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Going under: The history and mechanisms of general anesthesia · Daniel and Kelly’s Extraordinary Universe

0:00
Speaker 1: Hello, friends, just a heads up that on today's episode,
0:02
Speaker 1: we're going to be talking about the history of anesthesia.
0:05
Speaker 1: We'll also be discussing medical procedures in the pre anesthesia era,
0:09
Speaker 1: and we'll touch on triggering topics like mental health crises
0:13
Speaker 1: and suicides. Since one of my best friends is a
0:24
Speaker 1: physicist who likes to get philosophical from time to time,
0:28
Speaker 1: I sometimes find myself in discussions about time travel, which
0:31
Speaker 1: inevitably bring up the question of when in space and time.
0:35
Speaker 2: I'd like to be alive.
0:36
Speaker 1: If it were up to me, it would be amazing
0:39
Speaker 1: to see early human species create complex tools, or communicate
0:43
Speaker 1: complicated ideas to each other for the first time, or
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Speaker 1: sit at a table with Antoine von Lewinhook and ask
0:50
Speaker 1: him how to pronounce his name correctly while looking through
0:53
Speaker 1: his microscope, to see microscopic creatures swimming around in a
0:57
Speaker 1: drop of water, or to sit in the hall at
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Speaker 1: the Royal City Society when Charles Darwin and Alfred Russell
1:02
Speaker 1: Wallace's theory of natural selection is shared publicly for the
1:05
Speaker 1: first time. Any of those moments would be amazing to
1:08
Speaker 1: witness firsthand, But my answer is way more practical. I
1:13
Speaker 1: want to be alive in a time and place that
1:15
Speaker 1: has good sanitation, antibiotics, and critically anesthesia. Doctor Lindsay Fitzharris
1:22
Speaker 1: is a medical historian and author, and the prologue to
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Speaker 1: her book The Butchering Art makes it incredibly clear why
1:28
Speaker 1: living in the age of anesthesia is super awesome. Here,
1:32
Speaker 1: I'm going to recall a story from the beginning of
1:34
Speaker 1: her book. It was December twenty first, eighteen forty six,
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Speaker 1: and the crowd of medical professionals and spectators were settling
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Speaker 1: in to the operating theater at London's University College Hospital.
1:45
Speaker 1: In the middle of the room was a blood soaked table.
1:48
Speaker 1: The floor was covered in sawdust to soak up the
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Speaker 1: anticipated forthcoming pools of blood. Surgery on that day would
1:56
Speaker 1: be performed by the famous doctor Robert Liston, who was
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Speaker 1: well known for completing surgeries in thirty seconds or less.
2:03
Speaker 1: And we know that it took thirty seconds or less
2:05
Speaker 1: because he often started his surgeries by proclaiming time me, gentlemen,
2:10
Speaker 1: time me. Now, if you have a limb that needs
2:13
Speaker 1: to be amputated, you can be forgiven for wanting to
2:16
Speaker 1: get it done by the guy who does.
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Speaker 2: It in under a minute.
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Speaker 1: But speed sometimes came at the cost of accuracy, as
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Speaker 1: Liston once coupled a like amputation with an accidental testicle ectomy.
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Speaker 1: Most people avoided surgeries at all costs. Not only was
2:31
Speaker 1: it an absolutely miserable experience to be held down by
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Speaker 1: surgeon assistants while you were cut into, but if that
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Speaker 1: experience didn't kill you, subsequent infection often did. As this
2:42
Speaker 1: was in the era before sterile technique and antibiotics, and
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Speaker 1: it was gruesome to watch too. Physician James Simpson once
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Speaker 1: fled an operating theater because it was too much for
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Speaker 1: him to watch a breast removal surgery. After escaping the theater,
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Speaker 1: he proclaimed that he would instead study law. He did, however,
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Speaker 1: go on to complete medical training, and we'll hear more
3:01
Speaker 1: about his pioneering work on anesthetics for childbirth later in
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Speaker 1: the episode. But anyway, on this day, in front of
3:07
Speaker 1: a crowded theater, Liston was trying the anesthetic ether for
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Speaker 1: the first time. A thirty six year old butcher who
3:13
Speaker 1: needed a leg amputation was laying on the bench and
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Speaker 1: the ether was administered, knocking him out. The leg was
3:20
Speaker 1: quickly sawed off, the arteries tied off, and the flesh
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Speaker 1: closed up. All this was completed in just a few minutes.
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Speaker 1: When the groggy patient came to, he looked at Liston
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Speaker 1: and asked, when would the surgery begin?
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Speaker 2: Amazing. Welcome to Daniel and Kelly's Extraordinary Universe.
3:52
Speaker 3: Hi. I'm Daniel. I'm a particle physicist, and my most
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Speaker 3: terrifying experience with anesthesia was having my ten year old
4:00
Speaker 3: old son go under.
4:01
Speaker 4: Oh.
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Speaker 2: Hi, I'm Kelly Waitersmith.
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Speaker 1: I study space and parasites, and thus far, none of
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Speaker 1: my kids have had to go under anesthesia. I've had
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Speaker 1: anesthesia make me vomit and embarrass myself many times, but
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Speaker 1: I've never never been scared about it. What was so
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Speaker 1: scary about your kid going under.
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Speaker 3: The fact that nobody knows what they're doing or how
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Speaker 3: it works. And they're like, there's a pretty good chance
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Speaker 3: he'll wake up, And we're like, what.
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Speaker 1: Dan, you know it's more than just a pretty good chance. Like,
4:27
Speaker 1: we've got a lot of experience with this by now.
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Speaker 3: Yeah, we have played a resturan roulette with this many
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Speaker 3: many times, and mostly people survive, and that all is
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Speaker 3: fine scientifically, But when it's your kid going under, it's
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Speaker 3: an emotional decision and probabilities and statistics are irrelevant. Yeah,
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Speaker 3: it's just terrifying.
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Speaker 1: Yeap, Have you ever said anything particularly stupid coming out
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Speaker 1: of anesthesia?
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Speaker 3: That assumes I don't say stupid things when I'm not
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Speaker 3: under anesthesia, So I think my distribution of intelligence and
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Speaker 3: stupid doesn't change. How about you? Have you said absurd
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Speaker 3: stuff coming out of anesthesia?
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Speaker 1: I don't remember, but Zach told me that after I
5:07
Speaker 1: came out of a procedure, I just kept asking was
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Speaker 1: I polite to everyone? Was I polite to everyone? And
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Speaker 1: I just kept asking. I was really panicking about whether
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Speaker 1: or not I was polite to everyone, and Zach said
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Speaker 1: I was fine, and then I threw up. But I
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Speaker 1: didn't feel the procedure, which is great.
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Speaker 3: Well, I'm sure you're always polite to even when you're
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Speaker 3: in pain or when you're out of it.
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Speaker 2: Thanks. Yeah, apparently I really worry about that.
5:33
Speaker 3: And I'm sure that today you're going to give us
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Speaker 3: a very painless tour of the history of anesthesia, what
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Speaker 3: we know about it, how we've discovered it, and how
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Speaker 3: many humans have suffered unnecessarily through history.
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Speaker 1: Yes, well, I am attempting today to politely answer a
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Speaker 1: wonderful question from our listener Eric, and let's go ahead
5:49
Speaker 1: and hear that question.
5:50
Speaker 2: Now.
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Speaker 5: Hey, there's a whole lot of important stuff that we
5:53
Speaker 5: don't fully understand. Tangents as part of the plain episode
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Speaker 5: was my favorite part. I think I remember ones that
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Speaker 5: we don't really know how anesthesia works?
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Speaker 3: Is that true?
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Speaker 5: Seems like a cool episode idea history of anesthesia back
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Speaker 5: when getting someone really drunk was the best we could do,
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Speaker 5: to what we do now and if we actually understand it,
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Speaker 5: to the differences between anesthesia and sleep.
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Speaker 3: Thanks.
6:16
Speaker 1: Oh my gosh, there are so many cool topics in
6:18
Speaker 1: that question. I got to go down so many amazing
6:21
Speaker 1: rabbit holes. And if you would like to submit a
6:24
Speaker 1: question about whatever it is that keeps you up at night,
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Speaker 1: please send us those questions at questions at danieland Kelly
6:31
Speaker 1: dot org.
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Speaker 3: This question makes me wonder how much we do and
6:35
Speaker 3: don't know about why things work in medicine. I actually
6:39
Speaker 3: asked Katrina about this when I read this question, and
6:41
Speaker 3: she was like, you should be less surprised we don't
6:44
Speaker 3: know how tailent all works. I was like, I'm less
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Speaker 3: surprised now, but I'm more terrified. I guess all right, Like,
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Speaker 3: basically our bodies are huge Rube Goldberg machines, and we
6:55
Speaker 3: don't know how they work, but we have discovered if
6:57
Speaker 3: you press this button and pull this lever, that this
7:00
Speaker 3: thing happens, and now we rely on that for all
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Speaker 3: of modern medicine.
