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[Illustration: AN OPERATION ON THE EYE
From an MS. of the XIII century]
[Illustration: A SURGEON PERFORMING AN OPERATION
From a woodcut of the XVII century]
ANÆSTHETICS
ANTIENT AND MODERN
AN
HISTORICAL SKETCH
OF
ANÆSTHESIA
BURROUGHS WELLCOME & CO.
London (Eng.)
_Branches_: New York Montreal Sydney Cape Town
[All rights reserved
INDEX
PAGE
Anæsthesia, Dawn of, 7
Anæsthesia, Chloroform for, 69
Anæsthesia in Romance, 23
Anæsthesia in Roman Times, 17
Anæsthesia in the Antient Poets, 25
Anæsthesia, Local, in Antient Times, 27
Anæsthetic, an Antient Chinese, 18
Anæsthetics, Early Egyptian, 7
Anæsthetic, an Early Irish, 19
Anæsthetic, Freezing as an, 27
Anæsthetic, Mesmerism as an, 34
Anæsthetics used by the Hindus, 18
Anæsthetics, Chemical Era of, 30
Anæsthetics in the Middle Ages, 19
Anæsthetics, Local, 67
Anæsthetics of Antient Greece, 11
Carbon Tetrachloride, 67
Chloric Ether, 58
Chloroform, Discovery of, 58
Chronology, 73
Cocaine, 68
Colton, Dr. G. Q., 41
Davy, Sir Humphry, 33
Ether Epoch, 44
Ether, Sulphuric, 33
Ethyl Bromide, 67
Eucaine, 68
Faraday, Michael, 33
Holmes, Dr. Oliver Wendell, 52
Hypnotism, 37
Indian Hemp, 9
Jackson, Charles T., 50
“Letheon”, 52
Lycoperdon, 19
Mandragora, 11
Methyl Chloride, 66
Morphine, 29
Morton, W. T. G., 54
Nitrous Oxide Era, 41
Novocaine, 69
Opium, 27
Oxygen, 30
Priestley, Joseph, 32
Simpson, Sir James Young, 63
Stovaine, 69
Sulphuric Ether, 33
Wells, Horace, 42
[Illustration:
Comment adam et eue furent crees au ij · et au · iiij · c · de genesis
_From a woodcut of the XV century_
“And the Lord God caused a deep sleep to fall upon Adam, and he
slept: and He took one of his ribs, and closed up the flesh instead
thereof.”
_Genesis, chap. ii, verse 21_]
ANÆSTHETICS, ANTIENT AND MODERN
AN HISTORICAL SKETCH OF ANÆSTHESIA
“So God empal’d our Grandsire’s (Adam’s) lively look,
Through all his bones a deadly chilness strook,
Siel’d up his sparkling eyes with Iron bands,
Led down his feet (almost) to Lethe’s sands;
In briefe so numm’d his Soule’s and Bodie’s sense,
That (without pain) opening his side from thence
He took a rib, which rarely He refin’d,
And thereof made the mother of Mankind.”
[Sidenote: The Dawn of Anæsthesia]
Thus a sixteenth century poet quaintly describes, and draws an
impression of, from sacred records, the first operation tempered
by anæsthesia. It has been claimed that in the “deep sleep” that
the Creator “caused to fall upon Adam” is the germ of the idea of
anæsthesia that has come down to us from the dim ages of the past. It
is probable that primitive man employed digital compression of the
carotid arteries to produce anæsthesia, as the aboriginal inhabitants
of some countries do to-day. According to Caspar Hoffmann, this method
was practised by the antient Assyrians before performing the operation
of circumcision. Curiously enough the literal translation of the Greek
and Russian terms for the carotid is “the artery of sleep.”
[Sidenote: Early Egyptian anæsthetics]
The antient Egyptians are believed to have used Indian hemp and the
juice of the poppy to cause a patient to become drowsy before a
surgical operation. Pliny relates that they applied to painful wounds
a species of rock brought from Memphis, powdered, and moistened with
sour wine, which is the first record we have of local anæsthesia with
carbonic acid gas.
[Sidenote: The “Wine of the Condemned”]
The “sorrow-easing drug” which, as we are told in the fourth book of
the “Odyssey,” was given by Helen to Ulysses and his comrades, probably
consisted of poppy juice and Indian hemp. It is indeed actually
stated that she learned the composition from Polydamnia, the wife of
Thone, in Egypt. It is possible also that the “wine of the condemned,”
mentioned by the prophet Amos, may have been a preparation of these
drugs.
[Illustration: MANDRAGORA (_the Phallus of the Field_)
Inscribed in cuneiform characters and in Egyptian hieroglyphics ca.
3000 B.C.]
There are several passages in the Talmud which point to the fact that
the practice of easing the pain of torture and death, by stupefying the
sufferers, was a very antient one.
Thus it is stated: “If a man is led forth to death, he is given a cup
of spiced wine to drink, whereby his soul is wrapped in night”; and
again, “Give a stupefying drink to him that loseth his life, and wine
to those that carry bitterness in their heart.”
In connection with crucifixion, which was a common punishment for
malefactors among the Jews before the Christian era, with the sanction
of the Sanhedrin, the women were wont to ease the terrible death agony
of the sufferers by giving them something in the nature of a “wine of
the condemned” upon a sponge. It is probable that the “wine mingled
with myrrh” which, according to St. Mark, was offered to Christ before
nailing Him upon the Cross, was indeed a narcotic draught, given with
the object of lessening His sensibility to the agony.
