August/September 1979 | Volume 30, Issue 5
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
In the early 1840’s a visiting surgeon approaching the main building of Boston’s Massachusetts General Hospital, an imposing granite structure designed by Charles Bulfinch, could consider that he was about to enter one of the foremost temples of his art. From a parklike garden he ascended a flight of stone steps that led him through a portico of eight towering Ionic columns, then continued his climb inside the building up a gracefully winding cantilever staircase. On the fourth floor he entered the surgical amphitheater, located in the great dome with which Bulfinch had capped his architectural achievement. Here, in terms of facilities, he was virtually at the top of the surgical world.
On a sunny day the dome, consisting largely of skylights, provided clear, bright light for the surgeon’s work. A hundred or so observers, sitting in a steeply rising bank of seats, could see everything being done. One of these left us an impression of an “operating table covered with linen of snowy whiteness, rarely seen elsewhere, and for which the Hospital was noted” and of “handsome cases, in which artistically arranged surgical articles of every description, and adapted to any and all emergencies, were conspicuously placed.”
The same observer noted the presence of other and more ominous objects: “hooks, rings and pulleys inserted in the walls” for the attachment of powerful traction devices, and, standing in one corner in an upright sarcophagus, a mummy from ancient Thebes. The mummy may have been placed there to add a touch of scientific tradition, but for many patients who entered that room, its blackened, shriveled face and ghastly grin must have stood for something else: the chamber of horrors that this and all other operating rooms were in those days of pre-anesthesia surgery.
Reminiscing in 1897 about some of the scenes they had witnessed under that dome before anesthesia, a group of elderly physicians could only compare them with what they had heard about the tortures of the Spanish Inquisition. As one put it, “No mortal man can ever describe the agony of the whole thing from beginning to end.” At Massachusetts General Hospital surgical patients were not often tied down; they were held by strong attendants, but sometimes even the strongest were not able to cope with the spasms produced by cautery and the knife. One doctor remembered an operation performed by the hospital’s senior surgeon, Dr. John C. Warren, in which the cancerous end of a young man’s tongue was cut off by a sudden, swift stroke of the knife; then a white-hot iron was introduced into the mouth to cauterize the wound. Driven almost insane by the pain and the sizzle of his searing flesh, the patient burst out of his restraint, and a bloody struggle ensued.
Almost as bad as the cutting operations were those in which dislocations had to be reduced against the resistance of muscular contraction. The muscles could be relaxed by bleeding the patient to the point of extreme weakness, by administering tartrate of antimony, or by injecting a strong infusion of tobacco into the rectum. These crude procedures, however, were not completely effective, and so it was often necessary to attach straps to the body and affected limb and to apply traction by means of a block and tackle. The same aged physician who had been present at the tongue operation recalled with equal vividness seeing a poor wretch literally put to the rack for half an hour in an attempt to reduce a dislocation of the thigh, with the only results being outbursts of “yells and screams, most horrible in my memory now, after the interval of so many years.”
The good surgeon was the quick one. In any very lengthy operation, it was thought that the excruciating pain could cause the patient to die of shock. Limbs sometimes came off in less than a minute. But then it was still not over. Vessels had to be tied. The wound had to be sewed up. One surgeon of the period later observed that patients seemed to suffer as much in this stage of the operation as they had during the cutting. So the ligation and suturing, too, were done as rapidly as possible.
Under these circumstances there was little opportunity for the sort of careful observation aitd study that might have contributed to improvement of the surgical art. The fact that surgery, in spite of this, had made a considerable advance since the Middle Ages, when it grew out of the barber’s skill, was due mainly to increasing knowledge of anatomy and to experience gained in operating on victims of accidents or war. There was very little elective surgery, and even then it represented only a last desperate resort. Typically, in the five years prior to the introduction of anesthesia, operations at the Massachusetts General Hospital averaged about three a month.
During these years of limited surgical progress, many things had been tried as a means of inducing insensibility. About the best that had been found by the beginning of the 1840’s was opium—a large dose of laudanum given before the operation. But it was not enough to deaden the piercing pain of the knife. Another expedient was to make the patient “dead drunk.” It was not a success. Cold was applied, to numb the nerves, and various drugs were administered through the stomach, but they were inadequate.
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.
“ EIGHT STRONG MEN are engaged to occupy the front seats, to protect those under the influence of the Gas from injuring themselves or others. This course is adopted that no apprehension of danger may be entertained. Probably no one will attempt to fight.
“ THE EFFECT OF THE GAS is to make those who inhale it either Laugh, Sing, Dance, Speak or Fight, etc., etc., according to the leading trait of their character. They seem to retain consciousness enough not to say or do that which they would have occasion to regret.”
The conductor of the show and Chemical Lecturer (every entertainment in those days had to be either “educational” or “moral”) was “Professor” Gardner Quincy Colton, then thirty, who, with the aid of chemistry, was enjoying quite a success on the stage. Colton had conceived of his laughing-gas show while studying medicine in New York, and he had been on the road with it for less than a year.
