by Nicholas Magnin
New technology is rapidly progressing. Medicine, in particular, has made significant advancements in recent centuries. The luxury of treating complex medical conditions has contributed to worldwide life expectancies skyrocketing from approximately 30 years old up to 70 years old, more than doubling since the 1800s [1]. Currently, Americans have an average of 9.2 surgeries in their lifetime without painful trauma, thanks to modern medicine [2]. Today, doctors can perform invasive surgical procedures requiring incisions into the skin and, in some cases, the bone without the patient feeling it.
As various fields of medicine developed, pain management during surgery was an enormous hurdle to overcome. Before modern medicine, the patient’s reaction to acute pain directly limited or halted the progress of an operation. In the past, painful surgeries were viewed with horror, and patients had to be restrained as the full agony of the surgical blades piercing their bodies caused them to scream in pain. Frances Burney, who had a breast tumor removed in 1811, testified about her experience, stating, “When the dreadful steel was plunged into the breast—cutting through veins, arteries—flesh—nerves—I needed no injunctions not to restrain my cries. I began a scream that lasted unremittingly during the whole time of the incisors.” Surgeons often became nauseous and sympathized with their patients during the experience [3].
Not surprisingly, painful surgery was considered the last resort after careful consideration of all possible alternatives. Patients were forced to decide between living out their days in discomfort, being euthanized, or enduring the torture of being strapped down and cut open. When surgery was selected, a witness to several operations, James Moore, a medical student at Edinburgh in 1820, described it as “crude, dirty, rapid, bloody, and the last report of desperate doctors” [4]. The test of a good surgeon was the rapid speed used in a procedure, which reduced the use of sterile techniques and led to many mistakes. Unfortunately, early surgeries had close to a 50% mortality rate [5]. Eventually, this fear of the surgeon’s knife was eased by a series of discoveries that developed into one of the most underappreciated aspects of medicine today: anesthesia.
Anesthesia is an advanced method to relieve pain that enables a surgeon to operate on a stable patient without fear of inducing pain-evoked shock in their body. Anesthesia is often referred to as “putting people to sleep,” which is a more accurate description of general anesthesia. Administration of general anesthetics is considerably more complex than simply making the patient unconscious, because anesthesia eliminates the body’s ability to feel pain, move, or form memories [6]. Sedation, a subcategory of general anesthesia, is similar yet less intensive. Under sedation, the body feels no pain and memories cannot form, but the patient is slightly conscious, allowing communication between the patient and surgeon. This semi-sleep state is quite helpful for dental operations, like wisdom teeth removal, enabling the oral surgeon to get feedback from the patient to comfortably adjust their mouth [7]. Less invasive operations use regional and local anesthesia, enabling the patient to remain fully awake. Regional anesthesia can target and numb entire body parts, while local anesthesia precisely pinpoints the numbness to a small area. Numbing specific regions rather than the whole body, is an effective option for minor procedures, such as sutures, or for medical situations where the patient needs to remain awake, such as an epidural during childbirth [7].
