Part 5

In an interesting paper by Dr. Silvester, an anecdote is quoted, with an intention to show that anæsthetics were commonly had recourse to in severe operations as late as the end of the seventeenth century. The quotation is from a German work by A. G. Meissner, called Skizzen, or Sketches, and published at Carlsruhe in 1782. It is as follows:—

“Augustus, King of Poland and Elector of Saxony, suffered from a wound in his foot, which threatened to mortify. The court medical men were opposed to the operation of amputation; but during sleep, induced by a certain potion surreptitiously administered, his favourite surgeon, Weiss, a pupil of Petit, of Paris, cut off the decaying parts. The royal patient was disturbed by the proceeding, and inquired what was being done, but on receiving a soothing answer he again fell asleep, and did not discover till the following morning, after his usual examination, that the operation of amputation had really been performed.”

It is most probable that the potion surreptitiously administered in this case, was an ordinary sleeping draught, and that only the “decaying parts” were cut off, as in fact is stated. The decaying parts of course would be without feeling.

The mind of surgeons seems now and then to have turned spontaneously towards preventing or alleviating the pain of operations, and certain attempts and suggestions were made with this object during the later part of the last century, in apparent ignorance of what had been done by the ancients in this direction.

Ambroise Tranquille Sassard, principal surgeon of the Hospital la Charité at Paris, recommended the employment of a narcotic previous to serious and painful operations, the dose to be proportioned to the age and strength of the patient. He does not state whether the plan was actually tried.

Mr. James Moore, surgeon, recommended compression of the large nerves, and tried it on a patient in St. George’s Hospital, whose leg Mr. John Hunter amputated below the knee. The crural and sciatic nerves were compressed for nearly an hour by an instrument contrived for the purpose, and Mr. Moore considered that the greater part of the pain was prevented. The patient complained more of the sawing of the bone than of the cutting part of the operation. I am not aware whether this plan was tried in other instances, but it is certain that it did not come into general use.

M. le docteur Liégard (de Caen) has stated, that the peasants in his part of France are in the habit of tying a band very tightly round the arm or leg before operations on the extremities. He had himself removed a toe-nail in two cases, without pain, after a handkerchief had been tied very tightly round the lower part of the leg. By this measure both the nerves and blood vessels are, of course, more or less compressed.

The persons who believe in the existence of a force or power, which they call Mesmerism, or animal magnetism, made many and persevering efforts in recent times to cause insensibility to the surgeon’s knife. In some cases they were imposed on by dishonest and designing patients, who afterwards confessed they had suffered the pain to which they had pretended to be insensible, but in other cases I have no doubt of the operations having really been performed without pain. Absence of consciousness and sensation is a common symptom in many cases of hysteria and catalepsy, and in certain susceptible persons, hysteria and catalepsy, or conditions nearly resembling them, can be induced by acting on the imagination, or by exhausting the attention by means of the fixed stare and monotonous “passes” of the so-called Mesmerisers.

Dr. Esdaile was more successful in putting Hindoos to sleep, and operating on them in the hypnotized state, than any one has been with Europeans: yet it was only in a portion of the cases in which it was tried that the alleged agent took effect. In many instances, efforts continued for two or three months had no effect on the patient; and in many of the operations, which were reported as successful, “there was much convulsive movement of the limbs, corrugation of the brows, and even loud cries and sobs,” although the patients afterwards denied all knowledge of what had passed.

The discovery of the means of preventing pain, which will occupy the greater number of the following pages, did not arise out of any of the attempts either in ancient or modern times above enumerated. It sprung directly from the practice of inhaling chemical and medicinal substances.

The custom of inhaling the fumes of narcotic plants existed at the very commencement of the historic period, as appears by the following passages from Herodotus. Speaking of the people who inhabited some small islands on the river Araxes, which flows into the Caspian Sea, he says, “They add that they have discovered other trees that produce fruit of a peculiar kind, which the inhabitants, when they meet together in companies, and have lit a fire, throw on the fire as they sit round in a circle; and that by inhaling the fumes of the burning fruit that has been thrown on, they become intoxicated by the odour, just as the Greeks do by wine; and that the more fruit is thrown on, the more intoxicated they become, until they rise up to dance and betake themselves to singing.”

Again, when treating of the funeral ceremonies of the Scythians, he says, “When they have set up three pieces of wood, leaning against each other, they extend round them woollen cloths; and having joined them together as closely as possible, they throw red-hot stones into a vessel placed in the middle of the pieces of wood and the cloths. They have a sort of hemp growing in this country very like flax, except in thickness and height; in this respect the hemp is far superior: it grows both spontaneously and from cultivation; and from it the Thracians make garments very like linen, nor would any one who is not well skilled in such matters distinguish whether they are made of flax or hemp, but a person who has never seen this hemp would think the garment was made of flax. When, therefore, the Scythians have taken some seed of this hemp, they creep under the cloths, and then put the seed on the red-hot stones; but this, being put on, smokes, and produces such a steam, that no Grecian vapour-bath would surpass it. The Scythians, transported with the vapour, shout aloud; and this serves them instead of washing, for they never bathe the body in water.”

