[Victory over surgical pain : 170 years ago the era of modern anesthesia began - but what happened in the operating theater in the time before?] / Sieg über den Operationsschmerz : Vor 170 Jahren begann die Ära der modernen Anästhesie ­ aber was geschah in der Zeit davor im Operationssaal?

170 years ago, on 6 October 1846, the dentist William Thomas Green Morton, sucessfully demonstrated ether anesthesia in a patient undergoing surgery in the operating theater of the Massachusetts General Hospital in Boston. He thereby put an end to the unthinkable suffering of patients who had to undergo surgery when fully conscious. Before this "discovery" surgical procedures resembled a battle for life and death. Only a few documents exist illustrating the attitude of surgeons concerning their actions and which tortures patients had to tolerate. One of the first German standard operating procedures for the perioperative period was formulated in 1812 by Christian Bonifacius Zang. In her diaries and letters, the english novelist Frances Burney described her mastectomy without anesthesia on 30 September 1811. The Scottish physician and novelist John Brown, in his story of "Rab and his friends", painted a picture of the mastectomy of Ailie Noble by the famous Scottish surgeon James Syme in 1833, also without anesthesia. Finally, in his letters the Scottish scientist George Wilson described the amputation of his left foot at the ankle in January 1843, again by James Syme and again without the use of anesthesia.

Potent Inhalational Anesthetics for Dentistry.

Nitrous oxide and the volatile inhalational anesthetics have defined anxiety and pain control in both dentistry and medicine for over a century. From curious experimentation to spectacular public demonstrations, the initial work of 2 dentists, Horace Wells and William T. G. Morton, persists to this day in modern surgery and anesthesia. This article reviews the history, similarities, differences, and clinical applications of the most popular inhalational agents used in contemporary dental surgical settings.

Advertising in Heroic Couplets: Laughing Gas by Dentist W.J.A. DeLancey.

Dr. William J.A. DeLancey moved to Illinois from New England in 1858 to practice dentistry. Renowned for his good humor and amiable personality, DeLancey penned a seven-stanza poem in heroic couplets titled "Dental Surgery." These mock-heroic verses were published in about half of the Centralia Sentinel weekly newspapers issued in 1864. Inventor of a tooth powder and an electric dental motor, DeLancey became a statewide leader of Freemasonry. Unfortunately, both his vocational dental library and his avocational Masonic one were incinerated by a house fire in 1892. As a lifelong professional dentist, DeLancey was widely regarded as a true pillar of the communities and of the Masonic Temples in which he had served--first in Illinois (Galesburg and then Centralia) and finally in Williamsport, Indiana.

Special article: Horace Nelson MD, John Webster LDS--unrecognized Canadian anesthesia pioneers.

PURPOSE: The timing of the earliest reported ether anesthetics in early 1847, in regions to become Canada in July 1867, was examined using information from on-line and library-based sources. Previous authors had identified the first reported ether anesthetic given by a visiting American dentist in January 1847 in Saint John, New Brunswick. Nevertheless, they had reported three different anesthetics as the second occurrence - which would denote the first anesthetic given by a resident of Canada. PRINCIPAL FINDINGS: We confirmed that there were no reports of ether anesthetics being given in Canada before that reported on January 18, 1847 in Saint John. The information available for our review indicates that the second ether anesthetic, and the first by a Canadian, was given in Montreal by a dentist, Dr. John Horatio Webster, on February 20, 1847. The surgical assistant for that operation, Dr. Horace Nelson, later reported on animal and human experiments with ether, which he had led in Montreal starting in January 1847. CONCLUSION: Earlier authors, who may not have had access to the information now available, came to incorrect conclusions about the first ether anesthetic reported to have been given by a Canadian. Current information indicates that John Webster gave the first reported anesthetic in Montreal on February 20, 1847 following experiments with ether led by Horace Nelson. Both Webster and Nelson deserve recognition as Canadian anesthesia pioneers.

