discovery

The Age Of Discovery



Henry Hill Hickman (1800-1830)

Henry Hill Hickman was born in 1800; he trained in Medicine in London and Edinburgh. In 1823 he looked at ways to achieve anaesthesia and began his ghastly experiments, using carbon dioxide on mice, rabbits and puppies to name some.
hickman
Henry Hill Hickman
He made the animals insensible through asphyxia and proceeded to cut off parts of the animal. He described his technique as "Suspended Animation".

Hickman's idea of removing pain by inhaling a gas was absolutely correct, although he was using the wrong gas. Which is why he will always remain an important figure in the history of Anaesthesia. The possibility of inhalation anaesthesia was born.
He published his work and posted it to the leading authority at the time i.e. Sir Humphrey Davy, who was also President of the Royal Society at that time (1824).
He never read his work it seems, The Royal Society completely ignoring him: to add to that disappintment, in 1826, an article published in the Lancet effectively called his work “Surgical Humbug”
Hickman turned to King Charles X of France in April 1828, which seemed to have attracted the support of Napoleon’s field surgeon Baron Dominic Jean Larrey. Larrey thought it deserved further research but was out-voted by the short sighted Academicians 1, so the French did not pursue it either.
The link may have never been noticed if it had not been for an article by Thomas Dudley in the Lancet that highlighted his contribution.

The article read:"Permit me to make a few observations respecting the system of inhaling the sulphuretted ether for the purpose of causing insensibility during surgical operations. I am in a position to prove that a similar system was brought before the public nearly twenty years ago, by a Dr Hickman. Residing at Shiffnal and previously at Ludlow, where he Successfully performed various experiments with it upon Animals Dr Hickman commenced his experiments at Ludlow previous to the year 1824; after which he resided at Shiffnal for three years, and went to Paris in 1828, in Which year he presented a memorial to the King of France, Charles X but the prosecution of his inquiries Was cut short soon after by his decease, previous to which he published an account of his invention, either in a pamphlet, or in the form of an essay in the medical publications of the day. I well remember that the system was treated with very great severity in the medical reviews "2

His early death in 1830 (some suggest it was TB and others suicide) probably cost him a greater position in the history of anaesthesia.
In 1930 a memorial was erected to Henry Hill Hickman in the church at Bromfield, on the 100-year anniversary of his death, it reads:"This tablet is placed here at the initiative of the section of anaesthetics of the Royal Society of Medicine as a centenary tribute to the memory of the earliest known pioneer of Anaesthesia by inhalation"

The sad case of Henry Hickman. Discovered the route by which pain could be made insensible, wrong gas right idea.

Jules Germain Cloquet (1790–1883)

Shortly before the death of Hickman, in 1829 the first recorded painless operation using Hypnosis was performed by Jules Cloquet. 31 year old Jules Germain Cloquet was a French surgeon who practised medicine in Paris as the Chirurgien en chef adjoint at the Hospital St. Louis . Jules Cloquet was one of the youngest members of the Académie Nationale de Médecine in Paris.3
Cloquet had the same sort of reputation as Sir Ashley Cooper his English counterpart, known for his work with hernial disorders. He was also the first to describe and identify the remnant of the embryonic hyaloid , Jules Germain Cloquet artery, this vestige was to become known as Cloquet's canal.

cloquet
Jules Germain Cloquet
Cloquet's name is also associated with three anatomical terms regarding the femoral canal:

1. Cloquet's hernia: a hernia of the femoral canal

2. Cloquet's septum: a fibrous membrane bounding the anulus femoralis at the base of the femoral canal

3. Cloquet's gland: small lymphatic nodes in the femoral canal 4

Cloquet was a skilled artist; in his best-known work,"Anatomie de l'homme", most of the 1300 illustrations were drawn by him. He illustrated most of the images himself. He was the inventor of several surgical instruments, including some arterial forceps.

He also had a keen interest in alternative medical practices such as mesmerism, acupuncture but his responses to Henry Hill Hickman’s ideas were not known. His continued use of hypnosis was rarely successful but , mesmerism, as it was known, was the technique more widely experimented and used for surgical pain relief than any other.

In 1831 Samuel Guthrie US, Souberian (France) and von Liebig (Germany who is more famous for discovering OXO cubes) all simultaneously discovered chloroform.

