Who Discovered Anesthesia? By Joseph H. Hunt, M. D., of Brooklyn, New York. Chairman H istorical Committee, Medical Society County of. Kings. Address delivered before the Brooklyn Medical Society, November 16, 1896. [Reprinted from The Tri-State Medical Journal and Practitioner, St. Louis, Jan., Feb. and March, 1897.] THIS lias been a living question for nearly half a century. Could it have been settled in 1849, or in 1852, 1853, or in 1863, which are the dates the different times the subject has been before the U. S. Congress, the country stood ready to grant a substantial recognition to the individual who had conferred this great boon on the human race. If it could have been answered in 1867, the beautiful monument which was that year erected in Boston's public garden "To Commemorate the Dis- covery that the Inhaling of Ether Causes Insensibility to Pain," would not have remained without an honored name upon its shaft. That the battle has been vigorously and stubbornly fought, is shown by the great amount of literature on the subject which helps to crowd our library shelves and the pages of the medical journals of the period be- tween 1846 and 1868, the list of which fills no less than twenty-five columns in the catalogue of the library of the Surgeon-General's Office, which does not embrace all which are known to the writer. During the month of October just passed there have been numerous celebrations of the semi-centennial of the first application of sulphuric ether for surgical purposes in the Massachusetts General Hospital, which was on the 16th of October, 1846. The operator was Dr. John Collins Warren, an eminent surgeon of that time, and the person who administered the anaesthetic was Dr. W. T. G. Morton, a dentist of Boston. If this was really the first time that artificial anaesthesia was produced for surgical purposes, either the name of Warren or Morton, or both, should occupy the blank on the ether monument. Unfortunately, no sooner had Morton claimed public recognition for the discovery, than several other claimants appeared on the field, each ready to prove that Morton was an imposter,fand that Jackson, Wells, et al., were the true discoverers. Sulphuric ether was known to Raymond Lully, who wrote in the thirteenth century. Nitrous oxide gas was discovered by Priestley in 1790. Chloroform by Liebig in 1832. Anaesthesia has been claimed by numerous writers from the earliest history of medicine, including the ancient Egyptians and the Chinese. The celebrated Albertus Magnus gives in his "Liber de Mirabilis Mundi" 2 published in 1555, a formula for preparing what he calls aqua ardens. He distills a mixture of red wine, quick lime, common salt, tartar and green figs. You readily perceive that he would get an ethylific alcohol which, when inhaled in sufficient quantity, would be sufficient to produce anaesthesia. We learn that there were times when the narcotics, etc., which were administered for temporary purposes only, produced a narcosis lasting some- times for several days and possibly sometimes forever; but as a higher value began to be put on human life, or the work of the experimenter became more under observation of critical rivals, these uncertain methods were gradually abandoned, and we only know of them through obscure and some- what uncertain sources. Refrigeration of tissues and the phenomena of hypnotism were also occasionally employed. An English surgeon, James Moore, published in 1784 a tract entitled "A Method of Preventing or Diminishing Pain in Several Operations of Surgery." He employed clamps and other mechanical methods of pro- ducing pressure of the nerve trunks supplying the parts operated upon. Pare is said to have suggested the same method. Sir Humphrey Davy, at the time Dr. Davy, Superintendent of the Pneumatic Institution of Dr. Thomas Beddoes at Clifton, near Bristol, Eng., made the discovery of the intoxicating effects of nitrous oxide gas, April 9, 1799. He succeeded in allaying the pain caused by the "cutting" of one of his wisdom teeth by inhalation of this gas; and that it was inrawisdom tooth is shown by the opinion he then and there recorded: "As nitrous oxide in its extensive operation seems capable of destroying physical pain, it may probably be used with advantage in surgical operations in which no great effusion of blood takes place." Inhalation of nitrous oxide had been used by Dr. Pearson, of Birming- ham, for asthma, as early as 1785. Dr. Warren, of Boston, made use of inhalation of ether in the treat- ment of the later stages of consumption in 1805. In 1818 Farraday wrote to the Journal of Science and the Arts as fol- lows: "When the vapor of ether mixed with common air is inhaled, it pro- duces effects very similar to those of nitrous oxide. It is necessary to use caution in making experiments of this kind. By the imprudent inspira- tion of ether a gentleman was thrown into a very lethargic state, which con- tinued with occasional periods of intermission for more than thirty hours, and a great depression of spirits; for many days the pulse was so much lowered that considerable fears were entertained for his life." In the second edition of Christianson's work on poisons, published in 1839, is related the case of a young man who had been rendered insensible by the vapor of ether; and another of the druggist's boy who had fallen a victim to the stupefying effects of the drug in consequence of having broken a bottle of the liquid. One year after the first application of ether for producing anaesthesia in a surgical operation in the Massachusetts General Hospital, Dr. John C. Warren, who handled the knife on that occasion, wrote in his little book on "Etherization, with Surgical Remarks," as follows: "A new era has opened to the operating surgeon! His visitations on the most delicate parts are per- 3 formed, not only without the agonizing screams he has been accustomed to hear, but sometimes with a state of perfect insensibility, and occasionally even with the expression of pleasure on the part of the patient. Who could have imagined that drawing the knife over the delicate skin of the