HISTORICAL INTRODUCTION.
The most important discovery that has been made in the practice of medicine since the introduction of vaccination, is, undoubtedly, the power of making persons perfectly insensible to the most painful surgical operations, by the inhalation of the vapours of ether, chloroform, and other agents of the same kind.
In giving a brief outline of this discovery, it is necessary to inquire into the attempts of every kind which had previously been made to prevent severe pain; and also to notice the history of medicinal inhalations, whether undertaken with the view of preventing pain, or of relieving or curing disease.
The practice of taking opium and other vegetable narcotics, to relieve pain or procure sleep, was common in the most remote periods to which history extends; but the earliest notices which remain of any attempts to prevent the pain of surgical operations were written at the period of the Roman Empire. They were alluded to by Dr. Simpson at the Medico-Chirurgical Society of Edinburgh in November, 1847.[[4]] Dioscorides,[[5]] speaking of mandragora, says, “Some persons boil the root in wine down to a third part, and preserve the decoction, of which they administer a cyathus (rather more than an ounce and a half) in want of sleep and severe pains of any part, and also before operations with the knife or the actual cautery, that they may not be felt.” (Ante sectiones ustionesve, ut ne sentiantur.) Further on he says: “A wine is prepared from the bark of the root without boiling, and three pounds of it are put into a cadus (about eighteen gallons) of sweet wine, and three cyathi of this are given to those who require to be cut or cauterized: when being thrown into a deep sleep they do not feel any pain.”
The same author also adds,[[6]] in speaking of a kind of mandragora called morion, “They relate that a drachm of it being taken as a draught, or eaten 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. Medical men also use it when they have to resort to cutting or burning.”
In treating of mandragora, Pliny[[7]] remarks that the juice of the leaves is more powerful than the preparations made from the root. He says, “Some persons even die from a considerable draught. It has the power of causing sleep in those who take it. The dose is half a cyathus (six drachms). It is taken against serpents, and before cuttings and puncturings, lest they be felt. For these purposes it is sufficient for some persons to have sought sleep from the smell (of the medicine).”
Apuleius,[[8]] under the head mandragora, says, “If any one eat it he will immediately die, unless he be treated with butter and honey, and vomit quickly. Further, if any one is to have a limb mutilated, burnt, or sawn, he may drink half an ounce with wine, and whilst he sleeps the member may be cut off without any pain or sense.”
After reading the above passages from such well-known authors, it may be asked how it was that the practice of preventing the pain of surgical operations was entirely unknown just prior to 1846.
The reason, no doubt, was that the statement these passages contain was looked upon as a vulgar error of the period, which had imposed on the credulity of the authors. Dr. Woodville,[[9]] speaking of the use of mandragora by the ancients, says, “They employed it principally in continued watchings, and in those more painful and obstinate affections which were found to resist less powerful medicines.” He gives, in a foot note, a reference to the place in Dioscorides from which the passages above quoted are taken, and had he believed in the performance of operations without pain, we may conclude he would not have passed over so important a fact in silence.
With the knowledge we at present possess, however, a different view must be taken of the subject; and it must at least be allowed that the statements of the ancients had some foundation in truth. This is rendered more certain by the circumstance that atropa mandragora belongs to the same genus as belladonna, which has a greater power in annulling the common sensibility than any plant in present use, unless it be aconite. The loss of reason, described by Dioscorides as caused by mandragora, is a striking symptom of poisoning by the class of plants (the solanaceæ) to which it belongs. It appears from some remarks of Aretæus[[10]] and Cælius Aurelianus[[11]] that people were in the habit of taking mandragora as an inebriating agent in the time of the ancients, as an allied plant, the datura, is used at present by the natives of India. This practice would lead to a correct knowledge of the quantity which might be taken with impunity.
The mandrake is scarcely used in medicine at present, but its narcotic properties are well established. Hoffberg[[12]] administered the root in doses of three grains in some cases of gout, with the effect of relieving the pain.
Cases of poisoning by belladonna end, with very few exceptions, in recovery, however large the dose, and however alarming the symptoms may be; and, taking all the above circumstances into account, it is probable, that after ascertaining the right quantity to be administered for the purpose, this medicine or mandragora might be used, with considerable success, and no great danger, to prevent the pain of operations, if chemistry had not supplied us with agents much more convenient.
