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THE "GOOD SLEEP" — A NEW ERA IN SURGERY

News Flashes

In 1933 Americans could ponder such news flashes from the world of "astonishing, modern surgery" as:

• A patient in a New York hospital who read a newspaper throughout his painless operation.
• A seventy-year-old surgeon who performed a major abdominal operation upon himself.
• A Long Island patient who carried on a conversation with the surgeon during a forty-five-minute operation on his brain.

Anesthesia and Medical Progress

One of the most significant American contributions to the history of medical progress was the introduction of surgical anesthesia. In 1844 Horace Wells, a dentist from Hartford, Connecticut, began to use nitrous oxide ("laughing gas") during dental extractions. Two years later another dentist, William T. G. Morton of Boston, who had experimented with ether for pulling teeth, administered it for a surgical operation performed by John C. Warren at the Massachusetts General Hospital. Chloroform was introduced in Europe in 1848, but it was never very popular in the United States. The danger was that even a little too much in the bloodstream might paralyze the heart.

Ether

By the early 1930s ether was still the main anesthesia of choice, but it had its own problems. It caused stomach upsets, and because it was an intoxicant the human system developed a tolerance for it, just as with alcohol. During the second of the four stages of administration of ether, the patient could become excitable and need physical restraint. It was also highly explosive, and the sparks from an X-ray machine could touch off a blast. Extensive precautions had to be taken. Most surgical anesthesia techniques used nitrous oxide and oxygen until the patient lost consciousness. Then ether was administered by breathing through a cone, finishing off with nitrous oxide again to reduce post-operative vomiting. Nitrous oxide was the safest anesthetic; chloroform the most dangerous but the most efficient; ether the best for all-around work. Electric anesthetic machines and batteries of cylinders filled with different vapors under high pressure were part of the equipment of the surgery room. Watching the dials, the expert in charge controlled the strength and flow of the anesthetic by means of levers. Besides keeping the patient unconscious by replacing the ether lost in breathing, he watched the type of tissue through which the surgeon was cutting, since some tissues were more sensitive and would require an extra amount of anesthetic to prevent pain and shock. The patient's color had to be carefully watched to determine the need for more or less oxygen. Jaundiced persons and dark-skinned African Americans were difficult subjects for the doctor in charge of the anesthetic.

New Developments

New developments in anesthesia in the early 1930s created dramatic changes in surgery. Neocaine, a French drug, was used in spinal anesthesia. Injected into the lower spine, it deadened the abdomen and lower extremities, allowing the patient to remain fully conscious and to retain full use of his arms. It eliminated nausea after the operation, and there was no excitement stage, as there was with ether. Avertin, introduced from Germany in 1930, was given rectally and used for short operations, since its effects lasted only about an hour. Pernocton, taken by mouth or injected into the veins, put the patient into a deep sleep that lasted for several hours. It was used in childbirth with less harmful effects to the baby than other drugs. Local anesthetics such as novocaine (one-seventh as dangerous as cocaine), eucaine, and benzyl alcohol were also used frequently in major operations in place of ether, Novocaine was the drug used by the surgeon who operated upon himself. Sitting on the operating table, propped up by pillows, he swabbed the right side of his abdomen with iodine and alcohol and then injected novocaine from a small hypodermic syringe along the line he intended to cut. He was out of the hospital following the operation in far less time than usual. He pointed out his experiment proved that when the patient's system was not burdened with a general anesthetic, recovery was quicker. The newest local anesthetic in 1933 was diothane, developed by two Cincinnati, Ohio, chemists. It deadened pain longer than either novocaine or cocaine, had no habit-forming properties, and was considered valuable because it kept the patient comfortable longer after surgery.

Conquering Pain

By 1933 eighty-seven years had passed since Morton demonstrated the powers of ether fumes. World War I stimulated the use of anesthesia, and with later developments of local anesthesia and spinal anesthesia the trained physician anesthetist came into his own. The nurse anesthetist was also well established, and many of the medical anesthesiologists of the 1930s were introduced to anesthesia during their internship by nurse anesthetists. Month by month, surgeons reported new feats to Americans, adding fresh chapters to the age-old story of conquering pain.