Credit in science does not always go where it is deserved, especially when discoveries are ‘in the air’ and made by different people at nearly the same time. The first use of anaesthesia in surgery is a case in point. Credit is often given to the American William Morton, who applied the technique on 16 October 1846 at the Massachusetts General Hospital, in Boston. He certainly did use the technique, and generated a lot of publicity for it. But he had been pre-empted in 1842 by the less forceful Crawford Long, at his rural medical practice in Jackson County, Georgia. (Crawford Long was a cousin of John Henry ‘Doc’ Holliday, famous as the dentist friend of Wyatt Earp.) Unlike Morton, Long made a much more thorough and scientific investigation of the anaesthetic technique, including the use of control experiments.
By the early 1840s, it was widely known that inhaling ether could produce sensations of euphoria and even unconsciousness – it was used in some quarters to produce what would now be called a ‘legal high’, at parties known as ‘ether frolics’. It had been used occasionally to relieve the pain of dental extractions, but without any systematic study of what was going on. Long changed all that. On 30 March 1840, in his first operation using ether, the patient was made unconscious using a towel soaked in ether, and Long removed one of two tumours in her neck in front of several medical students. She felt nothing, and did not believe he had actually operated until he showed her the tumour. On 6 June, he removed the second tumour.
Over the following months and years, Long carried out further operations, deliberately using ether on some occasions and not on others to confirm that it was indeed the key factor. As he later wrote: ‘I was fortunate enough to meet with two cases in which I could satisfactorily test the anesthetic power of ether. From one of these patients, [Mary Vinson] I removed three tumors the same day; the inhalation of ether was used only in the second operation, and was effectual in preventing pain, while the patient suffered severely from the extirpation of the other tumors. In the other case, [Isam] I amputated two fingers of a negro boy; the boy was etherized during one amputation and not the other; he suffered from one operation and was insensible during the other.’20
Long was quite open about his work, which was known locally and copied by some of his colleagues, but he did not publish anything or attempt to spread the news until 1849. He even delivered his wife’s second baby painlessly with the aid of ether in 1846, the year before James Simpson independently pioneered obstetric anaesthesia in Britain. But William Morton was unaware of any of this when he carried out his well-publicized demonstration of ether anaesthesia in 1846.
Morton had dropped out of both dental school and medical school, but during his brief time as a medical student at Harvard attended chemistry lectures where he learned about the stupefying power of ether. Being unqualified was no bar to practising dentistry in those days, and, on 30 September 1846, Morton carried out a painlesss tooth extraction using ether. A newspaper report of this success led to an invitation from John Warren, the head surgeon at Massachusetts General Hospital, for Morton to anaesthetise a patient (52-year-old printer, Edward Gilbert Abbott) while Warren operated to remove a tumour from him. This operation, on 16 October 1846, was carried out in front of a large audience of students and surgeons and led to widespread publicity. According to eye-witness accounts, after the operation the patient was asked how he felt and replied ‘it feels as if my neck’s been scratched’. Within weeks, the news had spread to Europe, where Robert Liston used ether during an operation carried out at University College Hospital in London on 21 December. He commented ‘This Yankee dodge beats mesmerism hollow’.
This highlights the second key feature of anaesthesia. Liston was famous as ‘the fastest knife in the West End’, and could remove a leg in two-and-a-half minutes. Such speed was essential if patients were to survive the agonising ordeal of surgery. But when the patients felt no pain, surgeons could take their time over operations, making fewer mistakes and developing more complex techniques to deal with more complicated problems than removing a tumour from a neck or hacking off a leg.