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 utopian surgery early arguments against anaesthesia in surgery, dentistry and childbirth introduction historical background the case for pain the conquest of suffering nociception without tears crossing the threshold introduction before the advent of anaesthesia , medical surgery was a terrifying prospect. its victims could suffer indescribable agony . the utopian prospect of surgery without pain was a nameless fantasy - a notion as fanciful as the abolitionist project of life without suffering still seems today. the introduction of diethyl ether ch 3 ch 2 och 2 ch 3 (1846) and chloroform chcl 3 (1847) as general anaesthetics in surgery and delivery rooms from the mid-19th century offered patients hope of merciful relief. surgeons were grateful as well: within a few decades, controllable anaesthesia would at last give them the chance to perform long, delicate operations. so it might be supposed that the adoption of painless surgery would have been uniformly welcomed too by theologians, moral philosophers and medical scientists alike. yet this was not always the case. advocates of the "healing power of pain" put up fierce if disorganised resistance. the debate over whether to use anaesthetics in surgery, dentistry and obstetrics might now seem of merely historical interest. yet it is worth briefly recalling some of the arguments used against the introduction of pain-free surgery raised by a minority of 19th century churchmen, laity and traditionally-minded physicians. for their objections parallel the arguments put forward in the early 21st century against technologies for the alleviation or abolition of " emotional " pain - whether directed against the use of crude "psychic anaesthetisers" like today's ssris , or more paradoxically against the use of tomorrow 's mood-elevating feeling- intensifiers i.e. so-called "empathogen-entactogens", hypothetical safe and long-acting analogues of mdma . it's worth recalling too that early critics of surgical and obstetric anaesthesia weren't (all) callous reactionaries or doctrinaire religious fundamentalists. nor are all contemporary critics of the use of pharmacotherapy to treat psychological distress. the doubters, critics and advocates of caution were right to consider the potential diagnostic role of pain - and to emphasise that the risks , mechanisms and adverse side-effects of the new anaesthetic procedures were poorly understood. in victorian britain, around 1 in 2500 people given chloroform anaesthesia died directly in consequence. around 1 in 15,000 died as a direct result of being administered ether. this statistic pales beside the proportion that died from post-surgical infection ; but it compares with the present-day mortality figure of 1 in around 250,000 people who die as a direct result of undergoing surgical anaesthesia in the uk. safe and sustainable total anaesthesia that is 100% reliable - and reliably reversible - is as hard to achieve as safe and sustainable analgesia , euthymia , or euphoria . yet the technical and ideological challenges ahead in banishing suffering from the world shouldn't detract from the moral case for its abolition . * * * historical background the effect of inhaling ether, chloroform, nitrous oxide and similar agents was christened by the physician-poet oliver wendell holmes , sr (1809-94). in a letter to etherization pioneer william morton , who had solicited his opinion, holmes coined the words "anæsthetic" and "anæsthesia" from the greek an for "without" and esthesia for "sensibility". holmes once remarked that if the whole pharmacopoeia of his era "were sunk to the bottom of the sea, it would be all the better for mankind, and all the worse for the fishes"; but he knew anaesthetics were a spectacular exception. strictly speaking, the word for anaesthesia wasn't new - the greeks themselves occasionally used the term, notably the herbalist physician and surgeon dioscorides (c.40-c.90 ad). it had been revived on more than one occasion since: bailey's english dictionary (1724) defines anaesthesia as "a defect of sensation". but holmes was the first to propose the term to designate the state of unconsciousness induced by gas-inhalation for painless surgery. holmes apparently thought hard about his recommendation, and urged morton to consult with other scholars too. for he recognised that as news of the revolution spread like wildfire across the globe, the term would be "repeated by the tongues of every civilized race of mankind." the concept of pain-relief and even total insensibility for surgery wasn't original or unfamiliar. however, for thousands of years its reliable prospect had seemed impossibly utopian - as unrealistic as a future of lifelong bliss seems at present. the single or combined use of stupefying agents such as ethyl alcohol , mandragora , cannabis and opium to deaden the sensibilities prior to surgery had been practised in classical antiquity. herodotus (c.484-c.432 bc) relates how the scythians induced stupor by inhalation of the vapours of some kind of hemp , a remarkable if apocryphal feat in the low- thc era before superskunk . inhaling vapours to alter one's state of consciousness was practised too by the pythonesses of delphi , sacred female oracles who breathed in vapours from a rock crevice in the course of their priestly duties. however, inhalation was performed for the purposes of divination rather than anaesthesia. egyptian surgeons apparently half-asphyxiated children undergoing circumcision by first almost strangling them. this practice sounds almost as barbarous as the operation itself. centuries later, saint hilary bishop of poitiers (315-367), exiled to the orient in 356 a.d. by the roman emperor constantius, described drugs that "lulled the soul to sleep". but if they were administered in adequate dosage, there was a risk that the soul would not wake up, in this world at least. apuleius, a 5th century compiler of medical literature, recommends that “if anyone is to have a member mutilated, burned or sawed let him drink half an ounce with wine, and let him sleep till the member is cut away without any pain or sensation.” unfortunately, extreme pain tends to exert a sobering effect. a few mediaevals were surprisingly resourceful. the 13th century occultist, alchemist and learned physician arnold of villanova (c.1238-c.1310) searched for an effective anaesthetic. in a book usually credited to him, a variety of medicines are named and different methods of administration are set out, designed to make the patient insensible to pain, so that "he may be cut and feel nothing, as though he were dead." for this purpose, a mixture of opium, mandragora, and henbane was to be used. this method was similar to inhaling the vapours of the soporific sponge mentioned around 1200 by nicholas of salerno, and sporadically in different sources from the 9th to 14th centuries. arnold's recipe was modified by the dominican friar theodoric of lucca (1210-1298), who added the mildly narcotic juice of lettuce, ivy, mulberry, sorrel and hemlock to the opium-mandragora mixture. from this decoction, a new soporific sponge would be boiled and then dried; when needed again, it was dipped in hot water and applied to the nostrils of the afflicted. the typical effect still left much to be desired: general anaesthesia avant la lettre was more of an aspiration than an achievement. yet if the outcome was often disappointing, so too are the response- and remission-rates for drugs licensed to treat emotional distress in the era of big pharma . other painkilling techniques for surgery had a longer pedigree. blood-letting undoubtedly relieved pain, though it was carried out to dangerous and often fatal excess. before the invention of the suture or stitch in the 16th century by the french military surgeon ambroise paré (c.1510-1590), patients undergoing surgery frequently died - either because of bleeding or as a result of the method used to close the wound. wound-closure us

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