Part 2

Porta, writing in 1579, says: “It is possible to extract from several soporific plants a quintessence, which is to be shut up in a well-covered leaden vessel, lest the drug should evaporate. When it is to be used, the lid is to be removed and the medicament held to the nostrils, when its vapour will be drawn in by the breath and attack the citadel of the senses, so that the patient will be sunk in a deeper sleep not to be shook off without much labour.”

[Illustration: A SURGEON PERFORMING AN OPERATION ON THE EYE

From a woodcut of the XVII century]

Besides mandragora, opium, Indian hemp, and other plants with narcotic properties already referred to, that were used for anæsthetic purposes in mediæval times, certain substances are mentioned by early writers that cannot be identified. Thus Albertus Magnus mentions an animal product, of which he says: “Any person smelling it falls down as if dead and insensible to pain,” but there is no reference to such a drug by other writers of the period.

[Sidenote: Local anæsthetics in antient times]

Local anæsthesia was not unknown during the middle ages, and Cardow recommends the inunction of a mixture consisting of “opium, celandine, saffron, and the marrow and fat of man, together with oil of lizards.” He also adds: “If the patient drinks wine in which the seeds of the patulica marina have been steeped for a week, it will prevent him feeling any pain.”

[Sidenote: First mention of freezing as an anæsthetic]

Bernard mentions that it was customary in Salerno to mix the crushed seeds of poppy and henbane, and apply them as a plaster, to deaden sensibility, to parts that were about to be cauterised; while Bartolinus states that local anæsthesia was sometimes produced by freezing, thereby foreshadowing the use of ether and ethyl chloride as local anæsthetics.

[Sidenote: Boerhaave’s anæsthetic]

During the seventeenth century the belief in the narcotic draughts of the antients for producing anæsthesia appears to have waned, and few allusions are made to them until the middle of the eighteenth century, when fresh interest seems to have been excited in the subject. The famous Boerhaave is said to have used opium as an anæsthetic, both by inhalation of its vapour and also by internal administration in powder. According to Van Swieten, in his commentaries upon Boerhaave’s “Aphorisms,” the following is given as the recipe: “Oil of cinnamon, 2 drops; oil of cloves, 1 drop; citron peel, 2 grains; sugar, 2 drachms. Mix and add red coral, prepared, 1 drachm; pure opium, 2 grains. Mix for two doses, one of which is to be taken one hour before the operation, and the other one quarter hour before it, if the patient has not slept.”

[Illustration: AN OPERATION IN THE SEVENTEENTH CENTURY

From a painting by Franz Hals]

[Sidenote: An operation on the King of Poland]

In 1782, Weiss is said to have operated on the foot of Augustus, King of Poland, having previously placed the royal patient under the influence of “a certain potion surreptitiously administered.” Shortly afterwards Sassard, a surgeon of La Charité, in Paris, suggested that patients who were about to be operated upon should be drugged with narcotics as a means of preventing shock. That this method was sometimes practised is evidenced from a chapter in “Bell’s Surgery,” where the author not only refers to it but objects to the method on account of the sickness and vomiting it produced.

As late as 1847, Chisholm, of Inverness, recorded his use of a drug given internally to produce anæsthesia for surgical purposes; he substituted the internal use of morphine for ether inhalation in a case of ablation of the breast successfully performed upon a woman, who declared that she felt no pain during the operation.

[Sidenote: Anæsthesia by compression of the carotid arteries revived]

Other means of producing insensibility were suggested in the eighteenth century, and the antient method of compressing the carotid arteries was revived. This method had been used by Valverdi about 1560, and Morgagni employed it about 1750 in his experiments on animals, and suggested that it might be used on human beings. Compression of the nerves of the limb about to be removed, was also proposed, by James Moore in 1784, and tried by Hunter and others, but the results could not be regarded as successful.

[Sidenote: Nelson’s arm amputated]

Surgical operations at this time meant periods of agonising pain, and the stoutest hearts often quailed at the prospect. It is said that Lord Nelson was so painfully affected by the coldness of the operator’s knife when his right arm was amputated at Teneriffe, that at the Battle of the Nile he gave orders to his surgeon to have hot water kept ready, so that at the worst he might be operated upon with a warm knife.