When the entertainment began in Union Hall, Hartford, on that December evening in 1844, a young dentist, Horace Wells, was in the audience with his wife, Elizabeth. Born in Vermont in 1815, Wells had attended good schools in New England, studied dentistry in Boston, and opened a practice in Hartford in 1836. Soon he had become well known and respected in that city; patients listed in his still-existing daybook bore names that have long been prominent in Hartford; and his high professional standards are evident in a treatise on teeth and their care that he published in 1838. He was also known as an inventor who owned patents. Associates described Horace Wells as a thoughtful, sometimes abstracted young man who “had a mind of uncommon restlessness, activity, and intelligence.” He was “of medium height, with a head of remarkable size, complexion light, compactly built, of pleasing countenance and address,” animated and cheerful in conversation, yet unusually sensitive and inclined toward retirement from general society. Wells’s sensitivity was reflected in an extreme awareness of what other people thought of him and also in his distress at the suffering he often had to inflict upon his dental patients. A doctor remembered talking with Wells in 1840 and finding him “deeply impressed with the idea that some discovery would yet be made by which dental and other operations might be performed without any pain.”
When Professor Colton called for volunteers to come forward from the audience, Horace Wells—much to everyone’s surprise—was one of those who responded. He joined the inhalers on stage, took some of the laughing gas, and did something foolish for which Elizabeth later scolded him. Just what he did is not recorded, but she later recalled, “When we came out of the lecture to return home, I reproached my husband for taking the gas and making himself ridiculous before a public assembly.” It was an astonishing thing for a professional man allegedly so reticent and so conscious of his reputation to have done.
At a memorial banquet on an evening exactly fifty years later, Professor Gardner Colton recalled the performance:
“A number of gentlemen inhaled the gas, Dr. Wells among them. When Mr. Samuel Cooley got under the influence he began to dance and dash around and ran against some wooden settees and thereby jammed his legs. Dr. Wells said to him, ‘You must have hurt yourself.’ ‘O, no,’ said he. Well, after a while he began to feel some pain, after the effects of the gas had worn off, and then his leg began to bleed. He says, ‘I did not know I was running against the bench. I did not feel a particle of pain until the effects of the gas passed off.’ When the audience was going out Dr. Wells came to me and said, ‘Why cannot a man have a tooth extracted and not feel it under the effects of the gas?’ I said I did not know. ‘Well,’ said he, ‘I believe it can be done. Mr. Cooley did not know that he hurt himself until the effects of the gas passed off.’
“Said he, ‘I have a big molar that is decayed and I should be glad to have it pulled.’ The next day, on the llth, I took the bag of gas to his office, and I think Mr. Cooley was present, at any rate Dr. Wells sent out for a neighboring dentist, a Dr. Riggs, to come in and draw his tooth.”
The story is continued in a letter written by Dr. John M. Riggs:
“Wells took his seat in the operating chair. I examined the tooth so as to be ready to operate without delay. Wells took the bag in his lap and the tube in his mouth & inhaled till insensibility relaxed the muscles of his arms … his hands fell upon his breast & his head dropped on the head rest & I instantly [word illegible] the forceps into his mouth—onto the tooth and extracted it.
“Mr. Colton, Cooley & … two others stood by the open door ready to run out if Wells jumped up from the chair & made any hostile demonstrations. You may ask—Why did he not get up? Simply because he could not. Our agreement, the night previous, was to push the administration to a point hitherto unknown. We knew not whether death or success confronted us. It was a terra incognita we were bound to explore—the result is known to the world. No one but Wells & myself knew to what point the inhalation was to be carried—the result was painfully problematical to us but the great law of Nature, hitherto unknown, was kind to us & a grand discovery was born into the world.”
Nature had, indeed, been kind, and Wells had been luckier than he may have realized. He was fortunate in the chemical agent used. Nitrous oxide, if properly administered, has always been considered to be one of the safest of inhalation anesthetics. It is inert, inorganic (unable to combine with body tissues), nontoxic and nonirritating. In fact, nitrous oxide is even used as the propellant in cans of prepared whipped cream found in supermarkets.
Fortunate also was the brevity of the operation. Although, as indicated by its chemical designation, N2O, nitrous oxide contains oxygen in considerable quantity, the oxygen is not in a form that the body can use. Administered for the length of time some operations require, pure nitrous oxide would cause brain damage and death; it must be mixed with oxygen when used as an anesthetic.
And there were other problems unknown to Wells and Riggs. The effects of an inhalation anesthetic proceed in four stages. Stage one is simply analgesia, which, in the case of nitrous oxide, is rather pleasant. Toward the end of stage one sensations of pain may greatly diminish or disappear. If inhalation continues, a brief second stage may ensue: delirium excitement. Then the patient passes into the third stage, that of “surgical anesthesia.” Here there are hazards, even with a nitrous-oxide-oxygen mixture. The patient may become nauseated, throw up, aspirate some of the vomit, and choke to death if surgical appliances for clearing the windpipe are not available and in the hands of someone who knows how to use them. Or air supply to the lungs can be cut off by relaxation of the muscles of the tongue or pharynx, which would allow the tongue or epiglottis to cover the glottic opening. And there are other possible difficulties, including stage four, if the patient is allowed to enter it; this can mean respiratory failure, “vasomotor collapse,” and death. The administration of anesthesia is not a job for amateurs.
