In Our Time - Anaesthetics

Episode Date: March 29, 2007

Melvyn Bragg and guests discuss the history of anaesthetics, from laughing gas in the 1790s to the discovery of “blessed chloroform”. Remembering his unsuccessful stint at Edinburgh Medical school Charles Darwin described the horrors of surgery before anaesthetics : "I attended the operating theatre and saw two very bad operations... but I rushed away before they were completed. Nor did I ever attend again, for hardly any inducement would have been strong enough to make me do so; this being long before the blessed days of chloroform. The two cases fairly haunted me for many a long year."The suffering Darwin witnessed is almost unimaginable. In the 19th Century, a simple fracture often led to amputation carried out on a conscious patient, whose senses would be dulled only by brandy or perhaps some morphine. Many patients died of shock.The properties of gases like nitrous oxide or “laughing gas” held out hope. The chemist Humphrey Davy in the 1790s described it as “highly pleasurable, thrilling”. He also noticed his toothache disappeared. But he failed to apply his observations and it wasn't until the 1840s that there was a major breakthrough in anaesthetics, when an enterprising dentist in Boston managed to anaesthetize a patient with ether. It became known as the “Yankee Dodge”. Ether had its drawbacks and the search for a suitable alternative continued until chloroform was tried in 1847, winning many admirers including Queen Victoria, the first English royal to use it. So why did it take so long for inhaled gases to advance from providing merely recreational highs to providing an essential tool of humane surgery? What role did the development of the atomic bomb play in the development of anaesthetics? And how have society's changing attitudes to pain informed the debate?With David Wilkinson, Consultant Anaesthetist at St Bartholomew’s Hospital in London and President of the History of Anaesthesia Society; Stephanie Snow, Research Associate at the Centre for the History of Science, Technology & Medicine at the University of Manchester; Anne Hardy, Professor in the History of Modern Medicine at University College London

Thanks for downloading the In Our Time podcast. For more details about In Our Time and for our terms of use, please go to BBC.co.com.uk forward slash radio 4. I hope you enjoy the program. Hello, today it's the history of anaesthetics. Charles Darwin describes the horror of surgery before anaesthetics like this. I attended the operating theatre and saw two very bad operations, but I rushed away before they were completed.

Nor did I ever attend again, for hardly any inducement would have been strong enough to make me do so, this being long before the blessed days of chloroform. The two cases fairly haunted me for many a long year. In the 19th century, a simple fracture often led to amputation carried out on a conscious patient whose senses would be dulled only by brandy or perhaps some morphine. Many patients died of the shock. The properties of gases like nitrous oxide or laughing gas held out hope.

The chemist Humphrey Davy in the 1790s described it as highly pleasurable, thrilling. He also noticed his toothache disappeared, but he failed to apply his observations, and it wasn't until the 1840s there was a major breakthrough in anaesthetics when an enterprising dentist in Boston managed to anetititise a patient with ether. It became known as the Yankee Dodge. Ether had its drawbacks, and the search for suitable alternatives, continued until chloroform was tried in 1847,

winning many admirers, including Queen Victoria, the first English royal to use it, and other drugs followed. So why did it take so long for inhaled gases to advance from providing mere recreational highs to providing an essential tool of humane surgery. How did the development of the atomic bomb play a role in the development of anaesthetics and how have societies changing attitudes to pain

inform the debate? Joining me to discuss the history of anaesthetics at David Wilkinson, consultant anesthetist at St. Bartholingus Hospital in London and president of the History of Anesthesia Society. Stephanie Snow, research associate at the Centre for the History of Science, Acknowledge in Medicine at Manchester University,

and Anne Hardy, the history of modern medicine at University of College London. David Wilkinson, it's a 19th century before we see the use of gases for anaesthesia. It was a long time. But what kind of sedatives for pain were there before then? There were quite a large number of things that had been tried in early days. People tried alcohol. People tried morphine, opium, laudanum was well known.

But they weren't applied on a regular and sort of. of everyday basis. So very few people had the benefits of any sort of pain relief at all. How effective were alcohol and opium? Very poor. I mean, they can make you unconscious, but they don't provide any sort of lasting pain relief or true anesthesia as we know it today.

