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When Operative Pain Was Conquered
Who was who on ether day, October 16, 1864: (1) a newspaper reporter (2) John Call Dalton (3) W illiam W illiam son W ellington (4) Abel Lawrence Peirson (5) Charles Hosea H ildreth (6) W illiam Thomas Green Morton (7) Jonathan Mason Warren (8) G ilbert Abbott (9) John C ollins Warren (10) Eben H. Frost (11) Charles Frederick Heywood (12) Henry Jacob Bigelow (13) Augustus Addison Gould (14) Solomon Davis Townsend.
WHEN OPERATIVE PAIN WAS CONQUERED N. C. Hudson, BBS, Chicago
One hundred and twenty-two years ago— on Oc tober 16, 1846— William Thomas Green Morton, a dentist studying medicine at Harvard Medical College, gave the first successful public demon stration of surgical anesthesia. He administered ether to a patient undergoing removal of a tumor of the jaw, in the operating amphitheater of the Massachusetts General Hospital, Boston. The historic event, pictured on the front cover 1270
of this issue of t h e j o u r n a l , brought the practical application of anesthesia to the attention of the world. Within a year, surgical patients in several countries were being operated on with the bene fits of anesthesia. The pain and suffering associ ated with surgical operations were no longer nec essary. In the judgment of most dental and medi cal historians, the conquering of pain incident to surgical operation by means of an anesthetic
H i»
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Plaque designating Ether Dome a registered national h isto ric landmark.
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agent probably was dentistry’s greatest gift to mankind. On October 16, 1965, a bronze plaque was un veiled at a ceremony in the Ether Dome of the Massachusetts General Hospital. The plaque, situated to the right of the door from the hallway into the Ether Dome amphitheater, designates the site as a registered national historic land mark. An explanatory sign in the Ether Dome gives details of the historic public demonstration of anesthesia. Both the bronze plaque and a certificate were presented to the hospital by the US Department of the Interior, National Park Service. In its Nation al Survey o f Historic Sites and Buildings, the N a tional Park Service states: “Sitting atop the central section of Charles Bulfinch’s Massachusetts General Hospital Building, this skylighted operating room saw surgical history made on October 16, 1846. On that day, ether gas was used successfully in public to anesthetize a patient for surgery. “This epochal event was due partly to the efforts
a m
^
7-r ’ "
£ s
of William Thomas Green Morton, who adminis tered the ‘preparation’ to the patient. Morton, how ever, was one among many. People knew by the 1820’s that both ether and nitrous oxide could pro duce unconsciousness, and gas-induced jags were popular. From this frivolous use of ether, a Georgia physician, Dr. Crawford W. Long, noticed that it al leviated pain. In 1842, he successfully operated on an etherized patient, but he did not publicize his feat, perhaps for fear of alarming his neighbors. “A dentist, Dr. Horace Wells of Hartford, Con necticut, used nitrous oxide successfully in 1884 for a tooth extraction. William Morton was Wells’ partner until 1843, when Morton entered Harvard Medical College. Morton continued to practice den tistry while attending medical school, and in 1846 he found ether to be useful in extracting teeth. Ex cited by what he thought to be an original discovery, he obtained the permission of Dr. John Collins War ren, the eminent Chief Surgeon of the Massachusetts General Hospital, to use ether for surgery. “It is far from clear who should be credited with the successful use of ether for surgery, but there is less dispute about the site. Bare and utilitarian, the room remains practically unchanged, and students 1271
M assachusetts General Hospital, designed by Boston a rch ite ct Charles B ulfinch, as it appeared in 1846. Ether Dome can be seen rising about the center o f th e b u ild in g in foreground.
ON OCTOBER
16.