face might produce a sensation of unmixed delight! that the turning and twisting of instruments in the most sensitive bladder might be accompanied by a beautiful dream! that the contorting of anchylosed joints should co-exist with a celestial vision! If Ambrose Pare and Louis, and Dessault, and Cheselden, and Hunter and Cooper should see what our eyes daily witness, how would they long to come among us and perform their exploits once more! And with what fresh vigor does the living surgeon, who is ready to resign the scalpel, grasp it and wish again to go through his career under the new auspices!" Prof. Warren was then an aged surgeon about resigning his probe and scalpel to his, since then, no less distinguished son, the late John Mason Warren. Sir Joseph Lister, in his address as President of the British Association for the Advancement of Science, delivered at Liverpool a few weeks ago, said: "This is the jubilee of anaesthesia in surgery. That priceless blessing came from America. It had indeed been foreshadowed in the first year of this century by Sir Humphrey Davy, who having found a toothache from which he was suffering relieved as he inhaled laughing gas (nitrous oxide), threw out the suggestion that it might, perhaps, be used for prevent- ing pain in surgical operations." * * * "The discovery of anaesthesia inaugurated a new era in surgery. Not only was the pain of operations abolished, but the serious and sometimes mortal shock which they occa- sioned to the system was averted, while the patient was saved the terrible ordeal of preparing to endure them. At the same time the field of surgery became widely extended, since many procedures in themselves desirable, but before impossible from the protracted agony they would occasion, be- came matters of routine practice. "While considering the such signal service to surgery, anaesthetics have thrown light upon biology generally. It has been found that they exert their soporific influence not only upon vertebrata, but upon animals so remote in structure from man as bees and other insects. Even the functions of vegetables are suspended by their agency. They thus afford strong confirmation of the great generalization that living matter is of the same essential nature wherever it is met with on this planet, whether in the animal or vegetable kingdom. Anaesthetics have, also, in ways to which I need not here refer, powerfully promoted the progress of physiology and pathology." In the beautiful park known as the Public Garden, of Boston, Mass., there was erected in 1867 a monument to the unknown. A celebrated teacher of medicine is accustomed to annually tell his class in the medical college with which he is connected, that in Boston they have solved the uncertainty of the personality of the discoverer of anaesthesia by erecting a monument to "either" (ether). 4 It bears on its four faces the following inscriptions: "To commemorate the discovery that the inhaling of ether causes in- sensibility to pain; first proven to the world at the Massachusetts General Hospital in Boston, October, A. D., MDCCCXLVI." "Neither shall there be any more pain."-Revelations. "This also cometh forth from the Lord of Hosts which is wonderful in counsel and excellent in working."-Isaiah. "In gratitude for the relief of human suffering by the inhaling of ether, a citizen of Boston has erected this monument, A. D., MDCCCLXVH. The gift of Thomas Lee." Upon the summit of the exceedingly ornate monument is the statue of a physician holding a patient reclining in his arms, while he is in the act of administering the anaesthetic. There is no doubt but that the exhilarating and intoxicating, as well as the antispasmodic, effects of inhalations of sulphuric ether were well known in the early part of the present century. Dr. Pearson, of Birmingham, employed it in the treatment of spasmodic asthma in 1785, and Dr. John Collins Warren, of Boston, whose letter on the subject of anaesthesia has just been quoted from, made use of inhala- tions of ether in the treatment of the later stages of consumption in 1805. College students pursuing their chemical studies learned the exhil- arating effects of nitrous oxide (laughing gas) and sulphuric ether, and in boyish spirit experimented with the mysterious agents, and carried the knowledge thus gained to their homes and instructed their young compan- ions; and to get some one to inhale one of the intoxicating agents, and ob- serve his behavior, became one of the pastimes of gatherings of young people. Thus we find that in Northern Georgia the young people held what they called "ether frolics," and one who was an active participator in those affairs, says "that there was hardly ever a gathering of young people that did not wind up with an ether frolic. Old-fashioned 'quiltings' were very common at that time, and in the evening the boys and young men would go to these for the purpose of a dance or an ether frolic." The late Dr. J. Marion Sims, of New York, in his "Discovery of Anaesthesia," tells of such an occasion. "The girls and boys all finished the evening by inhaling ether. Some would laugh, some cry, some fight, and some dance, just as when nitrous oxide is inhaled." They were looking for new subjects when they perceived a colored lad peeping through the open door. Notwithstanding his resistance and violent struggles, the young men forcibly administered the ether to the young negro. After a long struggle he became quiet and unresisting. The young men were greatly surprised that he did not get up immediately and say or do some foolish thing for them to laugh at. He lay quietly, and with stertorous breathing. They tried to rouse him, but could not. They then became greatly alarmed and sent one of their number for a doctor who lived five miles away. The messenger found the doctor at home and they lost no time in returning to the scene. They found the young men who had administered the ether contemplating making their escape from the country, thinking that they had killed the boy; but the doctor's arrival reassured them, and fortunately his efforts were crowned with success-he was roused