Resistance to anesthesia in the 19th century

That is the topic of a new paper by Meyer R and Desai SP, here is the abstract:

News of the successful use of ether anesthesia on October 16, 1846, spread rapidly through the world. Considered one of the greatest medical discoveries, this triumph over man’s cardinal symptom, the symptom most likely to persuade patients to seek medical attention, was praised by physicians and patients alike. Incredibly, this option was not accepted by all, and opposition to the use of anesthesia persisted among some sections of society decades after its introduction. We examine the social and medical factors underlying this resistance. At least seven major objections to the newly introduced anesthetic agents were raised by physicians and patients. Complications of anesthesia, including death, were reported in the press, and many avoided anesthesia to minimize the considerable risk associated with surgery. Modesty prevented female patients from seeking unconsciousness during surgery, where many men would be present. Biblical passages stating that women would bear children in pain were used to discourage them from seeking analgesia during labor. Some medical practitioners believed that pain was beneficial to satisfactory progression of labor and recovery from surgery. Others felt that patient advocacy and participation in decision making during surgery would be lost under the influence of anesthesia. Early recreational use of nitrous oxide and ether, commercialization with patenting of Letheon, and the fighting for credit for the discovery of anesthesia suggested unprofessional behavior and smacked of quackery. Lastly, in certain geographical areas, notably Philadelphia, physicians resisted this Boston-based medical advance, citing unprofessional behavior and profit seeking. Although it appears inconceivable that such a major medical advance would face opposition, a historical examination reveals several logical grounds for the initial societal and medical skepticism.

File under “@pmarca bait.”

Hat tip goes to Neuroskeptic.

Comments

There is still a whole world of people resistant to anesthesia - natural childbirth is a real thing.

Personally I am continuing the good fight for natural dentistry. I think that the use of novocaine and the like alienate us from the entire experience of having root canal work done. We need to be closer to nature. And by "we" of course, I mean "you all".

I had root canal done here in the UK without anesthetic. It is not all that painful.

You were lucky the root was truly dead (no nerves) otherwise you'd not be able to prevent reflexive actions. Some dentists won't allow you do do that, since it causes the operation to be more difficult.

I too had a root canal with just a local anaesthetic, if you need Novocaine for that there is sth wrong with either you or your dentist!

And although i dont care what drugs people take, natural childbirth can actually be better, it can be simply easier to feel what is going on and react accordingly in terms of pushing etc.

It depends if the nerve within the tooth is dead already. I had a cavity where the nerve died without any infection, so such a root canal without anesthetic would be fairly painless. But if the nerve is alive and infected (a classic toothache), then drilling into it will be extremely painful.

I would like to think that lack of anesthesia would lead to better dental hygiene. But I suspect it will lead to more pulled teeth, old-west style.

I'm confused Patrick. Novocaine is a local anesthetic. Or do you mean forgoing the nitrous oxide?

My wife has had 4 children without anesthesia. Recovery is much faster and so is delivery, reducing the risk of other complications in the delivery. At the same time, my wife has always said that if she changed her mind, she'd be happy to take the anesthesia.

I suspect some of her desire to deliver without anesthesia is due to the bragging rights that come with it. There might be a genetic/upbringing factor here, too, as her father gets root canals without anesthesia. He claims it's the heat that hurts, so the dentist just has to drill in short intervals with short breaks in between.

Correct. There is less risk of ending up having a C section or needing to use forceps or vacuum extraction.

The first time my wife got an epidural, but it didn't really help and the place where the epidural went in has a permanent nerve injury so it is painful to touch. No more epidurals after that.

"The body knows best, so tough it out." I've noticed that this sentiment is expressed by people who enjoyed modern western childhoods, and have rarely or never experienced any really strong pain. The anti-vax crowd are similar.

As a child I usually got fillings without even novocaine. I was scared to get it because the dentist referred to the shot as a "bug bit."

It really wasn't that bad.

Perhaps in 100 years someone will write a similar article about marijuana.

I doubt it. It would start "Like this pro'b'tn thing is totally uncool dude" before meandering off into 26 pages about the lint he found in his belly button and it would never get around to making a point.

Yeah, then we can imprison people for writing 26 page papers about belly button lint. For freedom, of course.

Apart from some Greek music, and of course Bob Marley, marijuana seems fairly unique among drugs in that it has produced nothing worth listening to or reading much less banning. Heroin must come a close second.