Currently, administration of anesthesia requires precise dosing of medications to reach the desired effect without harmful repercussions on the patient. however, early medical practitioners lacked an understanding of pharmaceutics and pharmacology, resulting in drug concoctions that fell short of entirely eliminating pain. This insufficient dosing produced mild numbing effects through impairment of the whole nervous system. Home remedy sleeping potions such as dwale and laudanum were commonly used to sedate a patient. These potions were prepared by mixing herbs like henbane, belladonna, and opium with alcohol. Because of the variabilities in potency and dosing, the use of dwale and laudanum was considered quite dangerous [8, 9]. An insufficient amount of these concoctions caused the patient to suffer immense pain, and over-dosing could lead to side effects and death. As a solution, early medicine explored alternatives to drug-based pain remedies, beginning with the tourniquet to cut off blood flow to limbs. The tourniquet was successful in the sense that it allowed easier amputations, but its applications were narrowly limited to injuries on the limbs [10]. A second alternative method involved mesmerizing the patients into a tranquil state where their pain receptors would be turned off. Unfortunately for the patient, there was no validity in hypnotizing patients for anesthetic purposes. However, in an era where citizens had minimal ways to scrutinize doctors’ methods, this rumor could only be debunked through first-person experience. Patients agreeing to be mesmerized were essentially tricked into thinking their surgery would be painless, only to quickly realize they had been deceived when they felt the painful effects of their surgery.[11]
In the mid-1850s, the first significant advancement in anesthesia originated in dentistry. While dental problems were not usually life-threatening, dental care improved the quality of life for many individuals. However, as with surgeries, the pain during dental procedures tended to cause people to avoid it. William T. G. Morton was inspired to discover a safe sedation method so patients could undergo required dentistry without intense pain, specifically during tooth removal.[12] Fortunately, the drugs Morton sought already existed. Ether was discovered by Valerius Cordus in 1540, and nitrous oxide was discovered by Joseph Priestley in 1772.[13] These drugs were mainly used for jollification parties and humorous public demonstrations. It wasn’t until Horace Wells, a dentist and Morton’s colleague, noticed that people under the influence of these drugs were feeling little to no pain. In 1845, Wells successfully used nitrous oxide to numb a patient and remove their tooth. However, when he tried to repeat his success in public, his demonstration failed and left the patient screaming in pain.[14]
Morton continued the search for remedies that could provide pain-free dental operations. Nitrous oxide offered satisfactory anesthesia, but Well’s failed attempt to use it convinced Morton to focus on ether. Behind the scenes, Morton successfully used ether to perform a painless dental procedure, which subsequently led Morton to publicly demonstrate a pain-free dental surgery with the use of ether. Thus, the first successful case of general anesthesia was officially presented on October 16th, 1846.[12] Morton was not the first to use this technique, but he received significant recognition because his accomplishment was publicized, and knowledge about ether rapidly spread throughout the medical community.[13] Ether worked, but some doctors like James Young Simpson felt that it was not an ideal anesthesia, because ether had an unpleasant aroma and was dangerously flammable.[15] While Dr. Simpson routinely administered ether, he actively sought a still better alternative.
In his search for surgical pain medication, Dr. Simpson met Lyle Playfair, a Scottish chemist who had trained under the famous German chemist Justus von Leibig.[15] Playfair believed he accidentally created the compound that Simpson desired. Although the exact date is uncertain, a German pharmacist, Moldenhawer, developed chloroform around 1830.[16] In 1847, Simpson first administered a gaseous chloroform to two rabbits, who fell asleep and awoke without adverse effects. The following day, Simpson planned a testing party with a few colleagues. However, before the party began, the group saw the rabbits had died. Undeterred, Simpson and the group self-administered chloroform and safely awoke to note their life-changing discovery.[15] Chloroform did not grow in popularity as expected. It wasn’t until after chloroform was used on Queen Victoria for a C-section delivery that most surgeons recognized it as their anesthesia of choice. In 1858, Queen Victoria described her delivery with chloroform as “delightful beyond measure.”[17] The popularity of chloroform then quickly spread. Between approximately 1865 and 1920, chloroform was used in 80 to 95% of all narcoses performed in the UK and German-speaking countries.”[18]
In the US, chloroform’s popularity grew, as it was increasingly field-tested during the US Civil War. Soon, it was the war’s most popular anesthesia due to its portability and ease of administration. A dose of chloroform was commonly administered to soldiers with gunshot wounds requiring amputations. Contrary to the myth that soldiers were not given any pain remedies, Civil War medical documents stated that “Anesthesia was used in 95% of Civil War surgeries.”[19] The difficulties associated with battlefield surgeries stemmed from improper dosing, a lack of administrative knowledge, and an insufficient supply to meet the high number of patients. A doctor’s Civil War medical handbook[20] advised, “In the first stage, patients experience disorientation, in the second, they experience “excitement” while the third is considered the safest for surgery. The fourth stage is overdose, often resulting in death.” It became evident that many doctors were eyeballing dosages, rather than calculating measurements. Chloroform-related fatalities were rare, so underdosing was likely a much more common issue.[21] Civil War surgeons were pressured to work quickly. Consequently, some patients suffered from pain, requiring them to be immobilized by straps or held down by doctor’s assistants.[20] While chloroform was widely implemented and successful, its functionality remained limited to general anesthesia.
