informed Morton that he had experimented on himself by inhaling ether
on a folded towel. He found that he lost all power over himself, and
fell back in his chair in a state of curious sleep. Morton, however,
tells another story, and relates how, having procured some chemically
pure ether on September 30th, 1846, he shut himself in a room alone and
inhaled the vapour. He states: “I found the ether so strong that it
partly suffocated me, but produced no decided effect. I then saturated
my handkerchief and inhaled it from that. I looked at my watch and soon
lost consciousness. As I recovered I felt a numbness in my limbs, and
a sensation like nightmare. I thought for a moment I should die in
that state, but at length I felt a slight tingling of the blood in the
end of my third finger, and made an effort to press it with my thumb,
but without success. At the second effort I touched it, but there
seemed to be no sensation. I attempted to rise from my chair, but fell
back, and looked immediately at my watch and found that I had been
insensible between seven and eight minutes.”
THE FIRST DENTAL OPERATION UNDER ETHER
Morton soon had an opportunity of making a practical experiment with
the anæsthetic, for the same evening, about nine o’clock, a man
named E. H. Frost called upon him suffering from a violent attack of
toothache. “Can’t you mesmerise me?” asked the sufferer. “Upon which,”
says Morton, “I told him that I had something better than mesmerism by
means of which I could take out his tooth without giving him pain. He
gladly consented, and saturating my handkerchief with ether, I gave
it to him to inhale. He became unconscious almost immediately. It was
dark, and Dr. Hayden held the lamp. My assistants were trembling with
excitement, apprehending the usual prolonged scream from the patient
while I extracted a firmly-rooted bicuspid tooth. I was so agitated
that I came near throwing the instrument out of the window. But now
came a terrible reaction. The wrenching of the tooth had failed to
rouse him in the slightest degree. I seized a glass of water, and
dashed it in the man’s face. The result proved most happy. He recovered
in a minute, and knew nothing of what had occurred.”
[Sidenote: First surgical operation under ether]
Morton next appealed to Dr. John C. Warren, who was then Senior Surgeon
at the Massachusetts General Hospital, and obtained permission to test
his new anæsthetic on a patient about to undergo a surgical operation.
The date fixed was Friday, October 16th, 1846, and at the appointed
time a large number of medical men had assembled in the theatre. Morton
administered the anæsthetic successfully, and the operation, which was
for a congenital vascular tumour of the neck, in a young man named
Gilbert Abbot, was completed in about five minutes without a groan from
the patient. When it was finished, Dr. Warren exclaimed: “Gentlemen,
this is no humbug!” The interest excited amongst those who witnessed
the operation was naturally very great, and Dr. Henry J. Bigelow, who
was present, said to a friend whom he met later in the day: “I have
seen something to-day that will go round the world!” His prophecy
proved correct.
Up to this time Morton had not disclosed the nature of the agent
he employed, and nothing more was done until November 7th, when he
expressed his willingness to reveal the secret. On this date two major
operations were performed under ether, one by Dr. Hayward and the other
by Dr. Warren.
From this time ether took its place as a general anæsthetic, and the
practice of anæsthesia was firmly established.
[Sidenote: The origin of the words “anæsthesia” and “anæsthetic”]
Soon after the memorable 16th of October, a meeting was held in
Boston, to choose a name for the new anæsthetic agent, and the word
“letheon” was chosen by Morton himself; but, subsequently, Dr. Oliver
Wendell Holmes suggested the name “anæsthesia” for the condition, and
“anæsthetic” for the agent, which names have since come into general
use.
Although it has never been very clearly established whether Morton
or Jackson was the prime originator of the use of ether as an
anæsthetic, the former was recognised by the United States Government
as the discoverer, and received from it a handsome award. It seems
most probable that Jackson supplied the inspiration, while Morton
practically demonstrated it.
[Illustration: W. T. G. MORTON]
In reviewing the steps which led up to the discovery, it must not be
forgotten that both Morton and Jackson were after all but followers
of Collier, who first rendered himself unconscious with ether in the
laboratory of University College, London, and forged one of the most
important links in the chain of development.
Morton spent most of the remainder of his life in disputes about
priority, and in efforts to secure recognition. He died bankrupt
and broken-hearted on July 15th, 1868, before he had completed his
forty-ninth year.