1846
IN THIS ROOM T H E N
WAS GIVEN T H E FIRST PUBLIC TO T H E E X T E N T SULPHURIC T H E PATIENT
OF
T H E OPERATING DEMONSTRATION
PRODUCING INSENSIBILITY TO PAIN
ETHER WAS ADMINISTERED WAS GILBERT
ABBOTT THE
T H E PATIENT DECLARED
TH E
BY
OPERATION
OF T H E
DURING A SERIOUS
W ILLIAM THOMAS GREEN
HOSPITAL
SURGICAL OPERATION
MORTON A BOSTON
DENTIST
WAS T H E REMOVAL OF A TUMOR UNDER T H E JAW
SURGEON WAS JOHN COLLINS WARREN THAT HE HAD FELT NO PAIN DURING T H E OPERATION
AND WAS DISCHARGED W E L L K N O W L E D G E OF T H IS DISCOVERY
THEATRE
OF ANAESTHESIA
SPREAD
AND A
NEW
DECEMBER 7
FROM THIS ROOM THROUGHOUT TH E CIVILIZED WORLD ERA
FOR
SURGERY BEGAN
Explanatory sign in Ether Dome gives d etails of th e h isto ric dem onstration o f anesthesia in 1846. The Ether Dome ceased to fu n ctio n as an operating room in 1867 but is s till used daily fo r conferences and m edical rounds.
still sit in its sharply rising tiers of seats. The hospi tal is located on Fruit Street in Boston.” The Ether Dome is in current use as a lecture hall.
Ether and nitrous oxide Ether had been synthesized by Valerius Cordus in the middle of the 16th century, 300 years before 1272 ■ JADA, Vol. 76, June 1968
its anesthetic properties were realized. Humphrey Davy, experimenting with “laughing gas,” hinted at the possibilities of nitrous oxide as a surgical anesthetic in 1800. Wrote Davy: “As nitrous oxide in its extensive operation appears capable of de stroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.” Faraday, in 1818, noted that “when the vapour of ether mixed with common air is inhaled, it pro duces effects very similar to those occasioned by
nitrous oxide.” Hickman, in 1824, carried out a series of experiments on animals which proved that pain of surgical operations could be abol ished by inhalation of carbon dioxide. Despite these publications, no physicians of their day rec ognized the tremendous importance of their ex periments. T he greatest barrier to the evolution of the con cept of anesthesia was the callous, brutal attitude toward suffering, buttressed by the teaching of some religious fanatics. By the 1840’s this attitude was beginning to change. Suffering, instead of being regarded as inevitable and even salutary, had become a state to be corrected. The findings of Davy and Faraday led to laugh ing gas lectures and ether frolics of the 1840’s. These popular science demonstrations embold ened Long, Wells, and Morton to attempt anes thesia for patients undergoing surgical procedures, by inhalation of little-known chemical compounds.
Role o f Horace Wells The man whom many hold to have played the ma jor role in bringing about surgical anesthesia is Horace Wells. After studying dentistry in Boston, Wells entered practice in Hartford, Conn, in 1836. He taught dentistry to several students, one of whom was William Morton. Everything that has come to light about Wells reveals him as a sympa thetic, conscientious, alert dentist. Sensitive, he was troubled by the suffering he caused when he
Ether Dome is s till in use many hours each day fo r lectures.
extracted a tooth. He attended a lecture on chemi cal phenomena by G. Q. Colton, traveling chem ist, on December 10, 1844. As part of his demon stration, Colton manufactured some nitrous oxide, known as “laughing gas,” and invited spectators from the audience to come forward and inhale the fumes. Wells observed that no sign of pain was exhibited when the volunteers under the laughing jag of the gas, stumbled around the stage and scraped their shins on heavy benches. Im m edi ately there crystallized in Wells’ mind the idea of inhalation anesthesia. After the lecture, Wells talked with Colton and persuaded him to bring a bag of the gas to his office the next day. Wells had an aching tooth and felt that by inhaling suf ficient nitrous oxide he could have his tooth re moved painlessly. On December 11, 1844, Wells sat in his operating chair and held the bag of gas which he inhaled until he lost consciousness. His friend and former pupil, John Riggs, extracted the aching third molar. On regaining consciousness, Wells was delighted to note that he had felt no pain. Wells plunged into the manufacture of ni trous oxide and administered it to 15 patients with varying success. Full of enthusiasm, he went to Boston and, through the efforts of his former pupil, Morton, secured permission to give a dem onstration of painless dental extraction before one of the classes of the surgeon, Dr. John Collins W ar ren, at the Harvard Medical School. Early in Janu ary 1845 Horace Wells first read a paper on the use of nitrous oxide as an anesthetic agent, and then proceeded to administer nitrous oxide to one
Replica o f hollow glass ball used by M orton. A sponge inside ball was saturated w ith ether. M outhpiece was placed between the p a tie n t’s lips. Incom ing air passed over the ether-saturated sponge.