Dominic Jean Larrey 1766-1842

In France during the Napoleonic wars, a surgeon by the name of Dominic Larrey was making a name for himself.
larrey
Dominic Jean Larrey
Born in 1766 he was respected by French, English, Russian and Prussian alike he was rated alongside his Icon Ambroise Paré.
Larrey was orphaned at the age of 13. He was then raised by his uncle Alexis, who was chief surgeon in Toulouse. After serving a 6-year apprenticeship, he went to Paris to study under the great Desault, who was chief surgeon at the Hotel-Dieu de Paris. His studies were cut short by war. 5

Larrey was surgeon-in-chief of the Napoleons armies from Italy in 1797 to Waterloo in Belgium in 1815.
Larrey noticed at the battle of Preuss Elayss, in Poland how the cold controlled haemorrhage, although this has been mentioned before in 1050 (Lagunda) and also in the 16th and 17th centuries. He also was aware how pain was absent during amputation of those limbs that were cold.

flying
Flying Ambulance
The fore runner of the ambulance, the horse-driven version was created by Larrey in 1792.
Larrey, Napoleon's private surgeon, wanted to improve battlefield treatment of wounded soldiers. He designed a horse-drawn "flying ambulance" to carry surgeons and medical supplies onto the field of battle during the Rhine campaign of 1792. 6
Larrey set up the first field hospitals by placing medical tents close to battle instead of miles away in centralized areas. In 1792 he started a horse-drawn carriage ambulance service to and from fighting areas. By 1794 Larrey had added stretchers to his ambulance design.

In the Egyptian campaign of 1799, he used camels to power his ambulances.
With fellow surgeon Pierre Percy (1754-1825), Larrey formed a unit of " ambulance soldiers", including stretcher-bearers and trained doctors. Larrey's ambulances and medical units both impressed Napoleon's troops and boosted their morale.
His adoration from his troops echoed that of his icon Ambroise Paré. It can be argued that his tactics in dealing with the wounded would be the forerunner of the medical evacuation chain for all future armies.

Larrey did not lose one patient due to blood loss post operatively. Larrey described how wounded soldiers with maggot-infested wounds would arrive on the carts already recovering. What the world needed was open-minded physicians, who would listen and consider different sorts of treatment or ways to avert pain and lessen the suffering of the individual, especially on the battlefield.

Barron Larrey had seen a fair share of suffering during the Napoleonic campaigns, and not all the campaigns could provide harsh conditions that made amputations bearable on the Russian front. Larrey was the first to discover the cavitation’s caused by gunshot wounds.
He has also been accredited the invention of the modern Field Ambulance. Larry went on to become Napoleons personal surgeon, and then eventually made a Baron.

Napoleons assessment of Larrey was " The worthiest man I ever met," 7
In Napoleon's will, he called Larrey, the most virtuous man I have ever known. At another time, Napoleon said. If the Army were to erect a monument of the memory of any one man, it should be that of Larrey. All the wounded are his family.

Sir James McGrigor (1771-1858)

Sir James McGrigor, first baronet, military surgeon, was born at Cromdale, Invernessshire, on 9 April 1771.
He was educated at the grammar school at Aberdeen, and at Marshal College, where he graduated with a M.A. in 1788 and studied medicine at Aberdeen and Edinburgh.
mcgrigor
Sir James McGrigor
He joined the army as a surgeon in 1793 and saw service with an Irish regiment, the Connaught Rangers, in Flanders, the West Indies and in India.
He was appointed to the post of Deputy Inspector-General of Hospitals in 1805 and took part in the Walcheren expedition before his appointment as Inspector-General of Hospitals in August 1809.

In 1811, he was appointed Surgeon-General for the Duke of Wellington's army in Spain and Portugal during the Peninsular Wars (1808-14). 8
James McGrigor was knighted in 1814 and then given the appointment of Director General of the Medical Corps on 13 June 1815, just before the battle of Waterloo.

He is accredited with devising the chain of evacuation for the wounded. Here was a British Surgeon showing the same kind of dedication to the well-being of the wounded as Larrey was for the French.
obelisk
McGrigor Obelisk
McGrigor was responsible for bringing to the attention of the Duke of Wellington the need for an efficient Medical service so that more soldiers could be treated and returned to duty.
He also persuaded Wellington, following the siege of Badajoz, to mention medical officers in dispatches for the first time.
It was McGrigor that introduced the stethoscope in 1821, set up field hospitals for those injured in action, and generally improved the standards of cleanliness and hygiene.

McGrigor introduced the stethoscope in 1821, set up field hospitals for those injured in action, and improved the standards of cleanliness and hygiene.

Sir James was created a Baronet on 30 September 1831 and was appointed a Knight Companion of the Order of the Bath (KCB) in 1850.
An obelisk to his memory has been placed in Aberdeen and is now in Duthie Park. 8

George James Guthrie 1785-1856

George James Guthrie was born in London in 1785, he became an apprentice surgeon at the tender age of thirteen and passed the membership examination of the College of Surgeons two years later, becoming a member of the Royal College of Surgeons of England at the age of fifteen.

guthrie
George James Guthrie
He served as a medical officer for his regiment in Canada for five years and then saw several years active service, under Wellington, in the Peninsular War. 9
During the first peninsular war (1808-1811) Guthrie, a Staff Surgeon (a rank initiated by John Hunter) distinguished himself well.