Curiously enough, Jackson, like Wells, became insane, and died in
an asylum in 1880. When the friends of the rival claimants of the
discovery of anæsthesia were proposing that monuments should be erected
to each, Oliver Wendell Holmes characteristically suggested that all
should unite in erecting a single memorial, with a central group
symbolising painless surgery, a statue of Jackson on one side, a statue
of Morton on the other, and the inscription underneath:--
TO E(I)THER
The news of the “ether process for removing pain,” as it was then
called, spread rapidly. A private letter from Dr. J. Bigelow to Dr.
Francis Boote, of Gower Street, carried the first news to England,
and was communicated to the medical profession in London on December
17th, 1846. Two days later, Mr. James Robinson, a dentist, of Gower
Street, performed the first dental operation under ether in England,
the patient being a Miss Lonsdale, and the operation the extraction of
a firm molar tooth.
On December 21st the first surgical operation under the new anæsthetic
in England was performed by Robert Liston, in University College
Hospital, London.
[Sidenote: First surgical operation under ether in Great Britain]
In the operating theatre, thronged with students, were the late Sir
John Erichsen, the present Lord Lister, and many other famous surgeons.
Mr. Barton relates an amusing incident which happened prior to the
operation. Before the patient was brought in, the anæsthetist asked the
students who crowded the benches in the theatre from floor to ceiling
for some volunteer who would submit himself to be anæsthetised. A
young man, Sheldrake, of very powerful build and a good boxer, at once
offered to take the new anæsthetic, and came into the arena. “He lay on
the table, and the anæsthetist proceeded to administer the ether. After
the administration had proceeded for about half a minute, the subject
of the experiment suddenly sprang up and felled the anæsthetist with a
blow, and, sweeping aside the assistants in the arena, sprang shouting
up the benches, scattering the students, who fled like sheep before a
dog. He fell at the top bench, where he was seized and held down till
he regained his senses. The whole scene hardly occupied a minute.”
[Illustration: An apparatus called “Letheon”
One of the earliest employed for the administration of Ether]
[Sidenote: New method of administration]
Before operating, Liston addressed a few words to those present as
to the nature of the experiment about to be tried. The ether was
administered by Mr. William Squire in an apparatus he had devised,
which consisted of a large bell-shaped receiver containing the ether,
to which was attached a long tube and mouthpiece. The patient, a
middle-aged man, who was suffering from malignant disease of the skin
and tissues of the calf of the leg, for which amputation of the thigh
was deemed necessary, passed easily into complete insensibility, and
Liston rapidly removed the thigh, the cutting operation being declared
to have lasted only thirty-two seconds. In a few moments the patient
completely recovered consciousness, and apparently did not know that
the limb was off. When the towel was removed from the uplifted stump so
that he could see it, he burst into tears and fell back on his pillow.
Both surgeon and patient were much affected, and the scene in the
theatre was most impressive. All appeared to see what an incalculable
boon was in store for the human race, and Liston could scarcely command
his voice sufficiently to speak.
[Sidenote: A story of Liston]
Some amusing stories are related of Liston, who was a very big,
powerful man. His fine physique was often useful in the pre-anæsthetic
days, when a patient’s nerve gave way at the last moment at the sight
of the crowded theatre and the operating-table with its straps. It is
said that on one occasion a patient, losing his courage at the last
moment, rushed shrieking down the long corridor of the hospital, with
Liston at his heels. The man locked himself in a room, but the surgeon
with his shoulder broke in the door, and half-dragged half-carried the
poor wretch back to the operating theatre, where the operation for
stone was successfully performed.
[Sidenote: First surgical operation under ether in Scotland]
The practice of using ether was soon followed in other hospitals,
and not only medical men but distinguished laymen crowded to witness
its use. In Scotland, Dr. Moses Buchanan, Professor of Anatomy in
Anderson’s University, was the first to have news of the event, and
immediately after his lecture that day he experimented with ether
inhalation. On the following day, in the operating theatre of Glasgow
Royal Infirmary, a patient was placed under the anæsthetic and
successfully operated on for fistula. So rapidly, indeed, did the
practice spread from one centre to another, that by the end of the
first quarter of 1847 the use of the new anæsthetic may be said to have
become general in all operation cases.