The earliest reference to anæsthesia by inhalation is contained in the
works of Herodotus, who states that the Scythians were accustomed to
produce intoxication by inhaling the vapour of a certain kind of hemp,
which they threw upon the fire or upon stones heated for the purpose.
This was probably _Cannabis indica_, or Indian hemp, which was
employed by Oriental races as an anæsthetic from very early times.
[Sidenote: Anodyne poultices to deaden pain]
At the siege of Troy the Greek army surgeons employed anodyne and
astringent poultices to assuage the pain of the wounded. Thus
Patroclus, when his dagger from the thigh of Euryphylus--
Cut out the biting shaft; and from the wound
With tepid water cleansed the clotted blood;
Then, pounded in his hands, the root applied
Astringent, anodyne, which all his pain
Allay’d; the wound was dried, and stanched the blood.
_Iliad._
[Illustration: GATHERING MANDRAGORA
From an MS. of the XII century]
From this interesting description of the manner in which the early
Greek surgeons treated a wound, it is evident that, although they had
no actual knowledge of anæsthetics, they had found from experience the
advantage of cleansing the wound and applying an astringent and anodyne
dressing to deaden sensibility to pain, which probably, unknown to
them, also possessed antiseptic qualities.
MANDRAGORA AS AN ANÆSTHETIC
[Sidenote: The anæsthetics of antient Greece]
That the early Greeks also used certain methods for deadening
sensibility to pain is evidenced by several of the antient writers.
Pindar states “Machaon eased the sufferings of Philoctetes with a
narcotic potion.” Theocritus also alludes to Lucina, the goddess of the
obstetric art, as “pouring an insensibility to pain down all the limbs
of a woman in the throes of labour.” Aphrodite, to assuage her grief
for the death of Adonis, is said to have thrown herself on a bed of
lettuce and mandragora.
There is no medicinal plant around which cluster more mysterious and
quaint associations than mandragora. The Babylonians employed it more
than 2000 years B.C., and a figure cut from the root was used at that
early period as a charm against sterility. It is probable that the
antient Hebrews also believed it to possess these properties, judging
from the story of Rachel related in the book of Genesis. The early
Egyptians employed mandragora, which they called the “phallus of the
field,” as a medicinal agent, both as an anodyne and an anæsthetic, and
also used it in many of their superstitious rites.
[Illustration: GATHERING MANDRAGORA
From an MS. of the XIII century
“To gather ye mandragora, go forthe at dead of nyght and take a dogge
or other animal and tye hym wyth a corde unto ye plante. Loose ye
earth round about ye roote, then leave hym, for in hys struggles to
free hymself he wyll teare up ye roote, which by its dreadfull cryes
wyll kyll ye animal.”]
Theophrastus is the earliest writer on botany to allude to the virtues
of mandragora, among which he mentions its property of inducing
sleep, and of its use as an aphrodisiac in love potions. The Greeks
gave mandragora the name of “Circeum,” derived from that of the witch
Circe, and believed that an evil spirit dwelt in the plant; for, when
uprooted, it was said to utter such frightful shrieks that no mortal
man might hear them and live.
To prevent this catastrophe, it was usual in gathering the plant
to take a dog and let him be sacrificed to the rage of the demon.
This method is thus described by an antient writer:--“To gather ye
mandragora, go forthe at dead of nyght and take a dogge or other animal
and tye hym wyth a corde unto ye plante. Loose ye earth round about ye
roote, then leave hym, for in hys struggles to free hymself he will
teare up ye roote, whych by its dreadfull cryes wyll kyll ye animal.”
Certain rites and ceremonies were sometimes performed before gathering
the root, such as making three circles round it with a sword, and the
earth being loosened with an ivory spade, while to drown the cries of
the fatal herb a horn was sometimes blown by the gatherer.
According to an antient German legend, the mandragora always grew with
greater luxuriance beneath or near a gallows, for the flesh of the
felons hanged thereon was believed to nourish the mysterious root in
which the demon dwelt. Another legend current was, that the leaves of
the plant sometimes glowed with a peculiar light at night.
The supposed likeness of the root to the human form gave rise to many
of the superstitions connected with mandragora, and it was believed in
early times that there were actually two distinct species, viz., male
and female. These roots were often carved to resemble the human figure,
and were worn as charms to ward off disease.
[Illustration: MANDRAGORA
From an MS. of the XV century]
[Sidenote: Mandragora as an anæsthetic]
The first mention of mandragora (_Mandragora Atropa, L._), as an
anæsthetic, is made by Dioscorides (_ca._ A.D. 100), who evidently
recognised the difference between the hypnotic and anæsthetic effects
of the drug, from which one may assume that it was employed for both
purposes in the medical practice of that day. Respecting the former,
he states: “Eating which [mandragora] shepherds are made sleepy,” and,
referring to the latter property, he remarks that “three wine-glassfuls
of a liquid preparation of the root are given to those who are about to
be cut or burnt, for they do not feel the pain.”
