Things We Take for Granted: Anaesthesia — From Awake Surgery to Ether Day and Beyond

Start hereIn 1800 a chemist wrote that a gas he had been breathing might be used during some surgical operations. More than forty years passed before ether was used in an operation. What happened in between, and since?

For most of history, an operation meant being awake for every moment of it. Below: what surgery was like before anaesthesia, how it changed in the 1800s, what the numbers say now, and one small way to appreciate it.

011. Surgery before anaesthesia

Before the 1840s, most patients were awake during surgery, so operations were rare and surgeons worked fast.

People did have remedies, but none made surgery painless. A history of pain relief in the Canadian Journal of Anesthesia lists alcohol, cannabis, mandrake and opium among the remedies used since ancient times. The same history says that before general anaesthesia, surgery was done only out of extreme necessity. A 2022 history of the first public ether operation says operations were generally done “with minimal or ineffective pain relief”.

Speed mattered. The Linda Hall Library describes surgery before anaesthesia as “carried out with the utmost speed”. Robert Liston, described as probably the best surgeon of his day, was “noted for his skill and his speed as an operator”.

For example, think of how a dentist’s numbing injection changes a filling, then imagine an operation with nothing like it.

022. How it changed

Pain relief for surgery arrived in a rush in the 1840s, after earlier steps in England and Japan.

Davy’s suggestion, 1800

In 1800 the chemist Humphry Davy suggested that a gas he had been breathing might help in surgery.

Davy had been experimenting with nitrous oxide. In his 1800 book on the gas, he wrote that it “appears capable of destroying physical pain”. He added that it “may probably be used with advantage during surgical operations in which no great effusion of blood takes place”. More than forty years passed before ether, another vapour, was used in an operation.

Hanaoka’s operation in Japan, 1804

In 1804 the Japanese surgeon Hanaoka Seishū removed a breast cancer under general anaesthesia.

General anaesthesia means a temporary loss of feeling and a complete loss of awareness, like a very deep sleep. The Japanese Society of Anesthesiologists says Hanaoka removed a breast cancer under general anaesthesia on 13 October 1804. His drug, which he called tsūsensan, had a datura plant as its main ingredient. A 2004 history in the journal Breast Cancer says he spent almost 20 years working out the mixture.

It came 38 years before ether was first used in surgery. The Society notes that it was presented to the International College of Surgeons in Chicago in 1954.

Ether, from Georgia to Boston, 1842–1846

Ether was first used in surgery in 1842; a public operation in Boston in 1846 spread the news.

On 30 March 1842, in Jefferson, Georgia, the doctor Crawford Long removed a cyst from the neck of James Venable, who had breathed ether and felt no pain. Long did not publish his results until 1849.

Boston is where the news took off. On 16 October 1846, at Massachusetts General Hospital, the dentist William Morton gave ether to a patient, Gilbert Abbott, while the surgeon John Collins Warren operated on his neck. In the account in Morton’s authorised biography of 1859, Warren then told the audience: “Gentlemen! this is no humbug”. The 2022 history notes that this line first appears 13 years after the event, after Warren had died, and finds no convincing earlier evidence that he said it.

The date is still marked as Ether Day in Boston and as World Anaesthesia Day around the world. By the end of December 1846, ether had been used in surgery in Britain and France, and within a year in many countries.

Chloroform and childbirth, 1847–1853

Within a year came chloroform, and pain relief in childbirth, later taken up by a queen.

In January 1847 James Young Simpson of Edinburgh gave ether to a woman in labour. Simpson, a professor of midwifery, described chloroform as a new anaesthetic to a medical society in Edinburgh in November 1847. John Snow wrote in 1858 that Simpson “is justly considered” the person who introduced chloroform in place of ether.

Chloroform brought new dangers too. Snow’s book records the first death from chloroform: a girl of 15 having a toenail removed, near Newcastle, on 28 January 1848. He went on to study fifty such deaths.

