Dr Phil Hammond, GP and broadcaster

Occasionally, I do something on the telly that really makes me think. Scream! The History of Anaesthetics on Channel 5 recently was one such programme. It begged the question: do we take anaesthetists for granted?

It’s a tough job. First you’ve got to take patients as close as you can to death and then ­ the really tricky bit ­ you have to wake them up again. And yet deaths are very rare. For every million anaesthetics given in the UK, only five patients don’t make it through, and they were usually pretty sick in the first place. So why do surgeons get all the glory and nurses all the chocolates?

To appreciate anaesthetists you need to imagine life without them. Step back to 1840 when major surgery was a spectator sport, performed on conscious patients at breakneck speed and with no pain relief. Audiences would go to see the blood, smell the wounds and hear the screams, and the biggest crowd pleaser was the Scottish surgeon Robert Liston.

Liston was a gifted technician whose success relied on his speed; he could amputate a gangrenous leg in just 28 seconds, before holding up the severed limb as a trophy. The crowd loved it and, amazingly, many of his patients survived. But most were so scared of surgery that they would avoid it until they could cope no more. One of Liston’s patients had a tumour in his scrotum that was so big, he had to push it around in a wheelbarrow.

There were pain-relieving agents around at the time, but none had much impact until the arrival of ether. Its anaesthetic properties were noted by an American doctor, Crawford Long, who observed that when it was inhaled for recreational purposes, it made you giggle,become light-headed and fall over without feeling a thing.

In 1846, William Morton, an American dentist, successfully whipped a tooth out under ether, and when word of this reached Liston, he was determined to perform the first British operation under anaesthetic. The patient, a butler called Churchill, was given ether while Liston performed his customary quick-fire amputation. As he came round his words changed medicine forever: "When are you going to begin?"

Ether made surgery much more bearable but it was not a perfect anaesthetic ­ it was flammable and made patients vomit. A potentially huge breakthrough was made back in 1799, when a young chemist called Humphrey Davy produced nitrous oxide, or laughing gas, which gave him a fantastic trip. Alas, he did absolutely nothing with his invention, other than share it with his friends and have great parties, and it took nearly 50 years to realise what a good anaesthetic it was.

Next up was chloroform, which also started out as an ice-breaker at doctors’ parties until Dr James Simpson, a colleague of Liston, realised its potential to relieve the pain of childbirth. He met objections from the church, and one clergyman in particular who felt that "chloroform was the decoy of Satan meant to rob God of the earnest cries that arise at a time of help". But Simpson won the argument with the endorsement of two celebrity mothers ­ Kate Dickens and Queen Victoria.

Local anaesthetics arrived on the scene in 1860 with the discovery of cocaine, but once again doctors just couldn’t resist using it on themselves first and falling over. Many other anaesthetic drugs have been discovered and self-administered since, but none are perfect. Which is why we need anaesthetists to get exactly the right cocktail for individual patients.

Recently, I’ve witnessed brain surgery and a Caesarean section on conscious patients who didn’t feel a thing. Anaesthetists really do deserve a medal for that ­ or at least a chocolate orange

Guidelines in Practice, July 2004, Volume 7(7)
© 2004 MGP Ltd
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