In December of 1844 John Tyler was President of the United States. The Congress in Washington was debating the incorporation of the Republic of Texas, independent since 1836. The elections of 1844 had been won by James Polk who would assume the presidency in March of 1845. It was seventeen years before the Civil War.
Medicine and surgery were still very primitive. The good surgeon was the one who could operate the quickest, for example amputate a leg in 90 seconds. The patient had to be restrained by several assistants and generally received a stiff dose of alcohol before the operation. Progresses such as asepsia had to wait several decades for Pasteur, Lister, Koch and others to appear on the scene.
Dentistry was also in a very primitive state. The first dental school in the world in Baltimore, had graduated its first two students only two years earlier, in 1842. The majority of dentists had received their training from other dentists (preceptor system); a few were physicians who practiced dentistry. Dental offices in the cities were generally in the dentist's house; the instruments were primitive, often constructed by the same dentist. Asepsis was unknown.
People living in the countryside or in small towns were periodically visited by "itinerant dentists" who performed mainly extractions. "Dental offices" were outdoors or in special carriages. There were abundant charlatans and some still combined the extraction of teeth with other activities such as barbers or even blacksmiths.
Horace Wells was a young dentist practicing in Hartford, a town of 13,000 inhabitants in the State of Connecticut, about 90 miles north of New York City. He had been born in the State of Vermont on January 21, 1815 in a well-to-do and educated family, and he received a good general education. He trained as a dentist under a preceptor in Boston. In 1836, he opened his dental office in Hartford and was immediately very successful, having among his patients the Governor and his family, as well as numerous politicians and business men. In 1838 he married Elizabeth Wales, a young lady from a very good family; they had only one child, Charles Thomas, born in 1839.
Wells was a modest and unassuming individual, his shyness making him feel uncomfortable in social gatherings; but he was very skillful, open-minded and active. His practice consisted for the most part of tooth extractions and also dental prosthesis, for which it was frequently necessary to pull tooth roots and destroyed teeth. The generalized fear of having teeth pulled prevented many patients from having prosthesis. The suffering of his patients worried the young dentist who was constantly looking for ways to alleviate their pain. In 1838 Wells wrote a small book which shows his decided support of preventive dentistry, oral hygiene and children's dentistry. In spite of his youth, Wells had two students, who would in turn become famous, John Riggs1 and William Morton.
On Tuesday December 10, 1844, Horace and Elizabeth Wells attended a theater show in which Mr. Gardner Q. Colton first described the effects of the inhalation of gases and then administered nitrous oxide to volunteers from the public. Under the influence of the gas, these individuals became excited and euphoric, lost all their inhibitions and laughed ("laughing gas")2 to the delight of the public. Subjects at times could become aggressive and Colton had several strong attendants to protect the public. Colton, self-appointed professor and chemist went from town to town with these shows.
One of the volunteers to receive the nitrous oxide was Samuel Cooley, clerk in the local drugstore and known to Wells. Under the effect of the gas Cooley stumbled and injured his leg. Returning to the auditorium, he sat next to Wells, who asked him if he had pain and Cooley said he had not felt a thing. This impressed Wells who immediately thought of the possible use of nitrous oxide in general and dental surgery.
After the show, Wells contacted Colton and asked him to come to his office the next day bringing the nitrous oxide. That same night, Wells looked for John Riggs, his colleague and former student, and told him about his experience. Together they planned to test the anesthetic possibilities of nitrous oxide by extracting a molar of Dr. Wells that had extensive decay. Both doctors discussed at length the possible dangers and implications of the project. Horace Wells, normally cautious and prudent, showed great decision and resolve.
At 10 AM on December 11, 1844, Colton arrived at Wells' office. In addition to Wells and Colton, present were Riggs, a brother of Colton's and Sam Cooley. Wells sat in the dental chair, Colton opened the rubber bag that contained the nitrous oxide and John Riggs quickly opened the door of the room so everybody could escape if the gas inhalation made Wells dangerously aggressive.
Wells inhaled the gas, his skin whitened, his blue eyes half closed and in a few moments his head fell forward. Colton withdrew the bag from the patient's face, John Riggs grabbed the forceps and with experienced movements caught the molar and luxated it, expecting at every moment to hear the patient screaming and complaining as he had heard in the thousands of extractions he had performed before. But the patient did not grumble. The bloody molar was held by the forceps and the patient continued breathing. Wells woke up and exclaimed: "A new era in tooth pulling".
In fact, others before Wells had seen the anesthetic properties of nitrous oxide and ether. In England, the chemist Humphry Davy and his student Michael Faraday3, had verified them at the beginning of the century but, obviously, their minds were not ready to comprehend its potential usefulness in surgery. Wells' mind was ready, and he could then conceive its potential usefulness and plan the clinical investigation needed to prove it. This is one of the many examples in the history of science showing that the prepared mind can see the road to progress where others see only a fortuitous event.
