am aware of, occurs in the work on Surgery of Theodoric, an author who
lived in Italy in the latter half of the thirteenth century. He writes
as follows:[15] “The making of a flavour for performing surgical
operations according to Dominus Hugo. It is thus made:—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 the dock, which has large round apples, and of the water
hemlock [cicuta]—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 it is
boiled away in it (the sponge). 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. This being finished, in order to
awaken him, apply another sponge, dipped in vinegar, frequently to the
nose, or throw the juice of the root of fenugrek into the nostrils;
shortly he awakes.”
I altogether disbelieve that a sponge, prepared as above, would, after
being placed in hot water, give off any odour or vapour which would
cause insensibility. The active ingredients, as they exist in the
various plants, are not sufficiently volatile to be given off at a heat
below that of boiling water. Hemlock, indeed, contains a volatile
principle, which can be liberated by an alkali; but, even if it were set
free by any chance during the preparation of the sponge, it would all be
dissipated by the long boiling.
If sleep were really caused in this way, it must have been by some of
the moisture from the sponge reaching the mouth or throat, and being
swallowed; and it may be remarked that the author speaks of the
preparation of a taste or flavour (confectio saporis), rather than an
odour, although the sponge is certainly directed to be applied to the
nostrils. It must be remarked, also, that if the patient were made so
insensible, as not to feel the surgeon’s knife, he would be little
affected by vinegar, or the juice of fenugrek, in his nostrils.
Immediately after the prescription quoted above, and in the same
paragraph with it, Theodoric gives another recipe from Master Hugo,
directing antimony, quicksilver, soap, quick lime, and a little arsenic,
to be sublimed together. A portion of the resulting compound, the size
of a nut, is directed to be placed over a hernia, or whatever else is to
be operated on. Then follows a rather lengthy direction for subliming
arsenic, also from Dominus Hugo. The arsenic so sublimed is described as
rendering surgical operations extremely pleasant. The words are—“hæc
acus fiat mitis et suavis: sicut sudor beatæ virginis quum peperit
Christum.”
I have applied arsenic to the skin for twenty-four hours, with no other
effect than irritation, and an eruption of pimples, the sensibility of
the part being increased; and in my opinion, arsenic would not cause
insensibility, unless it were applied so long that the inflammation
caused by it should end in gangrene. I consider that the statement of
Theodoric, respecting arsenic, strengthens the doubts I have expressed
concerning his spongia somnifera. There is another reason for disputing
the efficiency of the above mentioned recipes. Theodoric directs the
patients about to undergo operations to be tied, or held by strong men.
In the operation for hernia, for instance, he directs the patient to be
tied to the bench, or table, with three bands, one round the ankles,
another round the thighs, and a third across the chest, holding the arms
and hands. This circumstance is the more significant, since Theodoric
had lived some time with Hugo, and seen his practice, as he states in
the dedication to his work.
It is reasonable also to conclude that if any successful plan of
preventing the pain of surgical operations had been introduced after the
revival of literature, it would not have fallen into disuse and been
forgotten.
In an interesting paper by Dr. Silvester,[16] an anecdote is quoted,
with an intention to show that anæsthetics were commonly had recourse to
in severe operations as late as the end of the seventeenth century. The
quotation is from a German work by A. G. Meissner, called _Skizzen_, or
Sketches, and published at Carlsruhe in 1782. It is as follows:—
“Augustus, King of Poland and Elector of Saxony, suffered from a wound
in his foot, which threatened to mortify. The court medical men were
opposed to the operation of amputation; but during sleep, induced by a
certain potion surreptitiously administered, his favourite surgeon,
Weiss, a pupil of Petit, of Paris, cut off the decaying parts. The royal
patient was disturbed by the proceeding, and inquired what was being
done, but on receiving a soothing answer he again fell asleep, and did
not discover till the following morning, after his usual examination,
that the operation of amputation had really been performed.”
It is most probable that the potion surreptitiously administered in this
case, was an ordinary sleeping draught, and that only the “decaying
parts” were cut off, as in fact is stated. The decaying parts of course
would be without feeling.
