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“Gentlemen, This Is No Humbug”
The single greatest medical discovery of the last century began as a parlor game, and brought tragedy to nearly everyone who had a hand in it
August/September 1979 | Volume 30, Issue 5
Victory over pain by another route had become possible in the late 1790’s, when the English physician Thomas Beddoes had conceived of the notion that medication could enter the body through the lungs, and it had become probable when his countryman Humphry Davy, the chemist, shortly afterward described the ability of nitrous oxide to produce insensibility and said that it could be used to abolish suffering during operations. And yet—following these basic discoveries—decades went by without their use. It is always easier to explain why something happens than it is to explain why something doesn’t happen, so this singular circumstance must remain the subject of speculation. One credible theory is that fear of killing the patient was the principal restraining factor—that physicians dreaded accusations of malpractice which might result from such radical use of a chemical agent. Also, the Hippocratic Oath commanded that regimens of treatment for patients would be “not for their hurt or for any wrong,” and there was no getting around the possibility that rendering a patient insensible with gas could be very wrong, particularly when nothing was known of the correct dosage, limits of toleration, or harmful side effects.
Still, the idea kept creeping forward. In the early 1820’s a young English physician, Henry Hill Hickman, produced unconsciousness by means of a gas, although he seems to have been using a benign asphyxia rather than a genuine anesthesia. Dr. Hickman made animals unconscious by means of carbon dioxide inhalation and operated on them without any evidence of pain. In 1824 he published his findings, with the strong suggestion that they would apply to human beings as well as to animals; he’d be willing, he said, to undergo a surgical operation himself while under the effects of “carbonic acid gas.” But he was unable to attract interest or support.
And then there was Crawford W.Long, a young man practicing medicine in Jefferson, Georgia, in the early 1840’s. It seems that nitrous oxide, or “laughing gas,” was being used as an exhilarant at gatherings of young people in the vicinity, and at one of these parties, Dr. Long was requested to prepare some of the gas for use. Not having the required apparatus, Long suggested sulphuric ether as an equally safe and effective agent, and as a result ether sniffing became popular at similar parties in the neighborhood. During one of these “happy hours,” Dr. Long noticed that people under the influence of ether often received what should have been painful bumps and bruises with apparent indifference.
In 1842 Long suggested to one of the sniffers, James M. Venable, who was scheduled to have a tumor removed from his neck, that the operation be performed with the aid of ether. Venable finally being persuaded, the operation was conducted painlessly and with complete success on March 30, 1842. Long conducted other operations using ether with the same excellent results. However, he didn’t make his discovery known until some seven years afterward. He was described as a gracious, unassuming man, who enjoyed the simple pleasures of playing whist and of hunting and fishing and who clearly was not the sort to put himself forward. And yet, later, he felt he had to explain why he had not published his discovery for the benefit of mankind. In his small-town practice, he said, he had no opportunity to experiment with ether in a capital operation; his uses were confined to relatively minor operations that could be performed very quickly. What would happen in a severe and long operation, with the patient unconscious under the effects of the vapor for an extended period, he preferred not to find out by himself. He wrote, “Had I been engaged in the practice of my profession in a city, where surgical operations are performed daily, the discovery would, no doubt, have been confided to others, who would have assisted me in the experiments; but occupying a different position, I acted differently, whether justifiably or not.”
What was needed was not discovery (it seems probable that anesthesia had been “discovered” several times) but demonstration and publicity. Indeed, that anesthesia was finally introduced seems to have been less the product of science than it was of show business. On December 10, 1844, an advertisement appeared in the Hartford Courant , reading in part:
“ A GRAND EXHIBITION of the effects produced by inhaling NITROUS OXIDE, EXHILARATING or LAUGHING GAS! will be given at UNION HALL, THIS (Tuesday) EVENING , Dec. 10th, 1844.
“ FORTY GALLONS OF GAS will be prepared and administered to all in the audience who desire to inhale it.
“ TWELVE YOUNG MEN have volunteered to inhale the Gas, to commence the entertainment.