The doctor John Snow built a wide reputation for his knowledge of anaesthetics. On 7 April 1853 he gave chloroform to Queen Victoria at the birth of Prince Leopold. By the account in the memoir published with his book, the Queen “expressed herself as greatly relieved”. This is the same John Snow who, in 1854, linked a London cholera outbreak to a public pump. Our page on clean tap water tells that story.

Numbing one part of the body, 1884 onward

From 1884, doctors could numb one part of the body while the patient stayed awake.

Local anaesthesia means a loss of feeling in one small area while the patient stays awake. In 1884 the Viennese eye doctor Carl Koller put a cocaine solution on the eye and made it numb. News of his discovery spread around the world in less than a month.

Cocaine was not safe, so chemists looked for something better. Its toxic effects were soon found, and a history of these drugs records many deaths among patients and addicted medical staff. Procaine followed in 1905, and lidocaine was first made in 1943.

033. What the numbers say now

Deaths caused by anaesthesia alone have become rare: about a tenth of the rate before the 1970s.

A meta-analysis pools the results of many earlier studies on one question; our page on trials, observational studies and meta-analyses explains how. A 2012 meta-analysis in The Lancet pooled 87 studies covering more than 21 million general anaesthetics. It found that deaths caused solely by anaesthesia fell from 357 per million before the 1970s to 34 per million in the 1990s and 2000s.

That is a fall of about 90%, by our arithmetic. For example, 357 per million is about one death in every 2,800 anaesthetics, and 34 per million is about one in 29,000.

Deaths around the time of surgery, from any cause, fell too. The same review found they dropped from 10,603 to 1,176 per million over the same decades. This happened even though patients arriving for surgery were, on average, at higher risk than before.

Not yet for everyone

Safe anaesthesia is still out of reach for a large part of the world.

The review found that deaths around the time of surgery fell most in developed countries, and linked the risk of dying to a country’s level of human development. A 2016 paper in BMJ Global Health, drawing on the Lancet Commission on Global Surgery, says 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The 2015 modelling study behind that figure put it at at least 4.8 billion people, about two-thirds of the world.

In practice, an operation that is routine in one place can be unsafe or unavailable in another.

044. Half-truths people repeat

Most of these hold a grain of truth; the dates and details are what make them useful.

“Morton discovered anaesthesia”

Doesn't hold up William Morton discovered anaesthesia. Hanaoka (1804) and Long (1842) came first; the 1846 Boston operation, where Morton gave the ether, spread it.

How sure: Strong museum, professional-society and journal sources agree on the earlier dates.

Morton’s part was real, but he was not the first. The 2022 history says Long used ether in surgery on several occasions from 1842 onwards, and that Morton later campaigned for sole recognition. Morton patented the use of ether in November 1846; the patent was later ruled unenforceable.

“Ether Day was the first public demonstration”

Still argued The 1846 operation in Boston was the first public demonstration of anaesthesia. Sources disagree about “first”; they agree the Boston operations of October 1846 are what spread anaesthesia.

How sure: Unsettled the hospital’s plaque and one library say first; a 2022 history says not.

The answer depends on what counts as public. The plaque in the operating theatre, now called the Ether Dome, calls it “the first public demonstration of anaesthesia” during a serious operation. The Linda Hall Library calls it the first successful public demonstration. The 2022 history disagrees, because Long and the dentist Horace Wells had already shown their methods to colleagues.

On its impact they are closer. The Linda Hall Library calls 16 October 1846 the moment the wider medical world began to embrace anaesthesia. The 2022 history sees it as the first of a series of operations under ether that together started the modern era.

“The first public ether operation was painless”

Partly The patient at the 1846 demonstration felt and showed nothing. He moved and cried out near the end, and accounts differ on how much pain he felt.

How sure: Moderate the hospital record and Bigelow’s 1846 report agree he moved; they differ on the pain.