There was something found in Northumbria, wasn't a suitor. I'm quoting from your notes very, daddling you with your own information. and nearby a place where we saw bones had been surgery on bones and this is very early days several, many centuries ago, a place that had been much fought over. Can you tell us what the seeds were that were found there?

There were a series of recipes that been described in medieval documents which was to form a drink called Dwaal, Dwayl, which was described that a man should drink it so he may be carven. and this contained a whole panacea of drugs, some of which we don't really understand why they were there, but basically they contained opium and extracts of scopolamine. And scopolamine was a very powerful sedative, which was used in the early 20th century

to produce a condition called Twilight Sleep. So back in the 13th century, 14th, 13th, 14th, 14th century, People were giving exactly the same combinations of drugs as we were giving in the early 20th century, which is quite bizarre. And they were giving it as a drink mixed with alcohol and then performing surgery. And you look at these recipes in these illuminated manuscripts and you think, well, that's a bit strange. It can't really be true. But in Sutra, this medieval hospital, in the drains of the apothea, in the pharmacy department, drains, they've found the seed balls, and when you look at the seeds, the exact proportion

of these seeds are in the exact proportion of many of these recipes, and they're not plants that grow in the area either. So they've been brought in specifically for that purpose. But by the way you're talking, from what I've read, this is rather an isolated instance. Usually it's sort of a bit of this and a bit of that and not very effective. Well, it's very hard for us to tell nowadays how effective and how much it was used. There are about 14 different recipes in 14 different manuscripts in various places around the country. Slightly contradicts what you said at the start that they weren't very effective. You're saying that this is the sort of stuff that was being administered, say, 100 years or so ago.

Well, I think modern an eathist would look at that and say, well, that really wouldn't work. But I think it was better than nothing. And it must have worked. Otherwise, they wouldn't have all written about it and kept on doing it. Insofar as the history of anaesthetics as we accept the term, it's in the late 18th century, it begins to kick in with Priestley and Humphrey Davy towards the end of the 18th century.

Humphrey Davy gets the star treatment, Priestley did it slightly before him, to ever this with poor, please. It happened the same with oxygen, didn't it? I mean, that seems to be his lot in life. But what did David do that was interesting, and then why didn't he take it any further? Well, Davy was brought up to Bristol

to work in the pneumatic institute by Beddows, and Beddows had decided that if he could work out a way of curing people's diseases by inhaling various substances, then that would be a good way forward. And this pneumatic institute, as he called it, was headed up by Davy, a bright young man from down in Penzance. And Davy experimented with all sorts of strange potions and some of them extremely toxic. And he describes how he breathed things in and out and how he got terrible head. and felt real and things.

On one occasion, he used nitrous oxide, which he then called Laughing Gas, because it made him giggle and all his friends giggle. And this he found relieved the pain of his toothache. And he made a use for recreation of the romantic poets, Coleridge and Saudi around Bristol, courting the fricker girls at the time, on giggling why in Laughing Ghost?

That's a new dimension to romantic poetry. Why didn't he take it forward, Stephanie Snow? Why didn't he? It was a throwaway line at the end of this treatise saying, could be of some use in surgery, but he didn't take it forward at all. No. Well, I think to understand why Davey didn't turn nitrous oxide into anaesthesia, we have to look at the way in which he and other doctors in general understood the body in the 1790s. For them, the body was a holistic system.

It's had its own equilibrium. So sickness in the body, through this equilibrium, into imbalance. So drugs and treatments concentrated on bringing the body. body back into balance and this had been the prevailing idea since the ancient Greeks. Now in the 18th century, investigation centred on the nervous system. Sensibility was thought to be conveyed through the nerves throughout the body. Irritability was a kind of nervous power which was located in the muscles and this gave them the capacity to contract in response to stimuli.

Now Davy understood sickness to be an imbalance in the irritability of the body or what he called to be excitement. And so treatment focused on restoring the balance. So, for example, of a patient was thought to have too much excitement, they were given depressants, things like bleeding or emetics to make them vomit. If they were thought to be depleted in excitement, they'd begin stimulants, things like alcohol and opiates. And this was the theory which underpinned Davy's work into nitrous oxide. So his leading question when he was researching it on animals and himself was what does nitrous oxide do to the nervous system? Does it stimulate it? Does it depressant? Does it depress it? Well, he found it was a very strong stimulant. He talked about his

