Princeton University, New Jersey, United States (Winter 2014)
A depiction of eye surgery c. 1195
The introduction of new technologies such as surgical anesthesia has led to better methods of diagnosis and treatment, but it also shows that the relationship between medical theory and practice is not always a smooth one. Surprisingly, anesthesia was first used for non-medical purposes, indicating that in medicine theory does not always neatly precede practice. A new technology such as anesthesia can also have a major impact on society, leading in the second half of the 19th century in both France and America to a great increase in the status of surgeons. In both countries the surgeons experienced a rise in status from barbaric cutters to respected and trusted professionals.
Ether anesthesia in medicine was first used in October 1846 by William Morton, a dentist, to remove a tumor from the neck of a patient at the Massachusetts General Hospital. This demonstration that anesthesia was safe and effective sparked a revolution. In America and Europe surgeons began to use it regularly. But Morton did not “discover” anesthesia. Others, such as Horace Wells and Crawford Williamson Long, had used it before, but neither publicized their findings nor understood its importance. Besides, anesthesia came to surgical practice only after it had been used recreationally for several years, in London and America, where men and women inhaled ether at parties (called ether parties or ether frolics) to get a high. Laughing gas, later used to numb the mouth during dentistry, was also used in people’s houses to punish housewives deemed annoying to their husbands. Though aware of such parties, doctors did not make the connection to medicine until the 1840s, when Morton recognized its potential. Anesthesia’s origins, then, began in ether parties before moving to dentistry and surgery.
The development of anesthesia made medicine more effective and reliable. Before anesthesia, surgical operations were painful and brutal. In the 1830s, 30 to 50% of patients died during surgeries, and surgeons were regarded as no better than butchers. In 1811, a member of the British Parliament summarized this attitude by stating, “There is no more science in surgery than in butchering.” In 18th century Britain, barber-surgeons needed no university education, unlike the higher status gentlemen-physicians. (America, though, was less rigidly stratified than Europe and considered everyone who practiced medicine to be a doctor, partly due to the lack of medical schools). Medical schools viewed surgery as a manual craft and did not teach it as a discipline. In the 5th century BC, the Hippocratic Oath distinguished physicians from men who engaged in “using the knife” to remove kidney or bladder stones and worked with their hands. The idea that surgeons were not doctors but merely butchers, then, had its origins in this ancient document.
After 1794’s Reign of Terror in France, surgeons experienced a slight rise in status. A college of surgery was opened to produce enough surgeons for the military. Reliance on surgery increased during the early 1800s, which focused on specific organs, detailed observation of patients, and autopsies. But in 1846, after Morton’s innovation, the status of surgeons rose further. They could now work more slowly, carefully, and precisely, with good asepsis, thus gaining credibility and respect.
A letter written by Dr. B. Joy Jeffries in Boston, Massachusetts, on December 17, 1872, reveals Jeffries’ support for ether as an anesthetic. He discusses another anesthetic agent called chloroform, and deems ether “a safe anesthetic.” His letter shows the importance of doctors (other than surgeons) giving credibility to anesthesia at a time when it was a newer procedure. But by 1877, the physician Lambert Ormsby was able to give specific numbers proving the safety of ether compared to other numbing and anesthetic agents. He included a chart of deaths due to ether (1 in 23,204), chloroform (1 in 2,873), chloroform and ether mixture (1 in 5,558), and bichloride (1 in 5,000). He concluded that chloroform was the most dangerous anesthetic and ether was about eight times safer.
There were, to be sure, further explanations for the rise of surgery – more medical schools for surgeons which gave practitioners skill, training, and accreditation. But anesthesia provided the tool to produce results and save lives. As surgeons were able to eradicate suffering rather than inflict pain, the perception of surgeons shifted from savage to specialist.
Historian C.A.H. Smith has called anesthesia “the most important discovery of American medicine in the last century.” He contributed the idea of the surgeon having the power to relieve suffering more so than anyone else before.
Thus, a newfound respect for surgeons arose as surgical operations became more controlled and conducted in professional environments rather than in scenes of physical struggle where surgeons restrained patients and stifled their screams. Safe and effective anesthesia in surgery facilitated the shift from classical to modern medicine, also illustrating how technological developments can change social and culture perceptions. Anesthesia made patients and other doctors take surgeons seriously, giving them even more credibility in the public’s eye – for surgeons held the power of life or death. Today, surgeons are highly esteemed and are some of the most generously compensated physicians.
- Roy Porter, Blood and Guts: A Short History of Medicine, W.W. Norton & Company: 2004.
- Ludwig Edelstein, “The Hippocratic Oath” from The Hippocratic Oath: Text, Translation, and Interpretation. Baltimore: Johns Hopkins Press, 1943, p. 1.