Mental illusions of all kinds have frequently been looked on as divine revelations, not only by savages, but even by nations having a considerable amount of civilization. The priestess at Delphos became intoxicated with the fumes of narcotic plants before delivering her oracular responses, and it is a curious circumstance that when America was discovered by Columbus, it was the custom of the Indians to throw tobacco on the fire during their religious ceremonies, when the piaches, or priests, who officiated, were thrown into a state of ecstatic inebriation by the smoke they inhaled.

I have already stated my belief that the Indian hemp administered, previous to surgical operations, in China, by Hoa-tho, in the beginning of the third century of our era, was exhibited by inhalation.

The fumes of various narcotic plants are inhaled by eastern nations at present, for smoking in the east is an entirely different process from smoking in the west of Europe, where the fumes of tobacco are merely drawn into the mouth and then puffed out again. In Asia and some of the eastern parts of Europe, the fumes of opium, tobacco, datura, Indian hemp, or whatever else is smoked, are always inhaled into the lungs.

John Baptista Porta of Naples makes the following statement in his work on Natural Magic, published in 1597:—

“At last shall be related a wonderful method by which any sleeping person may inhale a soporific medicine. From what we have said, any one will easily know that he is liable to suffer severely after sleep caused by medicine, and to have his suspicions aroused.

“But the quintessence is extracted from a number of the above named medicines by somniferous menstrua. This is put into leaden vessels perfectly closed, lest the least aura should escape, for the medicine would vanish away. When it is used, the cover being removed, it is applied to the nostrils of the sleeping person, he draws in the most subtile power of the vapour by smellings, and so blocks up the fortress of the senses that he is plunged into the most profound sleep, and cannot be roused without the greatest effort. After the sleep, no heaviness of the head remains, nor any suspicion of trick or fraud. These things are plain to the skilful physician, but unintelligible to the wicked.”

The author does not make known what the “somniferis menstruis” were, with which the “quinta essentia” were extracted. As sulphuric ether had been described more than fifty years before he published his work, it is not improbable that this was the evanescent substance which required to be so carefully closed up, and that the profound sleep was simply caused by this, as the narcotic principles dissolved in it would remain in the bottle in the form of extracts. The benefit of inhalation has been frequently attributed to medicines which were supposed to be inhaled, when it was really due to the menstruum in which the medicines were dissolved. This often happens at present when the menstruum is merely water. Baptista Porta does not say that operations were performed under the influence of the inhalation, or, in fact, that it was applied to any useful purpose whatever.

The Persian Pharmacopœia contains some recipes for fumigation, called bouc-houri, that were inhaled, for the medicines are directed to be made up into balls or cubes which are to be placed on the live coals, and the head is to be held over them. Some of the prescriptions contain myrrh, camphor, mace, and storax, and are for the cure of coryza and catarrh; one containing musk, camphor, guaiacum, etc., is said to comfort the brain and intellect, and to be useful in palpitation of the heart, faintness, and debility of the senses. This Pharmacopœia also contains a “remedium odorativum somniferum”, which consists of opium and camphor, besides the seeds of roses and the root of mandragora. The ingredients are to be powdered and put in a box, for the purpose of being smelt at. There is also a stupifying remedy prepared with five drachms of opium and ten drachms of black poppy, which are directed to be boiled to dryness in water with a pound of wheat, and then powdered. It is added that whoever shall take a drachm and a half of this wheat will be alienated from his senses. With regard to the last but one of the above prescriptions—that to be put in a box for smelling, it may be observed that, as heat was not applied, the only ingredient which would produce any effect is the camphor.

The discoveries of Cavendish, Priestley, Lavoisier, and others respecting the nature of atmospheric air and the more important gases, gave an impetus to medicinal inhalations, at the latter part of the last century. Dr. Beddoes, in particular, distinguished himself by the administration of oxygen, hydrogen, carbonic acid, and other gases, in consumption and various diseases. Dr. Richard Pearson exhibited the vapour of ether in consumption with some advantage in the year 1795. Three years afterwards, a medical pneumatic institution was established at Bristol, by the exertions of Dr. Beddoes and others. The celebrated Humphrey Davy was the superintendent. This establishment was not very successful in the immediate objects for which it was instituted, but Davy made at this place his masterly researches concerning nitrous oxide gas. In the course of his experiments, he found that severe pain arising from inflammation of his gums was relieved by breathing this gas, and he published the following opinion:—

“As nitrous oxide in its extensive operation seems capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.”

