In 1811, English novelist Fanny Burnie underwent a mastectomy without anesthesia with a dose of whiskey to relieve pain.

In the letters she wrote to her sister after the operation, she recalls, “I started screaming, which continued uninterrupted throughout the incision.” In fact, Burnie fainted twice from cleft pain, which likely came as a welcome relief.

It was performed at a time when surgical anesthesia was still in its infancy, and the limited options that exist can often be unreliable and dangerous. Tony Wildsmith, professor emeritus of anaesthesiology at the University of Dundee in Scotland and former Royal Archives of the Royal College of Anesthetists in the UK, said historical anecdotes like hers reveal ‘what it was like to have surgery before anaesthesia’.

Indeed, facing such pain would be a nightmare. Today, anesthetics have become a staple of medicine, consisting of a group of drugs that are used not only to control pain but also to relax muscles and render patients unconscious. Many people, at some point in their lives, will receive these medications — whether it’s a local anesthetic to numb the gums in the dentist’s office, an anesthetic during childbirth, or general anesthesia to induce deep sleep while doctors remove the tonsils.

But how did the doctors perform the surgery before the anesthesia? The answer reveals an even more rude, painful, and even questionable history.

Pain through the ages

Anesthesia as we know it today is a relatively new invention, but for centuries, we’ve been looking for ways to calm intense pain. As far back as the eleventh century CE, there are reports of physicians using sponges soaked in opium and mandrake juice to patients to induce drowsiness in preparation for surgery, and to relieve the pain that followed.

Going even deeper, manuscripts from Roman times to the Middle Ages describe a recipe for a soothing mixture called doyle. According to a medieval manuscript, the dye was made from an intoxicating mixture of bile, opium, mandrake juice, hemlock, and vinegar. From the 17th century onwards in Europe, opium and laudanum (opium dissolved in alcohol) became common pain relievers.

But these drugs were primitive, imprecise, and difficult to adapt to patients and their needs. Furthermore, it can be dangerous; A hemlock can be deadly, for example, and opium and laudanum are addictive. In high doses, mandrakes can cause hallucinations, abnormal heart rates — and in extreme cases, death.

Against the backdrop of this unforgiving medical landscape, when surgeons had to perform invasive surgeries, often the most sensible method they used was to be as quick and accurate as possible. “I went back over 150 years ago, and the surgery was short,” Wildsmith said. Efficiency and accuracy under time pressure became a measure of a surgeon’s skill.

But speed and accuracy were also limited to surgeons in less complex operations. For example, it is safe to assume that prior to the advent of surgical anesthesia in Europe and the United States in the mid-nineteenth century, high-risk surgeries such as caesarean sections and amputations in these areas were less common than they are today.

In fact, dentistry was one of the few types of surgery that was relatively more common during this period, because the pain and risks involved in doing so were less than the more serious types of surgery, Wildsmith explained.

questionable ways

As surgeons sought new ways to do their work, some unusual approaches emerged. One such technique was decompression, a technique that involves pressing on arteries to make a person unconscious, or on nerves to cause sudden numbness in the extremities.

Perhaps the first technique dates back to ancient Greece, where doctors called the arteries in the neck “carotid”, a word of Greek root meaning “awe”. “Therefore, there is evidence that they used it or knew that the compression of the carotid arteries would lead to unconsciousness,” Wildsmith said. He emphasized, however, that there was no indication that this method had been applied on a large scale – and perhaps for good reason.

In 1784, a British surgeon named John Hunter attempted to compress the nerves by placing a tourniquet on the patient’s limb and causing numbness. Surprisingly, it worked: Hunter managed to amputate a limb, and the patient seemed to feel no pain, according to the Royal College of Anesthesiologists.

Another technique for controlling pain included “magic”. Hektoen International reported that this pseudoscientific belief combined the elements of hypnosis with theories that there was a force-field-like fluid in humans that could be manipulated with magnets. The inventor of the technique, Austrian physician Franz Anton Mesmer, believes that by controlling this fluid fluid, he can put patients in an animation pause where they will be oblivious to the pain of surgery.

And these pseudoscientific practices gained real momentum. By the mid-1800s, witchcraft had spread to other parts of Europe and India, and surgeons used it to operate on patients. In several cases, patients reportedly did not feel pain, according to a report in Hektoen International.

But surgeons are beginning to question these methods and accuse proponents of misleading the public. This paved the way for new and more promising candidates for pain relief and anesthesia: a series of inhaled gases that, by the mid-19th century, were poised to usher in a new era of modern anaesthesia, according to Hektoen International.

From pseudoscience to modern anesthesia

Leading up to the mid-19th century, scientists and surgeons became increasingly interested in the clinical use of a sweet-smelling organic compound called ether, which is made by distilling ethanol with sulfuric acid. In fact, records of ether production date back to the 13th century, and in the 16th century, doctors who experimented with the mysterious substance discovered that it could sedate chickens.

Several hundred years later, surgeons revised the ether in their work. Finally, in 1846, an American dental surgeon named William Morton performed a general operation in which he supplied a patient with gaseous ether and then painlessly removed a tumor from the patient’s neck. This was the first clinical evidence that careful use of this gas could cause unconsciousness and relieve pain.

Then, in 1848, surgeons demonstrated that another compound, called chloroform, could successfully relieve pain during childbirth and other surgeries. Crucially, ether and chloroform gave surgeons more control over their patients’ condition, because by controlling the patient’s pain and sending them to sleep, it gave the surgeon more time to perform the surgery and thus more accurately. Over time, this made it possible to perform more complex surgeries. Neither gas is used surgically anymore, but both laid the foundation for the development of safer and more effective drugs that turned anesthesia into the delicate art it is today. Wildsmith recalled an 18th century oil painting showing a terrified man undergoing amputation.