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.
Dok su studenti medicine držali pacijenta, a posmatrači željno iščekivali, škotski hirurg Robert Liston spremao se da počne. Brzim pokretima je testerom sekao nogu svog pacijenta, isekavši goleničnu i lisnu kost, i posle samo nekoliko minuta, amputacija je bila završena. To je bilo 1830-ih godina, a Liston se proslavio brzinom kojom je operisao. Ovo je bilo važno, jer pre nego što je anestezija bila u širokoj upotrebi, pacijenti su u svesnom stanju morali da pretrpe celu operaciju.
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.
Potraga za anesteticima koji bi doveli do gubitka svesti i omogućili preciznije operacije počela je mnogo pre Listona. Oko 200. godine nove ere, kineski lekar Hua Tuo opisao je korišćenje mešavine alkohola i praška napravljenog od raznih sastojaka za anesteziranje pacijenata. A u 13. veku, arapski hirurg Ibn al-Kaf je opisao kako pacijenti uzimaju anesteziju, uglavnom udišući narkotike kao što su kanabis, opijum i mandragora sa natopljenog sunđera.
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.
Već krajem 18. veka, mnogi naučnici su razmišljali kako da primene hemiju u medicini. To je dovelo do velikog napretka na polju anestetika, a posebno su se izdvojili azot-suboksid, etar i hloroform.
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.
Godine 1799, engleski hemičar Hamfri Dejvi eksperimentisao je sa azot-suboksidom, iliti gasom smejavcem — sam ga je udisao, a i posmatrao kako deluje na prijatelje. Dejvi je primetio da njegova sposobnost ublažavanja bola može da bude korisna za operacije — ali proći će decenije dok se to ne dogodi. Za to su delom bili zaslužni neki hirurzi i pacijenti, koji su sumnjali u efikasnost i bezbednost korišćenja anestetika.
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.
Godine 1804, japanski hirurg Seišu Hanaoka uspešno je uklonio tumor dojke pacijentkinji anesteziranoj mešavinom lekovitog bilja. Međutim, ova vest je do daljnjeg ostala u Japanu.
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.
Najzad, etar je privukao pažnju u oblasti medicine. Formulisan je vekovima pre toga, a onda je počeo da se koristi rekreativno. Tokom takozvanih etarskih zabava koje su se održavale početkom 19. veka, jedan američki lekar je primetio da nije osetio bol pri padu dok je bio pod uticajem etra. Godine 1842, koristio je etar na pacijentu i uspešno uklonio tumor sa njegovog vrata.
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.
U međuvremenu, zubari su napokon počeli da prihvataju korisnost azot-suboksida. Ali, 1845. godine, kada je pred publikom jedan američki zubar pokušao da izvadi zub nekome pod anestezijom izazvanom azot-suboksidom, izgleda da je naišao na prepreku kada je taj pacijent zavrištao. Verovatno je bila u pitanju samo nedovoljna doza — ali to je bio loš publicitet za taj lek.
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.
U međuvremenu, zubari su usavršili korišćenje etra za vađenje zuba. I u oktobru 1846. godine, jedan američki zubar je pacijentu dao etar, dok je hirurg uklonio tumor sa njegovog vrata. Dva meseca kasnije, Liston je i sam izvršio amputaciju noge na pacijentu koji je bio pod uticajem etra, i koji je navodno povratio svest nekoliko minuta nakon toga i pitao kada će početi sa procedurom. Dalji uspesi sa korišćenjem etra dolazili su iz Indije, Rusije, i drugih država.
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.
Ali etar je imao i loših strana, uključujući neželjena dejstva. Škotski akušer Džejms Simpson čuo je za drugi anestetik pod nazivom hloroform. I 1847. godine, on i dvojica kolega odlučili su da ga sami probaju i smesta su se onesvestili. Ubrzo nakon toga, Simpson je koristio hloroform na jednoj pacijentkinji tokom porođaja. Postao je veoma popularan jer je brzo delovao i mislilo se da nema neželjenih dejstava— iako sada znamo da je štetan i verovatno karcinogen.
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.
Pošto anestetici nisu bili istraženi u potpunosti, ponekad su imali smrtonosne posledice. Neki doktori su imali seksistička i rasistička uverenja prema kojima su određivali količinu anestezije koju će dati, ako bi je uopšte i davali. Američki akušer Čarls Migz tvrdio je da su porođajni bolovi oblik uzvišene patnje i bio je sumnjičav prema tome da doktori treba da se mešaju u to. Tokom 1840-ih, američki lekar Džejms Marion Sims izvodio je eksperimentalne ginekološke operacije bez lekova protiv bolova, najviše na porobljenim crnkinjama.
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.
Do kraja 19. veka, oni koji su imali pristup anesteticima bili su podvrgavani sve komplikovanijim operacijama, uključujući i neke koje su ranije bile nemoguće. Hloroform je počeo da se smatra rizičnijom i opasnijom opcijom, te je do početka 20. veka izašao iz upotrebe. Pored novijih lekova, etar i azot-suboksid se koriste i danas— ali u drugačijim formulacijama koje su bezbednije i sa manje neželjenih dejstava, dok lekari pažljivo prate stanje pacijenta. Zahvaljujući ovim naprecima, brzina operacije nije uvek od suštinskog značaja, a umesto u stalnoj agoniji, operacija može da protekne i samo kao u snu.