skin tingling, his muscles were feeling strong, his mind buzzed with new ideas and theories. But he was never in any doubt that breathing nitrous oxide ultimately led to death. And that although it would stimulate the nervous system at the outset, sooner or later it would depress it to a point beyond which there was no return. So his view of the nervous system that it wasn't possible to separate sensibility without affecting the life of the body. And in fact, he had a personal fear about sensibility outliving all the other powers in the body. He was terrified of being buried alive and he asked his brother not to bury him for at least 10 days after his death for this very reason. So in the throwaway line where he says nitrous oxide might be of use in surgical operations,

he's really thinking about it as a stimulant. Can we, Can we, do we briefly tell us something about what might be the next stage, or I don't know how much this information was passed on from one to the other, the Henry Hickman intervention with suspended animation? Can we just be brief about it? Yes. It's interesting, but it is a slight digression.

Yeah, Hickman's experiments in the history of anaesthesia actually formed a pivotal role because they show us how ideas about the body were changing. But in terms of the actual sort of relation to Davy's work, all the sort of future work on ethereal nitrous oxide, they really didn't play a part. But basically Hickman's idea was that if you put animals to breathe carbon dioxide or you deprive them of oxygen, you could create a state that he called suspended animation.

This was when animals were insensible to pain, and they could then be revived by putting them in the fresh air. So he felt this was an option for possible transference to surgery. But at the time, although he tried to publish his pamphlet and get support in France, it wasn't taken up. And Hardy, we might ask the question why it took so long before this arrived. But first of all, I'd like to ask you, how was pain regarded in this period? Let's go back to the 1790s, because that was one of the fascinating things about reading for this, the way that pain was regarded.

On all fronts, Sid had a, when you tell us? Yes, pain is, it's a very complicated picture from the 1970s to roughly speaking 1850, because attitudes are changing. but if we start out in the late 18th century they're very distinct lay and medical perceptions of pain as far as the lay people are concerned they're becoming more sensitive to pain throughout the 18th century and we can see this in the amount of opium that's coming into the country

and being used in medical practice and elsewhere for centuries the Christian church had taken the view that pain was something to be endured, it fortified the spirit it was a trial sent by God and you were supposed to bear with it. Wisdom through suffering, wisdom through suffering. On the other hand,

society also recognised that chronic pain and pain through injury was a problem and people did use painkillers, as David has already pointed out. And particularly when after Sidonam developed Loudanum in the 1690s, which is a tincture composed of sherry and opium and flavoured with saffron and cloves and cinnamon,

which became very popular in the 18th century, we can see that thresholds of pain tolerance were declining throughout the 18th century. But at the same time, from the medical perspective, pain has seemed to be a good thing because pain is the body fighting infection, inflammation, damage. Pain during surgery was seen as a positive thing because it was keeping the body alive

when the systems might be otherwise depressed. It's pain that maintains vitality in the body. And it's also that transferred to the idea of morale and national character and character. We go back to Greece, you go back further than the Greeks. It's being manly to endure pain. And that's very strong in this country. At the other countries. Yes.

Yes. But you get your leg shot off at Trafalgar or your arm's shot and you endure it and so on and so forth. So it was all feeding in. So that's all feeding in. It's interesting that it begins to melt away. And that's why, where in the ideas is the idea. Is the idea of sensibility affecting it, or is it people's decision to take more of their life in their own hands?

Well, I think there are several things going on. Yes, enlightenment attitudes are suffering, that suffering is not really necessary and should be diminished. The romantic movement and the rise of sensibility and the emergence of humanitarianism. I mean, this is the age in which slave trade comes in question. By the 1830s and 1840s, you're getting the factory acts,

the restriction of the involvement of women and children in hard physical labour. You get the rise in, well, attitudes to animals. The Society for the Prevention of Cruelty to Animals is founded in 1827, I think I'm right, and gets a royal imprimatur when Victoria comes to the throne. So there are a number of different things going on, which means that society as a whole is becoming less tolerant of pain. But it's fascinating as to where it absolutely fascinates, to worry it's such.

