Insensibility During Surgical Operations Produced by Inhalation.

[Boston: David Clapp, December 1846].

First separate edition, very rare, of “the first published announcement of the discovery of surgical anesthesia, the most significant contribution to medicine made in the United Sates during the nineteenth century. In the summer of 1846, W. T. G. Morton, a Boston dentist, began investigating the anesthetic properties of sulphuric ether, and by September was using it successfully in his practice. Bigelow at this time was a rising young surgeon with connections to the Massachusetts General Hospital, and it was probably through his influence that Morton was allowed to give there, on 16 October, the first public demonstration of the efficacy of ether as a surgical anesthetic in an operation performed by John Collins Warren. The demonstration was highly successful, as was a repeat performance made the next day, but Morton, who wished to patent the process, refused to disclose the nature of his preparation or to allow any further trials. Bigelow, however, forced the issue by communicating Morton’s results in a brief announcement made on 3 November to the American Academy of Arts and Sciences. On 7 November an amputation was performed with ether, and Morton authorized Bigelow’s publication of the present detailed account of its use, read before the Boston Society of Medical Improvement on 9 November and printed in the 18 November issue of the Boston Medical and Surgical Journal” (Norman). “There have been many advances in the medical world over time that have greatly contributed to ameliorating and prolonging human life. The employment of surgical anesthesia is arguably one of the greatest medical discoveries of all time, and has immensely broadened our ability to treat the ill. While Dr. Henry Jacob Bigelow (1818-1890) was not the inventor of anesthesia, he was the first to publish and advocate its use in the 19th century … His contributions to the medical field have set him apart as one of the most influential and famous surgeons of America in the 19th century” (Malenfant et al). ABPC/RBH list four copies in the last 40 years. OCLC lists only two copies in US (Brown & Stanford).

“Theoretically, when administered, the perfect anesthetic agent should have analgesic properties, induce unconsciousness, prevent memory formation, relax the patient to prevent unwanted movement and be reasonably safe to use. The first agent that was demonstrated to have all these qualities was sulphuric ether [diethyl ether]. Ether was considered ideal due to the fact that low concentrations are required to anesthetize patients, ether does not cause hypoxia when administered, does not cause respiratory depression while acting as an anesthetic and it has a slow induction in the patient. Moreover, ether was easily transported, was much more versatile than nitrous oxide and was easily inhaled because it is so volatile. Ether was therefore a very safe and useful anesthetic, even when used by untrained and uneducated administrators. However, its discovery and widespread use as a general anesthetic took centuries to develop and was fraught with controversy …

“William E. Clarke, a medical student from Rochester, first administered ether as a general anesthetic in January 1842 to young woman named Hobbie who had a tooth removed by Elijah Pope, a dentist. Despite the fact that the procedure was successfully completed without pain, neither Clarke nor Pope published this discovery or made any claim to it until 40 years later. Similarly, on March 30, 1842, Dr. Crawford W. Long from Jefferson, Georgia, administered ether via inhalation from an ether soaked towel to James M. Venable before removing two small tumors from his neck. Long also proceeded to conduct a comparative trial to prove that, “insensibility to pain was caused by ether and was not simply a reflection of the individual’s pain threshold or as a result of self hypnosis.” Despite his ground-breaking methodology and research, Dr. Long did not publish his findings until 1849. By this time, the use of ether as an anesthetic had been widespread for three years and thus Dr. Long was also not credited with the discovery of the first inhalation anesthetic.

“On October 16, 1846, William Thomas Green Morton publicly demonstrated that diethyl ether was that perfect agent that possessed all the theoretical qualities previously mentioned. Dr. John Collins Warren invited W.T.G. Morton to demonstrate his claims of anesthesia, with permission, on Edward Gilbert Abbot as a vascular lesion was excised from the left side of his neck. Morton arrived late to the Bullfinch amphitheatre at the Massachusetts General Hospital in Boston after assembling an apparatus whereby to deliver the ether to the patient. He brought with him his anesthetic apparatus which he called the ‘Letheon,’ so named after the river Lethe in classical Greek mythology which seemingly obliterated painful memories. The apparatus consisted of a tube, placed in the patient’s mouth, connected to a glass globe with a hole on the opposite side of the tube designed to drag air over a rag soaked in sulphuric ether. The patient then inhaled ether gas through the apparatus for four minutes until he fell asleep. At this point, Warren was able to perform surgery while the patient was both unaware of his surroundings and experienced no pain. When the procedure was over, it is claimed that Warren turned to his audience and exclaimed, ‘Gentlemen, this is no humbug.’