[Sidenote: Simpson proves value of ether in midwifery]
The value of ether in midwifery practice still remained to be proved,
and Sir James Simpson was the first to suggest and test its use in this
department. On January 9th, 1847, he first administered ether to a
patient in order to facilitate the operation of turning. The result, he
reported, was most satisfactory and important, for it at once afforded
evidence of the one great fact upon which the whole of the practice
of anæsthesia in midwifery is founded, viz., that though the physical
sufferings of the patient could be relieved by the inhalation of ether,
yet the muscular contractions of the uterus were not interfered with.
THE DISCOVERY OF CHLOROFORM AS AN ANÆSTHETIC
The next epoch-making event in the history of anæsthesia was the
discovery of the anæsthetic properties of chloroform. The substance
itself had been known for over a quarter of a century. Thomson, in
his “System of Chemistry,” 1820, describes a liquid which is formed
by the union of chlorine and olefiant gas, called “Dutch liquid,” or
chloric ether. Early in the year 1831, Samuel Guthrie of Brimfield,
Massachusetts, who was then residing in Sackett’s Harbour, New York
State, in consequence of a statement that he had read that the
alcoholic solution of this chloric ether was useful in medicine as a
diffusible stimulant, devised an easy method of preparing it. This
being done, he wrote an article which he entitled “A Spirituous
Solution of Chloric Ether,” and forwarded it to the editor of the
“American Journal of Science and Art,” in which it was published in
October of the same year. In this article he fully describes his
method of preparation. A few months later, in January, 1832, Soubeiran
published a paper in a French journal, stating that he had discovered
this method in 1831, and to the distilled fluid he produced he had
given the name of “bichloric ether,” the formula being CHCl. Still a
third claimant to the discovery came forward in the person of Liebig,
who published his account in November, 1831, six months after Guthrie’s
manuscript was in the publisher’s hands, and one month after its
publication. The formula which Liebig deducted from his analysis was
C_{4}Cl_{5}, and he called his product “chloride of carbon.” Although
there may be some doubt as to which of these claimants was actually the
first to manufacture the liquid, it is clear that Guthrie was the first
to publish the account of the discovery. He was born in 1782, was a
surgeon in the United States Army in 1812, and died in 1848.
From an account given by D. B. Smith, of Philadelphia, in the “Journal
of the College of Pharmacy”[2] in 1832, there can be little doubt that
the liquid first made by Guthrie was a fairly pure chloroform. He
describes it in the following words: “The action of this ether on the
living system is interesting, and may hereafter render it an object of
importance in commerce. Its flavour is delicious, and its intoxicating
properties equal to or surpassing those of alcohol.” In 1834, Dumas
examined the liquid as prepared by Soubeiran, and declared that he had
not obtained it pure, and further, that Liebig had made an error in its
composition. On further research, Dumas gave the liquid the name of
“chloroform,” and first worked out the real formula, C_{2}HCl_{3} (or,
using the present system of atomic weights, CHCl_{3}).
[2] Now the “American Journal of Pharmacy”
[Sidenote: Previous use of chloroform in medical practice]
Although its narcotising properties were known to some extent, no one
who used it at that time seems to have conceived the idea of fully
testing its properties. In 1831, Ives, of Newhaven, treated a case of
difficult respiration by actual inhalation of the vapour, and published
the facts in “Silliman’s Journal” in January, 1832. Four years later,
Dr. Formby, of Liverpool, prescribed it in hysteria; and Tuson, of
London, employed it in the treatment of cancer and neuralgia in 1844.
[Sidenote: Simpson’s investigations]
The fact that one or two deaths had been attributed to the use of
ether about this time, caused many workers to make a search for other
agents with similar properties. Foremost among these investigators was
Dr. James Young Simpson, Professor of Midwifery in the University of
Edinburgh, who personally experimented with several chemical liquids in
the hope of finding something less disagreeable and persistent in smell
than ether.
[Illustration: DAVID WALDIE]
[Sidenote: Waldie suggests the use of chloroform]
About this time, Jacob Bell, a chemist, and a founder of the
Pharmaceutical Society, published a suggestion that chloric ether
should be used for inhalation instead of sulphuric ether; but his
suggestion was apparently never put into practice. In October, 1847,
Waldie, a chemist of Liverpool, was visiting Edinburgh, and in
conversation with Professor Simpson, suggested to the latter the use of
chloroform. He recommended the Professor to try it as an anæsthetic,
and promised to make and send him some on his return to his home in
Liverpool.