[Sidenote: The dawn of a new era]

Thus from the dawn of creation anæsthesia for surgical operations had been practised to some extent, but, owing to the uncertainty of the potency and action of the powerful narcotics and palliatives administered, and the danger attending their use when exact science was unknown, the practice seemed likely to fall into oblivion. At last a series of brilliant discoveries in chemistry created a new epoch in the history of anæsthesia.

THE CHEMICAL ERA OF ANÆSTHETICS

[Sidenote: Priestley’s discoveries]

The discoveries of Priestley about 1767 led up to the plan of administering gases and vapours of definite composition by inhalation through the lungs, and directly he had demonstrated the existence of “vital air,” or oxygen, the properties of this body were tested in the hope of great results in the art of medicine. Priestley’s experiments concerning the inhalation of oxygen were in time followed by those of Beddoes, who recommended the inhalation of oxygen, hydrogen and other gases in the treatment of disease. It seemed only natural that experiments with other gases and vapours by inhalation should follow. Pearson, of Birmingham, administered ether in this way in 1795 for the relief of consumption, and ten years afterwards Warren, of Boscombe, employed ethereal inhalation to relieve the sufferings attending the later stages of phthisis.

Priestley’s discoveries of the method of liberating and collecting gases, and his demonstrations that certain gases could be absorbed and compressed in water, led to the introduction of aërated waters--carbonic acid gas being the first to be employed.

[Illustration: JOSEPH PRIESTLEY]

In the course of time, nitrous oxide, which had been discovered by Priestley in 1776, was compressed in water, and came into general use as a medicinal agent.

[Sidenote: Anæsthetic properties of nitrous oxide]

In 1798, a Medical Pneumatic Institution was established at Bristol by the exertions of Beddoes and others, and Humphry Davy was appointed superintendent. It was here that he commenced and carried on his notable researches on nitrous oxide. In one of his experiments he constructed a box or chamber in which he inhaled the gas in measured quantities. One day, in the year 1799, when suffering from toothache or inflammation of the gums, he resorted to the inhalation of the gas, and discovered to his great delight that it relieved the pain, which led him to the conclusion he expresses in the following words in “Researches Chemical and Philosophical,” 1800: “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.”

[Illustration: SIR HUMPHRY DAVY]

[Sidenote: Faraday points out similarity in the effects of nitrous oxide and sulphuric ether]

About 1806, Woolcombe, of Plymouth, prescribed for Lady Martin, a patient suffering from asthma, the inhalation of sulphuric ether to relieve the attacks. Lady Martin found the inhalation gradually caused her to become unconscious, from which state she would recover in a short time, with the result that the paroxysm of dyspnœa had disappeared. But the teaching of this case, and even the more explicit account of Humphry Davy, was overlooked; and no further development occurred until the year 1818, when Faraday pointed out, in “The Quarterly Journal of Science and Arts,” that the inhalation of the vapour of sulphuric ether produced effects similar to those caused by nitrous oxide.

[Illustration: MICHAEL FARADAY]

About this time Professor Thompson, of Glasgow, was accustomed annually to amuse his students by allowing them to inhale ether and nitrous oxide until they were intoxicated, and occasionally became unconscious, when it was noticed that they were insensible to the prick of a pin, or a blow. In these cases the gas or ether was inhaled from a bladder. Two drachms of rectified and washed ether were poured into a bladder and allowed to diffuse. Then the mixture of air and ether vapour was breathed, the expired air being allowed to enter the bladder also. Curiously enough, very little improvement has been made on this method of administration to the present day.

[Sidenote: On the brink of the discovery]

It is an extraordinary fact that, even in the face of such experiments as those we have referred to, no one among the investigators who stood at this time on the brink of so great a discovery ventured over the threshold. It is almost inconceivable in these days to realise, that for thirty-nine years these substances were used for experimental purposes, and even for amusement, without a realisation of the great blessing to humanity that lay almost within grasp. The things that are apparently most plain may lie longest buried; so with the discovery of efficient anæsthesia, which even then developed in an indirect manner.

