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His early sympathy for suffering—Surgical
methods before the discovery of anaesthetics—His mental struggle caused by
the sickening sights of the operating theatre—His researches into the
history of anaesthesia—Indian hemp—Mandrake—Alcohol—Hypnotism and other
methods—Inhalation of drugs—Sir Humphry Davy—Anaesthetics discovered in
America—Horace Wells and laughing-gas— Morton and ether—Ether in Great
Britain—He uses it in midwifery practice—Search for a better anaesthetic—Discovery
of anaesthetic power of chloroform.
FROM his earliest student days the desire had
ever been present in Simpson's mind to see some means devised for preventing
the sufferings endured by patients on the operating table, without, as he
put it, "interfering with the free and healthy play of the natural
functions." It is difficult for us at the close of the nineteenth century to
understand, without an effort of the imagination, the strong incentives
which he had for such a wish. Even to-day, when operations are conducted
without the infliction of pain, young students are not unfrequently overcome
by the sight and the thought of what is in front of them. At the
commencement of a winter session the theatre is crowded with those students
who are entering upon surgical study, and with others, not so far advanced,
who have come to get a preliminary peep at the practice of this
fascinatingly interesting art. Many of these at first succumb and faint even
before the surgeon has begun his work, and sometimes are only persuaded to
pursue their studies by the encouragement of kindly teachers.
Simpson also went through this trying
experience, but it must have been a greater struggle to him to persist. The
surroundings of the surgeon at the commencement of the century were vastly
more repugnant to a youth of sensitive nature than to-day. The operating
theatre then has been compared to a butcher's shambles; cleanliness was not
considered necessary, and little attention was paid to the feelings of the
patient. He was held down by three or four pairs of powerful arms as the
surgeon boldly and rapidly did his work, despite the screams, stopping,
perhaps, only to roughly abuse the patient for some agonised movement which
had interfered with the course of action. The poor wretch saw the
instruments handed one by one by the assistant, and heard the surgeon's calm
directions and his remarks on the case. The barbarous practice of arresting
bleeding by the application of red-hot irons to the surface of the wound had
indeed ceased three centuries before, when that humane reformer, Pare, for
his foot on the stair; for his step in the room for the production of his
dreaded instruments ; for his few grave words, and his last preparations
before beginning. And then he surrendered his liberty and, revolting at the
necessity, submitted to be held or bound, and helplessly gave himself up to
the cruel knife.".
It was, indeed, a monstrous ogre this giant
Pain, holding the poor weak human creature in its merciless clutches, which
Simpson even in his youthful days bethought himself to attack. It is well
that we who are the heirs, should know how Simpson and those others whose
names are ever associated with his, slew the monster, won the victory, and
championed the human race forward into a land where further victories
undreamt of by themselves are now being daily won.
Simpson searched into ancient history in order
to ascertain the methods, if any, by which in remote and mediaeval times
surgeons sought to prevent the pain of operations. The most time-honoured
method seems to have been by the internal administration of drugs, the chief
one used being Indian hemp, which was well known in the East, and under one
of its names haschish gave origin to the term assassin (strictly eater of
haschish). A certain Arab Sheikh got together a band of followers to whom he
administered haschish, which produced in them its usual effect—beautiful
dreams of a delightful paradise. He induced them to believe so thoroughly in
his power to gain for them at death permanent entrance to this paradise that
they obeyed all his ferocious and bloodthirsty behests. Thus these assassins
became known as men obedient to their leader in any murderous enterprise.
Indian hemp was, and still is, used as a luxury all over the East, as well
as to annul pain, and was used by criminals doomed to torture or execution.
Simpson thought the nepenthe of Homer was a preparation: of this drug ; he
also refers to the fact that Herodotus relates that the Massagetae inhaled
the vapour of burning hemp to produce intoxication and pleasurable
excitement.
Mandrake was used in a similar manner and for
similar purposes as Indian hemp in the Middle Ages, but it fell into disuse
on account of the fatal results that often followed. It is frequently
referred to by Shakspeare both for its narcotic properties and for its
fabulous power of uttering a scream when torn up by the roots, to hear which
meant death or madness. Simpson cited also well-known passages from
Shakspeare to prove that the practice of "locking up the spirits a time "
was known to that poet.