of Dr. W arren’s students who volunteered to have one of his teeth extracted while under the effects of the anesthetic agent. On this important occa sion, Wells failed to administer sufficient dosage of nitrous oxide; the patient cried out in pain, and students jeered at Wells. Though Wells’ demon stration before W arren’s class was not completely successful, the patient later admitted that he felt no pain. Wells returned to Hartford where he con tinued to use nitrous oxide in his practice and taught other dentists to use it. When friends urged Wells to patent his discovery, he said, “No. Let it be free as the air we breathe.”
Role o f William Morton A year and a half later, Wells’ former student and former partner, Morton, successfully demonstrated the use of ether for anesthesia. On that historic occasion, already described, Morton used a device of his own fashioning to administer the ether (Fig 5). Into a hollow glass ball he inserted a sponge saturated with ether. The patient’s nostrils were closed with one hand, and the mouthpiece was placed between the patient’s lips; he then breathed through his mouth. The incoming air passed over the sponge saturated with ether. Morton had disguised the identity o f the ether with color and aromatics, and had given it the 1274 ■ JADA, Vol. 76, June 1968
name “ Letheon.” He also had applied for a patent on his discovery. On November 7, 1844, he ad ministered ether for the first major operation un der anesthesia— amputation at thigh level per formed by a Doctor Hayward at Massachusetts General Hospital. On November 12, patent no. 4848 was issued to Charles T. Jackson and Wil liam T. G. Morton for a “new and useful improve ment in surgical operations.” (Doctor Jackson, a physician and chemist, had suggested to Morton that he use highly purified ether. Later, he was to claim for himself the major role in conceiving anes thesia.) Shortly after his successful demonstrations, M or ton was barred by surgeons from the Massachusetts General Hospital; the surgeons also refused to use his preparation “ until informed what it is.” M or ton admitted that the agent which brought about anesthesia was “ sulfuric ether.” From then on, there was no further opposition in the hospital to the performance of operations on patients under etherization.
Reports on use o f anesthesia On November 18, 1844, an article appeared in the Boston Medical and Surgical Journal (fore runner of the New England Journal o f Medicine) by Dr. Henry J. Bigelow. The paper had been
P ainting by Robert Shaw Wesson (a Boston dentist) of the firs t public dem onstration of ether anesthesia was recently presented to th e American Dental Association by the M assachusetts Dental Society
read November 9 before the Boston Society of Medical Improvement; the author described the successful use of M orton’s procedure. This was the article that introduced the practice o f anesthe sia to medical men throughout the world. The first article on anesthesia in an American dental journal was that by Harris, Wescott, and Dwinelle, “ Inhalation of ethereal vapor for the purpose of inducing insensibility to the pain of surgical operations,” in the December 1846 issue of the American Journal o f Dental Science. A study of the bibliography of W. Harry Arch er’s Manual o f Anesthesia and Oral Surgery, chap ter one, and of the Index to Dental Literature re veals several other articles on anesthesia. In the Boston Daily Advertiser of December 12, 1846 (according to Archer), there appeared a report by a committee of Boston dentists, headed by J. F. Flagg, condemning the use of ether with faint and carefully qualified praise. Flagg later was to become one of the outstanding users and advocates of ether and then of chloroform anes thesia. Because of opposition raised by both the dental and medical professions, the use of anes thesia was slow in adoption. One of the chief prob lems was that charlatans quickly seized on anes thesia as a way to invade the medical and dental fields. T he Dental News Letter for July 1849 reported
