The Day the Universe Changed - James Burke [107]
An audience enjoys the effects of nitrous oxide, which the speaker has passed around in gas-filled bladders. Davy’s lectures were more sober affairs, and became fashionable social occasions.
A contemporary illustration showing one of the first uses of anaesthesia in Boston. The patient is breathing the gas through a tube attached to a flask containing liquid ether.
Major surgery was no longer a hideously painful experience during – or after – which the patient would most likely die from shock and in terrible pain. Moreover, with his patients unconscious the surgeon could now attempt what had previously been unthinkable: he could open major body cavities such as the thorax and the abdomen. Such operations had until then invariably ended in death. Anaesthetics had transformed medicine, though not altogether for the better.
Since doctors were now more readily inclined to operate they were also more interested in discovering more about the body on which they could perform curative incisions. Medical technology was stimulated. Hypodermic needles had been available since 1840. In 1844 John Hutchinson adapted an idea of James Watt’s for measuring vital capacity in the respiration of healthy adults. In 1848 came Karl Ludwig’s kymograph, which traced pulse beats on a graph. From 1850 photography became increasingly available for the recording of clinical data. In 1855 Karl Vierordt produced a means of recording blood pressure through measurement of the weight needed to block a pulse at the wrist.
The technique most encouraged by the existence of anaesthetic, however, was that of endoscopy. Chloroform or ether rendered painful incursions such as rectal examination much more bearable. In 1850 the otoscope was developed for internal examination of the ear. In 1851 Hermann von Helmholtz was studying the various attempts which had been made to look inside the eye, including the work of Jan Purkinje, who had found that the retina reflected light. Helmholtz placed the source of light and the observer’s eye at the same point in his new ophthalmoscope and thus made it possible to examine the interior of the living eye.
Czermak’s laryngoscope in use. Note the candlelight reflected into the patient’s throat by the mirror gripped in the doctor’s teeth.
In 1855 a singing teacher in London used a double mirror to reflect sunlight down the throat. Two years later, in Vienna, the operatic centre of Europe, a Polish physiologist called Johann Czermak added an artificial light source, reflected from a mirror on the observer’s head on to a hand mirror held in the patient’s throat. With this new laryngoscope operations could be carried out on the vocal chords. In the first one carried out on a member of the Austrian royal family a small tumour was successfully removed with the aid of a wire loop.
As the decade progressed, advances were made in systems for internal examination of the bladder, the vagina, the rectum and the stomach. The new watchword was: ‘Not seeing is not believing.’
The problem created by all these new aids to surgery was that as the number of operations increased so too did the death rate. The conditions under which surgeons worked and patients recuperated were in most cases more dangerous than the knife. In early mid-century Florence Nightingale described what she had seen in hospital wards where sixty patients occupied a single room: ‘Floors… of ordinary wood… saturated with organic matter… walls of plaster