The Forty Years Nobody Used the Gas

AFor a patient on the table before 1846, the only mercy a surgeon could offer was speed. Robert Liston, operating at University College Hospital in London, was celebrated for taking a thigh off in under thirty seconds, and the celebration tells us what the audience valued. Yet the chemistry that would put an end to such scenes was not new. Humphry Davy inhaled nitrous oxide at Bristol in 1799 and wrote that the gas might be used during surgical operations; ether had been synthesised centuries before and was inhaled for amusement at parties in Britain and the United States throughout the 1830s. Nearly half a century lies between Davy's written suggestion and the first use of an anaesthetic in a hospital theatre. That interval, rather than the discovery itself, is what historians of medicine now argue over, and what each side counts as evidence decides the argument's shape.

BThe events are documented to the day. On 16 October 1846 William Morton, a Boston dentist, gave ether to a printer named Gilbert Abbott while John Collins Warren removed a growth from the man's jaw at the Massachusetts General Hospital. Accounts crossed the Atlantic by ship, and on 21 December Liston amputated a leg under ether in London. The speed of that transfer — sixty-six days from one operation in Boston to imitation in Europe — is part of the puzzle, since it shows how little resistance the method met once it could be demonstrated. Priority was disputed immediately. Crawford Long, a physician in rural Georgia, had cut a cyst from a patient's neck under ether in March 1842 but published nothing until 1849; Horace Wells, once Morton's partner, had given nitrous oxide before students at the same Boston hospital in January 1845, and the patient cried out. Wells was hissed from the theatre and never recovered his standing.

CChloroform followed within a year. James Young Simpson, professor of midwifery at Edinburgh, tried it on himself and two colleagues in November 1847 and had it in obstetric use inside a week; it was easier to carry and pleasanter to breathe than ether, and it spread faster. It was also less forgiving. In January 1848 a girl of fifteen named Hannah Greener died under chloroform while a toenail was being removed, and by 1858 John Snow, who had made anaesthesia a speciality in itself, had gathered fifty fatal cases. Snow's answer was not to abandon the drug but to measure it. He held that chloroform was safe provided the vapour never rose above five per cent, a limit he could hold only with an inhaler of his own design. The contrast matters for the argument that follows: ether was the safer agent but the harder one to give, chloroform the easier to give but the readier to kill, and neither was well handled by a surgeon who was also cutting.

DElinor Vaughan-Mackie has argued for three decades that the delay was a matter of belief and not of equipment. Reading two hundred and forty surgical case books written in Britain between 1800 and 1845, she found in a third of them pain treated as something to be read rather than removed — a gauge of how much a patient could bear, and a stimulant preventing a failing body from giving way — while the teaching manuals of the same years warn against the depressing effects of insensibility. A profession that held suffering to be physiologically useful, she reasons, had no motive to seek a means of abolishing it. The gas parties of the 1830s are on her account the decisive illustration: hundreds of people watched others rendered senseless for entertainment and felt no prompting whatever to carry the observation into an operating theatre.

EDouglas Ferrier accepts the case books and reads them differently. Every surgeon of the period also wrote of pain as an evil, often on the same page, and a phrase lifted from such a page can carry an attitude the whole page will not support. His own account is a material one. Nitrous oxide made on a household scale varied in purity from batch to batch; ether evaporated at room temperature and could not be held at a working concentration in an open sponge; and no means existed of judging a dose except by the patient's own responses, which were precisely what the drug took away. What altered in the 1840s, on his reading, was not the value placed on suffering but the rise of dentistry as a trade with a financial reason to solve the problem, since dentists worked for fees on frightened but conscious patients and could experiment on cases that were in no way life-threatening. He adds that the surviving case books come overwhelmingly from the large teaching hospitals, so that country practice of the kind Long ran is nearly invisible.

FTwo recent studies have been read as supporting each side and settle neither. A survey of provincial newspapers found painless dentistry advertised in forty-one English towns by the close of 1847, against surgical use recorded at nine hospitals over the same months, which Ferrier takes as proof that the trade with the strongest incentive moved first; Vaughan-Mackie replies that advertisements measure commerce and not conviction. A re-examination of Wells's failed demonstration concluded that the bag of gas had been taken away too early, a finding each historian claims: for one it shows the technique sound and only the apparatus wanting, for the other it shows how readily an unpersuaded audience would read one cry as proof of failure. Perhaps the delay is in part an artefact of the question. We ask why anaesthesia came so late because we know that it came; those living in 1830 were not waiting for it, and had no means of knowing that there was anything to wait for.