The History of Ophthalmology
Part 3: Anesthesia and Infection
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Some form of anesthesia has been used since ancient times, but awareness of bacteria and infection was a Nineteenth Century discovery. These aspects of modern medicine evolved in relation to general surgery and dentistry, as well as ophthalmology.
Development of Anesthesia
Opium poppies have been used for anesthesia since ancient times in the Middle East (Sumeria, the Minoan culture on Cyprus, Egypt), and even farmed in some areas. China is known to have used wolfbane, cannabis incense, and a cannabis decoction in wine some time around 1,000 A.D. for surgical anesthesia.
According to ancient Greek and Roman texts, other anesthetics have been derived from some members of the Solanum species, which includes the edible nightshades – tomatoes, potatoes, peppers, and eggplant – and many plants poisonous to humans. Examples are belladonna (deadly nightshade), henbane, and mandrake. The ayurvedic medicine system practiced about 2,000 B.C. used Datura (Jimson Weed), and the name Datura comes from a Hindi word meaning thorn apple. In the Americas, coca was used.
These ancient herbal anesthetics were used either to put a patient to sleep, or to relieve pain, or both. The limitation and danger of their use was determining the correct dosage. Too little makes the herbal preparation useless, but too much makes it fatal.
Ancient Arabic and Iranian physicians were the first to use inhaled anesthetics. According to entries in two medical encyclopedias of the time, they used marine sponges dipped in a mix of opium and cannabis, with other substances. This was more effective than the anesthetic drinks prepared by Roman, Greek, and Indian doctors.
However, in Western Europe up until the 19th century, there were no effective anesthetics, beyond consumption of alcohol. Ether was first used in 1846 by an American dentist, one William Morton. In that same year its use spread to countries as far-flung as Scotland and Australia (Tasmania), which probably indicates the urgent need felt everywhere for an effective surgical anesthetic.
Ether’s limitation was that it caused vomiting, and chloroform soon replaced it. Dr. John Snow gave Queen Victoria chloroform for the births of her last two children in 1853 and 1857. This gave chloroform greater public acceptance. But at this time, anesthesia was not necessarily administered by a physician – it might be done by untrained members of the public, or by medical students. Many fatal overdoses resulted.
The term anesthesia was coined by Oliver Wendell Holmes, Sr. in 1846, from Greek words meaning “without sensation”. Although he is known now for his writing, he was a physician by profession.
Cocaine used in Eye Surgery
Cocaine was first used in 1884, in an eye surgery, at the suggestion of Sigmund Freud. The operating physician was Karl Koller, one of Freud’s colleagues, who recognized that cocaine would not only relieve existing pain, but also numb human tissue to prevent pain. Eye surgery was problematic at this time because the eye so easily moves in response to any stimulus – such as being incised for surgery! There can be reflex movement even if the patient is sedated or unconscious.
Dr. Koller moved from Vienna to the U.S. in 1888, and practiced ophthalmology in New York, promoting his use of local anesthetics. By this time, American eye surgeons were using local anesthetic for cataract removal. See Part 4: The Nineteenth Century: Seeing the Eye.
In 1922 the American Ophthalmological Society awarded him the first Lucien Howe Medal, it’s most prestigious award.
- Lucien Howe was another ophthalmologist of the time who worked at the University of Buffalo and Harvard Medical School to prevent blindness. He was first to established the merit of using silver nitrate eyedrops in newborn babies. Silver nitrate has antiseptic properties and prevented infection in the baby’s eyes from any gonorrhea or chlamydia condition in the mother. It was used for a long time, but is now replaced by antibiotic eyedrops.
General vs. Local Anesthesia
Most current eye surgery, including LASIK, uses local anesthesia in the form of numbing eyedrops, along with a mild sedative. The sedative helps patients lose their anxiety but does not cause unconsciousness. It is sometimes called “twilight anesthesia” or “conscious sedation”. It leaves the patient able to respond to requests.
A local anesthetic blocks your sensation of pain only in the treatment area, whereas a general anesthetic renders you unconscious. Some procedures, such as a corneal transplant, may use general anesthesia. Being unconscious, you do not feel pain or any other sensation, nor do you have any memory of the procedure. Nor can you breathe on your own, and you must be intubated for oxygen. A fully-qualified anesthesiologist must monitor you throughout your surgery, keeping track of your vital signs – blood pressure, heart beat and breathing rate.
Nor do you have any ability to move. You may have heard or read stories where a surgical patient was able to feel the surgeon working on them, feeling some pain, but was unable to move or speak. There are stories too of patients watching the surgery from above their bodies and recalling that afterwards, sometimes shocking the surgeon and nurses by making accurate remarks about the surgery.
Each person responds differently to the various drugs used for general anesthesia. Some people need higher doses, and it is part of the anesthesiologist’s job to accurately calibrate each patient’s dosage beforehand, and then to maintain that level during the surgery. Some people have life-threatening allergic reactions, such as severe swelling of the throat which blocks off breathing.
An anesthetic is different from an analgesic. An analgesic is a painkiller and can be mild and store-bought like acetaminophen or a powerful prescription drug like morphine. It removes your awareness of pain. An anesthetic blocks all sensation, not just pain.
General anesthesia is a complex and potentially dangerous service practiced by only specially-trained physicians. In ancient times, and right up through the 19th century, there must have been many cases of overdosing as experimentation went on without the sophisticated monitoring devices we have now.
History of Ophthalmology Part 1: The Ancient World
History of Ophthalmology Part 2: The Middle Ages: Spectacles
History of Ophthalmology Part 4: The Nineteenth Century: Seeing the Eye
History of Ophthalmology Part 5: The Twentieth Century: Swift Progress
History of Ophthalmology Part 6: What is a Laser?
History of Ophthalmology Part 7: Leading up to LASIK
History of Ophthalmology Part 8:LASIK Into the Twenty-First Century