CHAPTER XXIV. ETHER, 1846. The introduction of the use of ether into surgical practice in 1846 was through no accident, nor was it the result of prolonged research and experiment. It came as a surprise, but as a perfectly matured discovery for which many had hoped; yet remarkably few had sought it. No great scientist had wrought it out; no deep thinkers had prophesied it. It was, in fact, a part of the wave of world-advance which prevailed at the time. Everything felt the impulse of that wave. New political parties took life, and with them developed new conditions of old questions-political and social -conditions, many of which were to be settled finally among us only through the merciless sacrifices of a civil war. Our country had doubled its population in the first thirty years of the century,* and in the decade 1830-1840 the population increased by 4,000,000. Civilization kept pace with the growth. An American literature in some fashion was beginning adequately to supplement works of foreign authors; Bancroft, Hawthorne, Emerson, Holmes, Longfellow, Poe, Prescott and Whittier were writing. Newspapers, wretched as many of them were, vied with each other rapidly to spread news through the country. The introduction of the power-loom by an alumnus of Harvards made possible the growth of many thriving and permanent cities. The omnibus was giving way to the street car, the stage-coach to canal boats and * Population of United States in 1830 was 12,866,020. § Francis Cabot Lowell, 1793 H. U. steam railroads. Most important of all was the discovery by Morse in 1844 of the magnetic telegraph, and then followed a multitude of minor miracles. In medicine the speculative and dogmatic philosophies were passing. The labors of Bichat, Magendie, Johannes Müller, Rokitansky, Laennec, and Louis were supplemented by those of Claude Bernard, Du Bois-Reymond, Helmholtz, Ludwig, Virchow and others (names, names, alas! mostly, to modern readers, but names much repeated) resulting in the establishment of experimental physiology and pharmacology. In such a time, then, the world learned suddenly that surgical pain had been abolished. It was the fulfilment of the promise in Revelations, "Neither shall there be any more pain." Certain pain-killing drugs had long been known. Ancient history tells of sundry instances of surgery done upon patients under the influence of opium, hyoscyamus, conium, belladonna, mandrake, Indian hemp, and other narcotics-all given to the point of intoxication, with the hope that painless surgery would result. Physiology has long since taught the reason why these means failed. Napoleon's surgeon, Baron Larry, operated on his half-frozen, wounded soldiers, at the battle of Eylau, and bore testimony that intense cold produced partial insensibility. But, like mesmerism, hypnotism, nerveclamping, and alcoholic intoxication, all these lacked the sine qua non of Bigelow's test,-inevitable, complete, and safe. Ether was the first substance found to fulfill all these conditions. Remember, too, that in many of the agents used for the prevention or relief of pain, the real discovery was often within view, that the progress of surgery was retarded by the want of an anaesthetic, and, when we picture the horrors of those operations, we marvel at the seeming indifference of the scientific world, to the sufferings of mankind. The introduction of Petit's tourniquet in 1718 advanced our art somewhat in the estimation of men, by robbing ampu tations of some of their sickening unsightliness; yet the century was far advanced before the old prejudice against surgery was mitigated. Even in such a brilliant thinker and disciple of surgery as John Hunter there were traces of the early prejudice that surgery was beneath the calling and dignity of the physician, on account of the cruel nature of surgical work, which he terms "humiliating examples of the imperfectness of the science." Robert Liston, as late as 1844, said of operative surgery, to his class at the University College Hospital, "This is regarded as an inferior part of our professional duties, and truly it is so. The field of operative surgery, though happily narrowed, is still extensive." In his lectures Liston paid special attention to instructing students how to give the least pain in operating, especially in dividing the skin. Sir James Simpson relates how near he came to abandoning the study of medicine on account of the horrors of the operating room. Abernethy and Cheselden dreaded every operation they performed, and the latter is said seldom to have slept the night before an operation. John C. Warren refers to the sinking of heart he felt in the distress of every painful operation to which no habit could render him insensible. Here is a story of Nathan Smith which does credit to that great man's sensibility; and it can truly be said that the introduction of anaesthesia has not robbed the human surgeon today of the tenderness and sympathy illustrated by this anecdote: "Before the discovery of anesthesia, surgeons suffered in their sensibilities, as well as their patients. With other pupils I accompanied the doctor to a