JMS Pearce
Hull, England, UK

 

Fig 1. Warren and Morton’s operation in the Ether Dome, restaged with Mass General physicians assuming the roles of the original participants. Warren Zapol, MD, chief of anesthesia and critical care, starred as Dr. Morton, while Philip Kistler, MD, director of the Mass General stroke unit, played Dr. Warren. Painting by Warren and Lucia Prosperi. Paul S. Russell, MD Museum of Medical History and Innovation. Source

Anesthesia is one of the most humane and effective advances of all medical practices. The name commonly attached to the first general anesthetic, given on 16 October 1846, is that of the dental surgeon William TG Morton, who at the Massachusetts General Hospital successfully demonstrated ether anesthesia (vide infra). The well-known discovery needs no repetition. But there were other contenders who predated him. Their discoveries of general anesthesia sparked a fierce “ether controversy” about priority. Crawford Long, Gardner Colton, Horace Wells, and Charles T Jackson were the prime contenders. Some used nitrous oxide, others ether.

Joseph Priestly had reported his discovery of dephlogisticated nitrous air (nitrous oxide) in 1772. The first suggestion of preventing operative pain came from the brave self-experimenter Humphry Davy (1778-1829), who in a monograph in 1799 described two effects of nitrous oxide inhalation: relief of pain and euphoria.

“In cutting one of the unlucky teeth called dentes sapientiae I experienced great pain, which equally destroyed the power of repose and of consistent action.” After breathing “nitrous oxide the pain always diminished after the first four or five inspirations . . .”

He invented the phrase “laughing gas” and suggested:

As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations ¹

His assistant, Michael Faraday, confirmed his observations in 1818. But nobody tested this idea for more than forty years.

William E. Clarke, a medical student at the Berkshire Medical College in Massachusetts, in January 1842 discovered that the sister of a classmate, a Miss Hobbie, needed extraction of a tooth. Using an ether-soaked towel, Clarke removed the tooth painlessly. Ill-advised by his chief, Professor E. M. Moore, who thought it a hysterical phenomenon, Clarke made no further experiments, thereby forfeiting his claim for priority.

Fig 2. Henry J Bigelow’s paper: Insensibility during surgical operations.

Dr. Crawford Williamson Long (1815–1878) on 30 March 1842 was probably first to use ether for surgical anesthesia. He trained in medicine at the University of Georgia (Franklin College), in Pennsylvania, and in New York City. When he returned to Georgia to practice, ether was widely available, often used for recreational purposes known as “ether frolics.” In 1841 Long noticed that people who inhaled ether felt no pain from injuries received during their “frolics.” He wondered if ether could make surgery painless.² In 1842 a patient named, James Venable asked Dr. Long to remove a cyst from his neck. Three witnesses reported that on 30 March 1842 the operation was successful, and Venable felt no pain.^2,3 Long had administered di-ethyl ether (sulfuric ether) poured onto a towel and inhaled. He performed many operations including amputations and attended childbirth using this technique.⁴ However, working alone in a small village, he mistrusted himself and failed to publish his findings until 1849 in The Southern Medical and Surgical Journal.⁵ His work was therefore overlooked.

Horace Wells (1815-1848), an ill-fated dentist, was a pioneer of nitrous oxide anesthesia. He practiced in Hartford, Connecticut, with William Morton, who would become famous for ether anesthesia. Before this, Wells had noted the pain-killing properties of nitrous oxide (N20 or “laughing gas”) when on 10 December 1844, he and his wife Elizabeth attended a demonstration by Gardner Quincy Colton billed in the Hartford Courant as “A Grand Exhibition of the Effects Produced by Inhaling Nitrous Oxide, Exhilarating, or Laughing Gas.”⁶

Wells began his work by extensive self-experimentation with nitrous oxide, ether, and chloroform to compare their anesthetic properties. The day after he had witnessed Colton’s demonstration, Wells inhaled nitrous oxide provided by Colton while dentist John Riggs removed one of Wells’ molar teeth painlessly. He proceeded to demonstrate his technique at Massachusetts General Hospital in January 1845. He administered nitrous oxide during a dental extraction, but the patient cried out during the operation although he later claimed to have felt no pain. Wells was ridiculed and abruptly left the operating room.