Of the preparations of mandragora, he gives the following: “There are
those who boil the root in wine to a third part, and preserve the
decoction, of which they give a cyathus [small glass] in want of sleep
or severe pains in any part, and also before operations with the knife,
or the actual cautery, that they may not be felt”; also “a wine is
prepared from the bark of the root, without boiling, and three pounds
of it are put in a cadus [eighteen gallons] of sweet wine; of this,
three cyathi are given to those who require to be cut or cauterised,
when, being thrown into a deep sleep, they do not feel any pain.”
[Sidenote: “Morion,” a Grecian anæsthetic]
Dioscorides also refers to a substance called “morion,” believed to be
the white seed of the mandragora root, which is mentioned also by Pliny
as a narcotic poison. “A drachm of it,” he states, “taken in a draught,
or in a cake or other food, causes infatuation, and takes away the use
of the reason; the person sleeps without sense, in the attitude in
which he ate it, for three or four hours afterwards. Physicians use it
when they have to resort to cutting or burning.”
These allusions serve to prove how frequently anæsthesia was practised
by the physicians of antient Greece, to whom the narcotic property of
mandragora, which is allied to _Atropa Belladonna_, or deadly
nightshade, was well known.
[Illustration: GATHERING MANDRAGORA
From a drawing of the XVI century
The plant is being uprooted by the struggling dog, whilst a horn is
blown to drown the cries of the fatal herb]
The younger Pliny (A.D. 32–79), in his “Natural History,” also
describes the use of mandragora as a narcotic, and gives preference to
the use of the leaves over the root for that purpose. “The dose,” he
says, “is half a cyathus, taken against serpents, and before cuttings
and puncturings, that they may not be felt.” He further adds: “For
these purposes it is sufficient for some persons to seek sleep from the
smell,” from which it is clear that this anæsthetic was also used by
inhalation.
With reference to mandragora, Sir Benjamin Ward Richardson once
prepared a draught according to one of the recipes given by
Dioscorides, and took it. He tells us that “the phenomena repeated
themselves with all faithfulness, and there can be no doubt that, in
the absence of our now more convenient anæsthetics, ‘morion’ might
still be used with some measure of efficacy for general anæsthesia.”
Further allusion is made to mandragora as a surgical anæsthetic by
Apuleius in his “Liber de Herbis,” in which he says: “If anyone is to
have a limb mutilated, burnt, or sawn, he may drink half an ounce of
mandragora with wine; and while he sleeps the member may be cut off
without any pain or sense.”
Avicenna, the Father of Arabian medicine, gives special directions as
to the employment of mandragora, both as an anæsthetic and a hypnotic;
while Averrhöes, another Arabian physician, refers to the soporific
effects of the fruit of the same plant. Galen also alludes to its
powers to paralyse sensation, and Paulus Ægineta states: “Its apples
are narcotic, when smelled to, and also their juice, that if persisted
in they will deprive the person of his speech.” According to Isidorus,
“a wine of the bark is given to those about to undergo operations,
that, being asleep, they feel no pain”; and Serapion confirms this
statement in his works.
[Sidenote: Anæsthesia in Roman times]
Evidence of the practice of surgical anæsthesia is to be found in the
writings of several physicians during the time of the Roman Empire.
It is probable that the practice came to them from the Greek school,
for mandragora, which they almost invariably used, grew largely in the
Grecian Archipelago. Celsus recommends a pillow of mandragora apples to
induce sleep.
HINDU ANÆSTHETICS
From ancient records it appears probable, that the Hindus inhaled the
fumes of burning Indian hemp as an anæsthetic at a period of great
antiquity. As early as the year 977 they also knew of other drugs which
they employed for the same purpose.
Pandit Ballala describes an interesting surgical operation which was
performed on King Bhoja at that period. The patient was suffering from
severe pain in the head, and, his condition becoming critical, two
brother-physicians happened to arrive in Dhar, who, after carefully
considering the case, came to the conclusion that a surgical operation
was necessary to give relief. They are said to have administered to him
a drug called _sammohini_ to render him insensible, and while he
was completely under its influence they trepanned his skull and removed
the real cause of the complaint. They closed the opening, stitched up
the wound, and applied a healing balm.
After the operation, they are said to have administered to the King a
drug called _sanjivini_, to accelerate the return of consciousness
and to minimise the chances of death.
[Sidenote: An antient Chinese anæsthetic]
It is recorded that “a Chinese physician named Hoa-Tho, who lived about
A.D. 220 or 230, was accustomed to administer to his patients on whom
he wished to perform painful operations, a preparation called ‘Ma-yo’
(Indian hemp, probably), the effect of which was that, after a few
moments, they became insensible as if they were deprived of life.”
Miss Isabella Bird, when visiting the Tung-wah Hospital, in Hong-Kong,
states: “The native surgeons do not use chloroform in operations, but
they possess drugs which throw their patients into a profound sleep,
during which the most severe operations can be performed. One of them
showed me a bottle containing a dark brown powder, which, he said,
produced this result; but he would not divulge the name of one of its
constituents, saying it was a secret taught him by his tutor.”
From very early times the fumes of burning lycoperdon (_Lycoperdon
gygantum_) have been used for stupefying bees before taking honey
from the hive.
Thus it will be seen from the many allusions we have quoted from
writers in the early ages, it is evident that mandragora and Indian
hemp were the two drugs which were more or less in general use as
anæsthetics in antient times.
ANÆSTHETICS IN THE MIDDLE AGES
[Sidenote: An early Irish anæsthetic]
In a Celtic manuscript of the twelfth century on materia medica, a
preparation called “potu oblivionis” is mentioned, of which mandragora
was probably an ingredient. A draught of this preparation was used by
the early Irish to induce sleep.
