THE HISTORY OF ANÆSTHESIA.
_Anaesthesia and Analgesia. Drugs Possessing Narcotic Properties in use
since Prehistoric Times. Mandragora; Hemp; Hasheesh. Sulphuric Ether and
the Men Concerned in its Introduction as an Anaesthetic--Long, Jackson,
Wells, and Morton. Morton's First Public Demonstration of the Value of
Ether. Morton Entitled to the Credit of its Introduction. Chloroform and
Sir James Simpson. Cocaine and Karl Roller._
It is{300} not, perhaps, generally understood that we owe the term
_anaesthesia_ and the adjective _anaesthetic_ to the genius of Dr.
Oliver Wendell Holmes, who suggested their use to Dr. Morton. The term
_anaesthesia_ is applied to the artificial loss or deprivation of
all sensation, which may be either local or general. It should be
distinguished from _analgesia_, which means simply freedom from pain,
consciousness being retained. In this respect local anaesthesia is
really local analgesia, although the terms are confused in this regard.
Anaesthesia, in its present sense, is truly a modern discovery, which
is to be credited to the United States. In its less restricted
sense, however, it is a condition brought about by numerous
drugs,--intoxicants, narcotics, etc.,--some of which have been more or
less in use for centuries. Anaesthesia is also a condition which may be
produced in the hypnotic sleep,--a fact well recognized by the ancients,
although the attention of scientific men was scarcely drawn to the fact
until the days of the notorious Mesmer. The substances which may produce
loss of consciousness may be taken intentionally or unintentionally,
and maybe taken into the stomach, beneath the skin, or, when gaseous,
through the lungs, in which absorption of the same into the blood is
very speedy. It is not at all unlikely that the curious effects ascribed
to some of the ancient oracles were due{301} to the inhalation of gases
arising from natural springs or produced from other sources.
The most common source of narcotic drugs has always been the vegetable
kingdom; and the peculiar effects of the juices or other ingredients of
the poppy, henbane, deadly-nightshade, Indian hemp, mandragora, etc.,
have been sung in poetry, rehearsed in prose, and known from almost
prehistoric time. Ulysses and his companions were stupefied by
_nepenthe_; a draught of vinegar and myrrh, or gall, was offered to
Christ upon the cross, as it often was to malefactors; and Herodotus
speaks of a peculiar habit of the Scythians, who produced some
stupefying vapor,--probably from the seed of the hemp. From Biblical
times, at least, the most common narcotic seems to have been alcohol in
some of its numerous combinations. Furthermore, the effect of hemlock
has been celebrated since the days of Socrates, who was permitted to
drink it in order to soothe himself during his last hour.
Mandragora seems to have had a great reputation in times past,--so much
so that it is probable that more than one substance was included under
this term. Apuleius, who lived about a century later than Pliny, wrote:
"If any one is to have a member mutilated, burned, or sawed, let him
drink half an ounce of mandragora with wine, and let him sleep till the
member is cut away, without any pain or sensation." Among the Chinese
and the Indians similar drugs seem to have been in frequent use,
especially the _bhang_, ordinarily known as _hasheesh_. In many parts of
the East something of this kind was administered to condemned criminals,
as well as those compelled to undergo rude operations. It is said, also,
that mild intoxication was produced among the fanatics of the East for
the purpose of firing them to the point of heroic deeds, as it is
also said that among the Druids the practice prevailed of partially
stupefying the novitiates before initiating them into the most sacred
and secret rites of their cult.
Guy{302} de Chauliac was almost the only surgical writer of previous
centuries who has referred to agents for the relief of pain, although
during and before his time it was customary to give something to those
about to undergo torture, by which to deaden their sensibility; and,
though in the fables of all lands and all times something has always
figured to which was ascribed the power of making people oblivious to
pain or to the peculiarities of their situation, it is very difficult
to learn just what, if any, particular composition was referred to or
deserved such mention. There is allusion to something of the kind in
_Romeo and Juliet_; again, in _Cymbeline_; and in one of Middleton's
tragedies, published in 1567, entitled _Women Beware Women_, occurs this
passage:--
"I'll imitate the pities of old surgeons
To this lost limb, who, ere they show their art,
Cast one asleep, then cut the diseased part."