MESMERISM AS AN ANÆSTHETIC

[Sidenote: Mesmerism in antient times]

[Sidenote: Healing by “stroking”]

From the earliest ages the apparent power of some men to influence the minds and bodies of others has been known. Certain diseases were said to be affected by the touch of the hand of certain persons, who were supposed to communicate a healing virtue to the sufferer, and these practices were often connected with religious and magical rites. This method of healing was practised in antient times by the Chaldæans, Babylonians, Egyptians, Persians, Hindus, Greeks and Romans. Their priest-physicians are said to have effected cures and to have thrown people into deep sleep in the precincts of the temples. Such influences were at that time held to be due to supernatural power, a belief which was no doubt fostered by the priesthood. In the middle of the seventeenth century an Irishman named Valentine Greatrakes aroused great interest in England by his supposed power of being able to cure scrofula by stroking the patient with his hand. Most of the distinguished scientific men of the day, such as Sir Robert Boyle, witnessed and attested his cures, and thousands of sufferers crowded to him from all parts of the country. Since his time other men have come forward with similar claims, notably one Gassner, a Roman Catholic priest of Swabia, who in the early part of the eighteenth century attracted attention by stating that he could cure the majority of diseases by exorcism. His method had an extraordinary influence over the nervous systems of his patients, who in the end generally confessed themselves cured.

[Sidenote: Mesmer’s experiments]

In 1766, Mesmer, who was a pupil of Hehl, professor of astronomy at Vienna, and an advocate of the efficacy of the magnet for the cure of disease, met Gassner, and observed that the priest effected cures without the use of magnets and by manipulation alone. This led him to believe that some kind of occult force resided in himself, by means of which he could influence others. He held that this force permeated the universe, and more especially affected the nervous systems of men. In 1778, he removed to Paris, and shortly afterwards the French capital was thrown into a state of great excitement by the fact that human beings could be placed in a state of artificial sleep or trance, which was then called “mesmerism.”

Mesmer’s disciples claimed that even painful operations could be performed on patients in this condition without consciousness of pain.

[Sidenote: Braid’s researches on hypnotism]

[Sidenote: Esdaile operates on hypnotised patients]

Braid, who made a further investigation of the subject, dissented from the mesmerists as to the cause of the phenomenon, and called the condition “hypnotism.” In 1846, the Deputy-Governor of Bengal appointed a committee to observe and report on the surgical operations that were then being performed in India by Esdaile upon his patients, while under the influence of alleged mesmeric agency. The Committee reported on various experiments carried out under their observation, some of which had apparently been performed with great success. But from further investigation it was apparent that the method was uncertain, and success seemed to be due to the peculiar susceptibility of the patient operated upon. These experiments are worth recording, as they indirectly led to the practice of administering certain vapours to produce anæsthesia.

[Sidenote: Robert Collier one of the first pioneers]

One of the pioneers in the practice of inhalation was Robert H. Collier, who was a believer in mesmerism. In 1835 he was present at a lecture given by Dr. Turner, Professor of Chemistry at University College, London, and in the course of some experiments in the inhalation of ether was himself rendered unconscious, and also observed that his fellow-students who had inhaled it were insensible to pain. Four years later he went to America, and, while visiting his father’s estate near New Orleans, he was called to one of the negroes who had become insensible by inhaling fumes from a vat of rum, and who, in falling, had dislocated his hip. Finding the muscles flaccid, Collier reduced the dislocation without exciting the least sensation of pain in the patient. A little later he performed two operations upon patients while under mesmeric influence, with apparent success. These facts led him to connect the phenomenon of mesmerism with narcotism produced by inhalation, and in 1840 he commenced a lecturing tour throughout America on the subject. Three years later he returned to this country, and at Liverpool, where he landed, gave his first lecture, which he illustrated by experiments in mesmerism, and also showed the possibility of rendering a subject unconscious by the fumes of alcohol in which poppy-heads and coriander had been macerated. The theory he advanced, and attempted to prove throughout, was that the so-called mesmeric influence was identical in action with that of narcotic vapours.