“Dr. Charles T. Jackson, a teacher of Morton’s at Harvard Medical School, claims to have been aware of the analgesic properties of ether by February 1842, because he himself had used it to alleviate his own pain. Jackson then claimed that he had taught Morton about the possible anesthetic use of ether and encouraged him to use ether in his dental practice. Morton had also previously learned from both Horace Wells and Charles Jackson through a shared a dental practice with Wells and had studied with him at Hartford between 1841-1843. The partnership broke up when Wells left after financial losses and Morton went on to attend Harvard Medical School in Boston in March of 1844. While attending medical school Morton lived with and was taught by Charles Jackson. Morton saw the analgesic properties that ether possessed when applied directly to the skin and started experimenting on dogs, and later used ether in his dental practice when extracting rotten teeth. It was these experimentations and through this reputation that Morton was invited to publicly demonstrate his claim to having discovered a safe anesthetic agent.

“After the first trial at Massachusetts General Hospital, Morton went on to demonstrate the anaesthetic property of ether on October 17, 1846, when surgeon George Hayward successfully removed a tumour from a woman’s arm without pain. Following this second demonstration, Morton wanted to profit from his discovery and thus refused to tell anyone what his letheon mixture consisted of. It was only under threat of not being allowed to administer any further anaesthesia that Morton disclosed that the compound was, in fact, sulphuric ether. On November 7, 1846, George Hayward performed a leg amputation and a lower jaw removal under ether anaesthesia at the Massachusetts General Hospital with the third and fourth documented administration of ether as a general anaesthetic. Henry Bigelow officially announced the discovery of ether as an anaesthetic in the Boston Medical and Surgical Journal in the November 18, 1846 issue. Bigelow also sent a letter to Robert Liston, professor of clinical surgery at the University of London, and to Francis Boott in Great Britain, announcing the discovery. Boott subsequently gave his niece, Miss Lonsdale, anaesthesia on December 19, 1846, when she had a tooth extracted by British dentist, James Robinson. Boott wrote to the Lancet explaining, ‘the whole process of inhalation, extracting and waking was over in three minutes.’ Following this publication, ether as a general anaesthetic was documented in Dumfries, England [sic] on December 19, 1846, by James Frazer as William Scott operated on a patient, and subsequently on December 21, 1846, by Robert Liston at the University College Hospital for the amputation of a thigh and avulsion of a toenail. Following the operation Liston is quoted as stating, ‘This Yankee dodge beats mesmerism

hollow.’ The use of ether as an anaesthetic quickly spread throughout Europe and had continued use throughout Russia, South Africa and Australia by the summer of 1847.

“Following Morton’s public demonstration of ether on October 16, 1846, it did not take long for the ‘ether controversy’ to ensue. Morton, Wells, and Jackson all sought to claim the discovery as their own. Morton applied for a patent for the Letheon, which he was granted on November 12, 1846. Jackson had previously contacted Morton demanding that he was entitled to ten per cent of Morton’s profit, which Morton reluctantly later agreed to. In 1847, the French Academy of Medicine awarded the Monthyon prize of 5,000 Francs jointly to Morton and Jackson. However, Morton refused to accept his half of the reward maintaining that the discovery of ether as an anaesthetic was his and his alone. Morton spent most of the remainder of his life fighting for the claim to his discovery and for financial compensation. The matter ultimately came before the US Congress where the House of Representatives agreed to compensate Morton an undetermined amount. However, this compensation was ultimately dismissed by the Senate and thus Morton was never given any official financial reward in his lifetime. Ultimately, Morton’s refusal to accept anything but full claim to the discovery of ether anaesthesia impeded his recognition and acceptance in the medical community. Many of his peers did not like him and judged him more on his character than his discovery.

“In his book, Tarnished Idol (2001), Richard J. Wolffe says of Morton:

‘Although Morton was responsible for bringing ether anaesthesia into everyday surgical use, he was motivated to do so not by scientific or humanitarian reasons but out of a desire to find a way to perform painless tooth extraction in order to fit more patients … and thereby increase his income considerably, and afterward to patent the process and profit even more from it by leasing its use to other dentists and medical professionals.