Fig 3. MGH report on Morton vs. Jackson 1848.

He continued to provide nitrous oxide anesthesia for local surgeons for amputations and tumor removals, but dispirited by his ridicule in Boston did little dental work of his own. After Morton’s demonstration in 1846, he angrily published a letter describing his prior successes and with some justification claimed to be the discoverer of anesthesia. An unstable man, he became addicted to chloroform and ether and developed personality changes. One day in 1848, intoxicated by inhaling chloroform, he took a vial of sulphuric acid and threw it at two “abandoned females.” He was imprisoned. In his cell, perhaps overwhelmed by remorse, he inhaled chloroform, then severed his femoral artery, ending his life.⁷ Ironically, unknown to him, only days earlier the Paris Medical Society had publicly acclaimed him the discoverer of anesthetic gases.

William Thomas Green Morton, a former partner of Wells, in March 1844 began a dental practice in Boston. The partnership was dissolved as Wells believed Morton was unqualified. He had seen Well’s use of nitrous oxide and had discussed the possible use of ether with Charles Thomas Jackson. Morton painlessly extracted a tooth on 30 September 1846. On 16 October 1846, he gave the famous, successful demonstration of ether anesthesia at the Massachusetts General Hospital “Ether Dome”(Fig 1). The patient, twenty-year-old Edward Abbott, was seated in a chair while Morton gave the anesthetic ether. Chief Surgeon John Collins Warren then removed a tumor from Abbott’s jaw, and after the procedure insisted he had “felt no pain. . . . .”⁸ Warren exclaimed, “Gentlemen, this is no humbug.” However, Morton tried to keep the nature of his agent secret, referring to it as “Letheon” so that he could patent it.

Morton’s successful demonstration was widely acclaimed. He was awarded an honorary MD by the University of Washington in 1852. Many physicians on ethical grounds vehemently disapproved of Morton’s claim for a patent for “Letheon” (ether). He then spent years seeking profit and engaged in unseemly, costly arguments with Jackson who, like Wells, claimed priority in the discovery despite official recognition accorded to Wells and Crawford Long. Jackson claimed that the discovery was his. He said he had been experimenting with ether for several years and had discovered that inhaling ether could deaden the pain of surgery. Morton and others fiercely disputed this. Jackson had a history of similar disputes of priority with Samuel Morse’s patent for the telegraph, and with Gesner’s geological survey of the Bay of Lundy. Jackson eventually suffered a mental breakdown, or possibly a stroke, and was admitted to the McLean Asylum in 1873 where he died in August 1880. The ether row escalated into intrigue, deceit, and manipulation. Each contender took his case to the court of public opinion⁹ (Figs 2 & 3). Morton was also aware of Clarke’s earlier use of ether procuring a painless dental extraction. The “Ether Monument” commemorating these events in Boston bears no man’s name; it was nicknamed the “Either Monument”!

 

Fig 4. Blue plaque at 24 Gower St. Source

Ether anesthesia in Europe

Ether’s characteristic smell could not for long conceal the identity of Letheon, and its use spread quickly in the United States and Europe. Jacob Bigelow, physician, botanist, and father of Henry Jacob Bigelow, Harvard Professor of Surgery, wrote on 28 November to Dr. Francis Boott of London describing Morton’s discovery and enclosing his son’s paper (Fig 2).¹⁰ Boott forwarded the letter and H. J. Bigelow’s paper to The Lancet,¹¹ which published them both on 2 January 1847. Appended to the reprint was a letter from the great, mercurial surgeon Robert Liston (1794-1847) to Boott dated 21 December 1846 saying:

My dear Sir, – I tried the ether inhalation to-day in a case of amputation of the thigh, and in another requiring evulsion of both sides of the great toe-nail, one of the most painful operations in surgery, and with the most perfect and satisfactory results. It is a great matter to be able to destroy sensibility to such an extent, and without, apparently, any bad result. It is a fine thing for operating surgeons, and I thank you most sincerely for the early information.

