Samuel Spencer
Reading, Berkshire, UK

 

An unconscious naked man lying on a table being attacked by little demons armed with surgical instruments, watercolous by R. Cooper.

In 1863, Confederate General Thomas “Stonewall” Jackson was returning to camp after routing Federal armies at Chancellorsville, when he was mistaken for a Union cavalryman by his own sentries. In his long military career Jackson had been lucky enough to escape the bullets of Mexican grenadiers, Seminole guerrillas, and the cannonballs of the Federal siege train, but on this occasion his luck had run out. Two panicked volleys of friendly-fire later, Jackson was lying in a field hospital with two musket balls lodged in the broken remains of his left arm. His situation was dire. The bone-shattering Minié balls fired by Confederate rifles carried infectious particulates, necessitating amputation at a time when surgeons were not in the habit of washing their bone saws between procedures. The risk of meeting a sticky end on the operating table was very real, not only from blood loss and infection, but from what Civil War-era medical manuals described as death “by excess of suffering.”¹

You, reader, may breathe a sigh of relief that, as the beneficiary of modern anesthesiology, you may never have to experience the sensation of a bone saw scraping through your exposed humerus. As Stephanie Snow writes, “The expectation that surgery will be painless remains indeed at the bedrock of our twenty-first century medicine.”² All over the globe, patients surrender to the ministrations of surgeons confident that a host of amnesiacs, analgesics, and muscle relaxants will render the gory enterprise of surgery completely painless. In the early nineteenth century, patients enjoyed no such luxury. Although surgeons used everything from alcohol (even offering multiple wines to choose from³) to limb-clamping, bloodletting,⁴ and even hypnosis to ameliorate their patients’ agony, the age of true anesthetic was a long way away.

However, in 1847 mankind had brought a new weapon to bear in the war against surgical pain: chloroform. Medical history recognizes Edinburgh obstetrician James Y. Simpson as its “inventor,” though in reality chloroform had lined the shelves of British apothecaries since the early 1830s as a popular narcotic. Dr. Robert Mortimer had taken the first step in proving chloroform’s anesthetic qualities on animals five years earlier, but dared not use it on humans. Dr. Simpson, having no such qualms, chloroformed himself and two of his own medical assistants as they sat at his dining table. After emerging alive and well from a brief period of unconsciousness, Simpson realized he had changed the nature of surgery forever.⁵

By 1863 chloroform had become so commonplace that even soldier-surgeons on the front lines of the American Civil War carried it. Confederate medical manuals boasted that chloroform “banished that dread of being cut” and placed “unlimited confidence” in its universal application.⁶ General Jackson allegedly described being chloroformed as “the most delightful physical sensation I ever enjoyed…at one time (I) thought I heard the most delightful music that ever reached my ears. I believe it was the sawing of the bone.”⁷ General Jackson may have been unlucky in terms of dodging musket-balls, but he was fortunate enough to be injured at “the end of the medical Middle Ages”⁸ and the beginning of modern anesthesia. Sadly, he was too early to benefit from the germ theory and died eight days after his surgery from the less-than-sterile conditions of his field hospital. Nevertheless, we would do well to note General Jackson’s relief. It was the relief of a man who, until that day, had expected to be tortured to the limits of human endurance by his surgeon.

Nineteenth century patients spoke of surgery in fearful tones. In a letter dated March 1812, novelist Frances Burney described her unanesthetized mastectomy in unflinching detail. “I began a scream that lasted unintermittingly during the whole time of the incision,” she wrote, “and I almost marvel that it rings not in my ears still, so excruciating was the agony.”⁹ Patrick Brontë described his cataract surgery, a procedure that involved needles and poisonous belladonna being jabbed into his corneas, as eliciting pain “of a burning nature – but not intolerable.”¹⁰ However, in a letter to a Leeds newspaper in 1847, Patrick Brontë sang the praises of anesthesia as only one who had felt “the dread of being cut” could. “It appears to me to be evident, that as it regards the inhalation of the vapour of ether, a great…discovery has been made,” contended Brontë, “that ought to be patronized by every friend to humanity.”¹¹

Relief was not confined to the patients. Surgeons rejoiced that general anesthesia would make their jobs easier. Dentist-surgeon Walter Blundell noted that with the introduction of chloroform “the accustomed wailing of sufferers beneath surgeon’s instruments were all hushed” and “stillness reigned around the dreaded operating table.”¹² Samuel Gross remarked how convenient it was that chloroform spared doctors from having to tie down their patients or immobilize them in sheets, so their agonized writhing would not disturb the procedure.¹³

