Laughing gas

Suneet Sood, Professor of Surgery, Faculty of Medicine, UiTM

For anesthesiologists, December 16 is sacred. It’s the day someone first ever successfully demonstrated an anesthetic procedure to an admiring audience. The year was 1846, the anesthestist: WTG Morton. This article is about the events that led to the development of anesthesia.

Anesthesia in the middle ages

Prior to 1846, surgery invariably meant pain. Anesthesia was of four main types:

The stunner. This popular method of anesthesia was crude, but cheap and effective. The anesthesiologist would saunter nonchalantly towards the patient, holding a club behind his back and whistling a carefree tune. As he approached the patient he would point towards a distant window and exclaim, “Oh look, look! Nice birdie!”, or say something equally intellectual.1 As soon as the gullible patient looked away, the anesthesiologist would swing, his club connecting with the patient’s occiput on a point previously examined and marked with an “X”. He had to be careful: an operation could easily be botched if the he took his eyes off the occiput, if his footwork was faulty, or if the swing lacked proper follow-though. Textbooks of anesthesia provided detailed descriptions of clubs and grips.2

The spirit. The second method of anesthesia was more humane, but expensive. In this technique, the doctor would administer ethanol till the patient slid to the floor, smiling the beatific smile of one who has dutifully followed doctor’s orders. Depending on the duration of operation planned, the anesthetist’s dose could be small (called “shot”), or large (called “pint).3 The best ethanol was that bought from teachers, and results were better if patients drank it out of bells. For most citizens ethanol anesthesia was administered without ceremony, but for anesthetizing the King’s family proper protocol demanded a royal salute.

The soporific. The third popular anesthetic technique used opium. Opium was a painkiller, but unreliable. Patients would go to sleep, dreaming happy dreams, only to be woken rudely by the pain of someone chopping off their legs.4 Some enterprising surgeons would increase the dose of opium, so that during surgery the patient slept like the dead. Unfortunately, the patient usually was dead.

The suggestion. Mesmerism, a type of hypnosis, was a dramatic therapy popularized in the late 1700s by Franz Mesmer, a German physician who later practiced in Vienna. In great public demonstrations, he would make patients swallow iron filings, place magnets all over their bodies, and wave his hands at them dramatically, much like a windmill. The patients felt uneasy, and to Mesmer this was proof that they were healing. He referred to his therapy as “animal magnetism”; others called it Mesmerism. Mesmer claimed that it could cure everything, even pain during surgery. When a mesmerized patient screamed during surgery, Mesmer would assert that the screaming was caused by fear, not pain. The satisfied surgeon would continue to hack away merrily, but most patients were quite displeased, and some later chased him out of Vienna.

Unfortunately, these techniques were not very effective, and surgeons were constantly looking out for Effective Anesthesia. Effective Anesthesia appeared in 1846.

The anesthesiologists of the 1800s and their gases

Horace Wells and laughing gas. Wells was an American dentist, very unhappy because patients always felt excruciating pain during tooth extraction. One day Wells was watching a stage show where a man named Cooley was inhaling nitrous oxide (laughing gas). Cooley went berserk, and chased the audience around the hall. During this he injured his leg, but did not feel the pain, and Wells, watching him, was convinced that nitrous oxide had anesthetized Cooley. Therefore when Wells himself underwent a tooth extraction, he tried inhaling nitrous oxide, and found that the extraction was completely painless. Wells decided to show off his gas, but to his everlasting regret the demonstration failed.

laughing gas

Figure: Laughing gas was discovered in 1799 by Humphrey Davy, who noted its intoxicating properties. Later, enterprising theater houses often used it for shows. Laughing gas was popular because it made the subjects behave erratically, which greatly amused the audience. It was cheaper than buying diamonds, and married men thought that it could be used to humor their wives. (They were wrong.) Reproduced with permission from www.general-anaesthesia.com/images/laughing-gas.jpg

 William Thomas Green Morton and ether. Morton started life as a dentist, but is now known better as the Father of Anesthesia.5 Morton and Wells even worked together for a while. Morton’s chemistry teacher, Charles Jackson, taught that inhalation of the fumes of liquid ether caused unconsciousness. Unlike Wells, Morton was unwilling to try the agent on himself. He searched for a guinea pig, and one day a merchant agreed to undergo tooth extraction under ether. When he woke up, the merchant (whose name was Frost) exclaimed “Dude, this is cool!” or words to that effect. Morton was ready. He announced that he could provide anesthesia for surgical procedures. To skeptics he declared “For years my money was in other people’s mouths. Now let me put my money where my own mouth is,” and added, belching a little, “and demonstrate what my gas can do.” His demonstration, unlike that of poor Wells, was a great success.