Jack Kerouac

Well, opium seems to make for somewhat interesting literature: http://georgeorwellnovels.com/journalism/review-of-a-modern-de-quincey/. Maybe the old ways are the best ways.

A stupid joke among my friends is that two beers have the same effect as 250mg of Paracetamol. For relatively not intense chronic pain we already have alcohol and marihuana. After a long recovery of a broken bone I can tell that alcohol is kinder to the stomach than 1000mg of paracetamol once a day.

In Japan anesthesia for women bearing children is still seen as "preventing" the mother to create a "real" mother-child bond and most women choose to not use it, or are talked into not using it.

By comparison, in America, natural childbirth is seen as a silly thing that hippies do and most women are talked into getting an epidural and then coerced into having a C section when something goes wrong.

For many surgeries, the cost of anesthesia exceeds the cost of surgery. To readers of this blog interested in behavior motivated by costs and benefits, what might result? Call it the Economics of Medicine, a subject so fraught with ideology and politics that the obvious is usually overlooked. Oh, wait, economics isn't about the obvious, it's about the obscure.

If we're serious about bending the health-care cost curve downward, wouldn't the abolition of anaesthesia be a good first step?

First, note that anaesthesia doesn't save lives or cure diseases—it just makes people more comfortable. In light of this, we should regard it as akin to lifestyle drugs like Viagra or Rogaine, rather than as essential medical care. Society should be allocating its health-care spending for things like preventive care for low-income children, rather than making the wealthy more comfortable during the excision of their cholesterol-clogged gall bladders.

Second, eliminating anaesthesia will deter people from undergoing frivolous and unnecessary medical procedures, and will do so in a just and equitable way. Under America's current system of allocating medical care based on wealth, the rich can easily shell out thousands of dollars for the removal of mildly unsightly birthmarks, while the poor struggle to find a doctor who'lll re-attach their severed limbs. But wealth and poverty alike are sensitive to pain; indeed, the working classes have a greater tolerance for it than the pampered rich. An anaesthesia-free society would spend far less money on things like knee replacements, and proportionally fewer of those knee replacements would go to the greedy 1%.

No. Surgical pain is no respecter of class boundaries, and as a force for equality, should be celebrated rather than eliminated. The abolition of anaesthesia would be a significant step in the direction of a more just society.

Surgeons obviously work much better when their patients to is screaming in pain and jerking and spasming under his knife....

If he can't work under such conditions, he should not be a doctor because he's not sufficiently detached.

I think Merton was kidding.

Most obstetricians still prefer to minimize (to zero, if possible) the use of anesthesia during childbirth, as it has deleterious effects on the newborn child.

HAHAHAHAHAHAHAHAHA. How many obstetricians have you met?

It is true that pain does not do anything to help labor, however, the practice of using epidurals during labor actually does make other medical interventions including C sections, more likely. The problem is that once the epidural is in place the woman is confined to lying on her back in the bed and thus cannot change positions, walk around, or do any exercises designed to reposition the baby or speed delivery. This is why there is a movement towards natural childbirth today. It's not just a bunch of crazy people who like pain.

When I was a child I went to an old family friend as dentist. She did not believe in novacaine, and I actually got "raise your hand when it hurts" fillings. She claimed it was less likely to damage nerves, which seems like it might be true.

There is a great chapter in the book "Age of Wonder" about the chemist Humphrey Davy, who engineers a nitrous oxide generation and delivery system. He works with a physician for (as I recall) a couple of years, testing it out on every ailment they can find, in the hopes that it cures some disease. It doesn't, though they note it temporarily relieves painful symptoms. They conclude nitrous oxide is medically useless and never try it for surgical pain relief. An astonishing near-miss historically. This is about 50 years before ether.

Not surprised there was resistance to anesthesia, as there was decades-long resistance to handwashing before surgery after the procedure was discovered to reduce infections in 1847. And this was after Ignaz Semmwelweis showed it could reduce infection rates by 90%!

Anecdotally, my wife unintentionally gave birth to our second child without an epidural. My daughter simply decided to arrive faster than the anesthesiologist could get there! The birth seemed quite painful but at least was much quicker than with our first child. I personally was pleased by the rather low bill from the hospital without anesthesia nor the extra day of rest needed to recover from it.

I find it quite flabbergasting how many people here think epidurals are a good thing.

They aren't except when they are. Both of my children were born without any anesthesia, but my wife is a big strong girl and birthing my kids did not present any serious challenges. That is not true of everyone. It is nice to have medical options.

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