So much for the terra incognita into which Horace Wells ventured. His conclusion, after this brief exploration, was that the insensibility to pain was caused by the “excitement effect” of the gas. As he put it later, “While reasoning from analogy, I was led to believe that the inhaling of any exhilarating gas, sufficient to cause a great nervous excitement, would so paralyze the system as to render it insensible to pain, or nearly so; for it is well known, that when an individual is very much excited by passion, he scarcely feels the severe wounds which may at the time be inflicted…. I accordingly resolved to try the experiment of inhaling an exhilarating gas myself, for the purpose of having a tooth extracted.”
It must be obvious that Wells did not go through all this reasoning during the few seconds or minutes when Samuel Cooley was dashing around the stage and barking his shins. One must believe that he had been thinking about his hypothesis for a long time; that the word “ EXHILARATING ,” which he saw in large type near the top of Colton’s advertisement, suggested a chance to explore his theory; and that, once in Union Hall that evening, he overcame his natural reticence to go up on the platform and experience for himself the effects of the advertised exhilarant, much to his wife’s astonishment and displeasure. It had not been his own reaction, however, but the experience of Samuel Cooley that put all the pieces together.
Of course, this “excitement theory” did not quite comport with the way Wells had behaved in the chair. He had not become excited but had simply fallen into unconsciousness. Wells later made an explanatory comment. “When I commenced giving the gas, I noticed one very remarkable circumstance attending it, which was, that those who sat down resolving to have an operation performed under its influence, had no disposition to exert the muscular system in the least, but would remain quiet as if partially asleep. Whereas, if the same individuals were to inhale the gas under any other circumstances, it would seem impossible to restrain them from over exertion.”
Even today physicians and pharmacologists are not quite sure of the mechanics of drug action in the case of many chemical agents, including nitrous oxide. But it is thought that N2O produces its effect mainly by acting as a depressant upon the central nervous system. The excitement theory was probably wrong. Nevertheless, however it worked, N2O put people to sleep, and Wells lost no time in using it in his own dental practice and in urging others to adopt it. In the month following his memorable experiment he performed painless dental operations on twelve or fifteen people in Hartford. His mental and emotional state during this period was described by Elizabeth some years later: “He would lie awake at night and often abruptly leave his meals to hasten to his office. At length excitement and other causes undermined his health, and he was obliged to give over his profession for a time.” In this statement Elizabeth skipped over a story that must have been too painful for her to relate. The “other causes” she mentions grew out of Horace’s decision to make his experience known to the medical profession at large. The place to do this, he decided, was in Boston, an important medical center from which the news of his findings, once verified, could flash all over the world within days—the great news that suffering under the surgeon’s knife had ended. His purpose regarding the discovery was, in his own words, “to give it into the hands of the proper persons, without expecting to derive any pecuniary benefit,” with the desire “that it should be as free as the air we breathe.”
In Boston, sometime in January, 1845, he called on Dr. John C. Warren, who was a professor at the Harvard Medical School as well as the leading surgeon at Massachusetts General Hospital. A somewhat stooped individual with scanty gray hair and shaggy eyebrows, rather brusque and severe in manner and a hardened veteran of many harrowing experiences in the operating room, Warren was nevertheless a man of compassion. And also of great courage. He invited the young dentist from Hartford to present his discovery. As the first step, Wells gave a talk on nitrous oxide at the conclusion of one of Warren’s lectures. Whether this was in the amphitheater under the dome of the Bulfinch building is not recorded. Next, Wells was asked to administer the gas during an amputation of a limb. But as was frequently the case, the patient decided not to undergo the operation. It was then proposed that Wells demonstrate his nitrous oxide during a tooth extraction before an audience of medical students and physicians. During this demonstration, which is said to have taken place in a hall on Washington Street, the patient made an involuntary outcry. As Wells described the incident, “Unfortunately for my experiment, the gas bag was by mistake withdrawn much too soon, and he was but partially under its’ influence when the tooth was extracted. He testified that he experienced some pain, but not as much as usually attends the operation. As there was no other patient present, that the experiment might be repeated, and as several expressed their opinion that it was a humbug affair (which in fact was all the thanks I got for this gratuitous service), I accordingly left the next morning for home.”
Horace Wells was a young man for whom disgrace was worse than death. He had gone to Boston hoping, and deserving, to be hailed as a benefactor of mankind. Instead, he had been hooted out of town as a presumptuous charlatan. Combined with the effects of the worry, excitement, and nervous strain he had been laboring under for nearly two months, and possibly with a physical malaise of some sort, the experience made him ill, and he had to turn his dental practice over to Dr. Riggs for a while.