During the bloody battle of Talavera (May 1811) Guthrie was given charge of the entire army’s medical service. He found himself treating the many wounds in which out of 6500 British 4159 fell. Although the casualties were huge, the brave British soldiers won this battle. At Albuhera, in 1811, he operated in torrential rain for 18 hours at a stretch on 3000 casualties, without his assistant, who had been killed in the battle. 10

Guthrie introduced the pony cart to transport wounded in the winter campaign, which followed the taking of Ciudad Rodrigo to hospitals manned by regimental medical officers, so that wounded men were kept with their own comrades, and in contravention of the general order that sick and wounded be sent directly to general hospitals. Where possible, he operated on his men personally, because of this, some used to accuse him of neglecting others, but this was never proved, and Guthrie always strongly denied the accusation.

Guthrie published a book in 1820, described as: “A treatise on gunshot wounds, on injuries of nerves, and on wounds, extremities, requiring the different operations of amputation: in which the various methods are performing these operations are shown, together with them after treatment”.
This book also contained an account of the author’s successful case of amputation at the hip joint. Now considering these were days before anaesthesia, a successful amputation at the hip joint seems remarkable.

On his return to civilian life he founded an eye hospital, was appointed to the Westminster Hospital and was three times President of the Royal College of Surgeons of England. He reformed the College Charter, attacked nepotism in the College, strove to improve the status of army surgeons, and for twenty years gave regular lectures on the treatment of war wounds. 11

Guthrie was known as the English Larrey because of his originality.
At the Royal College of Surgeons Guthrie was a Member of Council from 1824-1856; a Member of the Court of Examiners from 1828-1856; Chairman of the Midwifery Board in 1853; Hunterian Orator in 1830; Vice-President five times; and President in 1833, 1841, and 1854.
He was Hunterian Professor of Anatomy, Physiology, and Surgery from 1828-1832. He was elected FRS in 1827. 12 He had turned down a knighthood.

He died of cardiac problems, aged 71, on his birthday 1st May1856 and was buried at Kensal Green. He had married twice, had three children – one of whom became a surgeon – but they left no issue.
Shrewd, outspoken but kind at heart, he possessed the true attributes of a great surgeon, a lion’s heart, the eye of an eagle and the fingers of a lady. His memory is kept alive by the RAMC by the award of the Guthrie Medal to outstanding civilian consultants to the Army. 13
Both James McGrigor and James Guthrie were the British surgeons whose standards rose above and moved far ahead of the civilian surgeons at the time.

The Age of Discovery the Industrial Revolution

With the growth of industrialisation during the early part of the 19th century, the western world started to see improvements to its economy.

In the United Kingdom, the riches and raw materials extracted from its empire, fuelled mass production for export to the rest of the world.
dental
Dental Chair
The Industrial revolution was now in full swing, there was now more money to pay for medical and surgical care.
The doctor now became a necessity not only for just high-society but also for the factory owner to keep his workers healthy so that production did not slow.

The consequence of this is that more people turned to the medical profession as the salary's that could be earned were quite generous.
On a like for like basis the doctors never fared as well as Solicitors or barristers, and apart from a very few, were not given a great deal of respect by the ruling classes. With that said however, a selection process was put in place allow only the best to qualify, so now it had become a competitive profession; in short, the candidates and the training got better and tougher.
The rewards for successful candidates were good, some opening their practices among the wealthy few, and did very well financially.

In America the training required, like Britain, was expensive, so only a privileged few could undertake training. Some opted for dentistry where no formal training was required.

It was the dentists who strangely enough decided to pursue a remedy for the pain that they created when they pulled a poor clients tooth. In some cases, they managed only to pull off the crown of the tooth and leave all the broken roots in.
The pain increased in their jaw and also in their wallet, as the cost was the same and no guarantee given.
This I believe increased the searching for an adequate pain-relieving agent by dentists during this period.

In surgery, the experiments continued, it was all about who is quick enough to perform the procedure before the patient bled to death or died in agony.
The quicker you were the more chance you had of succeeding in having a live patient at the end of the procedure. It is unfortunate however that infection claimed as many as the surgery.
The idea of pain completely being removed was wished for by the good surgeons, as they could improve their techniques and save many more lives by not rushing.
This was not really the wish held by the fast-bad surgeons. In their mind the operation was successful if the patient was breathing at the end of the procedure.
Dentists are trained and still used in some armies as war anaesthetists should they be required.

