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Can you imagine, I mean, can…you…imagine undergoing a mastectomy without anesthesia?  I cannot even fathom what that would be like.  There’s a scene in the HBO John Adams mini-series where Nabby undergoes a mastectomy with only some strong liquor and a stick to chomp down on, and it is horrifying to watch.  In 1811, Fanny Burney, a writer, experienced just that, a mastectomy for which she received only a wine cordial before undergoing.  The medical report recounts that the procedure took 3 hours and 45 minutes.  Fanny wrote a letter to her sister describing the experience nine months later.  Below is an excerpt from that letter, and I warn you if you are squeamish, you might want to stop reading now, because it is pretty graphic.

Yet—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 unintermittingly during the whole time of the incision—and I almost marvel that it rings not in my Ears still! so excruciating was the agony. When the wound was made, and the instrument was withdrawn, the pain seemed undiminished, for the air that suddenly rushed into those delicate parts felt like a mass of minute but sharp and forked poniards, that were tearing the edges of the wound—but when again I felt the instrument—describing a curve—cutting against the grain, if I may so say, while the flesh resisted in a manner so forcible as to oppose and tire the hand of the operator, who was forced to change from the right to the left—then, indeed, I thought I must have expired….presently, the terrible cutting was renewed – and worse than ever, to separate the bottom, the foundation of this dreadful gland from the parts to which it was adhered…Oh Heaven! I then felt the knife rackling against the breast bone – scraping it!

Enter our hottie from last week, Dr. John Snow, and a number of influential doctors in the 1840’s and 1850’s who started using ether to anesthetize patients during minor operations, labor, and major surgeries.  At the same time, dentists were starting to use nitrous oxide to knock patients out during dental procedures.  After ether came the introduction of chloroform, which was more dangerous but easier to administer.  Chloroform was known to occasionally cause sudden death, particularly in nervous patients. Knowing that just the anesthetic, let alone the surgery, might kill me is going to make me pretty nervous, which will only make the anesthetic more likely to kill me, which of course will make me MORE nervous. That sounds pretty horrible. As the decade progressed, anesthetics became safer and more sophisticated. In the late 1870’s, cocaine was used as a topical anesthetic. After that came more modern drugs that blocked nerves and relaxed muscles, allowing for a host of new types of operations never possible before.

The introduction of anesthesia was a game-changer for the medical field. Prior to its use, surgery was limited to certain parts of the body – abdominal, chest, or head surgery was basically impossible. Plus, the surgeon had to contend with a possibly squirming, hysterical, fully-conscious patient. The ability to anesthetize the patient gave surgeons the opportunity to perform longer, more complex operations and increased the patient survival rate. There are a lot of things about the 19th century that I find charming, but I would not give up modern medicine for every waistcoat and top hat in the world. And yet I am sure that people 200 years from now will say the same thing about our time…

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