Biting the Bullet. A Discussion on the Evolution of Anesthesiology Over Time

Writer: Maria Zajaczkowska

Editor: Farwa Tashin

Introduction

The history of anesthesiology is important in taking the time to consider the transformation of medicine from an agonizing and poorly organizational necessity to a safe and specialized practice. The patients who faced injuries that required surgery would be introduced to the phrase ‘biting the bullet’. This expression was used during the early 18th and 19th centuries by soldiers who were wounded in battle. These survivors would be obligated to bite on a lead bullet during in-field surgical procedures and amputations, as a method to endure the pain of being conscious. The early alternatives for sedatives evolved from herbal brews in the 18th century all the way to modern technologies such as mixtures of anesthetic compounds. Learning about all the scientific discoveries of providing relief for patients post-surgery allows for possible new discoveries to be made.

Early uses of pain management

The earliest use of an anesthetic can be traced to the medieval period, where doctors relied on natural herbs such as mandrake, cannabis, and opium to ease severe pain. Another method used was called the ‘’soporific sponge’. This sponge was used throughout the medieval period to create an alternative to the hazardous herbal concoctions. The sponge would be soaked with a diluted mixture of either a poisonous plant like hemlock or a narcotic like opium to induce an unconscious state for patients. The sponge method was one of the first forms of inhalational anesthesia used for surgery, marking an important milestone for surgical procedures free of excruciating pain.

Experimenting and enduring

The 19th century revolutionized the use of inhaled anesthesia, changing the way surgery was performed. In 1844, anesthesia practices began with the introduction of nitrous oxide followed later by ether in 1842 and chloroform in 1847. “Barbiturates”, a class of depressant drugs that slow the central nervous system, became popular throughout the 20th century(Chaturvedi 2011). The use of these drugs would bring on many hazardous long-term effects linked to addiction. The substance had several additional reports of short-term side effects such as impaired awareness due to weakened or damaged senses. Towards the end of the 20th century, technological advancements regulated use of intravenous sedatives such as benzodiazepines and propofol. The two sedatives were successful in acting as an anesthetic and providing relief. This evolution marked the beginning of major improvements in patient care, lowering the patient mortality statistics

Side effects

However, using narcotics as a method of treatment was not found to be a long-term solution. Narcotics would increase the risk of respiratory distress and lung damage. The opium would inhibit the brainstem directly, causing patients to have difficulty controlling their breathing. In some cases, this drug, when used as anesthesia, would cause apnea (Ferry,2025). Apnea is a serious disorder in which the brain stops receiving signals to breathe due to high levels of carbon dioxide build up within the blood, which can be fatal. Another side effect of opium was an increased risk of dependency on the narcotic. The consistent use of opium would result in a high tolerance, leading patients to become increasingly dependent on the substance.

“Ether day”

Anesthesia is one of the most important factors when preparing for surgery. Without anesthesia, a person could not endure nor survive such extensive trauma to the body. One of the first successful attempts at sedating a patient took place on March 30, 1842by Doctor Crawford Long. On this day, a surgical procedure was performed at his private practice in Jefferson, Georgia. The patient, James Venable, had a tumor removed from his neck and reported no pain afterwards (Thomas 1973). Dr. Long’s demonstration was the first procedure documented using ether, an inhalant for tumor removal. On October 16, 1846, a dentist named William T.G. Morton administered diethyl ether to patient Gilbert Abbott through inhalation. This method allowed Doctor John Collins Warren to surgically remove a mass growing on the side of the patient's neck. The surgery was performed at Massachusetts General Hospital and the patient reported no pain (Firth 2022). The day would later be recognized as “Ether day”, and publicized the use of standardized anesthesia during medical procedures. This day would be revolutionary in setting the standard of modern anesthesia and prioritizing the comfort of patients.

Progression of current modern advancements

In present day medical procedures, a precise and efficient anesthetic agent is a part of every surgical routine. Modern anesthesia uses intravenous drugs in which the medication is directly delivered through a needle and into the vein. This method allows for immediate relief and a significant reduction in side effects. Propofol is just one example of the discussed drugs. Sevoflurane or desflurane are examples of gases that are inhaled as a form of analgesic. Medications such as fentanyl are examples of opioids that are now used to provide relief for post surgical treatment. Lidocaine and other local anesthetics are used for local blocks, where only the specific body part is numbed for the procedure being done.

Conclusion

The evolution of anesthesiology has been a long journey towards painless and safe surgical procedures. With new technologies like machine learning being developed, medical professionals are able to use algorithms to predict patient responses to certain drugs and pain levels. Anesthesia has been developed for easier transition after the procedure where patients are able to recover in a much shorter time and much faster. Anesthesiology continues to improve through advancements in different chemical combinations and technologies to better curate a patient's medical plan with comfort as its number one priority.

References:

1. Chaturvedi, Ravindra, and R. L. Gogna. “Ether day: an intriguing history.” Medical Journal Armed Forces India, vol. 67, no. 4, Oct. 2011, pp. 306–308. PubMed Central, doi:10.1016/S0377-1237(11)60098-1. PMCID: PMC4920664

2. Ferry, Nicolas, et al. Opioid Anesthesia. StatPearls [Internet], StatPearls Publishing, Jan. 2025–, updated 6 July 2025, https://www.ncbi.nlm.nih.gov/books/NBK532956/

3. Firth, Paul G. “Ether Day Revisited: The Surgical Records of Edward Gilbert Abbott.” Annals of Surgery Open, vol. 2, 2022, article e166, Wolters Kluwer Health, Inc., doi:10.1097/AS9.0000000000000166. Mayo Clinic History & Heritage, Oct. 2024, https://history.mayoclinic.org/wp-content/uploads/2024/10/ETHERD1.pdf

4. Lee, J. A, and R. S Atkinson. “The History of Anesthesia.” A Synopsis of Anesthesia. 7th Ed. Bristol: Wright, 1973. Print.

5. Thomas, Roger K. “Crawford W. Long’s Discovery of Anesthetic Ether: Mesmerism, Delayed Publication, and the Historical Record.” Psychology Department, University of Georgia, 16 Mar. 2016, https://www.psychology.uga.edu/sites/default/files/inline-files/LongEther16March2016.pdf