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Sir James Young Simpson
Chapter VI. The Discovery of Anaesthetics (1844-1847)

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 fr 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.

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