When one day in September 1784 Frances Burney was surrounded by 7 men dressed in black and brandishing sharp and sharp objects , had no choice but to close her eyes, “renouncing all observation, all resistance, all interference, and sadly resolved to resign myself completely.”
The famous British writer was in Paris, in hands of an unusually large team of professionals, including two of the leading surgeons of the day, Dominique Jean Larrey, surgeon-in-chief of the imperial army, and Antoine Dubois, Napoleon’s own consulting surgeon.
A cancer had forced her to undergo a harrowing experience.
“Hopeless and desperate” she gave in to the inevitable, she would later tell her sister Esther in a letter marked “‘A story from Paris of a terrible operation”, one of the first des first-hand accounts of a mastectomy.
And one of the few that describe in detail the tremendous torment of those who underwent surgery before anesthesia was used.
He knew that he was going to “suffer much”, as Dubois had warned him, but he had to endure, “defying a terror that passes all description, and the most torturous pain”.
“However, when the terrible steel plunged into his chest, cutting the veins, the arteries, the flesh, the nerves” of his entrails, “a scream that lasted without interruptions during the entire time of the incision (…) so unbearable was the agony (…) I felt the knife against my sternum, scraping it!”
Burney’s testimony gives a profound vision of the physical and mental pain experienced by surgical patients.
And the consequences were not only felt in the body but also in the mind.
“Not for days, not for weeks, but for months I could not talk about this terrible matter without almost reliving it!”, Burney wrote.
Faced with the prospect of having body parts cut off while they were in their 5 senses, patients they endured any ailment, until they reached the brink of death, knowing that the pain of relieving it would be worse.
Surgeons also had such deeply distressing moments that, even for the most expert with the scalpel, operations were the last resort.
Burney says that Dr. Larrey “had tears in his eyes” when contemplating the procedure, and that the only time she spoke was to tell them how sorry she was for them, since she had noticed their concern at seeing her suffer so much.
Given so much horror, it is not surprising that attempts to relieve pain by producing unconsciousness are almost as old as civilization.
Many were harmless and ineffective while others were simply dangerous.
A toast and various potions
The ingestion of ethanol to induce a kind of detachment from pain was one of the most common practices.
They got patients drunk until that it wasn’t so much that it didn’t hurt but that they didn’t care so much that it hurt.
Alcohol often also served as a solvent in sedative potions, which healers and mystics from all over the world made with plants that could alter the mind.
One of the oldest examples is the máfèisàn
The exact recipe has been lost, but the legendary sedative is believed to have contained cannabis or blue-flowered wolfsbane (Aconitum nape llus), a poisonous plant that can be lethal.
That characteristic It is shared by some of the ingredients of other sedative potions, such as the beautifully named belladonna, one of the most toxic plants in the northern hemisphere that, however, was used for centuries in medicinal treatments, or hemlock, that official poison of ancient Greece who killed Socrates.
The latter was one of the ingredients of the English sedative “
- opium: probably the most effective pain reliever known, but highly addictive;
- boar bile: Although the use of animal matter in these recipes was unusual, the bile It was often mixed with fat to help emulsification and absorption of the ingredients. s;
- devil’s turnip: all of it with substances that can cause problems in human health. Its presence probably replaced the mandrake, the herb most used in Mediterranean recipes for its ability to produce drowsiness and hallucinations;
- henbane: like the mandrake, capable of inducing deep unconsciousness and durable and was widely used for sedation in Europe, Asia and the Islamic world;
- lettuce: for centuries the Lactucarium, the dried juice of wild lettuce, is has been associated with a mild sedative action, despite little or no scientific evidence to support this;
- vinegar: used for a long time to revive unconscious people as well as wake up the patient after the operation.
The opium poppy, Papaver somniferum, remains the source of many opiates. Its botanical name in Latin means “numbing poppy”. (Photo: GETTY IMAGES)The dwale is an example of the potions that began to be standardized in the Middle Ages around that particular group of plants.