The records tell a messier story than the legend. A 2022 study of the hospital’s handwritten records found the patient did not react to the first cut, but moved and cried out during the later part of the operation. It concludes the operation was done under incomplete general anaesthesia. A retrospective account in the hospital record says he later reported no pain. Henry Bigelow’s 1846 report says he afterwards called the pain “considerable, though mitigated”.

“Before anaesthesia there was nothing for pain”

Partly Before anaesthesia, patients had nothing at all for pain. People used alcohol, opium and plants such as mandrake, but none made surgery painless.

How sure: Moderate histories agree on what was used; how well it worked is harder to measure.

The remedies in section 1 were real, and some were used before operations. In the Middle Ages, sponges soaked in mandrake juice were used before surgery to make patients sleep. How well they worked is hard to judge. A 2017 history calls mandrake a true anaesthetic of ancient times, while the 2022 history of Ether Day says operations were generally done with minimal or ineffective pain relief.

“Churches opposed pain relief in childbirth”

Still argued Religious leaders fought against pain relief in childbirth. Some patients and doctors objected on religious grounds; how much weight those objections carried is argued.

How sure: Unsettled later studies disagree on how much real opposition there was.

The sources agree that some objections were raised. In December 1847 Simpson wrote that he had “often heard patients and others strongly object” to anaesthesia in labour as contrary to religion. He answered them in a pamphlet that argued from Scripture.

The historian A. D. Farr argued in 1980 that the main objections rested on views about the role of pain, and that “religious opposition is no more than a myth of historiography”. He found that opposition to anaesthesia lasted less than 15 years.

A 2013 study of Simpson and religion found the attack on his use of chloroform “brief, sporadic and of little moment”, and suggests he exaggerated it. A 2016 study of an Edinburgh maternity case-book found anaesthesia in childbirth rose sharply after his pamphlet. It reads this as support for real opposition, though chloroform’s arrival may also explain it.

“Safe anaesthesia is available everywhere now”

Doesn't hold up Today anyone who needs an operation can have safe anaesthesia. About 5 billion people lack access to safe, affordable surgical and anaesthesia care, by a 2015 estimate.

How sure: Moderate a large international estimate, repeated in later papers; it is an estimate, not a count.

The gains in section 3 are real, but uneven. The 2022 history of Ether Day repeats the estimate that 5 billion people lack timely access to safe anaesthesia.

055. One small way to appreciate it

Before an operation, patients can ask the anaesthetist questions, and professional bodies of anaesthetists publish what to talk about.

An anaesthetist is a doctor trained to give drugs that prevent pain during surgery. The American Society of Anesthesiologists suggests bringing written questions to the meeting with the anaesthetist and writing down the answers. Its list of things to discuss includes your health, your medicines, any bad reaction to anaesthesia in you or your family, your fears and your recovery. The Australian and New Zealand College of Anaesthetists says its fact sheets are a guide, and that questions about your anaesthesia should go to your treating specialist.

For example, the next time you or someone close to you has an operation, notice the anaesthetist’s visit. Anaesthesia has been in wide use for less than two hundred years.

This page describes history and data; it is not medical advice. For anything about your own operation or anaesthetic, talk to your doctor or anaesthetist.

Other pages in this series look at clean tap water, vaccines, electric light, writing and literacy, calendar and clock time, maps and GPS, and refrigeration.

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How we checked this · Last checked October 2026

• We read Humphry Davy's 1800 book, James Young Simpson's two 1847 pamphlets and John Snow's 1858 book on chloroform in their digitised texts.
• For Ether Day we used a 2022 study of the hospital's own handwritten records and the Linda Hall Library; for Hanaoka, the Japanese Society of Anesthesiologists.
• The Lancet Commission's own report was not open to us, so its 5 billion estimate is quoted from two later papers that cite it, alongside the 2015 modelling study behind it (at least 4.8 billion).
• Where sources disagree, about who was first or about religious objections, we show both sides. This page gives no medical advice.

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09Sources