A particularly frustrating part of all this was that, in the opinion of some people who had witnessed the demonstration, it had been a success. At least three who were present (Harvard medical students in 1845, doctors in 1864, when they made statements on the affair) were under the impression that Wells had proved his case. One, whose account of the pain experienced differed from Wells’s, wrote, “The patient halloed somewhat during the operation, but on his return to consciousness, said he felt no pain whatever. I took the gas, with others, at that time, and while under its influence, I was entirely unconscious … I regarded the operation at Boston, above described, as successful, and as proving the truth of Dr. Wells’ theory.”
Back in Hartford, Wells was improved in health with the coming of spring, 1845, but his illness seems to have been succeeded by a state of restless disorientation. “About this time,” a friend recalled, “he amused himself by giving lectures on ornithology, a branch of natural history of which he was fond, and in which he was well posted.” He resumed his dental practice in September, but shortly afterward invented (and later patented) an automatic shower bath, and the promotion of this device somewhat interrupted his professional career.
Meanwhile, the idea of putting people to sleep during painful operations had not been abandoned. Immediately after his experiment of December, 1844, Wells had shared his knowledge of nitrous oxide and its effects with Hartford dentists and doctors, and by the summer of 1845 it was being used successfully in dental operations throughout the city. He also had expressed the opinion that the vapors of sulphuric ether would produce the same effect. A dental patient later testified that Wells had used ether on him in 1845, and a Hartford doctor said that after discussions with Wells he had removed an encysted tumor from an etherized patient at about this time, but that after further investigation he decided that nitrous oxide was preferable as being “safe and more efficacious.”
Wells continued to make improvements in the construction of his nitrous oxide inhaling apparatus, in the nitrate of ammonia from which the gas was made, in the gas itself and in its mode of preparation. In 1847 he began acting around Hartford as a general anesthetist. He administered nitrous oxide in at least two major operations (one an amputation of the thigh) for Hartford surgeons. It seems logical to believe that in due time the use of anesthesia would have spread outward from Hartford to be adopted around the world.
That, however, was not the way in which the story was destined to unfold. The next chapter was to concern the actions of William T. G. Morton, another Yankee, born at Charlton, Massachusetts, in 1819 (he was four years younger than Wells). Morton began his study of dentistry at the College of Dental Surgery in Baltimore in 1840. Two years later he began practicing in Farmington, Connecticut, near Hartford, and studied under Horace Wells for a time. In the winter of 1842-43 he and Wells practiced as partners in Boston, but they later dissolved their partnership amicably, with Wells returning to Hartford. In March, 1844, Morton matriculated at Harvard Medical School, but he had married that same year; there were financial difficulties; and he had to keep on with his dentistry.
According to Wells, when he went to Boston for his ill-fated demonstration of nitrous oxide, he called on Morton and a friend of Morton’s, the physician and chemist, Dr. Charles T. Jackson, and told them about his discovery. Morton, later that year, visited him in Hartford and asked him for some of the gas. In reply, Wells said, he advised Morton to get the nitrous oxide from Jackson, who was a chemist and ought to be able to provide it. The exact details of what happened during the ensuing year are clouded by controversy; but it is certain that Morton did consult Jackson, and Jackson gave him an idea for using ether instead of nitrous oxide. The idea had grown out of something that happened to Dr. Jackson in the winter of 1841–42. On that occasion he was preparing a lecture in which he planned to demonstrate a theory on volcanic eruptions with the use of pure chlorine gas. During the preparation, a large jar of the gas overturned and broke. Jackson accidentally inhaled a large amount of the chlorine. His throat became severely inflamed, and in order to soothe the pain he alternately inhaled ammonia and ether, with great relief. Next day, his throat still painful, he made an extended trial of ether alone. Sitting in a rocker, with his feet on another chair, and breathing through an ether-soaked towel placed over his nose and mouth, w he “noticed a sense of coolness” and “a swimming sensation as if afloat in the air.” Soon afterward followed “entire loss of feeling, even of contact with my chair,” and total unconsciousness. The towel dropped to his chest, and when Jackson woke up he knew (he said later) that he had discovered the means of performing “a surgical operation on an individual without his suffering pain therefrom.”
Having made this discovery, Jackson described it to a few people, including four dentists and a couple of doctors, but otherwise he did no more to acquaint the medical profession with its full significance than Dr. Crawford Long had done. This was unfortunate, for if ever there was an individual qualified by reputation to introduce such a discovery and have it quickly accepted, it was Dr. Charles Jackson. He not only was a respected physician, with a degree from Harvard Medical School, but he also had been recognized for work in a wide-ranging area of science: mineralogy, geology, chemistry, even electricity, and he was known to scientists both in America and in Europe, where he traveled widely. Also, Jackson had already had a lesson in what may happen when one is slow in promoting good ideas. Returning on the Sully from Europe in 1832 with some electrical apparatus he had procured there, Jackson entertained his shipboard dinner companions one evening with an idea he had for sending signals over wires electromagnetically. One of his hearers was Samuel F. B. Morse, who not long after developed the telegraph and sent his famous message, “What hath God wrought!” It seemed to Jackson that he had wrought some of this himself, but when he tried to obtain recognition for the basic discovery, he was unsuccessful.