to consciousness after having been under the influence of the ether for over 5 an hour. The doctor read them a severe reprimand, warning them of the danger of such frolics and cautioned them against a repetition of them. This act broke up the ether frolics of that neighborhood. This was in 1839. Dr. Sims says that "this is unquestionably the first case in which sulphuric ether was ever given to the extent of producing complete anaes- thesia. " In 1842, the romping boy who had administered the ether to the young negro a few years before became a medical student in the office of Dr. Crawford W. Long, in the village of Jefferson, in Jackson county, Georgia. Dr. Crawford W. Dong Dr. Long was not so much older than his students but that he could be on familiar terms with them, and entered into their discussions and experi- ments more as a companion than a preceptor. All of them, including the doctor, were more or less acquainted with the ether frolics of the neighbor- hood, and young Wilhite's escapade with the colored boy was freely dis- cussed; and all experimented with the ether on each other, and noticed that on recovering from the ether intoxication they would sometimes find their persons bruised by having come in contact with the furniture or otherwise, and were not conscious of pain at the time. These facts suggested in the mind of Dr. Long the idea of using ether to prevent the pain of surgical 6 operations. The first favorable opportunity that offered was on March 30, 1842, when he removed a small tumor from the neck of Mr. James M. Venables. The ether was administered on a folded towel, and as soon as he came under the influence of the drug the cyst was removed without any evidence of suffering on the part of the patient, who asserted that he did not experience the slightest degree of pain, and was incredulous when assured that the operation was completed. Dr. Long was at the time a "country doctor,'' a general practitioner, who like "Ian MacLaren's*' Dr. MacLure, "was chest-doctor, and doctor for every other organ as well; he was accoucheur and surgeon; he was oculist and aurist and dentist, besides being chemist and druggist.'' A man "who had to do everything as best he could and as quickly.'' He lived and practiced in and about a country village, then more than a hundred miles from a railroad, with no medical societies where he could meet his professional confreres and inform them what he had done and gain wisdom and ambitious enthusiasm from their criticisms or commendations. He did not feel the importance of sending his valuable experiences to a medical journal that they might become matters of record. In fact, I do not believe that he was aware that hehaddone anythingof exceeding great importance or that no one else had done the same thing. So he worked unknown and "wasted his sweetness on the desert air.'' It was not until December, 1849, that Dr. Long published hi the Sowl/tern Medical and Surgical Journal an account of his first experience, which happened over twenty months before Gardner Q. Colton administered nitrous oxide to Horace Wells in Hartford, Conn., and more than three and a half years before W. T. G. Morton administered sulphuric ether in the Massachusetts General Hospital for Dr. John Collins Warren to perform a long and painful operation upon a telangiectasis of the neck. Dr. Long continued to do the little surgical work of his Georgia village without per- mitting his patients to feel the pangs inflicted by the keen-edged knife; and while the wonder became the village talk of his neighbors, their world was small. Dr. Long had no hospital or other opportunity in that quiet country life to perform an operation which he would regard as being of a magnitude worthy of reporting. It was not until Morton and Dr. Jackson had presented their petitions to the National Congress, asking for a reward and remuneration for their services that the Georgia physician put in his claim for recognition. One of the claimants for the honor and its rewards (Dr. Jackson) visited Dr. Long at Athens, Georgia, to which place he had removed after his early experience in Jefferson, and said to him: "You have the advan- tage of priority of date and in the first use of ether as an anaesthetic, but we have the honor of priority of publication.'' We shall see later whether they could even claim that. Had Dr. Long resided in a large city where his experience could have been repeated and verified in some hospital, with capital operations, such as do not come more than once in a lifetime in the experience of a country surgeon, the world would have been the gainer by fully four years in the great benefits derived from his discovery, and no one would have been able to dispute the honor with him. Like Pare and Jenner, he might have 7 become known as one of the world's greatest benefactors. As it is, his ■experience is but an interesting incident in the history. "Of all sad words of tongue or pen, The saddest are, it might have been." So far as we are concerned, surgical anaesthesia had its .beginning in 1844, in a dentist's office in the city of Hartford, Conn. I quote from a pamphlet issued during the last week, and written by •one of the principal actors in this dramatic history, who is still living, a young man of 82, vivacious, cheerful, alert and still actively engaged in administering his favorite anaesthetic and looking after the great business of the Colton Dental Association, which even if he had never been personally connected with it, could have with equal propriety borne his name. I refer to Mr. G. Q. Colton, who, to quote his own story, tells us: "On the 10th of December, 1844, I gave an exhibition of laughing gas in the city of Hartford, Conn. After a brief lecture on the properties and effects of the gas, I invited a dozen or fifteen gentlemen to come upon the stage, who would like to inhale it. Among those who came forward was Dr. Horace Wells, a dentist of Hartford, and a young man by the name of Cooley. Cooley inhaled the gas, and while under its influence ran against some wooden settees on the stage and bruised his legs badly. On taking his seat next to Dr. Wells, the latter said to him: 'You must have hurt yourself.' 