a history of anesthesia

A Terror That Surpasses All Description

In 1844, Gardner Quincy Colton—semi-professional dentist, traveling salesman, and itinerant huckster—came to Connecticut to demonstrate the exhilarating effects of nitrous oxide. It was not a medical demonstration but a sales pitch. Colton was just one of many gas-hawking entrepreneurs traveling the country and staging “ether frolics.” Attendees paid for a few sniffs, or sometimes just to watch other spectators get wrecked and embarrass themselves. The events were, of course, quite popular.

At Colton’s 1844 show was Horace Wells, then 29 years old and trying to make it as a dentist. After watching a man inhale the gas, trip, and laugh away a painful leg injury, Wells had a realization: the pain-relieving effect might be useful for dental surgery. It’s not surprising he would make the connection. At the time, dental hygiene was poor, tooth extractions common, and general anesthesia nonexistent. Surgery of any kind was a brutal, trying, and often deadly experience, accurately described as “a terror that surpasses all description, and the most torturing pain.”

Gas demonstration
Gas demonstration

In the grand tradition of self-experimentation, Wells tested his hypothesis by inhaling nitrous oxide and letting an associate pull out one of his teeth. He experienced no pain. Within a year, he had organized a public demonstration of what he expected to be a revolutionary wonder drug. Though the patient claimed to experience little pain during the procedure, he had moaned throughout. The assembled doctors, soured on the gas, called Wells’s panacea a “humbug.”

Around the same time, Wells’s one-time classmate and dental practice partner William T.G. Morton was self-experimenting with ether for anesthetic purposes. Whereas nitrous was fast-acting and brief, ether could completely incapacitate patients, making it more suitable for major surgeries. A year after Wells’s failed demonstration, Morton came to the same surgical theatre at Massachusetts General—now called the Ether Dome—and “etherized” a patient, whose neck tumor was then painlessly excised (though some recent historical digging suggests that Wells’s demonstration may not have actually occurred there). This time, the surgeon remarked, “Gentlemen, this is no humbug!”

And from thereafter, anesthesia was immediately accepted as standard medical practice. No, not really. We shall return to the bizarre story of Wells and Morton, but first let’s go backwards.

 

Before Ether

Morton and Wells, it turns out, weren’t the first to use inhalants for general anesthesia. Crawford Long was a surgeon from Georgia who had been using ether as an anesthetic in his surgical practice since 1842. For some reason, he had not bothered to publish or publicize his results.

Go back a little further to the late 1700s, when famed chemist Humphry Davy was performing experiments with nitrous oxide (which he called “dephlogisticated nitrous air,” a nod to the then-modern phlogiston theory of chemistry). Again in the tradition of self-experimentation, Davy quickly discovered the gas’s euphoric effects. He even experienced a classic drug-induced revelation: “Nothing exists but thoughts!” he wrote, dictates of scientific formality forcing him to leave off the “Duuuuude” that surely prefaced it. Then, he nearly as quickly became addicted to the gas, demonstrating a textbook example of Pavlovian conditioning: “the desire to breathe the gas is awakened in me by the sight of a person breathing, or even by that of an air-bag or air-holder.” Good thing for him everyone in the world isn’t always breathing.

Davy administers the gas
Davy administers the gas

Davy could hardly wait to share the gas with his high-society acquaintances, including Coleridge, prior to his career as an opium eater. In a scene ripe with Freudian symbolism, Davy sat his friends down, held a silk balloon full of laughing gas to their face, and allowed them to suck mother’s milk from the gaseous teat. He recorded their observations, noting that language was lacking to capture the experience: one user said they felt “like the sound of a harp,” another used the term “a display sky-rockets,” and the poet Robert Southey might have been the first to use the phrase “turned on” to describe a drug trip. Davy said the gas was “inconceivably pleasurable,” and also described a more megalomaniacal and/or Bruce-Banner-like reaction: “I seemed to be a sublime being, newly created and superior to other mortals … the thrilling increased, the sense of muscular power became greater …”

Though a fabulous chemist and a deliverer of a first-rate gas-bag, Davy wasn’t a surgeon, and he never used nitrous oxide as an anesthetic. But he did write an early 1800s monograph in which he suggested that the stimulating properties of the gas “may probably be used with advantage during surgical operations.”

