The painful story behind modern anaesthesia

N. Mohan

Consultant Anesthesia and Intensive care, Kauvery Hospital, Electronic City, Bengaluru

Background

Let’s go back to the Stone Age. Now imagine how surgeons would have operated! It was hell even to imagine. Few hunks would restrain the patient, the surgeon would take a saw to cut the limb… Oh my god so much pain! It’s better to die with the disease than to undergo surgery! Britain’s Daily Mail described medicine during the U.S. Civil War as a grisly ordeal. “A blood-curdling range of saws, knives and sharp hooks were used to administer much-needed surgery to maimed fighters,”

Of all the milestones and achievements in medicine, conquering pain must be one of the very few that has potentially affected every human being in the world.

The-painful-story-behind-modern-anaesthesia-1

Fig. 1. Depiction of amputation of limb carried out by restraining the patient.

The evolution of Anesthesia

Over the time people have used many techniques to numb the pain of surgery like – refrigeration technique, bilateral carotid artery compression, knock out blows on the head, mesmerism, hypnosis, alcohol, herbal concoctions etc. But none of these were safe or satisfactory.

The-painful-story-behind-modern-anaesthesia-2

Fig. 2. William T.G. Morton

On October 16th 1846, in Massachusetts General Hospital (MGH), Boston, USA, a dentist called William T.G Morton (1819-1868) first demonstrated an effective anesthetic vapor which could numb the pain of a surgery on a neck mass. This anesthetic agent was sulphuric ether in a customized glass device to deliver the vapors. Morton did not discover anaesthesia nor was he the first to attempt to relieve surgical pain. But he was the first person to successfully demonstrate the right agent, at the right place, before the right audience. He revolutionized surgical practice. It is not surprising then that the epitaph on his tombstone reads.

“Inventor and revealer of Inhalation Anesthesia: Before whom, in all time, Surgery was Agony; by whom Pain in Surgery was averted and annulled; since whom, Science has control of pain.”

The story of all inhalation anaesthetics starts with ether which was synthesized in 1540 by Valerie’s Cordus who described its medicinal properties. Joseph Priestley discovered Nitrous Oxide in 1772, but it was Humphrey Davy who named it as Laughing Gas and suggested that it could be used for painless surgeries in early 1800’s. Yet both nitrous oxide and ether were used as nothing but an entertaining intoxicant till middle of 19th century. In 1800s frolicking demonstrations were common to earn some money. One such person, Samuel Colt, used to fill balloons with Nitrous Oxide and it was given to guests to take snort. He earned more money by exhibiting frolics of intoxicated to the audience. In 1840s Horace Wells, a dentist in Hartford, Connecticut, USA, tried nitrous oxide on himself and behaved inappropriately in public assembly.

The-painful-story-behind-modern-anaesthesia-3

Fig. 3. Horrace Wells

The-painful-story-behind-modern-anaesthesia-4

Fig. 4. Charles T Jackson.

The-painful-story-behind-modern-anaesthesia-5

Fig. 5. Depiction Ether of frolics

Same day, a friend of Wells, got intoxicated, went berserk on stage and injured his knees but felt nothing despite a bleeding knee until the gas wore off. Wells made the connection from stage amusement to clinical tool, and, the next day itself he underwent tooth extraction from inhaled nitrous oxide which was pain free. He successfully used nitrous oxide on few of his patients for tooth extraction. He approached John Collins Warren, a leading surgeon, who arranged for a lecture demonstration at the Massachusetts General Hospital in Boston in January 1845. Unfortunately, during the demonstration the gas bag was removed early and the patient cried out before the tooth was extracted. Wells was humiliated amidst cries of “humbug”. Wells was disappointed, he returned to Hartford, suffered a debilitating illness followed by a mental depression that was exacerbated by the controversy that followed Morton’s successful demonstration on Ether Day (16th October 1846). He experimented with chloroform, which was an effective anaesthetic, and became addicted to it. Arrested for throwing acid onto prostitutes while he was intoxicated, Wells killed himself in jail.

