What did people do before anesthesia? - Sally Frampton

譯者: 穎君 紀 審譯者: Helen Chang

With medical students restraining the patient and onlookers eagerly awaiting,

醫學系學生壓制著患者， 旁觀者眼巴巴地等待

Scottish surgeon Robert Liston poised himself to begin.

蘇格蘭外科醫生羅伯特・李斯頓 正式開始截肢手術。

In quick succession, he cut his patient’s flesh,

他迅速切開病人的肌膚，

sawed through their tibia and fibula and, within just a few minutes,

鋸斷患者的脛骨和腓骨， 在這短短幾分鐘

the amputation was complete.

他就完成了截肢手術。

It was the 1830s and Liston was renowned for his surgical speed.

當時是 1830 年代， 李斯頓以手術速度之快聞名。

This was important because, before anesthesia was widely used,

手術速度很重要， 因為在麻醉劑普及之前，

patients had to consciously endure every moment of surgery.

患者在手術期間仍有意識， 必須眼睜睜看著自己的身體被切割。

The quest for anesthetics that could induce unconsciousness

麻醉劑讓病人在手術期間失去意識， 方便醫生來動更精細的手術，

and enable more meticulous surgeries launched long before Liston.

尋求麻醉劑的歷史， 遠早於李斯頓出世。

Around 200 CE, Chinese physician Hua Tuo described mixing alcohol

西元 200 年時，中國醫師華佗 就記載說，可以把酒精混入

with a powder of various ingredients to anesthetize patients.

一種內含許多成分的粉末， 用這混合物來麻醉病人。

And 13th century Arab surgeon Ibn al-Quff described patients taking anesthetics,

十三世紀時，阿拉伯外科醫生 伊本・阿爾克夫記載到

病人使用毒品當麻醉劑， 如大麻、鴉片、曼德拉草等，

likely inhaling drugs like cannabis, opium, and mandrake,

from saturated sponges.

他們用海綿攝取這些麻醉劑。

By the end of the 1700s, many scientists were pondering

18 世紀末，許多科學家在構思

chemistry’s medical applications.

怎麼把化學應用在醫學。

This led to a profusion of anesthetic advancements involving three main players:

在這時期，麻醉劑研發有了巨大進展， 三種化合物受到矚目：

nitrous oxide, ether, and chloroform.

氧化亞氮（笑氣）、乙醚，和氯仿。

In 1799, English chemist Humphry Davy began experimenting with nitrous oxide,

1799 年，英國化學家漢弗里・戴維 導入笑氣進行實驗，

or laughing gas— inhaling it himself and observing its effects on friends.

他自己吸了笑氣之後， 請朋友觀察自己的行為。

Davy noted that its pain-relieving abilities might make it useful

戴維發現笑氣能緩解疼痛， 可以應用在手術麻醉，

for surgical operations—

but it would be decades before that happened.

但這構想在幾十年後才實現。

This was, at least in part, because some surgeons and patients

其中起碼一部分原因是， 外科醫生和病人們

were skeptical of the effectiveness and safety of anesthetic drugs.

對麻醉劑的安全性和效力抱持懷疑。

In 1804, Japanese surgeon Seishū Hanaoka successfully removed a breast tumor

1804 年，日本的外科醫生華岡青洲 成功移除病患的乳房腫瘤，

from a patient anesthetized with a mix of medicinal herbs.

他以藥草製成的麻醉劑麻醉病人。

But the news stayed in Japan indefinitely.

但這則消息沒有傳到日本以外。

Eventually, ether started garnering medical attention.

最終乙醚獲得醫療界的注目。

It was first formulated centuries before then came to be used recreationally.

乙醚在幾世紀前問世， 一開始只用於娛樂。

During the so-called “ether frolics” of the early 1800s,

1800 年代早期流行 乙醚娛樂，在這期間，

an American physician noted that the fall he suffered

有位美國內科醫生發現

服用乙醚時，跌倒了也感覺不到痛。

while using ether was painless.

In 1842, he etherized a patient and successfully removed

1842 年，他用乙醚麻醉患者，

並成功移除病患脖子裡的腫瘤。

a tumor from his neck.

In the meantime, dentists finally began recognizing nitrous oxide’s promise.