With this event in his background, one might think that Jackson would have been leery at sharing his ideas. Yet when Morton came to him, that is precisely what Jackson did. He told the young dentist about ether. Morton used it to perform painless dental operations. A story about this appeared in a Boston newspaper and caused a good deal of discussion. Early in October, 1846, Morton called on the same Dr. John C. Warren whom Horace Wells had approached, announced that he was in possession of a means of preventing pain, and offered to demonstrate it during one of Warren’s operations. Warren, with even more courage than he had shown in the case of Horace Wells, considering how that had turned out (or did he strongly suspect that Wells, after all, had been right?), gave Morton his consent, and the brightly lighted stage on which Wells once had hoped to star was now made ready for another performer. In this instance, there is no question of locale. The demonstration, involving a young man who was to have a tumor removed from his neck, took place in the Massachusetts General amphitheater on October 16,1846, before an audience of doctors and medical students. One student described what happened: “Dr. Warren, who was to operate, waited a half hour; he then remarked sarcastically, ‘Dr. Morton has not come, perhaps he has another engagement.’ Then followed sneering remarks by the students, and sneering looks by the surgeons, for no one had faith in the experiment…. As Warren was about to begin the operation, Dr. Morton came in, out of breath, and red in the face from hurry.”
The reason for Morton’s lateness was that on the previous day a physician friend had advised him to add valves to his inhaling apparatus (a glass globe with an ether-soaked sponge inside) to aid in the elimination of expired air. A way of accomplishing this had occurred to Morton at midnight. He immediately had gone to an instrument maker and got him out of bed to make the modification. At the last minute he had snatched the apparatus from the instrument maker’s bench and headed for the operating room. Upon his entrance Warren greeted him with some annoyance: “Well, sir, your patient is ready.”
Morton, who was described as a very erect, stylishly dressed man “of commanding figure and appearance,” was certainly in command of himself at that moment. He had been up all night and had just rushed through the streets of Boston and up four flights of stairs to encounter a hostile audience and a patient whom he might just possibly kill, with a consequent indictment for manslaughter. Yet he administered the ether with composure, and when the patient was, as he judged, sufficiently unconscious, he stepped back and coolly echoed the surgeon’s previous remark.
“Your patient is ready.”
As Warren was making an incision near the lower jaw, Morton very nearly suffered the same fate that had overtaken Horace Wells. The patient muttered protestingly, as though he were still semiconscious. But Morton’s luck held. At the conclusion of the operation, Warren turned and stood facing the audience. He was a man whose normal demeanor was once compared with that of the Iron Duke, yet now there were tears in his eyes.
“Gentlemen,” he said quietly, “ this is no humbug.”
Upon recovering, the patient said he had felt some pain, “as though the skin had been scratched with a hoe,” but the issue was settled. A merciful hush had settled forever over the screaming that previously had been heard under what was now destined to be known as the Ether Dome.
The event made an enormous impression on the medical students who were present, the young men who would be the doctors and surgeons of later days. “We were thunderstruck ,” one of them recalled.
Morton administered ether even more successfully in the same amphitheater next day during an operation for removal of a tumor from a woman’s shoulder, and again successfully on November 7,1846, for a major operation, an amputation of the leg of a patient who previously had refused the operation, preferring death. Within days the news had flashed all over the world; within weeks inhalation anesthesia had been accepted enthusiastically by leading members of the surgical and medical professions in the United States, England, and Europe.
Now everybody tried to get into the act, including Dr. Oliver Wendell Holmes, whose witticisms were exemplified by one of his joking notices to patients: “The smallest fevers will be thankfully received.” It had occurred to Dr. Holmes that this process for producing insensibility was so new that there was no name for it. In a letter to Morton, Holmes said that everyone always wanted to have a hand in a great discovery, and he wished to propose a name for this one derived from the Greek. The words he suggested, “anaesthesia” and “anaesthetic,” promptly entered the language.
Morton, thinking of the discovery not in terms of a generic name but as a proprietary word, made a vain attempt to keep the nature of anesthesia a secret. During the demonstrations of October 16 and 17 he referred to it only as a preparation or a compound. This approach did not work. The surgeons of the Massachusetts General Hospital quickly recognized the vapor as ether from its odor, and Morton was compelled to admit that his agent was ether before he administered it for the leg operation on November 7.