Larrey, in his military campaigns, noticed the effect of cold in
diminishing sensitiveness, and suggested that cold might be made a
useful local anæsthetic. Many surgeons used to operate upon patients
under the influence of alcoholic narcotization. It was in 1776 that
Mesmer arrived in Paris and became the exponent of so-called "animal
magnetism,"--later termed "mesmerism," now known as hypnotism,--under
the influence of which he reduced to the state of unconsciousness of
pain (i.e., analgesia, as well as the more complete condition,
anæsthesia) a number of patients, who were operated upon without feeling
the slightest suffering.
But, in spite of the earnest attempts of humane surgeons in various
parts of the world, no agent had been discovered which was proven safe
and generally effectual, up to the time, for instance, of Velpeau, who
in 1839 wrote: "To escape pain in surgical operations is a chimera which
we are not permitted to look for in our time."
The substance known as sulphuric ether has been known{303} since
the thirteenth century, when, as it appears, Raymond Lulli made
certain--perhaps ambiguous--references to it. In 1540 it was known as
the sweet oil of vitriol. It was not called an ether until 1730, when
Godfrey spoke of it as such. It was frequently referred to during
the last century by various writers, and the first reference to its
inhalation seems to have been published in 1795 by Pearson. In a work
by Beddoes, on Factitious Airs, published at Bristol, in 1796, is a
statement that "Ether in pectoral catarrh gives almost immediate relief,
both to the oppression and pain in the chest." Beddoes also states
that after inhaling two spoonfuls he soon fell asleep. Later it was in
somewhat general use internally for mitigating the pains of colic. By
1812 it was often inhaled for experiment or diversion, its peculiar
exhilarating effects being generally known. So it is, perhaps, not
strange that so soon as it was definitely recommended for purposes
of surgical anæsthesia, a number of claimants for the honor of its
discovery should quickly arise.
It was the same with nitrous-oxide gas, which had been knowrn for
a number of years, and which was repeatedly used for the purpose of
anæsthesia before the introduction of ether for the same purpose.
Chloroform was discovered in the year 1831 by Guthrie, of Sackett's
Harbor, New York, and about the same time by Soubeiran, in France, and
Liebig, in Germany. But, although before the profession for sixteen
years, it was not recommended for the same purpose as sulphuric ether
until 1847, and then by Doctor--later, Sir--James Simpson.
For all practical purposes we may limit further consideration of the
history of anæsthesia to these three substances, and mainly to the
consideration of the introduction and adoption of ether, which displaced
nitrous oxide, preceded chloroform, and has held its own to the present
day as the anaesthetic in most general use, although in{304} many
respects inferior to chloroform. But the glamour of history pertains
mostly to ether, because of the peculiar difficulties and incidents
attending its production.
For the honor of its discovery there are four claimants:--Crawford
W. Long, of Danielsville, Ga.; Charles T. Jackson, of Plymouth,
Mass.,--both physicians; Horace Wells, of Hartford, Vt., and William T.
G. Morton, of Charleston, Mass.,--both dentists. It is only fair to each
of these four men to consider briefly the merits of the claims made for
each, while at the same time attributing the final success of the new
agent to the happy accidents which permitted Morton to make a public
demonstration of its power in the Massachusetts General Hospital, before
such eminent men as Warren, Bigelow, and others, by whose influence and
reputation the agent was at once received upon its merits. This was on
the sixteenth of October, 1846,--a year which deserves to be memorable
in the history of medicine.