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Speaker 1: I think my scariest example of this, and I think
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Speaker 1: I've said this on the show before, so I'll keep
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Speaker 1: it brief. As I was talking to someone about why
7:10
Speaker 1: deep brain stimulation works, where you essentially like stick an
7:13
Speaker 1: electrode in the center of someone's brains and shock it,
7:16
Speaker 1: which is usually to stop a seizure, and they were like,
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Speaker 1: we don't know. I was like, wow, we're shocking the
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Speaker 1: insides of people's brains and we're like it works, and
7:24
Speaker 1: that's great, but why I know?
7:27
Speaker 5: I know?
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Speaker 3: And the physicist to me wants to be like really
7:29
Speaker 3: reductionists and be like, we have to understand how these
7:32
Speaker 3: things work if we're going to do them right, like,
7:34
Speaker 3: because who knows what other consequences there could be. And
7:36
Speaker 3: also it makes me wonder like, how did we figure
7:38
Speaker 3: this stuff out if we don't know how it works
7:40
Speaker 3: or what it was going to do? Have we basically
7:42
Speaker 3: just been experimenting on ourselves unethically on other people for millennia,
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Speaker 3: like this is terrible. On the other hand, like you know,
7:50
Speaker 3: you've got to make progress. It's going to be a
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Speaker 3: long time before we have an understanding of the human
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Speaker 3: body that would satisfy a physicist. And we have kids
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Speaker 3: who need anesthesia when they go under.
8:01
Speaker 1: So yeah, yeah, well, and so that's actually a really
8:03
Speaker 1: nice transition into a book that I used to do
8:06
Speaker 1: a bunch of the research for this episode. It's doctor
8:08
Speaker 1: Lawrence Altman's book, Who Goes First, And it's essentially trying
8:12
Speaker 1: to figure out who should we test this stuff out
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Speaker 1: on first to make sure that it's safe. And this
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Speaker 1: book is all about self experimentation in medicine. Basically doctors
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Speaker 1: who decided I am the right person to test it
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Speaker 1: on first because I understand the risks and I'm the
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Speaker 1: one who has the idea, and so they tested it
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Speaker 1: on themselves. And there's a lot of self experimentation in
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Speaker 1: the history of anesthesia.
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Speaker 3: Is that sort of on the down low? I know
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Speaker 3: that you're not allowed to experiment on people unless you
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Speaker 3: have all sorts of ethical reviews, et cetera. But are
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Speaker 3: there such reviews for experimenting on yourself. Can you basically
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Speaker 3: do anything you want to your own body?
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Speaker 2: Why should I start here?
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Speaker 1: So I got kind of interested in this question and
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Speaker 1: after World War Two, and I promise I won't do
8:49
Speaker 1: like nearly one hundred years of history on this question.
8:51
Speaker 1: But after World War two there was the Nuremberg Code,
8:55
Speaker 1: and this was in response to the horrible experiments that
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Speaker 1: Nazi doctors did on people in their concentration camps. And
9:02
Speaker 1: one of the things that they were encouraging was like,
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Speaker 1: if you're going to do a procedure on someone, you
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Speaker 1: need to be willing or actually you need to do
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Speaker 1: it on yourself, because that is a way to show
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Speaker 1: that like you think this is safe, you're invested, blah
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Speaker 1: blah blah.
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Speaker 2: So for a while there it was encouraged for people
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Speaker 2: to do it on themselves.
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Speaker 1: Now, you're not supposed to experiment on yourself unless you
9:20
Speaker 1: were included in the permits and protocols that you submitted
9:23
Speaker 1: to get permission. And so you can say I need
9:26
Speaker 1: one hundred subjects and the first one is going to
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Speaker 1: be me. But yeah, you're not supposed to just willing
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Speaker 1: nilly experiment on yourself. Though I have heard of people
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Speaker 1: who do that anyway.
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Speaker 3: And I wonder if once you do that, if you
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Speaker 3: break the rules, if that did is not allowed to
9:42
Speaker 3: be considered in future questions, you know, sort of like
9:45
Speaker 3: doctor Mangela's data, or if they're like, well, you have
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Speaker 3: this data, you did it already, so let's use it.
9:51
Speaker 3: You know.
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Speaker 1: I've also come a lot across a lot of examples
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Speaker 1: where people have experimented on themselves. They got the answer
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Speaker 1: they expected, and then they moved forward as so they
10:00
Speaker 1: knew what they needed to know, but it's turned out
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Speaker 1: their sample size of one was completely misleading. And I've
10:06
Speaker 1: seen this in like, you know, trials for vaccines. Yeah,
10:09
Speaker 1: not anymore, these kinds of data would not fly anymore.
10:12
Speaker 1: Just to be clear, okay, but in the past, people
10:14
Speaker 1: have like tried a vaccine on themselves, been like this
10:16
Speaker 1: worked great on me, and then distributed it widely and
10:19
Speaker 1: turned out it works very different in different kinds of bodies.
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Speaker 1: So you can learn something from a sample size of one,
10:24
Speaker 1: but then you need to follow it up with much better,
10:27
Speaker 1: much more broad trials.
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Speaker 3: So let's zoom in and talk about today's topic, which
10:31
Speaker 3: is not how the whole human body works, but how
10:33
Speaker 3: we put parts of it to sleep. Yeah, let's go
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Speaker 3: all the way back to very early history, like what
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Speaker 3: were people doing thousands of years ago when they needed
10:43
Speaker 3: to have surgery?
10:44
Speaker 1: So I don't know many thousands of years ago, but
10:47
Speaker 1: something like one to two thousand years ago. We were
10:49
Speaker 1: just trying stuff out, which is maybe not so different
10:52
Speaker 1: than what we do now, but we've got better evidence now.
10:54
Speaker 1: But so there's evidence of Chinese and Arab positions inhaling
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Speaker 1: very kinds of drugs, mixing things in alcohol, and this
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Speaker 1: apparently helped with surgery, but we've sort of lost the recipes.
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Speaker 3: The physicians were doing drugs and that helped them with
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Speaker 3: the surgery, or the patients are getting the truck.
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Speaker 1: If I needed to amputate someone's limb, maybe I would
11:16
Speaker 1: want to be not completely present for that process.
11:19
Speaker 3: But it's like past the pipe there, dude, when you're done.
11:21
Speaker 2: With this, that's right, that's right.
11:23
Speaker 1: But so we don't really have great data on what
11:25
Speaker 1: it was that they were doing, but we do have
11:27
Speaker 1: some fun stories from like French surgeons from a long
11:30
Speaker 1: time ago who would knock people out, not with drugs,
11:33
Speaker 1: but by putting a wooden bowl over someone's head and
11:36
Speaker 1: hitting it with a hammer to like literally knock you out,
11:39
Speaker 1: Oh my gosh. And then for a while, attempting to
11:42
Speaker 1: mesmerize patients, you know, like hypnotizing them was popular. But
11:46
Speaker 1: then it became clear that some people were saying this
11:48
Speaker 1: worked and they were actually just like tricking a bunch
11:50
Speaker 1: of people, so that fell out of favor. But then
11:53
Speaker 1: what is kind of frustrating is that, around seventeen ninety
11:56
Speaker 1: nine it was discovered that actuallyitrous oxide does make it
12:02
Speaker 1: so that you don't feel pain. So Humphrey Davy was
12:05
Speaker 1: he a physics guy?
12:06
Speaker 3: I don't know, I've never heard of him.
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Speaker 2: Oh gosh. I heard his name before, and I just
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Speaker 2: assumed he was a physicist.
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Speaker 1: Why did you assume he was a physicist, because people
12:15
Speaker 1: don't care about old biologists.
12:19
Speaker 4: Uh.
12:20
Speaker 3: He sounds to me like a guy who would sit
12:21
Speaker 3: on a wall and fall off.
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Speaker 2: And crack yep, yep. Oh he's a chemist.
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Speaker 3: Oh god, all right, yeah, knock him off that wall.
12:27
Speaker 2: That's right, that's right.
12:28
Speaker 1: So in seventeen ninety nine, Humphrey Davy had a job
12:31
Speaker 1: where he was experimenting on various things, and one of
12:34
Speaker 1: the things he was experimenting with was nitrous oxide. Which
12:37
Speaker 1: is also called laughing gas. And he was experimenting with
12:40
Speaker 1: his friends, who included the poet Samuel Taylor Cooleridge and
12:44
Speaker 1: doctor Peter Roget who was the guy who compiled with Thesaurus.
12:48
Speaker 1: But anyway, they were sort of like knocking themselves out
12:51
Speaker 1: with nitrous oxide, and Humphrey Davy mentioned, oh, hey, when
12:55
Speaker 1: I take this, my headaches go away and my wisdom
12:58
Speaker 1: teeth don't hurt anymore, And so he noted it could
13:01
Speaker 1: be used for surgeries to remove pain. But then he
13:04
Speaker 1: goes on and does other stuff, like he gets knighted
13:06
Speaker 1: for inventing the minors safety lamp, and he never pursues
13:10
Speaker 1: this line of reasoning. So from as early as seventeen
13:13
Speaker 1: ninety nine, we could have been using things like nitrous
13:16
Speaker 1: oxide to knock people out in surgeries. But this just
13:20
Speaker 1: sort of like disappeared into the ether and was an
13:22
Speaker 1: idea that didn't get followed up on chemists.
