How Did Doctors Operate Before Anesthesia?

In 1811, the English novelist Frances Burney was living in France when she received a distressing diagnosis. At 59 years old, Burney had breast cancer. The disease would certainly be fatal unless—her French doctors proposed—Burney was willing to undergo a mastectomy.  

Surgical anesthesia had not yet been invented and wouldn’t be for nearly another 50 years. The harrowing prospect of being cut open while fully conscious and fully sensitive to pain filled Burney with a sickening dread. Yet like countless other desperate individuals before her, she was willing to experience unimaginable agony in order to preserve her life.   

On the day of her surgery, Burney would have been blindfolded and held down by four or more “dressers” whose chief job was to physically restrain the patient while the surgeon did his gruesome work as quickly as possible. For Burney, every second was nothing short of torture.  

“[W]hen the dreadful steel was plunged into the breast—cutting through veins, arteries—flesh—nerves—I needed no injunctions not to restrain my cries,” wrote Burney to her sister. “I began a scream that lasted unremittingly during the whole time of the incision—and I almost marvel that it rings not in my ears still! so excruciating was the agony.” 

The shock of the pain was so intense that Burney lost consciousness twice, but incredibly, the operation was a success. She healed and lived another 29 years. Burney was among the lucky few who survived a major surgical procedure in an era before anesthesia or an understanding of germ theory.  

“There's always a debate about what were the most important moments in human history but certainly pain relief in the mid-19^th century was one of the greatest,” says Ira Rutkow, a retired surgeon and medical historian. “That was followed 40 years later by the discovery of bacteria and viruses.” 

For centuries before those scientific landmarks, surgery was an excruciating ordeal reserved for life-threatening cases. Doctors could only operate on things they could see—badly broken bones, rotten teeth, tumors close to the surface—and wouldn’t dare to attempt internal surgery.   

“The concept of operating on something inside the brain or the chest, that was unthinkable,” says Rutkow, author of Empire of the Scalpel: A History of Surgery. “They didn't know the anatomy. They didn't know how to stop bleeding. They didn’t have pain relief. They certainly didn't know anything about infections. So those areas of the body were off limits.” 

Medical historians recognize October 16, 1846 as a turning point in surgical history, when two American doctors painlessly removed a lump from a patient’s jaw using ether, the world’s first effective anesthetic. For thousands of years before that, doctors and healers around the world experimented with herbs, plants and even prayers that would relieve at least some of the agonizing pain of surgery.  

As early as 4000 B.C., the Sumerians harnessed the analgesic effects of the opium poppy, the active ingredient in morphine. The legendary Chinese physician Hua Tuo, who lived at the turn of the third-century A.D., gave his surgical patients an herbal cocktail called Mafeisan, which may have included cannabis, wine and wolfsbane, which contains a powerful and potentially deadly neurotoxin. 

Nearly 1,000 years before ether and chloroform were first inhaled as surgical anesthetics, the Persian physician Ibn Sina (A.D. 980–1037) recorded a similar pain relief technique called the “soporific sponge.” A bundle of rags was soaked in a potent herbal concoction (recipes contained mandrake, henbane, opium and wine) and held under the nose of the patient, inducing what later Islamic physicians called “The Great Rest.”  

In ancient Peru, a type of cranial surgery called trepanation was surprisingly common. Used to treat head injuries and even headaches, trepanning involved making an incision in a patient’s scalp and drilling a small hole in the skull to relieve pressure. John Verano, an anthropologist who has studied hundreds of trepanned Peruvian skulls, thinks that Incan and earlier cultures may have used a corn beer called chicha to relax the patient (and possibly the surgeon), but dismisses the idea that coca leaves provided significant pain relief.  

“Coca leaves may have been chewed during the operation—people say it calms you down,” says Verano, author of Holes in the Head: The Art and Archaeology of Trepanation in Ancient Peru. “But coca is a mild stimulant. It's not an anesthetic, by any means. It doesn't put you out.” 

For surgeons operating without anesthesia, time was the enemy. The longer a patient was on the table, the greater their suffering and the greater the chance that they would die from blood loss or shock.  Amputations were the true test of any surgeon worth his salt in the early 19th century. The quicker the surgery, the better the odds that the patient would survive.  

“By the 19th century, doctors knew anatomy and they knew how to stop the bleeding, but they couldn't stop the pain, so they would try to perform an amputation of an arm or a leg in 25 seconds,” says Rutkow. “In less than 30 seconds, that leg was gone.” 
 

In the 1840s, the famed British surgeon Robert Liston would storm into his London operating theater and cry out, “Time me, gentlemen! Time me!” He could cut open a patient’s leg with a straight knife and saw straight through the bone in 25 seconds. To save time, he reportedly held the bloody knife in his teeth.  

Five out of six of Liston’s amputees survived, an impressive success rate for the time, but Liston’s incredible speed could come at a cost. During one historically botched procedure, Liston accidentally cut off the fingers of one of the dressers holding the patient down. According to the BBC, both the patient and the dresser died from infections and a third observer died of shock.   

Just a few years before ether and chloroform revolutionized medicine, one of the most buzzed-about methods for achieving painless surgery was hypnosis, originally known as mesmerism. 

Franz Anton Mesmer (1734-1815) was an Austrian physician who developed a theory that all illness and disease could be cured by manipulating a “universal fluid” within the body. Mesmer began by working with magnets, but then turned to “animal magnetism,” his term for a type of hypnosis that put patients into a deep sleep. 

Mesmerism as a medical practice was widely discredited in the 18th century, but it experienced a popular revival in 1840s England as a form of anesthesia. British physician John Elliotson promoted mesmerism in the pages of The Lancet and performed surgery on mesmerized patients in front of London audiences that included Charles Dickens and Michael Faraday. 

Inspired by Elliotson, surgeon James Esdaile opened the Calcutta Mesmeric Hospital in India, where he used hypnosis to sedate patients undergoing amputations, cataract surgeries and the removal of scrotal tumors.  

Mesmerism had vocal critics in the medical establishment, including Robert Liston, the speedy surgeon. When Liston first got his hands on ether in December 1846, he used it to sedate a patient undergoing a leg amputation. When the patient woke up after the operation, he asked Liston, “When are you going to begin?”  

Floored by the power of ether, a revolutionary new anesthetic from America, Liston proclaimed, “This Yankee dodge, gentlemen, beats mesmerism hollow.”