[Illustration: SIR JAMES YOUNG SIMPSON]
It appears to have been in that city that the drug was first introduced
and probably first used in England as a medicinal agent. Waldie
states that about the year 1838 a prescription was brought to the
Apothecaries’ Hall, Liverpool (where he held the position of manager),
of which one of the ingredients was chloric ether. The preparation was
at that timen apparently not known in this country, for Dr. Brett,
the chemist of the Company, specially prepared some from the formula
he found in the United States Dispensatory. Its properties pleased
some of the medical men, particularly Dr. Formby, by whom it was
introduced into local practice. Waldie, finding that the preparation
was not uniform in strength, improved the process by separating and
purifying the chloroform, and dissolving it in pure spirit, by which a
product of sweet flavour was obtained.
[Sidenote: On the eve of the great discovery.]
There seems little doubt that Waldie was the first to suggest the use
of chloroform, as an anæsthetic, to Professor Simpson, who at once
resolved to try it by experimenting on himself and his assistants. He
made the first experiment in his own house on November 4th, 1847, and
in a letter written to Waldie thus describes the event: “I am sure
you will be delighted to see part of the good results of our hasty
conversation. I had the chloroform for several days in the house before
trying it, as, after seeing it such a heavy, unvolatile-like liquid,
I despaired of it, and went on dreaming about others. The first night
we took it, Dr. Duncan, Dr. Keith and I all tried it simultaneously,
and were all ‘under the table’ in a minute or two.” Professor Miller,
who was a neighbour of Simpson’s, used to come every morning to see
if the experimenters had survived! He describes how, “after a weary
day’s labour, Simpson and his assistants sat down and inhaled various
drugs out of tumblers, as was their custom. Chloroform was searched
for and found beneath a heap of waste paper, and with each tumbler
newly charged the inhalers resumed their occupation. . . . A moment
more, then all was quiet; then a crash. On awakening, Simpson’s first
perception was mental. ‘This is far stronger and better than ether,’
said he to himself. His second was to note that he was prostrate on the
floor, and that among the friends about him there was both confusion
and alarm. Of his assistants, Dr. Duncan he saw snoring heavily, and
Dr. Keith kicking violently at the table above him. They made several
more trials of it on that eventful evening, and were so satisfied with
the results that the festivities did not terminate until a late hour.”
[Sidenote: Simpson achieves success]
On November 10th, 1847, Simpson communicated his discovery to the
Medico-Chirurgical Society of Edinburgh, in a paper entitled, “Notice
of a new anæsthetic agent as a substitute for sulphuric ether.” A day
or two afterwards an arrangement was made with Simpson to administer
the new anæsthetic to a patient who was about to be operated upon,
but, owing to some cause, he was unable to be present. The operation
went on without him, and the patient died on the first incision of the
knife. Simpson’s absence was providential indeed, for it saved the
reputation of chloroform at the outset. On November 15th, chloroform
was used for the first time in a surgical operation in the Edinburgh
Royal Infirmary. Three patients were operated on successfully under its
influence. One, who was a soldier, was so delighted with the effect
that, on awaking after the operation, he is said to have seized the
sponge with which administration had been made, and, thrusting it into
his mouth, again resumed inhalation more vigorously than before.
To Simpson, there is no doubt, belongs the merit of having made
anæsthesia triumph over all the opposition, which was at first,
actively, offered to its use. For this he well deserved the rewards
which fell upon him in the evening of his life.
Among those who aided in the establishment of the use of anæsthetics,
mention must be made of the work of John Snow, who by his researches
placed the practice on a scientific basis.
The advent of chloroform gave an impetus to other investigators in the
field of anæsthesia, and during the last fifty years many other bodies
have been introduced and tried with more or less success for the same
purpose. Methyl chloride, which was discovered by Dumas and Peligot,
was introduced by Deboe in 1887, who used it extensively in local
affections. In 1867, Sir B. W. Richardson introduced methyl bichloride
or methylene [methylene dichloride]. He formed a very high estimate of
its properties as a good general anæsthetic, and said he preferred it
for many reasons to chloroform, as he found that the anæsthetic sleep
was produced more quickly and was more prolonged.