Is this movement driven, is too strong a word, But is it sort of, is it pushed along by ideas about how we should behave to each other, an idea of a new sensibility of human behavior to each other, or is it the development of anesthetics itself dragging it along? Which is first? Now, what's the core of the connections? Well, I think they're probably running in parallel. I don't know, Stephanie might correct me here,

but I think the attitude to anesthetics and to pain in surgery is part of a changing perception among the medical profession that about pain and its role in the body and that they no longer have come to see it through the new physiology and as Stephanie was saying the study of the nervous system they come no longer to see it as being a positive good as playing a positive role in maintaining the body's functions but as being something that is in fact not necessary to maintaining life

David Wilkinson so let's say we're still at around 1800 and we got about 40 years ago, sorry about this, 40 years ago until it starts. And I pointed out one of the things it's rather strange. It took so long, and you put in the 1846. In that period, we had nitrous oxide, we had ether, and they were almost entirely recreational. There were fire ground stuff in some cases.

There were people got high on it, and these romantic poets in Bristol and so on. And so that was where it was. It didn't move much there at all. It didn't. And there's no question, though, That's exactly its position, purely recreational. And it was well known.

Ether was very popular with medical students, ether frolicing, where you'd go to a party instead of taking a six-pack of beer or a couple of bottles of wine. You'd sit there and you'd all, either the big bowl of ether in the middle of the room, and everybody'd sniff it or drink it. And ether drinking was very popular at one stage. There was a run Catholic priest in the,

Ireland in around the 1830s who tried to abolish alcohol and to encourage those people who signed the pledge, he would allow them to drink ether. And this was a very popular sort of alternate. And of course, drinking ether doesn't do you a lot of good. You get very high, very quickly. But there are sort of rather major systemic effects. Stephanie Snow, so where did the crossover, the crucial crossover, happened. It happened in America.

And can you just, it was seeing things at the fairground that inspired dentists and practical people. We're not talking about scientific development. We're talking about practical people who are doing the job, seeing this happening and thinking that could help us. People are in terrible pain with incredible toothache. We can't do surgery because it kills them. But this stuff might help.

That's right. Why did that happen? Okay. Well, the first surgical operations under Ether really didn't attract much attention. and these were performed by Crawford Long, and he was a country doctor in a small agricultural community in Georgia in the United States of America. Now, he was familiar with the exhilarating properties of ether and nitrous oxide,

like David said, you know, fairground stuff. And in fact, in his local community, the local youths wanted him to give them nitrous oxide again for recreation. But he couldn't, he didn't have the apparatus to make the gas, so he offered them ether instead. So it became a local fashion there. Now the time came when one of the young men, James Venables, needed an operation to have a sister removed from his neck, but he was absolutely terrified of pain. Now Long realised that under ether they didn't seem to notice pain if they bruised or bumped themselves.

So he said to Venables, come on, you know, I'll take it off, you breathe ether. The operation was a success and Crawford Long continued the practice once or twice a year. But he didn't publish because he was not convinced as to whether or not the anaesthetic effects came from ether. or the patient's imagination. And then in 1844, again in America, the dentist Horace Wells discovers the anaesthetic properties of nitrous oxide, again through the fairground, but he arranges to demonstrate it at Massachusetts General Hospital.

But the exhibition is a disaster. The patient howls when he starts to extract the tooth, and Wells abandons it. And humiliated? Absolutely, completely humiliated. And although we might see this, as goodness the advent of ether is on the horizon, At the time, there was no such view. The surgeons who knew about Wells' experiment

thought it was absolutely the right thing that there was no quest for pain. But the pace picks up now, Anne Hardy. William Morton, a Boston dentist, attended Horace Wells' public demonstration, and ended in humiliating failure for him. But he thought there's something there. Yes. Well, William Morton was a very interesting character,

long history of... Charleston? Well, he was only 26, but he had... You can be a Charlton, 27th. You can be a Charlton of 26 trail debts and fraudulent undertakings. And I think he was very much, I mean, the American medical marketplace, as we call it, was highly competitive. And dentistry is one of them. And he was very interested in making money.

And he saw the possibilities in painless dentistry. And the real piece of evidence here that suggests that he was in it for commercial reasons is that he tried to patent the process afterwards. So he picked up on, I mean, he picked up on ether because he consulted a colleague who was in fact using liquid ether to numb teeth before he extracted them. And Morton took up on this idea and went home and did some experiments himself using his family pets, involving soaking rags and so on in ether, and even having ether in bowls and holding the pet dog over this until it became. came unconscious. And having done this series of experiments, which were by no mean scientific,

he then used ether in his dental practice. And his demonstration was a great success. And he then, with an eye to the main chance, arranged for a public demonstration at the Massachusetts General Hospital in front of Boston's medical elite. And that was a success. And in that moment, it takes off. It does, yes. It wings across. to London, David Wilkinson, with the speed of light, isn't it?

