Anesthesia

by

Stephanie Snow

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0032

Introduction

The introduction of anesthesia in the 1840s in North America and Europe marked the beginnings of modern anesthesia and led to the establishment of the first, reliable method of pain-relief for surgery and childbirth. It came at a time when managing physical pain during surgery was a pressing problem for surgeons who had developed knowledge and techniques enabling more complicated and lengthy procedures than patients’ toleration of pain would allow. Initially anesthesia, using ether or nitrous oxide, was a highly contingent innovation and it was only after the Scottish physician James Young Simpson (b. 1811–d. 1870) established the anesthetic properties of chloroform in 1847 that it became widely used. Its introduction was fraught as relieving patients of surgical pain bucked older understandings that pain had a positive role to play as a stimulant for the body during the stress of an operation, and in childbirth numbing the pain of contractions was thought to increase the risk of complications. Moreover, pain was understood to have moral value in religious doctrine, especially the pain of childbirth. Between the 1840s and the 1880s anesthesia became established in Europe and North America, spurred on by the rapid extension of surgery to body cavities, including the chest, brain and abdomen, that followed the British surgeon Joseph Lister’s (b. 1827–d. 1912) development of antisepsis during the 1860s, which used chemicals to kill the germs that caused infections. Nevertheless, there was significant divergence between the choice of agent—ether, chloroform, or nitrous oxide—and the technique of administration—cloth or apparatus. By the 1890s, anesthesia had recalibrated social and medical understandings of pain and it was hailed as one of the great discoveries of the Victorian age though risks of fatalities remained. The twentieth century saw important developments in the introduction of muscle relaxants, new techniques of intubation, and the concept of balanced anesthesia was developed. This required practitioners to draw on a range of drugs that effected different functions including pain relief, muscle relaxation, amnesia, and sedation. The two world wars contributed to raising the status of anesthesia, standardizing practice and leveraging funding and support for the specialty which led to academic anesthesia emerging in the United Kingdom, the United States, and other parts of the world. From the 1950s new, halogenated agents were introduced, patient monitoring techniques improved, and anesthesia extended into sub-specialties including pain management and intensive care. Now, anesthesia is embedded in medical processes across the world, but questions remain about the exact nature of pain and the mechanism of unconsciousness.

General Overviews

The historiography of anesthesia has long been dominated by practitioner histories. Rushman, et al. 1996, Sykes 1960–1982, and Thomas 1975 focus on questions of discovery claims, apparatus, agents, the physiological process, and adopt, unsurprisingly, a celebratory tone. The first International Symposium on the History of Anesthesia was held in 1985 with Rupreht, et al. 1985 publishing the proceedings. Duncum 1946, published in the centenary year of the introduction of ether, was the first scholarly consideration of anesthesia from its origins in the 1840s to the beginning of the twentieth century. Duncum contextualized anesthesia within the wider changes across science, medicine, and society and established key themes such as the innate risks of chloroform compared to ether, divergence in practice across geographical areas and timelines, and the education of practitioners. Historians have generally stayed within this time period and the historiographical focus has centered mainly on the United Kingdom and the United States. Anesthesia has proved to be a rich lens for exploring themes which link to the wider social, political, and scientific history of medicine. Lawrence and Lawrence 1987 and Snow 2006 offer useful considerations of shifts in the understandings of pain, changing patient-practitioner relationships, critiques of the medicalization of birth, the growth in medical specialization, and the emergence of scientific medicine. Pernick 1985 uses anesthesia as a case study of the risks versus benefits of medical innovations. Historians have engaged much less with twentieth century and contemporary anesthesia though practitioner histories chart developments through the twentieth century with the two world wars presented as key turning points. Most literature covers the introduction and establishment of anesthesia in North America and Europe but the edited volume Eger, et al. 2015 is notable for spanning the 1840s to the 2010s and includes contributions from more than one hundred authors from all parts of the world. It thereby establishes the beginnings of a global history of anesthesia with a welcome broadening into new places including Japan, China, and Mexico. This important geographical diversification in the history of anesthesia is supported by Onajin-Obembe and Elegbe 2018 (Nigeria); Wessels, et al. 2017 (South Africa); and Wilson, et al. 2004 (Australia).

• Onajin-Obembe, B.O.I., and E. O. Elegbe. “The History of Anaesthesia in Nigeria.” African Journal of Anaesthesia and Intensive Care 18.1 and 2 (2018): 1–9.