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Speaker 3: Oh my gosh, what are you doing keeping secrets of
13:28
Speaker 3: painless surgery from the masses?
13:30
Speaker 1: Well, I mean no, he shared this result like in
13:33
Speaker 1: a report, but then he moved on to other things.
13:36
Speaker 2: But you know, let's both agree that chemists could be
13:38
Speaker 2: doing better.
13:39
Speaker 3: So before seventeen nine nine, before the discovery of nitrous oxide,
13:43
Speaker 3: people would just like Grin and Barrett, you know, they
13:45
Speaker 3: would like drink whiskey or smoke cannabis or pull from
13:48
Speaker 3: the opium pipe. It must have meant that a lot
13:51
Speaker 3: of people like avoided necessary surgeries because they were just like, yeah,
13:54
Speaker 3: it's just not worth it.
13:55
Speaker 1: Yeah, So literally you would be you know, you'd take
13:57
Speaker 1: a couple shots of some alcohol. Of big dudes would
14:01
Speaker 1: be brought in to hold you down, and then the
14:03
Speaker 1: surgeon would try to do things as fast as they could.
14:06
Speaker 1: And so surgeons were often picked not for their skill
14:10
Speaker 1: but for their ability to saw through things really super fast.
14:14
Speaker 1: Lindsay Fitzharris has this great book called The Butchering Art
14:17
Speaker 1: that included a bunch of stories of really horrible things,
14:20
Speaker 1: like a surgeon who was trying to cut through a
14:23
Speaker 1: leg and did it really fast and also took half
14:25
Speaker 1: of a scrotum with the leg and no bonus, I
14:30
Speaker 1: guess not for the guy who was under the knife.
14:34
Speaker 1: But yeah, So there were a lot of surgeries that
14:36
Speaker 1: they wouldn't do. Like maybe they had an inkling that
14:38
Speaker 1: surgery would help in this case, but it was a
14:41
Speaker 1: procedure that just would have been too hard to hold
14:43
Speaker 1: someone down for they might have lost too much blood.
14:45
Speaker 1: And so only the things that could be done fast
14:48
Speaker 1: were done, and they were done by people who were
14:50
Speaker 1: moving quickly, perhaps at the expense of moving carefully.
14:53
Speaker 3: Right, maybe it's more of a last ditch option.
14:55
Speaker 2: Oh god, yeah.
14:56
Speaker 3: Well, But as a research and nerd, I'm curious, how
14:59
Speaker 3: do we know these things about the earliest surgeries, Like
15:02
Speaker 3: do we have written records from China or you know,
15:07
Speaker 3: the Islamic world, or what is the sort of earliest
15:09
Speaker 3: record we have of medicine and surgery.
15:12
Speaker 1: So the earliest record that I came across while doing
15:14
Speaker 1: the research was two hundred CE where a Chinese physician
15:18
Speaker 1: was mixing alcohol with some other stuff. But the references
15:22
Speaker 1: that I read never included and we learned this from
15:25
Speaker 1: an ancient scroll that was found in such and such
15:28
Speaker 1: tomb or something like that. So I don't know the
15:30
Speaker 1: history of how this information came to be known, but
15:33
Speaker 1: I do know that more recently, for example, some of
15:36
Speaker 1: the stuff I'm going to be talking about next was
15:38
Speaker 1: like in the news and in letters written from one
15:41
Speaker 1: physician to another. But this was all much more recent fascinating.
15:44
Speaker 3: I wonder what they did in ancient Egypt, for example.
15:46
Speaker 3: You know those guys are pretty advanced, especially in surgery,
15:49
Speaker 3: or are They like took organs out and put them
15:51
Speaker 3: in weird vessels and stuff, so they knew their way
15:54
Speaker 3: around a body.
15:55
Speaker 1: Does it count as surgery if they're dead? Though, Like,
15:57
Speaker 1: I mean, it didn't.
15:59
Speaker 2: I think.
16:00
Speaker 1: I think they were also unimpressed with the brain, for example,
16:02
Speaker 1: and thought that, like the heart is where most of
16:04
Speaker 1: the important stuff happened. So I don't know that i'd
16:06
Speaker 1: want an ancient Egyptian surgeon to be working on me.
16:11
Speaker 3: All right, So let's fast forward back to the present.
16:13
Speaker 3: You said, Humphrey Davy missed his opportunity to save people
16:17
Speaker 3: from pain and just enjoyed hanging out with his friends
16:20
Speaker 3: Sam Coleridge and Peter Rodgit. What happened next? When did
16:23
Speaker 3: we actually start to figure stuff out and use it
16:26
Speaker 3: to save people from suffering.
16:27
Speaker 1: Well before we were saving people from suffering, we were
16:30
Speaker 1: allowing people to have a really stinking good time. And
16:33
Speaker 1: so in the early to mid eighteen hundreds, there were
16:37
Speaker 1: events called ether frolics or jags, where essentially people would
16:41
Speaker 1: get together huff ether and appreciate how awesome it made
16:44
Speaker 1: you feel. And there was no sort of surgical implication
16:48
Speaker 1: or plans to understand how this would work in surgery.
16:51
Speaker 1: It was just like, whoa, it's really fun when you
16:54
Speaker 1: huff ether or huff nitrous oxide.
16:56
Speaker 3: And let's have a biology physics disentanglement moment here, because
17:00
Speaker 3: physics ether refers to this concept that space is filled
17:04
Speaker 3: with something for like to propagate through, famously disproven by
17:08
Speaker 3: the Michaelson Morley experiment in the late eighteen hundreds. That's
17:11
Speaker 3: not where people are snuffing at your biology parties.
17:14
Speaker 1: Right, No, a chemist would tell you that ether is
17:17
Speaker 1: an organic compound. It's a mix of oxygen with alkyl groups.
17:21
Speaker 1: And you know, we both know that I don't know
17:22
Speaker 1: much about chemistry, but no, it's not a made up
17:26
Speaker 1: idea it is.
17:28
Speaker 2: It's an actual chemical compound.
17:30
Speaker 3: And what happens when you sniff it, you just like
17:32
Speaker 3: feel good or you pass out or what happens.
17:34
Speaker 1: Well, we'll go into more detail about what it's doing
17:36
Speaker 1: to the brain a little bit later, but for the
17:38
Speaker 1: purpose of these parties, it just sort of made you
17:40
Speaker 1: feel kind of silly and anything that heard stopped hurting
17:43
Speaker 1: and you'd laugh a lot more.
17:45
Speaker 2: And you know that all sounds fantastic.
17:47
Speaker 3: That sounds great. Why did you go out of fashion?
17:49
Speaker 1: Well, because it's also kind of dangerous. It can lead
17:51
Speaker 1: to vomiting and death, and if you do it too often,
17:55
Speaker 1: it can like impact your organs, and it's yeah, bad news.
17:59
Speaker 1: And we will encounter worries about some people who are
18:01
Speaker 1: thought to have maybe gone a little bit mad on
18:03
Speaker 1: account of all the ether and stuff they were taken.
18:06
Speaker 2: Probably chemists, yeah, I know, right, almost certainly chemists. God guys.
18:10
Speaker 1: All right, so let's take a break here, and when
18:13
Speaker 1: we get back from the break, we'll talk about the
18:16
Speaker 1: four men who brought anesthetics to the medical world and
18:20
Speaker 1: their downfall afterwards as they all fought for credit for
18:24
Speaker 1: being the first to come up with this idea.
18:26
Speaker 4: Oh no, all right, we're back.
18:48
Speaker 1: We were talking about ether parties, which do sound fun,
18:52
Speaker 1: but I would not engage in an ether party because I'm.
18:55
Speaker 3: A whimp and you're so wholesome, Kelly.
18:59
Speaker 2: Yeah.
18:59
Speaker 1: I work in this lab once where somebody said something
19:03
Speaker 1: to me to the effect of you're really nice, and
19:08
Speaker 1: it was like, in a condescending I've never had anyone
19:12
Speaker 1: be like, you're nice and that kind of sucks. But
19:15
Speaker 1: like anyway, so I have been told that I'm not fun,
19:17
Speaker 1: but that's fine.
19:18
Speaker 2: I'm not fun.
19:19
Speaker 3: You're a lot of fun. You're a lot of ways.
19:20
Speaker 3: Let me ask you a more personal question, which is
19:22
Speaker 3: what is your drug of choice? Are you an alcohol drinker?
19:26
Speaker 3: Do you chew on banana peels? How does Kelly unwined?
19:30
Speaker 1: Kelly does not enjoy chewing on banana peels at all.
19:34
Speaker 1: It makes Kelly feel really uncomfortable. Kelly enjoys a glass
19:38
Speaker 1: of red wine and caffeine. Kelly mostly lives a stimulant
19:42
Speaker 1: free like you know what. Kelly's favorite stimulant is the
19:45
Speaker 1: anti anxiety medication.
19:46
Speaker 2: She's hot. That's how eye roll.
19:51
Speaker 3: That's the modern day ether.
19:52
Speaker 2: What about you.
19:53
Speaker 3: I'm a big believer in caffeine as well, and I
19:55
Speaker 3: enjoy red wine, and for many years I did also
19:59
Speaker 3: enjoy banana peel. It helped to stimulate some creativity in
20:03
Speaker 3: my research, but no longer.
