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keywords=anesthesia, anaesthesia, anesthetics, anaesthetics, surgery, medicine, pain;
description=Utopian surgery : the case against anaesthesia in surgery compared with modern arguments against abolishing emotional pain;
author=dave@bltc.com;

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the, surgery, utopian, early, arguments, against, anaesthesia, in, dentistry, and, childbirth, introduction, historical, background, case, for, pain, conquest, of, suffering, nociception, without, tears, crossing, threshold,

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des progress toward a cruelty free world to this day viewing our darwinian pathologies of emotion as god given rather than gene driven obscures how biotechnology can abolish suffering of the flesh and spirit alike tomorrow s genetic medicine promises to turn heaven on earth from a pipedream into a policy option yet if pain is a punishment for original sin then one would assume it is wicked as well as futile to try and escape it realistic or otherwise by the 19th century a new age of humanitarianism and scientific optimism about mankind s capacity for earthly self improvement was slowly dawning the synthesis of the atmospheric gases oxygen carbon dioxide and nitrogen oxide by early scientific luminaries such as black priestley and lavoisier gave birth to the ill conceived but seminal discipline of pneumatic medicine its most famous champion was thomas beddoes 1760 1808 founder of the pneumatic medical institution in bristol beddoes hired the teenage humphry davy as its research director doctors and patients tried inhaling the newly discovered gases and vapours of volatile liquids to see if their inhalation cured any diseases the first gas recognised to have anaesthetic powers was nitrous oxide n 2 o inert colourless odourless and tasteless nitrous oxide was first isolated and identified in 1772 by the english chemist joseph priestley 1733 1804 priestley was a remarkable polymath a unitarian clergyman political theorist natural philosopher and educator writing of his research on gases he observed i cannot help flattering myself that in time very great medicinal use will be made of the application of these different kinds of airs priestley j experiments and observations on different kinds of airs 6 vols 1 228 1774 nitrous oxide doesn t induce an anaesthesia nearly as deep or effective as ether it s a strong analgesic in virtue of its tendency to promote opioid peptide release in the periaqueductal gray area of the midbrain but unlike ether it s only a weak anaesthetic nitrous oxide is not a muscle relaxant induction is rapid because of its low solubility its metabolism in the body is minimal but it inhibits vitamin b 12 metabolism chronic use of nitrous oxide can cause bone marrow damage it also inactivates the enzyme methionine synthetase critical to dna synthesis and cell proliferation nitrous oxide is short acting and generally regarded as safe to use even so patients are in danger of hypoxia if it s employed at the very high concentrations needed when it s the sole anaesthetic agent the exhilarating effects of inhaling nitrous oxide were noted by english chemist sir humphry davy 1778 1829 whenever i have breathed the gas he wrote the delight has been often intense and sublime sublime may not be quite le mot juste davy found that inhaling the compound made him want to giggle uncontrollably until he passed out so the illustrious scientist dubbed it laughing gas regrettably such a frivolous nickname probably discouraged the idea that the gas might serve a serious medical purpose in like manner today the racy street slang of short acting recreational drugs belies the clues they offer to a post genomic era of mental superhealth sublime or otherwise the nitrous oxide experience was so much fun davy wanted to share it with his friends notably the romantic poets samuel taylor coleridge 1772 1834 and robert southey 1774 1843 i am sure the air in heaven must be this wonder working gas of delight enthused southey tantalisingly davy himself remarked on the power of the immediate operation of the gas in removing intense physical pain in 1799 he inhaled nitrous oxide to banish the pain of an erupting molar tooth davy also discovered that taking the gas could induce voluptuous sensations his early research at beddoes pneumatic medical institute is well documented even though its implications were missed in an 80 000 word book on nitrous oxide re searches chemical and philosophical chiefly concerning nitrous oxide or dephlogisticated nitrous air and its respiration 1800 davy describes the different planes of anaesthesia stage 1 analgesia stage 2 delirium stage 3 surgical anaesthesia stage 4 respiratory paralysis though without appreciating the significance of the third plateau suitable for surgical operations most tantalisingly of all davy explicitly suggested the use of nitrous oxide as an analgesic during surgery since it appears capable of destroying physical pain it may probably be used with advantage during surgical operations in which no great effusion of blood takes place unfortunately this was an idea