The mind of surgeons seems now and then to have turned spontaneously
towards preventing or alleviating the pain of operations, and certain
attempts and suggestions were made with this object during the later
part of the last century, in apparent ignorance of what had been done by
the ancients in this direction.
Ambroise Tranquille Sassard, principal surgeon of the Hospital la
Charité at Paris, recommended the employment of a narcotic previous to
serious and painful operations, the dose to be proportioned to the age
and strength of the patient.[17] He does not state whether the plan was
actually tried.
Mr. James Moore, surgeon,[18] recommended compression of the large
nerves, and tried it on a patient in St. George’s Hospital, whose leg
Mr. John Hunter amputated below the knee. The crural and sciatic nerves
were compressed for nearly an hour by an instrument contrived for the
purpose, and Mr. Moore considered that the greater part of the pain was
prevented. The patient complained more of the sawing of the bone than of
the cutting part of the operation. I am not aware whether this plan was
tried in other instances, but it is certain that it did not come into
general use.
M. le docteur Liégard (de Caen) has stated,[19] that the peasants in his
part of France are in the habit of tying a band very tightly round the
arm or leg before operations on the extremities. He had himself removed
a toe-nail in two cases, without pain, after a handkerchief had been
tied very tightly round the lower part of the leg. By this measure both
the nerves and blood vessels are, of course, more or less compressed.
The persons who believe in the existence of a force or power, which they
call Mesmerism, or animal magnetism, made many and persevering efforts
in recent times to cause insensibility to the surgeon’s knife. In some
cases they were imposed on by dishonest and designing patients, who
afterwards confessed they had suffered the pain to which they had
pretended to be insensible, but in other cases I have no doubt of the
operations having really been performed without pain. Absence of
consciousness and sensation is a common symptom in many cases of
hysteria and catalepsy, and in certain susceptible persons, hysteria and
catalepsy, or conditions nearly resembling them, can be induced by
acting on the imagination, or by exhausting the attention by means of
the fixed stare and monotonous “passes” of the so-called Mesmerisers.
Dr. Esdaile was more successful in putting Hindoos to sleep, and
operating on them in the hypnotized[20] state, than any one has been
with Europeans: yet it was only in a portion of the cases in which it
was tried that the alleged agent took effect. In many instances, efforts
continued for two or three months had no effect on the patient; and in
many of the operations, which were reported as successful, “there was
much convulsive movement of the limbs, corrugation of the brows, and
even loud cries and sobs,” although the patients afterwards denied all
knowledge of what had passed.[21]
The discovery of the means of preventing pain, which will occupy the
greater number of the following pages, did not arise out of any of the
attempts either in ancient or modern times above enumerated. It sprung
directly from the practice of inhaling chemical and medicinal
substances.
The custom of inhaling the fumes of narcotic plants existed at the very
commencement of the historic period, as appears by the following
passages from Herodotus. Speaking of the people who inhabited some small
islands on the river Araxes, which flows into the Caspian Sea, he
says,[22] “They add that they have discovered other trees that produce
fruit of a peculiar kind, which the inhabitants, when they meet together
in companies, and have lit a fire, throw on the fire as they sit round
in a circle; and that by inhaling the fumes of the burning fruit that
has been thrown on, they become intoxicated by the odour, just as the
Greeks do by wine; and that the more fruit is thrown on, the more
intoxicated they become, until they rise up to dance and betake
themselves to singing.”
Again, when treating of the funeral ceremonies of the Scythians, he
says,[23] “When they have set up three pieces of wood, leaning against
each other, they extend round them woollen cloths; and having joined
them together as closely as possible, they throw red-hot stones into a
vessel placed in the middle of the pieces of wood and the cloths. They
have a sort of hemp growing in this country very like flax, except in
thickness and height; in this respect the hemp is far superior: it grows
both spontaneously and from cultivation; and from it the Thracians make
garments very like linen, nor would any one who is not well skilled in
such matters distinguish whether they are made of flax or hemp, but a
person who has never seen this hemp would think the garment was made of
flax. When, therefore, the Scythians have taken some seed of this hemp,
they creep under the cloths, and then put the seed on the red-hot
stones; but this, being put on, smokes, and produces such a steam, that
no Grecian vapour-bath would surpass it. The Scythians, transported with
the vapour, shout aloud; and this serves them instead of washing, for
they never bathe the body in water.”