Another commonly used drug during the Civil War was morphine, which was outstanding for relieving post-surgical pain and minor self-healing wounds. Doctors found many war veterans struggling with withdrawal cravings after the administration of this opioid drug, making it evident that morphine is exceptionally addictive.[22] This issue with morphine led Sigmund Freud, the famous neurologist and founder of psychoanalysis, to search for a suitable replacement.[23] The drug Freud was looking for was produced by the coca plant, discovered by indigenous peoples in South America, where they used it for both its energizing and anesthetic properties.[24] People would chew the leaves for energy, but their lips would also go numb. They used the coca plant medically to treat intracranial hematoma, where a head injury leads to inflammation, swelling, and pressure on the brain. To treat the hematoma, the indigenous doctors performed surgery: they drilled a hole in the head to relieve the pressure, quite similar to how this is treated today. An assistant would chew the coca leaves and spit their saliva around the site to alleviate pain during drilling. Following his voyage in 1499 to what is presumed to be Brazil, the Italian explorer Amerigo Vespucci shared what they learned from the South American indigenous peoples about the coca leaf and its properties[23], which led German scientist Dr. Albert Niemann to isolate the active compound in the coca leaf, known as cocaine.[24]
Cocaine produces remarkable focus and energy. Consequently, cocaine was used for recreational amusement before it was used medically. One of cocaine’s most popular uses was invented by a Frenchman, who mixed cocaine with wine to create Vin Mariani, a drink popularized worldwide as being one of the first beverages endorsed by celebrities, such as Pope Leo the 13th.[25] In America, pharmacist and Civil War veteran John Pemberton was a big fan of Vin Mariani, which he used to reduce his dependence on morphine in managing chronic pain from his war wounds. When his county in Georgia banned alcohol, Pemberton sought a non-alcoholic Vin Mariani alternative by mixing cocaine with ground cola nuts. This drink gained popularity in the US, eventually becoming Coca-Cola.[26]
Like Pemberton, Sigmund Freud was trying to find a non-addictive replacement for morphine and recognized the possibilities of cocaine. After Freud tried cocaine, he noticed pain relief effects remarkably similar to morphine and shared this information with his ophthalmologist colleague Carl Koller.[23] Koller applied some drops of liquid cocaine into a frog’s eye, then poked the frog’s eye to judge its reaction to the pain. The numb-eyed frog did not react after it was poked. After retesting on a rabbit and himself, Koller successfully performed the first local anesthetic surgery on September 11th, 1884.[27] Soon, Koller shared the news, and word spread about this discovery across the globe. Because of the loose regulations governing medical experimentation on animals and humans, scientists and doctors wasted no time experimenting with this new drug. After his first successful demonstration of spinal anesthesia for lower limb surgery on a patient on August 24th, 1889, Surgeon August Bier and his surgical assistant August Hildebrandt took turns injecting cocaine into each other’s spines to learn more about cocaine’s effects.[28] They reported that post-injection, they could not feel anything in their lower body, even after flinging cigar ashes onto one another and other insults.[29] The result of this outrageous self-experimentation was the discovery of regional anesthesia.
The development of different anesthesia types paved the way for fundamental and ground-breaking advances in dentistry, surgery, and other medical interventions. Today, anesthesia is one of the most common medical practices, with over 230,000 people estimated to undergo anesthesia worldwide each year.[30] Anesthesia allowed surgeons to transform their reputation from that of terrorizing butchers to prestigious medical practitioners. These foundational discoveries in anesthesia enables surgeons to perform medical procedures on stable, pain-free patients, revolutionizing surgical practice and its profound potential and boundless possibilities. Anesthesiologists may not always receive substantial credit for their role in a successful surgery, yet this fascinating profession should be credited with one of history’s most impactful medical advancements.
References Cited:
[1] Dattani, S., Rodés-Guirao, L., Ritchie, H., Ortiz-Ospina, E., & Roser, M. (2023). Life Expectancy. OurWorldInData. https://ourworldindata.org/life-expectancy
[2] Lee, P. H. U., & Gawande, A. A. (2008). The number of surgical procedures in an American lifetime in 3 states. Journal of the American College of Surgeons, 207(3, Supplement), S75. https://doi.org/10.1016/j.jamcollsurg.2008.06.186
[3] Booser A. (2021). The Astonishingly Slow Progress Towards Surgical Anesthesia: Part I. Missouri Medicine, 118(6), 511–517. https://pmc.ncbi.nlm.nih.gov/articles/PMC8672962/
[4] Stanley, P. For Fear of Pain: British Surgery, 1790 – 1850. Rodopi; 2003 (p. 11).