ahead of its time several decades of continuing surgical mayhem were to pass before the worldwide anaesthetic revolution davy s student michael faraday 1791 1867 studied nitrous oxide too he compared its pain relieving effects with the action of sulphuric ether in a brief anonymous 1818 article in the quarterly journal of science and the arts faraday noted how when the vapour of ether mixed with common air is inhaled it produces effects very similar to those occasioned by nitrous oxide a stimulating effect is at first perceived at the epiglottis but soon becomes very much diminished by the imprudent administration of ether a gentleman was thrown into a very lethargic state which continued with occasional periods of intermission for more than 30 hours in the years ahead there were other missed opportunities dashed hopes and false starts in 1824 english country doctor henry hill hickman 1800 30 a contemporary of davy and faraday performed allegedly painless operations upon non human animals using carbon dioxide induced anaesthesia thereby more or less asphyxiating the various mice kittens rabbits puppies and an adult dog whose various body parts he amputated hickman created in his victims a condition of what he called suspended animation this demonstration of inhalational anaesthesia didn t create the stir he anticipated arousing the interest only of napoleonic surgeon baron dominique jean larrey 1766 1842 hickman canvassed the possibility of pain free surgery for humans though the asphyxial narcosis induced by carbon dioxide makes this particular gas an unsuitable agent in vain he sent accounts of his work to the royal society of london it seems hickman s experiments reminded the royal society s president the ageing sir humphry davy of the undignified excesses of his youth nothing came of it beyond a footnote in the history books instead gases and vapours were used by medical instructors and their students for the purposes of hilarity and intoxication rather than the performance of pain free surgery nitrous oxide in particular was exploited in stage shows an advertisement for one such public entertainment promised that the effect of the gas is to make those who inhale it either laugh sing dance speak or fight etc etc according to the leading trait of their character they seem to retain consciousness enough not to say or do that which they would have occasion to regret admixed with oxygen nitrous oxide remains in surgical use but the first really effective and relatively safe general anaesthetic to gain acceptance was the now abandoned ether ether is liquid at room temperature but it vaporises very easily it can therefore readily be either swallowed or inhaled unlike nitrous oxide its vapour can induce anaesthesia without diluting the oxygen in room air to dangerously hypoxic levels ether itself had a long history before its use as a surgical anaesthetic it was marketed under the brand name anodyne by halle medical professor friedrich hoffmann 1660 1742 professor hoffmann recommended anodyne for pain due to earache toothache intestinal cramps kidney stones gallstones and menstrual distress in england materia medica london 1761 by w lewis describes ether as one of the most perfect tonics friendly to the nerves cordial and anodyne readers are advised that three to twelve drops should be taken on a lump of sugar and swallowed down with water in the 1790s medical maverick james graham 1745 1794 a famous london quack proprietor of the temple of hymen and owner of the celestial bed habitually inhaled an ounce or two of ether in public several times a day he took ether with manifest placidity and enjoyment but no one who witnessed him seems to have thought of exploiting its effects for operations ether was first discovered by catalan philosopher chemist raymundus lullius 1232 1315 lullius called it sweet vitriol its name until rechristened by german born london chemist w g frobenius in 1730 in greek ether means heavenly its synthesis described by german alchemist valerius cordus 1514 1554 in 1540 soon afterwards philippus aureolus theophrastus bombastus von hohenheim 1490 1541 better known as paracelsus noted its tendency to promote sleep and he observed how sweet vitriol ether quiets all suffering without any harm and relieves all pain and quenches all fevers and prevents complications in all disease paracelsus observed how chickens take ether gladly and they undergo prolonged sleep awake unharmed he had picked up much of his medical knowledge while working as a surgeon in several of the mercenary armies of the period 16th century warfare was endemic brutal and bloody paracelsus was not unduly afraid to challenge received medical wisdom or its proponents this is the cause of the world s misery that your science is founded upon lies you are not professors of the truth but professors of falsehood he informed his fellow doctors yet paracelsus didn t make the intellectual leap needed to take advantage of the properties of ether for human surgical medicine had he done so then given his undoubted brilliance as a publicist centuries of untold suffering might have been averted the first use of general anaesthesia probably dates to