Mental illusions of all kinds have frequently been looked on as divine
revelations, not only by savages, but even by nations having a
considerable amount of civilization. The priestess at Delphos became
intoxicated with the fumes of narcotic plants before delivering her
oracular responses, and it is a curious circumstance that when America
was discovered by Columbus, it was the custom of the Indians to throw
tobacco on the fire during their religious ceremonies, when the piaches,
or priests, who officiated, were thrown into a state of ecstatic
inebriation by the smoke they inhaled.
I have already stated my belief that the Indian hemp administered,
previous to surgical operations, in China, by Hoa-tho, in the beginning
of the third century of our era, was exhibited by inhalation.
The fumes of various narcotic plants are inhaled by eastern nations at
present, for smoking in the east is an entirely different process from
smoking in the west of Europe, where the fumes of tobacco are merely
drawn into the mouth and then puffed out again. In Asia and some of the
eastern parts of Europe, the fumes of opium, tobacco, datura, Indian
hemp, or whatever else is smoked, are always inhaled into the lungs.
John Baptista Porta of Naples makes the following statement in his work
on Natural Magic,[24] published in 1597:—
“At last shall be related a wonderful method by which any sleeping
person may inhale a soporific medicine. From what we have said, any one
will easily know that he is liable to suffer severely after sleep caused
by medicine, and to have his suspicions aroused.
“But the quintessence is extracted from a number of the above named
medicines by somniferous menstrua. This is put into leaden vessels
perfectly closed, lest the least aura should escape, for the medicine
would vanish away. When it is used, the cover being removed, it is
applied to the nostrils of the sleeping person, he draws in the most
subtile power of the vapour by smellings, and so blocks up the fortress
of the senses that he is plunged into the most profound sleep, and
cannot be roused without the greatest effort. After the sleep, no
heaviness of the head remains, nor any suspicion of trick or fraud.
These things are plain to the skilful physician, but unintelligible to
the wicked.”
The author does not make known what the “somniferis menstruis” were,
with which the “quinta essentia” were extracted. As sulphuric ether had
been described more than fifty years before he published his work, it is
not improbable that this was the evanescent substance which required to
be so carefully closed up, and that the profound sleep was simply caused
by this, as the narcotic principles dissolved in it would remain in the
bottle in the form of extracts. The benefit of inhalation has been
frequently attributed to medicines which were supposed to be inhaled,
when it was really due to the menstruum in which the medicines were
dissolved. This often happens at present when the menstruum is merely
water. Baptista Porta does not say that operations were performed under
the influence of the inhalation, or, in fact, that it was applied to any
useful purpose whatever.
The Persian Pharmacopœia[25] contains some recipes for fumigation,
called bouc-houri, that were inhaled, for the medicines are directed to
be made up into balls or cubes which are to be placed on the live coals,
and the head is to be held over them. Some of the prescriptions contain
myrrh, camphor, mace, and storax, and are for the cure of coryza and
catarrh; one containing musk, camphor, guaiacum, etc., is said to
comfort the brain and intellect, and to be useful in palpitation of the
heart, faintness, and debility of the senses. This Pharmacopœia also
contains[26] a “remedium odorativum somniferum”, which consists of opium
and camphor, besides the seeds of roses and the root of mandragora. The
ingredients are to be powdered and put in a box, for the purpose of
being smelt at. There is also[27] a stupifying remedy prepared with five
drachms of opium and ten drachms of black poppy, which are directed to
be boiled to dryness in water with a pound of wheat, and then powdered.
It is added that whoever shall take a drachm and a half of this wheat
will be alienated from his senses. With regard to the last but one of
the above prescriptions—that to be put in a box for smelling, it may be
observed that, as heat was not applied, the only ingredient which would
produce any effect is the camphor.
