The reign of anesthesia in cancer surgery was dated far to the 1844-1846 period. Therefore, the question arises concerning the preoperative practices of the medical masters before that era. It is the purpose of this paper to answer that important question. In sum, the historical texts will be handled chronologically in this pursuit.
Keywords: Chloroform; Onset; Previous practices; Medical masters; History
Recent reviews date the onset of anesthetic care in surgery to 1844  and 1846 . Therefore, in keeping with the admonition by a great scientist , the historical antecedents should be subjected to recondite research. In this context, this paper sets out to provide some answers chronologically.
1676 – Richard Wiseman , the nicely named observer, was perceptive: That you may be the more successful in the operation, I shall offer to your consideration these few qualifications. First, that the patient be of a strong constitution, and of a tolerable good habit of body, and not in a declining age, when the menstrua are ceased. Secondly, that the cancer be loose, and the axilla free from painful glands. It was also to be wished that the cancer took its original from some accident, as a bruise. Thirdly, that the operation be performed in the spring or autumn of the year; lest through the great heat of the summer the spirits be resolved; or by reason of the extreme cold in the winter the native heat should be choaked.
1725 – Friend  wrote a history of medicine up to the beginning of the 16th century wherein he considered that even when “surgery is very bold, and what would now be called cruel, yet he never rashly stuck in his knife at a venture: but always made himself master of the nature of the case, and considered the probability of success, before he attempted the operation in any of these dangerous distempers.”
1749 – Le Dran  drew attention to morbid growths
in terms of “they may be removed by extirpation, but unless
we are fortunate enough to correct the indisposition of the juices that produced them, the disease will almost certainly return, especially if it be of the carcinomatous kind.
1753 – Norford  noted that “in advising the stage of the operation, till all other means have failed, lest they should be thought rash.” In his view, “the palliative method, hardly deserves the name of a cure; because “It is no more than relieving the urgency of the symptoms, and making the patient tolerably easy under his complaints, without removing the cause.”
1769 – Morgagni  was motivated “to propose, on the one hand, the successful instances of their extirpation, many of which he had seen; and; on the other hand, the examples wherein there had been great fear and danger, which he likewise was not ignorant of: and then leave to the discretion of those who consulted him what they would do, without interposing any judgment or persuasion of his own.”
1783 – Benjamin Bell  believed in the circumstance of timing the extirpation “so that the most important matter to be here determined, is that period of the disease in which the operation is most advisable.”
1816 – Charles Bell  bothered about the patient’s consent and detailed a case: The tumour has increased in an extraordinary degree; it is larger than the fist, and quite open and full blown, like a flower. In its substance it is spongy and soft, and easily broken down; in colour it is cineritious, like slough, and bloody. It bleeds on being roughly treated, but has no sensibility. The young man’s health begins to break. He had been informed of the change which would take place,and now that it has come, he stands prepared for the worst,
and has consented to lose the limb.
1816 – Earle  reflected on the surgeon’s personal
doubts. He exemplified clearly: As the disease had existed
for nine months, and had resisted all applications, I did
not think that any good would arise from prosecuting
these measures, and much evil might be expected from the
delay which they would necessarily occasion. I therefore
thought it my duty to propose an operation, although from
the unhealthy appearance of the child, and the unfortunate
result of similar cases, I was not very sanguine of ultimate
success; still however I was led to entertain some hope from
the circumstance of being able to trace the spermatic cord
distinct and free from disease, for nearly an inch above the
tumor, and from the inguinal glands being perfectly healthy
1818 – Scarpa  was worried concerning the
agony of the ill patient vis-à-vis surgery: Darting pains,
extending to the head, disturbed the patient night and
day, notwithstanding the use of opium internally, and
externally, of anodyne cataplasms. In order to remove the
disease effectually, I considered the excision of the anterior
hemisphere of the eyeball necessary.
1829 – Cooper  differentiated between niceties,
i.e., “a nice manipulation” of the patient and “a careful
examination of this disease by dissection.”
1835 – Balfour  found favor in preparatory dieting,
as did the approbation of Sir George Ballingall: who saw
the case, ordered two grains of calomel, and half a grain
of opium, to be taken twice a day. This treatment was
continued for seven days, until the mouth became slightly
affected. Saline medicine was then administered, and,
as the throat had assumed an aphthous and oedematous
appearance, a stimulating gargle was prescribed. The throat
was also scarified, in order to afford relief from the feeling of
suffocation which the patient experienced.
1836 – Mackintosh  gave a preparatory purgation
that more or less obviated surgery as follows:
The doctor purged him well with drastic medicines, till he
made the poor man really sick, and then, being resolved to make
a good job out of a bad customer, he discovered some obscure
disease of the liver, and as he knew mercury to be a remedy for
affections of that organ, he mereurialized him well, so much so,
that he kept up a salivation for many weeks. During this period,
the patient felt for the first time that he had a stomach; his
appetite became impaired, and as the doctor knew that tonics
were good for that, he sent many bottles of such drugs. Bark,
steel, and bismuth, were at last had recourse to, but, alas! The
patient got weaker and weaker; the doctor grew tired of his
patient, and the patient dissatisfied with his doctor, so that they
parted, as it were, by mutual consent.
1837 – Warren  had to follow the course of
consultation thus: The patient, finding an increase in his
sufferings, became more desirous of an operation. I then agreed
to submit the case to a consultation of the surgeons of the
Hospital, and if they should determine that an operation was
proper, I would not shrink from performing it. Accordingly, a
consultation was held, the case was fully considered, and the
result was, that the patient should be made acquainted with the
danger and uncertainty of a surgical operation, and that, if after
a view of these, he desired it to be done, it was right to undertake
it. The patient, after a consultation with his friends, determined
to go through it, and it was performed at the Hospital.
1842 – Budd  brought into prominence the
pathological basis of surgical intervention: If we watch the whole
course of cancer from its first origin in some external part,– as
in the female breast, for example,–to its fatal termination, we
observe the following series of events. At first all that can be
discovered is a small, hard tumour, lying loose in the substance
of the organ. This, now, constitutes the whole disease; for, at this
time, there is no other tumour in the body, and the general health
is not affected. If the cancer be cut out at this very early period, it
sometimes happens that the disease never returns, and that the
patient is radically cured.
Elsewhere , I considered the pros and cons of the history
of cancer surgery. Here, I have addressed the old preoperative
practices. This is in keeping with the need to advance the
literature of the life sciences using historical parameters .
Indeed, as was said of the historical milestones in cancer surgery
, “There was of course, very little elective surgery prior to