Crawford Long graduated, in 1839, from the medical department of the
University of Pennsylvania, and settled in Jefferson, Georgia, where
it seems to have been a common thing to have what was known as "ether
frolics," during which the exhilarating effects of the inhalation of
the drug were matters of common sport and amusement at various small
gatherings. Long himself frequently inhaled the drug and often felt its
benumbing effects. It is stated that it finally occurred to him to give
it a trial in a surgical operation, and that, in May of 1842, he removed
a small tumor from the neck of a patient thus anaesthetized and without
any pain. Owing to the sparseness of the population and the lack of
dissemination of medical knowledge in those days, no public report
was made of these operations, which produced nothing more than local
town-talk. A young student of Long's, named Wilhite, kept a negro boy
under the influence of ether for some time, to Long's surprise. Long
lived one hundred and thirty{305} miles from any railroad, and the
first published account of his operations appeared in 1849, which was
suggested by an account of Morton's work, which he had read in the
editorials of the _Medical Examiner_ for December, 1846. Long died in
1878, the unfortunate controversy in which the four claimants already
mentioned participated being not yet concluded. Nevertheless, there is
every reason to think that he is entitled to the credit of having
first anaesthetized a patient with sulphuric ether for the purpose of
producing insensibility to pain.
Horace Wells began the study of dentistry in 1834, in Boston, and later
opened an office in Hartford, Connecticut. He seems to have been a young
man of great ingenuity, continually making new instruments and devising
new experiments. To him is to be credited the first operation ever
performed without pain by the use of nitrous-oxide gas. In 1844 a Dr.
Colton delivered a lecture in Hartford upon the subject of this gas.
A young man who inhaled it, and became excited, ran against some
furniture, badly bruising himself, but made no complaint of pain.
Wells, noticing this, said to a by-stander that he believed that one,
by inhaling a sufficient quantity, could have a tooth extracted or a leg
amputated without pain. The following day he inhaled the gas himself and
had a tooth extracted by a Dr. Higgs. Wells remained unconscious for a
little while, and, on recovering consciousness, cried out: "A new era in
tooth-pulling! It did not hurt me as much as the prick of a pin! It is
the greatest discovery ever made!"
He at once began the manufacture and use of the gas, which became quite
general in that locality. His attention was also called to the action of
the vapor of ether, which Dr. Marcy, a physician of Hartford, suggested
to him to try as a substitute for gas; but Wells, finding it more
difficult to administer, discontinued it and confined himself to the use
of nitrous oxide. A month later Dr. Marcy gave{306} ether to a sailor
for a small operation, the man feeling no pain. These experiences of
Wells and Marcy occurred two years after Long's work with ether, each
being in total ignorance of the experiments of the other.
In 1845 Wells visited Boston for the purpose of introducing nitrous
oxide as an anaesthetic, and called upon his fellow-dentist and old
partner, Morton, among others. He was discouraged, with his lack of
success, returned to Hartford, and continued the frequent use of gas for
a couple of years longer, but met with no encouragement in introducing
it for general surgical purposes, on account of prejudice and fear upon
the part of physicians and surgeons. Wells died in January, 1848, a few
days before the Medical Society of Paris passed a resolution that to him
is due all the honor of having first discovered and successfully
applied the use of vapors or gases whereby surgical operations could
be performed without pain. There stands to-day in Hartford the monument
erected by the city and the State, with the following inscription:--
"Horace Wells, who discovered anæsthesia, November, 1844."
William T. G. Morton was born in 1819, and, after failing in business
in Boston, in 1840 went to Baltimore and studied dentistry. In 1841 he
entered the office of Horace Wells, above alluded to, as assistant, and
in 1842 became his partner, after having introduced a new kind of
solder for fixation of artificial teeth to gold plates. In 1843 this
partnership was dissolved, Wells moving to Hartford, while Morton, in
1844, entered the office of Dr. C. P. Jackson as a medical student,
matriculating in the Harvard School, but never graduating. After Wells's
visit to Boston, during which he tried to introduce "laughing gas,"
Morton and he had numerous interviews, especially with regard to this
gas. Morton was not well versed in chemistry, and sought the advice of
his medical preceptor, Jackson, with regard to its manufacture. Asking
why{307} Morton wished to make it and being told the reason, Jackson
suggested the use of' sulphuric ether, just as Marcy had suggested its
use to Wells, saying that it was easy to procure, safe in employment,
and equally productive of results. He also stated that the students at
Cambridge College often inhaled ether for amusement.
