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.
医学学生控制住病人、 旁观者焦灼等待着, 苏格兰外科医生罗伯特·利斯顿 (Robert Liston) 准备开始手术。 接二连三地,他切开了病人的肌肉, 锯断了胫骨和腓骨,仅仅几分钟内, 便完成了截肢手术。 那是 19 世纪 30 年代, 利斯顿以手术速度而闻名。 这很重要,因为在麻醉药广泛使用之前, 患者必须有意识地忍受手术的每一刻。
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.
早在利斯顿之前,人们就开始寻求能够使 人失去知觉并实现更精确手术的麻醉剂。 大约在公元 200 年,中国医生 华陀描述了将酒精与 多种成分的粉末混合 以使患者麻醉的方法。 13 世纪的阿拉伯外科医生伊本·库夫 描述了患者接受麻醉的情况, 很可能是吸入大麻、 鸦片和曼德拉草等药物, 浸润在海绵里。
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.
到 18 世纪末,许多科学家 开始思考化学在医学上的应用。 这导致了一系列麻醉方面的改进, 主要涉及三个化合物: 笑气、醚和氯仿。
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.
1799 年,英国化学家 汉弗莱·戴维开始用笑气进行实验, 他自己吸入后观察朋友的反应。 戴维注意到笑气具有缓解疼痛的能力, 可能对手术有用, 但在几十年后才真正应用于手术中。 至少部分原因是因为 一些外科医生和患者 对麻醉药物的效果和 安全性持怀疑态度。
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.
1804 年,日本外科医生花岗 清秀成功地为一名患者切除了乳腺肿瘤, 并采用一种混合草药的麻醉剂。 但这一消息没有传出日本。
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.
最终,醚开始引起医学界的注意。 它在几个世纪前首次被制成, 然后被用于娱乐。 在 19 世纪初的所谓的 “醚派对”期间, 一位美国医生注意到自己在使用 醚后摔倒,不感到疼痛。 1842 年,他为一名患者 使用醚进行麻醉, 并成功地切除了他的颈部肿瘤。
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.
与此同时,牙医们终于开始认识到 笑气的潜力。 但是,在 1845 年,当一位 美国牙医试图给一位 被笑气麻醉的患者拔牙时, 他似乎遇到了问题,患者尖叫起来。 这可能只是剂量不足, 但对这种药物来说 是负面的公众态度。
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.
与此同时,牙医们 改进了用于拔牙的醚。 在 1846 年 10 月, 一位美国牙医给一位患者施用了醚, 一位外科医生切除了 这个人的颈部肿瘤。 两个月后,利斯顿本人为一位麻醉 的病人进行了上肢截肢手术, 据报道,病人在几分钟后恢复了意识, 并询问手术何时开始。 印度、俄罗斯等地的医生 也取得了醚麻醉的成功。
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.
但是醚也存在问题,包括不愉快的副作用。 苏格兰产科医生詹姆斯·辛普森听说了 一种名为氯仿的替代麻醉剂。 1847年,他和两位同事决定自己 尝试一些氯仿, 并很快昏倒了。 之后不久,辛普森给他的一位 分娩中的患者施用了氯仿。 它很快流行起来,因为它起效快, 被认为没有副作用, 尽管现在我们知道它是有害的, 很可能是致癌的。
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.
由于麻醉剂尚未完全被理解, 它们有时会导致致命后果。 一些医生持有性别歧视 和种族歧视的态度, 并在麻醉的情况下 主观决定麻醉剂剂量。 美国妇产科医生查尔斯·米格斯认为 分娩的疼痛是一种神圣的受苦方式, 并质疑医生对其的干预。 在 19 世纪 40 年代,美国医生 詹姆斯·马里昂·辛姆斯 在未给黑人奴隶妇女 减缓疼痛的情况下 进行了实验性的妇科手术。
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.
到了 19 世纪末, 那些可以使用麻醉剂的人 进行越来越复杂的手术, 包括一些原本不可能的手术。 氯仿被认为是一种 风险更大、更有毒的物质, 并在 20 世纪初逐渐冷门。 在新药物的推动下, 醚和笑气仍然在今天使用, 但是更安全、 副作用更少的改良配方, 而医生密切监测患者的状态。 源于这些进展, 速度不再是最重要的; 与其是剧痛, 手术更像是做了一场梦。