Blessed Days of Anaesthesia

Stephanie J. Snow is a research associate at the Centre for the History of Science, Technology & Medicine at the University of Manchester.  Stephanie is married to the great great great nephew of John Snow, who not only administered anaesthesia to Queen Victoria for the births of Prince Leopold and Princess Beatrice, but showed that cholera was transmitted by contaminated water from the Broad Street pump.  In her new book Blessed Days of Anaesthesia: How Anaesthetics Changed the World she looks at the history of anaesthesias and how its discovery left not only a medical and scientific legacy, but a compassionate one too.  In the excerpt below Snow paints a vivid picture of life before anaesthesia.

Fanny Burney was no stranger to pain.  Best known for her novel Evelina, published in 1778, Fanny suffered from mastitis after the birth of her son, Alex, in December 1794. The pain was so intense ‘as to make life-even my happy life-scare my wish to preserve!’ she wrote.  Little did she know then that seventeen years later she would have to bear a mastectomy without pain relief.  Her description of the operation, undertaken in Paris, is a moving testimony to the awful suffering patients endured in operations without anaesthesia.  The first indication of the problem was a ‘small pain’ in her breast.  Reluctant to seek medical advice, she was eventually persuaded by her husband, M. d’Arblay, to consult M. Dubois, the surgeon who had treated her for the breast abscess.  Dubois’ opinion was that ‘a small operation would be necessary to avert evil consequences.’ ‘My dread & repugnance, from a thousand reasons besides the pain, almost shook all my faculties, &, for some time, I was rather confounded & stupefied than affrighted,’ Fanny recalled. As ‘the pains became quicker & more violent’ she sought a second opinion.  M. Larrey, recently awarded a baronetcy for his services to Napoleon’s armed forces, prescribed a new regime of therapies which brought some improvement.  However, his concern was strong enough to ask for a further opinion from the anatomist Dr Ribe and, as a last resort, Dr Moreau, a physician.  But to no avail.  After a final consultation between doctors, Fanny was summoned to attend them.  Seeing Larrey shrinking behind the sofa she realized ‘all hope was over.  I know saw it was inevitable, and abstained from any further effort.  …I was formally condemned to an operation.’  The doctors were unequivocal about the severity of the forthcoming operation: ‘vous souffrirez beaucoup’, warned Dubois.  Ribe charged Fanny to cry and scream during surgery; any attempt to restrain herself could have serious consequences, he warned.  But Dubois and Larrey refused to give Fanny more than four hours notice of the operation.  They wanted to limit her anxiety they said.  When operations were performed at home, patients’ families often attended, but M. d’Arblay was too agitated; the doctors refused to have him present.  To keep Fanny’s fears in check, a closet in the house was secretly filled with dressings, bandages, and compresses.  Fanny made her will and appointed two women to attend her during the procedure.  On the morning of 30 September 1811 Fanny recieved a letter from Larrey giving her two hours notice of the operation.  ‘I will not be ready until 1 o’clock,’ she protested; in the event Dubois was delayed until 3 o’clock.  Fanny waited; ‘the sight of ht immense quantity of bandages, compresses, sponges, Lint-made me a little sick,’ she wrote.  Finally ‘7 Men in black’ entered the salon.  Dubois took charge, ordering a bedstead, old mattresses, and sheets to be placed in the centre of the room.  Fanny later recalled, ‘every thing convinced me danger was hovering above me, & that this experiment could along save me from its jaws.’  So she climbed on the bed and Dubois placed a thin handkerchief over her face. Its transparency permitted her to see the seven men and nurse gather round the bed, but when she saw ‘the glitter of polished Steel’ she closed her eyes, unable to watch ‘the terrible incision’.  The experience was ‘a terror that surpasses all description, & the most torturing pain’, she wrote.

When the dreadful steel was plunged into the breast-cutting through veins-arteries-flesh-nerves-I needed no injunctions not to restrian my cries.  I began a scream that lasted unintermittingly during the whole time of the incision-& I almost marvel that it rings not in my Ears still! so excruciating was the agony. …I then felt the Knive [rack]ling against the breast bone-scraping it!  …I bore it with all the courage I could exert, & never move, nor stopt them, nor resisted, nor remonstrated, nor spoke…Wehn all was done, & they lifted me up that I might be put to bed…I then saw my good Dr Larry, pale nearly as myself, his face streaked with blood, & his expression depicting grief, apprehension, & almost horrour.

Fanny recovered but it was six months before she could begin to record her ordeal.  ‘I dare not revise, nor read, the recollection is still so painful,’ she wrote to her eldest sister Esther.

Fanny’s account tells us clearly that operations were the last resort of surgeons and patients.  Pain was not the only problem; the perils of blood loss and infection made all surgery life-threatening.  Exposing a patient to such risks could only be justified when all other courses had been explored.  When the diarist Samuel Pepys agreed to have his bladder stone removed in 1658, it was the only escape from ‘a condition of constant and dangerous and most painful sickness and low condition and poverty’.  He knew he was fortunate to survive the operation: he preserved the stone in a special case and celebrated ‘operation day’ for the remainder of his life.  And though anatomical knowledge and surgical techniques expanded considerably during the eighteenth and early nineteenth centuries, surgery remained a risky business.  Major operaitons included amputation, hernia, ovariotomy, lithotomy (removal of bladder stones), trepan (cutting a hole in the skull to remove injured or diseased parts without disturbing the dura surrounding the brain), and many smaller procedures such as removing polyps or repairing fistula in the rectum.  But most surgeons performed few operations.  Records from Amsterdam suggest that on average, fewer that four lithotomies a year were performed between 1725 and 1821; a mortality rate of around 20 percent indicated the risks involved.  At large and presitgious London hospitals only a handful of major operations took place each month.  University College hospital surgeon Robert Liston performed only two or three operations each month.  Surgeon to the Royal Navel hospital in Plymouth, Stephen Hammick, undertook fewer than two amputations a month during his twenty-two year career.