that “ Letheon is still used to considerable extent in Boston for extraction o f teeth; while in this city [Philadelphia] and in most other places, so far as we have been able to learn, it has been gen erally abandoned.” The Dental ■News Letter of September 1847 contained a letter from Flagg on anesthesia. A n other article by Flagg, “General directions for administering sulphuric ether by inhalation,” ap peared in the Dental News Letter of 1847-1848, volume 1, number 2, p. 13. The American Journal o f Dental Science, vol ume VIII, 1847, contained a long section on anes thesia and dentistry. The January 1848 issue (8:1: 147-158) contained an article by Sir James Y. Simpson, entitled “Account of a new anaesthetic agent, as a substitute for sulphuric ether in sur gery and midwifery.” The American Society of Dental Surgeons in 1848 called attention to the introduction “ in the practice of the profession, of sulphuric ether, chloroform, and a similar agent, known as alde hyde— for the purpose of subdueing pain and sensibility during the extraction of teeth, and the performance of other surgical operation. . . The society, says Archer, expressed alarm that the use of these anesthetic gases encouraged charlatanism. Advertisements of “dentistry without pain” in jured the profession, it was asserted. Hudson: WHEN OPERATIVE PAIN WAS CONQUERED ■ 1275
A D A ’s 1864 resolution on Wells
The American Dental Association at its fourth annual meeting in Niagara Falls in 1864 adopted a resolution “that to Horace Wells, of Hartford, Connecticut, (now deceased) belongs the credit and honor o f the introduction o f anesthesia in the United States of America, and we do firmly pro test against the injustice done to truth and the memory o f Dr. Horace Wells, in the effort made during a series o f years and especially at the last session o f Congress, to award the credit to other persons or person.” The American Medical Association in 1870 at its 21st annual meeting held in Washington, DC, resolved “ that the honor of the discovery of prac tical anesthesia is due to the late Dr. Horace Wells, of Connecticut.” The world generally ignored the contenders for the fame of having discovered surgical anes thesia. Research in extending application of the principle o f anesthesia went forward rapidly. Chemists and pharmacists struggled to improve the anesthetic agents. Dentists and physicians con tinued to experiment with new means of admin istration. From 1850 to 1860 chloroform was used for many dental and major surgical operations. Dr. John Snow o f London was the first physi cian to specialize in anesthesiology. He perfected improved methods of administering anesthetics. Benjamin W ard Richardson, another Londoner,
1276 ■ JADA, Vol. 76, June 1968
introduced the first successful local anesthetic in the form o f an ether spray, in 1867, which held its favor until the introduction of cocaine in 1884. In the late 1860’s, according to Archer, mix tures of ether and chloroform were suggested and used for inhalation anesthesia, and nitrous oxide was reintroduced by G. Q. Colton in his various “Dental Institutes.” The enormous extraction prac tice built by Colton and his associates gave a great impetus to the use of nitrous oxide for ex traction. In 1868 Edmund Andrews, a Chicago surgeon, m ade a great contribution to anesthesia by proposing the m ixture of oxygen with nitrous oxide. In 1883 G. V. Black lectured and gave a prac tical demonstration on “Bromide of ethyl as an anesthetic for dental purposes or any very short operation.” Black’s first public demonstration, like that o f Wells’, was a failure. A good share of the advances in anesthesia were made by dentists in the United States and Europe, as a reading of Archer’s book will show. Since the 1880’s research has made possible such progress in anesthesia that today there is hard ly a surgical situation for which there is not a suit able anesthetic. Yet, anesthesia remains primarily empirical. To this day, no one has satisfactorily explained what pain is. The world owes an immeasurable debt o f grat itude to the dentists Wells and M orton and others, and to the physicians, Long and Snow and others, who were the first to show their colleagues how to conquer surgical pain with anesthesia.