Hanaoka Seihu 1760-1835

In 1804, the Japanese surgeon Hanaoka Seishu (1760-1835) performed general anaesthesia for a mastectomy. He did this by combining traditional Chinese herbal medicine western surgery techniques learned through Rangaku or Dutch studies.

seishu
Hanaoka Seihu
Hanaoka performed his first surgery on a 60-year-old woman with breast cancer. Although she survived the operation, she died six months after her surgery. However, he continued to perform complex surgery, which was often successful. He also trained more than two thousand students throughout his career.14
His patient was a 60-year-old woman called KanAiya. He used a compound he called Tsusensan, based on the plants Daturametel and Aconitum and others.

The recipe for Hanaoka’s anaesthetic ("Tsusensan") is as follows: 8 parts of Datura Alba (white angel trumpet or thorn apple), 2 parts of Aconitum japonicum (Japanese aconite), 2 parts of Angelica dahurica (Chinese angelica), 2 parts Angelica decursiva (Norwegian angelica), 2 parts of Ligusticum Walachia and 2 parts Arisaema japonicum. The mixture is ground to a paste, boiled in water, and drunk warm. After 2 to 4 hours one will become impervious to pain and subsequently fall unconscious. Depending on the dosage, this effect will last 6 – 24 hours.

The active ingredients in this concoction are scopolamine, hyoscyamine/atropine, aconitine and angelic toxin. When combined, these give rise to anaesthesia, sleep and paralysis, most important of these substances being the tropane alkaloids atropine (named after Atropa belladonna and still currently used by ophthalmologists to dilate pupils), and the powerful scopolamine, both of which are substances which act to inhibit the transmission of stimuli between neurons (as acetylcholine antagonists). 15
The most common surgery carried out in Japan is eyelid surgery.

Ephraim McDowell 1771-1830

The term laparotomy arises from the Greek word "lapara", meaning "flank", and the suffix "-tomy" arising from the Greek word "το μή" meaning "a (surgical) cut". 16
seishu
Ephraim McDowell
Ephraim McDowell was born in Virginia and moved to Danville, Kentucky. He furthered his education in Edinburgh and was a student of the well respected surgeon John Bell, in the late 18th century.
When he eventually moved back to the States he settled in the town he was brought up in, which at the time was the capital city of Kentucky, Danville.
He was approached by a patient, a Mrs Jane Crawford who was to epitomise the hardy Kentucky folk that produced the likes of Davy Crockett and his band of heroes that died at the Alamo. McDowell diagnosed her condition which was a large abdominal mass, as a very large ovarian Tumour.
He suggested that he could remove the tumour but only if she came to his surgery at Danville some 60 or so miles away. She, being the tough woman that she was got on her horse and rode the 60 miles a couple of days later.

seishu
McDowell Plaque
He carried out the operation and the patient recited the psalms throughout, she had no anaesthetic and the operation took 25 minutes to perform. The 15Ib tumour was successfully removed and the wound stitched. It took 3 weeks for her to recover and she returned to her homestead the same way, 60 miles on horseback.
She is known to have lived for 13 years after the tumour was removed, the first successful laparotomy indeed, no anaesthetic, just prayer.

The qualities of character demonstrated by Dr Ephraim McDowell 200 years ago are still essential for surgeons today.

One of the most common emergency surgical procedures undertaken in this country is an Appendicectomy.
The first known surgical removal of the appendix was in 1735, by Claudius Amyand (a Huguenot refugee and founder of the St George's hospital in London), who operated on an 11-year-old boy.

Physician Francois Melier first suggested the possibility of removing the appendix in 1827 but was largely ignored. It took urging by Reginald H. Fitz in 1886 for the profession to recognize the potential for surgical treatment of appendicitis. 17
There are three claimants for the honour of having performed the first appendectomy in the United States.
The New York surgeon Robert Hall is usually credited with being the first, and he operated on his patient in 1886. The Philadelphia surgeon Thomas Morton is sometimes credited with this achievement, but Morton performed his operation in the following year.
The earliest record would seem to be that of William West Grant of Davenport, Iowa who operated in 1885. Ironically, Hall was to die of a ruptured appendix in 1897, while Morton’s son and brother also both died of appendicitis. 18

William E Clarke

While attending undergraduate school in Rochester, New York, in 1839, classmates Clarke studying to be a Chemist and Thomas Green Morton apparently participated in Ether frolics with some regularity.
He left his home town and went off to Massachusetts, to further advance his chemistry at the Berkshire Medical College.

clarke
William E Clarke
In January 1842 William E Clarke returned to his home town of Rochester, New York, during a break in the lecture schedule.
Clarke discovered that the sister of one of his classmates, a Miss Hobbie, needed a tooth extracted.