'No.' Then he began to feel some pain and was astonished to find his legs bloody; he said he felt no pain till the effects of the gas had passed off. "At the close of the exhibition Dr. Wells came tomeand said: 'Why can- not a man have a tooth extracted under the gas and not feel it?' I replied that I did not know. Dr. Wells then said he believed it could be done and would try it upon himself if I would bring a bag of gas to his office. The next day, 11th of December, 1844, I went to his office with a bag of gas. Dr. Wells ■called in a neighboring dentist, Dr. Riggs, to draw his tooth. I gave the gas to Wells, giving somewhat more than the night before, and Dr. Riggs extracted the tooth. Dr. Wells, on recovering, exclaimed: ''It is the greatest discovery ever made; I didn't feel it so much as the prick of a pin! ' That was the first tooth ever drawn without pain; a fact which no one, even Dr. Morton, ever disputed.'' Mr. Colton taught Wells how to manufacture the gas and administer it and went off on his "exhibition business.'' Horace Wells continued to use the nitrous oxide gas as an anaesthetic, for extracting teeth, during the remainder of that year and the following (1845), until, on account of failing health, he went to Europe the latter part •of the year. We have abundant evidence that the well-known similarity in the action of nitrous oxide and sulphuric ether was discussed between Horace Wells and his friends, among whom were Dr. E. E. Marcy, who, I believe, is still living in New York City, who prepared some ether for Wells and used some of it himself, in removing a cyst from a man's scalp. Wells also tried the ether, and pulled a tooth from a patient under its influence. He, however, found the ether unpleasant in some of its effects ((who of ns has not), and also on account of its odor, and the general 8 belief among his medical advisers that it was dangerous to life, he dropped it. Not, however, before he had communicated the fact to Valentine Mott, of New York City, and suggested that it might be used in great surgical operations. This is attested in a certificate from Dr. Mott, published in Dr. Horace Wells. Truman Smith's work on Anaesthesia, and also in an article in the Boston Medical and Surgical Journal of June 15, 1845, which is, so far as I have been able to learn, the earliest publication made on the subject. After the use of nitrous oxide had become a familiar and well-known process in Hartford, Dr. Wells visited Boston and called on Dr. W. T. 9 G. Morton, who had been, before removing to Boston, a student of Dr. Wells, and his friend, Dr. Charles T. Jackson, as well as Drs. Warren and Bigelow, and communicated to them what he had been doing in Hartford. Dr. Warren gave him permission to lecture before his class in the medical Dr. W. T. G. Morton. college on the subject, and to exhibit his method. For some reason he failed to administer enough gas to the patient, and when the tooth was pulled the man screamed, and the students regarded the exhibition as a failure and ridiculed the unfortunate dentist and pronounced the thing a humbug. Drs. Morton and Jackson, in special, threw ridicule upon the 10 laudable endeavor of a sensitive young man to bring out one of the greatest •discoveries of the age. Dr. Wells, discouraged, returned to Hartford and resumed his practice. At the close of 1845 he went to Europe on account of his ill health, where lie remained for several years. Dr. Gardner Q. Colton. It was while in Europe that he learned that his former pupil and friend were claiming as a new discovery a fact which he had himself demon- strated to them, and been successfully practicing for more than a year. He had an opportunity while there, and presented his claims to the Academy of Sciences in Paris, and was given the honor of an M. D. While Dr. Wells was in Europe, in October, 1846, his aforetime student, partner and friend (?) Morton, went to their mutual friend (?) Dr. Charles T. Jackson, a highly educated man, a graduated physician, a pro- 11 fessional consulting chemist, a member of numerous scientific and other societies at home and in Europe, including the medical society which was most prominent in Boston at the time, ostensibly to borrow a rubber bag, which, he said, he wished to inflate with common air and allow a timid patient to inhale, under the impression that it would prevent the pain of having a tooth extracted. A sort of mental anaesthesia, such as was much talked of about that time in connection with so-called Mesmerism. Accounts somewhat differ; another is that Morton called on Jackson to request him to instruct him in the method of preparing nitrous oxide gas, and found Dr. Jackson too busy with other work, which he could not give up. He took pains, however, to tell Morton that he could not make a safe gas without special instruction. That unless he had special skill he was liable to make nitric oxide, which was irritable and poisonous. Dr. Jack- son suggested to him the use of sulphuric ether, telling him that its proper- ties were very similar to the nitrous oxide, and that it could be obtained in any drug store and did not require the use of any special apparatus. He also told him that the students in a neighboring college were in the habit of using it for amusement. Morton procured some ether and that evening, September 30, 1846, an opportunity offered itself for him to try the experiment. Mrs. Morton, in a recent number of McClure's Magazine, gives a dramatic and interesting account of this, her husband's first practical ap- plication of the knowledge he had gleaned from his visit to Dr. Jackson. It seems that a patient presented himself with his face bandaged, beg- ging the dentist to mesmerize him while his tooth was being drawn, else he could not possibly endure the pain of the operation in his extremely sore mouth. Dr. Morton assured him that he had something better than Mesmerism, and saturated a handkerchief with the ether, which he had that day procured, and held it over the man's face while an