- B. Joy Jeffries, “Ether,” The British Medical Journal, Vol. 1, No. 628 (Jan. 11, 1873), 48-49. BMJ Publishing Group. http://www.jstor.org/stable/25233806
- Lambert H. Ormsby, “The Advantages Of Ether As An Anæsthetic: With A Description Of A New Inhaler,” The British Medical Journal, Vol. 1, No. 850 (Apr. 14, 1877), 451-453. BMJ Publishing Group. http://www.jstor.org/stable/25244391
- C. A. H. Smith, “The Discovery of Anesthesia,” The Scientific Monthly, Vol. 24, No. 1 (Jan., 1927), 64. American Association for the Advancement of Science. http://www.jstor.org/stable/7799
- Anonymous surgeon, “Physicians, Surgeons, and General Practitioners, by Not Keeping Their Respective Places, Cause Hospital Abuses.” Association Medical Journal, Vol. 1, No. 21 (May 27, 1853), p. 472. BMJ Publishing Group. http://www.jstor.org/stable/25494665
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- Boivin, Jean-François. “Risk of Spontaneous Abortion in Women Occupationally Exposed to Anaesthetic Gases: A Meta-Analysis.” Occupational and Environmental Medicine, Vol. 54, No. 8 (Aug., 1997), pp. 541-548. BMJ Publishing Group. http://www.jstor.org/stable/27730788
- Browner, Stephanie. “Ideologies of the Anesthetic: Professionalism, Egalitarianism and the Ether Controversy,” American Quarterly, Vol. 51, No. 1 (Mar., 1999), pp. 108-143. The Johns Hopkins University Press. http://www.jstor.org/stable/30041635
- “The Hippocratic Oath” from The Hippocratic Oath: Text, Translation, and Interpretation, by Ludwig Edelstein (Baltimore: Johns Hopkins Press, 1943), p. 1.
- Jeffries, B. Joy. “Ether,” The British Medical Journal, Vol. 1, No. 628 (Jan. 11, 1873), pp. 48-49. BMJ Publishing Group. http://www.jstor.org/stable/25233806
- Ormsby, Lambert H. “The Advantages Of Ether As An Anæsthetic: With A Description Of A New Inhaler,” The British Medical Journal, Vol. 1, No. 850 (Apr. 14, 1877), pp. 451-453. BMJ Publishing Group. http://www.jstor.org/stable/25244391
- Pearson, Michele L, William C. Levine, Robert J. Finton, Charles T. Ingram, Kathleen B. Gay, Gerda Tapelband, J. David Smith and William R. Jarvis. “Anesthesia-Associated Carbon Monoxide Exposures among Surgical Patients,” Infection Control and Hospital Epidemiology, Vol. 22, No. 6 (Jun., 2001), pp. 352-356. The University of Chicago Press. http://www.jstor.org/stable/30141461
- Porter, Roy. Blood and Guts: A Short History of Medicine, W.W. Norton & Company: 2004.
- Rosenberg, Charles. “The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth Century America,” Perspectives in Biology and Medicine. 1977, 20: 485-506.
- Rosenberg, Charles. The Care of Strangers: The History of America’s Hospital System. Baltimore: Johns Hopkins University Press, 1987. 1-48, 212-237.
- The Royal College of Surgeons of Edinburgh. “A History,” http://www.rcsed.ac.uk/site/345/default.aspx#1600s
- Saint Louis University School of Medicine. Lecture. The History of Surgery: A Brief Account of How an Esteemed Art and Science Came to be What It Is Today. http://www.slucare.edu/pdf_nov5/history_surgery.pdf
- Sebert, Michael E, Mary Lou Manning, Karin L. McGowan, Elizabeth R. Alpern and Louis M. Bell, “An Outbreak of Serratia Marcescens Bacteremia after General Anesthesia.” Infection Control and Hospital Epidemiology, Vol. 23, No. 12 (Dec., 2002), pp. 733-739. The University of Chicago Press. http://www.jstor.org/stable/30143047
- Smith, C. A. H. “The Discovery of Anesthesia,” The Scientific Monthly, Vol. 24, No. 1 (Jan., 1927), pp. 64-70. American Association for the Advancement of Science. http://www.jstor.org/stable/7799
SUZANNE RAGA graduated from Princeton University in 2011, with an undergraduate degree in history of science and technology and a certificate in language and culture of ancient Rome. Her independent work at Princeton focused on the digital book and music publishing revolutions. She is the author of You Rock! How To Be A Star Student & Still Have Fun, and she is the founder of the music blog After The Show.