distant town to see a capital operation. It was a case to excite commiseration. The patient was old enough to understand the purpose in hand, but not sufficiently mature to perceive its necessity. It was a chilly morning, as we sat by the fire, and the doctor looked at the patient at the farther end of the room. The lad was emaciated and trembling. Dr. Smith was visibly affected, his eyes dropped tears, and his heart trembled as he whispered to me, 'I shall not do what they expect! It is a cruel business, and I will perform a less severe operation, in the hope that it may have the same effect.' On examination it became apparent that the severer operation (amputation of the thigh) could not be avoided. Before we returned to the room, he said to the attending physician, Hall, you know all about this boy's sufferings; at the moment we begin, bend over and across the bed to hide us from his sight, and do your best to comfort him,' the tears still falling from his eyes. At once he became calm, the tremor left him, and in less time than while I write this period, the operation was completed, and the patient recovered." Then there is that striking picture so graphically sketched by Ashurst ;* of a physician of the old days, himself the patient, who speaks: "I at once agreed to submit to the operation, but asked a week to prepare for it; not with the slightest expectation that the disease would take a favorable turn in the interval, or that the anticipated horrors of the operation would become less appalling by reflection upon them, but simply because it was so probable that the operation would be followed by a fatal issue that I wished to prepare for death and what lies beyond it, whilst my faculties were clear and my emotions comparatively undisturbed. The morning of the operation arrived. The operation was a more tedious one than some which involve greater mutilation. It involved cruel cutting through inflamed and morbidly sensitive parts, and could not be despatched by a few strokes of the knife. . . Of the agony it occasioned I will say nothing. Suffering as great as I underwent cannot be expressed in words, and thus, fortunately, cannot be recalled. The particular pangs are now forgotten; but the blank whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so. Only the wish to save others some of my sufferings makes me deliberately recall and confess the anguish and humiliation of such a personal experience; nor can I find language more sober and familiar than that I have used to express feelings which, happily for us all, are too rare as matters of general experience to have shaped into household words. During the operation, in spite of the pain, my senses were preternaturally acute. I watched all that the surgeon did with a facinated intensity. I still recall with unwelcome vividness the spreading out of the instruments, the twisting of the tourniquet, the first incision, the fingering of the sawed bone, the sponge pressed on the flap, the tying of the blood vessels, the stitching of the skin, and the bloody dismembered limb lying on the floor. These are not pleasant *Semi-centennial of Anesthesia, Massachusetts General Hospital, October 16, 1896. remembrances. For a long time they haunted me, and, though they cannot bring back the suffering, they can occasion a suffering of their own, and be the cause of a disquiet which favors neither mental nor bodily health." Opium and alcohol were the two agents most commonly used in the days immediately preceding the introduction of ether. Dorsey and Warren gave laudanum, and Mott says, "I was in the habit of giving opiates freely before the introduction of anaesthetics, both before and after operations. Opium and its preparations are the only anodynes well adapted for surgical use. No substitutes are worthy of confidence." Physick followed Richerand's suggestion, and employed alcohol, pushed to the point of intoxication. The earliest period at which ether is distinctly mentioned under that name is by Godfrey in the "Transactions of the Royal Society" for 1730. The first scientific account of the employment of hypnotic anaesthesia for surgical purposes is given by Recamier and Baron de Potel about 1821. Hypnotism was recommended by Cloguet in 1829, who removed a cancer of the breast, without pain to the patient, by its use. Previous to the discovery of ether anaesthesia, inhalations of various vapors had often been employed, particularly for the amelioration of pulmonary affections. Inhalers had been used by Mudge, Gairdner, Darwin, Beddoes and Watt. Charles Scuddamore advocated the inhalation of iodine and conium in phthisis, and Sigmond speaks of the inhalation of stramonium. The inhalation of ether itself was advocated for phthisis and asthma, accompanied commonly by the statement that its use was attended with much danger, and always with much uncertainty. Anthony Todd Thomson, in the "London Dispensatory" of 1818, gives the following summary of the knowledge then extant upon the use of ether: "As an antispasmodic, it relieves the paroxysm of spasmodic asthma, whether it be taken into the stomach, or its vapors only be |