assistant held the lamp. The operation was a complete success-even more than seemed de- sirable-for the subject did not at once regain consciousness after the tooth was extracted, and the frightened dentist dashed a glass of cold water in the face of the sleeping patient. This roused him and Dr. Morton inquired if he was ready to have the tooth out, and on the man's assenting, was shown the tooth lying on the floor. "Glory! Hallelujah!'' was the grateful Eben Frost's (the patient's name) first exclamation, and the echo of that doxology has been heard in every operating room in the civilized world since that time. When Morton next met his friend and preceptor (Morton had at one time been registered as a student in Dr. Jackson's office), he told him of the success of the experiment, and Dr. Jackson advised him to go to Dr. Warren (John Collins Warren), who was then the leading surgeon in Boston and professor of surgery in the medical college, and obtain his permission to administer it at the Massachusetts General Hospital, where Dr. Warren was the principal operator. An account says that "Morton strongly objected to going to the hospital; that everybody could smell the ether and it would not be kept secrect," which it seems to have been Morton's first intention to do, as Dr. Jackson says that "in the course of the conversation Morton repeatedly begged him to keep the matter secret." That Dr. Morton did, however, take Dr. Jackson's advice is shown by 12 the following account given by Professor Warren, who performed the first operation on October 16, 1846: "The first proposal for the employment of ether by inhalation, for the prevention of pain in surgical operations, was made by Dr. W. G. T. Morton, about the middle of October, 1846. Calling Dr. Charles Thomas Jackson. on me he stated that he had possession of a means of accomplishing this object; that he had made.trials of its efficacy in the extraction of teeth; and that he wished me to test its power in surgical operations. The article used for this purpose not being mentioned, I supposed it was not proper for me to demand what it was; but I did think it necessary, before taking the responsibility of using it or sanctioning its use, to ascertain whether a trial 13 could be made without any apprehension of danger. Having satisfied my- self on this point by various questions, I agreed to give Dr. Morton the desired opportunity as soon as it should be in my power. No such opportunity having occurred within a day or two in private practice, and being at that time in The Wells Monument, Hartford, Conn. the performance of my tour of duty at the Massachusetts General Hospital, I seized the occasion of the first operation in that institution for the pro- posed experiment. "The patient was a young man about twenty years old, having a tumor on the left side of the neck, lying parallel to and just below the left portion 14 of the lower jaw. This tumor, which had probably existed from his birth, seemed to be composed of tortuous, indurated veins, extending from the surface quite deeply under the tongue. My plan was to expose these veins by dissection sufficiently to enable me to pass a ligature around them. "The patient was arranged for the operation in a sitting posture, and everything made ready; but Dr. Morton did not appear until the lapse of nearly half an hour. I was about to proceed, when he entered hastily, excused the delay, which had been occasioned by his modifying the apparatus for the administration. The patient was then made to inhale a Dr. John M. Riggs.. fluid from a tube connected with a glass globe. After four or five minutes he appeared to be asleep, and was thought by Dr. Morton to be in a con- dition for the operation. I made an incision between three and four inches long in the direction of the tumor, aud, to my great surprise, without any starting, crying out or other indication of pain. The fascia were then divided, the patient still appearing wholly insensible. Then followed the insulation of the veins, during which he began to move his limbs, cry out, and utter extraordinary expressions. These phenomena led to a doubt of the success of the application, and in truth I was not satisfied myself until I had, soon after the operation and on various other occasions, asked the question whether he suffered pain. To this he always replied in the negative; adding, however, that he knew of the operation, and compared the stroke of the knife to a that of a blunt instrument passed roughly across his neck. 15 Now that the effects of inhalation are better understood, this is placed in the class of cases of imperfect etherization. "On the following day an operation for the extirpation of a tumor from the arm was performed by Dr. Hayward, during which the patient exhibited no sign of physical or mental suffering." (Etherization; with Surgical Remarks. By John C. Warren, M. D., Boston, 1848. Pages 4, 5 and 6.) It is unfortunate for the memory of Drs. Jackson and Morton that they tried to hide their discovery under the veil of secrecy and the protection of patents both in this country and in England. I do not think that Dr. Jackson had, at first, any intention of doing so; but Dr. Morton and his attorney believed that the idea was original with Jackson, and that the fact that ether had such properties was a dis- covery of Dr. Jackson's, who was at that time a sort of Thomas A. Edison in chemistry and physics, and discovering all sorts of things. It seems, that Morton at first had the idea of leaving Dr. Jackson out altogether, but his attorney advised him that it would not stand if both names were not associated in the application. The special peculiar odor of ether was con- cealed by a perfume and the material called "Compound Letheon." Mrs. Morton, in the article from which I have already quoted, says, that "he never enforced the patent for his humanity was too great to keep back from suffering millions so precious an agency of relief." That state- ment is partially true, but it is a fact that he abundantly tried to enforce his. rights ( ?). We are told that he not only sold the right to use the "Compound Letheon" in at least one city, but that he also "instituted a suit against a public charity (the New York Eye Infirmary) for having made some use in their operations of the vapor of sulphuric ether, thus violating his patent."' The judge before whom the case was brought, decided against the validity of the patent, and it was carried to a higher court and the first decision con- firmed. This decision of Judge Shipman of the U. S. Circuit Court, Southern District of New York, is to be found in the American Law- Register of September, 1863. Bearing on this subject, I quote from resolutions which were adopted by the American Medical Association at its meeting in New York in 1864r "Whereas, The said Dr. Morton, by suits brought against charitable medical institutions for the infringement of an alleged patent covering all anaesthetic agents, not claiming sulphuric ether only, but the state of anaesthesia, however produced, as his invention, has by this act put him- self beyond the pale of an honorable profession and of true laborers in the cause of science and humanity; therefore," etc., etc., etc. (Transactions A. M. A. 1864.) When it was announced that the Massachusetts General Hospital, where the "Compound Letheon" had been successfully used several times, refused to use it longer unless the veil of secrecy was removed, Morton wrote to Dr. Warren informing him that the agent used was sulphuric ether, and that they had the permission of the patentees to use it in the hospital, and asked Dr. Warren to give him a list of all similar institutions in the country, that he might extend its benefits to them. It is singular that all four of the claimants, for the discovery failed 16 alike to publish anything in the professional journals or elsewhere, unless Morton's circular, entitled "Morton's Letlieon," cautioning those who attempted to infringe upon his legal rights, a copy of which is to be found in the Library of the Surgeon-General's Office at Washington, can be called such publication. It was the reports of the operations under its influence in the Massachusetts General Hospital, that first informed the medical world what the dentists had been doing. In this connection, I quote from an editorial in the Chicago Medical Examiner, December, 1865, presumably written by Dr. N. S. Davis: "Dr. Morton's first administration of the ether in the Massachusetts Gen- eral Hospital, was on the 10th [16th] of October, 1846. On the 3d of November, less than thirty days thereafter, an account of it was read by Dr. Henry J. Bigelow, to the American Academy of Arts and Sciences, and on the 9th to the Boston Society for Medical Improvement, and published by the same in the Boston Medical and Surgical Journal for November 18, 1846. The facts were also communicated to prominent members of the profession in London and Paris. Within six weeks it had been fully and successfully tested in London, and in three months it was in familiar use in the hospitals of Paris, from which its use spread so rapidly over the whole of Europe that in less than fifteen months Prof. Simpson had gathered and tabulated more than three hundred cases of the larger amputations alone, in which ether or chloroform had been used. The use of these anaesthetics was adopted a little less rapidly in this country than in Europe, yet, from the report already alluded to, it appears that before the 1st of April, 1848, they were in almost daily use in every public hospital in the United States, and by all the distinguished surgeons, north, south, east and west. And not only this, but they had also been administered in 'more than two thousand cases of obstetrics.' Thus, within the incredible short space of eighteen months, the use of anaesthetics had been fully introduced into the practice of surgery, obstetrics and dentistry throughout Europe and America, and that, too, without requiring Dr. Morton to travel a mile or expend a dollar beyond the limits of Boston.'' Dr. Laird W. Nevius, of Chicago, in his interesting and valuable little book on the "Discovery of Modern Anaesthesia'' (which is the only real impartial account of the discovery that I have read), after speaking of Dr. Bigelow's paper being published in t he AAv/coz Medical and Surgical Journal, November 9, 1846, says: "A copy of this journal was sent to Dr. Booth, of London. As soon as Dr. Booth had read the article, he communicated the important intelligence to Dr. Liston, the distinguished surgeon of the University College. On the 21st of December, 1846, Dr. Liston practi- cally and successfully tested the discovery, and immediately communicated the fact to a former pupil of his, Professor Miller, of Edinburgh, in the following enthusiastic words: 'Hurrah! rejoice! Mesmerism and its professors have met with a heavy blow and great discouragements. An American dentist has used ether (inhalation of it) to destroy pain in his operations, and the plan has succeeded. Yesterday I amputated a thigh, and removed, by evulsion, both sides of the great toe-nail, without the patients being aware of what I was doing, so far as regards pain. The amputation-man heard, he said, what was said, was conscious, but felt the 17 pain neither of the incisions nor that of tying the vessels. I mean to nse it again to-day. In six months no operation will be performed without this precious preparation. Rejoice! 