In later days the intoxication produced by
alcohol was taken advantage of, and instances of its use have been known in
quite recent years in the Colonies, where both a surgeon and chloroform were
out of reach.
No drug, however, was known to be of such value
in producing anaesthesia as to be constantly used, and many trials were made
of other means, notably that of compressing the nerves supplying the part to
be operated upon, but this was found to be too painful in itself. The stupor
produced by compressing the carotid arteries—a method taken advantage of by
the ruffians known as garotters—was also put in practice for a time during
the sixteenth and seventeenth centuries, but it was found too barbarous a
method even for those days.
Hypnotism was known to the Indians, Egyptians,
and Persians at a very remote period, and may possibly have been used by
them sometimes to produce anaesthesia for surgical purposes. Simpson was
attracted by the words of the poet Middleton in his tragedy " Women, beware
Women " (1617) where he says—
"I'll imitate the pities of old surgeons To this
lost limb—who ere they show their art Cast me asleep, then cut the diseased
part."
When hypnotism made one of its periodic
re-appearances in 1837, this time under the name of mesmerism, after that
extraordinary exponent of its powers Mesmer, Simpson recognised in it a
possible method for "casting the patient asleep" before operation and set to
work to investigate its phenomena. A Frenchman named Du Potet, disheartened
by the prejudice against mesmerism in his own country, came to London in
1837, and was fortunate enough to receive the support of Dr. John Elliotson,
physician to University College Hospital. Elliotson's advocacy of the new
practice was received with ridicule by the profession, and was treated with
such scathing contempt by the Lancet and other journals, that he was
completely ruined.
Simpson was very successful in his experiments
with mesmerism, conducted on the lines suggested by Elliotson, but he
recognised that, after all, it was not the agent for which he was seeking,
and dropped his researches.
He did not resume them even when Liston, a few
years later, stimulated by the advocacy of the Manchester surgeon Braid, who
met with a better reception than Elliotson, and by the relation of a long
series of successful cases by a surgeon named Esdaile, in Calcutta, actually
performed operations with success on patients brought under its influence.
The first suggestion to produce anaesthesia by
the inhalation of drugs was made by Sir Humphry Davy in 1800. He discovered
by experiment upon himself that the inhalation of nitrous oxide gas—commonly
known as a laughing gas—had the power of relieving toothache and other pains
; he described the effect as that of "uneasiness being swallowed up for a
few minutes by pleasures," Although he stopped short at this stage, and does
not seem to have used the inhalation to produce actual loss of
consciousness, he, nevertheless, forecast the future by suggesting that
nitrous oxide might be used as an inhalation in the performance of surgical
operations, in which "no great effusion of blood" took place.
Some thirty years later Faraday pointed out
that ether had effects upon the nervous system when inhaled, similar to
those of laughing-gas. These two drugs came to be inhaled more in jest than
in earnest; more as an amusing scientific experiment for the sake of the
pleasure-giving excitement they set up, than for the purpose Davy had
suggested. Ether, it is true, was recommended even before Davy's day for the
relief of the suffering in asthma, but until the fifth decade of the century
no one had attempted to prevent suffering as inflicted by the surgeon or the
dentist, by producing the state of unconsciousness brought about by the
inhalation of such drugs as ether—a process now known to the world as
anaesthesia.
The persons who first made the bold experiments
which resulted in the discovery of how to produce anaesthesia were
Americans; and two men were prominently concerned in the discovery. Several
others made isolated and successful efforts with both ether and nitrous
oxide, but they lacked the confidence and the courage to make their success
public and to persist in their experiments. Of these, Dr. Long, of Athens,
Georgia, was one of the earliest; he is said to have successfully removed a
tumour from a patient under the influence of ether in 1842, and in the
Southern States he is regarded as the discoverer of anaesthesia. Dr.