[Sidenote: Uses his alcoholic mixture as an anæsthetic in 1842]

He claimed to have administered the fumes of his alcoholic mixture to a Mrs. Allen, of Philadelphia, in 1842, and while under its influence he extracted a tooth without causing her pain. Collier’s lectures excited general attention at the time, and there is little doubt that they gave a fresh impetus to research on the subject of anæsthesia by inhalation. He must therefore be regarded as an important pioneer, who, had he given up his ideas of mesmerism and proceeded systematically with his plan of making the body insensible by inhaling the vapour of alcohol, would have had no one to dispute with him in priority.

THE NITROUS OXIDE ERA

Although, as already stated, Humphry Davy had discovered the anæsthetic properties of nitrous oxide as far back as the year 1800, forty-four years elapsed before his idea was put into practical use.

[Sidenote: Colton lectures on nitrous oxide]

On December 11th, 1844, Dr. G. Q. Colton, a well-known lecturer on popular scientific subjects in America, and a pupil of Professor Turner, of London, delivered a lecture at Hartford, Connecticut, during which he gave a demonstration of the action of nitrous oxide gas. Horace Wells, a dentist, then in practice in the same town, formed one of the audience.

[Illustration: HORACE WELLS]

[Sidenote: Wells makes his historic experiment]

Among the persons who were invited by the lecturer to inhale the gas for the amusement of the audience was a man named Cooley, who wounded himself severely by falling against the benches, and only became aware of the fact when he saw the blood. Wells was greatly struck by this incident, and he determined to test the anæsthetic effects of the gas upon himself the next day by having a decayed upper molar extracted while under its influence. After the lecture he asked Dr. Colton if he would come to his house and administer the gas to him; and, on receiving his promise, he induced a Dr. Riggs to be the operator.

The historic event is described by the latter as follows: “A few minutes after I went in, and, after conversation, Dr. Wells took a seat in the operating chair. I examined the tooth to be extracted, with a glass, as I usually do. Wells took a bag of gas from Dr. Colton and sat with it in his lap, and I stood by his side; he then breathed the gas until he was much affected by it: his head dropped back, I put my hand to his chin, he opened his mouth, and I extracted the tooth. His mouth still remained open some time. I held up the tooth with the instrument that the others might see it; they, standing partially behind the screen, were looking on. Dr. Wells soon recovered from the influence of the gas so as to know what he was about, discharged the blood from his mouth, and said, ‘A new era in tooth-pulling!’ He said it did not hurt him at all. We were all much elated, and conversed about it for an hour later.”

[Illustration: “A NEW ERA IN TOOTH-PULLING”

The first dental operation performed on Horace Wells whilst under the influence of nitrous oxide gas]

[Sidenote: “A new era in tooth-pulling”]

After this, Wells extracted several teeth from his patients under nitrous oxide gas with equal success, and then went to Boston in order to make his discovery known to the medical profession in that city. He remained there some days in the hope of being allowed to try the gas in a case of amputation in the Massachusetts General Hospital, but the experiment was postponed. Dr. Warren, senior surgeon to the institution, however, invited him to address his class on the subject of anæsthesia, after which he was asked to administer the gas in a case of tooth extraction. He was assisted on this occasion by Morton, a Boston dentist who had been his pupil, and afterwards, for a time, his partner. The experiment, as Wells himself confesses, was not quite a success, the gas-bag having been removed too soon. The whole thing was denounced as a piece of humbug, and Wells was hissed out of the room as an impostor.

[Sidenote: Wells disheartened by failure]

[Sidenote: The death of Horace Wells]

Disheartened at length by the failure of his repeated attempts to establish his claims to priority as the discoverer of anæsthesia, his mind appeared to become affected, and for a time he wandered about the streets of New York. On January 4th, 1848, he was arrested and charged with throwing vitriol, but while in gaol he opened his radial artery, having first inhaled ether to make death painless. This sad event closed, at the age of thirty-two, the career of Horace Wells, to whom at least belongs the credit of having first shown the practicability of producing insensibility by nitrous oxide, and of having thus, in his own words, “established the principle of anæsthesia.”

