With medical students restraining the patient and onlookers eagerly awaiting, Scottish surgeon Robert Liston poised himself to begin. In quick succession, he cut his patient’s flesh, sawed through their tibia and fibula and, within just a few minutes, the amputation was complete. It was the 1830s and Liston was renowned for his surgical speed. This was important because, before anesthesia was widely used, patients had to consciously endure every moment of surgery.
Con estudantes de medicina suxeitando ao paciente e público agardando con ansia, o cirurxián escocés Robert Liston preparábase para empezar. Con movementos rápidos, cortou a carne do paciente, serroulle a tibia e o peroné e, en cuestión de minutos, completou a amputación. Na década de 1830 Liston era coñecido pola súa rapidez cirúrxica. Isto era importante porque, antes de que se estendese o uso de anestesia, os pacientes tiñan que soportar cada momento da cirurxía conscientes.
The quest for anesthetics that could induce unconsciousness and enable more meticulous surgeries launched long before Liston. Around 200 CE, Chinese physician Hua Tuo described mixing alcohol with a powder of various ingredients to anesthetize patients. And 13th century Arab surgeon Ibn al-Quff described patients taking anesthetics, likely inhaling drugs like cannabis, opium, and mandrake, from saturated sponges.
A busca de anestésicos que puidesen inducir inconsciencia e permitisen cirurxías máis meticulosas comezou moito antes de Liston. Sobre o ano 200 da Era Común, o fisiólogo chinés Hua Tao describiu unha mestura de alcol cun po de varios ingredientes para anestesiar pacientes. O cirurxián árabe do s. XIII Ibn al-Quff fala de pacientes que tomaban anestésicos, probablemente inhalando drogas como cánnabis, opio e mandrágora, de esponxas saturadas.
By the end of the 1700s, many scientists were pondering chemistry’s medical applications. This led to a profusion of anesthetic advancements involving three main players: nitrous oxide, ether, and chloroform.
A finais do s. XVIII, moitos científicos reflexionaban sobre as aplicacións médicas da química. Isto levou a novos avances na anestesia, con tres protagonistas claros: o óxido nitroso, o éter e o cloroformo.
In 1799, English chemist Humphry Davy began experimenting with nitrous oxide, or laughing gas— inhaling it himself and observing its effects on friends. Davy noted that its pain-relieving abilities might make it useful for surgical operations— but it would be decades before that happened. This was, at least in part, because some surgeons and patients were skeptical of the effectiveness and safety of anesthetic drugs.
No 1799, o químico inglés Humphry Davy empezou a experimentar co óxido nitroso, tamén chamado gas da risa, inhalándoo el e observando o seu efecto en amigos. Davy decatouse de que a súa capacidade de aliviar a dor podía ser útil para operacións cirúrxicas, pero pasarían décadas antes de que iso acontecese. Isto debeuse, en parte, a que algúns cirurxiáns e pacientes eran escépticos ante a eficacia e a seguridade dos anestésicos.
In 1804, Japanese surgeon Seishū Hanaoka successfully removed a breast tumor from a patient anesthetized with a mix of medicinal herbs. But the news stayed in Japan indefinitely.
No 1804, o xaponés Seishū Hanaoka conseguiu extirpar un tumor de mama dunha paciente anestesiada cunha mestura de herbas medicinais. Pero a noticia non saíu do Xapón.
Eventually, ether started garnering medical attention. It was first formulated centuries before then came to be used recreationally. During the so-called “ether frolics” of the early 1800s, an American physician noted that the fall he suffered while using ether was painless. In 1842, he etherized a patient and successfully removed a tumor from his neck.
Co tempo, o éter empezou a atraer a atención dos médicos. Formulárase séculos antes de que se empezase a usar con fins recreativos. Durante as coñecidas como “festas do éter” a principios do s. XIX, un médico americano decatouse de que a caída que sufrira baixo os efectos do éter fora indolora. No 1842, tratou un paciente con éter e extirpoulle un tumor do colo con éxito.
In the meantime, dentists finally began recognizing nitrous oxide’s promise. But, in 1845, when an American dentist attempted a public tooth extraction on someone anesthetized with nitrous oxide, he apparently encountered a setback when his patient screamed. It was probably just an insufficient dose— but it was a bad publicity moment for the drug.
