It's 1844, and surgeries are brutal, agonizing, and necessary slapdash. One man promises he can make it so patients feel no pain. He proves it with a patient who screams hysterically throughout a short procedure. Here's how a side effect of laughing gas nearly strangled anesthesiology in its cradle.
Medical students at Harvard fought to cram themselves into an operating theater for an unprecedented procedure. A dentist had been making the rounds, claiming that he had a gas, nitrous oxide, that could stop a patient from feeling pain during a procedure. At that time, all surgery rooms came equipped with a table, some good strong lights, and a group of even stronger men who would hold the writhing patient down while the surgeons cut flesh and sawed through bone. Successful surgeons were fast surgeons. Not only was the pain horrible, but patients couldn't stay still, increasing the likelihood that they would rip wounds wider or cause slips of the knife.
Horace Wells, a Connecticut dentist, believed he could provide relief both for patients and for anyone who had to watch or perform such torturous procedures. Nitrous oxide, he claimed, would make the young man upon whom he was about to perform a tooth extraction, feel no pain.
The young man spent the entire procedure screaming. Wells' reputation was ruined. People became leery of the entire concept of anesthesia. It was just a form of snake-oil. (Fortunately, later demonstrations of other types of anesthetic gas went better, and the idea of pain killers during surgery caught on in a big way.)
Claiming that someone feels no pain and that their horrifying screams are just a side effect seemed a little too convenient, but that is what Wells did, and he was right. The young man whose tooth had been extracted was quick to agree that he hadn't felt pain. He had just screamed.
As more doctors experimented with nitrous oxide, they found that more people screamed - or rather, fewer people screamed, since fewer people had their teeth extracted without anesthesia, but more people screamed without feeling pain. Although nitrous oxide is called "laughing gas," it produces all kinds of outbursts. Sometimes people groan or moan, and sometimes they start screaming. Each experience can be different. One dentist noted that a twenty-six-year-old woman had a perfectly sedate first appointment, screamed once during her second appointment, and on the third appointment spent the entire procedure screaming. She didn't recall feeling any pain. During the second appointment, she said she screamed because she had had a frightening experience on an omnibus that morning, and suddenly felt like she was back on the bus. (Even today, dentists note that nitrous oxide can cause flashbacks.)
Dentists constantly experimented, varying the ratio of oxygen to nitrous oxide, trying to find something that was consistently successful. Journals recommended the specific mixes of laughing gas and oxygen that their contributors believed were least likely to provoke outbursts of screaming. One journal warned against using too much oxygen, as it made people prone to screaming and "stamping." Another was enthusiastic about adding oxygen to the mix, claiming that it caused "less frequent screaming." Yet another book stated, with confidence, "in most cases a mixture containing 12 3/4 percent of oxygen answered admirably."
Today, machines that dispense laughing gas will not allow the oxygen level to get below thirty percent, and will crank that percentage up to seventy. The exact mix is changed for every visit, and carefully calibrated to the patient and their conditions. But people still do have flashbacks, and bad reactions to laughing gas. Fortunately, those reactions aren't used as excuses to yank the teeth out of someone's head without pain killers.
Images: Wellcome Images
[Via The Dawn of Modern Anesthesia, Transaction, Journal of the British Dental Association, British Journal of Dental Science and Prosthetics, The Administration of Nitrous Oxide, Inhalation Sedation.]