Morton next applied for a patent, and in doing so he ran into two problems. The first one was represented by Dr. Charles T. Jackson, who in mid-October had informed Dr. Warren that he, not Morton, was the real discoverer of inhalation anesthesia. It was possible that Jackson also would apply for a patent, and if he did, this could lead the patent office to declare an “interference” and conduct a long hearing, with the outcome in doubt. Morton’s attorney told him that he’d better induce Jackson to co-sign his application. This Jackson did, but he assigned his rights to Morton and did not, at least openly, participate in the attempted commercialization. The second problem was that the patent law requires an application to include a clear and complete description of what the invention consists of. The Morton-Jackson application therefore could not hold back any secrets. Nor could it claim ether as their discovery; that had been known for at least three centuries; nor could it claim the effect of ether as a discovery, for this effect, analogous to intoxication, had been the basis of popular “ether parties” for a number of years. Accordingly, the letter of application, dated October 27, 1846, stated: “It has never (to our knowledge) been known until our discovery that the inhalation of such vapors (particularly those of sulphuric ether) would produce insensibility to pain … under the action of the knife or other instrument of operation of a surgeon calculated to produce pain. This is our discovery, and the combining it with or applying it to any operation of surgery … constitutes our invention.”
Whoever it was in the patent office who read and approved this application should have at once decided what a U.S. Circuit Court declared seventeen years later: that this was a great and beneficial discovery of the utmost importance to mankind, but it legally was not entitled to patent protection.
In an additional attempt to cast a proprietary veil over his invention, Morton added some aromatic oils to ether and called the mixture Letheon, an excellent name. But when he offered Letheon to individuals and hospitals on a fee basis, the effort was not successful. The predominant view of the medical profession was that expressed by a Dr. J. F. Flagg: “If it is simple sulphuric ether, and it will produce the desired effect, I shall use it, and so will others who wish to do so…. I doubt the validity of such letters patent. It would seem to me like patent sun-light or patent moon-shine .”
Horace Wells heard about this almost immediately, and Crawford Long, in Jefferson, Georgia, read about it in December, 1846. Long was interested but decided that before announcing his own prior discovery he would wait a few months to see if anyone else claimed a discovery still earlier than his. And while he was waiting, the matter somehow slipped his mind. Wells and his physician friends in Hartford, on the other hand, at once began an attempt to set the record straight. Wells wrote to the Boston Medical and Surgical Journal ; the Journal also received case reports from Hartford surgeons who had operated painlessly upon patients made insensible with nitrous oxide and who asserted the right of Horace Wells to be recognized for his discovery of inhalation anesthesia in 1844.
In 1847 Wells went to Paris, then regarded a one of the world’s great centers of research verification, and presented his claims to French scientific and medical societies. He concocted a typical Yankee scheme to buy pictures in France and sell them when he got home in order to pay for the trip, but his plan with regard to his anesthesia claim was not as well thought out. A Dr. C. S. Brewster then living in Paris attended one of the meetings at which Wells’s presentation was made. Brewster observed that Wells undoubtedly would have received the recognition he sought, but unfortunately he had brought no documentary proof from America. Wells returned to Hartford, gathered up testimonials, affidavits, and other papers and sent them to Dr. Brewster to convey to the French societies. In the meantime a bitter conflict between Morton and Jackson had broken out. Each wrote to the French Academy of Sciences claiming to be the true discoverer and excluding the other. These and other claims and counterclaims produced a three-sided struggle for recognition.
Late in 1847 Dr. James Y. Simpson of Edinburgh, Scotland, discovered that chloroform, too, was an effective anesthetic, and this new agent led indirectly to the undoing of Horace Wells. Early in 1848, Dr. Wells opened a practice in New York, offering painless dentistry through the use of all three anesthetics: nitrous oxide, ether, and chloroform. During the week beginning January 16 he became involved in a bizarre incident. All that week Manhattan was alarmed by reports of a cloaked “monster in human form” who was throwing acid on women walking on Broadway. On Friday evening the supposed monster was arrested. He gave his name as Jonathan Smith, was held to bail in the sum of $2,000, and, not being able to meet it, was confined in the Tombs. Jonathan Smith turned out to be Horace Wells.
On Saturday, accompanied by an escort, Wells was allowed to go to his rooms on Chambers Street, where he obtained his razor and other necessities and—unknown to his guard—a bottle of chloroform.
On Sunday evening, in his cell, Wells tied a handkerchief over his nose and mouth and soaked it with chloroform; then, presumably while in an early stage of anesthesia, he slashed his left thigh to the bone with a razor, severing the femoral artery. An inquest was held, and the jury returned a verdict that Horace Wells “came to his death … by inflicting a wound in his left thigh with a razor, while laboring under an aberration of mind.” A letter written by Wells just before the suicide and found in the cell revealed that during the past week he had been “in the constant practice of inhaling chloroform for the exhilarating effect produced by it.” Considering that information, and with all regard for the jury’s opinion, the letter can hardly be thought of as a product of mental derangement. The language is clear and coherent. Rather than the rambling of a disordered mind, it is an expression of shame and remorse—and what disgrace, real or imagined, could do to Horace Wells must be remembered. But if not insanity, what was it that caused him to throw acid—the act that precipitated the disaster?