This suggestion of Sir Humphrey Davy was not acted on either by himself or any other person for nearly half a century, when the late Mr. Horace Wells, Surgeon Dentist of Hartford, Connecticut, having witnessed the exhibition of nitrous oxide gas by a public lecturer, named G. Q. Colston, was induced, in consequence of what he saw of its effects, to request Mr. Colston to accompany him to his office and exhibit the gas to him, whilst another dentist, named Dr. Riggs, extracted a tooth for him which was troublesome. The tooth was extracted without pain, and Mr. Wells, after the effect of the gas had subsided, exclaimed, “A new era in tooth pulling.” This took place on December 11th, 1844. Mr. Wells administered the nitrous oxide in thirteen or fourteen cases of tooth-drawing in Hartford with a success more or less complete, and before the end of the year he repaired to Boston to introduce his discovery to the professors at the Massachusetts General Hospital. He called on Drs. Warren and Hayward, who invited him to exhibit the gas to one of the patients, who was expecting to have a limb amputated. He remained two or three days in Boston, but the patient decided not to have the operation performed at that time. The nitrous oxide was consequently tried on an individual who required to have a tooth extracted. This patient felt some pain, and the application was considered to be a failure. It is worthy of remark that Drs. Charles T. Jackson, and W. T. G. Morton, were present on this occasion. Mr. Wells returned to Hartford in disappointment. He expressed his opinion to his friends that the nitrous oxide gas was uncertain in its action, and not to be relied on; and he altogether abandoned the use of it until some time after Dr. Morton’s discovery of the effects of sulphuric ether in preventing pain.

As long ago as 1818 an article, which is believed to have been written by Mr. Faraday, appeared in the Quarterly Journal of Science and Arts, describing the great resemblance between the effects of the vapour of ether and nitrous oxide gas. This circumstance has since been published in all the standard works on chemistry; and it was the annual custom of the late Professor Turner, of University College, London, to pour a little ether into a bladder of air, and allow some of the students to inhale the vapour. The same practice prevailed, more or less, in other colleges, both in Europe and America, when the lecture on ether was delivered. The resemblance between the action of nitrous oxide and that of vapour of ether was therefore extensively known.

Dr. Morton, surgeon dentist of Boston, in America, administered sulphuric ether, by inhalation, to a man in his office, on the 30th of September, 1846, and extracted a tooth without causing any pain. He applied the ether in several cases of a similar kind during the next few days. Having obtained the permission of Dr. J. C. Warren, he administered it to a patient in the Massachusetts General Hospital, on whom that surgeon performed an operation on the neck. On the following day, Dr. Morton exhibited ether to a woman in the same hospital, whilst Dr. Hayward removed a large fatty tumour from the arm, and after this date it was frequently administered.

Dr. Morton was well acquainted with Mr. Horace Wells, before alluded to, and had been in partnership with him. Before administering the ether to his patient in September 30th, Dr. Morton had a conversation with Dr. Charles J. Jackson, Professor of Chemistry, respecting the safety and propriety of the application, and the names of these gentlemen were associated in a patent which they took out for the discovery. Dr. Jackson asserts that Dr. Morton knew nothing of the effects of the vapour of ether till he gave him the information; whilst the latter says it was his intention to use the ether before he went into Dr. Jackson’s laboratory. It seems impossible to arrive at the exact truth on this point, but it is admitted on all hands, that Morton was the first who administered ether to prevent the pain of an operation. Dr. Jackson has indeed claimed the whole merit of the discovery, on the ground of the alleged information he gave to Dr. Morton; but, if every word Dr. Jackson says be admitted, it only appears that he suggested the use of ether to Dr. Morton, just as Sir Humphrey Davy had suggested the use of nitrous oxide to all the world in the year 1800. Dr. Jackson had inhaled ether as hundreds of others had done, and being aware of Davy’s suggestion of nitrous oxide for preventing the pain of operations, he concluded that ether might also have that effect.

It will be shown further on that Mr. Waldie, of Liverpool, had a greater share in the introduction of chloroform than Dr. Jackson had in the introduction of ether—even supposing that Dr. Morton was previously quite ignorant of that medicine; for when he informed Dr. Simpson of the existence and nature of chloroform, he was able to give him, not merely an opinion, but an almost certain knowledge of its effects; yet Dr. Simpson is justly considered to be the person who discovered and introduced the use of undiluted chloroform as a substitute for ether.

The practice of the ancients in giving mandragora and Indian hemp has no connection with the recent discovery for preventing the pain of operations, which may be briefly related as follows:—Sir Humphrey Davy made the suggestion that nitrous oxide gas might be employed for this purpose, and, at the end of forty-four years, Mr. Horace Wells carried this suggestion into practice, but failed to bring the nitrous oxide into general use, and gave the matter up. Two years later, Dr. Morton, who was well acquainted with the efforts of Mr. Wells, applied the vapour of ether, which was already known to resemble nitrous oxide in its action. He succeeded completely in preventing the pain of operations, and in bringing his discovery into general use throughout the civilized world. In a short time the inhalation of ether was found to be so safe and certain in its action, and to prevent the pain of operations so entirely, that the most ardent imagination could scarcely conceive that anything further could be desired in this direction.