The nitrous oxide "dream" of Cora Gray: a dental anesthesia story of 1884.

In the September 1884 issue of Frank Leslie's Popular Monthly magazine, a fictional dramatic short story was published concerning the dental use of nitrous oxide. Entitled, "Cora Gray," it was written by the well-known American journalist and poet John Whittaker Watson (1815-1848), who authored hundreds of sentimental, tragic and dramatic poems, serials and stories concerning the destitute lives and deaths of downtrodden young women of that time. His greatest poetic effort, "Beautiful Snow," (1869) tells of a young prostitute who freezes to death in a snow bank. Watson, born in New York City, was educated at the University of New York, where he studied medicine. He also developed and used his skills as an engraver, journalist and writer. Watson obviously based his imaginative narrative on his medical knowledge of nitrous oxide and its physical and psychological side effects when inhaled. The story centers around the dreamlike romantic experiences of a 19-year-old female dental patient while she is under the effects of this gas. It explicitly depicts the administration of nitrous oxide and the resulting erotic visions and hallucinations that the young patient experiences. We make reference to other cautionary scientific writings from the late 1800s, in order to point out and clarify the potentially negative repercussions of nitrous oxide when administered to female dental patients without the presence of a third party. The ethics and propriety of anesthesia administration remain as perennial questions in dentistry to this day.

Horace wells' demonstration of nitrous oxide in Boston.

Horace Wells, a dentist in Hartford, Connecticut, first used nitrous oxide in dentistry in December 1844. A few weeks later he travelled to Boston, Massachusetts, to demonstrate to physicians and dentists the use of nitrous oxide in painful procedures. Wells' unsuccessful demonstration of nitrous oxide for the extraction of a tooth is well known, but other details of this trip are poorly understood. A description of Wells' visit to Boston was compiled using information from 21 statements and 5 newspaper notices. The precise date and location of Wells' demonstration could not be determined. There is no primary evidence that Wells' demonstration occurred in the surgical amphitheater (Ether Dome) at Massachusetts General Hospital. Wells' demonstration of nitrous oxide probably occurred around the end of January 1845, in a public hall on Washington Street, Boston.

Sites and artifacts related to Horace Wells in Hartford, Connecticut.

Horace Wells, a contender for recognition as the discoverer of anesthesia, is celebrated in the town where he conducted most of his work, Hartford, CT. His only descendant was his son, Charles Thomas Wells (1839-1909), an influential and successful business executive at Aetna Insurance Company. He was a man of considerable influence, and he worked tirelessly with city officials and the Connecticut Dental Association in celebrating the 50th anniversary of his father's contribution to medicine. This discovery is unique because events and individuals in 1 country, the United States, contributed entirely to the birth of a medical specialty. Sites in Jefferson, GA; Hartford, CT; and Boston, MA and their environs celebrate this most precious contribution to modern medicine, especially since the introduction of safe anesthesia permitted the development of surgical specialties and obstetrics. We trace the history and relationship between Horace Wells and several sites and artifacts in Hartford, CT. These sites span the most important, distinctive, and attractive parts of the city: Bushnell Park, Trinity College, Cedar Hill Cemetery, the Athenaeum, and the Connecticut Historical Society.

Keeping ether "en-vogue": the role of Nathan Cooley Keep in the history of ether anesthesia.

In this report, we explore the little known role of Dr Nathan Cooley Keep in the dissemination of ether anesthesia in Boston. Keep was a prominent Boston dentist who, for a short time, taught and employed both William Morton and Horace Wells. He used ether anesthesia for a variety of dental and other surgical procedures requiring pain control. Keep administered ether to anesthetize Henry Wadsworth Longfellow's wife during the delivery of their daughter. This was the first use of ether for obstetric anesthesia. Dr Keep was also the first Dean of the Harvard Dental School and convinced the Massachusetts General Hospital to appoint a dentist to the staff of the hospital for the first time.

