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Before effective anaesthetics, surgery was very crude and very painful. Before 1800 alcohol and opium had little success in easing pain during operations. Laughing gas was used in 1844 in dentistry in the USA, but failed to ease all pain and patients remained conscious. Ether (used from 1846) made patients totally unconscious and lasted a long time. However, it could make patients cough during operations and sick afterwards. It was highly flammable and was transported in heavy glass bottles. Chloroform (used from 1847) was very effective with few side effects. However, it was difficult to get the dose right and could kill some people because of the effect on their heart. An inhaler helped to regulate the dosage.