Beginning of Inhaled Anesthesia

The story of anesthesia continues with another amateur and itinerant chemist, Gardner Quincy Colton (1814–1898) ( Fig. 1-5A ). Colton had attended 2 years of medical school at the Crosby Street College of Physicians and Surgeons in New York. While in school, he perfected the manufacture of nitrous oxide by heating ammonium nitrate, and after 2 years of study, he proclaimed himself to be a "Professor of Chemistry" and went on the road to lecture on chemistry and present "scientific exhibitions."

On the night of December 10, 1844, Professor Colton presented his exhibit featuring inhalations of nitrous oxide at Union Hall in Hartford, Connecticut. It was at the Colton exhibit that the dentist Horace Wells (1815–1848) originated an idea that culminated in the first successful demonstration of inhalation anesthesia 22 months later. Wells had experimented with mesmerism to relieve the pain of dental extractions and was aware of the work of Humphry Davy. He attended the Colton demonstration and observed a young man, Samuel A. Cooley, sustain a significant leg injury without pain after nitrous oxide inhalation. Here was the answer to the problem of painful tooth extractions that had occupied his mind. He arranged for Colton to administer nitrous oxide to him on the following day for extraction of one of Wells' own teeth by fellow dentist, John M. Riggs. Only a slight tinge of pain was felt, and Wells proceeded to manufacture nitrous oxide according to Colton's instructions and use it for extractions of teeth. He recognized the enormous potential of his discovery and used his connections in Boston to arrange a date at the Harvard Medical School to demonstrate the technique of painless surgery.

Wells' appointment was to administer the gas for a leg amputation. The patient scheduled for this procedure refused to proceed with the anesthetic, and a young male student agreed to breathe nitrous oxide for extraction of

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William T. G. Morton (see Fig. 1-5B ), a young dentist from Boston, was acquainted with Wells, having been a former student and colleague of his, and had attended the failed demonstration at Harvard. Morton had lingering thoughts about a more suitable agent, in part arising from his interest in promoting his business of selling dentures. He had invented a new method for fitting dentures, but the process was prohibitively painful, and few patients would submit to the procedure. An adequate analgesic could accelerate his business.

Morton was initially trained as a dentist but had enrolled briefly at Harvard Medical School. Because of financial difficulties, he had abandoned these studies and returned to dentistry. In the course of his education, he became acquainted with Charles A. Jackson, a professor of chemistry at Harvard Medical School. On Morton's queries, Jackson advised a trial of sulfuric ether as an alternative to nitrous oxide. Later, Jackson was to claim priority in the discovery of anesthesia based on these consultations, but Morton countered that Jackson's role was negligible. Morton obtained the ether and, after performing experiments on himself and his pet animals, administered the agent successfully on September 30, 1846, to Eben Frost for extraction of an upper bicuspid tooth. Prompted by this success, he promoted use of the

Figure 1-5 A, Gardner Q. Colton was born in Georgia, Vermont, and studied medicine briefly at the College of Physicians and Surgeons in New York City. His demonstrations of nitrous oxide inhalations were the spark that prompted Horace Wells and William T. G. Morton to use gas inhalation for relief of surgical pain. After a long and adventurous career, he died at age 84 in Rotterdam, Holland. B, William T. G. Morton was born in 1819 on a farm near Charlton, Massachusetts. After several business failures, he studied at the Baltimore College of Dental Surgery, and in 1842 entered into a partnership in Boston with another dentist, Horace Wells. This partnership was dissolved within a year on amicable terms. During this association, the two dentists had devised a new method for fitting dentures that required removal of all the diseased teeth, a prohibitively painful procedure for most patients. Morton experimented with laudanum and opium without success, and in proceeding with his investigations, he realized that a greater knowledge of medicine was essential for further success. He briefly entered Harvard Medical School while continuing a part-time dental practice. During the summer of 1844, Morton, on the advice of Charles T. Jackson, used sulfuric ether for painless tooth extractions, and the study of this agent eventually led to his successful demonstration of ether anesthesia at Massachusetts General Hospital on October 16, 1846. The remainder of Morton's life was spent in efforts to patent and receive a monetary recognition for the discovery of ether anesthesia. Broken and despondent, he died of a cerebral hemorrhage in New York City in July 1868. (Images courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, IL.)

The events of October 16, 1846, a complete triumph for Morton, have been recounted several times by others, but certain points are of special interest. The patient, George Abbott, whom Morton apparently had never met, was to have a vascular tumor of the neck with large tortuous veins excised in the sitting position by 68-year-old chief surgeon John Collins Warren (1778–1856). Fearing a difficult airway or air embolism, a modern anesthesiologist might seek special equipment for this case, perhaps a special laryngoscope and central venous catheters. Morton, however, had only a poorly designed inhaler and no intravenous access. Close examination of the circumstances surrounding administration of this anesthetic indicates how dangerous this bold endeavor by Morton actually was and how likely it was to fail miserably. With the inhaler that he used, it seems unlikely that the vapor could be administered during the surgical procedure. Fortunately for Morton, the kinetic properties of ether result in a prolonged emergence, and Mr. Abbott responded only briefly at the end of the procedure ( Fig. 1-6 ).

Morton, intending to profit from his discovery, withheld identification of the ether he used and called it Letheon. He masked the aroma and appearance of ether by adding a colored dye and additional scents. For a fee,

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Figure 1-6 Drawing by H. H. Hall in Rice's Trials of a Public Benefactor illustrates the first public demonstration of ether anesthesia at Massachusetts General Hospital on October 16, 1846.^[482] From left: Henry J. Bigelow (1818–1890), the earliest advocate and sponsor for William T. G. Morton at the hospital, who also wrote the classic article describing the first experiences with ether anesthesia in the Boston Medical and Surgical Journal. Augustus A. Gould, with whom Morton and his wife were boarding and who suggested the design of the first inhaler. Gould also suggested the name Letheon. Jonathan Mason Warren (1811–1867), son of John Collins Warren, who later devised new surgical procedures for nasal deformity and cleft lip. Hall erroneously places him at this event. Others (not shown) who were present are George Heywood, house officer, and Eben Frost, who had a tooth pulled by Morton after ether administration on September 30, 1846. John Collins Warren (1778–1856), 68-year-old Chief of Surgery at Massachusetts General Hospital who performed the operation that day; William T. G. Morton, to whom credit is given for introducing ether anesthesia to the world; Gilbert Abbott, 28-year-old house painter and printer with a congenital vascular tumor, visible in the drawing as a tumor below the left mandible; Samuel Parkman, Morton's anatomy instructor at Harvard Medical School; and George Hayward (1791–1863), 53-year-old senior surgeon at Massachusetts General Hospital, who performed an excision of an arm mass with ether anesthesia the following day, October 17, 1846. His operation for vesicovaginal fistula is considered to be an original procedure. Also present was Solomon D. Townsend, one of the prominent surgeons at Harvard Medical School. (Courtesy of the Wood Library-Museum of Anesthesiology, Park Ridge, IL.)

Figure 1-7 Title and opening paragraph of Henry J. Bigelow's description of the first ether anesthetics.^[120]