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25. Conquerors of Pain

PAIN associated with surgical operations had been a scourge upon mankind long before the dawn of history; and its searing, agonizing, frightening finger followed the surgeon’s scalpel like a shadow until the middle of the nineteenth century. Then, within the short span of four years, means of relief were twice discovered in a new nation, the United States of America, whose medical men until then had looked to Europe for leadership in medical progress.

Nature yields her secrets to man only as his mind and his imagination expand sufficiently to cope with new ideas. Ether had been synthesized by Valerius Cordus in the middle of the sixteenth century – 300 years before the anesthetic properties were realized. Humphry Davy, experimenting with “laughing gas,” hinted at the possibilities of nitrous oxide as a surgical anesthetic in 1800; but nearly half a century was to pass before surgical patients were to be relieved of fright, humiliation, agony, and shock on the operating table.

Four men played leading roles in bringing about the advent of anesthesia. Crawford Williamson Long, a physician, working independently, was first to use ether as an anesthetic in his practice in Jefferson, Georgia, March 30, 1842. Horace Wells, a dentist, of Hartford, Connecticut, who used nitrous oxide as an anesthetic in his dental practice as early as December, 1844, sought to demonstrate its possibilities for use with surgical patients before Dr. John C. Warren’s class at the Harvard Medical School in January, 1845, but failed through a technicality. William Thomas Green Morton, a dentist studying medicine at the time, successfully demonstrated use of ether as an anesthetic upon a patient undergoing a surgical operation, October 16, 1846, in the operating amphitheatre of the Massachusetts General Hospital. Morton’s claim to discovery was challenged by Dr. Charles Thomas Jackson, physician and chemist, whole suggestion led Morton to experiment with highly purified ether.

Conquering pain incident to surgical operation by means of an anesthetic agent probably was medicine’s greatest gift to mankind up to the time. Ironically, none of the four men who claimed to have brought it about received the recognition he felt he deserved. As Robinson wrote; “The four men did not meet in a tavern and pledge eternal brotherhood as the world rejoiced in the Victory over Pain. Alone they drank the wine of bitterness, and tasted the lees of hatred. There was limitless glory for all, but not one would grant a share to another.”

Despite tremendous advances in anesthesia during six score years since its world wide adoption we still know little about pain. Given by nature as a warning signal for the protection of life, its mechanisms can be controlled or thwarted, but these are little understood. Man early turned to his surroundings, seeking to assuage pain with herbs, leaves, cool water, or mud from the earth that bore him. When man learned to ferment wine, he created his first anodyne, physical as well as psychic. A clay tablet impressed in Babylon about 2250 B.C., proposes a remedy to relieve the pain of toothache. Theophrastus wrote of hellebore for relief of pain in the fourth century, B.C..: Herodotus the Greek and Susruta the Hindu both discussed cannabis; Dioscorides in the first century wrote of opium, and knew about mandrake, essential ingredient of “wine of the condemned.” Used to ease the punishment tortures of transgressors. Dioschrides, too, was perhaps the first to use the word, anesthesia. Galen recommended lettuce as an anodyne. Ancient Greeks also knew that compression of carotid arteries produces insensibility. However, as Robinson stated, the term, anesthesia, was applied more often by Greek poets and dramatists than by medical men, and though sensibilities may have been blunted in various ways, there is no record that ancient Greeks performed operation under anesthesia.

Little progress was made toward relief of pain during the thousand years of the Middle Ages. Lack of standards for drugs was a primary drawback. The “spongia somnifera,” a means of inhaling volatile agents, was known in the ninth century. “Sweet Vitriol” was mentioned in the thirteenth century by Baymondus Lullius, and again 200 years later by Paracelsus, who distilled it from a mixture of sulfuric acid and alcohol. Cordus in 1540 described synthesis of a product that was named “ether” by Frobenius of Germany in 1730. As early as 1513, monks used alcoholic fumes to alleviate pain. Pare in 1543 used pressure to induce anesthesia – but the method was nearly as painful as the operation it masked. Seventeenth century France forbade stupefaction of patients with herbal remedies; and in the middle of that century, Severino of Naples experimented with refrigeration anesthesia – which reached limited popularity only in the twentieth century.

