The first attempts at general anesthesia were probably
herbal remedies administered in
prehistory.
Alcohol is one of the oldest known
sedatives and it was used in ancient
Mesopotamia thousands of years ago. The Sumerians are said to have cultivated and harvested the
opium poppy (
Papaver somniferum) in lower Mesopotamia as early as 3400
BCE. The ancient Egyptians had some surgical instruments, as well as crude analgesics and sedatives, including possibly an extract prepared from the
mandrake fruit. In China,
Bian Que (
Chinese: 扁鹊,
Wade–Giles: ''Pien Ch'iao'', ) was a legendary Chinese
internist and surgeon who reportedly used general anesthesia for surgical procedures. Despite this, it was the Chinese physician
Hua Tuo whom historians considered the first verifiable historical figure to develop a type of mixture of anesthesia, though his recipe has yet to be fully discovered. Throughout Europe, Asia, and the Americas, a variety of
Solanum species containing potent
tropane alkaloids was used for anesthesia. In 13th-century Italy,
Theodoric Borgognoni used similar mixtures along with opiates to induce unconsciousness, and treatment with the combined alkaloids proved a mainstay of anesthesia until the 19th century. Local anesthetics were used in
Inca civilization where
shamans chewed
coca leaves and performed operations on the skull while spitting into the wounds they had inflicted to anesthetize.
Cocaine was later isolated and became the first effective local anesthetic. It was first used in
eye surgery in 1884 by
Karl Koller, at the suggestion of
Sigmund Freud. German surgeon
August Bier (1861–1949) was the first to use cocaine for
intrathecal anesthesia in 1898. Romanian surgeon Nicolae Racoviceanu-Piteşti (1860–1942) was the first to use
opioids for intrathecal analgesia; he presented his experience in Paris in 1901. The "soporific sponge" ("sleep sponge") used by Arabic physicians was introduced to Europe by the
Salerno school of medicine in the late 12th century and by
Ugo Borgognoni (1180–1258) in the 13th century. The sponge was promoted and described by Ugo's son and fellow surgeon,
Theodoric Borgognoni (1205–1298). In this anesthetic method, a sponge was soaked in a dissolved solution of opium,
mandragora, hemlock juice, and other substances. The sponge was then dried and stored; just before surgery the sponge was moistened and then held under the patient's nose. When all went well, the fumes rendered the individual unconscious. 's
Researches chemical and philosophical: chiefly concerning nitrous oxide (1800), pp. 556 and 557 (right), outlining potential anesthetic properties of
nitrous oxide in relieving pain during surgery The most famous anesthetic,
ether, may have been synthesized as early as the 8th century, but it took many centuries for its anesthetic importance to be appreciated, even though the 16th century physician and polymath
Paracelsus noted that chickens made to breathe it not only fell asleep but also felt no pain. By the early 19th century, ether was being used by humans, but only as a
recreational drug. Meanwhile, in 1772, English scientist
Joseph Priestley discovered the gas
nitrous oxide. Initially, people thought this gas to be lethal, even in small doses, like some other
nitrogen oxides. However, in 1799, British chemist and inventor
Humphry Davy decided to find out by experimenting on himself. To his astonishment he found that nitrous oxide made him laugh, so he nicknamed it "laughing gas". In 1800 Davy wrote about the potential anesthetic properties of nitrous oxide in relieving pain during surgery, but nobody at that time pursued the matter any further. Hanaoka learned traditional Japanese medicine as well as
Dutch-imported European surgery and Chinese medicine. After years of research and experimentation, he finally developed a formula which he named tsūsensan (also known as mafutsu-san), which combined
Korean morning glory and other herbs. Hanaoka's success in performing this painless operation soon became widely known, and patients began to arrive from all parts of Japan. Hanaoka went on to perform many operations using tsūsensan, including resection of
malignant tumors, extraction of
bladder stones, and extremity amputations. Before his death in 1835, Hanaoka performed more than 150 operations for breast cancer. However, this finding did not benefit the rest of the world until 1854 as the
national isolation policy of the
Tokugawa shogunate prevented Hanaoka's achievements from being publicized until after the isolation ended. Nearly forty years would pass before
Crawford Long, who is titled as the inventor of modern anesthetics in the
West, used general anesthesia in
Jefferson, Georgia. Long noticed that his friends felt no pain when they injured themselves while staggering around under the influence of diethyl ether. He immediately thought of its potential in surgery. Conveniently, a participant in one of those "ether frolics", a student named James Venable, had two small tumors he wanted excised. But fearing the pain of surgery, Venable kept putting the operation off. Hence, Long suggested that he have his operation while under the influence of ether. Venable agreed, and on 30 March 1842 he underwent a painless operation. However, Long did not announce his discovery until 1849. operation conducted at Massachusetts General Hospital. The daguerreotype was taken by Southworth & Hawes on July 3, 1847.