Sir T. Spencer Wells also advocated its use, and stated, in 1872, that
it had fewer drawbacks than any then known anæsthetic. Tetra-chloride
of methyn [carbon tetrachloride], which much resembles chloroform,
was discovered by Regnault in 1839, and its anæsthetic properties
were first made known by Sansom and Harley in 1864. Simpson was of
the opinion that it had a more depressing effect upon the heart than
chloroform, and was more dangerous generally as an anæsthetic.
Nunneley, of Leeds, also contributed work of value in this department
of research, and introduced ethyl bromide and chloride of carbon. He
dispelled the idea, long prevalent, that anæsthetics could be found
only in a limited class of chemical compounds.
Among other substances which have been introduced during the last
twenty-five years, but which, owing to one defect or another,
have since been practically abandoned, mention should be made of
butylic hydride [butane], ethylene, amylene, ethyl nitrate, aldehyde
(introduced by Poggiale), carbon bisulphide, ethidene dichloride
[ethylene dichloride] (discovered by Regnault and first used as an
anæsthetic by Snow), and ethyl bromide, first prepared by Serullus in
1827.
LOCAL ANÆSTHETICS
Local anæsthesia, already alluded to as probably the earliest form of
numbing sensibility to pain, was practised in antient times by the
inunction of various narcotics, but after the seventeenth century the
practice seems to have almost entirely gone out of use. The latter end
of the nineteenth century, however, marks a new era in this department.
On September 15th, 1884, considerable interest was aroused by a
communication made at the Ophthalmological Congress at Heidelberg, by
Karl Koller, of Vienna, in which he demonstrated the effects of cocaine
as a local anæsthetic.
[Sidenote: The discovery of Cocaine]
The alkaloid now known as cocaine was isolated by Gädeke, from the
leaves of the _Erythroxylon Coca_ as far back as 1855. He called
it ethroxylene. Four years later a further investigation of the plant
was made by Nieman, who noticed that the leaves produced a numbness
of the tongue; and in 1874 Hughes Bennett demonstrated that cocaine
possessed anæsthetic properties. In 1880, Von Anrep, who made a careful
investigation of the drug, hinted that the alkaloid might be of use in
general surgery as a local anæsthetic, and Koller undertook a series
of experiments on animals in the laboratory of Professor Stricker, in
which he found that complete anæsthesia of the eye, lasting, on an
average, ten minutes, followed the introduction of a two per cent.
solution of the alkaloid.
The immense value of such an anæsthetic in ophthalmic operations
was universally recognised, and it at once came into general
use. In painful conditions of mucous surfaces, and for minor
operations, cocaine has been found of great service, and as a
local anæsthetic it has a large field of usefulness. Since the
introduction of cocaine, other substances have been brought forward,
which, after extensive trials, have proved to be of real clinical
value. Of these may be mentioned eucaine, a synthetic product
(benzoyl-vinyl-diaceton-alkamine) discovered by Merling, and first
studied by Vinci in Liebreich’s laboratory. Of the two forms of this
drug used, which are known as A and B, the latter was soon found to be
the only one suitable for producing local anæsthesia. Its properties
are similar to those of cocaine, with the exception that it produces
no vaso-constriction, and it is claimed that it is equal in anæsthetic
power, whilst its toxicity is very much less.
[Sidenote: Stovaine and Tropa-cocaine]
Stovaine, or benzoyl-ethyl-dimethylaminopropanol hydrochloride, more
recently introduced, is a synthetic product elaborated by Fourneau, and
derived from tertiary amyl alcohol. It is much less toxic than cocaine,
but its comparative value still remains to be proved by further trial.
Tropa-cocaine, a drug closely allied to cocaine, and derived from the
leaves of the Java coca plant, has recently been much used in Germany,
but it does not appear to possess any advantages over cocaine or
eucaine.
Novocaine, or para-amido-benzoyl-diethylamino-ethenol hydrochloride,
has lately been found to possess satisfactory properties as a local
anæsthetic in dental operations. It is said to be free from the toxic
and local irritant action common to other local anæsthetics.
THE NECESSITY FOR ABSOLUTE PURITY IN CHLOROFORM
[Sidenote: Administration of Chloroform]
[Sidenote: Purity an essential]
[Sidenote: Danger of impurities]