[Illustration: 0327]
On the evening of the same day, September 30, 1846, Morton administered
ether for the extraction of a tooth, the patient stating that he had
felt no pain. On the following day he visited the office of a well-known
patent lawyer for the purpose of securing letters patent upon his
supposed discovery. This lawyer, learning of Jackson's connection with
the subject, took time to consider the matter, consulted with Jackson,
and came to the conclusion that the patent must be a joint affair,
neither one having exclusive right to claim it. But Jackson,{308}
fearing the censure of the Massachusetts Medical Society should his name
be connected with the patent, and Morton--as a dentist--having no such
fine scruples, it was agreed that the patent should be made out in the
names of both, but that Jackson was to at once assign his interest
to Morton; in return for which he was to receive a ten per cent,
commission. Meantime Morton called upon Warren, one of the surgeons in
the Massachusetts General Hospital, who promised his co-operation and
sent him an invitation to test his invention in the hospital on October
16. 1846. The clinic-room was filled when Morton placed the patient
under the influence of his _letheon_, as he had named it; after which
Warren removed a tumor from the neck of a young man, and as it appeared,
without pain.
[Illustration: 0329]
Upon the following day another operation was performed upon a young
woman, with the same happy result, while on November 7th an amputation
was made, entirely painlessly. At this time Morton endeavored to
disguise the odor of the substance he was using by aromatic oils. It was
not until the staff of the Massachusetts General Hospital declined to
use an agent whose composition was kept secret that Morton revealed
publicly the fact that this was nothing but sulphuric ether disguised
by aromatics. From a report of the Commissioner of Patents, published a
little later, the following paragraph is taken, the report being in the
nature of a commentary upon the discovery:--
It has been known for many years that the vapor of sulphuric ether,
when freely inhaled, would intoxicate to the same extent as alcohol when
taken into the stomach.
The fact has stood, further, upon the pages of science for many years
that the inhalation of sulphuric ether was productive of "temporary
narcotic stimulant effects."
After the issuance of letters patent Morton began selling office-rights,
such being the custom then, as now, among the dental profession, who are
much more commercial in{310} their proclivities than their brethren of
the medical profession. The result was an almost endless litigation,
with the development of the greatest personal animosity and rivalry
between Jackson and Morton, as well as the friends and descendants of
the other claimants. Morton wrecked his fortune and ruined his health in
his efforts to get substantial recognition and remuneration from the
United States Government; and the history of his repeated attempts to
interest Congress and the various officials of the government, from the
president down, is instructive, but far from pleasing, reading. In these
attempts he practically failed, and died from an illness contracted
through exposure, after maddening disappointment, although he had been
the recipient of numerous honors and some small pecuniary recognition
from societies and individuals. Morton died in 1868. In reviewing the
history of his life and labors there is much to justify the inscription
upon the monument erected to his memory at Mount Auburn Cemetery,
Boston:--
"_Inventor and revealer of anæsthetic inhalation, before-whom in all
time surgery was agony, and by whom pain in surgery was averted and
annulled; since whom science has controlled pain_."
