List the ways in which this patient is in danger
What were the factors that influenced the discovery and
acceptance of anaesthetics in surgery?
Until the mid-19th century, surgery
was extremely painful and dangerous,
so major operations were not
possible. Surgeons would give
patients a drug like opium or try to get
them drunk before an operation, but
there were no effective anaesthetics.
In 1799 Humphrey Davy discovered
that the gas nitrous oxide ('laughing
gas') could dull pain and published a
pamphlet to bring attention to this.
Unfortunately, most surgeons ignored
this discovery. Those that did use it
found that it did not work on everyone,
so the search continued.
The use of ether was pioneered in the
USA by Dr Crawford Long in 1842,
who used it to remove a tumor from a Five surgeons participating in an
man’s neck. In October 1846, a amputation before anaesthetic
Massachusetts dentist William
Thomas Green Morton (1815-68), painlessly removed a tumor from a man's jaw, after giving
him ether, a gas which had been recently discovered. News of the operation reached Britain
very quickly and by the end of the year, several successful operations had been performed
using it. However, ether was an
irritant and caused coughing and
vomiting in some patients. It was also
Sir Robert Liston was the first British
surgeon to use ether for an operation
in December 1846.
In 1847 James Simpson, the
professor of midwifery at Edinburgh
University discovered chloroform,
which was quicker acting than ether
and didn't appear to have any side
effects. By the start of the 20th century
it was realized that chloroform could
cause liver and heart damage.
Early operation with anaesthetic
Surprisingly, many people opposed
the introduction of anaesthetics. Some religious people thought that it was God's intention for
women to feel pain during childbirth. Others worried that surgeons would not have the
experience to give the right dose, and people sometimes did die from overdoses of ether and
chloroform. It worried other people that they wouldn't know what the surgeon was doing to
them while they were unconscious.
The death of Hannah Greener in 1848 from a chloroform overdose provided those who
argued against its use with powerful ammunition.
However, little opposition remained after Queen Victoria
was given chloroform for the birth of her eighth child
Prince Leopold, in 1853 and Princess Beatrice in 1857. In
addition, positive press reports did much to combat
people’s fears. Chloroform remained the most popular
anaesthetic until the 1900s, when it was realised that it
could damage the liver.
Queen Victoria and Prince Albert
with some of their children.
Think about this:
• Discovery is often the result of a chain of
• Royal approval helped bring about the acceptance of
A device invented by Dr
John Snow for inhaling
• The administration of anaesthesia required expertise.
'An Operation in 1846' Information Sheet
This account describes an operation carried out by Sir Robert Liston on 21
December1846 at University College Hospital, London:
'He then takes from his long
narrow case one of the
straight amputating knives of
his own invention. It is
evidently a favourite
instrument, for on the handle
are little notches showing the
number of times he had used
it before. His house Surgeon,
Ransome, puts the saw and
the artery forceps onto the
chair close by, then threads a
wisp of well waxed hemp
ligature through his own
...... the porters are waiting
just outside, and the patient
(Frederick Churchill, a butler)
is carried in on a stretcher
and laid on the table.....
Liston stands by, trying the
edge of his knife against his
thumbnail, and the tension
Ransome holds the limb.
"Now gentlemen, time me,"
says Liston to the students.
The huge left hand grasps the
thigh, a thrust of the long
straight knife, two or three
rapid sawing movement(s)
and the upper flap (of skin) is
made. Half a dozen strokes
and Ransome places the limb
in the sawdust.
"Twenty - eight seconds!"
says William Squires. The
femoral artery is tied with two
stout ligatures, a strip of wet
lint placed between the flaps
and the stump raised'.
An Operation in 1846
Sir Robert Liston’s operation was the first operation in England to be carried out using
anaesthetic. The patient had been put to sleep with ether.
1. Do you think that the patient felt any pain during the operation?
2. Why do you think the surgeon worked so quickly?
3. What sort of equipment did the surgeon use?
4. Why do you think that the amputated leg was placed in sawdust?
James Simpson (1811-1870)
In the early 19th century, patients dreaded
surgical operations. Effective anaesthetics
were not discovered until 1842, so
patients had to endure excruciating pain.
In an amputation, the patient would be
held down while the surgeon cut through
all the soft tissue and bone. The horror of
pain forced surgeons to work quickly,
often leading to mistakes and a low
survival rate. The first successful steps in
the conquest of pain were taken by
James Simpson and his assistants having
Who was James Simpson? inhaled chloroform
Simpson was the youngest son of a Scottish village baker. He trained as a doctor and
became Professor of Midwifery at Edinburgh University. Simpson wanted to cut down the
suffering of his patients in childbirth. He often used ether, but disliked it because of its strong
smell which made his patients cough.
How did he become well known?
In 1847, Simpson and two assistants experimented with a new anaesthetic, chloroform,
which had none of the side effects of ether. Within a month he had used it successfully on
over 50 patients.
Was there any opposition to Simpson's ideas?
Unfortunately, the use of chloroform was not without risks. Some doctors did not know how to
use it properly and in 1848, Hannah Greener, aged 15, died from an overdose of chloroform.
There was opposition from those who saw chloroform as unnatural and members of the
Calvinist Church of Scotland claimed its use was forbidden in the bible.
Why was chloroform accepted?
In 1853 Queen Victoria was successfully anaesthetised during the birth of her eight child.
This turned the tide and from then on chloroform became widely accepted. However, its
effects sometimes meant that surgeons spent too long on operations and patients could still
die from blood loss and infection as more complicated operations were attempted.
What was Simpson's legacy to medicine?
Although his name is always mentioned in books as the developer of anaesthetics, chloroform
was only used until around 1900 when it was discovered that it could damage the liver. From
then on surgeons returned to using ether. Today, surgeons use a complex mix of drugs
administered by a qualified anaesthetist. Simpson's use of chloroform helped to gain popular
support for the use of anaesthetics and removed one of the obstacles in the development of
Improvements in 19th Century Surgery
What were the advantages and disadvantages of the following
Advantages Anaesthetic Disadvantages
How have operations improved by the end of the 1860s?