He applied Ether via a towel to a patient whilst a dentist Elijah Pope, painlessly removed one of her teeth. Because they never recorded it at the time, they missed an opportunity for everlasting fame. Historians now only mention it briefly. 19
The reason he never pursued it was, Professor E. M. Moore, Clarke's preceptor, told him that the entire incident could be explained as the hysterical reaction of women to pain. At Moore's suggestion, Clarke discontinued his experimentation. 20
If he had not listened to the explanation of his Professor, maybe Clarke would have pursued this even further and been accredited with its discovery. This chemist could have cemented his place in history if he had applied the scientific process of experimenting on more than one individual and not just listening to a professor who was obviously so sceptical that he had to find and explanation to completely throw Clarke off the trail.
Clarkes lost opportunity was Morton’s gain, but the world is the winner as suffering during a surgical procedure has ceased.

Crawford Long 1815-1878

Crawford Long was Born in Danielsville, Georgia on November 1, 1815, He came from a cotton farming well to do family and his first surgical act was to nearly amputate his sister’s fingers with an axe (accidentally) and then to put those bleeding fingers back into place, most children of his age would have panicked, and the result would have been the loss of his sister’s fingers, his quick action and follow up by his mother saved the fingers.

crawford
Crawford Long
He graduated from medical school at the University of Pennsylvania in 1839. Like many of those credited with discovering anaesthesia, Long, was exposed to the recreational use of nitrous oxide and ether. After training in New York, he returned to Georgia and began medical practice in rural Jefferson.

Crawford Long successfully carried out an operation with Ether, four years before its official discovery.

On 30th March 1842, Dr Crawford Williamson Long excised from an acquaintance, James Venable, one of two tumours from his neck.

Venable was one of many people at the time who had a liking to ether parties, so he was used to sniffing the vapours, this meant that the thought of the "anaesthetic" via this substance was not feared as much as it could have been had he not tried it first. He had rendered his patient insensible via an ether-soaked towel. Some medical students and several other onlookers watched the operation. At first, Dr Long’s patient could scarcely believe what had happened. Only when he was presented with the half-inch- diameter cyst, did Mr Venable realise that a tumour had been removed.

His bill for two dollars itemised the cost of the Ether as well as the tumour excision. On 6th June, Dr Long excised Mr Venable’s second tumour.

Other pain-free operations on different patients under ether anaesthesia followed.

crawford
Crawford Long Mural
The procedures included the removal by Dr Long of a toe, a finger and another cyst. He did not however publish his results until after Morton successful attempt, so was not credited with its discovery. Crawford Long figures historically, as the unofficial discoverer of anaesthesia. 19

"Why do we not give the credit to Davy ... Hickman ... Wells ... or too Long, who frequently practised ether anaesthesia?

In science the credit goes to the man who convinces the world, not to the man to whom the idea first occurs ... Morton convinced the world, the credit is his." And, "The rival claims or priority (for the first use of anaesthesia) no longer interest us." 21

Horace Wells 1815-1848

In 1844 the dentist Horace Wells first observed the effects of nitrous oxide when he had it demonstrated to him by Gardner Quincy Colton, a member of a circus.
wells
Horace Wells
During a performance, a young man by the name of Cooley had Nitrous Oxide administered to him and fell into a chair on the stage, bruising his leg, to the laughter of the audience. Wells, who said to him, 'that must have hurt', Cooley replied that he had not felt a thing, just at that point he started to feel the pain from the bruising. It was then that Wells suggested to Colton about the possibility of having a tooth extracted under Nitrous Oxide.
He decided to try it on himself. 22
Wells had a molar extracted by Dr John Riggs and he felt nothing.
Wells then began experimenting with Nitrous Oxide and extracting teeth on his own patients, who suffered no pain what so ever. He was quoted as saying: “A new era in dentistry and tooth pulling, the greatest discovery ever made.”

Wells approached John. Collins Warren 1778-1856 a surgeon at the Massachusetts General Hospital and was invited to demonstrate the technique.
The Nitrous Oxide was not delivered for long enough, or an insufficient dose was administered, and the patient felt pain, Wells was booed out of the operating room with cries of Humbug, Humbug!