Not many ages after the Greek and Roman authors above quoted were describing the effects of mandrake in preventing the pain of operations, another plant, the Indian hemp, was employed for the same purpose in a more remote part of the world. M. Stanislas Julien, in an article on Chinese Medicine,[[13]] gives a notice of a work entitled “Koukin-i-tong, or a General Collection of Ancient and Modern Medicine,” in fifty volumes, 4to., and makes an extract from it respecting Hoa-tho, a practitioner, who flourished under the dynasty of Wei, between 220 and 230 of our era. Respecting Hoa-tho, it is stated that—“When he found that it was necessary to employ acupuncture, he applied it in two or three places; he did the same with the moxa, if it was indicated by the nature of the affection which he had to treat. But if the malady was situated in parts on which the needle, the moxa, or liquid medicines could not act—for example, in the bones, in the medulla of the bones, in the stomach, or the intestines, he gave to the patient a preparation of hemp (Ma-yo), and, at the end of some instants, he became as insensible as if he had been drunk, or deprived of life. Then, according to the case, he made openings and incisions, performed amputations, and removed the cause of mischief; he then brought together the tissues with points of suture, and applied liniments. After a certain number of days (at the end of a month, according to the annals of the later Hân) the patient found himself reestablished, without having experienced the slightest pain during the operation.”
We are not informed of the way in which the hemp was administered. If insensibility was caused so quickly, as is stated, it must have been by inhaling the fumes of the hemp when exposed to heat, and not by taking it into the stomach. This view of the matter is rendered more probable by the circumstance that the ancient Scythians were in the habit of inhaling the fumes of hemp,[[14]] several centuries before the time of Hoa-tho, and also by the practice of the Hindoos at present, who inhale the fumes of hemp from a pipe. The remark that the patient became reestablished at the end of a certain number of days, must refer to his recovery from the wound caused by the operation, and we are not informed how long the state of insensibility continued.
The next notice of any attempt to prevent the pain of operations, that I 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.
On the 19th of January 1847, just a month after the first application of ether for the prevention of pain on this side of the Atlantic, Dr. Simpson of Edinburgh administered the vapour in a case of labour, and ascertained that it was capable of removing the sufferings of the patient without interfering with the process of parturition. Etherization was soon afterwards employed in the reduction of strangulated hernia and dislocations of the femur and humerus, some of them of long standing. It was also used with advantage in neuralgia, tetanus, and the convulsions of infants, and it became more and more general in surgical operations.
No great improvement in the practice of medicine was probably ever established so readily as the inhalation of ether for the prevention of pain. Yet it met with stout opposition in certain quarters, and when a serious operation in which ether had been used terminated unfavourably, there were those who attributed the patient’s death to the new practice, although numerous other patients had sunk in exactly the same manner long before ether was used. In one of these cases a coroner’s inquest was held, and the jury returned a verdict that the death of the deceased was caused by the inhalation of ether, although the patient had not even been made insensible by it, had felt all the pain of the operation, which was retarded by her struggles, and did not die till the third day. Notwithstanding a certain amount of opposition and mistrust, the inhalation of ether was becoming more general in the course of the year 1847, and there is every reason to conclude that it would very soon have obtained the complete confidence of the medical profession and the public, had it not been for circumstances which must next be considered.
A medicine called chloric ether has been in use since 1831. It consists of a solution of chloroform in spirits of wine. It is somewhat variable in strength, but usually contains about twelve per cent. of its volume of chloroform. Dr. Henry Jacob Bigelow of Boston tried this by inhalation, as well as other substances, when Dr. Morton first used sulphuric ether, but he did not succeed with it in causing insensibility to pain. Mr. Jacob Bell of London tried the chloric ether in the beginning of 1847, and succeeded in causing insensibility with it in some cases.[[34]] After this time the chloric ether was exhibited occasionally in St. Bartholomew’s and the Middlesex hospitals, and in the private practice of Mr. Lawrence, but it did not come into general use, owing to its expense, and its frequently failing to cause insensibility.
The relation of chloroform to chloric ether is exactly the same as that of opium to laudanum, and no one acquainted with this circumstance could doubt for a moment that chloroform inhaled alone would produce the effects which it did when inhaled from its solution in spirit; the only uncertainty about the matter that could possibly exist would be whether it might not be too strong for use in its undiluted state.