Jackson, of Boston—a scientific chemist—laid claim to the honour of the
discovery after others had fought the fight and established the practice of
anaesthesia. Neither of these men, for the reason already given, deserves
the honour which is now universally attributed to their fellow-countrymen,
Wells and Morton.
Horace Wells was born at Hartford, Connecticut,
in 1815, and was educated to the profession of dental surgeon. He gave much
attention to the desire present in the minds of many men at that time to
render dental operations painless. On December 10, 1844, he witnessed at a
popular lecture the experiment of administering laughing-gas, and noticed
that a Mr. Cooley, while still under the influence of the gas, struck and
injured his limb against a bench without suffering pain. The idea at once
occurred to Wells that here was the agent he was in search of, and the very
next day he experimented upon himself. If it has ever been fortunate to have
toothache it was so for Wells that day; he was troubled by an aching molar
which was removed by a colleague named Rigg, whilst he was fully under the
influence of nitrous oxide 5 and thus he began what he himself at once
called on recovering consciousness, " a new era in tooth-pulling." He
proceeded promptly to test the experiment upon others and with complete
success; and then making his success known, he proceeded with his former
pupil Morton to Boston, and gave a public demonstration of his method which
unfortunately was so imperfectly carried out that he was laughed at for his
pains and stigmatised an impostor. Wells himself stated that the failure was
due to the premature withdrawal of the bag containing the gas, so that the
patient was but partially under its influence when the tooth was extracted.
Wells and Morton were ignominiously hissed by the crowd of practitioners and
students gathered to see the operation. Wells never recovered from the
disappointment and the illness which resulted, and although he was able to
explain his discovery to the French Academy of Science in 1846, he
unfortunately died insane in New York two years later. Undoubtedly he was
the first to discover the practicability of nitrous oxide anaesthesia, and
to proclaim the discovery with a discoverer's zeal. Although his career
ended so sadly, his efforts had, nevertheless, inspired to greater endeavour
his colleague Morton, who had not only been associated in his experiments,
but had been deeply interested in the subject for many years.
William Thomas Green Morton was born in 1819 ;
his father was a farmer at Charlton, Massachusetts. He qualified as a
dentist at Baltimore, and entered into successful practice at Boston. Fired
with the same ambition as Wells, he made attempts to extract teeth
painlessly with the assistance of drugs administered, or sometimes of
hypnotism. In December, 1844, after Wells's failure with nitrous oxide gas,
he wisely abandoned that agent and investigated another which promised
better results. He experimented first with a drug known as chloric ethery but
failing to get the desired effect, and at the suggestion of the
aforementioned Dr. Jackson, he proceeded to investigate the effect of
ordinary ether. The first experiments were made on animals, and were so
encouraging that he believed he had at last found the desired agent,
provided the effect on human beings corresponded with that upon dumb
creatures. Boldly and heroically he made the necessary experiment upon
himself, and on September 30, 1846, inhaled ether from a handkerchief while
shut up in his room and seated in his own operating-chair. He speedily lost
consciousness, and in seven or eight minutes awoke in possession of the
greatest discovery that had ever been revealed to suffering humanity. We can
picture the man gradually awakening in his chair first to the consciousness
of his surroundings and then to the consciousness of his great achievement
sitting with his physical frame excited by the influence of the drug which
he had inhaled, and his soul stirred to its deepest depth by the expanding
thought of the far-reaching effects of what he had done.
"Twilight came on," he said, in subsequently
relating the event. "The hour had long passed when it was usual for patients
to call. I had just resolved to inhale the. ether again and have a tooth
extracted under its influence, when a feeble ring was heard at the door.
Making a motion to one of my assistants who started to answer the bell, I
hastened myself to the door, where I found a man with his face bound up, who
seemed to be suffering extremely. 'Doctor,' said he, '1 have a dreadful
tooth, but it is so sore I cannot summon courage to have it pulled ; can't
you mesmerise me?' I need not say that my heart bounded at this question,
and that I found it difficult to control my feelings, but putting a great
constraint upon myself I expressed my sympathy, and invited him to walk into
the office. I examined the tooth, and in the most encouraging manner told
the poor sufferer that I had something better than mesmerism, by means of
which I could take out his tooth, without giving him pain. He gladly
consented, and saturating my handkerchief with ether I gave it to him to
inhale. He became unconscious almost immediately. It was dark. Dr. Haydon
held the lamp. My assistants were trembling with excitement, apprehending
the usual prolonged scream from the patient, while I extracted the
firmly-rooted bicuspid tooth. I was so much agitated that I came near
throwing the instrument out of the window. But now came a terrible reaction.
