
Agonising surgery paved the way for anaesthetics - Tomte
https://www.bbc.com/future/article/20200624-how-agonising-surgery-paved-the-way-for-anaesthetics
======
RcouF1uZ4gsC
The demonstration by Liston of anesthesia in many ways was the moment that
modern surgery was born. Liston was the epitome of the old surgery which was
an agonizing, hurried, dirty, last ditch effort to save a life. Anesthesia
could get rid of the agony and hurry. However, surgery was still a very deadly
enterprise due to infection. In the audience watching the demonstration, was a
young man named Joseph Lister. Lister would pioneer the practice of antiseptic
(which would evolve into aseptic) surgery. Anesthesia and asepsis are the
foundations of modern surgery. The passing of the baton from Liston to Lister
is the birth of modern surgery.

~~~
epmaybe
Well there's a fun fact, Listerine was named after Joseph Lister

~~~
function_seven
And the companion fun fact: so is _Listeria_ :)

~~~
aaronbrethorst
Nothing says fun quite like listeria-induced gastroenteritis!

------
Jedd
In literature, I recall physically squirming during the sequence in Neal
Stephenson's Baroque Cycle when our protagonist had some bladder stones
removed sans anaesthesia.

And more recently, reading a thoughtful review of the BBC comedy series
'Quacks' from 2017 - where they described breathtaking advances in medicine
around 1840.

Things went from "Let's cut this off quickly enough that you don't die from
shock" with a 20+% chance of dying from the truly agonising operation meant to
save you -- to a few decades later when they'd mostly worked out how to
_safely_ knock you out, carefully operate, and were aware of germ theory &
sterilisation procedures.

------
clon
I am in my mid-thirties and I was still operated on without anaesthesia as a
child, growing up in a Russian-occupied part of Europe.

I remember being tied to a sort of lazy-chair with heavy belts and getting a
giant lollipop afterwards. Everything in-between seems like a blur.

While it sounds brutal, it was actually a better option, and I am thankful to
the surgeon for not putting me under. The thinking was, as I understand now
from speaking to my parents, that soviet anaesthesia options were rather
primitive and dangerous, especially to a child, and the surgeon elected to
omit it, making the operation that much more challenging. Thankfully, he was
at the top of his game.

~~~
digikazi
I had the exact same experience myself. I'm from a former Eastern Bloc
country.

I had to go have my adenoids removed, and it was done with just a local
anesthetic - actually, if I remember correctly I was given an injection
beforehand which made me sort of woozy, but not very. I didn't get belted down
to a lazy-chair, but I did sit on the lap of a beefy nurse who kinda held me
down and made sure I didn't squirm too much. My dad was a doctor and was
present throughout.

I live in the UK now and when I say that this sort of operation was done with
just a local or nothing at all, people don't believe me.

~~~
lsh
Roald Dahl recounts this in his book 'Boy'

> I have only one unpleasant memory of the summer holidays in Norway. We were
> in the grandparents’ house in Oslo and my mother said to me, “We are going
> to the doctor this afternoon. He wants to look at your nose and mouth.”

> I think I was eight at the time. “What’s wrong with my nose and mouth?” I
> asked. “Nothing much,” my mother said. “But I think you’ve got adenoids.”
> “Don’t worry about it,” she said. “It’s nothing.” I held my mother’s hand as
> we walked to the doctor’s house. It took us about half an hour. There was a
> kind of dentist’s chair in the surgery and I was lifted into it. The doctor
> had a round mirror strapped to his forehead and he peered up my nose and
> into my mouth. He then took my mother aside and they held a whispered
> conversation. I saw my mother looking rather grim, but she nodded.

> The doctor now put some water to boil in an aluminum mug over a gas flame,
> and into the boiling water he placed a long thin shiny steel instrument. I
> sat there watching the steam coming off the boiling water. I was not in the
> least apprehensive. I was too young to realize that something out of the
> ordinary was going to happen. Then a nurse dressed in white came in. She was
> carrying a red rubber apron and a curved white enamel bowl. She put the
> apron over the front of my body and tied it around my neck. It was far too
> big. Then she held the enamel bowl under my chin. The curve of the bowl
> fitted perfectly against the curve of my chest. The doctor was bending over
> me. In his hand he held that long shiny steel instrument. He held it right
> in front of my face, and to this day I can still describe it perfectly. It
> was about the thickness and length of a pencil, and like most pencils it had
> a lot of sides to it. Towards the end, the metal became much thinner, and at
> the very end of the thin bit of metal there was a tiny blade set at an
> angle. The blade wasn’t more than a centimeter long, very small, very sharp
> and very shiny.

> “Open your mouth,” the doctor said, speaking Norwegian. I refused. I thought
> he was going to do something to my teeth, and everything anyone had ever
> done to my teeth had been painful. “It won’t take two seconds,” the doctor
> said. He spoke gently, and I was seduced by his voice. Like an ass, I opened
> my mouth. The tiny blade flashed in the bright light and disappeared into my
> mouth. It went high up into the roof of my mouth. It went high up into the
> roof of my mouth, and the hand that held the blade gave four or five very
> quick little twists and the next moment, out of my mouth into the basin came
> tumbling a whole mass of flesh and blood. I was too shocked and outraged to
> do anything but yelp. I was horrified by the huge red lumps that had fallen
> out of my mouth into the white basin and my first thought was that the
> doctor had cut out the whole of the middle of my head.

>“Those were your adenoids,” I heard the doctor saying.

> ...

> That was in 1924, and taking out a child’s adenoids, and often the tonsils
> as well, without any anesthetic was common practice in those days.