20:05
Speaker 1: Ah well, we all have had youthful indiscretions.
20:10
Speaker 3: All right, So now let's talk about the indiscretions of
20:13
Speaker 3: various men in history who brought us anesthesia.
20:16
Speaker 1: So the first person we're going to chat about is
20:18
Speaker 1: doctor Crawford Long, and he was at one of these
20:21
Speaker 1: ether frolics and he was really enjoying it, and he
20:24
Speaker 1: noted to himself that when he or others did things
20:27
Speaker 1: that should be painful, they didn't seem to feel the pain.
20:30
Speaker 1: And he was a physician and this made him think, oh,
20:34
Speaker 1: you know, maybe this could be used in surgery. And
20:38
Speaker 1: so he was the first person to actually test it out.
20:40
Speaker 1: So he had a patient who needed two small cysts removed,
20:44
Speaker 1: and the patient was nervous about getting the surgery done
20:46
Speaker 1: because it was painful, and he was like, look, this
20:48
Speaker 1: isn't critical. I don't want these things taken out. And
20:50
Speaker 1: the patient had also tried ether recreationally and really enjoyed it,
20:54
Speaker 1: and so Long was like, look, let's try it.
20:56
Speaker 2: I'm going to put you under the ether.
20:58
Speaker 1: You know that you don't feel as much much pain
21:00
Speaker 1: under the ether, so let's see how it goes. And
21:02
Speaker 1: actually it went great. Wow, and Long started using this
21:06
Speaker 1: gas for other operations as well. But the big thing
21:10
Speaker 1: here is that he didn't share this information with the
21:13
Speaker 1: medical profession widely, so he didn't like write a paper
21:16
Speaker 1: or go to a surgery that was watched by a
21:19
Speaker 1: lot of other people. So at the time, surgeries were
21:21
Speaker 1: done in operating theaters where students of medicine were sort
21:25
Speaker 1: of sitting in the same room. So now, like you know,
21:27
Speaker 1: if you've watched Gray's Anatomy, you know that there is
21:29
Speaker 1: like a elevated area and you can be behind glass
21:32
Speaker 1: and you can sort of peek in.
21:33
Speaker 3: Like a splash guard there and make sure, you know,
21:35
Speaker 3: get sprayed in the face.
21:36
Speaker 1: I'm wondering if maybe they're protecting the patient more than anything,
21:39
Speaker 1: like you're you know, when you sneeze, they don't want
21:41
Speaker 1: the germs settling into the patient's abdomen.
21:43
Speaker 3: But uh, I wonder if they used to pass around
21:45
Speaker 3: raincoats the way they do it like SeaWorld in the
21:47
Speaker 3: first few rows, you know.
21:48
Speaker 2: Oh so gross.
21:50
Speaker 1: I know they used to put sawdust under the operating
21:53
Speaker 1: tables to absorb the blood. Uh yeah, intense, And I
21:57
Speaker 1: don't think they always cleared the sawdust before the next person.
22:00
Speaker 1: And I read some stories where the guy would like
22:01
Speaker 1: take the saw where he had amputated a leg and
22:03
Speaker 1: he'd kind of like wipe it off on his apron
22:06
Speaker 1: and then get to the next guy, which we don't
22:10
Speaker 1: do anymore.
22:10
Speaker 3: And who would come to these things anyway? Is it
22:12
Speaker 3: just medical students or is this like, you know, an
22:15
Speaker 3: afternoon with the family. What are we going to do?
22:17
Speaker 3: This is before movies. Let's go see some legs get
22:19
Speaker 3: cut off.
22:20
Speaker 1: I don't know if you bring little Susie with you,
22:22
Speaker 1: but like, definitely the medical students are there. And this
22:25
Speaker 1: isn't too far after people used to go to like
22:28
Speaker 1: public executions for fundsies.
22:30
Speaker 3: Yeah, that's what I was thinking.
22:31
Speaker 1: Yeah, and so I do think some people did come
22:33
Speaker 1: off the streets just to kind of watch. That's probably
22:37
Speaker 1: not how I'd spend my day. What was Shakespeare around?
22:41
Speaker 5: Like?
22:41
Speaker 1: Were the options to go to the globe and see
22:43
Speaker 1: a Shakespearean play or watch someone get their leg amputated
22:46
Speaker 1: my timeline of history?
22:48
Speaker 3: Not a hard choice, I mean, geez, yeah, Shakespeare's a
22:52
Speaker 3: couple hundred years before He's like early sixteen hundreds, late
22:55
Speaker 3: fifteen hundreds.
22:56
Speaker 1: Oh all right, well, and maybe I would watch the amputation.
22:58
Speaker 1: You know, what else are you going to do in London?
23:00
Speaker 1: So anyway, Long gets the ball rolling but doesn't share
23:03
Speaker 1: with anyone, so it stops with him. But then in
23:06
Speaker 1: eighteen forty four, a dentist called Horace Wells goes to
23:10
Speaker 1: a nitrous oxide demonstration. So there were people who would
23:13
Speaker 1: travel around the country and they would essentially get up
23:16
Speaker 1: on a stage and they'd be like, this nitrous oxide
23:18
Speaker 1: stuff is great. Is there a volunteer from the audience
23:21
Speaker 1: who would like to feel, you know, what nitrous oxide
23:24
Speaker 1: feels like. So they'd have them inhale some nitrous oxide
23:27
Speaker 1: and then they'd be like.
23:27
Speaker 2: I feel great. He he he would be so fun, and.
23:29
Speaker 3: People would watch this and they're like, let's amputate your leg. Sure,
23:32
Speaker 3: he he he he.
23:34
Speaker 1: Well and so uh, so Wells was watching this demonstration
23:40
Speaker 1: and one of the people who got sort of exposed
23:42
Speaker 1: to nitrous oxide got a pretty big laceration on their leg,
23:45
Speaker 1: but clearly didn't feel it while it was happening, And
23:48
Speaker 1: so Wells afterwards goes to the guy doing the demonstration
23:51
Speaker 1: and is like, whoa, hey, I saw that someone got
23:54
Speaker 1: hurt and then they were totally fine. And I'm a dentist,
23:57
Speaker 1: so can you like come with me to my dentist
23:59
Speaker 1: off and we can try like knocking out my patients
24:03
Speaker 1: before doing the procedure.
24:04
Speaker 3: This is a dentist who cares, who doesn't want to
24:07
Speaker 3: cause his patient's pain.
24:08
Speaker 2: That's right, it's amazing.
24:09
Speaker 1: I miss oh you. This is a joke about dentists
24:12
Speaker 1: in general. I didn't get it because I have an
24:14
Speaker 1: amazing dentist. I love him so much.
24:19
Speaker 3: I hope he listens to the pod. And here's how
24:20
Speaker 3: much you love him.
24:21
Speaker 2: You're the best doctor, Cayton.
24:26
Speaker 1: Okay, So before he started using it on his patients,
24:28
Speaker 1: he decided he wanted to try it on himself. So
24:30
Speaker 1: this is an example of self experimentation. So Wells calls
24:33
Speaker 1: over a dentist friends of his. The guy who did
24:36
Speaker 1: the nitrous oxide demonstration knocks Wells out, and the friend
24:41
Speaker 1: dentist who came over pulled out a molar, and Wells
24:44
Speaker 1: doesn't feel a thing.
24:45
Speaker 3: So we just like sacrifices a healthy molar to science.
24:49
Speaker 2: Yes, amaz, yeah he does.
24:50
Speaker 3: I like this dentist.
24:51
Speaker 2: Yeah, no, me too.
24:52
Speaker 1: He's willing to get his hands dirty for the arts.
24:55
Speaker 1: I appreciate that.
24:56
Speaker 3: All right, So far I'm voting for Horace Wells to
24:57
Speaker 3: get credit for this.
24:58
Speaker 2: I like Wells too.
24:59
Speaker 1: So Els does this on fifteen other patients, and he
25:02
Speaker 1: decides this is awesome, right, Yeah, So in eighteen forty five,
25:05
Speaker 1: he goes to Massachusetts General Hospital and they're doing one
25:08
Speaker 1: of these big public surgeries, and he decides he's going
25:12
Speaker 1: to remove a tooth from a volunteer. But he doesn't
25:15
Speaker 1: give the volunteer enough nitrous oxide. Oh no, And so
25:19
Speaker 1: now we know that, you know, some people require more
25:21
Speaker 1: nitrous oxide to get knocked out, some require less, and
25:24
Speaker 1: this guy just didn't get the right amount for whatever reason.
25:27
Speaker 2: And so the patient is clearly feeling pain during this.
25:30
Speaker 1: Procedure, and it is very embarrassing to doctor Wells because
25:34
Speaker 1: he's got this whole audience and it's clearly not working,
25:37
Speaker 1: and so this was sort of devastating for him.
25:40
Speaker 3: This is his big moment.
25:41
Speaker 1: Wow, this was his big moment. And we'll see that
25:43
Speaker 1: he doesn't actually emotionally recover from this.
25:46
Speaker 2: Oh no, I know, I know some.
25:49
Speaker 3: Like emotional nitros oxide. He needs some of that antidepressants.