Charles T. Jackson graduated at Harvard Medical College in 1829. after
having led an already eventful career as geologist and mineralogist. He
spent several years abroad, meeting many of the most distinguished
men upon the Continent and displaying, in many ways, a great deal
of scientific talent and mechanical ingenuity. In 1835 he opened, in
Boston, the first laboratory for teaching analytical chemistry in the
United States. A year later he was made State Geologist of Maine, and
spent three years in this capacity. He also did a great deal of work
upon the State geological surveys of Rhode Island, New Hampshire,
and New York, while he was the first to call attention to the mineral
resources of the southern shore of Lake Superior, where, in 1845. he
opened up copper{311} and iron mines. In 1846 and 1847 he became deeply
interested in the subject and discovery of anaesthesia, and after the
successful introduction of ether by Morton, in the Massachusetts General
Hospital, set up the claim that it was he who had suggested it to
Morton. In a pamphlet, published a little later, he states: "In the year
1837 I discovered that ether-vapor was superior to alcohol as a remedy
for the strangling and toxic effects of chlorine-gas after inhalations
for that purpose in my laboratory." He then relates how he administered
the vapor to himself for the relief of the irritation produced by
inhaling chlorine, and describes his sensations upon going to sleep
and awakening. This claim in its entirety was a great surprise to
both Morton and Wells, and led to a most unseemly discussion, which
degenerated into a downright professional fight. After the death of
Wells, Jackson and Morton both claimed that nitrous-oxide gas was not an
anaesthetic, and that insensibility to pain could not be produced by it,
in consequence of which the use of the gas was quite discontinued. It
became, then, simply a question of priority as to the administration of
ether for relief of pain during surgical operations. Wells being dead,
this brought Long into the conflict. Jackson visited Europe again, and
presented his claim before numerous societies in such a way as to be
recognized abroad as the discoverer of anaesthesia. The relative merits
of the whole controversy appear to have been pretty well summed up in
a memorial sent to the Senate and House of Representatives by several
hundred members of the Massachusetts Medical Society, which contains the
following paragraph:--"The undersigned hereby testify to your honorable
bodies that, in their opinion, William T. G. Morton _first proved_ to
the world that ether would produce insensibility to the pain of surgical
operations, and that it could be used with safety. In their opinion, his
fellow-men owe a debt to him for this knowledge."
In{312} the Public Garden in Boston there has been erected a monument
to the memory of the discoverer of ether, the donor being, at the time,
unable to mention the individual to whom it should be dedicated. Upon
one face is this inscription:--
"_To commemorate the discovery that the inhaling of ether causes
insensibility to pain, first proven to the world at the Massachusetts
General Hospital, in Boston, October, 1846_."
Upon another face are these words:--
"_In gratitude for the relief of human suffering by the inhaling of
ether a citizen of Boston has erected this monument, A.D. 1867_.
_The gift of Thomas Lee_."
Morton's untimely death, largely due to disappointment and, as he
thought, to persecution, has been already mentioned. In 1873 Jackson's
mind became deranged, and he died in an asylum in 1880.
Sir James Paget has summed up the relative claims of our four
contestants in an article entitled "Escape from Pain," published in the
_Nineteenth Century_ for December, 1879. He says: "While Long waited and
Wells turned back and Jackson was thinking, and those to whom they had
talked were neither acting nor thinking, Morton, the practical man,
went to work and worked resolutely. He gave ether successfully in severe
surgical operations, he loudly proclaimed his deeds, and he compelled
mankind to hear him." As Dr. Morton's son, Dr. W. J. Morton, of New
York, says, when writing of his father's claim: "Men used steam to
propel boats before Fulton, electricity to convey messages before Morse,
vaccine-virus to avert small-pox before Jenner, and ether to annul pain
before Morton."
So much for ether. I have already stated that chloroform was discovered
by Guthrie in 1831. But, though discovered in this country, it was first
introduced as an anæsthetic agent in Scotland, by Simpson, who, in
1847, at the age of thirty-six, began to direct his attention to the
discovery{313} of some means of alleviating pain during childbirth,
having a very large obstetric practice. Simpson was not satisfied
with sulphuric ether, because of its strong and disagreeable odor,
and inquired of his friend Waldie, Master of Apothecaries' Hall, of
Liverpool, if he knew of nothing likely to be a satisfactory substitute.
