It is hard to read about surgery over the centuries without flinching: the crudity of the tools, the lack of anaesthetic, and not least what seems like astonishing guts (metaphorically speaking) in carrying out techniques that nowadays seem indistinguishable from butchery.
The past saw such gruesome and widely practiced techniques like trepanation, in which part of the skull is removed to reveal the brain to provide relief for headaches or following injury. Excavations reveal that in Neolithic times up to one in three skulls have holes drilled or scraped out. The head was particularly prone to damage from slings and clubs and other primitive weapons, and the aim of trepanation was to relieve what felt like extreme pressure, release blood and ‘evil air’, and leave the brain nicely aerated.
The even more remarkable finding is that many of these skulls – between 50% and 90% according to some sources – belonged to people who survived. We know this because the edge of the hole has healed. The procedure was popular in Europe as a treatment for epilepsy and mental illness up to the 18th century, and afterwards for head injury. Cornish miners in the 19th century apparently insisted on having their skulls bored after even minor head injuries, as a precautionary measure.
But when hospitals began to flourish in the 19th century, holes in the head became even more dangerous. The problem was hygiene: the infection risk was so high in these hospitals that doctors managed to make a mad idea even worse. As a result the mortality rate shot up to about 90%.
If this wasn’t bad enough, the only pain relief available for having your head excavated with a sharp instrument was intoxication. Alcohol, cannabis and opium were the basic anaesthetics until Humphrey Davy personally experimented with nitrous oxide or laughing gas. In 1800, he had the foresight to write: “As nitrous oxide in its extensive operation 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.”
Naturally for such a wildly innovative idea, nobody in medicine took any notice for 50 years. But during this time laughing gas and ether were used as party tricks: so-called ‘ether frolics’ were hugely popular in the US. (Over a century later, the American journalist and author Hunter S Thompson described ether’s effects as making you behave “like the village drunkard in some early Irish novel”.) Then it finally dawned on some medical students that the frolickers appeared not to care about injury. Could this be put to practical use, they wondered.
The first public anaesthetic using ether was thought to have been delivered by William Morton on 16 October 1846 at Massachusetts General Hospital. The idea soon spread, especially after Queen Victoria welcomed the use of chloroform for the birth of Prince Leopold in 1853, although chloroform later lost favour due to sudden deaths from heart arrhythmias, now known as ‘sudden sniffer’s death’ among teenage solvent abusers.
Nowadays, being numbed and put to sleep for an operation is routine in many parts of the world – the World Health Organisation reports that each year there are 230 million major surgical procedures under anaesthesia.
But anaesthetics still come with their own risks, and rates appear to be strongly dependent on health care expenditure levels. The UK Royal College of Anaesthetists says that there are life-threatening allergic reactions in less than 1 in 10,000 people and that most recover. But not all. Around 1 in 100,000 general anaesthetics still lead to the death of the patient.