How could Davy suggest that, but never follow up on it? Why did it take four decades for anyone in the Western world to think that nitrous oxide, which Davy said capable of “destroying physical pain,” might have medical applications?

 

The Culture of Pain

The answer, or at least part of it, is that the Western world was beholden to a very strange assumption: that pain was good. As Stephanie Snow describes in Blessed Days of Anesthesia, pain was thought to have both physiological and moral value. Christian beliefs dictated that pain was god’s will, a punishment for sin, and a necessary and unavoidable feature of the human condition. Doctors—perhaps partially wrapped up in those same beliefs—believed pain to be a vital and beneficial component of medical treatment, not something to be avoided.

Pain was seen as especially important to surgery, as it was thought to stimulate the body to deal with the stress of the operation. Surgical texts claimed “smart of the knife is a powerful stimulant, and it is much better to hear a man bawl lustily than to see him sink silently into the grave.” This belief made a certain kind of sense: patients were more likely to die if they lapsed into unconsciousness during an operation, so staying awake was a good thing, and soporific analgesics like alcohol were to be avoided. In fact, Davy’s belief in the utility of nitrous oxide for surgery was based not on its pain-relieving properties, but its stimulating effects: it would keep the patient awake. As if symbolizing cultural attitudes towards pain, the word itself, “anesthesia,” did not exist until years after Morton’s ether demonstration—it was coined by Oliver Wendell Holmes.

I also think surgeons were ignoring the concept of anesthesia because of a narrowness of focus akin to functional fixedness. Because operations were riskier the longer they lasted, speed was the most prized ability of surgeons at the time. It seems likely that doctors were so fixed on improving speed and efficiency that they weren’t able to reorient their thinking to ponder a solution that obviated the need for that quickness. That, combined with the immense egotism of medical practitioners—when Semmelweis suggested doctors wash their hands to prevent childbed fever, they ignored him because “gentlemen’s hands are clean”—might have slowed the introduction of anesthesia even without the cultural baggage around pain.

The Gross Clinic, an 1875 painting of surgery
The Gross Clinic, an 1875 painting of surgery

As anesthesia slowly wended its way into the practice of western medicine starting in the late 1840s, it revealed even more ghastly and stifling cultural beliefs than the simple idea that pain was good. For example, many doctors were reluctant to anesthetize women, out of concern their delicate frames could not recover from the soporific effect, or because it suggested impropriety to be around an unconscious woman, or because labor pains were a punishment for Eve’s treachery. One doctor worried that under anesthesia, women in labor would feel “the sensations of coitus” rather than the “pangs of travail.”

That is just the tip of the iceberg. “Heroic manly fortitude” (actual quote) was said to make most men insensitive to pain, thus rendering anesthesia unnecessary (one man who suffered through an operation for an anal fistula without anesthetic was said to have “borne the operation heroically and only complained of smarting in the parts”). Anesthesia was seen as unnecessary for anyone that wasn’t white, since “lesser” races were supposedly insensitive to pain. And, perhaps most horrifyingly of all: infants were not routinely given general anesthesia until 1985 on the assumption they could not feel, or remember, pain. For many doctors, any excuse to not give anesthesia would do.

As acceptance grew through the 18th century, anesthesia made life easier for patients. But, says Snow, a broader consequence was that it changed western cultural assumptions about pain. Pain was no longer a necessity of the human condition. It is no coincidence, she argues, “that from the 1860s onwards public executions became private events, legislation was introduced to reduce cruelty to animals in scientific experiments, and ideas of pain in Christian doctrine were reworked.” By the 1880s, even death didn’t have to be painful: by then there was already a book extolling the virtues of euthanasia.