The wrenching of the tooth had failed to rouse him in the slightest degree ;
he remained still and motionless as if already in the embrace of death. The
terrible thought flashed through my mind that he might be dead—that in my
zeal to test my new theory,' I might have gone too far, and sacrificed a
human life. I trembled under the sense of my responsibility to my Maker, and
to my fellow-men. I seized a glass of water and dashed it in the man's face.
The result proved most happy. He recovered in a minute, and knew nothing of
what had occurred. Seeing us all stand around he appeared bewildered. I
instantly, in as calm a tone as I could command, asked, " Are you ready to
have your tooth extracted?" "Yes," he answered, in a hesitating voice. "It
is all over," I said, pointing to a decayed tooth on the floor. "No," he
shouted, leaping from his chair. The name of the man who thus for the first
time underwent an operation under anaesthesia induced by ether was Eben
Frost."
'The nature of the agent used by Morton was kept
secret only a short period ; the steps he took to bring his discovery before
the medical profession would have rendered it difficult if not impossible,
even if ether had not a penetrating tell-tale odour. Morton laid his method
before one of the surgical staff of the Massachusetts General Hospital,
Boston, the same institution where Wells's ill-managed demonstration had
taken place two years before ; he requested, with complete confidence, to be
allowed to exhibit the powers of his agent. The surgeon was sceptical, but
wisely consented, after having satisfied himself that there was no risk to
life. A patient suffering from a tumour was chosen, and readily consented to
act as a subject for demonstration. A large crowd of professional men and
students assembled in the surgical theatre on the morning of October 16,
1846, the day chosen for the trial.
The senior hospital surgeon, Dr. J. Collins
Warren, was to perform the operation. The spectators, many of whom no doubt
recollected the failure with laughing-gas, were disposed to deride when the
appointed hour passed and Morton did not appear ; but the delay was due only
to the desire of the dentist to bring a proper inhaler, and although the
crowd received him with a chilling reserve, and the occasion was one fit to
try the nerve of the strongest, Morton did not lose his presence of mind. He
promptly anaesthetised the patient, and as unconcernedly as does the modern
administrator, nodded to the surgeon that the patient was ready. From the
first moment that the knife touched the patient, until the operation was
concluded, no sound, no movement indicated that he was suffering. The men
who had scoffed once and had come, even the surgeon himself, prepared to
scoff again, realised the success and the wonder of it, and remained to
admire. "Gentlemen, this is no humbug," exclaimed Dr. Warren, as he finished
his handiwork. When the patient recovered he was questioned again and again,
but stoutly maintained that he had felt no pain—absolutely none. "Gilbert
Abbott, aged twenty, painter, single," was the description of the man on
whom was performed the first surgical operation under the influence of
ether.
News of the great success rapidly spread, and
the experiment was repeated by Morton and others in America, and similar
work was taken up throughout Europe. It cannot be said that Morton derived
much benefit from his discovery. Although the greatness of it was recognised
in his lifetime, and he received several honours and presents, he entered
into prolonged squabbles concerning the discovery which worried him into a
state of ill-health, ending in his death in 1868. A monument was erected
over his grave by the citizens of Boston, bearing the following concise
description of his achievement:—
"WILLIAM T. G. MORTON, " Inventor and revealer
of anaesthetic inhalation, By whom pain in surgery was averted and annulled
; Before whom in all time surgery was agony, Since whom Science has control
of Pain."