WHEN OPERATIVE PAIN WAS CONQUERED N. C. Hudson, BBS, Chicago
One hundred and twenty-two years ago— on Oc tober 16, 1846— William Thomas Green Morton, a dentist studying medicine at Harvard Medical College, gave the first successful public demon stration of surgical anesthesia. He administered ether to a patient undergoing removal of a tumor of the jaw, in the operating amphitheater of the Massachusetts General Hospital, Boston. The historic event, pictured on the front cover 1270
of this issue of t h e j o u r n a l , brought the practical application of anesthesia to the attention of the world. Within a year, surgical patients in several countries were being operated on with the bene fits of anesthesia. The pain and suffering associ ated with surgical operations were no longer nec essary. In the judgment of most dental and medi cal historians, the conquering of pain incident to surgical operation by means of an anesthetic
H i»
IT H E R D O M I
m u A G iw m m g e n e r a i ìì
& 3 b is ? }
m m m ä iP M ®
£
•HICISTE H ID H /ÌT JO im i j i s t q i u c im m m m z m m m rim m o jí s im a m t j u h ìs to th c à&t m Awm m m m T T T 13 a r a
m
w m m m m
n m m r m m M » i , '¿ a m
o o m m im o h ìtim s
àm
» S 3 & F 3 U 8 S B i*&
r i a im i o m o f ram p ì ®
m &m
t u , v v v iv m m m w r m i m m m n A Y im iiX L '■ '- m
. s &
Plaque designating Ether Dome a registered national h isto ric landmark.
w äm m
s m
m
t t y m
g
|% |> 5 :
s. ì
m
agent probably was dentistry’s greatest gift to mankind. On October 16, 1965, a bronze plaque was un veiled at a ceremony in the Ether Dome of the Massachusetts General Hospital. The plaque, situated to the right of the door from the hallway into the Ether Dome amphitheater, designates the site as a registered national historic land mark. An explanatory sign in the Ether Dome gives details of the historic public demonstration of anesthesia. Both the bronze plaque and a certificate were presented to the hospital by the US Department of the Interior, National Park Service. In its Nation al Survey o f Historic Sites and Buildings, the N a tional Park Service states: “Sitting atop the central section of Charles Bulfinch’s Massachusetts General Hospital Building, this skylighted operating room saw surgical history made on October 16, 1846. On that day, ether gas was used successfully in public to anesthetize a patient for surgery. “This epochal event was due partly to the efforts
a m
^
7-r ’ "
£ s
of William Thomas Green Morton, who adminis tered the ‘preparation’ to the patient. Morton, how ever, was one among many. People knew by the 1820’s that both ether and nitrous oxide could pro duce unconsciousness, and gas-induced jags were popular. From this frivolous use of ether, a Georgia physician, Dr. Crawford W. Long, noticed that it al leviated pain. In 1842, he successfully operated on an etherized patient, but he did not publicize his feat, perhaps for fear of alarming his neighbors. “A dentist, Dr. Horace Wells of Hartford, Con necticut, used nitrous oxide successfully in 1884 for a tooth extraction. William Morton was Wells’ partner until 1843, when Morton entered Harvard Medical College. Morton continued to practice den tistry while attending medical school, and in 1846 he found ether to be useful in extracting teeth. Ex cited by what he thought to be an original discovery, he obtained the permission of Dr. John Collins War ren, the eminent Chief Surgeon of the Massachusetts General Hospital, to use ether for surgery. “It is far from clear who should be credited with the successful use of ether for surgery, but there is less dispute about the site. Bare and utilitarian, the room remains practically unchanged, and students 1271
M assachusetts General Hospital, designed by Boston a rch ite ct Charles B ulfinch, as it appeared in 1846. Ether Dome can be seen rising about the center o f th e b u ild in g in foreground.
ON OCTOBER
16.