It is an entirely plausible theory that—in addition to an act performed under the influence of chloroform—this was something akin to posthypnotic behavior, that phenomenon in which a person, while in a hypnotic trance, receives a suggestion that he executes at some later time without really understanding why he acts. It is also to be noted that this posthypnotic action often takes place when the subject receives an aural or visual signal that is included in the instruction or suggestion given to him while he is in the trance. It is known today that certain stages of anesthesia or even analgesia can produce a very suggestible mental state.
With that in mind, one may read the last letters of Horace Wells and discern in them an influence that may have been similar. One of them reads in part: “The facts so far as I am concerned are briefly «= these:—On Tuesday evening last a young man with whom I had recently formed an acquaintance, went with me to my office in Chambers St., and while there, he said a woman of bad character had spoiled a garment for him while walking in the street by throwing something like vitriol upon him; that he knew who it was, and would pay her back in the same coin. As I had some sulphuric acid in my office which I was using in some chemical experiments, he requested the liberty of taking some of it, for this purpose. He accordingly cut a groove in the cork of a phial, so that a small quantity only might escape when it was suddenly thrust forward.”
The story told by the letter continues. Accompanied by Wells, the young man went out on Broadway and sprinkled acid on a girl’s shawl. He then proposed sprinkling other girls, but Wells, coming to his senses in the cold January air, took the phial away from him and went home. Also mentioned in the letter were two other friends of the young man whom Wells had recently met, and who “had resolved to drive all the bad girls out of Broadway by sprinkling them with acid.” Since Wells had been inhaling chloroform “for [its] exhilarating effect,” it may be reasonably supposed that his new friends were doing the same. On Friday evening, while sniffing the vapor, Wells lost consciousness, and on coming out of his stupor was “exhilarated beyond measure, exceeding anything which I had ever before experienced.” In a delirious state, he saw the phial of acid on the mantel, seized it, and rushed out into the street, where he threw acid at two women and may have thrown it at others—he could not be sure. The effect of the chloroform did not pass off until some time after his arrest.
Much of the letter is harrowing in the extreme. It dwells upon the disgrace in which Wells had placed himself, upon the misery he had brought his relatives (“all of whom are among the most respectable members of society”), including his wife and child, whom his death would leave destitute of support—and yet if he were to live and try to work for them he would become a maniac (“I could not live and be called a villain”). His anguish was all the more severe because his name was “familiar to the whole scientific world as being connected with an important discovery….”
Wells insisted in his letter that others were involved in the acid throwing that had been going on all week; and that the act for which he was arrested had been his one and only misdeed under the influence of chloroform.
The suspicion that he was also temporarily under the influence of a powerful suggestion from one of the “others” is strengthened by an incident that took place two days after the Monday (January 24) when Dr. Wells’s body was discovered in his cell. A young doctor from Georgia, twenty-two, who was living on Greene Street, perhaps half a mile away from Wells’s rooms on Chambers Street, on Wednesday evening told his roommate that he was feeling queer; he thought he was becoming deranged. The young physician had come to New York to attend medical lectures, and the fact that he and Wells, both strangers in town, had met, seems probable, because when his roommate told him about Wells’s suicide, he asked that he might have the newspaper, so he could read about it. Sometime between three and four o’clock on the following morning his roommate, missing him from the bed, got up and, feeling around in the darkness, found the young doctor on the floor in a pool of blood; he seemed to be dead. Lights were brought, and it was discovered that the young man had committed suicide by cutting through the femoral artery of his right thigh with a razor. Had he and Wells been sniffing chloroform together, and was he the one who had instituted the campaign of “revenge” against the bad girls on Broadway? At that time chloroform had been in use as an anesthetic for little more than a year. It was the most potent and also the most toxic of the three agents; yet at the time little was known about its effects upon the brain and nervous system. The young men’s use of chloroform could have produced severe reactions, all the more disturbing to them because they were inexplicable.
On the same day the Georgian’s death was discovered, Horace Wells was buried in Hartford. His estate was found to be insolvent. His office equipment, instruments, and household furniture were sold at auction.
Morton did not come to a much happier end. As soon as his patent was granted, he gave up his dental practice in order to promote and profit from Letheon. But the patent was never effective; it finally was declared invalid; fortune eluded him; and his fame was clouded by controversy and criticism. Eventually he asked Congress for compensation. Bills were introduced appropriating a total of $100,000 as an award to the discoverer of anesthesia. In the hearings on this bill Morton’s claim was opposed not only by supporters of the dead Horace Wells and by Dr. Jackson but also by Dr. Crawford Long, who finally had got around to publishing an account of his discovery in the December, 1849, issue of The Southern Medical and Surgical Journal . The battle in behalf of Horace Wells’s widow and son was led by Truman Smith, U.S. Senator from Connecticut, an attorney who assembled an impressive array of evidence from doctors, dentists, and other citizens of Hartford. The news of Wells’s pathetic death, combined with a regard for his character and the impoverishment of his family, inspired a wave of sympathy and support in Connecticut. It was all too complicated for Congress, and as a result nobody got a penny, although the hearings went on for years. There was an attempt to aid Morton by physicians of Boston, New York, and Philadelphia, who thought that even if he should not own anesthesia he ought to be rewarded in some way. Testimonials were published and contributions were collected. But these did not save him from being reduced to near-poverty and nervous ill health by his frustrations and failures.