C.T. Jackson's 15 October 1846 letter to J.-B.A.L. Elie de Beaumont: Jackson's thoughts on Ether Day's Eve?

As did the previous letter on 30 November 1845 from Charles T. Jackson to J.-B.A.L. Elie de Beaumont, this 15 October 1846 missive underscores the cordial professional relationship between the two geologists. Remarkably, in this "Ether Day's Eve" letter, Jackson never reveals whether he had any clue that W.T.G. Morton would be publicly demonstrating ether anesthesia for surgery the next morning. More importantly, since Elie de Beaumont would play a future pivotal role in assigning initial credit for "discovering anesthesia" to his geological colleague Jackson, rather than to Morton, letters such as these from November of 1845 and October of 1846 can only raise more questions about the impartiality of Elie de Beaumont.

Dentist-physician George J. Ziegler: rogue researcher, "cosmic" editor and social activist.

An industrious self-made man, George Jacob Ziegler (1821-1895) was successively a hairdresser, dentist, physician, author and editor. He is best known as the medical editor of the Periscope section of the Dental Cosmos, and as a social activist who championed the welfare of soldiers, women, and nonsmokers. Ziegler's most unfortunate legacy was his research on dogs, which he misinterpreted as demonstrating nitrous oxide's safety in resuscitation. Pointing to Ziegler's work, dental anesthetist G.Q. Colton would popularize clinical use of 100% nitrous-oxide anesthetics during his 35-year professional career. Consequently, hundreds of thousands of patients worldwide received asphyxial anesthetics.

Morton's Letheon: When was the name Letheon chosen?

Letheon was the commercial name that Boston dentist William T. G. Morton chose for his ether-based "preparation" that was inhaled to produce insensibility during surgical and dental procedures. The multiple editions of Edward Warren's Some Account of the Letheon (1847) as well as Nathan P. Rice's Trials of a Public Benefactor (1859) provide the only known accounts of the meeting hosted by the physician Augustus A. Gould at which the name Letheon was chosen. Neither Warren nor Rice mentions when the meeting occurred. In all likelihood, it was held at some point in a three-week period from mid-November to just short of December 9, 1846, the publication date of the earliest known reference to the name. The absence of the word Letheon in Morton's public notices around the end of November 1846 or, indeed, in any document until his December 9 advertisement in The Boston Medical and Surgical Journal suggests a later date for the meeting than has been previously reported.

Elton Romeo Smilie, the not-quite discoverer of ether anesthesia.

Like William T.G. Morton, Elton Romeo Smilie (1819-1889) was raised in Massachusetts, attended medical school in New England, practiced dentistry there, strove for clinical invention, and moved to Boston. In October 1846, both announced that inhaled ethereal preparations achieved reversible insensibility in surgical patients. Smilie published a report in the Boston Med Surg J 3 wk before Bigelow used that forum to broadcast Morton's Ether Day. Smilie's preparation was an ethereal tincture of opium, and, as he mistakenly believed the opium to be volatile and important, he ceded priority to Morton for ether anesthesia. The two authors collaborated on chloroform, but Smilie soon headed off in the Gold Rush to California. It is tempting to speculate that Charles T. Jackson and Morton were indebted in part to Smilie.

How chloroform anesthesia reached Lowell, Massachusetts: From Simpson's pamphlet to Gladwin's advertisement.

J.Y. Simpson of Edinburgh, Scotland discovered chloroform anesthesia in November 1847. During this time, W.T.G. Morton's agents had been collecting royalties for the use of ether across much of the United States. After reading about the advantages of chloroform as cited in C.T. Jackson's writings in the Boston Daily Atlas, S.F. Gladwin, a dentist in Lowell, Massachusetts, who had been reluctant to pay any ether royalties, demonstrated his independence and opportunism in swiftly adopting chloroform in his practice and publicizing its use through local advertisements.