The true nature of the so-called chloric ether was, however, known to very few persons. It did not enter into the pharmacopœias, and it was mentioned in very few of the works on materia medica. I examined a specimen of it, and found that its properties when inhaled were due to a volatile body containing chlorine, which evaporated first, leaving a great quantity of spirits of wine behind. I concluded that the volatile body was hydrochloric ether, and as this article is so volatile that it exists in the form of gas except in comparatively cold weather, and consequently could not be conveniently used for inhalation, I did not consider the matter any further. M. Flourens had indeed experimented on animals with undiluted chloroform, but was so struck with its great and dangerous power, that he was far from recommending its use in surgical practice.
It was left for Dr. Simpson of Edinburgh, who had already the merit of having discovered the use of inhalation in midwifery, to be the first to administer chloroform in an undiluted state, and to recommend it successfully for general use. Mr. Waldie, of the Apothecaries’ Hall of Liverpool, first mentioned chloroform to Dr. Simpson, as the latter states in a foot-note to his first pamphlet on the subject. Mr. Waldie has given the following account of the circumstance in a pamphlet on chloroform.[[35]]
“When in Scotland, in October last, Dr. Simpson introduced the subject to me, inquiring if I knew anything likely to answer. Chloric ether was mentioned during the conversation; and, being well acquainted with its composition, and with the volatility, agreeable flavour, and medicinal properties of the chloroform, I recommended him to try it, promising to prepare some after my return to Liverpool, and to send it to him. Other engagements and various impediments prevented me from doing this so soon as I should have wished; and in the meantime Dr. Simpson, having procured some in Edinburgh, obtained the results which he communicated to the Medico-Chirurgical Society of Edinburgh on the 10th of November, and which he published in a pamphlet entitled—‘Notice of a New Anæsthetic Agent as a Substitute for Sulphuric Ether in Surgery and Midwifery.’”
Dr. Simpson’s first experiments with chloroform were made in the early part of November 1847, and his pamphlet on the subject, which was published on the 15th of that month, had a wide circulation, and created great interest. Chloroform was immediately used everywhere to a greater extent than ether had been. An impression became very prevalent that chloroform was safer than ether. This impression arose rather from the general tenour of Dr. Simpson’s essay than from any direct statement, for he had not treated on this point.
The great strength of chloroform as compared with ether, and the extreme care required in its use, were indeed soon pointed out;[[36]] these precautions, however, attracted but little attention till the first death from chloroform occurred near Newcastle on the 28th January, 1848. Ether was exhibited by inhalation during eleven months in Europe, and about sixteen months in America, before chloroform was introduced. During all this time no death was occasioned by its use, if we except one at Auxerre in France, which appeared to be occasioned by want of air, owing to an imperfect inhaler, and not to the effect of ether. Chloroform had only been employed between two and three months when the above mentioned death occurred, and this was soon followed by others in nearly all parts of the world. These accidents have prevented many persons from inhaling chloroform, and they have prevented a still greater number from enjoying that freedom from anxiety and apprehension before an operation, which ought to be one of the greatest advantages of any plan for preventing pain. As chloroform possesses advantages over ether, in being more convenient and less disagreeable, it continues to be used, to the exclusion of the latter agent, in most parts of the world. In the Massachusetts General Hospital, however, where sulphuric ether was first employed, it was resumed three or four years ago, and the use of chloroform was prohibited by the governors, on account of two accidents from it. Ether is also employed out of the hospital, both in surgical and obstetric practice, in Boston and the neighbourhood; and I have been informed that this is also the case in Philadelphia, whilst in the state of New York both chloroform and ether are employed. I learned last year that ether was the agent employed for causing insensibility at Naples and at Lyons.
Several volatile substances have been tried in a few cases with the effect of causing insensibility, since the introduction of chloroform, but none of them came into use except amylene, which was first employed by me in King’s College Hospital in November 1856, after I had made several experiments on animals with it, and inhaled small quantities of it myself. I have administered it in a great number of operations already, and find it to possess certain advantages over chloroform in the greater number of cases. Although it has not yet been generally employed in this country, it has been used extensively in Paris, Strasbourg, Lyons, and other places on the continent, with very favourable results.
It is not improbable that, amongst the multitudes of new bodies which chemistry makes known every year, some agent may be found superior to those hitherto used; and besides the great practical advantages which are directly derived from the discovery of inhalation for the prevention of pain, the method of breathing medicinal substances in the gaseous state offers great facilities for the investigation of their effects, and cannot fail to hasten the time when the mode of action of medicines will be a branch of exact knowledge.