And what happens, they're waiting, they're onto it, aren't they? Doctor and, it was Robinson and who, Liston, was it? Doctor and the dentist, yeah. That's right. They grabbed it. It came at the speed of sail, really. The sailing boat came across.

Speeding it up a bit, I can't see the clock. It was, they sent a letter to a botanist called Boot, who lived in Gow Street, and he knew a dentist called Robinson well. And in December, early mid-December, they

took out a tooth. And Liston, the great surgeon of his era, was just up the road at UCH. And he heard about this and he two days later did an amputation of a leg

under ether anaesthesia given by a medical student, Squire. And there is this concept that it's sped across the world immediately. And in fact, an anaesthetic was given in Paris before this, a couple of days before that. So the French

were the first Europeans to give anesthesia. But in fact, it wasn't all that popular. You'd think, wow, here it comes. But the Americans were very slow to use it in Boston. And it wasn't a universal snapping up of the idea

in the UK either. What was the problem? Well, it's still part of this concept that maybe it's not quite the right thing to do. There was no, in America, for example, there was no sort of FDA to approve a drug. There was no, the American Medical Association didn't give an opinion. The New York Society didn't give any sort of lead on this.

So it was left to the individual. And as we've already heard, Morton was sort of slightly shady character. So was this the right thing to be doing? So there was a slight unease, as well as this concept of, yes, everyone should do it. Lots of surgeons, even when, when it was well established, banned its use. We don't want that to. We don't want to try it.

So the old things like pain is manly, pain is necessary to health, and pain is a religious given, was still around. Very strongly. They hadn't been flaked away. Not at all. Stephanie Snow, doctors in the UK and dentists, as David said, were trying out ether. John Snow, who worked in Soho, a GP working in Soho, most famous for saying that cholera was carried by contaminated water

and doing something about it. He got fascinated by this, smitten by it, he said, didn't he? And he went to work. What did he bring to the table? Well, Snow approached Ether in a very different way to most doctors, whereas most doctors went and got some ether and found a willing patient. He went and got some ether and set up a series of chemical and physiological experiments. So, first of all, using animals,

he established that the degree of anaesthesia was determined by the concentration of ether vapor in the blood. and that temperature was the thing which determined the concentration of ether vapor. So he deduced that if he could find a method of controlling the temperature of ether, he had a method for actually controlling the dose of anaesthesia. So he tested all this out on animals and devised a metal inhaler, which he could put in a water bath and obviously use the water to adjust the temperature, before he took it up in practice.

And really within a few months, he described the process as five identifiable, degrees so that to begin with the ether sort of entered the nervous system it suspended the higher and more subtle functions of the brain then it suspended sensibility and if it was kept on being inhaled ultimately it was sort of depressed the important systems like respiration and circulation so the skill of anaesthesia was getting the patient into the fourth degree where there was complete insensibility to pain the reflexes were suspended but you still hadn't got to the fifth dangerous level. And because he based his practice on the use of inhaler, this was a method of doing this. But he understood that in London, most doctors couldn't relate to this system. So he gave

them practical guidelines. You know, when you lift up the patient's arm and it's motionless, this doesn't mean that all the reflexes are suspended. You have to wait until the eye is not susceptible to movement. And really tried to translate between his scientific view of it. And and the way in which it was going to be safe practice at the bedside. And, Hardy, there were problems with ether, and there were difficulties with it. Could you spell those out? It seems as if it's, and I sort of slightly implied in a sort of getting on with it, why, that it was Shazam, boomed it at all shit.

But it hasn't, as David quite rightly pointed out. But there were real problems with it and difficulties and worries and legitimate worries. Can you just address that? I can try. Thank you. Yeah, I mean, there's part of the problem is that, getting the dosage right and you can make a patient excited

and too excited in fact for his or her own good but ether is also a very pungent substance and people didn't like inhaling it and it's also an irritant so it can cause coughing and it can in fact in certain circumstances produce congestion of the lungs

and lead on to fatalities of one kind or another so it wasn't easy to use in practice So it was easy. And then we come in the next stage of this... The saga. Yes. But it's all happening. It's very close together now. It's very much in the middle of the 19th century.

