Nitrous Oxide
Because of the embarrassing public demonstration by Wells in 1863,
the revival of nitrous oxide as a surgical anesthetic was delayed until its reintroduction
by the same man, Gardner Q. Colton, whose lecture and demonstration Wells had attended
in 1844 and from whom he obtained the gas used in his first experiments with inhalation
analgesia. Soon after the Wells debacle in 1844, Colton abandoned nitrous oxide
demonstrations and joined his brother in California, where he unsuccessfully panned
for gold and served briefly as Justice of the Peace for San Francisco. His stay
in San Francisco terminated when he was involved in controversial land sales, and
he moved to Boston, taking a job as a writer for the Boston
Transcript.[135]
Colton also resumed
his "laughing gas" exhibitions, and in 1863, he joined into a partnership with Joseph
H. Smith, a dentist in New Haven, Connecticut, for the "painless extraction of teeth."
The business thrived, and between 1864 and 1897, the Colton Dental Association had
treated nearly 200,000 patients without a fatality. Colton demonstrated nitrous
oxide inhalation in Paris at the First International Congress of Medicine in June
of 1867, and its wider use in Europe originates from that time. Colton was a unique
individual who promoted the continued use of a valuable agent, but he remained ignorant
of its true chemical nature. In his writings,[136]
he states, for example, the following:
The gas is composed of half nitrogen and half oxygen and because oxygen is the
life giving principle of the air, a person lives a little faster while under its
influence. It acts as an exhilarant, as by supplying an extra supply of oxygen to
the lungs, the pulse is increased 15 to 20 beats to the minute.
Until 1870, nitrous oxide was administered with air, and the livid
appearance of many patients raised the question about whether the analgesic properties
of the gas were primarily caused by lack of oxygen. The idea of using nitrous oxide
with oxygen is usually credited to Edmund Andrews[137]
(1824–1904), a Chicago surgeon, who was able to provide analgesia without cyanosis,
therefore confirming the inherent analgesic properties of nitrous oxide. Andrews
noticed that the nitrous oxide provided to dentists in gaseous form was often impure
and advocated instead the use of liquid nitrous oxide contained in iron flasks.
This pure nitrous oxide, when combined with oxygen, provided satisfactory anesthesia
without cyanosis for short procedures. Paul Bert[138]
(1833–1886), a French physiologist who contributed significantly to an understanding
of blood gas tensions at altered barometric pressures, demonstrated that nitrous
oxide and oxygen mixtures produced highly satisfactory surgical anesthesia without
hypoxia when delivered at pressures greater than 1 atm. Frederick Hewitt[139]
(1857–1916) devised the first anesthesia machine to deliver variable portions
of nitrous oxide and oxygen. Johnson demonstrated that pupillary dilation, lividity,
jactitation, and clonic movements of the extremities after nitrous oxide and air
administration were caused by extreme hypoxia, because they could be reproduced exactly
by administering nitrogen with only 0.5% oxygen.[140]
These developments led to the reintroduction of nitrous oxide
into the operating room, where Horace Wells had predicted it would be used with success.
Nitrous oxide and oxygen anesthesia was promoted in the United States by Elmer I.
McKesson[141]
(1881–1935), Paluel J. Flagg
[142]
(1886–1970), and F. W. Clement[143]
(1892–1970). McKesson's method for induction of anesthesia with 100% nitrous
oxide did not survive into the later part of the 20th century. A landmark publication
by C. B. Courville described the neuropathologic findings in patients who had sustained
hypoxic insults during anesthesia with high concentrations of nitrous oxide.[144]
W. D. A. Smith recounts the revival of nitrous oxide after Colton's reintroduction
of the agent in an entertaining and informative book on the subject.[145]