[Sidenote: The “Sleeping Sponge”]
[Sidenote: Method of using the “Sleeping Sponge”]
Coming to the fifteenth century, the method of producing insensibility
to pain by the inhalation of the volatile principles of drugs, which
had been handed down by tradition from the early ages, seems to have
been revived by Hugo of Lucca, a Tuscan physician. He is described
as “chief of a school of surgeons that treated wounds with wine,
oakum and bandaging, with happy success.” Theodoric, his son, who
was a monk-physician, and practised surgery, mentions, in 1490, a
preparation used by his father which he calls “oleum de lateribus.”
This he describes as “a most powerful caustic, and a soporific which,
by means of smelling alone, could put patients to sleep on occasion of
painful operations which they were to suffer.” The mixture was placed
on a sponge in hot water, and then applied to the nostrils of the
patient, and was called the “spongia somnifera.” The following is the
composition of the “sleeping sponge” and the method of using, as stated
by Theodoric: “Take of opium, of the juice of the unripe mulberry, of
hyoscyamus, of the juice of hemlock, of the juice of the leaves of
mandragora, of the juice of the woody ivy, of the juice of the forest
mulberry, of the seeds of lettuce, of the seeds of dock, which has
large round apples, and of the water-hemlock, each an ounce: mix all
these in a brazen vessel, and then place in it a new sponge; let the
whole boil as long as the sun lasts on the dog-days, until the sponge
consumes it all, and has boiled away in it. . . . As oft as there shall
be need of it, place this sponge in hot water for an hour, and let it
be applied to the nostrils of him who is to be operated on until he has
fallen asleep, and so let the surgery be performed.”
[Illustration: AN OPERATION ON THE LIVER
From an MS. of the XIV century]
According to Bodin, the sleep produced was so profound that the patient
often continued in that condition for several days afterwards. The
method of arousing the patient employed by Hugo, however, is thus
described: “In order to awaken him, apply another sponge, dipped in
vinegar, frequently to the nose, or throw the juice of fenugreek into
the nostrils; shortly he awakens.”
According to Canappe, in his work “Le Gyidon pour les Barbiers et
les Chirurgiens,” published in 1538, the “Confectio soporis secundum
dominum Hugonem” was used by surgeons at that period.
[Illustration: A SURGEON AMPUTATING A LEG
From a woodcut of the XVI century]
Reginald Scott, in a work written in the sixteenth century, gives the
following recipe for making an anæsthetic: “Take of opium, mandragora
bark and henbane root, equal parts; pound them together, and mix with
water. When you want to sew or cut a man, dip a rag in this, and put it
to his forehead and nostrils. He will soon sleep so deeply that you
may do what you will. To wake him up, dip the rag in strong vinegar.
The same is excellent in brain-fever, when the patient cannot sleep;
for if he cannot sleep, he will die.”
[Sidenote: Anæsthesia in romance]
The writers and poets of mediæval romance in more than one instance
allude to anæsthesia produced by drugs. Boccaccio, who wrote his
“Decameron” in 1352, in the story of Dionius, alludes to a certain
anæsthetic liquid of Surgeon Mazzeo della Montagna, of Salerno. “The
doctor,” he says, “supposing that the patient would never be able to
endure the pain without a soporific, deferred the operation until the
evening, and in the meantime ordered the water to be distilled from a
certain composition, which, being drunk, would throw a person asleep as
long as he judged it necessary.” Boccaccio, probably, borrowed his idea
from the recipe given by Nichols, a provost of the famous old school of
Salerno, who published a recipe for making an anæsthetic, similar to
that of Reginald Scott.
In Brooke’s “Tragicall Historye of Romeus and Julietta,” printed in
1562, which supplied Shakespeare with the plot and much material for
his play “Romeo and Juliet,” Friar Laurence thus speaks to Julietta: “I
have learned and proved of long time the composition of a certain paste
which I make of divers somniferous simples, which beated afterwards
to powdere, and dronke with a quantitie of water, within a quarter of
an houre after, bringeth the receiver into such a sleepe, and burieth
so deeply the senses and other spirits of life that the cunningest
phistian will judge the party died.
“And, besides that, it hath a more marvellous effect, for the person
which useth the same feeleth no kind of grief, and, according to the
quantitie of the draught, the patient remaineth in a sweete sleepe; but
when the operation is perfect and done, he returneth unto his first
estate.”
[Illustration: A SURGEON AMPUTATING A LEG
From a woodcut of the XVI century]
Shakespeare’s references to mandragora, poppy and other “drowsy
syrups,” are too well known to need quotation; but the following
allusion by Middleton, in his play called “Women beware Women!” is not
without interest:--
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.
William Bulleyn, the author of “A Bulwark of Defence against Sickness,”
who practised as a surgeon in the reign of Henry VIII, describes an
anæsthetic which he directs to be prepared from the juice of a certain
herb (probably mandragora) “pressed forth, and kept in a closed earthen
vessel according to art, bringeth deep sleep, and casteth man into a
trance, or deep terrible sleep, until he shall be cut of the stone.”
[Sidenote: Allusions to anæsthesia by antient poets]
The poet Marlowe thus refers to mandragora in his play “The Jew of
Malta”:--
_Barabas_:
I drank of poppy and cold mandrake juice,
And being asleep, belike they thought me dead,
And threw me o’er the walls.
