From Party Drug to Medical Miracle

 

etherPersons of a certain age who had surgery as children may remember the anesthesiologist placing a gauze covered wire cage over their noses and mouths. With the cage firmly in place, the doctor dripped a liquid onto the apparatus. The liquid turned into a gas within the cage and they eventually drifted into a deep, dreamless sleep. I can attest to the liquid’s very bitter taste because it dripped into my chattering three-year-old mouth prior to my tonsillectomy. When I complained that the substance tasted yucky, the doctor said to stop talking. So much for bedside manner! The awful tasting stuff was ether and its primitive method of administration was not much changed since the Civil War, but thank goodness for that cage and that foul tasting liquid.

L0010649 Interior with a surgeon attending to a wound in a man's side

Credit: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org Interior with  Oil By: Johan Joseph

Imagine surgeons operating without administering anesthesia. It is the stuff of nightmares and horror movies, but it was the reality for patients prior to the 19th century. The use of anesthesia has a fairly brief and somewhat sordid history. Ether, the first incarnation of what we depend on today to render us unconscious during procedures, started modern life as a recreational drug.

Ether does not occur in nature, but it has been a known substance since the 13th century and has been used for medicinal purposes since the 18th. Its early medical use was not as an anesthetic, however. Physicians treated headaches, asthma, and other conditions with ether while remaining ignorant of its best and most important purpose.

ether-frolicsIn addition to medical usage, ether’s effects as a mind altering substance became known to laypersons in both Europe and the United States. In 18th and 19th century Europe, ether drinking became popular, especially in Ireland where the Catholic Church urged its use as an alternative to alcohol addiction. In England and Scotland, ether was added to distilled spirits and sold in pubs. Until the very late 19th century, it was entirely possible to walk into a pharmacy and purchase ether without a doctor’s prescription. In the United States, ether came into its own as an inhaled drug of choice for recreational purposes. Well-heeled, adventurous Americans, especially medical students, attended “ether frolics” where they got high by “huffing”, as today’s kids say, the stuff. Hard to believe what our ancestors accepted as safe, isn’t it? Despite such foolishness, it was these frolics that led to the discovery of ether as anesthetic.

crawford long photoAnyone who knows the city of Atlanta, will recognize Crawford Long as an important figure in Georgia history. A major hospital, public schools, and a museum all bear his name.

Crawford Williamson Long was born November 1, 1815 in Danielsville, Georgia. His father, a wealthy merchant and planter, was a cousin of famed gambler and member of Wyatt Earp’s OK Corral posse, John  Henry “Doc” Holliday. By all accounts, Crawford Long was a very capable student who by age 14 had exhausted all his local academy had to offer. He applied to the University of Georgia in Athens where he earned his A.M. degree in 1835. In 1836, Long began his medical training at Transylvania College in Lexington, Kentucky under the tutelage of renowned surgeon Benjamin Dudley. Long observed and assisted in surgeries where the only options to ease pain at the time were mesmerism (hypnotism), alcohol consumption, and other ineffective methods. No doubt observing surgery performed under such conditions was as disturbing to the young medical student as it was horrendous for the patients. After a year at Transylvania, Long transferred to the University of Pennsylvania where he trained under some of the best practitioners of the day, gaining firsthand knowledge of the latest treatments and methods. He graduated in 1839 and did his hospital internship in New York City. With his education completed, he returned to Georgia and took over a rural practice in 1841 in Jefferson.

The New Georgia Encyclopedia tells us this about Long’s discovery of ether’s most important use:

During his medical school years Long observed traveling showmen who demonstrated hypnotism and sometimes the effects of nitrous oxide, or “laughing gas,” on the crowds. At school Long had also witnessed antics at laughing gas parties and “ether frolics,” in which participants would inhale nitrous oxide or sulfuric ether for entertainment. He observed that attendees often fell or bumped into things but seemed to feel no pain until the effects of the gas wore off.

As he established his medical practice, Long began to experiment with sulfuric ether as an anesthetic. He performed his first surgical procedure using the gas on March 30, 1842, when he removed a tumor from the neck of a young man. Though he performed more surgeries using anesthesia over the next several years and began using it in his obstetrical practice, Long did not publish his findings. Many doctors were skeptical that the use of gases or other chemicals during surgery would provide pain relief, and Long wanted to be sure of his discovery. He made no secret of his investigation among his colleagues and friends in Jefferson, however. Some local residents thought that Long was engaging in witchcraft. Others believed that he was disturbing the natural order of things and that pain was God’s way of cleansing the soul.

An editorial ran in the December 1846 issue of Medical Examiner about a Boston dentist named William Morton who claimed to have used ether as an anesthetic. The January 1847 issue featured several articles about various experiments in etherization. After reading these accounts, Long began writing his own account of his discovery and collecting notarized letters from former patients. In 1849 he presented his findings to the Medical College of Georgia (later Georgia Health Sciences University) in Augusta, and while there he learned of two others who also claimed to be the discoverers of surgical anesthesia—Horace Wells and Charles Jackson. The ether controversy was well under way before Long made his claim. Although the others sought wealth and fame for the discovery, Long simply wanted the recognition of his peers and to alleviate the suffering of patients. An article about his discovery, along with copies of affidavits, was published in the Southern Medical and Surgical Journal in December 1849…[1]

 

While Long did not receive the credit and recognition he deserved during his lifetime, today it is generally accepted that he was the first physician to use ether to eliminate pain during surgery.

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Notes and Resources

  1. https://www.georgiaencyclopedia.org/articles/science-medicine/crawford-long-1815-1878

http://broughttolife.sciencemuseum.org.uk/broughttolife/techniques/ether

https://www.smithsonianmag.com/science-nature/ether-went-from-recreational-frolic-drug-first-surgery-anesthetic-180971820/

https://www.thesunmagazine.org/issues/421/going-under

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2044.1960.tb13901.x

The Right Chemistry: Under the influence of ether