While ether remained a laboratory curiosity and a remedy for whooping cough, reduction of pain during operations was accomplished only as surgeons developed speed in operating. But by other routes, science was groping for the answer. Priestley and Scheele independently discovered oxygen about 1771; Lavoisier learned of oxygen’s significance in respiration in 1792; and these advances gave rise to the school of pneumatic medicine – those who sought to administer medicines via inhalation. These findings also became bases for experiments in Britain; by Humphry Davy with nitrous oxide; by his student. Michael Faraday, with ether; and by Henry Hill Hickman with carbon dioxide.

Davy, in 1800, at the end of his Researches, wrote “as nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.” Faraday, in 1818, noted that: “When the vapour of ether mixed with common air is inhaled, it produces effects very similar to those occasioned by nitrous oxide.” Hickman, in 1824, carried out a series of experiments on animals, proving that pain of surgical operations could be abolished by inhalation of carbon dioxide. Despite extensive publication of works of these men, in England and in France, no physicians of their day recognized the tremendous import of their experiments.

Meanwhile, experiments reported by Franz Anton Mesmer of Vienna, as early as 1776, with “animal magnetism,” were enjoying a popular revival in many European countries and in the United States. First employment of mesmerism to relieve pain in surgical patients was by Jules Cloquet, a French surgeon, who removed a breast from a mesmerized patient. James Braid, surgeon of Manchester, England, was first to apply the term, hypnotism, to the process. Meanwhile, Samuel Guthrie, physician turned chemist in upper New York state, in 1831 was distilling “sweet whiskey” from chloride of lime and alcohol – at about the same time that Soubeiran in France and Liebig in Germany announced their independent discoveries of a heavy, sweet, volatile, “chloric ether,”in 1832. Daniel Smith, one of the principal founders of the Philadelphia College of Pharmacy, wrote of its delicious flavor and intoxicating qualities, “more grateful to the taste than hydrated ether.” In 1834, Dumas, a French chemist, gave the fluid the name of chloroform. Even though Guthrie’s eight-year old daughter once fell asleep while playing about a vat, chloroform’s great promise escaped the country doctor’s attention.

While it seems amazing that the idea of anesthesia did not dawn upon medical men much earlier, in view of these scientific signposts. It must be recognized that the greatest barrier to evolution of such a concept was the eighteenth century attitude towards suffering. “Behind the decent, civilized Georgian façade,” wrote Cartwright, “there lies a callousness, a brutality almost unparalleled in history. Pain and suffering were held to be of no account; what mattered was not the degree of pain inflicted, but the fortitude with which it was borne. To such a mentality, anesthesia would have seemed not the greatest single boon ever vouchsafed to suffering humanity, but a matter of very minor importance…

“Turn over the pages for fifty years, consider the state of the world in the eighteen-forties, and we see a very different picture. During that half century…man’s attitude to suffering had altered instead of being no inevitable and even salutary part of life, it had become a disease to be cured radically wherever possible. In such a world, the hideous tortures inflicted by the surgeon upon the helpless sick were realized to be necessary, but were regarded with horror and disgust…

The acceptance of anesthesia is not just an incidental happening, an unrelated accident…it is one of the outward signs of a great inward working of men’s minds.”

Though Davy and Faraday failed to attach much importance to pain-relieving properties of nitrous oxide and of ether, revealed by their experiments, their findings led to laughing gas lectures and ether frolics of the 1840’s. These popular science demonstrations, in turn, emboldened Long, Wells, and Morton to attempt what then seemed incredible-anesthesia for patients undergoing surgical procedures by inhalation of little-known chemical compounds.

Although controversy over recognition and credit for practical application of the principle of anesthesia was long and bitter, evidence seems clear that Crawford Williamson Long was first to use ether for surgical anesthesia for other than dental operations. It seems clear, also, that William E. Clarke, a chemist, and Elijah Pope, a dentist, used ether on a patient in Rochester. New York, for extraction of a tooth, in January, 1842. Dr. Long, having observed that he and his friends were temporarily insensible to pain following experimental inhalation of ether, administered ether on a towel held over the face of James M. Venable, and while he was anesthetized, removed an encysted tumor from the back of the patient’s neck. This operation was performed March 30, 1842.