It's in a few years. And it seems to be sort of London, America, Paris, and now Edinburgh, where we meet James Simpson, an eminent doctor in Edinburgh, a brilliant man, who was keen to find a better alternative. And he had dinner parties at which his unfortunate research assistants, instead of being given port, were given bottles of gas to sniff and to see which one could be

the more if most effective anesthetic. Sounds like a jolly evening, yeah. Well, it was a jolly evening. Well, yes, I mean, I think they got very jolly a lot of the time. And Simpson was an obstetrician and he was very interested in pain and childbirth,

which he saw as being unnecessary. Although the Bible said it was, then he went and retract. I'm stealing the point. He reinterpreted the Bible, changed, yes. He was interesting. He was another one. Like John Snow, he was a working class boy who'd made good, and he was under 30 at this time. And yes, he had obviously risen to the heights of medical society in Edinburgh, and he had these dinner parties, and the ladies, you know, were upstairs, and they were enjoying, you know, sniffing stuff in the dining room instead of having port, as you say.

And it's a very famous story about how they... But the Bible, just to bring this back in, because we mentioned it earlier in the programme, but just to absolutely key it, for listeners. In the Old Testament, it said, we came to the world through, woman gives labour through suffering. Yes, and sorrow shall bring forth children. This was taken to mean that pain

was essential to birth and pain was essential to life and it was part of the original condition of being born. And he had to address that as well as find in the aesthetic. So he addressed that in a very straightforward word, didn't he? Well, he said he'd gone back to the original Hebrew, and his translation was different. And I forget the exact phraseology.

Can you remember, Stephanie? He said that there was labor, but there was no reason not to alleviate that. And that it was in the good of humanity to do that. So, I mean, that was his argument. Because at the time, he thought there might well be a religious, you know, dislike of chloroform. We haven't got to clarify. We haven't got the famous story.

I interrupted, Anne. Well, I was just trying to... What I wanted Stephanie to come across with was the exact phraseology that Simpson used in his retranslation of the biblical phrase. But anyway, he did retranslate it so that it was not sorrow as in pain, but it was more like, you know, you will labour to bring forth a child. And so that was why he was interested in analytics. childbirth. And to go back to the famous story is that they were inhaling, happily inhaling chloroform, and they were getting very happy on it. It's a sweet

flavoured sort of liquid, I think I'm right in saying. So it's much, much nicer than ether. And they were having a jolly good time. And when the ladies entered the room, they found all three gentlemen unconscious on the floor. And there's a description from somewhere, and I think it's line play fair, who says, you know, and Simpson woke up among the table legs and realised that both his companions, his research assistants were still unconscious and that he, by God, this stuff

worked. And that was what really converted him to chloroform as an anaesthetic. Before we move out, David Wilson, I want to come straight to you about what he did with chloroform. But just as a little digression, what we've heard,

what I've heard around this table in the last few minutes is experiments on animals, dogs being held over bowls of ether, pumping stuff into themselves. In a sense, it would be inconceivable today, and therefore we might not have chloroform. Totally inconceivable today. And it's amazing how they...

They used to experiment on themselves, right the way through anesthesia, everybody used to do it to themselves. Morton, his original things, although he did animals, he also forced his assistance to take ether, pretty much against their wishes. And he went out onto the streets of Boston,

offering sort of some amount of money if you'd come back to my house and smell this stuff and it didn't get many takers for that either. So there was this there was no ethics committee there was no double-blind clinical trials.

It's another programme as to whether another programme as to whether some of the major advances in medicine in other areas would have developed at all under present conditions. That's another programme. So chloroform, Simpson finds out chloroform

and this is a major event, as Anne says, a dramatic event. What happens next? Well, within three days he'd written a paper and published it on its use. I mean, he was a real go-getter, Simpson. And he had such a name that this made a huge impact. And he sent pamphlets about its use to Queen Victoria, right in that very early years, because he was physician accoucher to the Queen. And so she knew all about it. And the word spread. And as soon as it was being used in obstetric practice, then immediately it became into surgical practice as well.