~~~
twox2
My grandfather (russian) talks about getting his tonsils removed when he was a
kid in the army. He said the doctor was digging around his throat with a hot
spoon and periodically telling him to spit.

------
CamperBob2
Something I've never understood is why anesthesia was ever something that
needed to be invented or discovered in the first place. Haven't people been
aware of opium for hundreds, maybe thousands of years? Seems like every
surgeon in town would have had his own garden for raising opium poppies.

I'm sure there are other plants with soporific or dissociative effects that
would make surgery less painful. (Coca leaves, maybe?) But _Papaver
somniferum_ is the one that mostly comes to mind.

~~~
dmurray
Alcohol was a popular drug for this.

~~~
blotter_paper
...and also a blood thinner :/

------
linuxlizard
I just finished reading _The Ghost Map_, the story of John Snow's study of
London's cholera epidemic. There's a good section of the book about his
studious study of ether and chloroform. Good book, highly recommended in our
current pandemic timeline.

------
Perenti
I have Brugada Syndrome, which is a genetic condition that affects the sodium
ion channels in cardiac tissue. To prevent sudden unexpected death, I have an
implantable defibrillator. Every few years I get upgraded, sometimes leads
fail and need to be revised as well.

General anaesthetics are dangerous for Brugada patients, so most of the
surgery is done under local anaethetics. I have to tell the surgeons when I
can feel pain, so they can put a bit of local where it's hurting. Given how
"special" the sensations are when they get to a bit where there's not enough
numbing, I can only imagine what it must have been like before modern
anaethesia.

My last procedure was in March this year, and involved a lead revision, a
defib upgrade and moving the unit deeper into my chest. Surgery lasted 3 and a
half hours, so numbing wore off during the surgery. Not a lot of fun.

~~~
rscho
Next time, I suggest trying to ask for a locoregional anesthesiologist to
perform a pectoral block. Long-lasting local anesthetics work far longer than
3.5 hours, and no reinjection required.

They might refuse due to fear of toxic dose, but worth trying.

~~~
Perenti
Unfortunately, they have to use absolute minimal doses of locals as well, as
they also increase cardiac arrythmias in Brugada patients, especially those of
us with very distinct type I Brugada ECG patterns.