Waldie, acquainted with the chemical composition of chloric ether,
suggested that chloroform be prepared from it and used. Simpson
experimented with this in 1847, and established its anaesthetic
properties, which he made known through a paper read on November 10th of
the same year. It was arranged that upon the 13th of the month a public
test should be made at the Royal Infirmary; but Simpson, who was to
administer the chloroform, was unavoidably detained. Accordingly the
operation was performed as of yore, without an anaesthetic, and during
its performance the patient died upon the table. Had this death taken
place during the employment of chloroform, it would have been the
death-blow of that substance as an anaesthetic. The first public trial
took place two days later, the test proving a great success. Simpson
goes down in history, then, not as the discoverer of anaesthesia, but as
the one who introduced chloroform for anaesthetic purposes. He died in
1870, and upon his bust in Westminster Abbey is this inscription:--
"To whose genius and benevolence the world owes the blessings
derived from the use of chloroform for the relief of suffering."
It is a bit of most interesting medical history that after Simpson's
announcement of his discovery he was violently and vehemently opposed
by the Scottish clergy, who reviled him for endeavoring to relieve the
pains of childbirth, basing their opposition upon the primeval curse:
"In sorrow shalt thou bring forth children." And the beautiful ease with
which Simpson refuted this childish sophistry must ever be memorable;
for with one short argument he silenced his opponents and turned upon
them the{314} ridicule of the entire profession. For he reminded
them that the first operation recorded in history was performed under
anaesthesia, since, when God created Eve from one of Adam's ribs, he
"caused a deep sleep to fall upon Adam."
Cocaine is now such a universally recognized local anaesthetic that
there is the best of reason for referring to it here--the more so
because it affords another opportunity to do honor to a discoverer who
has rendered a most important service not only to our profession, but to
the world in general.
The principal active constituent of coca-leaves was discovered about
1860 by Niemann, and called by him cocaine. It is an alkaloid which
combines with various acids in the formation of salts. It has the
quality of benumbing raw and mucous surfaces, for which purpose it was
applied first in 1862 by Schroff and in 1868 by Moreno. In 1880 Van
Aurap hinted that this property might some day be utilized. Karl Koller
logically concluded from what was known about it that this anaesthetic
property could be taken advantage of for work about the eye, and made
a series of experiments upon the lower animals, by which he established
its efficiency and made a brilliant discovery. He reported his
experiments to the Congress of German Oculists, at Heidelberg, in 1884.
News of this was transmitted with great rapidity, and within a few weeks
the substance was used all over the world. Its use spread rapidly to
other branches of surgery, and cocaine local anaesthesia became
quickly an accomplished fact. More time was required to point out its
disagreeable possibilities, its toxic properties, and the like, but it
now has an assured and most important place among anæsthetic agents, and
has been of the greatest use to probably ten per cent, of the civilized
world. To Koller is entirely due the credit of establishing its
remarkable properties.
The{315} writer makes no apology here for having introduced two distinct
chapters,--one upon the history of antiseptic surgery, the other upon
the history of anæsthesia. First of all, they are the two grandest
medical discoveries of all time; and, secondly, they are of Anglo-Saxon
origin,--the one British, the other American. To the introduction of
anaesthetics and antiseptics is due a complete revolution of earlier
methods, complete reversal of mortuary statistics, and the complete
relief of pain during surgical operations; in other words, to these two
discoveries the human race owes more of the prolongation of life and
relief of suffering than can ever be estimated or formulated in words.
What an everlasting disgrace it is that, while to the great murderers of
mankind, men like Napoleon in modern times and his counterparts in all
times, the world ever does honor, erects imposing monuments and writes
volumes of encomiums and flattering histories, the men to whom the world
is so vastly more indebted for all that pertains to life and comfort
are scarcely ever mentioned save in medical history, while the world
at large is even ignorant of their names. For this reason, if for
none other, these chapters find an appropriate place in a work of this
character.
Those interested in a somewhat more elaborate presentation of this
subject may find it in an anniversary address delivered by the writer on
October 16, 1896 (the semicentennial of Morton's public demonstration),
in the Medical School of the University of Buffalo, and published in the
_Buffalo Medical Journal_ of November, 1896.