Whilst the discoverer of nitrous-oxide
anaesthesia was dying from chagrin and inaction, and the revealer of
anaesthetic inhalation by ether was wasting time in unworthy disputes
concerning priority, and fruitless endeavours to gain pecuniary reward, a
bolder than either had taken up the work where they had left it, with the
high object of pursuing it until he had for ever established the benefit to
humanity which he recognised in it. He went straight forwards and onwards,
strong in his endeavour ; undeterred by the jeers of the ignorant, the
opposition of the prejudiced or the attacks of the jealous, with no thought
of or wish for reward except that which was to come daily from the depth of
sufferers' hearts.
During the Christmas holidays of 1846 Simpson
was in London, and discussed the new discovery with Liston, who was one of
the first to operate under ether in Great Britain at University College
Hospital. The great surgeon thought that the chief application of the
process would be in the practice of rapidly operating surgeons j it was at
first generally believed that the inhalation could be borne for only a brief
period* Simpson speedily showed that no evil resulted if the patient
remained under the influence of the vapour for hours. In the month of
January, 1847, gained f°r the Edinburgh Medical School the proud honour of
being the scene of the first use of anaesthetics in obstetric practice. In
March of the same year he published a record of cases of parturition in
which he had used ether with success; and had a large number of copies of
his paper printed and distributed far and wide at home and abroad, so eager
was he to popularise amongst the members of his profession the revolutionary
practice which he introduced. From the day on which he first used ether in
midwifery until the end of his career he constantly used anaesthetics in his
practice. He quickly perceived, however, the shortcomings of ether, and
having satisfied himself that they were unavoidable, he set about his next
great step, namely, to discover some substance possessing the advantages
without the disadvantages of ether. In the midst of his now immense daily
work he gave all his spare time, often only the midnight hours, to testing
upon himself the effect of numerous drugs. With the same courage that had
filled Morton he sat down alone, or with Dr. George Keith and Dr. Matthews
Duncan, his assistants, to inhale substance after substance, often to the
real alarm of the household at 52, Queen Street. Appeal was made to
scientific chemists to provide drugs hitherto known only as curiosities of
the laboratory, and for others that their special knowledge might be able to
suggest. The experiments usually took place in the dining-room in the quiet
of the evening or the dead of night. The enthusiasts sat at the table and
inhaled the particular substance under trial from tumblers or saucers; but
the summer of 1847 passed away, and the autumn was commenced before he
succeeded in finding any substance which at all fulfilled his requirements.
All this time he was battling for anaesthesia, which, particularly in its
application to midwifery, was meeting with what appears now as an
astonishing amount of opposition, on varying grounds from all sorts and
conditions of persons; but the vigour and power of his advocacy and defence
of the practice in the days when laughing-gas and ether were the only known
agents, were as nothing to that which he exerted after his own discovery at
the end of 1847.
The suggestion to try chloroform first came from
a Mr. Waldie, a native of Linlithgowshire, settled in Liverpool as a
chemist. It was a " curious liquid," discovered and described in 1831 by two
chemists, Soubeiran and Liebig, simultaneously but independently. In 1835
its chemical composition was first accurately ascertained by Dumas, the
famous French chemist. Simpson was apparently not aware that early in 1847
another French chemist, Flourens, had drawn attention to the effect of
chloroform upon anirilals, or he would probably have hastened to use it upon
himself experimentally, instead of putting away the first specimen obtained
as unlikely; it was heavy and not volatile looking, and less attractive to
him than other substances. How it finally came to be tried is best described
in the words of Simpson's colleague and neighbour, Professor Miller, who
used to look in every morning at nine o'clock to see how the enthusiasts had
fared in the experiments of the previous evening.