In the fifteenth century, a mixture of opium, mandrake and henbane was the sedative preferred for surgical procedures such as amputation and from then until the 19th century sedatives changed very little.
However, concoctions were not the only method practiced in after unconsciousness.
Blows, pressures and mesmerism
If taking potions that, in inexperienced hands, could poison the patient was not very advisable, allowing them to hit you hard on the head was not the most attractive option either, but one that, when all else failed or was unavailable, was called upon to render unconscious Who needed surgery.
It was a merciful measure, but its consequences could be, among others, head trauma.
Another technique was to apply pressure to the nerves, to cause numbness in the extremities, or the arteries in the neck.
The ancient Greeks called them “carotids”, a name derived from the Greek for stupor or stunning, perhaps indicating that since then it had been known that compressing them would cause unconsciousness.
Although the first method was used in 1784 by a British surgeon named John Hunter to amputate a limb and according to the UK Royal College of Anesthesiologists the amputee felt no pain, the second, it was not very common… for good reason: the obstruction of blood flow to the brain put the patient’s life at risk.
It was less dangerous hypnotism, introduced as “animal magnetism” or “mesmerism” in the latter part of the 18th century, which could be effective but only on susceptible individuals.
Speed
Before that big picture, the best you could hope for was to be in the hands of surgeons like Robert Liston, whose operations at University College Hospital in London in the early 1840 were notorious for their speed, intensity, and success.
Not only was the chance of dying from a Liston amputation 1 in 6, much better than the average Victorian surgeon, but from the first cut until the amputated limb fell into a box of sawdust they barely passed 25 seconds.
With no painkillers available, the The skill of surgeons like him shortened that almost unimaginably horrible trauma of surgery.
But that also limited the variety of possible procedures.
More complicated operations required anesthesia, not only to avoid pain, but, in some parts of the body, to relax the muscles and access the organs.
Finally!
Finally , in the middle of the 19th century, the first agent that was successfully demonstrated in public appeared: diethyl ether.
It had been originally synthesized (by the action of sulfuric acid on ethanol) in the 13th century and, although there are early reports that it produced both pain relief and loss of consciousness, such observations were not applied clinically by 600 years.
Chloroform also entered the scene and the two compounds gave surgeons more time to operate and, therefore, to do it more meticulously.
However, in the decade of 1850 there was heated debates about the risks and benefits of anesthesia.
There were doubts about whether pain was necessary for surgical success.
During the Crimean War (1853-1853), the head of British Army medicine specifically prohibited the use of chloroform in battlefield surgery.
A surgeon military commented that he preferred to listen to “the loud screams” of the soldiers while they went through the operating room. It was a sign, he said, that they were fighting to survive.
“Pain was considered a vital function, as they thought it was like a stimulant for the body to withstand the stress of the operation“, explained to the BBC Stephanie Snow, historian of medicine at the University of Manchester and author of books on the history of anaesthesia.
For 1860, however, anesthesia was commonly used.
The patients had less likely to refuse surgery and surgeons could take more time with the procedures and try new and more sophisticated operations.
At the beginning of the 20th century, the first local anesthetics, based on cocaine, were used , and anesthesiologists began to emerge as a separate profession.
But ether and chloroform, sometimes used in combination, remained s being the only general anesthetics (although chloroform was discontinued in the 1930).
A world war was necessary to develop the drugs and gases used today in operating rooms, which owe their existence to the development of nuclear weapons.
“Nuclear bombs needed uranium hexafluoride and the sudden advance during the Second World War in fluorination chemistry made it possible to produce very effective, non-flammable and safer anesthetics,” he told the BBC William Harrop-Griffiths, Chairman of the Clinical Quality and Research Board of the Royal College of Anesthesiologists in the United Kingdom.
“From something that killed tens of thousands, came drugs that saved hundreds of thousands “.
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