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Agony without Ecstasy: Surgery before anesthesia

Oil on board by unknown artist, mid 19th century. Amputation with several  attendants holding down the patient and students observing the procedure.

 “A study of operative surgery in the days before anesthesia reveals on the one hand a picture of heroic boldness and masterly self-control on the part of the surgeon, and on the other, a ghastly panorama, sometimes of stoic fortitude and endurance, sometimes of abject terror and humiliation, but always of agonizing wretchedness and pain on the part of the unhappy victim, man or woman, whose necessities required a recourse to the surgeon’s aid.” — JOHN ASHHURST, JR., MD

 To a 21st century patient, the only possible reaction to a 19th century operating room is shock and horror. The silver handles of the surgeon’s instruments gleam, while the knives are caked with blood. The air is filled with the sound of screaming as the victim (as 19th century doctors often referred to their pre-anesthesia patients) hears their surgeon cut through skin, muscle, tendon, and bone; for some, the operation outlasted their ability to scream, only leaving the sound of the “squash, squash” of the surgeon’s forceps (as one doctor vividly described it). Relatively few people attempted surgery before anesthesia, and comparatively few survived it, not for loss of blood, but for the sheer shock they had endured.

Against this backdrop, the introduction of general anesthesia is nothing short of  miraculous. On the 50th anniversary of Dr. John Warren’s first successful operation using ether, Massachusetts General Hospital held a semi-centennial celebration attended by physicians from all over the world. Here is a selection of the remarks from the occasion:

“Of the agony [that my surgery] occasioned, I will say nothing. Suffering so great as I underwent cannot be expressed in words, and thus fortunately cannot be recalled. The particular pangs are now forgotten; but the blank whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so. I still recall with unwelcoming vividness the spreading out of the instruments, the twisting of the tourniquet, the first incision, the fingering of the sawed bone, the sponge pressed on the flap, the tying of the blood-vessels, the stitching of the skin, and the bloody dismembered limb lying on the floor. Those are not pleasant remembrances.”  — ANONYMOUS DOCTOR WRITING TO SIR JAMES SIMPSON, RENOWNED SURGEON

“How often when operating in some deep dark wound, along the course of some great vein, with thin walls, alternately distended and flaccid with the vital current — how often have I dreaded that some unfortunate struggle of the patient would deviate the knife a little from its proper course, and that I, who fain would be the deliverer, should involuntarily become the executioner, seeing my patient perish in my hands by the most appalling form of death.” — VALENTINE MOTT, MD

 “What victim of surgery, who, under ether, sinks into a calm and dreamless sleep, during which his abdomen can be cut open, his bowels taken out, handled, and replaced, his nerves cut, his veins or arteries tied, and his skin sewed up, and who is made so completely oblivious as to ask on awakening, ‘Are you not ready to begin?’ but concedes with gratitude, on realizing the result, that this is the greatest discovery ever made for the happiness of mankind?” — DAVID CHEEVER, MD


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