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