For the family of Horace Wells the discovery of anesthesia had been, as Elizabeth Wells once remarked, “only a source of bitter misfortune.” The wife of William Morton, also named Elizabeth, might have said the same. On Monday, July 6,1868, her husband went to New York to reply to an article that recently had appeared in one of the monthlies supporting Jackson’s claim. He seemed very agitated when he left home. The weather was hot. On Saturday she received a telegram saying he was ill and asking her to join him. By Wednesday he had recovered sufficiently so that they decided to go for a drive. The ride ended in Central Park, where Morton suffered a seizure. He died that evening in St. Luke’s Hospital. He was buried in Mt. Auburn Cemetery near Boston under a tombstone that declared him to be the inventor of inhalation anesthesia. Five years later Dr. Jackson visited the grave and saw the inscription. It may have triggered the acute maniacal attack that he suffered then or shortly afterward. Confined in a hospital, Dr. Jackson never recovered his reason. He died in 1880.
Of the American “discoverers,” only Dr. Crawford Long lived out a placid life. He was still practicing contentedly in Georgia when he collapsed and died in 1878 while attending a patient.
If Horace Wells had lived a couple of weeks longer, he would have received a letter from his friend Dr. Brewster in Paris telling him that the Paris Medical Society had awarded him the honor of having first discovered and then successfully applied the use of vapors or gases to abolish pain during surgery. Within twenty years or so the same recognition would be awarded Wells by the American Medical and the American Dental associations. The French Academy of Medicine tried to honor Jackson and Morton jointly for the discovery with the prestigious Montyon prize, but Morton refused to accept it on that basis, so bitter had the relationship between the two men become. Both were subsequently and separately recognized by various institutions in the United States and abroad—Morton by busts in the Smithsonian Institution and in the Hall of Fame at New York University. The Information Please Almanac lists Crawford Long as the first user of ether anesthesia, and his statue stands in Statuary Hall at the U.S. Capitol. As represented by dozens of other statues and memorials, the competition still goes on. In Boston’s Public Garden there is a monument known simply as the Ether Monument, erected in 1867, which has no name on it at all, indicating the dilemma the donor found himself in at the time, with the controversy between Jackson and Morton still raging. There is a story still current around Boston that Dr. Oliver Wendell Holmes suggested that the monument should bear an inscription reading “To E(i)ther.”
In its historical perspective, anesthesia was delayed altogether too long, but it did arrive in time to alleviate some of the immense suffering that followed major battles of the Civil War. One of the beneficiaries was Stonewall Jackson. The surgeon who attended the great general after his ultimately fatal wounding at Chancellorsville administered chloroform before amputating his left arm. As Jackson began to feel relief from the severe pain he had been in for hours, he exclaimed, “What an infinite blessing!” and continued to murmur “blessing” until he drifted off into unconsciousness.
It was not an unalloyed blessing. Unfortunately, the advent of anesthesia was not accompanied by surgical asepsis, which came along about twenty years later. After operating with unscrubbed hands and unsterilized instruments, surgeons saw—without knowing why—that many of their patients died of “blood poisoning,” infections, fever, abscesses, erysipelas, gangrene. In the words of the noted surgeon W. W. Keen, “the acute pain of the operation was abolished, but the after-suffering… was something dreadful to see.” With operations easier and more numerous because of anesthesia, this kind of suffering greatly increased. And even after the advent of asepsis, which, combined with anesthesia, as Keen said, “separated us from the surgical past as by a great gulf,” there was still the unfortunate fact that virtually painless surgery caused the number of unnecessary operations to increase enormously—to an estimated U.S. yearly total of more than 2,000,000 in 1976, with some 10,000 needless deaths resulting.
Still, there are few who would dispute Stonewall Jackson’s appraisal of the contribution to human welfare made by the men who brought us anesthesia. Of these, which one deserves the most credit is a matter of opinion. Of their many memorials, one of the most impressive, because it so effectively summons their silent presences from the past, is in the old operating room under the Ether Dome. Restored in 1930, this room, as well as the building that houses it, are both designated as National Historic Landmarks, and name plates on the amphitheater seats are inscribed with the names of people who were distinguished in their service to the hospital. The inscriptions are small. One must bend over and look very closely to see that the plates on the five seats of the center front section bear the names, from left to right, of Dr. John C. Warren, and then, as “Honorary Guests,” Dr. William T. G. Morton, Dr. Horace Wells, Dr. Charles T. Jackson, and Dr. Crawford W. Long.