Jun

10

The Development of Anaesthesia, from Victor Niederhoffer

June 10, 2019 |

1 Comment so far

1. Joyce Ilson MD on July 31, 2019 4:34 am

   Dr Morton was a Boston dentist also enrolled as a medical student at Harvard. On 9/30/1846 when Morton was 27 years old he successfully used inhalation ether to painlessly extract a tooth.This extraordinary event was witnessed by his colleagues and a glowing account was published the next day in the Boston daily newspaper along with an advertisement promoting his painless dental services. With this and a few other similar painless dental extractions Morton now had the necessary leverage to convince Harvard’s esteemed surgeon Dr Warren to operate Oct. 16 on a young man with a neck tumor with Morton as the anesthetist. The anesthetic went so well that Warren was alleged to have said ‘This is no humbug” at the conclusion of the procedure. Whether this was his actual utterance is controversial as that turn of phrase was not popular at the time but from eyewitness accounts Warren was clearly impressed and scheduled a more extensive surgical procedure for 3 weeks hence on Nov 7. Warren delayed only because he was ethically troubled that Morton was secretive and reluctant to release the ingredients in the anasthetic preparation. Morton’s secrecy was partially related to his joint pending patent on the ether inhalation anesthesia process along with the physician and chemist Jackson.They called
   their preparation “Lethium” but in reality it was just plain old ether,otherwise known as diethyl ether or sulphuric ether, without any fancy additives or new twists and known to pneumatic medicine.Ironically its anesthetic properties were discovered at recreational frolic parties when ether altered participants(academic society including doctors) would seemingly be oblivious to pain when bumping themselves or falling down. Warren would only proceed with the next procedure, a scheduled low thigh amputation on a 26 year old woman painfully disabled by a probable tubercular knee if Morton divulged the composition of the mysterious and magical anasthetic. Morton,already in the surgical ring of the Massachusetts General Hospital amphitheater (subsequently crowned the Ether Dome) and surrounded by anxiously expectant colleagues,finally agreed and revealed that the anesthetic was familar unaldulterated ether,reassuring Warren to surgically proceed.The amputation with ether anesthetic was a great success and was widely publicized both in the Boston press, medical journals, and letters by physicians and dentists to their colleagues across the land and to Europe. Inhaltion anesthetics caught on like wildfire both here and abroad, with rapid and wide acceptance by surgeons and patients. Within a year a textbook was published and both civilian and military surgeons were using ether anesthesia. Over time anesthetic agents evolved to be better tolerated and less toxic. Even Queen Victoria had her 8th child delivered with the assistance of anesthetic (chloroform) which promoted anesthesia for obstetric use. Of note is that Morton was not the first to successfully demonstrate ether anesthetic in an operation before colleagues.That honor belongs to Crawford Long MD of rural Jefferson, Georgia. He operated on 6 patients all witnessed in the 4 years prior to Morton but refrained fronm publishing his elegant and impressive results until 1849. In addition Dr.Wells of Hartford, also a dentist and senior colleague and teacher of Morton, had success with nitrous oxide as an anesthetic but his public demonstration off site before Harvard medical students in January,1846 was accidentally bungled and he failed to get recognition for his achievements. As an aside, Morton died addicted and penniless, Jackson was committed to a mental asylum and Wells died by suicide. There is an Ether Monument in Boston but it was not dedicated to an individual because of the controversy between claims as discoverer( Morton, Jackson, Wells and Crawford) at the time. Inhalation anesthesia has both relieved human suffering and made complicated and extensive surgery possible as well as safe. The article published in the New England Journal of Medicine( The former Boston Journal of Medicine and Surgery) was voted the most significant contribution to medicine in its 200 year history of publication. What I fail to understand is that ether was used hundreds of years earlier to both sedate animals and later by Davies as treatment for human respiratory disease that it took so long for it’s first trial as an inhalation anesthetic agent.