25:51
Speaker 1: He does need some antidepressants, as we'll see. So then
25:55
Speaker 1: the next group that gets in on this at around
25:58
Speaker 1: the same time is doctor William Morton and his chemistry teacher,
26:03
Speaker 1: doctor Charles Jackson. Morton starts experimenting with ether instead of
26:08
Speaker 1: nitrous oxide. And it turns out that ether sort of
26:10
Speaker 1: works a little bit better. And at the time, the
26:12
Speaker 1: professors and the students were playing with ether too, so
26:15
Speaker 1: they were doing these ether parties and you'd get together
26:17
Speaker 1: with your professors and like get high on ether.
26:20
Speaker 2: Times have changed and.
26:21
Speaker 3: So no, no, no, I do that all the time
26:23
Speaker 3: with my classes. Yeah.
26:24
Speaker 2: Absolutely, Oh yeah, I don't. Uh, we're moving on.
26:27
Speaker 3: So if any administrators that you see or Vara listening, I.
26:31
Speaker 1: Was a joke, of course, good, yes, yes, So I
26:33
Speaker 1: think Morton had been aware of what Wells was doing,
26:36
Speaker 1: and he starts using ether instead of nitrous oxide. He
26:39
Speaker 1: talks to his chemistry professor, He's like, can you get
26:42
Speaker 1: me some ether? And to try out the ether, Morton
26:45
Speaker 1: wasn't willing to test on himself. He extracted the tooth
26:48
Speaker 1: of one of his assistants. Oh, but the ether he
26:51
Speaker 1: was using wasn't pure enough and it was painful for
26:53
Speaker 1: the assistant. So Morton's like, oh shoot. So then he
26:56
Speaker 1: starts testing on himself because he can tinker with the
26:58
Speaker 1: doses and the purity. And apparently his wife is like
27:02
Speaker 1: super not excited that he's doing this, because he's like
27:05
Speaker 1: I put sid a timer and I knocked myself out
27:07
Speaker 1: for eight minutes, and she's.
27:08
Speaker 3: Like, no, that's not good.
27:11
Speaker 2: It's not good. What are you doing.
27:12
Speaker 3: You're getting drained brimage.
27:14
Speaker 2: Oh god.
27:15
Speaker 1: So later he tries it out on a patient who
27:17
Speaker 1: has a toothache and it works great. So he also
27:19
Speaker 1: goes to Massachusetts General Hospital in eighteen forty six and
27:24
Speaker 1: there is a surgeon who is doing a procedure to
27:27
Speaker 1: excize a neck tumor. At the time, Morton was a
27:31
Speaker 1: second year Harvard medical student, and he gets permission to
27:34
Speaker 1: administer ether well. The surgeon is removing the tumor, and
27:38
Speaker 1: the procedure goes so well that when it's done, the
27:41
Speaker 1: surgeon looks out at the audience and says, gentlemen, this
27:44
Speaker 1: is no humbug.
27:47
Speaker 3: You have to translate for me. Is that good? Humbug
27:50
Speaker 3: is bad? So no humbug is good?
27:52
Speaker 2: That's right. Yes, Yeah, the double negative threw you a bit.
27:55
Speaker 3: So if you're getting like comments from a reviewer in
27:57
Speaker 3: the eighteen hundreds, and a reviewer too is like, this
27:59
Speaker 3: paper is no humbug, then that's good.
28:01
Speaker 2: That's good. Yeah, you probably got past reviewer too. Good job.
28:06
Speaker 1: So it worked but Morton at this point sees a
28:09
Speaker 1: cash cow, and so he doesn't want to tell anybody
28:11
Speaker 1: what it is, and so he names it Lethion, which
28:15
Speaker 1: is after the mythological river LETHI. I think it's pronounced
28:18
Speaker 1: where the souls of the dead forget their earthly lives.
28:22
Speaker 1: I don't know if I'd want to be taking something
28:24
Speaker 1: that's usually associated with helping the dead forget things, like
28:27
Speaker 1: I'd rather stay alive while I forget the procedure.
28:30
Speaker 3: Would you like to take a trip on the river sticks?
28:32
Speaker 2: Yeah, no, thank you, I'll pass. Can you just take
28:35
Speaker 2: this moler out please?
28:36
Speaker 3: That's one big humbug for that idea.
28:38
Speaker 2: That's right, amen.
28:39
Speaker 1: But ether has a super distinct smell, and so Surgeon's
28:42
Speaker 1: pretty quickly figured out what he was doing, and he
28:45
Speaker 1: tried to get money some other ways. He tried to
28:47
Speaker 1: make this like very particular device for administering the ether,
28:52
Speaker 1: but other people figured out better devices, and so anyway,
28:54
Speaker 1: eventually Morton realizes he's not going to make a ton
28:57
Speaker 1: of money, and everybody now transitions to trying to figure
29:01
Speaker 1: out who can get the most credit for it. So,
29:02
Speaker 1: if you're not gonna get rich, at least you can
29:04
Speaker 1: impress the whole world.
29:05
Speaker 3: Right here comes the dark side of science.
29:07
Speaker 2: That's right. Here we go.
29:08
Speaker 1: So Wells who was the first to do a public
29:11
Speaker 1: demonstration of it, and if you remember, he's the one
29:15
Speaker 1: where he did the public demonstration. It didn't work. He
29:17
Speaker 1: was super embarrassing. So Wells is interested in this, but
29:20
Speaker 1: he's trying out some other ways to maybe make it
29:22
Speaker 1: work better because it was embarrassing when he did the
29:24
Speaker 1: nitrous oxide thing. So he starts trying chloroform instead. But
29:28
Speaker 1: he gets addicted to the chloroform and it seems to
29:32
Speaker 1: have eventually like sort of messed with his mental health,
29:34
Speaker 1: messed with his mind. So he goes to jail for
29:38
Speaker 1: throwing sulfuric acid on prostitutes.
29:41
Speaker 3: Oh boy.
29:42
Speaker 1: Yeah, And while he's in prison, he had apparently managed
29:45
Speaker 1: to smuggle some chloroform in and he commits suicide using
29:49
Speaker 1: the chloroform and a razor blade in prison. So and
29:53
Speaker 1: the worst well not the worst. The worst thing is
29:55
Speaker 1: he died.
29:55
Speaker 2: That's awful.
29:56
Speaker 1: But his wife a few days later gets a letter
29:59
Speaker 1: from the Paris Medical Society and they have concluded that
30:02
Speaker 1: Wells is the one who should get credit for doing
30:04
Speaker 1: the first painless surgery under anesthesia.
30:07
Speaker 3: Oh no, so that letter could have saved his life probably.
30:10
Speaker 1: Yeah, it seems like he was super concerned about the
30:13
Speaker 1: credit anyway. So next up we'll talk about Morton.
30:16
Speaker 3: Well, that's a big humbug.
30:17
Speaker 1: That is a huge humbug. Humbug of the year maybe.
30:21
Speaker 2: Yeah.
30:21
Speaker 1: So Morton is the guy who was trying to make
30:23
Speaker 1: a bunch of money off of ether and he had
30:25
Speaker 1: kind of worked with his chemistry professor, and he and
30:28
Speaker 1: his chemistry professor, it turns out end up in this
30:30
Speaker 1: giant debate about who should get the credit. And Morton,
30:34
Speaker 1: as I mentioned, he had this device that people stopped using,
30:36
Speaker 1: and then he's frustrated because other dentists are using this procedure.
30:40
Speaker 1: So now he's not even making money by having the
30:42
Speaker 1: most patients.
30:43
Speaker 3: In the meantime, a lot of people are now having
30:46
Speaker 3: surgeries and procedures without pain.
30:48
Speaker 1: So that's good, that should be huge, right, Yeah, But
30:50
Speaker 1: that's not doing it for him. And in eighteen sixty eight,
30:53
Speaker 1: a magazine article comes out saying that Morton's professor Jackson
30:57
Speaker 1: is the one who should get the credit, and that
30:59
Speaker 1: seems to drive Morton absolutely crazy, and he drives to
31:02
Speaker 1: New York to confront the editors and dies of a
31:05
Speaker 1: stroke in Central Park.
31:06
Speaker 2: Oh my gosh, at forty eight.
31:08
Speaker 3: This whole area is like cursed.
31:10
Speaker 2: I know, it's horrible.
31:12
Speaker 3: Or maybe it's just the product of all this self
31:14
Speaker 3: experimentation with these crazy drugs.
31:16
Speaker 1: I mean, I do think that the fact that these
31:19
Speaker 1: drugs are a bit mind altering and had been used
31:21
Speaker 1: maybe way too often and at way too high doses,
31:24
Speaker 1: could have had something to do with the mental health
31:27
Speaker 1: problems these people had. But anyway, Jackson, the chemistry professor
31:31
Speaker 1: is backed by the Academy of Sciences of the Institute
31:34
Speaker 1: of France, so it looks like the medical communities in
31:36
Speaker 1: France are sort of.
31:37
Speaker 2: Divided on who they're going to back.
31:39
Speaker 1: Jackson gets told that he's getting the credit, but he
31:42
Speaker 1: becomes an alcoholic and he's found screaming at Morton's gravestone.