The discoveries of Cavendish, Priestley, Lavoisier, and others
respecting the nature of atmospheric air and the more important gases,
gave an impetus to medicinal inhalations, at the latter part of the last
century. Dr. Beddoes, in particular, distinguished himself by the
administration of oxygen, hydrogen, carbonic acid, and other gases, in
consumption and various diseases. Dr. Richard Pearson exhibited the
vapour of ether in consumption with some advantage in the year 1795.[28]
Three years afterwards, a medical pneumatic institution was established
at Bristol, by the exertions of Dr. Beddoes and others. The celebrated
Humphrey Davy was the superintendent. This establishment was not very
successful in the immediate objects for which it was instituted, but
Davy made at this place his masterly researches concerning nitrous oxide
gas. In the course of his experiments, he found that severe pain arising
from inflammation of his gums was relieved by breathing this gas, and he
published the following opinion:—
“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.”[29]
This suggestion of Sir Humphrey Davy was not acted on either by himself
or any other person for nearly half a century, when the late Mr. Horace
Wells, Surgeon Dentist of Hartford, Connecticut, having witnessed the
exhibition of nitrous oxide gas by a public lecturer, named G. Q.
Colston, was induced, in consequence of what he saw of its effects, to
request Mr. Colston to accompany him to his office and exhibit the gas
to him, whilst another dentist, named Dr. Riggs, extracted a tooth for
him which was troublesome. The tooth was extracted without pain, and Mr.
Wells, after the effect of the gas had subsided, exclaimed, “A new era
in tooth pulling.” This took place on December 11th, 1844.[30] Mr. Wells
administered the nitrous oxide in thirteen or fourteen cases of
tooth-drawing in Hartford with a success more or less complete, and
before the end of the year he repaired to Boston to introduce his
discovery to the professors at the Massachusetts General Hospital. He
called on Drs. Warren and Hayward, who invited him to exhibit the gas to
one of the patients, who was expecting to have a limb amputated. He
remained two or three days in Boston, but the patient decided not to
have the operation performed at that time. The nitrous oxide was
consequently tried on an individual who required to have a tooth
extracted. This patient felt some pain, and the application was
considered to be a failure. It is worthy of remark that Drs. Charles T.
Jackson, and W. T. G. Morton, were present on this occasion. Mr. Wells
returned to Hartford in disappointment. He expressed his opinion to his
friends that the nitrous oxide gas was uncertain in its action, and not
to be relied on; and he altogether abandoned the use of it until some
time after Dr. Morton’s discovery of the effects of sulphuric ether in
preventing pain.
As long ago as 1818 an article, which is believed to have been written
by Mr. Faraday, appeared in the _Quarterly Journal of Science and
Arts_,[31] describing the great resemblance between the effects of the
vapour of ether and nitrous oxide gas. This circumstance has since been
published in all the standard works on chemistry; and it was the annual
custom of the late Professor Turner, of University College, London, to
pour a little ether into a bladder of air, and allow some of the
students to inhale the vapour. The same practice prevailed, more or
less, in other colleges, both in Europe and America, when the lecture on
ether was delivered. The resemblance between the action of nitrous oxide
and that of vapour of ether was therefore extensively known.
Dr. Morton, surgeon dentist of Boston, in America, administered
sulphuric ether, by inhalation, to a man in his office, on the 30th of
September, 1846, and extracted a tooth without causing any pain. He
applied the ether in several cases of a similar kind during the next few
days. Having obtained the permission of Dr. J. C. Warren, he
administered it to a patient in the Massachusetts General Hospital, on
whom that surgeon performed an operation on the neck. On the following
day, Dr. Morton exhibited ether to a woman in the same hospital, whilst
Dr. Hayward removed a large fatty tumour from the arm, and after this
date it was frequently administered.
Dr. Morton was well acquainted with Mr. Horace Wells, before alluded to,
and had been in partnership with him. Before administering the ether to
his patient in September 30th, Dr. Morton had a conversation with Dr.
Charles J. Jackson, Professor of Chemistry, respecting the safety and
propriety of the application, and the names of these gentlemen were
associated in a patent which they took out for the discovery. Dr.