However, while chloroform may have banished “that dread of being cut,” it instituted new forms of dread in its place. In 1848, fifteen-year-old Hannah Greener died less than two minutes after inhaling from a chloroform-soaked handkerchief. Medical opinions varied on whether the chloroform poisoned or merely asphyxiated her, but for the public, the risks had been made clear.¹⁴ To administer anesthesia was to run a gauntlet between Scylla and Charybdis. Every step chloroform took you away from the pain of surgery brought you a little closer to death. This was by no means a problem exclusive to nineteenth century surgeons. A physician in the Middle Ages would have fed patients extracts of hemlock and henbane in the hope that vinegar would be sufficient to dilute the mixture’s lethality, while leaving its numbing qualities intact.¹⁵ Likewise, a surgeon in Victorian London would have had to administer just enough chloroform to numb their patient, without leaving them unable to breathe.

In the nineteenth century, the surgical approach to preventing airway obstruction could only be described as “artisanal.” Existing techniques had been designed for unanesthetized surgeries in which surgeons cut swiftly and patients, as much as they wished otherwise, were conscious and in control of their bodies. The long, invasive procedures enabled by general anesthetic left plenty of opportunities for patients to choke on their own flaccid tongues. Whether the surgeon elected to draw forward the patient’s tongue with forceps at the start of the anesthetization process, thereby saving their life, was a matter of personal preference rather than professional practice.¹⁶ However, even with knowledge of highly-publicized deaths, patients’ demand for chloroform grew unabated. As Snow observed, “the fear of pain…was stronger than the fear of anesthetic death.”¹⁷

The emergence of general anesthetic did more than extinguish the dread surrounding surgery. It challenged the relationship between surgeon and patient that had built up over centuries. The image of the screaming patient grappling with the fearful saw bones vanished, replaced by patients sleeping inert and insensible in the calm, autocratic care of a professional surgeon. Never before in history had people been so happy to be rendered so helpless.

 

References:

1. Chisolm, A manual of military surgery: prepared for the use of the Confederate States Army (Richmond: Ayres & Wade, 1863)
2. Stephanie Snow, Operations Without Pain: The Practice and Science of Anaesthesia in Victorian Britain (Basingstoke: Palgrave Macmillan, 2006).
3. Thomas Jackson, Narrative of the Eventful Life (Josiah Allen and Son, 1847)
4. Stephanie Snow, Blessed Days of Anaesthesia: How Anaesthetics Changed the World (Oxford: Oxford University Press, 2009) pg. 4
5. Snow (2006) pg. 63
6. Chisolm (1863) pg. 427
7. R. Dabney, Life and campaigns of Lieut.-Gen. Thomas J. Jackson (New York: Blelock & Co, 1866) pg. 696
8. Pat Leonard, William Hammond and the End of the Medical Middle Ages (2012) https://opinionator.blogs.nytimes.com/2012/04/27/william-hammond-and-the-end-of-the-medical-middle-ages/ <accessed 12/04/19>
9. Letter from Frances Burney to her sister Esther about her mastectomy without anaesthetic (1812) https://www.bl.uk/collection-items/letter-from-frances-burney-to-her-sister-esther-about-her-mastectomy <accessed 12/04/19>
10. Brontë family annotated copy of Thomas John Grahams, Modern Domestic Medicine (1826)
11. Patrick Brontë, Correspondence on Sulphuric Ether (Leeds Mercury, 5th June 1847) <accessed via British Newspaper Archive>
12. Walter Blundell, Painless Tooth-Extraction Without Chloroform. With Observations of Local Anæsthesia by Congelation in General Surgery (John Churchill, 1854) pg. 3
13. Samuel S. Gross. A System of Surgery (4th Ed. Philadelphia: Henry C. Lea, 1866) Vol.1, pg. 479, 536
14. Snow (2006) pg. 65, 66
15. Dawson, I., Medicine in the Middle Ages (London: Hodder Headline Ltd, 2005)
16. Adrian A. Matioc, “An Anaesthesiologist’s Perspective on the History of Basic Airway Management: The “Artisanal Anaesthetic” Era: 1846 to 1904.” Anaesthesiology, March 2017: 394-408
17. Snow (2006) pg. 141

 

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SAMUEL SPENCER is an LLB graduate of the University of Kent, a certified solicitor, and a liscenced blackjack dealer. He was raised in Reading in the Royal County of Berkshire, where he co-founded the Young Friends of Reading Museum. He believes that history is a vital aspect of modern medicine, as it is for all things society likes to take for granted.

 

Spring 2019  |  Sections  |  Surgery