As we all know, anesthesia is a very important procedure in most modern surgical operations. Without the aid of anesthetics, few patients can endure the excruciating pain of surgery. Therefore, before the invention of anesthetics, surgical operations often failed because the patient died before the operation was completed because he could not bear the severe pain. Although many countries (such as China, India, Babylon, Greece, etc.) have accumulated experience in anesthesia in ancient times, they mainly used plant-based anesthetics (datura flowers, opium, Indian hemp leaves, etc.), and also used nerve stems. Mechanical compression, drinking, bloodletting, etc. can make the patient lose consciousness, or even hit the patient's head with a stick to cause coma. There are also methods of applying alcohol to the surgical site during surgery, relying on the endothermic effect of alcohol to relieve pain. However, these methods are all Unsatisfactory.
Before the use of anesthetics, the pain experienced by those who died under the surgeon's knife was indescribable. Every operation was accompanied by blood-curdling screams of pain.
Because the patient was in great pain and suffered a lot of shock during the operation, the operation was forced to develop rapidly. Russian surgeon Pirogov could saw off a thigh in three minutes and cut off a breast in half a minute. The famous French doctor Jean-Dominique Lary performed amputations on 200 patients in 24 hours. Among these fast surgeons, the most famous was the British doctor Robert Liston. He was famous for his extremely fast operations and was known as the "Liston Flying Knife".
Liston graduated from the University of Edinburgh and invented medical supplies such as trauma ointment and hemostatic forceps. Among them, wooden bars for fixing fractures were still in use until World War II. He was 1.88 meters tall and had a naturally impatient temper. He was a very controversial figure in the medical community at that time. Among the cases he handled, three were particularly frightening: he once cut off the patient's legs within two and a half minutes, but due to excessive force, he also cut off the patient's testicles; a teenager with an ulcer on his neck , due to Liston's overconfidence, he misdiagnosed. When he cut the affected part with a knife, the boy immediately bled to death; he also set a record of the only operation in history with a mortality rate of 300%: he cut it with great speed. The patient in the lower leg died of infection the next day (which was quite common at the time). His assistant accidentally cut off his finger and died of infection. Another innocent victim, a famous doctor who was observing the operation, was stabbed by him. He hit the vital point between his legs and died of shock due to fear.
In this case, one of mankind's early desires must have been the hope for a magical painkiller. To achieve this goal, ancient doctors conducted extensive research on the analgesic properties of certain plants and carefully accumulated a lot of knowledge from practical experience.
400 years ago, cocaine and opium were well known as drugs that affected the psychological state. They are also often used as medicine. In the early 1st century AD, the Roman writer Celsus suggested using hyoscyamus as a sedative. For the Romans, the most powerful anesthetic was datura. The reason is still sufficient: datura seeds contain belladonna and scopolamine, both of which slow down the heart rhythm. If taken properly, they can completely eliminate pain and reduce the mental trauma caused by surgery to patients. Pliny, around AD 75, described the more constructive use of this drug by Roman doctors. These anesthetic drugs, known to the ancient Romans, continued to be used throughout the European Middle Ages. But there have been big changes in the route of intake. The most common way of ingestion is the "hypnotic sponge" method mentioned in countless classics from the 9th to 15th centuries AD. It involves mixing a number of drugs, including opium, mandrake, hyoscyamus and poison extracted from Gelsemium celery, into a sponge, which is then left to dry. When anesthetic is needed, a sponge can be soaked and placed over the patient's mouth, allowing the patient to inhale the scent. These cocktails would certainly render anyone unconscious, although inhalation of the deadly Gelsemium poison, which depresses both the motor and sensory centers of the nervous system, would make the entire operation extremely risky.
But it turns out that these prescriptions are not as popular as they say - because they can be fatal in high doses.
In addition to the West, ancient Chinese have legends and records about surgical anesthesia a long time ago. In the 2nd century AD, the medical scientist Hua Tuo invented "Ma Fei Powder" and made it possible to use general anesthesia for abdominal surgery. The use of general anesthesia in Europe and the United States dates from the early 19th century, more than 1,600 years later than in our country. This is the most important progress in anesthesia in China.