Jackson asserts that Dr. Morton knew nothing of the effects of the
vapour of ether till he gave him the information; whilst the latter says
it was his intention to use the ether before he went into Dr. Jackson’s
laboratory. It seems impossible to arrive at the exact truth on this
point, but it is admitted on all hands, that Morton was the first who
administered ether to prevent the pain of an operation. Dr. Jackson[32]
has indeed claimed the whole merit of the discovery, on the ground of
the alleged information he gave to Dr. Morton; but, if every word Dr.
Jackson says be admitted, it only appears that he suggested the use of
ether to Dr. Morton, just as Sir Humphrey Davy had suggested the use of
nitrous oxide to all the world in the year 1800. Dr. Jackson had inhaled
ether as hundreds of others had done, and being aware of Davy’s
suggestion of nitrous oxide for preventing the pain of operations, he
concluded that ether might also have that effect.
It will be shown further on that Mr. Waldie, of Liverpool, had a greater
share in the introduction of chloroform than Dr. Jackson had in the
introduction of ether—even supposing that Dr. Morton was previously
quite ignorant of that medicine; for when he informed Dr. Simpson of the
existence and nature of chloroform, he was able to give him, not merely
an opinion, but an almost certain knowledge of its effects; yet Dr.
Simpson is justly considered to be the person who discovered and
introduced the use of undiluted chloroform as a substitute for ether.
The practice of the ancients in giving mandragora and Indian hemp has no
connection with the recent discovery for preventing the pain of
operations, which may be briefly related as follows:—Sir Humphrey Davy
made the suggestion that nitrous oxide gas might be employed for this
purpose, and, at the end of forty-four years, Mr. Horace Wells carried
this suggestion into practice, but failed to bring the nitrous oxide
into general use, and gave the matter up. Two years later, Dr. Morton,
who was well acquainted with the efforts of Mr. Wells, applied the
vapour of ether, which was already known to resemble nitrous oxide in
its action. He succeeded completely in preventing the pain of
operations, and in bringing his discovery into general use throughout
the civilized world. In a short time the inhalation of ether was found
to be so safe and certain in its action, and to prevent the pain of
operations so entirely, that the most ardent imagination could scarcely
conceive that anything further could be desired in this direction.
Dr. Morton withheld at first the name of the agent he was employing, but
its strong and peculiar odour revealed it so plainly that concealment
was impossible. Dr. Bigelow, of Boston, having tried sulphuric ether,
and found it to produce all the effects of the so-called letheon, he
made the subject known, not only to his own countrymen, but also by
letter to Dr. Boot of London. The first operation under the influence of
ether on this side of the Atlantic, was the extraction of a tooth, at
the house of Dr. Boot, on Dec. 19th, 1846. Mr. Robinson, of Gower
Street, administered the ether and performed the operation. The patient
was a lady, named Miss Lonsdale. The ether was quite successful in
preventing the pain in this case, as well as in two operations performed
at University College two days afterwards, by the late Mr. Liston. These
operations were amputation of the thigh, and evulsion on both sides of
the great toe-nail. The ether was given by Mr. Squire, of Oxford Street,
with an apparatus which he contrived for the occasion.
Considerable opposition was made to the inhalation of ether in America,
soon after its introduction, and it seemed likely to fall into disuse,
when the news of its successful employment in the operations of Mr.
Liston, and others in London, caused the practice of etherization to
revive. Mr. Robinson, dentist, gave much time and attention to the
exhibition of ether in London on its first introduction, and was on the
whole very successful. This was not generally the case, however, with
other operators during the first six weeks of the new practice. Owing to
imperfections in the inhalers employed and in the method of using them,
the ether often either failed altogether or only made the patient partly
insensible; and Mr. Liston, and some other surgeons, were inclined to
discountenance the use of it, in consequence of the struggles and cries
of patients to whom it had been administered.
It soon became apparent, however, that the vapour of ether was capable
of inducing a state of perfect quietude, with entire absence of pain,
during all kinds of surgical operations. From the 28th of January the
ether produced the desired effect in every operation that was performed
in St. George’s Hospital, until the time when chloroform was introduced
as a substitute for this agent.[33]
Ether was employed in Paris a few days after its first application in
London, and in a short time it was in use nearly all over the world.