It so happened that a former pupil of Wells, a certain W.G. Morton. 22 was at this demonstration and it was this that possibly gave him the impetus to perfect the procedure.
Wells was unfairly discredited by the medical establishment and never recovered from the humiliation. Wells gave up dentistry and became a travelling salesman for the next couple of years selling household items and canaries.
In 1847 Wells was approached by WG Morton and was asked to market his Lethe-on in Europe.
While in Europe he became addicted to Ethers rival Chloroform, and became unbalanced, so in January 1848 he returned to the USA.
One day in New York whilst hallucinating, Wells threw Sulphuric acid over a couple of prostitutes; he was arrested for this act and was imprisoned.
In despair after realising his appalling crime, Wells committed suicide by slicing open his femoral artery whilst under the influence of drugs. 23

"The lessons of science should be experimental, also the sight of a planet through a telescope is worth all the course on astronomy; the shock of the electric spark in the elbow out values all theories; the taste of the Nitrous Oxide, the firing of an artificial volcano, are better than volumes of chemistry". 24
Wells was in essence a sympathetic man who was looking for a way to ease the pain that his patients had to suffer.

William Thomas Green Morton (1819-1868)

William Green Morton was born at Charlton, Massachusetts, on 19th August 1819. At the age of 17 he became a businessman in Boston, but after several years without success he took up the study of dentistry at the Baltimore College of Dental Surgery, and eventually trained as a dentist.
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William Thomas Green Morton
Ironically, he studied under Horace Wells in Hartford Connecticut and the two became associates.

Morton decided to leave the dentistry profession and study medicine at Harvard University.
Having observed Horace Wells attempt to perform a painless tooth extraction using Nitrous Oxide, and fail miserably, also being called a "Humbug" in the distinguished company of surgeons, Morton decided to research into other substances especially Ether, which he had become familiar with, whilst studying chemistry under Dr Charles T. Jackson. 24 He it seems in discussion with Jackson, experimented with Ether.
He eventually carried out a painless extraction on September 30th 1846.

He was now convinced that he could administer Ether successfully using the inhaler he had designed, so he contacted Dr Warren at the Massachusetts General hospital to arrange a demonstration on a patient.

Before I continue with further information about Morton, one must understand how difficult it was mentally for a surgeon to perform an amputation pre-anaesthesia.
Before anaesthetics, the surgeons had to be very hard and controlled men, especially emotionally. This was because of the stress that a surgical procedure put on the surgeon’s shoulders.
In reality, these surgeons went to the operating theatre as though they were walking the "Green Mile" for the patient.
A Surgeon at one of the London Hospitals a Mr Abernethy, on proceeding to perform an important surgical operation, was accosted by a colleague, who said, "How are you? How do you feel today Sir?" Mr Abernethy replied, "I feel as if I was going to be hanged".

Pain
Pain
This surgeon who was Hunters successor vomited when he emerged from the operating theatre because of the pain and anguish he just inflicted. It is easy to think that they were very hard men, but as the surgeon who worked on the Elephant man said, "Surgeons should retire at 50 because the stress is too much to bear for any longer". 25

A typical example below : “The case was an interesting one of a white swelling, for which the thigh was to be amputated. The patient was a yoconsider-uth of about 15, thin and pale but calm and firm. One surgeon felt for the femoral artery, had the leg elevated for a few minutes to exsanguinate the limb before the compression tourniquet was applied. The white swelling was fearful, frightful. A little wine was given to the lad; he was pale but resolute; his father supported his head and left hand.
A second surgeon took the long, glittering knife, felt for the bone, thrust in the knife carefully but rapidly. The boy screamed terribly; the tears went down the father’s cheeks. The first cut from the inside was completed, and the bloody blade of the knife issued from the quivering wound, the blood flowed by the pint, the sight was sickening; the screams terrific; the operator calm.”
26

This is why that surgery was rushed, to get it over as quick as possible so that all parties would suffer less.

Now you might begin to understand the relief that surgeons had when Anaesthesia became known to them, and then was proven to relieve the suffering of the patient. With anaesthesia not only was there insensibility to pain from the patient but it relaxed the surgeon, who was now not under pressure to complete the operation as quickly as possible. It also meant that he could be certain of the results.
“Anaesthesia was discovered. Do you know what it means to relieve man of his pain and suffering? Anaesthesia is the most humane of all of man’s accomplishments, and what a merciful accomplishment it was. For this great discovery, we are indebted to Dr W. T. G. Morton.”

Morton went into partnership with Horace Wells in 1842-1843 and this is where he became motivated to finding a substance that was suitable for dental and surgical procedures. The partnership did not last, that is when Morton decided to study Medicine at Harvard in 1844.

surgery
So, it was on the 16 October 1846 at Boston University Hospital Massachusetts when William Thomas Green Morton delivered four minutes of inhalation ether and anaesthetised Edward G Abbott who was a printer from that city.
Ether Dome
Ether Dome
John Collins Warren the eminent surgeon who carried out the surgical procedure was led to exclaim, “Gentlemen this is no Humbug.”