.Crawford Long was born November 1, 1815, near Danielsville, Georgia. He was graduated at nineteen years of age from the University of Georgia, in 1835. After reading medicine under Dr. Grant of Jefferson, Georgia, he entered the Medical Department of the University of Pennsylvania in 1838. Among his instructors were Philip Syng Physick, once a pupil of John Hunter, and George B. Wood and Franklin Bache, who also were instrumental in development of the Philadelphia College of Pharmacy, and co-editors of the United States Dispensatory. After graduation in 1839, Long spent eighteen months “ “walking the hospitals” of New York, studying surgery, before buying Dr. Grant’s practice and settling in the small Georgia town of Jefferson. After his first success, Dr. Long used ether whenever he could persuade surgical or obstetrical patients to permit it. He ran into opposition prejudice, and rumor among country fold, however, and accumulated but few case histories. Busy with a large practice, he found no time to report his findings. It was not until he read of Morton’s “Letheon” anesthetic in the Medical Examiner of December, 1846, that he was stimulated to write a communication for publication. Dr. Long was frequently interrupted in his writings, so that the manuscript lay unfinished until December, 1849, when the paper finally was published in the Southern Medical and Surgical Journal. By that time, Wells was a suicide, and Morton and Jackson were embroiled in their famous ether controversy. Crawford Long, his economic position suffering from the aftermath of the War between the States, carried on his practice, literally dying “in the harness” as he assisted a new life into the world, June 6, 1878. To the end, his most cherished treasure was evidence of his priority of use of ether for anesthesia.

Horace Wells, for a time a successful dentist in Hartford, Connecticut, was born at Hartford, Vermont, January 21, 1815. After studying dentistry in Boston, he entered practice in the Connecticut city in 1836. Ingenious and restless, he had several inventions to his credit. He had taught dentistry to several students, including William Morton, before witnessing his first laughing gas demonstration on the evening of December 10, 1844. The following day, Wells persuaded the lecturer, Dr. Gardner Q. Colton, to administer nitrous oxide to him, and induced a former dental student, Dr. John Mankey Biggs, to extract a molar. Upon regaining consciousness, he was elated to note that he had felt no pain. Wells then plunged into manufacture of nitrous oxide and administered it to fifteen patients with varying success. Full of enthusiasm, he hurried to Boston, and through efforts of another of his former dental student, Dr. Morton, secured permission to give a demonstration of painless tooth pulling before one of the classes of the famous surgeon, Dr. John Collins Warren, at the Harvard Medical School. On this occasion he failed to administer sufficient dosage of nitrous oxide; the patient cried out in pain and students jeered and called the demonstration “humbug.” Wells retreated to Hartford, temporarily dropped his plans for promotion of laughing gas, and turned to selling his patented shower bath.

When a year and a half later, Wells’ former partner, Morton, successfully demonstrated use of ether for anesthesia. Wells sought to establish his claim to priority..
As the Jackson-Morton battle became more heated. Wells enlisted support in his behalf in Congress, but this only added to the confusion of the issue. In New York, seeking support for use of nitrous oxide, Wells was arrested for an act suggesting derangement and committed suicide while in prison, January 24, 1848.

Though his motives might be questioned and considered anything but altruistic. William Thomas Green Morton brought the practical application of anesthesia to the attention of the world. Born on a farm near Chariton, Massachusetts, August 19, 1919, Morton early evinced a desire to study medicine, but economic circumstances led him, instead, to study dentistry, perhaps in Baltimore for a time, but not at Baltimore College of Dental Surgery, as is often claimed. In 1841, he became a student of Dr. Horace Wells; then, in 1843, he became Wells’ partner for a year. Still yearning to become a physician, Morton enrolled as a medical student on March 20, 1844, under Dr. Charles T. Jackson, and in November of that same year, he enrolled in the Harvard Medical School. Morton continued to practice dentistry and established a factory for manufacture of false tooth. His method of fitting required removal of all the “old fangs” – a none too pleasant procedure. Seeking a pain deadener as a means of popularizing his treatment with patients. Morton tried many things; champagne, laudanum, opium, and, at the suggestion of Dr. Jackson, sulfuric acid.