1846
IN THIS ROOM T H E N
WAS GIVEN T H E FIRST PUBLIC TO T H E E X T E N T SULPHURIC T H E PATIENT
OF
T H E OPERATING DEMONSTRATION
PRODUCING INSENSIBILITY TO PAIN
ETHER WAS ADMINISTERED WAS GILBERT
ABBOTT THE
T H E PATIENT DECLARED
TH E
BY
OPERATION
OF T H E
DURING A SERIOUS
W ILLIAM THOMAS GREEN
HOSPITAL
SURGICAL OPERATION
MORTON A BOSTON
DENTIST
WAS T H E REMOVAL OF A TUMOR UNDER T H E JAW
SURGEON WAS JOHN COLLINS WARREN THAT HE HAD FELT NO PAIN DURING T H E OPERATION
AND WAS DISCHARGED W E L L K N O W L E D G E OF T H IS DISCOVERY
THEATRE
OF ANAESTHESIA
SPREAD
AND A
NEW
DECEMBER 7
FROM THIS ROOM THROUGHOUT TH E CIVILIZED WORLD ERA
FOR
SURGERY BEGAN
Explanatory sign in Ether Dome gives d etails of th e h isto ric dem onstration o f anesthesia in 1846. The Ether Dome ceased to fu n ctio n as an operating room in 1867 but is s till used daily fo r conferences and m edical rounds.
still sit in its sharply rising tiers of seats. The hospi tal is located on Fruit Street in Boston.” The Ether Dome is in current use as a lecture hall.
Ether and nitrous oxide Ether had been synthesized by Valerius Cordus in the middle of the 16th century, 300 years before 1272 ■ JADA, Vol. 76, June 1968
its anesthetic properties were realized. Humphrey Davy, experimenting with “laughing gas,” hinted at the possibilities of nitrous oxide as a surgical anesthetic in 1800. Wrote Davy: “As nitrous oxide in its extensive operation appears capable of de stroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.” Faraday, in 1818, noted that “when the vapour of ether mixed with common air is inhaled, it pro duces effects very similar to those occasioned by
nitrous oxide.” Hickman, in 1824, carried out a series of experiments on animals which proved that pain of surgical operations could be abol ished by inhalation of carbon dioxide. Despite these publications, no physicians of their day rec ognized the tremendous importance of their ex periments. T he greatest barrier to the evolution of the con cept of anesthesia was the callous, brutal attitude toward suffering, buttressed by the teaching of some religious fanatics. By the 1840’s this attitude was beginning to change. Suffering, instead of being regarded as inevitable and even salutary, had become a state to be corrected. The findings of Davy and Faraday led to laugh ing gas lectures and ether frolics of the 1840’s. These popular science demonstrations embold ened Long, Wells, and Morton to attempt anes thesia for patients undergoing surgical procedures, by inhalation of little-known chemical compounds.
Role o f Horace Wells The man whom many hold to have played the ma jor role in bringing about surgical anesthesia is Horace Wells. After studying dentistry in Boston, Wells entered practice in Hartford, Conn, in 1836. He taught dentistry to several students, one of whom was William Morton. Everything that has come to light about Wells reveals him as a sympa thetic, conscientious, alert dentist. Sensitive, he was troubled by the suffering he caused when he
Ether Dome is s till in use many hours each day fo r lectures.
extracted a tooth. He attended a lecture on chemi cal phenomena by G. Q. Colton, traveling chem ist, on December 10, 1844. As part of his demon stration, Colton manufactured some nitrous oxide, known as “laughing gas,” and invited spectators from the audience to come forward and inhale the fumes. Wells observed that no sign of pain was exhibited when the volunteers under the laughing jag of the gas, stumbled around the stage and scraped their shins on heavy benches. Im m edi ately there crystallized in Wells’ mind the idea of inhalation anesthesia. After the lecture, Wells talked with Colton and persuaded him to bring a bag of the gas to his office the next day. Wells had an aching tooth and felt that by inhaling suf ficient nitrous oxide he could have his tooth re moved painlessly. On December 11, 1844, Wells sat in his operating chair and held the bag of gas which he inhaled until he lost consciousness. His friend and former pupil, John Riggs, extracted the aching third molar. On regaining consciousness, Wells was delighted to note that he had felt no pain. Wells plunged into the manufacture of ni trous oxide and administered it to 15 patients with varying success. Full of enthusiasm, he went to Boston and, through the efforts of his former pupil, Morton, secured permission to give a dem onstration of painless dental extraction before one of the classes of the surgeon, Dr. John Collins W ar ren, at the Harvard Medical School. Early in Janu ary 1845 Horace Wells first read a paper on the use of nitrous oxide as an anesthetic agent, and then proceeded to administer nitrous oxide to one
Replica o f hollow glass ball used by M orton. A sponge inside ball was saturated w ith ether. M outhpiece was placed between the p a tie n t’s lips. Incom ing air passed over the ether-saturated sponge.