31:46
Speaker 1: Like even after Morton dies, he's still angry enough to
31:49
Speaker 1: like go to his gravestone and yell at him. He
31:51
Speaker 1: ends up in an asylum where he stays for twelve
31:54
Speaker 1: years and dies at seventy five.
31:56
Speaker 3: I hope to never be found yelling at gravestone.
31:58
Speaker 1: Yeah, Like wow, you know, that seems that's pretty high end,
32:02
Speaker 1: Like at the point where your enemy has passed on,
32:05
Speaker 1: I feel like.
32:05
Speaker 3: You can move on.
32:07
Speaker 2: But I guess it's not always that easy.
32:10
Speaker 3: On the other hand, gravestones are kind of there for
32:12
Speaker 3: you to like visit someone who's passed and talk to
32:14
Speaker 3: them and connect with them. And so if Yellen's what
32:17
Speaker 3: you gotta do, I guess that is the place for it.
32:20
Speaker 1: Yeah, I guess, sure, sure, but maybe i'd want to
32:23
Speaker 1: like smoke some banana peels to chill me out before
32:25
Speaker 1: I get there.
32:26
Speaker 3: Yeah, But I'm also intrigued by this facet of history
32:29
Speaker 3: where like societies are deciding who gets credit for something. Yeah,
32:34
Speaker 3: you know, that's not the way we do things these days,
32:36
Speaker 3: at least not on physics. Like if you make a discovery,
32:39
Speaker 3: you argue about the paper, or you argue about who
32:41
Speaker 3: gets prizes. But it's never like the American Physical Society
32:44
Speaker 3: decides Daniel gets credit for this idea or Sally gets
32:47
Speaker 3: credit for that idea.
32:49
Speaker 1: I mean, I feel like the Nobel Prize has just
32:51
Speaker 1: like that is the ultimate arbiter of who gets credit
32:53
Speaker 1: for the idea, and maybe nobody else minds. I guess
32:57
Speaker 1: I don't or nobody else feels like it's worth weighing in.
32:59
Speaker 2: I don't know.
33:00
Speaker 3: Yeah, yeah, I guess this is all pre Nobel Prize stuff,
33:03
Speaker 3: so m M, maybe that plays a role. Fascinating all right, So,
33:06
Speaker 3: so far three folks have tried to take credit for
33:09
Speaker 3: it and either died or gone mad. Who's up next?
33:12
Speaker 1: I saved the best for last, so remember the No,
33:16
Speaker 1: this is actually the best. So the first person who
33:19
Speaker 1: we talked about who didn't share his results publicly and
33:23
Speaker 1: was just like, oh, this is great. I'm going to
33:24
Speaker 1: make sure that all of my patients are well taken
33:26
Speaker 1: care of from here on out. He continues his medical practice,
33:30
Speaker 1: owns a pharmacy in Georgia, and has a happy life.
33:33
Speaker 3: Oh my gosh, I was waiting for the disaster there.
33:36
Speaker 3: But no, I'm glad he lives happily.
33:38
Speaker 1: Ever after he does well, he dies at sixty two.
33:40
Speaker 1: He dies well prepping to give ether to a woman
33:43
Speaker 1: in labor. So that wasn't great for her. I'm sure
33:45
Speaker 1: she was like no at first, give me the either.
33:48
Speaker 3: But that's not a good sign if your doctor drops
33:52
Speaker 3: dead during labor.
33:53
Speaker 4: No.
33:54
Speaker 1: No, But actually, before we go to a commercial, I
33:57
Speaker 1: want to real quick tell you this story about chloroform
33:59
Speaker 1: in the UK. So the UK was more interested in chloroform.
34:03
Speaker 1: We were more interested in nitrosoxide and ether. And a
34:06
Speaker 1: very important time when you can use ether is during childbirth.
34:10
Speaker 1: So there was the Scottish obstetrician James Simpson. We talked
34:13
Speaker 1: about this guy in the intro. He ran out of
34:15
Speaker 1: the operating theater and thought about becoming a lawyer because
34:18
Speaker 1: it was so upsetting to watch surgeries without ether. But anyway,
34:21
Speaker 1: around eighteen forty seven he's experimenting with different gases, decides
34:25
Speaker 1: chloroform is best. But there was this idea at the
34:28
Speaker 1: time that women needed to actually go through the process
34:31
Speaker 1: of labor and that the pain was sort of part
34:33
Speaker 1: of it, and taking the pain away was unethical or like,
34:36
Speaker 1: wasn't okay on religious grounds, and so he wasn't able
34:39
Speaker 1: to start administering it widely until John Snow and any
34:43
Speaker 1: epidemiology nerds out there are.
34:45
Speaker 2: Like John Snow with the cholera pump and the Broad
34:49
Speaker 2: Street pump.
34:49
Speaker 1: But anyway, so he helped figure out the cause of cholera.
34:51
Speaker 1: I think the pandemic was wrapping up by the time
34:53
Speaker 1: he figured it out. He in eighteen fifty three administers
34:57
Speaker 1: chloroform to Queen Victoria while she's giving We're to her
35:00
Speaker 1: eighth child. That's high stakes, that's super high stakes.
35:03
Speaker 2: But it goes great. Queen Victoria is like, awesome.
35:06
Speaker 1: Everyone should have access to this, and now it becomes
35:09
Speaker 1: super widespread. It has since been sort of superseded by
35:12
Speaker 1: other methods because it is kind of nasty stuff, and
35:15
Speaker 1: if you use it for too long it damages like
35:17
Speaker 1: the liver, kidney, hearts, and eventually chloroform falls out of favor.
35:21
Speaker 1: But Queen Victoria and obstetrician James Simpson helped bring some
35:26
Speaker 1: pain relief to women in childbirth.
35:29
Speaker 3: Hurrah, Hurrah James and Queen Victoria. It's amazing how these
35:32
Speaker 3: things are cultural, right have, Like, yeah, one person in
35:35
Speaker 3: one country can turn a whole society in one direction
35:38
Speaker 3: or another to use chloroform and not just oxide. It's
35:41
Speaker 3: incredible how random history really is.
35:44
Speaker 2: Oh my gosh, yeah, it absolutely is. Agreed.
35:46
Speaker 3: All right, Well, let's take a break and when we
35:48
Speaker 3: come back, we'll learn what we do and don't know
35:51
Speaker 3: about how anesthesia actually works.
36:14
Speaker 1: All right, So let's chat about what we know about
36:17
Speaker 1: how anesthesia works. And let's just clarify there's different kinds
36:20
Speaker 1: of anesthesia. In this episode, we've been talking about general anesthesia,
36:24
Speaker 1: where you breathe it in and it totally knocks you out,
36:26
Speaker 1: you feel no pain.
36:27
Speaker 2: We're going to go into a bit more detail about that.
36:30
Speaker 3: Well, you don't remember feeling pain, right, Isn't There still
36:32
Speaker 3: some debate about like are you actually feeling pain? But
36:35
Speaker 3: then the experiences are wiped from your memory, and so
36:38
Speaker 3: it's like you didn't feel pain.
36:40
Speaker 1: If you're taking a local anesthetic, you are awake, and
36:43
Speaker 1: so like when I got an epidural when I was
36:45
Speaker 1: giving birth to my second kiddo, I was awake, you know,
36:47
Speaker 1: but I didn't feel any pain. I felt very itchy, right,
36:51
Speaker 1: but I didn't feel any pain.
36:54
Speaker 2: And he was a ten pounder.
36:55
Speaker 1: And so I don't think that my memory was wiped
36:57
Speaker 1: because if so, I would have been feeling pain in
36:59
Speaker 1: the moment, right.
37:00
Speaker 3: But general anesthesia you're not conscious of right. So it's
37:03
Speaker 3: possible that you are aware of the pain, you just
37:06
Speaker 3: don't remember it, right because generalisty you don't remember the procedure.
37:09
Speaker 1: Yeah, I think there is a subset of people who
37:12
Speaker 1: like will wake up sometimes and they can't move, Yeah,
37:17
Speaker 1: but I don't think they feel pain. They're just like,
37:19
Speaker 1: this is a very disconcerting experience.
37:22
Speaker 3: Well, let's hope not. But it strikes me that, like,
37:24
Speaker 3: if I went through a very painful experience and then
37:27
Speaker 3: somebody came and deleted those memories, I wonder how that
37:29
Speaker 3: would be different, oh from the experience of general anesthesia.
37:32
Speaker 2: Right, yeah, I don't know.
37:33
Speaker 3: Anyway, Maybe that's more philosophy question. But tell us what
37:36
Speaker 3: we know about how this actually works medically and neurologically.
37:39
Speaker 2: Not a lot.
37:40
Speaker 1: So. The Proceedings of the National Academy of Sciences is
37:45
Speaker 1: a big, prestigious group of scientists in the United States,
37:48
Speaker 1: and a twenty twenty paper started by saying anesthetics are
37:52
Speaker 1: used every day in thousands of hospitals to induce loss
37:55
Speaker 1: of consciousness, Yet scientists and the doctors who administer these
37:58
Speaker 1: compounds lack am a lie secular understanding for their action.
38:02
Speaker 3: This is twenty twenty twenty. I'm talking about ancient history anymore.