 

Everyone Else

Hanaoka Seishū
Hanaoka Seishū

That’s all very Eurocentric, so let’s take a side trip to discuss what everyone else was doing. Around the same time Davy was staging his ether frolics and realizing that nothing is real but thoughts, man, Japanese surgeon Hanaoka Seishū was developing and testing a compound called tsūsensan. It was an herbal concoction comprised of nearly a dozen ingredients, and the active compounds included narcotizing paralytics like scopolamine and atropine. Special credit, too, goes to his wife (name unknown, but there’s a movie about her), who tested the creations and was blinded by a bad batch. In 1804, Seishū performed a partial mastectomy and anesthetized the patient with tsūsensan. It’s widely considered to be the first documented usage of general anesthesia; Seishū later performed more than 100 other surgeries, and was renowned in Japan (see his actual illustrated casebook here; more info here and here)

Still further back, things become more speculative. Hua Tuo was a second-century AD Chinese surgeon who supposedly crafted a mixture of wine and herbs called mafeisan, which he used as a general anesthetic. Modern attempts to recreate it have not been successful, in part because Tuo burned all his manuscripts shortly before he died (his collected works were referred to as The Book of the Black Bag, which is great), and possibly because the brew may have been secondary to anesthetic effects induced by acupuncture. Tuo was the last Chinese surgeon for centuries, since Confucianism held surgery to be a taboo form of body mutilation—an interesting correspondence to how Christian conceptions of pain centuries later kept surgeons from taking up Davy’s ideas about nitrous oxide.

Step back six more centuries—that is, 2500 years ago—and you have Bian Que. He was said to have employed an “intoxicating wine” that made patients “feign death” for up to three days. While that is plausible, the rest of the story is that he then performed a double heart transplantation, so I suspect the story is mythical.

Bian Que (left) and Hua Tuo (right)
Bian Que (left) and Hua Tuo (right)

There are bits and pieces of attempts at anesthesia in various other times and places. In the 7th century BCE, doctors in India were using cannabis vapors for sedation (vaping: three millennia old). A few centuries later, the Assyrians and Egyptians were using carotid compression—basically a choke hold—to induce brief periods of unconsciousness. Romans both bled patients into unconsciousness or mixed mandrake root into wine to induce it. Lastly, and this isn’t really anesthesia, but the priestesses at Delphi were said to report on their visions after inhaling gases emanating from geologic faults; historians have suggested they may have been inhaling ethylene, a general anesthetic—so the oracles were just tripping balls on magic gas spewing out of ruptures in the earth’s crust.

By contrast, general anesthesia was known and perhaps even common in the Arabic world more than a millennium ago. By 1000 AD, the first texts devoted to surgery were published by Abu al-Qasim al-Zahrawi, which included descriptions of general anesthesia. Twenty years later, a medical canon published by Ibn Sina described the use of “soporific sponges,” infused with a variety of compounds, the primary anesthetic actor of which was probably opium. To use the sponges, a piece of cloth was soaked in solution and placed over the patient’s face to induce unconsciousness, allowing surgery to be performed (read more on Al-Zahrawi here).

I would like to describe the transition from these older techniques to modern surgical practice, especially vis-a-vis what was happening in Europe, but cannot seem to unearth that information.

 

Morton, Wells, and Credit

Let’s return to Horace Wells and William Morton. By 1848, Morton was pitching his gas and a newly-designed inhaler to doctors, billing himself as the inventor and “revealer” of anesthesia. Morton called his gas “Letheon,” but it was ether, and most people knew it. Wells, meanwhile, had left medicine altogether and become an itinerant salesman (one source claims he sold canaries at one point, which can’t be right). He still held out hope that “his” gas—nitrous oxide—would find a toehold.

In early 1848, Wells began to self-experiment with the anesthetic properties of ether and chloroform. After days of constant huffing he was badly delusional and completely unhinged, and threw a vial of sulfuric acid at two women in the street. They were unhurt, but Wells was sent to the Tombs. Upon returning to coherency following his hallucinatory episode, Wells became so distraught over his actions that he asked guards to retrieve his shaving kit, then took a sniff of chloroform to dull the pain and cut his femoral artery. He bled to death, leaving behind a wife and child, and a tragic reminder that self-experimentation only sounds cool when it works out (read more on Wells here).