Having secured the ear of one of his medical instructors, Dr. Warten, Morton paved the way for Horace Wells’ demonstration of nitrous oxide at the Harvard Medical School. Though Wells failed, his successful attempt fired Morton’s imagination. Morton began experimenting in secret, testing ether on gold fish, on a dog, on two dental assistants, and on himself. His results were not uniform, and again he consulted Dr. Jackson. Jackson suggested that he use highly purified ether, so Morton experimented further, and his results were much better. On September 30, 1846, employing an ether-saturated handkerchief held over the face. Morton Anesthetized Eben H. Frost, and extracted a molar successfully without pain. Morton now was in a frenzy of excitement and enthusiasm. He envisioned a fortune from anesthesia. Morton again approached the elderly and highly reputed surgeon, Warren, who had once experimented with mesmerism, and who had used ether in treatment for pulmonary conditions. Upon receiving word that Dr. Warren would permit his experiment, Morton hastly designed an apparatus for administering the anesthetic and sought to disguise the identity of ether with color and aromatics, giving it the name, “Letheop.”

In was on the morning of October 16, 1846, that Gilbert Abbott, suffering from a tumor of the jaw, was prepared for operation in the emphitheatre of Boston’s Massachusetts General Hospital. Present besides Dr. Warren were Drs. Charley F. Heywood (house surgeon), Henry J. Bigelow, Augustus A. Gould, Solomon D. Townsend, and other prominent surgeons. Morton, readying his apparatus, was late, arriving just as Dr. Warren was about to proceed. Morton saturated a sponge in the globular glass inhaler with is disguised ether preparation, spoke calmly to the patient, put the mouthpiece to his lips, and instructed him to breathe carefully in and out of the globe. Abbott at first flushed and moved spasmodically, then sank into unconsciousness. Morton turned to Dr. Warren and said “Sir, your patient is ready.”

Dr. Warren proceeded with the rather complicated task of removing the tumor, and closed the wound. The patient had only moved his legs a bit and made a few incoherent sounds. Upon emerging from the effects of the anesthetic, Morton questioned him. Abbott said he had felt no pain, only a scratching sensation. Dr. Warren is reported to have turned to his colleagues and students and said: “Gentlemen, this is no humbug.”

Morton immediately applied for a patent for his discovery. Meantime, on November 7, he administered ether for the first major operation under anesthesia-amputation at thigh level performed by Dr. Hayward at Massachusetts General Hospital.

On November 12, Patent No.4848 was issued to Charles T. Jackson and William T.G. Morton for a “new and useful improvement in surgical operations.”

On November 18, there appeared an article in the Boston Medical and Surgical Journal, by Dr. Henry J. Bigelow. The paper had been read, November 9, before the Boston Society of Medical Improvement. It he described the successful use of Morton’s procedure. This was the article that introduced the practice of anesthesia to medical men throughout the world.

Shortly thereafter, surgeons of Massachusetts General Hospital barred Morton and declined to use his preparation “until informed what it is.” Morton promptly backed away from his position of secrecy and admitted that the agent which brought about anesthesia was “sulfuric ether.” From then on, there was no further opposition in the hospital to performance of operations on patients under etherization.

The medical profession, once informed, was quick to adopt the use of ether anesthesia. In Europe there was more ready acceptance of ether anesthesia than in the United States. The successful surgical operation under anesthesia in the Old World was performed by Dr. Robert Liston, December 21, 1846, at University College Hospital of London. One observer of Liston’s amputation of patient’s infected leg through the thigh that day was a young Quaker, Joseph Lister. As Flexner noted, had anesthesia not been discovered, surgical antisepsis, as developed twenty years later by Lister, could not have been achieved.

Though the medical profession generally accepted the principle of surgical anesthesia, its early course was not smooth. In December, 1846, the Philadelphia Medical Examiner denounced it as quackery. Both clergymen and laymen denounced it as against God and nature. Especially was there opposition to use of ether to relieve the pain of childbirth. Meantime, too, Morton was having his troubles. He had a patent, but he could not protect it. Very soon, too, it was found that ether, administered from a saturated sponge or towel, was as effective as when Morton’s complicated apparatus was used. On December 9, 1846, Horace Wells published in the Hartford Journal, his claim as discoverer of surgical anesthesia. Dr. Jackson, who had shown little interest in Morton’s work until Morton began to receive credit in the press as discoverer of anesthesia, then first advanced his claim of having suggested use of pure ether. Morton acknowledged his indebtedness to Dr. Jackson, included his name in the patent application and made an arrangement to share with him profits expected from licensing. But, as world became interested in anesthesia, Jackson became more selfish and more assertive. He claimed full credit, saying Morton merely was his agent. There was shadowy precedent for Jackson’s actions; he had tried to take credit from Samuel F.B. Morse for invention of the telegraph; and again, he had tried to take for himself that due Dr. William Beaumont for his students of gastric function made with the cooperation of Alexis St. Martin, young French-Canadian with a “window” in his stomach left by a shotgun accident.