Late one evening, it was the 4th of November,
1847, on returning home after a weary day's labour, Dr. Simpson with his two
friends and assistants, Drs. Keith and Duncan, sat down to their somewhat
hazardous work in Dr. Simpson's dining-room. Having inhaled several
substances, but without much effect, it occurred to Dr. Simpson to try a
ponderous material which he had formerly set aside on a lumber-table, and
which on account of its great weight he had hitherto regarded as of no
likelihood whatever ; that happened to be a small bottle of chloroform.' It
was searched for and recovered from beneath a heap of waste paper. And with
each tumbler newly charged, the inhalers resumed their vocation. Immediately
an unwonted hilarity seized the party—they became bright eyed, very happy,
and very loquacious—expatiating on the delicious aroma of the new fluid. The
conversation was of unusual intelligence, and quite charmed the
listeners—some ladies of the family and a naval officer, brother-in-law of
Dr. Simpson. But suddenly there was a talk of sounds being heard like those
of a cotton mill louder and louder; a moment more and then all was quiet—and
then crash ! On awakening Dr. Simpson's first perception was mental—"This is
far stronger and better than ether," said he to himself. His second was to
note that he was prostrate on the floor, and that among the friends about
him there was both confusion and alarm. Hearing a noise he turned round and
saw Dr. Duncan beneath a chair—his jaw dropped, his eyes staring, his head
bent half under him; quite unconscious, and snoring in a most determined and
alarming manner. More noise still and much motion. And then his eyes
overtook Dr. Keith's feet and legs making valorous attempts to overturn the
supper table, or more probably to annihilate everything that was on it. By
and by Dr. Simpson having regained his seat, Dr. Duncan having finished his
uncomfortable and unrefreshing slumber, and Dr. Keith having come to an
arrangement with the table and its contents, these derunt was resumed. Each
expressed himself delighted with this new agent, and its inhalation was
repeated many times that night—one of the ladies gallantly taking her place
and turn at the 107 table—until the supply of chloroform was fairly
exhausted."
The lady was Miss Petrie, a niece of Mrs.
Simpson's ; she folded her arms across her breast as she inhaled the vapour,
and fell asleep crying, "I'm an angel! Oh, I'm an angel"! The party sat
discussing their sensations, and the merits of the substance long after it
was finished; they were unanimous in considering that at last something had
been found to surpass ether.
The following morning a manufacturing chemist
was pressed into service, and had to burn the midnight oil to meet Simpson's
demand for the new substance. So great was Simpson's midwifery practice that
he was able to make immediate trial of chloroform, and on November 10th he
read a paper to the Medico-Chirurgical Society, describing the nature of his
agent, and narrating cases in which he had already successfully used it. "I
have never had the pleasure," he said, "of watching over a series of better
and more rapid recoveries j nor once witnessed any disagreeable results
follow to either mother or child ; whilst I have now seen an immense amount
of maternal pain and agony saved by its employment. And I most
conscientiously believe that the proud mission of the physician is
distinctly twofold—namely to alleviate human suffering as well as preserve
human life." In a postscript to the same paper he states on November 15th
that he had already administered 108 chloroform to about fifty individuals
without the slightest bad result, and gives an account of the first surgical
cases in which he gave the agent to patients of his friends, Professor
Miller and Dr. Duncan, in the Edinburgh Royal Infirmary. "A great
collection," he says, "of professional gentlemen and students witnessed the
results, and amongst them Professor Dumas, of Paris, the chemist who first
ascertained and established the chemical composition of chloroform. He
happened to be passing through Edinburgh, and was in no small degree
rejoiced to witness the wonderful physiological effects of a substance with
whose chemical history his own name was so intimately connected." Four
thousand copies of this paper were sold in a few days, and many thousands
afterwards.
It is worthy of mention that, according to a
promise, Professor Miller had sent for Simpson a few days after the
discovery to give chloroform to a patient on whom he was about to perform a
major operation ; Simpson, however, was unavoidably prevented from
attending, and Miller began the operation without him—at the first cut of
the knife the patient fainted and died. It is easy to imagine what a blow to
Simpson, and to the cause of anaesthesia this would have been had it
happened while the patient was under chloroform.
Thus in little more than a year from the date of
Morton's discovery of the powers of ether, Simpson had crowned the
achievement by the discovery of the equally wonderful and beneficial powers
of chloroform. Already he had made two satisfactory answers to the question
he had early set himself—first, the application of anaesthesia to midwifery
practice; and, second, the discovery of the properties of the more portable
and manageable chloroform; the third, and perhaps the greatest, the defence
of the practice, and the beating down of the powerful opposition to
anaesthesia was yet required to render his reply complete. |