This statement probably referring to Horace Wells failed attempt a year earlier. The drug Morton used that day was Ether.
The following day Morton’s second successful demonstration went better than the first when surgeon George Hayward removed a large tumour from a woman's arm.

Henry Bigelow wrote: "The present operation was performed by Dr Warren, and though comparatively slight, involved an incision near the lower jaw of some inches in extent. During the operation the patient muttered, as in a semi-conscious state, and afterwards stated that the pain was considerable, though mitigated; in his 27 own words, as though the skin had been scratched with a hoe. There was, probably, in this instance, some defect in the process of inhalation, for on the following day the vapour was administered to another patient with complete success. A fatty tumour of considerable size was removed, by Dr Hayward, from the arm of a woman near the deltoid muscle.
The operation lasted four or five minutes, during which time the patient betrayed occasional marks of uneasiness; but upon subsequently regaining her consciousness, professed not only to have felt no pain, but to have been insensible to surrounding objects, to have known nothing of the operation, being only uneasy about a child left at home. No doubt, I think, existed, in the minds of those who saw this operation, that the unconsciousness was real; nor could the imagination be accused of any share in the production of these remarkable phenomena."


With the official discovery of anaesthesia, surgery took gigantic steps forward. With Ether and later Chloroform, the patient suffered no direct surgical pain during the surgical procedure, the surgeons then pursued surgical cures for almost any condition, which could warrant it.

In a letter to Morton, Oliver Wendell Holmes (1809-1894) (who is better known for writing hymns,) suggested the word "Anaesthesia", which had been used by the Greeks, 28 and when translated means: "An=without" Aaesthesia=sensibility".

It is quite a shame that this discovery was clouded by the bitter fight for recognition with Charles Jackson the Chemist being the main accuser to Morton and Horace Wells.
Morton's greatest mistake was however to try and hide the real identity of the substance.
He added some odour-masking impurities to Ether and called it a different name "Letheon", thinking to benefit financially by the discovery.
The mainstream of medicine at the time felt that the medical institutions and patients were being held to ransom for a substance that was widely available but its identity hidden.
The problem for Morton, Ether, having been around for centuries, could not be patented.

This fight the recognition of discovery (and $100,000 reward) went on and is likely to have led to the premature deaths of all three involved.

The inscription in the “Ether Dome” at Boston Hospital reads:“On October 16, 1846, in this hall, the former operating theatre occurred the first public demonstration of narcosis, which resulted in analgesia during a major surgical intervention. Ether sulphurous was applied by William Thomas Green Morton, a dentist from Boston. Gilbert Abbot was the patient and a neoplasm of the jaw was removed by John Collins Warren. The patient declared that he did not feel any pain and he was emitted whole on December 7th. This discovery has spread from this room and opened a new era for surgery.” 29

Morton died suddenly of "brain congestion" in 1868. He received recognition eventually by the Academia. Morton Epitaph reads:"By whom pain in surgery was averted and annulled, before whom in all time surgery was agony, since whom science has control of pain". What a sad outcome for this man, he was the first to prove scientifically that the agent ether was an anaesthetic, but the stress of proving that it was his idea, eventually led to his premature death.

"That so unlikely an outcome should accrue to a man possessed of such limited talent and so many flaws, and one lacking in a sense of ethics and decency was one of the bitter ironies of history." 24
It is not widely known but one of the first appendectomies in America was carried out by WTG Morton’s son, George Thomas Morton.
The discovery of Anaesthesia spread around the world quickly, arriving in England later that year, with it being used successfully to extract a tooth in London by James Robinson in December 1846.

The Spreading of the Word



Word of the means to alleviate pain during surgery was soon spread across America and then eventually to Europe. Francis Boott an American from the city of Boston (although his parents were British), had many friends on both sides of the pond; one of those friends was Jacob Bigelow, Professor of Materia Medical at Harvard.
He wrote to Francis Boott sending him an account of the process used. He also mentions that he sent his daughter to Morton's private rooms to have a tooth painlessly extracted using Ether.
Not long after he receives the message at his house on Gower Street in London, the dentist James Robinson extracted a molar under Ether anaesthetic from a young woman. She was completely insensible to pain throughout the entire procedure.

Boott was born in Boston, Massachusetts, the brother of Kirk Boott, one of the founders of Lowell, Massachusetts. Kirk Boott's father (born in Derby, England, 1750-1817), was also called Kirk Boott. He had emigrated to the United States from England in 1783 and worked in Boston as a 'Wright'. 30

Francis Boott
Francis Boott
Boott wrote to the famed surgeon of the day Robert Liston and he in turn contacted Peter Squire a chemist showing him Boott's letter.
The chemist suggested it was most interesting and Liston ordered some for the following Monday in which he had a planned amputation to perform. Peter Squire tried the concoction out on his son William and was suitably impressed.
From then on it was history, with Liston painlessly amputating a patient’s leg using ether. William Squire was the anaesthetist.
Liston is quoted as saying:"We are going to try a Yankee dodge today gentleman for making a man insensible, Time me gentlemen, time me!' 31
It took Liston less than a couple of minutes to remove his patients leg when anaesthesia was first used.