38:05
Speaker 3: This is basically today.
38:06
Speaker 1: That's right, that's where we are. But another thing that
38:08
Speaker 1: was sort of interesting is that they mentioned in eighteen
38:11
Speaker 1: forty six William Morton demonstrated general anesthesia with inhaled anesthetic
38:16
Speaker 1: diethyl ether. So apparently they picked team Morton, Like, I
38:22
Speaker 1: don't know if they you know.
38:23
Speaker 3: We're wading into this controversy.
38:25
Speaker 2: Yeah, that's right, that's right, but they're giving credit to him.
38:27
Speaker 3: Well, I hope that the descendants of these four gentlemen
38:30
Speaker 3: are not like still battling it out. I hope they
38:32
Speaker 3: get together and toast these guys and all of their achievements,
38:36
Speaker 3: and I'll get along.
38:37
Speaker 1: I think it would be much nicer to just appreciate
38:39
Speaker 1: the memory of people who took pain away for so
38:42
Speaker 1: many of us, as opposed to like turning it into
38:44
Speaker 1: a nasty fight for credit. But yeah, anyway, Okay. So
38:48
Speaker 1: I ended up reaching out to two different anesthesiologists because
38:53
Speaker 1: it was really complicated working through the literature and I
38:57
Speaker 1: couldn't tell if I was reading sort of fringe idea
39:00
Speaker 1: or the main idea, And so I ended up talking
39:02
Speaker 1: to doctor Shannon Stem and doctor a Joa Botang Evans. So,
39:07
Speaker 1: the main mechanism that we think is important here is
39:10
Speaker 1: a neurotransmitter called gabba aminobeic acid or just GABBA. Your
39:16
Speaker 1: neurons have receptors and these receptors are responsible for tinkering
39:21
Speaker 1: with the electrical charge inside of the neuron, So let's
39:24
Speaker 1: talk about why that's important. So our neurons are connected
39:27
Speaker 1: to each other, there's like this open area in between
39:30
Speaker 1: neurons called the synaps, and when chemicals are released into
39:33
Speaker 1: that synapse, one cell has talked to another and a
39:35
Speaker 1: message passes between the neurons. The way you get that
39:39
Speaker 1: message into the synapse is that your cell needs to
39:42
Speaker 1: pass a certain electrical charge to initiate what's called an
39:46
Speaker 1: action potential. So usually your neuron has a little bit
39:49
Speaker 1: of a negative charge and when it starts to accumulate
39:52
Speaker 1: a positive charge, at some point it'll pass the threshold,
39:54
Speaker 1: an electrical charge will pass through the neuron, the chemicals
39:57
Speaker 1: will get released into the synaps, and the conversation between
40:00
Speaker 1: neurons will happen.
40:01
Speaker 3: This is fascinating to hear about because I think about
40:04
Speaker 3: neurons all the time, but from the point of view
40:07
Speaker 3: artificial neural networks. They do a lot of machine learning
40:09
Speaker 3: and AI, and we use neural nets all the time,
40:12
Speaker 3: but we never think about them as neurons anymore. Where
40:15
Speaker 3: we use the same language. You know, in our mathematical
40:17
Speaker 3: model is that a neuron is like a little blob
40:20
Speaker 3: and it has inputs, and if the inputs are high
40:22
Speaker 3: enough that they add up to a certain amount, then
40:24
Speaker 3: the neuron is activated and it sends like a pulse
40:27
Speaker 3: to its output, which is linked to other neurons. Of course,
40:30
Speaker 3: and my understanding of the brain basically is that it's
40:32
Speaker 3: this big network of neurons that are all firing and
40:35
Speaker 3: stimulating each other. And so you're talking about the bit
40:38
Speaker 3: between the neurons, the sydnaps, the connection and whether that
40:41
Speaker 3: thing is allowed to fire or is inhibited from communicating
40:44
Speaker 3: with other neurons. Is that right?
40:45
Speaker 2: Yeah, pretty much.
40:46
Speaker 1: I mean we're focusing on the neurons too. So what
40:49
Speaker 1: GABA does is it inhibits the action potential. So what
40:53
Speaker 1: essentially happens is that your neuron has all of these
40:55
Speaker 1: receptors on it, and it has three different kinds of
40:58
Speaker 1: GABA receptors for them. When this chemical GABA binds, they
41:03
Speaker 1: open up and they let chloride ions in, and so
41:06
Speaker 1: these ions have a negative charge, and so the negative
41:10
Speaker 1: charge in the neuron gets more negative, which makes the
41:13
Speaker 1: cell less likely to hit that action potential point and
41:16
Speaker 1: talk to the next neuron price. There is another kind
41:19
Speaker 1: of receptor that when GABA binds to it, it opens
41:23
Speaker 1: up and it lets potassium ions out, and these are
41:26
Speaker 1: positive charge, so the positive charge is fleeing, and so
41:29
Speaker 1: here again the cell is getting more negative, but just
41:32
Speaker 1: through a slightly different mechanism. So in all of these cases,
41:35
Speaker 1: GABA is making the cell more quiet less likely to
41:39
Speaker 1: communicate with the next cell down the line.
41:42
Speaker 3: And it's just like a hypothesis or something we can
41:44
Speaker 3: observe by taking like a single neuron and putting it
41:47
Speaker 3: in an experiment and you know, connecting it to electrodes.
41:51
Speaker 1: So I can't say that I am an expert in
41:54
Speaker 1: how we know this. One of the women that I
41:57
Speaker 1: talked to did mention that there was some experiment done
42:00
Speaker 1: in mice where they genetically tinkered with the mouse so
42:04
Speaker 1: that their GABA receptors were kind of messed up. And
42:07
Speaker 1: when you do that, anesthesia doesn't work the same way
42:11
Speaker 1: in these mice. So that's pretty good evidence that GABBA
42:15
Speaker 1: is somehow involved in anesthesia. But in terms of what
42:18
Speaker 1: we know about what these neurons are doing in our
42:21
Speaker 1: brains in response to GABBA, like, I don't know that
42:23
Speaker 1: we've been able to observe that happening in real time.
42:26
Speaker 3: Yeah, although the system is so complicated, it's hard to
42:28
Speaker 3: draw conclusions. Right. There's the famous example of the scientist
42:32
Speaker 3: who trains frogs to jump when he says jump and
42:35
Speaker 3: then it cuts their legs off, and he says jump
42:37
Speaker 3: and they don't jump, and it's like, oh, see, they
42:39
Speaker 3: can't hear me, so therefore they must hear with their legs. Yeah, right, Like,
42:43
Speaker 3: you can obviously draw the wrong conclusion when you're dealing
42:45
Speaker 3: with a complex system. Was that a ridiculous example?
42:48
Speaker 2: Yeah, what famous experiment does that?
42:50
Speaker 3: I've never heard it without a real experiment. It's a
42:52
Speaker 3: famous anecdote illustrating how you can draw the wrong conclusion
42:56
Speaker 3: from your data, even if it sounds reasonable. Right, So,
42:59
Speaker 3: in this case, saying like it interferes with the gabba
43:01
Speaker 3: and the anesthetics don't work the same way, and that
43:03
Speaker 3: is suggestive, but I don't know how conclusive it is.
43:06
Speaker 1: Yes, absolutely, I agree, and further highlighting the fact that
43:10
Speaker 1: we don't really know what's going on. We've looked at
43:12
Speaker 1: the structure of the chemicals that are used as general anesthetics,
43:16
Speaker 1: and based on the chemical structures. We've tried to predict
43:19
Speaker 1: other kinds of chemicals that should also act as anesthetics
43:22
Speaker 1: because we think we understand what's going on. In some
43:25
Speaker 1: cases that works and other cases it doesn't, So there's
43:28
Speaker 1: something we don't understand. Also, doctor Shannon stem was telling
43:32
Speaker 1: me that xenon kind of has similar characteristics when you
43:36
Speaker 1: give it to people, like it acts as an anesthetic,
43:39
Speaker 1: and xenon is a noble gas, so it's not supposed
43:41
Speaker 1: to be reacting with anything.
43:43
Speaker 2: So what the heck is happening there? We don't know.
43:46
Speaker 3: Maybe it just interferes. Xenon can also like kill you
43:49
Speaker 3: because you can breathe it in and it can interfere
43:52
Speaker 3: with you breeding oxygen, right, so maybe it just gets
43:55
Speaker 3: in the way.
43:56
Speaker 1: Yeah, yep, maybe it does just get in the way.
43:58
Speaker 1: And then it also seems like the function some of
44:00
Speaker 1: the different kinds of anesthetics that we try is making
44:03
Speaker 1: sells more excitatory, so more likely to talk to each other.
44:06
Speaker 1: And so I saw what appeared to be a hypothesis
44:09
Speaker 1: where the idea was just that it messes up communication.
44:13
Speaker 1: So instead of having like a clear signal traveling from
44:15
Speaker 1: neuron to neuron, there's just all kinds of things communicating
44:18
Speaker 1: with each other at weird times, and it's more about
44:21
Speaker 1: like the pattern of communication getting thrown off. But anyway,
44:24
Speaker 1: I want to make clear that anything that I have
44:26
Speaker 1: gotten incorrect is my fault and not the fault of
44:28
Speaker 1: the anaesiologists who very patiently tried to explain this all
44:32
Speaker 1: to me.