[5] Melin, M. D. (2016). The Industrial Revolution and the Advent of Modern Surgery. Intersect, 9(2), 2-12. https://www.semanticscholar.org/paper/The-Industrial-Revolution-and-the-Advent-of-Modern-Melin/f1812075a27755add8429197340c9140fb8f2d19
[6] Pruthi, S. (2023, February 16). General anesthesia overview. Mayo Clinic. Accessed 4/8/25. https://www.mayoclinic.org/tests-procedures/anesthesia/about/pac-20384568
[7] Akron General. (2023, May 30). Anesthesia overview. Cleveland Clinic. Accessed 4/8/25. https://my.clevelandclinic.org/health/treatments/15286-anesthesia
[8] Carter A. J. (1999). Dwale: an anaesthetic from old England. British Medical Journal (Clinical research ed.), 319(7225), 1623–1626. https://doi.org/10.1136/bmj.319.7225.1623
[9] Stefano, G. B., Pilonis, N., Ptacek, R., & Kream, R. M. (2017). Reciprocal Evolution of Opiate Science from Medical and Cultural Perspectives. Medical Science Monitor : International medical journal of experimental and clinical research, 23, 2890–2896. https://doi.org/10.12659/msm.905167
[10] Gawande, A. (2012). Two Hundred Years of Surgery. The New England Journal of Medicine: 366(18). doi: 10.1056/NEJMra1202392. https://www.nejm.org/doi/full/10.1056/NEJMra1202392
[11] Wright-Mendoza, J. (2018, September 29). The Mystical Practice That Preceded Medical Anesthesia. JSTOR Daily. Accessed 4/8/25. https://daily.jstor.org/the-mystical-practice-that-preceded-medical-anesthesia/
[12] Robinson, D. H., & Toledo, A. H. (2012). Historical development of modern anesthesia. Journal of Investigative Surgery: 25(3), 141–149. https://doi.org/10.3109/08941939.2012.690328
[13] Chaturvedi, R. & Gogna, R. L. (2011, October 22). Ether Day: An Intriguing History. Medical Journal of the Armed Forces of India. Accessed 6/10/25. doi: 10.1016/S0377-1237(11)60098-1
[14] Haridas, R. P. (2013, November). Horace Wells’ Demonstration of Nitrous Oxide in Boston. Anesthesiology 119(5), 1014–1022. Accessed 6/10/2025. https://pubmed.ncbi.nlm.nih.gov/23962967/. doi: 10.1097/ALN.0b013e3182a771ea
[15] Schwarcz, J. (2017, March 20). James Simpson Chloroform Pioneer Took the Pain Away. Office for Science and Society. McGill University. Accessed 6/10/25. https://www.mcgill.ca/oss/article/health-history-science-science-everywhere/joe-schwarcz-james-simpson-chloroform-pioneer-took-pain-away.