This was the first operation under ether anesthesia (Fig 4) in Europe.¹²

When the discovery reached Edinburgh, James Young Simpson, a professor of midwifery, had been experimenting upon himself and assistants, inhaling various vapors to find an effective anesthetic. In November 1847 he tried chloroform with complete success, and soon in Britain it was preferred to ether. In 1853 royal sanction was given to anesthetics by Queen Victoria, who accepted chloroform from her physician, John Snow, when she gave birth to Prince Leopold.

During the American Civil War, ether and particularly chloroform became indispensable in thousands of amputations and other procedures for wounded Union and Confederate soldiers.

 

Conclusion

Chemists, physicians, and dentists each played significant roles in the discovery of anesthesia. They all deserve recognition. Sir Humphry Davy was the man who first suggested that nitrous oxide had analgesic properties that might be used in surgery. Next, William Edward Clarke was the first to use ether as a general anesthetic during dental extraction. Crawford Williamson Long should be recognized for the first use of ether for a general surgical operation, and Horace Wells for the first use of nitrous oxide for dental extraction. In May 1870 the AMA resolved, “that the honor of the discovery of practical anesthesia is due to the late Horace Wells of Connecticut.”¹³ William Morton, the person who received widest praise as the discoverer of anesthesia, should be recognized for the first public demonstration of ether anesthesia and for sedulously promoting its general use.

 

References

1. Davy H. Researches, chemical and philosophical; chiefly con­cerning nitrous oxide, or dephlogisticated nitrous air, and its respiration. London: J. Johnson; 1800. Cited by Cartwright FF. Humphry Davy’s Researches on Nitrous Oxide. Brit. J. Anaesth 1972; 44, 291-296.
2. Desai S P, Desai MS, Chandrakant SP. The discovery of modern anaesthesia-contributions of Davy, Clarke, Long, Wells and Morton. Indian J. Anaesthesia: 2007:51 (6): 472-478 https://rcoa.ac.uk/about-college/heritage/history-anaesthesia
3. Rafael A. Ortega, Keith P. Lewis, Christopher J. Hansen; Other Monuments to Inhalation Anesthesia. Anesthesiology 2008; 109:578–587 https://pubs.asahq.org/anesthesiology/article/109/4/578/8525/Other-Monuments-to-Inhalation-Anesthesia
4. Keys TE. The History of Surgical Anesthesia. USA, Schuman 1945. second, edition: New York, Dover Publications, Inc. of 1963.
5. Long, CW (1849). “An account of the first use of Sulphuric Ether by Inhalation as an Anaesthetic in Surgical Operations.” Southern Medical and Surgical Journal.
6. Haridas RP. Horace Wells’ demonstration of nitrous oxide in Boston. Anesthesiology. 2013;119(5):1014-22.
7. Anonymous. Distressing case of suicide. New York Tribune 1848 Jan 25;2.
8. Duncum BM. The Development of Inhalation Anaesthesia. Oxford: Oxford University Press, 1947. This was written for the centenary of Morton’s great demonstration, and was reprinted by the Royal Society of Medicine.
9. Report of the Board of Trustees of the Massachusetts General Hospital, Presented to the Corporation at their Annual Meeting, January 26, 1848. (Boston: Printed by John Wilson, 1848). Transferred to the Library of Harvard Medical School, 1938.
10. Bigelow HJ. Insensibility during surgical operations produced by inhalations. Boston Med Surg J. 1846;35:309-317.
11. Bigelow, Henry Jacob. Insensibility during Surgical Operations produced by Inhalation. The Lancet 1847;1 (1): 5–8 and 16–17.
12. Bigelow HJ. Ether and chloroform : a compendium of their history, surgical use, dangers, and discovery. Boston : David Clapp, Printer, 1848.
13. Jacobsohn PG. Horace Wells: Discoverer of Anaesthesia. Anesth Prog 1995; 42:73-75.

 

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JMS PEARCE is a retired neurologist and author with a particular interest in the history of science and medicine.

 

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