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By Julie M. Fenster. New York, HarperCollins, 2001, 278 pp., $24.00.
We admire inventors. We have a picture of the inspired tinkerer working in a basement perfecting the gadget that will change the world. And we like things simple. It’s easiest to think that an invention springs full formed from the mind of its inventor, as Edison produced the light bulb, Marconi the radio, and the Wright Brothers the airplane. Of course, this is too simple. There are predecessors who sparked the inspiration and counterclaims and sidebars to explain how invention is so often a group process, even if we credit one inventor.
So who invented anesthesia? If you learned a name for this invention, it was probably William Thomas Green Morton. He turns out to be the most colorful and rascally character in this wonderful book, but he isn’t the only one. The invention of anesthesia was one of the most divisive issues in medicine in the 19th century. Fenster has dug up an amazing story of the origin of the first great advance in modern medicine and tells it in a lively and dramatic fashion. Her book doesn’t start off lively because she has to tell us how operations went before anesthesia was applied. We are used to surgical suites being in the bowels of a complicated hospital building, but they used to be at the top of the towers of the hospital. This provided plenty of light, but it also meant the patient could scream his head off, with the noise released to the outside with as little echo as possible within the halls. Opium might be used, but it produced nausea and death. Liquor might produce a drunk patient, but this would not necessarily mean the patient was insensate, and he or she might become belligerent. Mesmerism had some sensational successes, but most physicians thought it a humbug. Ice could help some, and sometimes patients were bled beforehand until they fainted. There was nothing that worked well. Edward Everett wrote, "I do not wonder that the patient sometimes dies, but that the surgeon ever lives."
Nitrous oxide, discovered by Priestley in 1772 and known always as "laughing gas," was an intoxicating entertainment. At parties, balloons of the stuff would be available for guests, and traveling shows would charge money for taking a snort of the gas and then make more money by exhibiting the intoxicated to audiences. Samuel Colt operated such an exhibition to finance the beginnings of his revolver factory. Another exhibitor was Gardner Quincy Colton, who brought laughing gas to Hartford, Conn., in 1844. A local dentist, Horace Wells, tried the gas and made a fool of himself in some unspecified way, according to his wife. A friend of Wells cut capers across the stage and banged up his knees against a settee. The friend felt nothing until the gas wore off. Wells made the connection from stage amusement to clinical tool, and, in the tradition of self-experimentation, had a colleague take out one of his teeth while he was under the gas, which Colton provided. After waking, Wells proclaimed, "I didn’t feel so much as the prick of a pin!"
Nitrous oxide was perfect for dental extractions, which were painful but brief. It was not adequate for long, major operations, but it might work for minor ones, and as early as 1800 Sir Humphry Davy in England had suggested as much. Ether also began to be used as an entertaining intoxicant; it had potential for surgical anesthesia as well but was not so used. There is no good answer to the puzzle of why it took physicians so long to banish pain from their surgeries. It may have been largely that the jolly highs produced by ether and nitrous oxide obscured any potential for practical use. Before Wells, they were amusements and not tools.
The 23-year-old Morton met up with Wells in 1842. Before that time, Morton had been run out of cities such as Baltimore, St. Louis, and Cincinnati by a simple business expedient. He would forge letters of recommendation, buy goods on credit, sell them, and abscond with the money to the next place. He did this several times before he was 21 and thus was able to plead that he was not accountable due to his youth. (Fenster writes, "William Morton started over many times more than the average person, but then his mistakes disappeared from his mind, long before they had a chance to turn into remorse.")
The cunning and unscrupulous Morton decided to settle down and become a dentist under Wells’s tutelage. He then moved to Boston, and the tangled tale of attribution becomes impossible to comprehend completely. He met Charles T. Jackson, a chemist and geologist, who later maintained that he suggested the use of ether for dental extractions. Morton insisted that he had experimented with ether on animals beforehand and gave a trumped-up story of how, in September 1846, he extracted a tooth from a patient under ether who never even realized the procedure had been done. Morton wanted to make money from his "invention" of ether and did what no self-respecting physician would ever have done: he patented it, thus breaking a tradition of giving gratis to the practice of medicine any advance in the reduction of human suffering.
Morton was invited to administer ether before a rapt audience at the Massachusetts General Hospital on October 16, 1846, known by historians of anesthesia as Ether Day. The surgery, a removal of a neck tumor, went perfectly. The patient was without suffering, and the surgeon turned to the audience in the operating theater afterwards and proclaimed, "Gentlemen—this is no humbug." Cheers erupted. Morton’s place in history was forever made. But the wily Morton could not make it pay. He tried to market a patent concoction called Letheon, a mixture of ether and oil of orange, but everyone guessed that it was only the ether that did the business, and so the patent was useless. There was a tradition in Europe that those who had granted boons of science to humanity would be rewarded by generous sums of money; America had no such tradition, but, to the end of his life, Morton vigorously petitioned Congress for $100,000 to recompense his benevolence. Jackson learned to despise him and dug up the dirt on his youthful sociopathy. Jackson and Wells both claimed to have made the basic discovery and opposed any monetary award for Morton.
Indeed, Morton got medals and fame for what he had done, but it never made him rich, and rich was what he wanted to be. Wells experimented with chloroform, which was an effective anesthetic but more dangerous than ether, and became addicted to it. Arrested for throwing acid onto prostitutes while he was chloroformed, Wells killed himself in jail. Jackson never got the recognition he was sure he deserved for the invention of ether, which only compounded the bitterness he felt about his belief that he had also given Morse the idea for the telegraph. He spent the last 7 years of his life in an asylum.
None of the inventors got what he wanted. This is a complicated tale, wittily told. We have no one hero on which we can bestow the title of Inventor of Anesthesia. In fact, Fenster reports a competing and prior claim by Dr. Crawford Long in Georgia, who used ether to remove a swelling on a patient’s neck in 1842. This is a messy history, entertainingly told.
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