Horace Wells conducted the first public demonstration of the inhalational anesthetic at the
Massachusetts General Hospital in
Boston in 1845. However, the
nitrous oxide was improperly administered and the person cried out in
pain. On 16 October 1846, Boston dentist
William Thomas Green Morton gave a successful demonstration using
diethyl ether to medical students at the same venue. Morton, who was unaware of Long's previous work, was invited to the
Massachusetts General Hospital to demonstrate his new technique for painless surgery. After Morton had induced anesthesia, surgeon
John Collins Warren removed a tumor from the neck of
Edward Gilbert Abbott. This occurred in the surgical amphitheater now called the
Ether Dome. The previously skeptical Warren was impressed and stated, "Gentlemen, this is no humbug." In a letter to Morton shortly thereafter, physician and writer
Oliver Wendell Holmes Sr. proposed naming the state produced "anesthesia", and the procedure an "anesthetic". The first use of anesthesia in the Southern Hemisphere took place in
Launceston, Tasmania, that same year. Drawbacks with ether such as excessive vomiting and its explosive
flammability led to its replacement in England with
chloroform. Discovered in 1831 by an American physician Samuel Guthrie (1782–1848), and independently a few months later by Frenchman Eugène Soubeiran (1797–1859) and Justus von Liebig (1803–1873) in Germany, chloroform was named and chemically characterized in 1834 by Jean-Baptiste Dumas (1800–1884). In 1842, Dr
Robert Mortimer Glover in London discovered the anaesthetic qualities of chloroform on laboratory animals. In 1847, Scottish obstetrician
James Young Simpson was the first to demonstrate the anesthetic properties of chloroform on humans and helped to popularize the drug for use in medicine. This first supply came from local pharmacists, James Duncan and
William Flockhart, and its use spread quickly, with 750,000 doses weekly in Britain by 1895. Simpson arranged for Flockhart to supply
Florence Nightingale. Chloroform gained royal approval in 1853 when
John Snow administered it to
Queen Victoria when she was in labor with
Prince Leopold. For the experience of child birth itself, chloroform met all the Queen's expectations; she stated it was "delightful beyond measure". Chloroform was not without fault though. The first fatality directly attributed to chloroform administration was recorded on 28 January 1848 after the death of Hannah Greener. This was the first of many deaths to follow from the untrained handling of chloroform. Surgeons began to appreciate the need for a trained anesthetist. The need, as Thatcher writes, was for an anesthetist to "(1) Be satisfied with the subordinate role that the work would require, (2) Make anesthesia their one absorbing interest, (3) not look at the situation of anesthetist as one that put them in a position to watch and learn from the surgeons technique (4) accept the comparatively low pay and (5) have the natural aptitude and intelligence to develop a high level of skill in providing the smooth anesthesia and relaxation that the surgeon demanded" These qualities of an anesthetist were often found in submissive
medical students and even members of the public. More often, surgeons sought out nurses to provide anesthesia. By the time of the
Civil War, many nurses had been professionally trained with the support of surgeons. John Snow of London published articles from May 1848 onwards "On Narcotism by the Inhalation of Vapours" in the London Medical Gazette. Snow also involved himself in the production of equipment needed for the administration of
inhalational anesthetics, the forerunner of today's
anesthesia machines. Alice Magaw, born in November 1860, is often referred to as "The Mother of Anesthesia". Her renown as the personal anesthesia provider for William and Charles Mayo was solidified by Mayo's own words in his 1905 article in which he described his satisfaction with and reliance on nurse anesthetists: "The question of anaesthesia is a most important one. We have regular anaesthetists [on] whom we can depend so that I can devote my entire attention to the surgical work." Magaw kept thorough records of her cases and recorded these anesthetics. In her publication reviewing more than 14,000 surgical anesthetics, Magaw indicates she successfully provided anesthesia without an anesthetic-related death. Magaw describes in another article, "We have administered an anesthetic 1,092 times; ether alone 674 times; chloroform 245 times; ether and chloroform combined 173 times. I can report that out of this number, 1,092 cases, we have not had an accident". Magaw's records and outcomes created a legacy defining that the delivery of anesthesia by nurses would serve the surgical community without increasing the risks to patients. In fact, Magaw's outcomes would eclipse those of practitioners today. The first comprehensive medical textbook on the subject,
Anesthesia, was authored in 1914 by anesthesiologist Dr.
James Tayloe Gwathmey and the chemist Dr.
Charles Baskerville. This book served as the standard reference for the specialty for decades and included details on the history of anesthesia as well as the physiology and techniques of inhalation, rectal, intravenous, and spinal anesthesia. == Society and culture ==