‘[Morton was] unpolished, a poorly educated man, with little scientific knowledge and possessed of an unscrupulous character … perhaps even a criminal mind that led him to lie, steal, and commit gross misdeeds in order to achieve his goals … the pursuit of money, no matter how gained. He forged ahead ruthlessly, appropriating the ideas of others, in order to prove the pain alleviating properties of ether, not in the service of humanity or science, but because in his view, the patenting of such a discovery would bring him a fortune … clearly it is another of the bitter ironies of history that fate chose such an unworthy and ill prepared agent to preside as midwife at the birth of the death of pain’” (Van Heerden, pp. 386-9).

“Bigelow was born March 11, 1818 in Boston. His father, Jacob Bigelow, taught medicine at Harvard. Bigelow entered Harvard College at fifteen years old and, after a not entirely smooth undergraduate career (including an incident in which he discharged a musket in his Hollis Hall room) graduated in 1837. He studied medicine both at Harvard and at Dartmouth College (at the latter, under Oliver Wendell Holmes, Sr.), receiving his M.D. at Harvard in 1841. He was elected a Fellow of the American Academy of Arts and Sciences in 1846.

“His ‘Insensibility during Surgical Operations Produced by Inhalation’ (1846), detailing the discovery of ether anesthesia, was selected by readers of the New England Journal of Medicine as the ‘most important article in NEJM history’ in commemoration of the journal’s 200th anniversary. ‘Dr. Harlow’s case of Recovery from the passage of an Iron Bar through the Head’ (1850) brought the case of Phineas Gage out of complete obscurity into merely relative obscurity, and largely neutralized remaining scepticism about the case. Bigelow described the structure and function of the Y-ligament of the hip joint in great detail, and it still carries his name. In 1878 he published ‘Lithotrity by a Single Operation’, in which he described his technique for ‘the crushing and removal of a stone from the bladder at one sitting.’ Prior to this, surgeons would crush a bladder stone and then spend only a few minutes removing the pieces. The remaining fragments would remain for a later session for removal. This resulted in much discomfort and complications as the remaining fragments found an exit on their own. Removing the entire bladder stone in one procedure was a great advancement.

“Bigelow died October 30, 1890 after an accident, at his country home in Newton, Massachusetts” (Wikipedia, accessed 21 March 2018).

This separate printing of Bigelow’s article is something of a bibliographical puzzle. It has the appearance of an offprint, with ‘Reprinted from’ at the head of the first page, followed by the title and date of the journal issue exactly as it appears in the journal publication. However, the main text has been reset, and the final seven controversial paragraphs referring to Jackson and Morton’s proposed patent have been omitted – hence the separate issue is paginated [309]-316, while the journal issue is [309]-317. The separate issue was therefore presumably issued later than the journal issue (as is usually, although not always, the case with offprints). Fulton & Stanton suggest a publication date in December 1846, based on the reprinting of the article in the Hartford Courant, dated 26 December, which has the same text as the separate issue. Fulton & Stanton (IV. 1) also state of the journal issue that “no exact offprint appears to have been made”, so the offered work is without doubt the earliest separate printing.

 

Cushing B380; Dibner 128, note; Fulton & Stanton, The centennial of surgical anesthesia, an annotated catalogue (1946), IV.1; Garrison-Morton 5651; Grolier/Medicine 64A; Heirs of Hippocrates 1859; Norman 232; Osler 1355; Wellcome II, p. 166. Duncum, The Development of Inhalation Anaesthesia (1947), pp. 99-120. Keys, The History of Surgical Anesthesia (1963), p. 29. Malenfant et al, ‘Henry Jacob Bigelow (1818-1890): his contributions to anatomy and surgery,’ Clinical Anatomy 24 (2011), 539-43. Van Heerden, ‘The controversial conquering of pain,’ The Proceedings of the 16th Annual History of Medicine Days, March 30th and 31st, 2007 Health Sciences Centre, Calgary, AB, pp. 383-390.



Reprinted from: The Boston Medical and Surgical Journal, vol. XXXV, no. 16. 8vo (230 x 154 mm), pp. [309]. 310-316. Stitched in self-wrappers as issued, extremeties slightly frayed, corner andspine with wear. Custom slip case.

Item #4503

Price: $4,500.00

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