Morton (left), Wells (center), and Snow
Morton (left), Wells (center), and Snow

Morton’s story is less sad but far stranger. He was largely despised in the medical community for his attempts to patent and cash in on “an agent capable of mitigating human suffering.” Beyond that, he was mired in a debate over who deserved credit for the “discovery”: one of Morton’s med school lecturers, Charles Jackson, claimed that he’d demonstrated ether while Morton was a student. The pair publicly feuded over credit and (more importantly) compensation. Neither was particularly likeable. Morton spent years buttonholing Congress to award him an honorarium for the discovery. Jackson, meanwhile, had a long history of claiming dubious co-credit for inventions and ideas: he’d also do so with guncotton, the telegraph, modern theories of digestion, and copper mining from Lake Superior.

The Jackson-Morton rivalry extended to one of the 19th century’s trials of the century: the George Parkman murder. A scion of one of Boston’s richest families, Parkman was murdered, dismembered, and cremated by John Webster, a Harvard lecturer who owed him money. The 1849 trial was one of the first cases to make use of forensic evidence and a tabloid bonanza. Since all that was left of the body were some bone fragments and loose teeth, the entire case turned on whether the bones, particularly the teeth, could be positively identified as Parkman’s. Morton the erstwhile dentist testified for the defense, while Jackson testified for the prosecution. Webster was convicted, confessed, and executed; Boston Brahmins sent engraved invitations to the hanging.

Morton died in 1868 (more on him here and here) and Jackson in 1880, but you can keep going down the rabbit hole, and of course I’m going to. Morton’s son—also William Morton, also a doctor—was a pioneer in “electrotherapeutics,” developing a device that delivered electricity to x-ray machines. In 1912, he and an accomplice were indicted and convicted of mail fraud, having sold 3.5 million shares of nonexistent stock for a mining concern in Ontario. He was later pardoned by the president.

His accomplice in the stock swindle was Julian Hawthorne, who had a long career as a journalist and essayist; he was the son of Nathaniel Hawthorne and Sophia Peabody (side note: when Julian was born, Nathaniel sent a telegram to his sister: “A small troglodyte made his appearance here at ten minutes to six o’clock.”). Unlike Morton, Julian was not pardoned, and spent a year in prison. After his release, he wrote a book called The Subterranean Brotherhood which advocated an end to incarceration. Both Hawthorne and Morton maintained their innocence.

There ends the story of Morton, Wells, and Jackson, but there is still one other person who deserves some time, and that is John Snow. Snow is more commonly known for his crackerjack epidemiological work in identifying the source of a London cholera outbreak in 1854. He’s considered one of the fathers of epidemiology, but he should be more well known for his role in standardizing anesthetic practices.

Morton's original inhaler
Morton’s original inhaler

Wells, Morton, and/or Jackson may have “discovered” anesthesia, but it might never have taken hold were it not for Snow’s dedication and investigatory work. Morton had built a simple breathing apparatus that was an improvement on soaked rags or sponges held over a patient’s mouthm but Snow worked at refining a breathing apparatus that would administer a constant and controllable flow of gas. He tested the device and the effects of anesthesia on thousands of patients, keeping notes and making refinements to his device (the notes are still in his archives, which is really neat).

If any single event can be said to have spurred the use of general anesthesia, it is when Queen Victoria was given chloroform during the 1853 birth of Leopold, administered under the watch of and with the apparatus designed by Snow. Victoria described the experience as “soothing, quieting, delightful beyond measure.”

As the 19th century wore on, nitrous oxide came to be used more and more in dentistry, where its fast but mild and transient action was seen as a benefit. Ether and chloroform continued to be the general anesthetics of choice, both coming with their own set of risks: ether smelled like paint thinner and was highly flammable (surgeries were done by candlelight at the time); chloroform gave a deeper unconsciousness but had a much higher chance of causing spontaneous unexpected death. A few decades later, a big step forward was the introduction of paralytics like curare, which ensured that patients remained absolutely still. It wasn’t until the mid 1900s that modern anesthetics were developed and deployed.

 

A Final Trivium & Additional Reading

Another option for surgical pain reduction in the early 1800s was hypnotism, then known as mesmerism. A British surgeon, upon completing his first surgery on an etherized patient, proclaimed “this Yankee dodge beats mesmerism hollow!”

For further reading on anesthesia generally, I recommend this visual timeline of anesthesia, this somewhat difficult to navigate website, and Stephanie Snow’s Blessed Days of Anesthesia. I also strongly recommend this amazing article about Humphry Davy’s nitrous experiments.

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