Today it takes on average, 90 or so minutes to undertake the same procedure. The biggest difference to day is that the mortality rate is extremely low as opposed to Liston’s time when it was very high.

Antonius Mathijssen



Antonius Mathijssen was a Dutch army officer who invented Plaster of Paris bandages in 1851.
He was born November 4, 1805 to a village physician in Budel, a Dutch town on the Belgian border. He was educated at hospitals in Maastricht, Brussels and the army medical school in Utrecht.

He received his commission as medical officer 3rd class in the Royal Netherlands Army in 1828.
mathijssen
Antonius Mathijssen
While working at military hospital in Haarlem Mathijssen in 1851 first used plaster of Paris as a bandage. He discovered that a bandage soaked in water and plaster of Paris hardened within a few minutes and thus made a good fixation for broken bones. He published his findings in a Dutch medical magazine Repertorium in February 1852.

The technique he used is still in common use today, although we have different types of bandage made of different fibres with differing strengths, plaster of Paris is still the primary bandage used when there is a danger of swelling.

He retired from the army in 1868 as first medical officer first class (Lieutenant Colonel).
Mathijssen was said to have died June 15, 1878, aged 72, in Hamont.
Memorial monuments are located in both Budel and Hamont. The last Dutch army hospital in Utrecht was named after Dr Mathijssen until the army hospital merged with the navy hospital in the early 1990s. 32

"Nospe' res avaientun Paris de pierre, nosfilsauront un Paris de pla'tre". Our fathers had a Paris made of stone; our sons will have a Paris made of plaster. 182

References:

1 http://www.quotesea.com/quote/therapidreleaseofcarbondioxideintothe Paul Wignal
2 The Lancet, Volume 49, Issue 1223, 6 February 1847, Page 163
3 http://en.wikipedia.org/wiki/Jules_Germain_Cloquet
4 http://www.whonamedit.com/doctor.cfm/2298.html
5 http://en.wikipedia.org/wiki/Dominique_Jean_Larrey
6 http://www.discoveriesinmedicine.com/A-An/Ambulance.html
7 Napoleon Bonaparte on Dominic Larry
8 http://en.wikipedia.org/wiki/Sir_James_McGrigor,_1st_Baronet
9 http://www.lmi.org.uk/LibraryAndArchives/RecentExhibitions/BattleExhibi tion/BattleExhibGuthrie.aspx
10 http://www.bmj.com/content/338/bmj.b1058.full?ijkey=pdku3aYzpYPig9F &keytype=ref
11 http://www.rsmpress.co.uk/bkhurt.htm
12 http://www.aim25.ac.uk/cgibin/vcdf/detail?coll_id=10203&inst_id=9&nv1 =search&nv2=
13 http://waterloo200.org/themes/science-technology/surgeon-george-james-guthrie-wellingtons-combat-medic/
14 http://www.sciencemuseum.org.uk/broughttolife/people/seishuhanaoka.aspx
15 www.General-anaesthesia.com
16 Wikipaedia
17 https://www.quora.com/Who-performed-the-first-appendectomy
18 https://www.americanheritage.com/appendicitis-100
19 Synopsis of Anaesthesia Rusden Lee Atkinson p875 (11th ed)
20 http://www.answers.com/topic/anesthesia-discovery-of
21 http://www.asksam.com/cgibin/as_web6.exe?Command=DocName&File= Osleriana&Name=2004- 36%20Crawford%20W.%20Long%3A%20A%20Georgia%20Student
22 Victory over Pain Robinson p96
23 BLTC Research David Pearce 2004
24 WWW.Famousamericans.net
25 Victory over Pain Robinson p78/9
26 http://www.rcoa.ac.uk/index.asp?PageID=200
27 http://thinkexist.com/quotation/there_is_nothing_more_helpless_and_irr esponsible/328335.html
28 Dioscorides 40-90ad
29 http://www.historyofbiologyandmedicine.com/unitedstates.htm
30 https://en.wikipedia.org/wiki/Francis_Boott
31 Robert Liston Surgeon
32 https://en.wikipedia.org/wiki/Antonius_Mathijsen
33 Hugo,Victor Marie Notre-Dame de Paris, pt.3, ch.2.


Ken True ODP
Author
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