'Thine always, R. L.' " In the last number of the British Medical Journal we get an echo from that first operation. Sir Joseph Lister, in his address before the British Medical Association, from which I have already quoted, said: ''I witnessed the first operation in England under ether. It was performed by Robert Liston, in University College Hospital, and it was a complete success. Soon afterwards I saw the same great surgeon amputate the thigh as painlessly, with less com- plicated anaesthetic apparatus, by aid of another agent, chloroform, which was being powerfully advocated as a substitute for ether by Dr. (afterwards Sir James Y.) Simpson, who also had the great merit of showing that con- finements could be conducted painlessly, yet safely under its influence." Simpson first employed ether anaesthesia in midwifery, in Edinburgh, January 19, 1847, but two months and three days after its first use as an anaesthetic in surgical operations at the Massachusetts General Hospital. It was soon recognized, however, that sulphuric ether had its more or less unpleasant side for this use, an Dr. Simpson cast about for a more agree- able substitute. His attention was called to the experience of a surgical pupil of Dr. John Bell. It seems that after the anaesthetic properties of ether had been announced, "this young man exhibited such a passion for the article that Dr. Bell, fearing some accident, gave strict orders that he should not be allowed access to the ether bottle. Hunting through the cellar of the shop, he was fortunate enough to discover a bottle labeled 'chloric ether'-the name by which chloroform was then known. The ad- venturous student immediately made trial of its contents, and succeeded in procuring an insensibility that was more agreeable than the anaesthesia which had followed the inhalation of ether." (Lyman on Artificial Anaesthesia and Anaesthetics, Wm. Wood & Co., New York, page 8.) On November 15, 1847, came Dr. Simpson's first opportunity to use the new agent. It was on three cases in the Royal Infirmary, Edinburgh. In two of the cases Professor Miller, to whom Robert Lister had written the en- thusiastic letter quoted from, was the operator, and the other was a case of Dr. Duncan's. It so happened that among the spectators was Professor Dumas, of Paris, the chemist who had first ascertained and established the chemical composition of chloroform. He happened to be passing through Edinburgh, engaged in an official investigation for the French government, 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. That since then it has been the almost universal anaesthetic in obstetric work, is well known. Sir James Y. Simpson, in his work on x\n aesthetics, relates several in- stances of the narrow escape chloroform had of being condemned in the very conception of its use. I quote as follows: "After the discovery of the anaesthetic effects of chloroform, I was of course anxious to get it tried in a surgical operation. Two days previous to that on which the first cases were operated upon, an operation took place in the Infirmary, at which I could not be present, to test the power of 18 chloroform; and, so far, fortunately so; for the man was operated upon for hernia, without any anaesthesia, and suddenly died after the first incision was made through the skin, and with operation uncompleted." In another case, a patient was urged by her physician to take chloroform for the purpose of having a tooth extracted which had worn her out with the pain. She postponed it for a few hours, meanwhile retiring to her bed in order to obtain some rest before undergoing the test. On going to her room, an hour or two subsequently, she was found dead. In another case, death in- stantaneously followed the use of an abscess lancet, without chloroform, the practitioner deeming it unnecessary to use anaesthesia in so slight a case. What more desirable sponsor could the new discovery have than the genial "Autocrat of the Breakfast Table. " After Morton had demonstrated the value of his agent to the surgeons at the Massachusetts General Hospital, and it began to assume some im- portance, he found that it needed a name. He called upon several of his friends, who made list of certain words significant of the subject. The cognomen chosen by Morton was " Letheon," and under that title he secured his patent. Edward Warren, in his pamphlet, "Some Account of the Letheon," gives an interesting letter from Oliver Wendell Holmes, from which the following is quoted: Boston, November 21, 1846. My Dear Sir: Everybody wants to have a hand in a great discovery. All I will do is to give you a hint or two as to names-or the name-to be applied to the state produced and the agent. The state should, I think, be called "Anaesthesia." This signifies insensibility-more particularly (as used by Linnaeus and Cullen) to objects of touch. The adjective will be "Anaesthetic." Thus we might say the state of anaesthesia, or the anaesthetic state- The means employed would be properly called the anti-anaesthetic agent. Perhaps it might be allowable to say anaesthetic agent, but this admits of question. Yours respectfully, O. W. Holmes. Dr. Morton. Who recognizes it by the name disgraced by secrecy and a patent-right to-day? The name bestowed by the literary taste of Dr. Holmes has been accepted the world over. In connection with Holmes, the following is from his introductory lecture before the medical class at Harvard University, November 3, 1847, one year after Morton's first experiment: "The knife is searching for the disease, the pulleys are dragging back the dislocated limbs-Nature her- self is working out the primeval curse which doomed the tenderest of her creatures to the sharpest of her trials; but the fierce extremity of suffering has been steeped in the waters of forgetfulness, and the deepest furrow in the knotted brow of agony has been smothered forever." (Quoted from Dr. Hayden's Anaesthesia.) At the time the wealthy Thomas Lee bequeathed $10,000 to com- memorate the discovery of the anaesthetic power of ether, he and the general public supposed that the idea that nitrous oxide gas was an anaesthetic had been given up. Wells was dead, by his own hand, while confined as a lunatic in a New York prison, and Morton, Jackson and Long, in their fights before Congress and elsewhere for recognition had ignored and suppressed all knowledge of it. Therefore the donor left his money to erect a monument to the principal of the three more commonly used anaes- 19 thetics, and mentioned the name of no one, and in the public ceremonies at the unveiling of the monument, it is said that the names of the individuals who may have discovered "that the inhaling of ether causes insensibility to pain,'' were carefully-not mentioned. In view of the acrimonious discussions over the subject, it may be best that the purity of the Ether Monument