In 1847, Morton’s friends, realizing he faced financial difficulties, advised him to appeal to Congress for compensation. A petition was signed by leading Boston physicians, and filed with Congress. A representative from Connecticut objected citing Wells’ credit for discovery of anesthesia. Jackson, meantime, pressed his claims in Paris with the French Academy of Science.

In 1847, too, Dr. James Young Simpson of Edinburgh, Scotland, began using ether in his obstetrical practice. Finding ether to have some disagreeable qualities, such as odor and tendency to irritate bronchi, Simpson searched for replacements. He tried, on himself and on his associates, such drugs as “chloride of carbon, acetone, nitric ether, benzene, vapor of iodoform, and chloroform.” He found chloroform (Guthrie’s “sweet whiskey”) most suitable, and campaigned vigorously for its use in obstetrics and in surgery. Scottish clergymen objected to use of chloroform in women in childbirth, contending that labor was pain to be reduced with patience and fortitude. This controversy was quieted only by the acceptance of chloroform by Queen Victoria during the birth of her eight child. For a time, chloroform found considerable favor, due to its less unpleasant odor and because lower dosage was required for anesthesia; but, as use proved it to be more dangerous, ether again rose to first choice.

First to manufacture chloroform in Canada was Pharmacist J.D.B. Fraser, of Pictou Nova Scotia, who supplied it to doctors less than four months after Simpson’s first report. First Canadian physician to use chloroform in surgery was Dr. W.J. Almon of Halifax, who employed it in February, 1848. On March 22, 1848, Pharmacist Fraser supplied chloroform used during the birth of his son, Robert.

Morton’s and Jackson’s claims and counterclaims continued before the United States Congress and abroad. Wells’ proponents fought for his claim even after his death. Also, in 1849, Crawford Long first published his claim to priority based on having used ether in March, 1842. The French Academy, unable to reach another decision, split the Priz Monlyon equally between Jackson and Morton.

The ether controversy continued through the period of the War between the States. United States government agencies used freely, ignoring Morton’s patent. Crawford Long continued to present his evidences of claim. Morton’s misfortunes left him in poverty. Jackson continued to publish pamphlets, making more and more extravagant claims. To one of these, written by a supposed friend, is attributed the rage followed by apoplexy that ended Morton’s life in New York. July 15, 1868, Jackson was to spend the last seven years of his life in the MeLean Asyulum, a department within Massachusetts General Hospital, where he died, August 28, 1880.

While the world generally ignored the contenders for fame of anesthesia’s discovery, progress in extending application of the principle of anesthesia, and search for newer anesthetic agents, went forward rapidly. Dr. John Snow of London, was the first physician to specialize in anesthesiology. He perfected improved methods of administration of anesthetics. Benjamin Ward Richardson, another Londoner, introduced the first successful local anesthesia in the form of an ether spray, in 1867, which held its favor until the introduction of cocaine, in 1884. Since, research has made possible progress in anesthesia until today when there is hardly a situation for which there is not an effective anesthetic. Yet, as Keys wrote, “anesthesia remains primarily an empirical development. Our ignorance of pain is still appalling.” And Robinson, pointing to the responsibility of the anesthesiologist, commented: “Since every case of anesthesia brings the patient to the gates of death, anesthesia remains the most dangerous specialty in medicine. Eternal vigilance is the price of safety in anesthesia.”