Du Bartas, as translated by Sylvester in 1592, makes the following
allusion to anæsthesia:--
Even as a surgeon minding off to cut
Som cureless limb; before in use he put
His violent engins in the victim’s member,
Bringeth his patient in a senseless slumber:
And griefless then (guided by use and art)
To save the whole, saws off the infested part.
Porta, writing in 1579, says: “It is possible to extract from
several soporific plants a quintessence, which is to be shut up in a
well-covered leaden vessel, lest the drug should evaporate. When it is
to be used, the lid is to be removed and the medicament held to the
nostrils, when its vapour will be drawn in by the breath and attack the
citadel of the senses, so that the patient will be sunk in a deeper
sleep not to be shook off without much labour.”
[Illustration: A SURGEON PERFORMING AN OPERATION ON THE EYE
From a woodcut of the XVII century]
Besides mandragora, opium, Indian hemp, and other plants with narcotic
properties already referred to, that were used for anæsthetic purposes
in mediæval times, certain substances are mentioned by early writers
that cannot be identified. Thus Albertus Magnus mentions an animal
product, of which he says: “Any person smelling it falls down as if
dead and insensible to pain,” but there is no reference to such a drug
by other writers of the period.
[Sidenote: Local anæsthetics in antient times]
Local anæsthesia was not unknown during the middle ages, and Cardow
recommends the inunction of a mixture consisting of “opium, celandine,
saffron, and the marrow and fat of man, together with oil of lizards.”
He also adds: “If the patient drinks wine in which the seeds of the
patulica marina have been steeped for a week, it will prevent him
feeling any pain.”
[Sidenote: First mention of freezing as an anæsthetic]
Bernard mentions that it was customary in Salerno to mix the crushed
seeds of poppy and henbane, and apply them as a plaster, to deaden
sensibility, to parts that were about to be cauterised; while
Bartolinus states that local anæsthesia was sometimes produced by
freezing, thereby foreshadowing the use of ether and ethyl chloride as
local anæsthetics.
[Sidenote: Boerhaave’s anæsthetic]
During the seventeenth century the belief in the narcotic draughts of
the antients for producing anæsthesia appears to have waned, and few
allusions are made to them until the middle of the eighteenth century,
when fresh interest seems to have been excited in the subject. The
famous Boerhaave is said to have used opium as an anæsthetic, both
by inhalation of its vapour and also by internal administration in
powder. According to Van Swieten, in his commentaries upon Boerhaave’s
“Aphorisms,” the following is given as the recipe: “Oil of cinnamon, 2
drops; oil of cloves, 1 drop; citron peel, 2 grains; sugar, 2 drachms.
Mix and add red coral, prepared, 1 drachm; pure opium, 2 grains. Mix
for two doses, one of which is to be taken one hour before the
operation, and the other one quarter hour before it, if the patient has
not slept.”
[Illustration: AN OPERATION IN THE SEVENTEENTH CENTURY
From a painting by Franz Hals]
[Sidenote: An operation on the King of Poland]
In 1782, Weiss is said to have operated on the foot of Augustus,
King of Poland, having previously placed the royal patient under the
influence of “a certain potion surreptitiously administered.” Shortly
afterwards Sassard, a surgeon of La Charité, in Paris, suggested
that patients who were about to be operated upon should be drugged
with narcotics as a means of preventing shock. That this method was
sometimes practised is evidenced from a chapter in “Bell’s Surgery,”
where the author not only refers to it but objects to the method on
account of the sickness and vomiting it produced.
As late as 1847, Chisholm, of Inverness, recorded his use of a drug
given internally to produce anæsthesia for surgical purposes; he
substituted the internal use of morphine for ether inhalation in a case
of ablation of the breast successfully performed upon a woman, who
declared that she felt no pain during the operation.
[Sidenote: Anæsthesia by compression of the carotid arteries revived]
Other means of producing insensibility were suggested in the eighteenth
century, and the antient method of compressing the carotid arteries was
revived. This method had been used by Valverdi about 1560, and Morgagni
employed it about 1750 in his experiments on animals, and suggested
that it might be used on human beings. Compression of the nerves of the
limb about to be removed, was also proposed, by James Moore in 1784,
and tried by Hunter and others, but the results could not be regarded
as successful.
[Sidenote: Nelson’s arm amputated]
Surgical operations at this time meant periods of agonising pain, and
the stoutest hearts often quailed at the prospect. It is said that Lord
Nelson was so painfully affected by the coldness of the operator’s
knife when his right arm was amputated at Teneriffe, that at the Battle
of the Nile he gave orders to his surgeon to have hot water kept
ready, so that at the worst he might be operated upon with a warm knife.
[Sidenote: The dawn of a new era]
Thus from the dawn of creation anæsthesia for surgical operations
had been practised to some extent, but, owing to the uncertainty of
the potency and action of the powerful narcotics and palliatives
administered, and the danger attending their use when exact science was
unknown, the practice seemed likely to fall into oblivion. At last a
series of brilliant discoveries in chemistry created a new epoch in the
history of anæsthesia.