of Dr. W arren’s students who volunteered to have one of his teeth extracted while under the effects of the anesthetic agent. On this important occa sion, Wells failed to administer sufficient dosage of nitrous oxide; the patient cried out in pain, and students jeered at Wells. Though Wells’ demon stration before W arren’s class was not completely successful, the patient later admitted that he felt no pain. Wells returned to Hartford where he con tinued to use nitrous oxide in his practice and taught other dentists to use it. When friends urged Wells to patent his discovery, he said, “No. Let it be free as the air we breathe.”
Role o f William Morton A year and a half later, Wells’ former student and former partner, Morton, successfully demonstrated the use of ether for anesthesia. On that historic occasion, already described, Morton used a device of his own fashioning to administer the ether (Fig 5). Into a hollow glass ball he inserted a sponge saturated with ether. The patient’s nostrils were closed with one hand, and the mouthpiece was placed between the patient’s lips; he then breathed through his mouth. The incoming air passed over the sponge saturated with ether. Morton had disguised the identity o f the ether with color and aromatics, and had given it the 1274 ■ JADA, Vol. 76, June 1968
name “ Letheon.” He also had applied for a patent on his discovery. On November 7, 1844, he ad ministered ether for the first major operation un der anesthesia— amputation at thigh level per formed by a Doctor Hayward at Massachusetts General Hospital. On November 12, patent no. 4848 was issued to Charles T. Jackson and Wil liam T. G. Morton for a “new and useful improve ment in surgical operations.” (Doctor Jackson, a physician and chemist, had suggested to Morton that he use highly purified ether. Later, he was to claim for himself the major role in conceiving anes thesia.) Shortly after his successful demonstrations, M or ton was barred by surgeons from the Massachusetts General Hospital; the surgeons also refused to use his preparation “ until informed what it is.” M or ton admitted that the agent which brought about anesthesia was “ sulfuric ether.” From then on, there was no further opposition in the hospital to the performance of operations on patients under etherization.
Reports on use o f anesthesia On November 18, 1844, an article appeared in the Boston Medical and Surgical Journal (fore runner of the New England Journal o f Medicine) by Dr. Henry J. Bigelow. The paper had been
P ainting by Robert Shaw Wesson (a Boston dentist) of the firs t public dem onstration of ether anesthesia was recently presented to th e American Dental Association by the M assachusetts Dental Society
read November 9 before the Boston Society of Medical Improvement; the author described the successful use of M orton’s procedure. This was the article that introduced the practice o f anesthe sia to medical men throughout the world. The first article on anesthesia in an American dental journal was that by Harris, Wescott, and Dwinelle, “ Inhalation of ethereal vapor for the purpose of inducing insensibility to the pain of surgical operations,” in the December 1846 issue of the American Journal o f Dental Science. A study of the bibliography of W. Harry Arch er’s Manual o f Anesthesia and Oral Surgery, chap ter one, and of the Index to Dental Literature re veals several other articles on anesthesia. In the Boston Daily Advertiser of December 12, 1846 (according to Archer), there appeared a report by a committee of Boston dentists, headed by J. F. Flagg, condemning the use of ether with faint and carefully qualified praise. Flagg later was to become one of the outstanding users and advocates of ether and then of chloroform anes thesia. Because of opposition raised by both the dental and medical professions, the use of anes thesia was slow in adoption. One of the chief prob lems was that charlatans quickly seized on anes thesia as a way to invade the medical and dental fields. T he Dental News Letter for July 1849 reported
