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A Brief History of Anesthesiology

From Sumerians to Sarasota Memorial

Perhaps the biggest miracle of modern surgery is that you get to sleep through it. This wasn’t always the case. Like every branch of medicine, the discovery and study of anesthesia has been a long one, full of twists and turns, dead ends, weird ideas and incredible innovation.

As Sarasota Memorial Hospital celebrates its 100th anniversary—and the recent addition of FPG Anesthesiology—let’s look back at this winding path of medical invention.

And be glad we’ve come so far.

Ancient Anesthesiology – Poppies & Potions

The first documented attempts at what could be called early anesthesia actually come from around 4,000 BCE, when Sumerians in Mesopotamia discovered alcohol and used ethanol as a sedative. Shortly after, they learned to cultivate the opium poppy for its euphoric and pain-relieving qualities. (That’s “milk of the poppy” for all you Game of Thrones fans.)

A botanical illustration of an opium plant.

Word quickly spread through the Babylonian Empire and beyond, where this was big news for the Egyptians and Assyrians, who would simply pinch the patient’s carotid artery until they passed out from lack of blood to the brain. This was most commonly done before performing eye surgery or a circumcision.

In the millennia following, the field of anesthesiology is largely confined to such herbal remedies, with historical texts from Europe to Asia documenting use of everything from juniper and jasmine to cannabis and the poisonous stinking nightshade, as physicians and alchemists searched for anything that could ease a patient’s pain during surgery.

Herbal remedies are found at the apothecary during the Middle Ages.

The Middle Ages saw little innovation in the field, minus the incredible idea to just mix everything together. This would eventually evolve into a potion called dwale, containing alcohol, opium, bryony, hemlock, henbane, vinegar, and, because the Middle Ages are weird, bits of lettuce and some human bile. This will be the anesthetic standard in Europe until the mid-16th century.

Meanwhile, in the Islamic Golden Age, physicians use what’s called a “soporific sponge,” fixed under a patient’s nose, to calmly induce unconsciousness. It is one of the first forms of inhaled anesthesia, and soon spreads to Europe.

On the other side of the world, Incan shamans discover the medicinal properties of coca leaves, chewing them and using their cocaine-infused saliva as a general anesthetic.

The field has a ways to go.

Growing Pains – Better Anesthesia Through Chemistry

By the time the 16th century rolls around, herbal remedies are out and alchemy is in, as a Swiss physician named Paracelsus first distills ether, testing its analgesic effects on chickens and stray dogs. (What is it with these guys and dogs?) He will eventually become known as perhaps the first medical chemist. Diethyl ether is discovered 15 years later by a German botanist.

Portrait of Paracelsus by Augustin Hirschvogel, 1538.

Things move quickly from there.

In 1659, Sir Christopher Wren and Robert Boyle inject opium into a dog (It’s a tradition at this point) using a goose quill as a makeshift needle. This will have sweeping impacts across near every field of medicine, including anesthesiology. In 1775, Joseph Priestly discovers nitrous oxide but doesn’t think to try breathing it in.

Events take a bizarre step backwards in 1779, when a German named Franz Anton Mesmer pushes magnetism and hypnosis as a sort of “mind over matter” form at anesthesia—it worked about as well as you’d expect—but the discipline is right on track by 1800, when a chemist named Humphry Davy somehow discovers that inhaling nitrous oxide made one stoned, silly and sleepy. He names it “laughing gas.”

Five years later, pharmacist Friedrich Serturner isolates the sleep-inducing agent in opium. He names it “morphium,” as homage to the Greek god of dreams, Morpheus. It is the first alkaloid ever isolated in any plant and a fantastic leap forward for science.

And in 1821, an unknown English physician named Henry Hill Hickman pushes the boundaries of what is possible through anesthesia—and makes a strong case for animal cruelty laws—by suffocating puppies to the point of unconsciousness under a glass dome and then performing amputations. He reports carbon dioxide to be an effective anesthetic.

Henry Hill Hickman performing experiments on suspended animation. Watercolour and gouache by Richard Tennant Cooper, c.1912.

The scientific community is aghast and Hickman is publicly humiliated in a Lancet article titled “Surgical Humbug.” He dies alone at the age of 30. Today, he is recognized as one of the fathers of modern anesthesia.

The age of surgery had begun.

The Birth of Modern Surgery – Chloroform, Cocaine & a Call to Order

20 years after Hickman, an American physician named Crawford W. Long becomes the first to use an inhaled anesthetic, draping an ether-soaked towel over the patient’s nose and mouth before removing a vascular tumor from his neck. Inhalation anesthesia will become the key to making more invasive and ambitious surgeries possible. Dr. Long will become the first anesthesiologist featured on a US postage stamp.

By 1846, etherized surgeries are common enough that the surgical amphitheater at Massachusetts General Hospital becomes known as “The Ether Dome,” where students, visiting physicians, and a curious public can witness the miracles of modern medicine. Dr. William Morton performs the first public demonstration. Dr. Oliver Wendell Holmes, Sr., coins the term “anaesthesia.”

Ether Day by Robert C. Hinckley, c.1887, shows the first etherized surgery in the Ether Dome.

It’s also around this time that chloroform is discovered, quickly becoming a standard anesthetic for use during childbirth. In 1853, Dr. John Snow chloroforms Queen Victoria for the birth of Prince Leopold, and again in 1857 for Princess Beatrice.

Then the Europeans discover cocaine. Dr. Karl Koller, friend of Sigmund Freud, begins prescribing it as an anesthetic during eye surgery, while others use it for dental procedures and even as the first spinal anesthetic. Ostensibly, their patients get some too.

Cocaine Toothache Drops are openly advertised for children in 1885.

By the turn of the century, however, cocaine has fallen out of favor, replaced by less harmful variants like procaine and Novocain, and the field of anesthesiology starts to coalesce and formalize around a series of professional organizations and various “societies.” The first in the US is the Long Island Society of Anesthesiologists, founded in 1907. The American Board of Anesthesiology forms in 1940, six years after the first intravenous anesthetic is administered.

Much of the story through the second half of the 20th century is one of refining techniques and synthesizing safer and better anesthetics. In 1956, the discovery of halothane introduces a non-flammable alternative to ether, greatly reducing risk of operating room fires, though it is eventually replaced by safer variants like enflurane, isoflurane and, eventually, sevoflurane, which is still in use today. And in 1973, propofol is first synthesized, eventually replacing sodium pentothal and becoming the gold standard for inducing general anesthesia. Today, it sits on the World Health Organization’s List of Essential Medicines.

Anesthesia Today - Take A Deep Breath and Count Backwards from 10…

Anesthesiology in the 21st century is a far cry from the Wild West days of the 19th century or even what it was 30 years ago. The field, and our understanding of it, continues to grow by leaps and bounds. And as surgical therapies become more and more commonplace and accessible, the need for skilled anesthesiologists has never been greater.

At Sarasota Memorial, we’re meeting that need with First Physicians Group Anesthesiology, our own in-house team of board-certified Physician Anesthesiologists and Certified Registered Nurse Anesthetists. Collaborating directly with the patient’s care team, FPG Anesthesiology provides comprehensive anesthesia services for surgical inpatients at both Sarasota Memorial Hospital campuses, in addition to patients undergoing procedures at Sarasota Memorial’s outpatient facilities.

And they’re on call 24 hours a day, 7 days a week, to provide compassionate pain relief for expectant mothers, cesarean deliveries, and other emergency surgeries.

To learn more, go to FPG Anesthesiology.