  Covers the establishment of anesthesia as a specialty in Nigeria including training and legal and regulatory frameworks.

• Duncum, Barbara M. The Development of Inhalation Anaesthesia. London: Oxford University Press, 1946.

  The first scholarly work on the history of anesthesia which remains an excellent starting point for information on the development of apparatus and techniques in the wider context of scientific developments across Europe and North America. Identifies key themes such as geographical variations and divergences and the ongoing debates over anesthetic fatalities and the various inquiries into chloroform deaths.

• Eger, E. I., R. N. Westhope, and L. J. Saidman, eds. The Wondrous Story of Anaesthesia. New York: Springer, 2015.

  A comprehensive volume of the history of anesthesia which covers its introduction in the 1840s through to the 2010s with unparalleled geographic spread.

• Lawrence, C., and G. Lawrence. No Laughing Matter: Historical Aspects of Anaesthesia. London: Wellcome Institute for the History of Medicine, 1987.

  Catalogue of an exhibition organized by the Wellcome Institute for the History of Medicine and the Science Museum. The introduction and overviews to catalogue entries offer condensed insights into the historiography of anesthesia and draw attention to many areas that continue to remain ripe for historical investigation.

• Pernick, Martin S. A Calculus of Suffering: Pain, Professionalism and Anesthesia in Nineteenth-Century America. New York: Columbia University Press, 1985.

  One of the best explorations of the introduction of anesthesia within the wider context of US 19th-century medicine. Coming at a time of intraprofessional conflict, Pernick argues that conservative physicians developed a new calculus of suffering which enabled the use of anesthetics on a risks versus benefits basis and marked a new approach to medical practice in the United States.

• Rupreht, J., M. J. van Lieburg, J. A. Lee, and W. Erdmann, eds. Anaesthesia: Essays on Its History. Berlin: Springer-Verlag, 1985.

  Outputs from the first international symposium on the history of anesthesia held in 1985. Useful for identifying specific developments in agents, apparatus, and techniques with good spread across anesthetic practice in Europe. International symposia on the history of anesthesia continue to be held to the present day with proceedings being published in the form of edited volumes.

• Rushman, G. B., N. J. H. Davies, and R. S. Atkinson. A Short History of Anaesthesia: The First 150 Years. Oxford: Reed, 1996.

  A concise survey of key moments in the history of anesthesia from the 1840s to the 1990s.

• Snow, Stephanie J. Operations without Pain: The Practice and Science of Anaesthesia in Victorian London. Basingstoke, UK: Palgrave Macmillan, 2006.

  A nuanced account of the introduction and dissemination of anesthesia. Explores the wide debates across medical and public spheres on the use and safety of anesthesia, showing how by the 1860s, anesthesia was accepted as a natural though not unproblematic accompaniment to surgery and dentistry, and was established as a specialty by 1900.

• Sykes, W. S. Essays on the First Hundred Years of Anaesthesia. 3 vols. Edinburgh: Livingstone, 1960–1982.

  DOI: 10.1097/00132586-196012000-00047

  A useful overview of key figures and debates in anesthesia.

• Sykes, Keith, and John Bunker. Anaesthesia and the Practice of Medicine: Historical Perspectives. London: Royal Society of Medicine Press, 2007.

  Maps how anesthesia developed through the twentieth century and integrated with other areas of medical practice to develop sub-specialties including chronic pain management and intensive care.

• Thomas, K. Bryn. The Development of Anaesthetic Apparatus. Oxford: Association of Anaesthetists, 1975.

  A comprehensive survey of the development of apparatus from the 1840s to the 1970s.

• Wessels, Q. B., J. C. Correia, and A. M. Taylor. “The Early History of Ether Anaesthesia in the Cape Colony, South Africa.” Vesalius 23.2 (2017): 52–62.

  A useful account of the take-up of ether as an anesthetic in South Africa.

• Wilson, Gwen, Alison Holster, and Jeanette Thirlwell Jones. One Grand Chain: A History of Anaesthesia in Australia:1846–1962. Melbourne: Australian & New Zealand College Of Anaesthetists, 2004.

  A welcome geographical broadening of the historiography from a practitioner which charts the take-up of anesthesia in Australia though sadly there are few references.