that “ Letheon is still used to considerable extent in Boston for extraction o f teeth; while in this city [Philadelphia] and in most other places, so far as we have been able to learn, it has been gen erally abandoned.” The Dental ■News Letter of September 1847 contained a letter from Flagg on anesthesia. A n other article by Flagg, “General directions for administering sulphuric ether by inhalation,” ap peared in the Dental News Letter of 1847-1848, volume 1, number 2, p. 13. The American Journal o f Dental Science, vol ume VIII, 1847, contained a long section on anes thesia and dentistry. The January 1848 issue (8:1: 147-158) contained an article by Sir James Y. Simpson, entitled “Account of a new anaesthetic agent, as a substitute for sulphuric ether in sur gery and midwifery.” The American Society of Dental Surgeons in 1848 called attention to the introduction “ in the practice of the profession, of sulphuric ether, chloroform, and a similar agent, known as alde hyde— for the purpose of subdueing pain and sensibility during the extraction of teeth, and the performance of other surgical operation. . . The society, says Archer, expressed alarm that the use of these anesthetic gases encouraged charlatanism. Advertisements of “dentistry without pain” in jured the profession, it was asserted. Hudson: WHEN OPERATIVE PAIN WAS CONQUERED ■ 1275
A D A ’s 1864 resolution on Wells
The American Dental Association at its fourth annual meeting in Niagara Falls in 1864 adopted a resolution “that to Horace Wells, of Hartford, Connecticut, (now deceased) belongs the credit and honor o f the introduction o f anesthesia in the United States of America, and we do firmly pro test against the injustice done to truth and the memory o f Dr. Horace Wells, in the effort made during a series o f years and especially at the last session o f Congress, to award the credit to other persons or person.” The American Medical Association in 1870 at its 21st annual meeting held in Washington, DC, resolved “ that the honor of the discovery of prac tical anesthesia is due to the late Dr. Horace Wells, of Connecticut.” The world generally ignored the contenders for the fame of having discovered surgical anes thesia. Research in extending application of the principle o f anesthesia went forward rapidly. Chemists and pharmacists struggled to improve the anesthetic agents. Dentists and physicians con tinued to experiment with new means of admin istration. From 1850 to 1860 chloroform was used for many dental and major surgical operations. Dr. John Snow o f London was the first physi cian to specialize in anesthesiology. He perfected improved methods of administering anesthetics. Benjamin W ard Richardson, another Londoner,
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introduced the first successful local anesthetic in the form o f an ether spray, in 1867, which held its favor until the introduction of cocaine in 1884. In the late 1860’s, according to Archer, mix tures of ether and chloroform were suggested and used for inhalation anesthesia, and nitrous oxide was reintroduced by G. Q. Colton in his various “Dental Institutes.” The enormous extraction prac tice built by Colton and his associates gave a great impetus to the use of nitrous oxide for ex traction. In 1868 Edmund Andrews, a Chicago surgeon, m ade a great contribution to anesthesia by proposing the m ixture of oxygen with nitrous oxide. In 1883 G. V. Black lectured and gave a prac tical demonstration on “Bromide of ethyl as an anesthetic for dental purposes or any very short operation.” Black’s first public demonstration, like that o f Wells’, was a failure. A good share of the advances in anesthesia were made by dentists in the United States and Europe, as a reading of Archer’s book will show. Since the 1880’s research has made possible such progress in anesthesia that today there is hard ly a surgical situation for which there is not a suit able anesthetic. Yet, anesthesia remains primarily empirical. To this day, no one has satisfactorily explained what pain is. The world owes an immeasurable debt o f grat itude to the dentists Wells and M orton and others, and to the physicians, Long and Snow and others, who were the first to show their colleagues how to conquer surgical pain with anesthesia.