Entre tanto, os dentistas por fin recoñeceran o potencial do óxido nitroso. Pero, no 1845, cando un dentista americano intentaba a extracción pública dun dente dunha persoa anestesiada con óxido nitroso, aparentemente atopou un imprevisto cando o paciente lanzou un grito. Probablemente se debese só a unha dose insuficiente, pero resultou en mala publicidade para o medicamento.
Meanwhile, dentists refined ether for tooth extractions. And, in October 1846, an American dentist administered ether to a patient, and a surgeon removed the man’s neck tumor. Two months later, Liston himself performed an upper leg amputation on an etherized patient, who reportedly regained consciousness minutes after and asked when the procedure would begin. Further ether-enabled successes followed from India, Russia, and beyond.
Durante este tempo, os dentistas refinaron o éter para a extracción de dentes. En outubro de 1846, un dentista americano administroulle éter a un paciente e un cirurxián extirpoulle un tumor do colo. Dous meses despois, o propio Liston amputoulle a parte superior da perna a un paciente tratado con éter, que aparentemente recuperou a consciencia minutos despois e preguntou cando comezaría o procedemento. Outros éxitos produto do uso do éter chegaron da India, Rusia e máis alá.
But ether had issues, including unpleasant side effects. Scottish obstetrician James Simpson heard about an alternative anesthetic called chloroform. And, in 1847, he and two colleagues decided to try some themselves and promptly passed out. Soon after, Simpson administered chloroform to one of his patients during childbirth. It quickly gained popularity because it was fast-acting and thought to be side-effect-free— though we now know it’s harmful and probably carcinogenic.
Pero o éter tiña problemas, incluíndo efectos secundarios desagradables. O tocólogo escocés James Simpson escoitara falar dun anestésico alternativo chamado cloroformo. No 1847, el e mais dous colegas decidiron probalo por si mesmos e desmaiáronse rapidamente. Pouco despois, Simpson administroulle cloroformo a unha das súas pacientes durante o parto. Gañou popularidade con velocidade porque actuaba rápido e porque se pensaba que non tiña efectos secundarios, aínda que hoxe sabemos que é daniño e probablemente canceríxeno.
Because anesthetics weren’t yet fully understood, they sometimes had lethal consequences. And some doctors held sexist and racist beliefs that dictated the amount of anesthesia they’d provide, if any at all. American obstetrician Charles Meigs argued that the pain of childbirth was a form of divine suffering and was skeptical that doctors should interfere with it. Throughout the 1840s, American physician James Marion Sims conducted experimental gynecological surgeries without pain relief, primarily upon enslaved Black women.
Debido a que a os anestésicos non se entendían de todo, en ocasións tiñan consecuencias letais. E algúns doutores tiñan crenzas sexistas e racistas que determinaban a cantidade de anestesia que lle darían aos pacientes, se acaso lles daban. O tocólogo americano Charles Meigs sostiña que a dor durante o parto era unha forma de sufrimento divino e dubidaba se os doutores deberían interferir nel. Durante a década de 1840, o médico americano James Marion Sims levou a cabo cirurxías xinecolóxicas experimentais sen analxésicos, principalmente en mulleres negras escravizadas.
By the late 19th century, those who could access anesthetics were undergoing increasingly complex operations, including some that were previously impossible. Chloroform came to be understood as a riskier, more toxic option, and fell out of favor by the early 1900s. Alongside newer drugs, ether and nitrous oxide are still used today— but in modified formulations that are safer and produce fewer side effects, while doctors closely monitor the patient’s state. Thanks to these advances, speed is not always of the essence and, instead of acute agony, surgery can feel like just a dream.
A finais do s. XIX, aqueles que tiñan acceso aos anestésicos podían someterse a operacións cada vez máis complexas, incluíndo algunhas que, ata ese momento, eran imposibles. Empezouse a descubrir que o cloroformo era unha opción tóxica e perigosa e a principios do s. XX caeu en desuso. Xunto con novos medicamentos, o éter e o óxido nitroso seguen a usarse en formulas modificadas, máis seguras e con menos efectos secundarios, mentres os doutores controlan o estado dos pacientes. Grazas a estes avances, a rapidez xa non é sempre esencial e, en lugar de ser unha agonía, as cirurxías poden parecer un simple soño.