was known as one of the fastest surgeons in London at that time, he could amputate a limb in less than a minute. Robert Liston was 6'2" tall and was very strong.

There is no doubt about it this man was arrogant, but his arrogance stemmed from his ability to do his job better than any other at that time. He was quick, he knew what he was doing. Not only did he have a sharp knife he also had a sharp mind. It was said that he never used to bother himself with minor operations as he felt this was far below his abilities.
This arrogance can be seen today in many surgeons and in some cases anaesthetists, who feel their skills should be reserved for more complicated procedures.

Robert Liston
Robert Liston
So, the first major operation performed in this country was done at the University College Hospital in London. William Squire administered the first anaesthetic. William Squire happened to be the apothecary's nephew who made ready the Ether substance that was to be used.
The patient's name was Frederick Churchill who was a butler, who had broken his leg sometime earlier and it had been left to fester and it needed to be amputated, otherwise he would have died.
Liston is quoted as saying "This Yankee dodge, gentleman, beats mesmerism hollow”

So there it was, the stage was set, audience in place and his assistant William Cadge at the ready, that he commanded William Cadge, to take the artery and press on it. He is then quoted as saying to the medical audience ...“Gentlemen time me!”
It took less than a minute (it is recorded as 25 seconds) before the limb was on the floor and vessels tied off. Today the average time taken to amputate a limb would be about 90 minutes.
His need for speed was unnecessary because of the effectiveness of the anaesthetic, this was however the first time, and it was in the nature of the surgeon at that time to work as expeditiously as possible.
Overcome with joy at the success of the anaesthetic, Liston held a party at his house that night; Cadge, his assistant was anaesthetised with Ether at the party.

In the People's Journal which was written in January 9, 1847, there is a famous quotation which states: "Tell, happy hour that brings the glad tidings of another glorious victory. Oh, what a delight for every feeling of heart to find the New Year ushered in with the announcement of this noble discovery of how to steal the sense of pain and veil the eye and memory from all the horrors of an operation: WE HAVE CONQUERED PAIN!"2

I have mentioned that very little surgery was done in peacetime, OK, yes, there were some who had their boils lanced without anaesthetic, stones removed from their bladder and fractures that were reduced. In most cases, however, surgery was a last resort, to try to save the life of the unfortunate patient. The mortality rate was high, and this was worsened because patients had very few reserves of strength, their bodies could not withstand the shock of the surgery. The reason for this was because in most cases, the patient put off surgery until everything else had been tried and death was certain without it.

Fear of death today as a result of major surgery lingers in most people even with our modern equipment, excellent anaesthetic agents and the superb anaesthetists, surgeons and staff we have today.
Surgeons and anaesthetists will however impress on the patient that there is a danger of bleeding, infection and other complications that could lead to the death of the patient.

In the days before anaesthesia, the surgeon would first emphasize that you will certainly die, in agony, without surgery and this agony might last several weeks.
The surgeon then persuaded the patient that although the pain of the procedure will be excruciating, it would be short lived, and he would be as quick as possible, he would offer to give a substance to ease the expected agony whether that be, alcohol, opium, mesmerism or any other known substance or combined technique.
He would also explain there was a very good chance that the patient could survive procedure. The surgeons were not heartless individuals and would genuinely want to save the life of the patient, it is however true that without experimenting, progress would not have been made, and in the early days, doctors would experiment with this potion or that herb to cure a disease, and in some cases, he would kill the patient instead of curing the patient.
The same applied to surgeons who would experiment with a procedure that had never been tried before and as a result either kill the patient or make things worse for the patient or in some cases make things better.

In some cases, it was the surgeon who was trying to enhance his own reputation and the reputation of the hospital that he worked for, which was the main factor. A typical example of this was the Hoo Loo operation in the 1820s, by Key and Cooper.
These big high profile surgical procedures would attract a very large audience of paying medics which could be quite profitable for the surgeon and the hospital.
Still, Advancement in surgery in the early years came primarily from the Armed Forces surgeons, during times of war.

References:

1 Genesis 2:21 King James Version
2 The Peoples Journal Of London 1847 On Anaesthesia


Ken True ODP
Author
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