[16] Defalque, R. J., & Wright, A. J. (2000, January). Was Chloroform Produced before 1831? Anesthesiology: 92, 290. https://doi.org/10.1097/00000542-200001000-00060
[17] Schwarcz, J. (2022, September 21). Anesthesia a la Reine. Office for Science and Society. McGill University. Accessed 6/10/25. https://www.mcgill.ca/oss/article/medical-history/anesthesia-la-reine
[18] Wawersik J. (1997). Die Geschichte der Chloroformnarkose [History of chloroform anesthesia]. Anaesthesiologie und Reanimation, 22(6), 144–152. https://pubmed.ncbi.nlm.nih.gov/9487785/
[19] Reimer, T. (2017, January 22). Anesthesia in the Civil War. National Museum of Civil War Medicine. Accessed 6/10/25. https://www.civilwarmed.org/anesthesia/
[20] Chisolm, J. J. (1861). A Manual of Military Surgery For The Use Of Surgeons In The Confederate Army. Richmond, VA: West & Johnston. Accessed 6/10/25. https://archive.org/details/manualofmilitarychis/page/n5/mode/2up
[21] Dalton, K. (2020, June 8). Confederate Use of Anesthesia in the Civil War. National Museum of Civil War Medicine. Accessed 6/10/25. https://www.civilwarmed.org/anesthesia-3/
[22] Stefano, G. B., Pilonis, N., Ptacek, R., & Kream, R. M. (2017). Reciprocal Evolution of Opiate Science from Medical and Cultural Perspectives. Medical Science Monitor 23, 2890–2896. https://doi.org/10.12659/msm.905167
[23] Karch, M. D. A Brief History of Cocaine. 2nd ed. Routledge. Boca Raton. 2006. Accessed 6/10/2025. https://research-ebsco-com.libproxy.clemson.edu/c/7j2xc6/search/details/odmnqxcr65?db=e025xna
[24] Biondich, A. S., & Joslin, J. D. (2016). Coca: The History and Medical Significance of an Ancient Andean Tradition. Emergency Medicine International, 2016, 4048764. https://doi.org/10.1155/2016/4048764
[25] Wielenga, V., & Gilchrist, D. (2013). From gold-medal glory to prohibition: the early evolution of cocaine in the United Kingdom and the United States. JRSM short reports, 4(5), 2042533313478324. https://doi.org/10.1177/2042533313478324
[26] Long, J. (2024). John Pemberton: The Drug-Addled Mind Behind Coca-Cola. History Defined. https://www.historydefined.net/john-pemberton/
[27] Calatayud, J., & González, Á. (2003, June). History of the Development and Evolution of Local Anesthesia Since the Coca Leaf. Anesthesiology, 98, 1503–1508. https://doi.org/10.1097/00000542-200306000-00031
[28] Erjavic, N., August Karl Gustav Bier (1861–1949). Embryo Project Encyclopedia ( 2017-11-15 ).Arizona State University. ISSN: 1940-5030. Accessed 6/10/2025. https://hdl.handle.net/10776/13012
[29] Felton, J. (2021, April 19). The Doctor Who Tested Spinal Anesthesia by Mashing His Assistant’s Testicles and Smashing His Shins With A Hammer. IFLS. Accessed 6/10/2025. https://www.iflscience.com/the-doctor-who-tested-spinal-anesthesia-by-mashing-his-assistants-testicles-and-smashing-his-shins-with-a-hammer-59427
[30] Gottschalk, A., Van Aken, H., Zenz, M., & Standl, T. (2011, July 8). Is Anesthesia Dangerous? NIH, 108(27), 469–474. https://doi.org/10.3238/arztebl.2011.0469
Image Sources:
Beach Wooster. Amputation of the Thigh for White Swelling, at the Dissecting Room, Stuyvesant Institute. The American Practice Condensed, or The Family Physician – Being the scientific system of medicine. JamesM’Alister. New York. 1848. Wikimedia Commons. No known copyright. https://commons.wikimedia.org/wiki/File:The_American_practice_condensed,_or_The_family_physician_-_being_the_scientific_system_of_medicine_(1848)_(14592439200).jpg,
Cydone. Laudanum (Opiumtinktur) 100ml Medizinflasche. 2008. Wikimedia Commons. Public domain. https://commons.wikimedia.org/wiki/File:Laudanum_poison_100ml_flasche.jpg
Unknown Artist. Sir James Young Simpson (1811-1870) and two friends, having tested chloroform. 1832. Reference: WT/D/1/20/1/26/81. Wellcome Library, London. Public domain/No known copyright. https://wellcomecollection.org/works/uudw76sp/items
Unknown Artist. Advertisement of Vin Mariani with Pope Leo XIII. Uploaded by Ich. Wikimedia Commons. https://commons.wikimedia.org/wiki/File:Mariani_pope.jpg
Jules Chéret. Poster for Mariani Tonic Wine. 1894. Uploaded by Magnus Manske. Modified by Soerfm. Wikimedia Commons. Public domain. https://commons.wikimedia.org/wiki/File:Vin_mariani_publicite156.jpg
Unknown Artist. Coca-Cola Advertisement. 1886. Uploaded by Vladan Kzmvic. Wikimedia Commons. Public domain. https://commons.wikimedia.org/wiki/File:Coca-Cola_Advertisement.jpg
The Mary Bruce Project 
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