Friday, August 29, 2014

"Ether Day," by Julie M. Fenster

Anyone seen Stephen Soderbergh's new show for Cinemax, "The Knick"? Set in a New York City hospital in the year 1900, Clive Owen stars as Doctor John Thackery -- your typical grumpy, brilliant, drug addicted surgeon. Yes, it might sound a little like period version of "House," but not so far off from the reality of slightly earlier events recounted in Julie Fenster's book "Ether Day."

At least John Thackery was able to work with the benefit of ether, chloroform, and cocaine -- if not antibiotics or reliable electricity!

As early as 1800, English chemist Humphrey Davy wrote that nitrous oxide's ability to eliminate physical pain, "…may probably be used with advantage during surgical operations." Nonetheless, the concept of surgical anesthesia was not seriously considered for the greater part of another half-century.

During that time nitrous oxide (aka "laughing gas") and ether were used in theatrical entertainments, as well as recreational substances of intoxication. As for surgical patients…their options included opium, alcohol, mesmerism, ice, or nothing at all. Sometimes patients were bled until they fainted in preparation for an operation. Procedures from amputations to open heart surgery were performed without benefit of anesthesia.

Friday, October 16, 1846 is the day known as "Ether Day" – the first operation conducted at Massachusetts General Hospital on a patient rendered insensible by means of a so-called "secret" compound "invented" by dentist William Morton. Morton's secret was a mixture of sulfuric ether and orange oil (to disguise the ether smell). Just hours prior to the scheduled surgery, Morton scrambled for help in building an apparatus to deliver the ether mixed with air. His concern for the apparatus was twofold: 1) protecting his commercial control, and 2) controlling the dose to avoid killing patients.

William Morton arrived 25 minutes late to his date with destiny, but he succeeded in bringing his (very) newly designed apparatus with him. Perhaps surprisingly the untested apparatus was successful in controlling administration of ether to the patient – a young man who was undergoing removal of a complicated tumor that was wound around the blood vessels and nerves of his neck.

Another dentist, Horace Wells, who actually knew Morton and was friendly with him, had previously pioneered the use of nitrous oxide in dentistry. An early attempt at using nitrous oxide as an anesthetic for medical surgery was not entirely successful, likely due to poor quality control over the particular batch of gas used. Wells was so humiliated he became physically ill, and dropped out of sight for some time.

Morton quickly followed up his success with the ether mixture he named "Letheon" by applying for a patent. Thus, ether was not only the first successful use of anesthetic gas for surgery, it was the first commercialization of a medical procedure. The medical community was not impressed by the ethics of such a move, disliking both the concept of patenting "a gift to humanity" and the claim of "invention" over such a commonly available chemical.

Despite Morton's patent, many dentists and surgeons – including surgeons for the U.S. Army – proceeded to use ether anesthesia whenever they felt it appropriate without paying any royalties. The mass violation of Morton's patent rights rendered them valueless. Morton also had competition for scientific precedence as the discoverer of inhalation anesthesia. For one, Horace Wells resurfaced, arguing that Morton had lifted the entire concept of inhalation anesthesia from him.

In the meantime, an eminent Scottish obstetrician, Dr. James Simpson, took an interest in finding a better anesthetic gas than ether. Ether is highly flammable – a serious hazard especially at a time when artificial light and heat depended on open flames. It also has a strong smell that makes many people nauseated. Simpson hosted fellow scientists for a series of sniffing parties, eventually identifying chloroform as a promising candidate (it worked well and didn't kill anyone or blow up). 

Chloroform did have its issues though. For one thing, it sometimes killed people. Also, it could be addictive, as evidenced by poor Horace Wells who ended his days dependent on regular chloroform inhalation -- in the midst of accusations that he had been involved in acid attacks on New York City prostitutes.

In the end, chloroform and ether remained in common use well into the 20th century, when better anesthetics were finally developed.

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