To whom should final credit go? A dozen decades have not brought the answer. Inconclusive arguments continue, motivated for the most part by region pride. Long unquestionably was first to employ anesthesia in patients undergoing surgical operations, but as Robinson pointed out, “Long’s first use of ether was of importance to no one except the four or five patients upon whom he used it, and for four years ether remained unknown and unavailable to the world whose pain it might have eased.” Of Wells, Keys wrote: “Although Wells had failed to convince the world of the value of nitrous oxide as an anesthetic agent, he is credited with conceiving the idea of anesthesia and of publicizing the possibility of its use.” Jackson, the twisted genius that sought credit for other men’s ideas, no longer has proponents. Cartwright summed up the question by commenting: “By means of ether (Morton) brought about the revolution in medicine which he pneumatic physicians had looked for in vain”; and, “Of one thing there is no possible doubt: the general acceptance of anesthesia dated from Morton’s successful demonstration of October 16, 1946…Within a year, hardly an operation was performed throughout the civilized world without the use of ether…”

To Long, Wells, Morton, Simpson, and to a host of ethers, the world owes a great debt of gratitude. Dr. Oliver Wendell Holmes gave appropriate recognition on behalf of all mankind when he wrote: “By this priceless gift to humanity, the fierce extremity of suffering has been steeped in the water of forgetfulness; and the deepest furrow in the knotted brow of agony has been smoothed forever.”

REFERENCES

Ackerknecht, E.H., unpublished monograph.

Ackerknecht, E.H., A Short History of Medicine, New York, Ronald Press Co., 1955.

Archer, W. Harry, Life and Letters of Horace Wells, Discoverer of Anesthesia. Journal American College of Dentists, Vol.11, No.2, June, 1944; and Vol.12, No.2, June 1945.

Beecher, H.K., and Ford. C., Some New Letters of Horace Wells Concerning on Historic Partnership, Journal of the History of Medicine and Allied Sciences, Vol.9, No.1, January, 1954.

Beecher, H.K., and Ford, C., Nathan P. Bice’s “Trials of a Public Benefactor.” Journal of the History of Medicine and Allied Sciences, Vol.15, No.2, April, 1960.

Boland, Frank: The First Anesthesia. Athens, Georgia, University of Georgia Press, 1950.

Camac, C.N.B: Epoch-Making Contributions to Medicine, Surgery, and the Allied Sciences. Philadelphia, W.B. Saunders Co., 1909.

Cartwright, F.F: The English Pioneers of Anesthesia, Bristol, John Wright & Sons, Ltd., 1952.

Fifty Years of Pharmacy in Nova Scotia. Halifax, 1925.
Flexner, James T., Doctors on Horseback. New York. The Viking Press, 1937.

Ford, William W., William Thomas Green Morton: More Books. Vol.21, No.8, October, 1946, Boston Public Library.

Fuller, R.C: The First Authentic Record of the Use of Chloroform on This Side of the Atlantic, Canadian Pharmaceutical Journal, Vol.58, 118, October, 1923.

Hurwitz, Alfred, and Degenshein, George A: Milestones in Modern Surgery. New York, Hoeber-Harper, 1958.

Keys, Thomas E., The History of Surgical Anesthesia. New York, Schuman’s, 1945.

Major Ralph, H: A History of Medicine, Vol.2, Springfield, Illinois, Charles C. Thomas, 1954.

Redman, Kenneth: Some Memorials on Crawford W. Long. The First Performer of an Ether Anesthesia. The South Dakota Journal of Medicine and Pharmacy, Vol.11, No.2, February, 1959.

Fobinson, Victor: Victory Over Pain, New York, Henry Schuman, 1946.

Taylor, Frances Long: Craford W. Long and the Discovery of Ether Anesthesia. New York, Paul B. Hoeber, 1928.

Thorward, Jurgen: The Century of a Surgeon. New York, Pantheon Books, 1956.

Wilson, R.C: Drugs and Pharmacy in the Life of Georgia. Athens, Georgia, University of Georgia Press, 1959.

THE PICTURE

Before a skeptical group of surgeons in the operating amphitheatre of Massachusetts General Hospital, October 16, 1846, William T.G. Morton, Boston dentist, prepared to anesthetize Dr. John C Morton, Boston dentist, Gilbert Abbott, by causing him to inhale ether. Though Crawford W. Long, Georgia Physician, had used ether for anesthesia in 1842, and Horace Wells, Connecticut dentist, tried unsuccessfully to demonstrate anesthesia with nitrous oxide in 1845, reports of painless operations resulting from Morton’s methods gave practical anesthesia to mankind. Within a year, ether was being used world-wide to conquer pain incident to surgical operations.