should remain untarnished by the name of one of the discontents. If it must bear the name of the discoverer of anaesthesia by means of sulphuric ether, let it bear those of Michael Farraday, Drs. Crawford W. Long and W. T. G. Morton. If the monument had been erected in memory of the discovery of anaesthesia, it should bear the additional names of Sir Humphrey Davy, M. D., Gardner Q. Colton, and Dr. Horace Wells. Let his name be placed among the rest, notwithstanding the fact that there are those who believe that his rights were forfeited by his attempted secrecy, which was broken and given to the world by Dr. Bigelow and the other Boston surgeons who published at once accounts of its use in their surgical work. He gave the priceless gift to humanity when he found that the Massachusetts General Hospital would have nothing to do with a secret anaesthetic, and the United States Court would not recognize the validity of his patent. Dr. Charles J. Jackson only gave Morton the information he had gained from Farraday and scientific teachers after him, and was shared by scientific students the world over. Of the men who were most active in this exciting drama, Horace Wells, died, aS already stated, as an insane suicide, January 24, 1848. The City of Hartford and the State of Connecticut have erected in Bush- nell Park, Hartford, a bronze statue of Dr. Wells, with this inscription: HORACE WELLS. WHO DISCOVERED ANAESTHESIA. NOVEMBER, 1844. Dr. Jackson also became deranged, and died August 28, 1880, in the McLean Asylum, a department of the hospital so often alluded to, where Morton-Jackson's first experiments were made. Dr. Morton (he received the honorary degree of M. D. from the Washington University, Baltimore, in 1848) died July 15, 1868, either in Central Park, New York City, or in an ambulance while being carried from there to St. Luke's Hospital, in a fit of delirium from some acute brain trouble. In Mt. Auburn Cemetery, Boston, a beautiful monument bears this inscription: W. T. G. MORTON Born Aug. 9, 1819. Died July 15, 1868. Inventor and revealer of ancesthetic inhalation, before whom in all time surgery was agony; by whom pain in surgery was averted and annulled; since whom science has control of pain. Erected by citizens of Boston. Dr. Morton received a recognition in the shape of a share of the Montyon prize, amounting to 2500 francs, from the French Academy, a silver 20 casket containing one thousand dollars from the trustees of the Massa- chusetts General Hospital, and other citizens of Boston; the order of St. Vladimir from Russia; and the order of Vasa from Sweden. Though Dr. Jackson's connection with the discovery was but that of a Sir James Y. Simpson consulting chemist, lie received foreign honors in excess of the others. They include the Cross of the Legion of Honor from France, the Order of the Red Eagle from Prussia, and other orders and medals from Turkey, Italy, and Sweden, besides sharing the Montyon prize of 5000 francs with Dr. Morton. 21 Though this paper has already reached a length much in excess of the writer's original plans, he is unwilling to bring it to a close without some additional reference to the only one of those whose names have been prominently connected with this tragic history, who is still living, though nearly three years past the four-score allotted to the best of men. When Dr. Horace Wells gave up his life, anaesthesia by the adminis- tration of nitrous oxide died with him. Gardiner Q. Colton, who had been the original agent in introducing it to Dr. Wells, gave up the lyceum platform in 1849, and joined that tide of people, who were attracted to the golden sands of California. We do not learn that he ever delved with pick and shovel, but know that he was an adjuster of the misunderstandings of those who did, for he was the first Justice of the Peace in San Francisco, and we do not think that any of his decisions were ever reversed by a higher court. In a few years he returned to the east, but soon lost his Californian wealth in the salt springs 'of Syracuse, N. Y., and returned to his former occupation as a scientific lecturer. Though he was accustomed to tell his audiences of the anaesthetic properties of the laughing-gas, no one became enough interested in it to desire a repetition of Dr. Wells' fateful experience. It was not until June, 1863, again in the State of Connecticut, that Dr. J. H. Smith, a New Haven dentist, concluded to try the gas, and again Mr. Colton was requested to administer it. Again it was a success, and such was the fame that this second-time discovered anaesthetic agent brought to Dr. Smith and Mr. Colton that they, in the twenty-four days which they continued to operate together in New Haven, extracted over three thousand teeth under the anaesthetic influence of nitrous oxide. Mr. Colton abandoned his other scientific work, and came to New York City and organized the great dental association which bears his name, and where the nitrous oxide has been administered to nearly 200,000 patients without their having had the misfortune to meet with a serious accident. Nitrous oxide is now used in nearly every operating dentist's office in the world, and their use of it dates from the rediscovery in 1863. Mr. Colton was in early life a medical student in one of the colleges of New York City, with the late Willard Parker for a preceptor, but funds be- came low, and as he had been a leader among the students, experimenting with laughing gas, he was persuaded by them to arrange a public exhi- bition, which proved to be such a financial success that it was repeated with various scientific variations until they resulted, as has been shown, in twice introducing nitrous oxide as one of the triumvirate of anaesthetics. Both Morton and Wells were given the honorary title of M. D. in acknowledgment of their services to our profession; and the qualified institution which confers a similar degree upon Gardner Q. Colton, will honor itself and medicine more than the modest gentleman who has given a longer period of his life than is allowed to many of us to the study and development of anaesthesia.