The-painful-story-behind-modern-anaesthesia-6

Fig. 6. Death of Wells

Before W.T.G Morton was a dentist, he had ventured various jobs which was in vain. He would forge letters of recommendation, buy goods on credit, sell them, and abscond with the money to the next job. He joined the College of Dentistry but left without completing it. Morton then decided to settle down and become a dentist and became a business partner with Dr. Wells. Morton attended professor Charles T Jackson, a chemist, physician, mineralogist and a geologist, who claimed that it was he who suggested the use of ether first for dental extractions. Morton conducted a lot of experiments with ether on animals and in September 1846, he extracted a tooth from a patient under ether. The story is further complicated by a competing claim by Dr. Crawford Long, a physician at Georgia who used ether to remove a swelling from a patient’s neck in 1842. There are good evidences for his claim of using ether anaesthesia for tooth extraction in the year 1842 itself, but Dr. Long didn’t publish it until 1849.

Morton wanted to make money from his “invention” of ether, so he patented it. He tried to market a patent concoction called Letheon, a mixture of ether and oil of orange, but everyone discovered that it was only ether that worked, and so the patent was useless. At that time in Europe there was a tradition that those who contributed boons of science to humanity were rewarded with generous money but America had no such tradition. To the end of his life, Morton vigorously petitioned Congress for $100,000 to recompense his benevolence. Jackson and Wells both claimed to have made the basic discovery and opposed any monetary award for Morton.

The saga of discovery of inhalation anaesthesia ended in tragedy for all the major personalities. Wells committed suicide. Jackson never got the recognition he was sure he deserved for the invention of ether; He spent the last seven years of his life in an asylum. Morton got many medals and fame that never made him rich. In July 1868 Morton was outraged to read an article in the Atlantic Monthly that credited the invention of etherization to Professor Jackson. He drove his car furiously on roads, ran to a lake nearby jumped over the fence and fell down. He was taken to a St. Luke’s hospital where he died few hours later, probably due the cerebral haemorrhage. With touching faith in the integrity of medical scholarship, Dr. Long waited to receive due recognition for his discovery. It never came in his lifetime.

Morton not only showed the properties of ether but also developed a crude but scientific method of administering ether, keeping in mind about both overdose and rapid reversibility from ether anaesthesia; which not even Wells or Long had thought of. Even though Morton did not discover ether or its administration, his persistent efforts to publish his deeds and get recognition, spread the science of inhalation anaesthesia throughout the world, and invoked quest for other anaesthetics. Therefore, he’s rightly called father of anaesthesia.

In India, in March 1847, ether was administered at the Medical College Hospital, Calcutta, under the supervision of Dr. O’Saughnessy, the surgeon. The first chloroform anaesthesia in India was administered in January 1848 (Chloroform was first used by Simpson in Edinburgh UK, on 15 November 1847). Interestingly, David Waldie, a chemist who was credited for introducing chloroform in clinical anaesthesia came to Calcutta in 1853, started his chemical company, and lived there till his death in 1889.

When antisepsis and then asepsis were introduced in the 1880s, surgery expanded dramatically from body surface surgeries to invasive procedures. This necessitated refinement in anaesthesia techniques and led to discoveries like the use of local anaesthetics for regional anaesthesia, use of muscle relaxants, new safer inhalation agents and intravenous anaesthetics. Better understanding of science of pain and technological advances in monitoring of body vitals ed to the evolution of anaesthesia practice. The concept of balanced anaesthesia came to be practiced where many drugs or techniques are used in combination to minimize the side effects and maximize the benefits.

Anaesthesiologist today has moved out of the operation theatre and has become indispensable part of perioperative care, intensive care units, trauma and resuscitation teams, pain clinics, cardiac catheterisation laboratories, and interventional and other radiological suites.

References

  1. Crawford W. Long (1815-1878) discoverer of ether for anesthesia. JAMA. 1965;194(9):1008-9.
  2. Chaturvedi R, et al. Ether day: an intriguing history. Med J Armed Forces India. 2011;67(4):306-8.
  3. Boulton TB, et al. The origins of modern anaesthesia. In Wylie & Churchill-Davidson’s A Practice of Anaesthesia 6th ed. Healy TEJ, Wylie CPJ, eds. London: Edward Arnold, 1995:3-35.
  4. Fenster JM. Ether Day: The Strange Tale of America’s Greatest Medical Discovery and The Haunted Men Who Made It New York: Harper Collins, 2001.
  5. Wolfe RJ. Tarnished Idol: William Thomas Green Morton and the Introduction of Surgical Anaesthesia: A Chronicle of Ether Controversy San Anselmo, California: Norman Publishing, 2001.
  6. Robinson DH, et al. Historical development of modern anesthesia. J Invest Surg. 2012;25(3):141-9.

Journals

Find Doctor
Book Appointment