Before the 19th century, surgery was severely limited by pain, only partially offset by drugs such as opium, hashish and alcohol. Ice and pressure on nerves was used to provide local anaesthesia. The discovery of potentially useful anaesthetic drugs was almost accidental however and arose as a by-product of recreational use of new substances.
Ether had long been known to alleviate pain in colic, and to induce excitement and insensibility when inhaled mixed with air. It became popular in America at parties called ‘ether frolics’. Crawford Long, noticing that these riotous party-goers appeared insensible to pain, used sulphuric ether to remove two neck tumours in 1842. Sadly he did not publicise this and it was Morton, a Massachusetts dentist, who reaped the glory for using ether in 1846.
Nitrous oxide had been discovered by Priestley a century previously and became the British equivalent of ether frolics. Fashionable celebrity parties included the poet Coleridge and Roget of Thesaurus fame. Nitrous oxide induced euphoria leading to dancing and recitation but unfortunately proved to be a weak anaesthetic agent. Its first public demonstration by American dentist Horace Wells in 1844 was a flop.
James Young Simpson, Professor of Obstetrics in Edinburgh, found ether unsatisfactory for relieving the pain of childbirth. He tried out various agents with friends after dinner parties. After inhaling chloroform they all collapsed but woke up the next morning unharmed. Simpson was impressed and used it in obstetric practice despite opposition from other doctors and religious ministers. Its use in obstetrics was only accepted in 1853 when Queen Victoria had chloroform administered by John Snow for the birth of Prince Leopold.
The discovery of local anaesthetic drugs also involved self-administration. Peruvian Indians were known to achieve well-being from chewing coca leaves. Cocaine, the active ingredient isolated in 1859 numbed the tongue. Freud in Vienna used it on his patients– and himself, becoming addicted in the process. But it was his colleague Koller who instilled cocaine into his own eye in 1884, producing surface anaesthesia.
Vassily Anrep performed the first nerve blocks but his work went unrecognised in the West. Thereafter Halsted in the USA used cocaine for nerve blocks (also becoming addicted), Corning accidentally performed the first spinal injection on a dog and by 1889 Bier had established the use of spinals for surgery.
In our modern world of ‘big pharma’ and research ethics we might consider these early pioneers somewhat ‘gung ho’ in their approach – but would anaesthesia have evolved without the bravado of self-experimentation?