A knockout victory over pain

It is impossible to imagine the agonies of surgery before anaesthesia. The writer Fanny Burney’s harrowing account of her mastectomy – performed by Napoleon’s surgeon-in-chief Dominique Larry – is a terrifying reminder.

‘When the dreadful steel was plunged into my breast, I began a scream that lasted uninterruptedly and I am amazed it rings not in my ears still,’ she wrote. ‘I then felt the knife scraping against my breast bone and thought I must have expired… my eyes hermetically shut, such that the eyelids seemed indented into my cheeks.’

Six months later, she confided to her sister Esther, ‘I dare not revise, nor read [her account of the operation]; the recollection is still so painful.’

Fanny Burney’s ordeal has a particularly poignant resonance for having been, in retrospect, quite unnecessary. A decade earlier, in 1800, a brilliant young Cornish chemist, Humphry Davy, had demonstrated unequivocally the anaesthetic properties of the gas nitrous oxide in a series of experiments carried out mostly on himself. The blessed relief it conferred when one of his wisdom teeth became intensely inflamed prompted him to suggest that, as the gas was so ‘capable of destroying physical pain, it may be used with great advantage during the surgical operation’.

It would, however, be another 44 years before the first practical application of Davy’s insight – an astonishing hiatus, certainly, but a reflection in its way of the extraordinary implications of the phenomenon of anaesthesia – that it might be possible to suspend sensation and induce oblivion, without endangering life.

In 1844, a Connecticut dentist, Horace Wells, attended a public demonstration of nitrous oxide’s exhilarating effects as ‘the laughing gas’ – a popular entertainment at the time – and was struck by how one of the volunteers from the audience seemed indifferent to the Fanny Burney: agony with no anaesthetic chloroform. The latter he administered to Queen Victoria during the birth of her eighth child, Prince Leopold, prompting the accolade that it was ‘delightful beyond measure’.

A decade later, during the American Civil War, 80,000 operations (mostly amputations) would be carried out under chloroform anaesthesia. ‘A complete vindication of the utility of this remedy and proof of its necessity,’ pronounced professor of surgery J Julian Chisholm.

And so it has been ever since; though it is now customary to initiate anaesthesia with an intravenous injection of a barbiturate drug and maintain it with a combination of ‘gas and air’. There are five million operations a year in Britain with a mortality rate of less than one per cent.

Still, two centuries later, the phenomenon of anaesthesia remains quite as marvellous as when first described by Humphry Davy. For, astonishingly, it remains quite unknown why it should be that half a dozen quite different chemical agents should each exert the same fourfold effect on the functioning of the brain, inducing a reversible state of immobility, amnesia, analgesia and unconsciousness.

It is not for want of trying as, in recent years, Professor Emery Brown of MIT and others have deployed all the sophisticated gadgetry of electroencephalograms and brain scanning techniques to elucidate what is going on.

They have found surprisingly that the anaesthetised brain remains sensitive to stimuli, such as light and sound, but the ‘information’ goes no further and is not integrated into the type of neural activity involved in conscious awareness.

There thus appears to be a general disconnect between different brain networks but ‘the discovery of a fundamental mechanism that explains the phenomenon of anaesthesia has become less and less likely’.

The Oldie