Surgery

The Scientific Revolution in the sixteenth and seventeenth centuries revolutionized medicine. William Harvey (1578-1657) advanced all branches of medicine with his discoveries about circulation of the blood. A fascination with the human body, and the renewed study of anatomy helped forge dramatic advances in the understanding of how the body worked. The era also saw the innovations of great surgeons such as Ambroise Pare (1510-1590).

Trained as a barber-surgeon, Pare's writings on surgery influenced the profession for centuries. His books were translated into Japanese, Latin, German, English and Dutch. Pare, a military surgeon for four kings of France, made his first great innovation at the Siege of Turin in 1537. At the time, conventional treatment of gunshot wounds called for treatment that today would be considered sadistic torture: the cleansing of wounds by boiling oil.

Stationed at the battle field where many soldiers were wounded, Pare used up the supply of boiling oil before all the men's wounds could be treated. To treat the others, he developed a milder mixture consisting of egg yolk, turpentine, and oil of roses. The soldiers who had received Pare's mixture looked better the next morning, while the other soldiers' wounds remained unchanged. The success of the milder treatment lead to abandonment of the boiling oil dressing.

Pare's books on surgery related everything from effective treatment of gunpowder wounds to methods for removing arrows and treatment of urinary-tract infections. He also discussed the use of ligature to repair damaged blood vessels. Pare and other surgeons enhanced the reputation of the profession. But until the nineteenth century, surgeons and their patients were limited by their inability to fend off infection or control pain. Their failure to do so meant that surgery was generally painful and life-threatening.

The limits of anesthesia in the pre-modern era shaped the way doctors operated on patients. One measure of the need to limit pain was the value placed on speed in surgery. Reportedly, Scottish surgeon Robert Liston could amputate a limb in 29 seconds. Long operations were impossible, because patients died on the operating table due to shock, pain, and heart failure.

Surgeons from ancient times developed anesthetics drawn from plants or plant products, such as opium from the poppy plant and wine drawn from grapes. But all of these substances had flaws, such as dangerous side effects. All were difficult to control for dosage, and none provided surgeons with what they most needed—a patient who would lie still and not feel pain during surgery, then awaken after the procedure was over.

This changed with the development of effective anesthesia in the eighteenth century. There was no single inventor of anesthesia. Indeed, controversy marked the early use of anesthesia, with many different individuals claiming credit. Ether, the first gas to be used widely, was described as early as 1540 as a solvent which could also be used to aid patients with pleurisy and pneumonia. The gas gained new life in the early 1800s, when American and British pleasure-seekers marveled at the changes in behavior and perception induced by inhaling ether or nitrous oxide.

The story of the first public display of anesthesia by dentist William Thomas Green Morton is a story of claims, counterclaims, and frustration. The first to have his claims of innovation overlooked was Crawford Williamson Long, a physician in Jefferson, Georgia. Long reported the safe removal of a tumor in the neck of a patient anesthetized with ether in 1842. His failure to promptly report his use of the substance to medical journals resulted in the eclipse of his achievement by Morton in 1846.

Another dentist, Horace Wells, also was frustrated in his claim to be the first to successfully use a gas anesthetic. Wells used nitrous oxide in 1844 to anesthetize patients while their teeth were being pulled. Wells attempted to perform a dental procedure under anesthesia before a class of Harvard Medical students. The 1845 demonstration was a failure. The patient cried out in pain, and Wells was ridiculed. Eventually he committed suicide, after a bitter campaign to gain credit for his discovery.

Morton did not know about the use of nitrous oxide as an anesthetic until after Wells, a former teacher, traveled to Boston to display the new technology in 1845. Taking a more careful and politic route than Wells, Morton conducted a series of experiments using ether with dogs, goldfish, and other animals. He applied for a patent, and in 1846 performed a successful tooth extraction on a patient who had inhaled ether. He also associated himself with a number of prestigious physicians, then scheduled a public display of ether anesthetic. The 1846 display, during which a prominent surgeon operated on a vascular tumor, was a success.

Though Morton received credit for the first successful use of ether anesthesia, his credit was challenged a second time after the procedure was deemed successful. This time, he was accused by a chemist who had advised him, Charles T. Jackson, who said he was the true inventor.