early nineteenth century japan on 13th october 1804 japanese doctor seishu hanaoka 1760 1835 surgically removed a breast tumour under general anaesthesia his patient was a 60 year old woman called kan aiya her sisters had all died of breast cancer kan sought hanaoka s help for the anaesthetic hanaoka used tsusensan an orally administered herbal preparation he had painstakingly developed over many years its main active ingredient seems to have been the plant chosen asagao many details of hanaoka s early life and experiments are obscure scholars rely on mayaku ko a collection of anaesthetics and analgesics a pamphlet written by his close colleague shutei nakagawa s in 1796 as a young man hanaoka had arrived in kyoto aged 23 he learned both traditional japanese medicine and dutch inspired surgery for centuries western presence in japan was limited by law to a single island in nagasaki bay the import of medical books was prohibited but japanese physicians were able to write down the orally transmitted medical lore of their dutch counterparts critically and allied to his surgical prowess hanaoka believed in the duty to relieve pain apparently he performed numerous experiments on non human animals in his search for a non toxic anaesthetic hanaoka went on to perform scores of operations on human beings under anaesthesia he even operated on his daughter and wife unfortunately under the national seclusion policy of the tokugawa shogunate 1603 1868 japan was essentially isolated western physicians and their patients knew nothing of hanaoka s work and tradition the breakthroughs that heralded the modern era of anaesthesiology were to come in the new world once again the story is messy and involved albeit better known in artificial anesthesia and anesthetics new york william wood and co 1881 henry m lyman records how in january 1842 the chemist and berkshire medical college student william e clarke 1818 78 administered ether on a towel to a miss hobbie after which the dentist elijah pope extracted a painful tooth it seems clarke was inspired by his earlier experience of ether frolics in rochester yet this was a one off somehow clarke and pope failed to recognise the potentially momentous ramifications of what they had done they neither wrote about nor repeated their feat as far as we know so conventionally the first clinical use of ether as a surgical general anaesthetic on humans is usually credited to rural georgian pharmacist and physician crawford williamson long 1815 78 on 30th march 1842 dr long removed a cyst from the neck of a mr james venable under ether anaesthesia mr venable consented to be a guinea pig for the occasion on account of his dread of pain dr long had learned of its properties while ether frolicking at medical school at the university of pennsylvania the use of such social intoxicants was as prevalent in the 1830s and 1840s as the mdma fuelled raves of a later era ether filled balloons were liberally handed out for the enjoyment of the audience a practice that might fruitfully enliven some academic lectures even today in the era of ether frolics medical students and budding chemists helped prepare gases for the festivities a tradition of service that likewise continues more discreetly in the groves of academe even now historically it seems likely that the medical connection may finally have helped several people more or less independently to draw the link between a form of stage show entertainment and the opportunity to perform pain free operations in any event although dr long administered anaesthesia to his patients on various occasions and extended its use to obstetrics he didn t publicise his discovery beyond his local practice indeed until the publication in 1849 of his scholarly article for the southern medical and surgical journal an account of the first use of sulfuric ether by inhalation as an anesthetic in surgical operations his work was mostly unknown to the wider world long s adoption of pain free surgery was common knowledge in jefferson georgia at least some local residents apparently suspected him of practising witchcraft others thought merely that it was unnatural and religious traditionalists objected that pain was god s way of cleansing the soul long s explanation of his early reticence was rational it may even be true though the full story is probably more complex the question will no doubt occur why did i not publish the results of my experiments in etherization soon after they were made i was anxious before making my publication to try etherization in a sufficient number of cases to fully satisfy my mind that anaesthesia was produced by the ether and was not the effect of the imagination or owing to any peculiar insusceptibility to pain in the persons experimented on whatever the reason the anaesthetic revolution was now imminent connecticut dentist horace wells 1815 1848 attempted a public demonstration of surgical anaesthesia in january 1845 wells had earlier been one of the stage volunteers who tried inhaling nitrous oxide during a demonstration by p t barnum s apt disciple professor gardner quincy colton 1814 98 at union hall in hartford connecticut one of the other volunte...