THE CHEMICAL ERA OF ANÆSTHETICS
[Sidenote: Priestley’s discoveries]
The discoveries of Priestley about 1767 led up to the plan of
administering gases and vapours of definite composition by inhalation
through the lungs, and directly he had demonstrated the existence of
“vital air,” or oxygen, the properties of this body were tested in the
hope of great results in the art of medicine. Priestley’s experiments
concerning the inhalation of oxygen were in time followed by those
of Beddoes, who recommended the inhalation of oxygen, hydrogen and
other gases in the treatment of disease. It seemed only natural that
experiments with other gases and vapours by inhalation should follow.
Pearson, of Birmingham, administered ether in this way in 1795 for the
relief of consumption, and ten years afterwards Warren, of Boscombe,
employed ethereal inhalation to relieve the sufferings attending the
later stages of phthisis.
Priestley’s discoveries of the method of liberating and collecting
gases, and his demonstrations that certain gases could be absorbed
and compressed in water, led to the introduction of aërated
waters--carbonic acid gas being the first to be employed.
[Illustration: JOSEPH PRIESTLEY]
In the course of time, nitrous oxide, which had been discovered by
Priestley in 1776, was compressed in water, and came into general
use as a medicinal agent.
[Sidenote: Anæsthetic properties of nitrous oxide]
In 1798, a Medical Pneumatic Institution was established at Bristol by
the exertions of Beddoes and others, and Humphry Davy was appointed
superintendent. It was here that he commenced and carried on his
notable researches on nitrous oxide. In one of his experiments he
constructed a box or chamber in which he inhaled the gas in measured
quantities. One day, in the year 1799, when suffering from toothache
or inflammation of the gums, he resorted to the inhalation of the
gas, and discovered to his great delight that it relieved the pain,
which led him to the conclusion he expresses in the following words in
“Researches Chemical and Philosophical,” 1800: “As nitrous oxide in its
extensive operation seems capable of destroying physical pain, it may
probably be used with advantage during surgical operations in which no
great effusion of blood takes place.”
[Illustration: SIR HUMPHRY DAVY]
[Sidenote: Faraday points out similarity in the effects of nitrous
oxide and sulphuric ether]
About 1806, Woolcombe, of Plymouth, prescribed for Lady Martin, a
patient suffering from asthma, the inhalation of sulphuric ether
to relieve the attacks. Lady Martin found the inhalation gradually
caused her to become unconscious, from which state she would recover
in a short time, with the result that the paroxysm of dyspnœa had
disappeared. But the teaching of this case, and even the more explicit
account of Humphry Davy, was overlooked; and no further development
occurred until the year 1818, when Faraday pointed out, in “The
Quarterly Journal of Science and Arts,” that the inhalation of the
vapour of sulphuric ether produced effects similar to those caused by
nitrous oxide.
[Illustration: MICHAEL FARADAY]
About this time Professor Thompson, of Glasgow, was accustomed annually
to amuse his students by allowing them to inhale ether and nitrous
oxide until they were intoxicated, and occasionally became unconscious,
when it was noticed that they were insensible to the prick of a pin,
or a blow. In these cases the gas or ether was inhaled from a bladder.
Two drachms of rectified and washed ether were poured into a bladder
and allowed to diffuse. Then the mixture of air and ether vapour was
breathed, the expired air being allowed to enter the bladder also.
Curiously enough, very little improvement has been made on this method
of administration to the present day.
[Sidenote: On the brink of the discovery]
It is an extraordinary fact that, even in the face of such experiments
as those we have referred to, no one among the investigators who stood
at this time on the brink of so great a discovery ventured over the
threshold. It is almost inconceivable in these days to realise, that
for thirty-nine years these substances were used for experimental
purposes, and even for amusement, without a realisation of the great
blessing to humanity that lay almost within grasp. The things that are
apparently most plain may lie longest buried; so with the discovery of
efficient anæsthesia, which even then developed in an indirect manner.
MESMERISM AS AN ANÆSTHETIC
[Sidenote: Mesmerism in antient times]
[Sidenote: Healing by “stroking”]
From the earliest ages the apparent power of some men to influence
the minds and bodies of others has been known. Certain diseases were
said to be affected by the touch of the hand of certain persons,
who were supposed to communicate a healing virtue to the sufferer,
and these practices were often connected with religious and magical
rites. This method of healing was practised in antient times by the
Chaldæans, Babylonians, Egyptians, Persians, Hindus, Greeks and Romans.
Their priest-physicians are said to have effected cures and to have
thrown people into deep sleep in the precincts of the temples. Such
influences were at that time held to be due to supernatural power, a
belief which was no doubt fostered by the priesthood. In the middle
of the seventeenth century an Irishman named Valentine Greatrakes
aroused great interest in England by his supposed power of being able
to cure scrofula by stroking the patient with his hand. Most of the
distinguished scientific men of the day, such as Sir Robert Boyle,
witnessed and attested his cures, and thousands of sufferers crowded
to him from all parts of the country. Since his time other men have
come forward with similar claims, notably one Gassner, a Roman Catholic
priest of Swabia, who in the early part of the eighteenth century
attracted attention by stating that he could cure the majority of
diseases by exorcism. His method had an extraordinary influence over
the nervous systems of his patients, who in the end generally confessed
themselves cured.