Crawford Long and ether. Crawford Long was an American surgeon. He often administered ether anesthesia for his cases, keeping careful records. Although he probably started giving ether anesthesia well before Morton did, he published his results very late. Consequently, Morton became Father of Anesthesia, while Long could not even become a distant relative.

James Young Simpson and chloroform. Simpson was an English obstetrician who changed his name. When he was young he was James, but when he grew older he became Young.6 He liked to inhale chloroform, which smelled great. Unfortunately it always put him to sleep. He decided to give it to women to help them deliver painlessly. He was an impressive figure with his long hair, big belly, and aroma of chloroform: England had no choice but to award him a knighthood.

Anesthesia in America: 1840-1850

Life in America was very eventful for these anesthesiologists in the decade 1840-50. Horace Wells was longing to show nitrous oxide to the world. In 1845 he asked John Collins Warren, a surgeon, to conduct a tooth extraction while he, Wells, administered nitrous oxide in the presence of dozens of skeptical physicians and students. Unfortunately, the patient said “Ouch” towards the end. This “Ouch” was actually smaller than most ouches ordinarily experienced during tooth extraction, but there is no doubt that the observers were thrilled with this failure. “Humbug! Humbug!” they yelled in glee, as Wells ran out of the room in shame.

Among this audience was WTG Morton. Morton and Wells had worked together, and had realized early on that theirs would never be one of the great Damon-and-Pythias friendships.7 Morton’s gas was ether, and he convinced Warren, the surgeon, to give him a chance. On 16 December 1846 Warren, several observers, and the patient waited for the anesthesiologist to arrive. Morton came late because he was trying to find ways to disguise the ether. He finally poured orange color into the ether solution.  “It’s Letheon,” said Morton, unwilling to disclose the name of the horrible-looking orange fluid. Warren started to operate, fully expecting the patient to scream. However, the patient remained asleep, and woke quietly after the procedure. Morton collected his equipment and went out, leaving behind a dumbstruck audience. Finally, Warren spoke. “Gentlemen, this is no humbug,” he said.

After this demonstration, all sorts of things started to happen. Morton was christened “Father of Anesthesia, before whom in all time surgery was agony, since whom science has control of pain”. Morton was pleased, but Wells was upset. “Nitrous is good, too,” he would whine. He first whined in America, then went off to France to whine some more. When he returned, people were still chanting “Ether, ether”, not “Nitrous, nitrous” as he had wanted. He began to weep,8 ran amuck on the roads, and was quickly thrown into prison.

Jackson, who had been Morton’s teacher, suddenly piped up and said, “But I taught Morton! I should be the Father of Anesthesia! Anyway, Morton stole all my ideas!” Of course, it was madness to think that anybody would care, and, indeed, Jackson finally ended up in an asylum. Crawford Long also claimed that though he published his results late, he was the first to use ether, therefore he deserved paternity of Anesthesia. When nobody listened he just sulked quietly, but in the end he lived more peacefully than most of the pioneers of anesthesia.

Morton was never a genius. From all accounts, in fact, he was a somewhat dishonest man who had a more than fair share of good fortune. He should have presented his discovery to the world for the benefit of the sick and needy. Unfortunately, he patented Letheon and spent the rest of his life defending the patent.9 Surgeons had too much business sense to give royalties to Morton when they could use it for free. Morton ran from surgery to surgery, snatching bottles of ether and shouting “Royalties, royalties, where are my royalties?”10 He spent the rest of his life in the courtroom, trying to stop others from using his patented drug, and became penniless.11 Morton was left fuming, and one day he jumped into a pond in a nearby park to cool off.

The moral of the story is that even persons of mediocre intellect and mediocre ethics can become everlastingly famous. There is hope for all of us!

 

Notes

1.       Anesthesiologists were highly intellectual persons even before 1846.

2.       For short operations, the ideal club was the putter, held in an interlocking grip. For longer operations, the correct club was the driver, held in a ten-finger grip. Other clubs included the mashie and the nibblick, with obvious uses.

3.       Or a “magnum” for very long operations.

4.       Invariably a terrible way to wake up.

5.       This job-changing from dentistry to anesthesia was becoming an epidemic.

6.       This is tougher to understand than obstetrics.

7.       Morton must have shouted “Humbug” at least as happily as the others during Wells’s failed demonstration.

8.       Ironical for a laughing gas specialist.

9.       He was more interested in patents than in patients.

10.   Or words to that effect.

11.   His lawyers thrived.