How did doctors perform surgery before modern anesthesia?

In 1811, English novelist Fanny Burney underwent a mastectomy without so much as a shot of whiskey to dim the pain. In letters she wrote to her sister after the operation, she recalls, "I began a scream that lasted unintermittingly [sic] during the whole time of the incision — and I almost marvel that it rings not in my ears still! So excruciating was the agony." In fact, Burney fainted twice from the pain of the incision, which likely came as a welcome relief. 

Her operation took place during a time when surgical anesthesia was still in its infancy, and the limited options that existed could be unreliable and often dangerous. Historical anecdotes like hers reveal "what a disgusting thing surgery was before anesthesia," said Tony Wildsmith, professor emeritus of anesthesia at the University of Dundee in Scotland, and former honorary archivist at the Royal College of Anaesthetists in the United Kingdom. 

Indeed, confronting such pain would be nightmarish. Today, anesthetics are now a fixture in medicine, comprising an array of drugs that are used not just for managing pain but also for relaxing muscles and making patients unconscious. Many people will, at some point in their lives, receive these drugs — whether it's a localized anesthetic to numb their gums at the dentist's office, an epidural during childbirth or a general anesthetic to induce a deep slumber while doctors remove tonsils. 

But how did doctors do surgery before anesthetics? The answer reveals a cruder, more painful and occasionally suspect History. 

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Pain through the ages

Anesthesia as we know it today is a relatively new invention, but for centuries, we have been searching for ways to soothe severe pain. As far back as the 1100s, there are accounts of physicians applying sponges soaked with opium and mandrake juice to patients to induce sleepiness in preparation for an operation, and to dull the pain that followed. 

Going back even further, manuscripts stretching from Roman to medieval times describe a recipe for a sedative mixture called "dwale." Made from a heady concoction of boar bile, opium, mandrake juice, hemlock and vinegar, the tincture was brewed "to make a man sleep whilst men cut him," according to one manuscript from the Middle Ages. From the 1600s onward in Europe, opium and laudanum (opium dissolved in alcohol) became common pain relievers.