[Sidenote: Mesmer’s experiments]
In 1766, Mesmer, who was a pupil of Hehl, professor of astronomy at
Vienna, and an advocate of the efficacy of the magnet for the cure
of disease, met Gassner, and observed that the priest effected cures
without the use of magnets and by manipulation alone. This led him to
believe that some kind of occult force resided in himself, by means of
which he could influence others. He held that this force permeated the
universe, and more especially affected the nervous systems of men. In
1778, he removed to Paris, and shortly afterwards the French capital
was thrown into a state of great excitement by the fact that human
beings could be placed in a state of artificial sleep or trance, which
was then called “mesmerism.”
Mesmer’s disciples claimed that even painful operations could be
performed on patients in this condition without consciousness of pain.
[Sidenote: Braid’s researches on hypnotism]
[Sidenote: Esdaile operates on hypnotised patients]
Braid, who made a further investigation of the subject, dissented
from the mesmerists as to the cause of the phenomenon, and called the
condition “hypnotism.” In 1846, the Deputy-Governor of Bengal appointed
a committee to observe and report on the surgical operations that
were then being performed in India by Esdaile upon his patients, while
under the influence of alleged mesmeric agency. The Committee reported
on various experiments carried out under their observation, some of
which had apparently been performed with great success. But from
further investigation it was apparent that the method was uncertain,
and success seemed to be due to the peculiar susceptibility of the
patient operated upon. These experiments are worth recording, as they
indirectly led to the practice of administering certain vapours to
produce anæsthesia.
[Sidenote: Robert Collier one of the first pioneers]
One of the pioneers in the practice of inhalation was Robert H.
Collier, who was a believer in mesmerism. In 1835 he was present at
a lecture given by Dr. Turner, Professor of Chemistry at University
College, London, and in the course of some experiments in the
inhalation of ether was himself rendered unconscious, and also observed
that his fellow-students who had inhaled it were insensible to pain.
Four years later he went to America, and, while visiting his father’s
estate near New Orleans, he was called to one of the negroes who had
become insensible by inhaling fumes from a vat of rum, and who, in
falling, had dislocated his hip. Finding the muscles flaccid, Collier
reduced the dislocation without exciting the least sensation of pain in
the patient. A little later he performed two operations upon patients
while under mesmeric influence, with apparent success. These facts led
him to connect the phenomenon of mesmerism with narcotism produced
by inhalation, and in 1840 he commenced a lecturing tour throughout
America on the subject. Three years later he returned to this country,
and at Liverpool, where he landed, gave his first lecture, which
he illustrated by experiments in mesmerism, and also showed the
possibility of rendering a subject unconscious by the fumes of alcohol
in which poppy-heads and coriander had been macerated. The theory he
advanced, and attempted to prove throughout, was that the so-called
mesmeric influence was identical in action with that of narcotic
vapours.
[Sidenote: Uses his alcoholic mixture as an anæsthetic in 1842]
He claimed to have administered the fumes of his alcoholic mixture to a
Mrs. Allen, of Philadelphia, in 1842, and while under its influence he
extracted a tooth without causing her pain. Collier’s lectures excited
general attention at the time, and there is little doubt that they gave
a fresh impetus to research on the subject of anæsthesia by inhalation.
He must therefore be regarded as an important pioneer, who, had he
given up his ideas of mesmerism and proceeded systematically with his
plan of making the body insensible by inhaling the vapour of alcohol,
would have had no one to dispute with him in priority.
THE NITROUS OXIDE ERA
Although, as already stated, Humphry Davy had discovered the anæsthetic
properties of nitrous oxide as far back as the year 1800, forty-four
years elapsed before his idea was put into practical use.
[Sidenote: Colton lectures on nitrous oxide]
On December 11th, 1844, Dr. G. Q. Colton, a well-known lecturer on
popular scientific subjects in America, and a pupil of Professor
Turner, of London, delivered a lecture at Hartford, Connecticut, during
which he gave a demonstration of the action of nitrous oxide gas.
Horace Wells, a dentist, then in practice in the same town, formed one
of the audience.
[Illustration: HORACE WELLS]
[Sidenote: Wells makes his historic experiment]
Among the persons who were invited by the lecturer to inhale the gas
for the amusement of the audience was a man named Cooley, who wounded
himself severely by falling against the benches, and only became aware
of the fact when he saw the blood. Wells was greatly struck by this
incident, and he determined to test the anæsthetic effects of the gas
upon himself the next day by having a decayed upper molar extracted
while under its influence. After the lecture he asked Dr. Colton if
he would come to his house and administer the gas to him; and, on
receiving his promise, he induced a Dr. Riggs to be the operator.
The historic event is described by the latter as follows: “A few
minutes after I went in, and, after conversation, Dr. Wells took a seat
in the operating chair. I examined the tooth to be extracted, with a
glass, as I usually do. Wells took a bag of gas from Dr. Colton and sat
with it in his lap, and I stood by his side; he then breathed the gas
until he was much affected by it: his head dropped back, I put my hand
to his chin, he opened his mouth, and I extracted the tooth. His mouth
still remained open some time. I held up the tooth with the instrument
that the others might see it; they, standing partially behind the
screen, were looking on. Dr. Wells soon recovered from the influence of
the gas so as to know what he was about, discharged the blood from his
mouth, and said, ‘A new era in tooth-pulling!’ He said it did not hurt
him at all. We were all much elated, and conversed about it for an hour
later.”