44:33
Speaker 3: And how terrified you think they are by not really
44:35
Speaker 3: knowing how this works. Doesn't that make it something of
44:38
Speaker 3: an art For every patient you have to really monitor them.
44:40
Speaker 3: Maybe they're reacting differently because you can't always predict how
44:43
Speaker 3: much anesthetics somebody is going to need.
44:45
Speaker 1: Yeah, so they both highlighted to me during our conversations
44:49
Speaker 1: how amazing the monitoring equipment is now. So yes, you
44:53
Speaker 1: do need to be careful. Some people need more, some
44:55
Speaker 1: people need less. Some people have strong reactions, but they're
44:59
Speaker 1: monitored very carefully, and as long as the people know
45:01
Speaker 1: what they're doing, you know, and I'm sure hopefully all
45:04
Speaker 1: certified anesthesiologists do know what they're doing.
45:07
Speaker 2: You know.
45:07
Speaker 1: They felt like it would be good if we knew
45:09
Speaker 1: the mechanism, maybe that would help us become even better
45:12
Speaker 1: at this stuff. But they felt like not knowing the
45:15
Speaker 1: mechanism didn't keep us from doing a good and safe job.
45:19
Speaker 1: And I feel like there's got to be all kinds
45:21
Speaker 1: of physics stuff that you apply that even though you
45:24
Speaker 1: don't understand it at a like atomic level or whatever,
45:27
Speaker 1: you can still form predictions and you know, do amazing
45:30
Speaker 1: new experiments.
45:31
Speaker 3: Oh for sure, there's so many cases where we don't
45:33
Speaker 3: understand the microphysics. It's too complicated for us to model that.
45:37
Speaker 3: We know generally how things behave and so absolutely you
45:40
Speaker 3: don't need to know all the details. I'm just super
45:43
Speaker 3: curious and oh yeah, you know, somebody's life is at
45:45
Speaker 3: stake here, and so it seems pretty important. You get
45:49
Speaker 3: a sense from them, like what is the cutting edge?
45:51
Speaker 3: Are we gonna in ten years develop new amazing anesthetics
45:55
Speaker 3: that are better or safer or transcendently wonderful or something.
46:00
Speaker 1: I didn't get a clear answer on that. They did
46:02
Speaker 1: mention in passing again how great we are getting it
46:05
Speaker 1: monitoring and how we're getting a better understanding of how
46:08
Speaker 1: people from different backgrounds respond differently to anesthesia so that
46:11
Speaker 1: we can try to make things even safer for everyone.
46:14
Speaker 1: My conversations with Shannon highlighted that they are trying to
46:18
Speaker 1: predict different compounds that would make good anesthetics, and they're
46:21
Speaker 1: trying those out. So maybe we'll even have better tools
46:23
Speaker 1: in the future. But if they were here, they might
46:27
Speaker 1: give a much better answer, no surprise. So the final
46:32
Speaker 1: question we got from the listener is going under anesthesia
46:36
Speaker 1: different than sleeping or is it the same? And it's
46:39
Speaker 1: definitely different than sleeping. So the anesthesiologists I talked to
46:42
Speaker 1: said that it's more like a drug induced reversible coma.
46:46
Speaker 2: Whoa, yeah.
46:46
Speaker 1: So the main criteria or that you want the person
46:49
Speaker 1: to be unconscious, not feeling pain, not moving, and making
46:53
Speaker 1: no memories. So when you're sleeping, one you move, people
46:58
Speaker 1: sleepwalk sometimes Two if somebody were to poke you, you
47:02
Speaker 1: would feel pain.
47:03
Speaker 4: Three.
47:04
Speaker 1: As I understand it, the main function of sleep is
47:06
Speaker 1: that it helps us consolidate memories and sometimes you even
47:09
Speaker 1: remember the dreams that you had, whereas when you are
47:12
Speaker 1: knocked out under general anesthesia, you don't make any memories. Additionally,
47:16
Speaker 1: when you are sleeping, when you do an EEG, you're
47:20
Speaker 1: looking at the activity in your brain and you'll see
47:23
Speaker 1: that we alternate between two different kinds of brain waves.
47:27
Speaker 1: So when we're in rapid eye movement sleep, our brains
47:30
Speaker 1: are doing one thing, and when we get out of
47:32
Speaker 1: rapid eye movement sleep, our brains are doing something different.
47:35
Speaker 1: And we're going to probably go into a lot more
47:37
Speaker 1: detail about this in a future episode because we're getting
47:39
Speaker 1: doctor Gina Poe on the show to tell us all
47:41
Speaker 1: about sleep and why we sleep, So more on that later.
47:44
Speaker 1: But the point is that when we're sleeping, our brains
47:47
Speaker 1: are sort of alternating between two modes, and when you
47:49
Speaker 1: go under anesthesia, you are staying in the same mode
47:53
Speaker 1: the whole time. And I believe it also just like
47:55
Speaker 1: creates different sort of electrical patterns altogether, so there's really
47:59
Speaker 1: no way in which it's sleep. And this is we
48:01
Speaker 1: can sort of end on a moderately interesting story, which
48:04
Speaker 1: is Michael Jackson used to take this drug called propofol
48:09
Speaker 1: and it's an anesthetic. It helped knock him out and
48:11
Speaker 1: it made him feel good, and so he was given
48:14
Speaker 1: it by his doctor at night to help him sleep.
48:17
Speaker 3: Because he has sleep problems.
48:18
Speaker 1: Right, Okay, yeah, but it's not actually sleep. So all
48:22
Speaker 1: of the important things that your body does while you're
48:25
Speaker 1: sleeping are not getting done, or at least they're not
48:27
Speaker 1: getting done as well when you're knocked out by something
48:31
Speaker 1: like propofol. And so part of why it's thought that
48:34
Speaker 1: he ended up dying was because he was laying down,
48:36
Speaker 1: but he was actually over time.
48:38
Speaker 2: Being deprived of sleep.
48:39
Speaker 3: Oh my god.
48:40
Speaker 1: So it is different than sleep in a way that
48:42
Speaker 1: is very meaningful and important.
48:44
Speaker 3: It's amazing how vital and how crucial all these brain
48:47
Speaker 3: functions are, how little we understand them, and yet how
48:51
Speaker 3: much we rely on all these medical advances to manipulate them.
48:56
Speaker 2: Yeah, it's incredible.
48:57
Speaker 1: And you know, despite the fact that we don't really
49:00
Speaker 1: stand this at a mechanistic level, I am still on
49:03
Speaker 1: team anesthesia. I would not want to live and any
49:06
Speaker 1: time that didn't have it. And you know, in addition
49:09
Speaker 1: to not needing to be like literally pinned down and
49:12
Speaker 1: restrained while someone cuts into you for surgeries, Yeah, anesthesia
49:15
Speaker 1: opened up much longer, much more complicated surgeries. And it has, uh,
49:20
Speaker 1: i'd say, really changed our lives in a lot of
49:22
Speaker 1: great ways.
49:22
Speaker 3: Yeah, and it's so recent right until Yeah, just a
49:25
Speaker 3: couple hundred years ago, surgery was horrible suffering.
49:29
Speaker 2: M M.
49:30
Speaker 3: Makes me wonder what medical advances in a few years
49:33
Speaker 3: or a few hundred years people will be unable to
49:36
Speaker 3: live without or imagine what it was like before we
49:39
Speaker 3: had them.
49:39
Speaker 1: Yeah, no, it's incredible. I mean I had to have
49:41
Speaker 1: my wisdom teeth out. I can't imagine someone just yanking
49:43
Speaker 1: those out with pliers without being knocked out. And clearly
49:46
Speaker 1: that is one of the easier surgeries I've never I've
49:48
Speaker 1: never had someone have to cut into my abdomen, for example,
49:52
Speaker 1: So hurrah for living today.
49:56
Speaker 3: All right, Well, we hope that journey into the history
49:58
Speaker 3: of anesthesia didn't put you you all to sleep numb.
50:01
Speaker 3: Your brain couldn't have.
50:03
Speaker 2: It was fascinating.
50:05
Speaker 3: Some folks like to listen to the podcast to fall asleep,
50:08
Speaker 3: so we hope that they're now asleep. Pleasantly. Have a
50:12
Speaker 3: great night.
50:12
Speaker 1: Everyone sleep tight, And let's end by hearing what Eric
50:16
Speaker 1: thought about our hour long episode on anesthesia.
50:20
Speaker 6: Eric, that definitely answered my questions. I went to college
50:23
Speaker 6: in Atlanta, so I think I'm definitely gonna have to
50:26
Speaker 6: be on Team Crawford Long in the Great Anesthesia Wars.
50:29
Speaker 6: And I admit to a little disappointment that I was
50:31
Speaker 6: born too late for ether parties and too early to
50:34
Speaker 6: live in a city on Mars. But I do live
50:37
Speaker 6: in the golden Age of podcasts. So thank you so
50:39
Speaker 6: much and.
50:40
Speaker 3: Have a great day.
50:48
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50:57
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