與此同時，牙醫終於了解笑氣的好。

But, in 1845, when an American dentist attempted a public tooth extraction

但是 1845 年，有位 美國牙醫公開展示拔牙，

on someone anesthetized with nitrous oxide,

他用笑氣麻醉受術者，

he apparently encountered a setback when his patient screamed.

卻遇到了意外：病患開始尖叫。

It was probably just an insufficient dose—

有可能只是他用的笑氣劑量不夠，

but it was a bad publicity moment for the drug.

但這起事件還是讓笑氣的名聲蒙了灰。

Meanwhile, dentists refined ether for tooth extractions.

不久後牙醫師改良了乙醚，用來拔牙。

And, in October 1846, an American dentist administered ether to a patient,

1846 年 10 月， 美國牙醫對患者施以乙醚麻醉，

and a surgeon removed the man’s neck tumor.

外科醫生順利移除患者脖子裡的腫瘤。

Two months later, Liston himself performed an upper leg amputation

兩個月後，李斯頓執刀，

為乙醚麻醉過的患者進行截肢手術，

on an etherized patient,

who reportedly regained consciousness minutes after

患者據說在手術完成後幾分鐘醒來，

and asked when the procedure would begin.

還問里斯頓手術何時開始。

Further ether-enabled successes followed from India, Russia, and beyond.

印度、俄羅斯等國家也緊跟著傳出 使用麻醉後手術成功的案例。

But ether had issues, including unpleasant side effects.

但乙醚也不是沒有疑慮，像是副作用。

Scottish obstetrician James Simpson heard about an alternative anesthetic

蘇格蘭婦產科醫生詹姆斯・辛普森 耳聞了一種乙醚的替代品：

called chloroform.

氯仿。

And, in 1847, he and two colleagues decided to try some themselves

1847 年，詹姆斯和兩位同事決定 用自己的身體測試這項藥劑，

and promptly passed out.

攝入後不久，他們就全部陷入昏迷。

Soon after, Simpson administered chloroform

之後，辛普森把氯仿

to one of his patients during childbirth.

指定為產婦用的麻醉劑。

It quickly gained popularity because it was fast-acting

越來越多醫生選擇使用氯仿， 因為氯仿作用速度快，

and thought to be side-effect-free—

當時醫生們也以為氯仿沒有副作用。

though we now know it’s harmful and probably carcinogenic.

不過現在我們都知道氯仿會致癌。

Because anesthetics weren’t yet fully understood,

麻醉劑的特性還沒有全面明朗，

they sometimes had lethal consequences.

所以有時會出現致死案例。

And some doctors held sexist and racist beliefs that dictated

也有些醫生會以性別和種族

the amount of anesthesia they’d provide, if any at all.

來決定是否麻醉，以及投下的劑量。

American obstetrician Charles Meigs argued that the pain of childbirth

美國婦產科醫生查爾斯・米格斯爭辯說

女性的生產痛是種神聖的受難，

was a form of divine suffering

and was skeptical that doctors should interfere with it.

醫生不該投藥來減緩這種痛。

Throughout the 1840s, American physician James Marion Sims

1840 年代，美國內科醫生 詹姆斯・馬里恩・西姆斯

conducted experimental gynecological surgeries without pain relief,

施行了不用麻醉藥的婦科手術，

primarily upon enslaved Black women.

受試者大多是遭奴役的黑人女性。

By the late 19th century, those who could access anesthetics

19 世紀後期，有辦法 接觸到麻醉劑的族群，

were undergoing increasingly complex operations,

已經可以進行更加複雜的手術，

including some that were previously impossible.

甚至是以前做不了的手術。

Chloroform came to be understood as a riskier, more toxic option,

越來越多人發現氯仿的風險和毒性，

and fell out of favor by the early 1900s.

所以在 1900 年代早期遭到摒棄。

Alongside newer drugs, ether and nitrous oxide are still used today—

除了新開發的麻醉劑以外， 乙醚、笑氣則被沿用至今，

but in modified formulations that are safer and produce fewer side effects,

這兩種麻醉經過改良後， 減少了副作用和風險，

while doctors closely monitor the patient’s state.

且醫生也須隨時注意患者 使用麻醉後的身體狀態。

Thanks to these advances,

多虧這些醫學成就，

speed is not always of the essence and, instead of acute agony,

速度不再總是手術的關鍵，

手術也不再是慢性折磨， 成為睡夢中發生的小事。

surgery can feel like just a dream.