Hua Tuo's contribution to anesthesiology has been recognized by the international medical community, and research on the ingredients of Ma Fei San has continued. Laval of the United States pointed out in his book "Four Thousand Years of Medicine": "Some Arab authorities mention inhalational anesthesia, which may have evolved from the Chinese. Because it is said that the Chinese Hippocrates Hua Tuo, the late Hua Tuo, used this technique to apply some mixtures containing aconite, datura and other herbs for this purpose. "The Hippocrates mentioned in it was the ancient Greek physician and the founder of Western medicine. who.
Unfortunately, "Ma Fei San" has been lost. Since the 19th century, the objective requirements for surgical treatment have grown day by day, and the requirements for anesthesia have become more urgent. At the same time, the development of chemistry has provided favorable conditions for the exploration and research of anesthesia.
In 1799, the British chemist David was the first to discover the anesthetic effect of nitrous oxide. After inhaling nitrous oxide, he found that the pain in the inflammatory site was relieved, so he concluded: " Nitrous oxide can act as an anesthetic during surgery with little bleeding." In a letter to a friend, David described the joy and relief he felt after inhaling nitrous oxide. Therefore, nitrous oxide is also called "laughing gas". However, this discovery failed to be promoted clinically in time.
In 1824, Hickman used carbon dioxide, nitrous oxide and oxygen to anesthetize animals and perform amputation surgeries. He requested human experiments but was not granted permission. It wasn't until 1893, when the chemist Scofen confirmed that inhaling large amounts of laughing gas could make people drunk and even unconscious, that the era of anesthetics really began.
In addition to nitrous oxide, other methods of anesthesia have also been explored. In 1818, the famous scientist Faraday pointed out in his work that "ether has the effect of causing coma, and its effect is very similar to that of nitrous oxide." In 1842, a chemistry student named William Clark in Rochester, USA, administered ether to a woman who needed to have her teeth extracted, making her extraction painless. On March 30 of the same year, another American doctor, Crawford Lange, used ether inhalation anesthesia to successfully perform resection surgery on a patient with a neck and back tumor. He then continued to perform many minor surgeries using ether. Because Lange lived in a remote place at that time, his achievements were not known to the world.
In the summer of 1844, the American dentist Moulton went to Boston for an internship and came to learn chemistry from his schoolmate Jackson. The latter graduated from Harvard Medical School and was a chemist. During a casual conversation, Moulton mentioned that it would be nice if the nerve of the tooth could be destroyed when extracting the tooth. Jackson said he had some ether, a substance that could relieve toothache, and casually gave some to Moulton. Later, a patient came to Moulton to have a tooth extracted and hoped it wouldn't hurt too much. So Moulton handed the patient a handkerchief dipped in ether and let him inhale it, causing him to gradually lose consciousness. Then with the help of an assistant, he extracted the tooth. After Moulton pulled out the tooth, he asked the patient how he felt. The patient happily said: "It's a miracle! There is no pain at all." This success caused a great sensation. Anesthetics are beginning to be recognized and used by more and more doctors.
On October 16, 1846, another surgeon at Massachusetts General Hospital, USA, used ether anesthesia to cut out a tumor from a patient's neck. It only took 8 minutes, proving for the first time that surgery can be done during surgery. During surgery, ether can be used for general anesthesia. News of the successful operation spread quickly in the United States and then around the world. Various countries have successively adopted ether anesthesia for surgery, ending the era when patients had to endure severe pain to undergo surgery. China and Russia were both countries that began to use ether anesthesia the year after Moulton's success.
Later, obstetrician and gynecologist Simpson used ether in obstetric surgery, but after a while, he found that chloroform was more effective than ether in anesthesia, so chloroform became the third important Narcotics.
Today, ether and chloroform are still the most commonly used anesthetics for general anesthesia.
Knowledge Points
Cocaine
Also known as cocaine, it is the first natural alkaloid with local anesthetic effect discovered by humans. It is a long-acting ester local Anesthetic, with high fat solubility, strong penetrating power, good affinity to nerve tissue, and good surface anesthesia. Its vasoconstrictive effect may be related to blocking the reuptake of norepinephrine by nerve endings. It is highly toxic. In small doses, it can excite the cerebral cortex and produce a sense of euphoria. As the dose increases, it can excite the respiratory, vasomotor and vomiting centers. In severe cases, convulsions may occur. Large doses can cause the inhibition of the descending dissimilation of the cerebral cortex. Central respiratory depression occurs and myocardial depression occurs, causing heart failure. Because of its high toxicity and tendency to become addictive, it has recently been replaced by other local anesthetics.