[Illustration: “A NEW ERA IN TOOTH-PULLING”
The first dental operation performed on Horace Wells whilst under the
influence of nitrous oxide gas]
[Sidenote: “A new era in tooth-pulling”]
After this, Wells extracted several teeth from his patients under
nitrous oxide gas with equal success, and then went to Boston in order
to make his discovery known to the medical profession in that city.
He remained there some days in the hope of being allowed to try the
gas in a case of amputation in the Massachusetts General Hospital,
but the experiment was postponed. Dr. Warren, senior surgeon to the
institution, however, invited him to address his class on the subject
of anæsthesia, after which he was asked to administer the gas in a case
of tooth extraction. He was assisted on this occasion by Morton, a
Boston dentist who had been his pupil, and afterwards, for a time, his
partner. The experiment, as Wells himself confesses, was not quite a
success, the gas-bag having been removed too soon. The whole thing was
denounced as a piece of humbug, and Wells was hissed out of the room as
an impostor.
[Sidenote: Wells disheartened by failure]
[Sidenote: The death of Horace Wells]
Disheartened at length by the failure of his repeated attempts to
establish his claims to priority as the discoverer of anæsthesia, his
mind appeared to become affected, and for a time he wandered about the
streets of New York. On January 4th, 1848, he was arrested and charged
with throwing vitriol, but while in gaol he opened his radial artery,
having first inhaled ether to make death painless. This sad event
closed, at the age of thirty-two, the career of Horace Wells, to whom
at least belongs the credit of having first shown the practicability of
producing insensibility by nitrous oxide, and of having thus, in his
own words, “established the principle of anæsthesia.”
THE ETHER EPOCH
Probably the first published account of the use of ether as a medicinal
agent was made by Morris in a letter read before the Society of
Physicians in London,[1] on December 18th, 1758, in which he advocates
its use internally, and also as an external application.
[1] “Med. Obs. and Enq.” by the Society of Physicians in London, vol.
2, page 176, 1764.
In 1818, Faraday, as already stated, had called attention to the
anæsthetic properties of ether, and showed that the vapour of sulphuric
ether, when inhaled, produced effects similar to those of nitrous
oxide. After Wells’ failure at Boston nothing further seems to have
been done for a time to investigate the use of nitrous oxide as an
anæsthetic.
[Sidenote: Early experiments with ether]
In 1839, William E. Clarke, a young medical student of Rochester, New
York, was in the habit of amusing some of his friends, among whom was
another student named W. T. G. Morton, by the inhalation of ether.
Emboldened by his experiences, in 1842 he is said to have administered
ether, by means of a towel, to a young woman named Hobbie, and
during the period of insensibility which followed, one of her teeth was
extracted by a dentist named Elijah Pope.
J. Marion Sims relates the following incident which he states happened
in the year 1839:--“A number of youths in Anderson, South Carolina,
were exhilarating themselves one day with the seductive vapour of
ether. In their excitement they seized a young negro who was watching
their antics, and compelled him to inhale the drug from a handkerchief
which they held over his mouth and nose by main force. At first his
struggles only added to the amusement of his captors, but they soon
ceased as the boy became unconscious, stertorous and apparently
dying. After an hour or two of anxiety on the part of the spectators
he, however, revived, and was apparently no worse for his alarming
experience.”
[Sidenote: Long claims to have used ether in 1842]
Three years after this incident one of the participators in the affair,
named Wilhite, became the pupil of Dr. Crawford W. Long, a physician
then practising in Jefferson, Jackson County, Georgia. Both the doctor
and his pupils used occasionally to amuse themselves by inhaling ether,
and the former often noticed that while thus excited he was insensible
to blows and bruises. Wilhite recounted to him his memorable experience
with the negro boy; and, in March, 1842, Long is said to have persuaded
a patient, on whom he was about to operate for a small encysted tumour,
to inhale ether until he was insensible. The patient consented, and
the tumour was removed without any pain or accident. This memorable
event was simply recorded by Long in his ledger thus:--“James Venable,
1842. Ether and excising tumour, $2.00.” Three months later he removed
another tumour from the same patient in a similar way, and also
performed three other operations during that year. He is said to have
again repeated the experiment in 1843 and 1845, but the district in
which he lived was so far removed from contact with the large cities
and centres of thought, that the discovery remained unknown and
unpublished until long after the anæsthetic properties of ether had
been fully proved elsewhere. Long himself admits that he considered
ether impracticable owing to the shortness of the anæsthetic state, and
he therefore abandoned its use.
[Sidenote: Marcy’s experiment]
Towards the end of the year 1844, Dr. E. E. Marcy, a surgeon of
Hartford, is said to have administered ether to a patient, and to have
removed an encysted tumour about the size of a walnut from the scalp.
It is stated that Horace Wells was present at this operation, which was
quite successful, but, being warned that ether was dangerous to life,
the experimenters abandoned its use in favour of nitrous oxide gas.
[Sidenote: Morton’s experiments with ether]
In 1846, W. T. G. Morton (referred to previously) who had been
in partnership with Wells as a dentist, and assisted him in the
unfortunate experiment with nitrous oxide in Boston, now directed his
attention to the finding of a more suitable anæsthetic for painless
operations in dental surgery. After many unsuccessful attempts with
various narcotics, Charles T. Jackson, a chemist of Boston, whose
pupil he had been, suggested that he should try sulphuric ether, the
properties of which had been known for so long.
[Illustration: CHARLES T. JACKSON]
[Sidenote: Jackson’s story]