A Brief History of Early Neuroanesthesia

Srinivas Chivukula, B.S.; Ramesh Grandhi, M.D.; Robert M. Friedlander, M.D.


Neurosurg Focus. 2014;36(4):e2 

In This Article

Abstract and Introduction


Two key discoveries in the 19th century—infection control and the development of general anesthesia—provided an impetus for the rapid advancement of surgery, especially within the field of neurosurgery. Improvements in anesthesia and perioperative care, in particular, fostered the development of meticulous surgical technique conducive to the refinement of neuroanatomical understanding and optimization of neurosurgical procedures and outcomes. Yet, even dating back to the earliest times, some form of anesthesia or perioperative pain management was used during neurosurgical procedures. Despite a few reports on anesthesia published around the time of William Morton's now-famous public demonstration of ether anesthesia in 1846, relatively little is known or written of early anesthetics in neurosurgery. In the present article the authors discuss the history of anesthesia pertaining to neurosurgical procedures and draw parallels between the refinements and developments in anesthesia care over time with some of the concomitant advances in neurosurgery.


Modern neurosurgery arose in the wake of two great advances in the late 19th century—infection control and the advent of general anesthesia.[15] The seminal report by Joseph Lister (1827–1912) in 1867 on the concept of antisepsis inarguably challenged the scourge of postoperative infection in surgery; in the years immediately following its publication, mortality rates associated with infection plummeted by as much as 30% among patients undergoing major surgery.[14] Equally profound was the popularization of general anesthesia in 1846 in the form of ether vapor brought about at the Massachusetts General Hospital by a demonstration by Dr. William Morton (1819–1868), which paved the way for subsequent advances in neurosurgery (Fig. 1).[14,19] Yet, even in the earliest times, some form of anesthesia or perioperative pain management was in use during neurosurgical procedures, especially craniotomies.[2] Much has been written about neuroanesthesia in the years since 1846, but relatively little documentation exists of neurosurgical anesthesia in earlier ages.[6,10,26] The following is a brief description of the substances and techniques used in early neuroanesthesia until the discovery of ether and chloroform in the 19th century. Because no history of neuroanesthesia can be told without the associated surgical context (and vice versa), we also discuss the relevant neurosurgical advances that paralleled the refinements and developments in anesthesia over the ages.

Figure 1.

Removal of a head and neck tumor by Dr. John C. Warren from a patient, Edward G. Abbott, under the influence of ether anesthesia in the "Ether Dome" amphitheater at the Massachusetts General Hospital on October 16, 1846. William T. G. Morton, at whose request the public demonstration was arranged, is seen holding the anesthesia-delivery apparatus behind and to the patient's right. The painting is entitled "Ether Day 1846" and was created in 2000 by artists Warren and Lucia Prosperi. Reprinted courtesy of Massachusetts General Hospital.