Let's say with obstetric, because it's a good story about Queen Victoria. We seem to be telling stories this morning. That's not bad. But it is. I mean, he persuaded her to take chloroform. Well, not him. I mean, he'd instruct, he'd send information to her.

Yeah, he sent information. That's right. And she then, there's a whole series of letters that she wrote to all sorts of duchesses and things around the country who were in labour and who'd had chloroform themselves. And she was obviously building a sound. up to this and she decided that at her next pregnancy she was going to have chloroform.

And lo and behold, in 1853, she went into labour. And they called up John Snow. And it's quite interesting because the two obstetricians who were looking after her weren't in favour of this at all, but she insisted on it. And so Snow turned up and then also looking at this chap, not very viewing him very well. and he very calmly dropped a little bit of chloroform onto a handkerchief held by the Queen's face, never made her unconscious, but very cleverly just letting her breathe a little bit of this vapour

allowed her to have an analgesic face, so complete pain relief as she produced the baby. And she described it as, therefore, this blessed chloroform that produced this pain relief. She was the head of the Church of England, and so if she'd had it for child, then the religious objections to its use in childbirth began to diminish. So it's all not saying it's terrific, isn't it? The way I don't certainly... Stephanie Snow, so the alternative is enough for our ether chloroform. Chloriform, we've talked about some of ethos problems.

Chloriform has it problems too, hasn't it? Chloriform had a problem in that it was far more likely to cause instant fatality during inhalation. Snow argued that basically there were two causes of chloroform death. one would be an asphyxia which you'd actually pick up on you'd see the patient struggling to breathe but if you had the poisoning of the heart that could happen instantaneously

and his argument that that was through overdosage so if you administered chlorathrom through an inhaler within safe boundaries it was actually safe but in practice as David was saying most doctors dropped chloroform onto a cloth or a hanky I mean Simpson used to do it on a silk handkerchief for private patients

so there was no measures in that method of actually sort of preventing fatalities, only observation. And also there were deaths. There was a sad death of the young 15-year-old up in the North East. Yes, Hannah Green had died in February 1848, which was only weeks after Simpson had announced its discovery. There was an inquest, there was a lot of debate as to what the cause of death was. But I mean, I think from the beginning, chloroform was in doubt

with this slightly sort of sinister edge because of this sort of instant. capacity to cause death. And then he got a further bad name because it was thought to be used in robberies. Villains would rush up behind persons in Dark Alas and slam a handkerchief across their face and then take all their worldly goods and even Conan Doyle took it up in a story which

infuriated Snow, John Snow, the careful man saying this was impossible, it was ludicrous and so on. So can you tell us about that? Absolutely. Well, in the early 1850s there were a serious of abductions and muggings and the victims claimed that they'd been overpowered by chloroform. Now, overpowering of victims wasn't a new thing.

There were lots of abductions at the time. But the point about chloroform was that they were saying it was instantaneous. As you said, someone simply wafted a handkerchief in front of their face. They woke up naked on a bed, you know, robbed of all their life's worth. Snow's argument was that you couldn't administer chloroform either without force or with consent. So if you're actually going to administer it with force, you would have to have the patient to breathe it. you'd have to hold them down. And his argument was that the patient would have enough time,

or at least the abductee, would have enough time to fight off the attacker and shout for help. Now, this got taken up in the House of Parliament, and a bill was passed against stupefying offences, and chloroform was named. It's extraordinary how this myth has gone on. John Foal's first book, The Collector, he describes how this young man goes out and chloroforms,

this young woman and drags her back to his, is flat and keeps her there until she succumbs from her flu eventually. And this whole concept of, you know, snatching people by chloroform in them has kept on coming through right the way through literature and in movies as well. It's quite a bizarre, really. And hardly, can we look at the effect it had on surgery and dentistry, ether and chloroform? Let's talk about surgery. As I mentioned earlier on, it was considered to be extraordinary dangerous.

It was quite rare. Many or many people died of the act of surgery. What did this do for surgery? Well, anaesthesia does help to transform surgery, but it's only one of a clutch of developments around that time in the 1850s that make new kinds of surgery possible. Surgery is already becoming, was already changing in that surgeons were, I mean, we talked about amputations and in fact amputations constituted

something like 80% of all surgical operations until about 1850. But surgeons are beginning to go in for reconstructive surgery rather than amputation to limit the damage and trauma to the individual. But reconstructive operations take longer. So that's where, again, they're beginning to need some kind of painkiller. And when anisea comes along, you can begin to see the change. Surgeons are, you know, if you look at the medical journals, surgeons used to report one operation.