THE ETHER EPOCH

Probably the first published account of the use of ether as a medicinal agent was made by Morris in a letter read before the Society of Physicians in London,[1] on December 18th, 1758, in which he advocates its use internally, and also as an external application.

[1] “Med. Obs. and Enq.” by the Society of Physicians in London, vol. 2, page 176, 1764.

In 1818, Faraday, as already stated, had called attention to the anæsthetic properties of ether, and showed that the vapour of sulphuric ether, when inhaled, produced effects similar to those of nitrous oxide. After Wells’ failure at Boston nothing further seems to have been done for a time to investigate the use of nitrous oxide as an anæsthetic.

[Sidenote: Early experiments with ether]

In 1839, William E. Clarke, a young medical student of Rochester, New York, was in the habit of amusing some of his friends, among whom was another student named W. T. G. Morton, by the inhalation of ether. Emboldened by his experiences, in 1842 he is said to have administered ether, by means of a towel, to a young woman named Hobbie, and during the period of insensibility which followed, one of her teeth was extracted by a dentist named Elijah Pope.

J. Marion Sims relates the following incident which he states happened in the year 1839:--“A number of youths in Anderson, South Carolina, were exhilarating themselves one day with the seductive vapour of ether. In their excitement they seized a young negro who was watching their antics, and compelled him to inhale the drug from a handkerchief which they held over his mouth and nose by main force. At first his struggles only added to the amusement of his captors, but they soon ceased as the boy became unconscious, stertorous and apparently dying. After an hour or two of anxiety on the part of the spectators he, however, revived, and was apparently no worse for his alarming experience.”

[Sidenote: Long claims to have used ether in 1842]

Three years after this incident one of the participators in the affair, named Wilhite, became the pupil of Dr. Crawford W. Long, a physician then practising in Jefferson, Jackson County, Georgia. Both the doctor and his pupils used occasionally to amuse themselves by inhaling ether, and the former often noticed that while thus excited he was insensible to blows and bruises. Wilhite recounted to him his memorable experience with the negro boy; and, in March, 1842, Long is said to have persuaded a patient, on whom he was about to operate for a small encysted tumour, to inhale ether until he was insensible. The patient consented, and the tumour was removed without any pain or accident. This memorable event was simply recorded by Long in his ledger thus:--“James Venable, 1842. Ether and excising tumour, $2.00.” Three months later he removed another tumour from the same patient in a similar way, and also performed three other operations during that year. He is said to have again repeated the experiment in 1843 and 1845, but the district in which he lived was so far removed from contact with the large cities and centres of thought, that the discovery remained unknown and unpublished until long after the anæsthetic properties of ether had been fully proved elsewhere. Long himself admits that he considered ether impracticable owing to the shortness of the anæsthetic state, and he therefore abandoned its use.

[Sidenote: Marcy’s experiment]

Towards the end of the year 1844, Dr. E. E. Marcy, a surgeon of Hartford, is said to have administered ether to a patient, and to have removed an encysted tumour about the size of a walnut from the scalp.

It is stated that Horace Wells was present at this operation, which was quite successful, but, being warned that ether was dangerous to life, the experimenters abandoned its use in favour of nitrous oxide gas.

[Sidenote: Morton’s experiments with ether]

In 1846, W. T. G. Morton (referred to previously) who had been in partnership with Wells as a dentist, and assisted him in the unfortunate experiment with nitrous oxide in Boston, now directed his attention to the finding of a more suitable anæsthetic for painless operations in dental surgery. After many unsuccessful attempts with various narcotics, Charles T. Jackson, a chemist of Boston, whose pupil he had been, suggested that he should try sulphuric ether, the properties of which had been known for so long.

[Illustration: CHARLES T. JACKSON]

[Sidenote: Jackson’s story]