It kinda sucks, but hey, despite many cardiac episodes (my first VF was at 14,
and I'm 58 now) I'm still alive. And I'm a cyborg.

~~~
rscho
I understand and I agree.

Another thing you might try is hypnosis or autohypnosis. It works pretty well
for that kind of thing. Besides, that would also allow the anesthesiologist to
give you efficient painkillers and sedation that does not interact with sodium
channels.

However, I think you would find the cumulative dose of 3.5 h of intermittent
lignocaine injections surprisingly high. And let me assure you that they have
absolutely no idea of your true lignocaine plasma level. The comparative peak
with long-lasting drugs will likely be much lower.

All in all, I guess my main point is that if by chance you're doing that
without an attending anesthesiologist you should try to ask for one and you
_might_ find it far more comfortable.

You probably already know this, but:

[https://www.google.com/url?sa=t&source=web&rct=j&url=http://...](https://www.google.com/url?sa=t&source=web&rct=j&url=http://www.orpha.net/data/patho/Ans/en/Brugada_EN.pdf&ved=2ahUKEwiZoK6mgq3qAhVBs4sKHT7ND3kQFjABegQIAxAB&usg=AOvVaw0AJykZAmSc77mOGJ-
ILKJk)

~~~
Perenti
Yeah, I did know most of that. But a nice summary anyway. One big difference
is that they monitor me with 7 (in the ward) and 12 (during surgery) lead ECG,
not 5.

Fortunately, being in Australia where there is universal health care, I have
an excellent team working with me. Typically in the Cardiac Catheter
Laboratory there's the Professor (surgeon), a cardiac aneathetist, several
registrars and students, several nurses, a technician from Biotronik, and a
cardiac scientist.

They use absolutely minimal doses of lignocaine, based on my reporting pain
levels during surgery. They do give me a very small dose of propofol during
the test at the end, when they induce VF and AF to test the unit. I'm told
this is much less stressful than being awake while fibrilating and being
shocked (twice). I know that going into VF and AF feels bloody aweful, and
syncope often results in nasty falls, so being knocked out for that makes
sense. I did break my arm once when shocked though - those stainless steel
tables are bloody hard!

I know a patient in the US who had a bill for $145k after getting his ICD. I
on the other hand pay nothing, except a lifetime of higher taxes than
Americans pay.

------
alexpotato
I think it's in one of Atul Gawande's books but he mentions how before
anaesthesia, the incentive was to have surgeries be as fast as possible to
minimize the duration of pain endured by the patient.

He then goes on to recount a story of a surgeon performing an operation in
front of a group and the following happened:

\- He accidentally cut the person assisting him

\- A woman in the crowd suffered a heart attack from the shock of watching the
above

\- The assistant ended up dying of infection from the cut

\- The patient also ended up dying.

As he tells it, it was the only operation where the mortality rate was 300%

------
battery423
Its crayz how young everything is.

1970 for co2 monitoring.

------
blackrock
How much money does an anesthesiologist make these days?

~~~
jedberg
They make $400K+, and also have the highest malpractice insurance rates of all
the disciplines. On the upside, they have low overhead, since they don't need
an office to see patients in.

~~~
joefourier
I’m amazed at how American medical salaries are orders of magnitude out of
proportion with other western countries. Here in Ireland an anaesthesiologist
makes about 100k€/year, and about 60k€/year after tax. That wouldn’t even
cover malpractice insurance in the US.

Salaries for other doctors and surgeons are similar - a neurosurgeon will make
perhaps 4x-5x less money here than in the States. Meanwhile cost of living in
Dublin is about the same as major American cities like Seattle with one of the
highest rents in Europe.

~~~
blackrock
Perhaps this means that Ireland has a better health care system? Assuming that
your surgical mortality rate is similar to that of the United States.

Realize that the cost of basic medical insurance in the United States, for you
and your family (spouse and children), is now approaching $7,000/year USD. It
can easily exceed $550/month. This is tied to your employer. And this is just
insurance. You still have to pay some percentage of the cost if you actually
have to perform the procedure.

~~~
ReallyAnonymous
Actually, without subsidies, it's around $3500 / month for a family and that's
with a $5k - $10k deductible. I have a collegue that retired after inheriting
a lot of money and that's what he pays for health insurance.

Most small business owners that I take care of are on their spouse's
insurance.

If Americans don't think that the cost of health insurance is destroying
entrepreneurship, they're idiots. For example, if you're single and want to
open your own garage to fix cars, you may have to compete with the shop down
the road that doesn't worry about insurance bc they're on their spouses. So
that shop has $3500 a month less costs than yours.

------
hoseja
And still, nobody knows how it actually works.

------
redis_mlc
The first half of the article is very entertaining.

Note that Russian dentists were late in adopting anesthesia, and the result
was patiencs flinching during procedures, causing broken teeth and other
complications.