They're now beginning to report series of operations. So there's that. And the nature of operations begins to change too. They become elective. People become much more prepared to undertake minor surgery, for example, than they ever were before. And surgeons also, in combination with developments like the artery clamp, the introduction of antiseptic measures and asepsy,

they begin to undertake more. explorative surgery on the body. In the 1860s it was said that surgeons would never enter the brain, the thorax, or the abdominal abdomen. And by the end of the 19th century, they were working on both the brain and the abdomen. I've got two carried away by chloroform. We have to deal with cocaine, halothane and the atom bomb. So it's one each. And I'm sorry about that, but it's only fair because otherwise we, you know, Trey's description,

we're going to get got for it. Stephanie Snow, cocaine became a key drug. That's right. Carl Collar, end of the century, about the time of Freud, yeah. Yes, 1884, Sigmund Freud, a young neurologist in Vienna, asked a friend, Carl Collar, to carry out some experiments using cocaine for him. Carl Collar was an eye surgeon. He was actively looking for a local anaesthetic.

In eye surgery, ether and chloroform could cause trouble. Part of the reason was that during the operation, surgeons would require the eye to be kept in a certain position. The other problem was that post-anesthetic vomiting, could actually put undue pressure on the eyeball. So there was an active search for a local anaesthetic. Collar started to carry out the experiments that Freud had asked him to. He gave a liquid solution of cocaine to one of his friends.

And as the friend drank it, he remarked on this instant numbness of his tongue. Now, this wasn't a new observation. But for Collar, it was a eureka moment. So he took cocaine to the laboratory. He tried it on frogs. The Cornia stayed still. He tried it on himself. and cocaine became taken up as a very widely used anaesthetic for eye surgery.

And our next big jump forward and we're into the 20th century, the 1940s, David Wilkins, this halothane, which happened here in this country, ICI actually. It did. Can you tell us about that and why that was so effective? Well, that came in in the 1950s, and it really was the first time you could have something which was very pleasant to inhale. It hadn't got much of a smell.

It was very easy to control the concentration, very fast onset and quite fast recovery compared with things that had gone before. And the whole extraordinary rationale was that it was based on fluoride chemistry, and the subsequent developments have all been based on adding more and more fluoride chemistry into these chemicals. It's like a Christmas tree with baubles hanging on it. and each coloured bauble was a different halogen atom and they switched them all from chlorine and bromine and put them all into fluoride

and they produced very stable anaesthetics. And can you tell us about why the atom bomb was helpful in the development of anaesthetics? I don't think I can. You pitched a question of the wrong person. I know, but I'm just trying to sort of share it out, you know. I mean, it's first, apparently, and I don't know the full ins and outs, but fluorination is an integral part of making atom bombs.

And in the Manhattan Project, they really learned a terrific amount about how you put fluoride into chemicals. And this was therefore a byproduct, both in refrigerators, putting fluoridization of things in, to keep things, cold and then it was applied into the chemistry of anaesthetic agents. To sort of redeem myself, that was my fault. Where do you think we are now with anaesthetics? I mean, it's a much further to go.

Can it become much more localized, specific and particular? What's your view of where it's going at the moment? Well, again, I mean, I'm not a practitioner, but I would have thought that there probably is considerable scope for refinements in the way in which anesthetics are used. probably new combinations, new substances that are under review. I'm looking for a huge paradigm shift. We're just doing what they did from the 1840s.

We're using smelly agents, we're using local anaesthetics, and we're using muscle relaxants. I want a complete shift. I want to go to something like electrical anesthesia. The body's an electrical machine. Why can't we put certain parts of the body in magnetic fields and just switch them off and be pain-free that way? way. Stop poisoning people with anaesthetics.

Right. Well, thank you all very much indeed. I thought that was really. I loved it. Thank you, Anne Hardy, Stephanie Snow and David Wilkinson. And next week, yes, St. Hilda, 7th century, an amazing lady in what was called the Dark Ages. She proved that it wasn't. Thanks for listening. We hope you've enjoyed this Radio 4 podcast. You can find hundreds of other programmes about history, science and philosophy at BBC.com.com. forward slash radio 4