This discovery transfigured Wells, who started to experiment feverishly with nitrous oxide and other gases, including ether. But he preferred nitrous oxide because he considered it safer. After utilizing the procedure in several patients with great success, he decided to make a presentation in Boston. At that time, Boston, with the Harvard Medical School and the Massachusetts General Hospital, was already a medical center of the greatest importance. Wells contacted William Morton, his former student, who had his dental office in Boston.
Morton, born in 1819, had been one of the first students in the just opened Baltimore College of Dentistry, the first dental school in the world. He left the school, however, before graduating and completed his training with Wells as his preceptor. He was then Wells' partner and finally opened his own office in Boston. By 1844, Morton eager to learn, had enrolled as a part-time student at Harvard in order to increase his knowledge of medicine (and to impress a young lady he later married). Morton had no special scientific interests, but he was a very practical and ambitious individual.
Wells and Morton consulted initially with Charles Jackson, Professor of Chemistry, an erudite man but arrogant and ambitious. Wells' enthusiastic explanations found no echo in Jackson, who denied the fact that gas inhalation can induce anesthesia. The two men then turned to Dr. John Collins Warren, Professor of Surgery at the Massachusetts General Hospital, who, although incredulous, accepted Wells offer to demonstrate his method at the hospital.
On January 20, 1845, this demonstration was performed. Warren presented Wells to his students, but the patient who had been scheduled that morning, for an amputation, refused to be operated. Warren then asked his students if anybody needed a tooth extraction and one student agreed to the intervention. Wells, nervous and insecure, stepped forward and timidly explained his technique.
After examining the patient, Wells applied the gas bag, opened the valve and told the patient to breath deeply. When the patient seemed to lose consciousness, Wells grabbed the forceps and proceeded to perform the extraction. The patient initially did not complain, but then emitted a harsh howl, and after awakening said he had felt pain. The students' laughter and Warren's disdain destroyed the sensitive Wells, who left humiliated and discredited.
Back in Hartford, Wells had a nervous breakdown and had to leave his practice, referring his patients to Dr. Riggs. In July of that year (1845), Wells had partially recovered his health and started to administer nitrous oxide for surgeons to remove tumors or perform amputations. At no time did Horace Wells attempt to obtain an economic benefit from his discovery having always the good of humanity in mind.
More than a year later, William Morton began to be interested in the problem. He consulted Charles Jackson again, about other drugs that might have an effect similar to nitrous oxide. Jackson suggested ether.
Morton performed his first extraction with ether on September 30, 1846. Immediately after, the patient, Eben H. Frost, was requested to sign an affidavit stating that the tooth had been pulled painlessly. This news appeared the following day, October 1, in the Boston Daily Journal, and attracted a large clientele to Morton's office.
Twenty one months after Wells' unfortunate episode, John Collins Warren allowed William Morton to demonstrate the use of ether as an anesthetic. On October 16, 1846, Morton performed a successful demonstration in which Warren removed, painlessly, a tumor from the neck of a patient. Contrary to Wells failure, Morton's presentation was a total success.
William Morton left his practice and started to administer anesthesia with ether for oral and general surgery. For this he developed the first anesthetic mask. Morton initially refused to disclose the type of gas used (he called it "letheon"), but was later forced to reveal that it was ether and to allow its use by hospitals and other institutions. However, he tried to patent, if not the drug, the method for its use. It is obvious that, unlike Wells, Morton sought the fame and money he could derive from this method.
A bitter controversy was unleashed soon afterwards among Wells, Morton and Jackson4 over priority in the discovery of general anesthesia by inhalation. Dr. Crawford Long added his name to the conflict. Dr. Long was a rural physician from Jefferson, Georgia, who claimed he had used ether for surgical procedures in 1842. Long, however, never communicated his experiences, nor did he demonstrate the method to the public or the medical community, until the controversy between Wells, Morton and Jackson became public.
Late in 1846, Wells traveled to Europe, trying to start a business buying and selling art pieces, but found that his fame as the discoverer of anesthesia had preceded him. He gave then successful demonstrations in some leading medical institutions in Paris. Back in the United States, Wells published a booklet entitled "History of the Discovery of the Application of Nitrous Oxide, Ether and Other Vapors in Surgical Operations", in which he asserted his priority.
In January of 1848, Horace Wells moved to New York where he started to experiment with chloroform, trying to establish the best methods and safest doses for its use. Apparently he became addicted to this drug and one evening, on Broadway, while under the influence of chloroform, he sprayed sulfuric acid on the face of two women, burning the neck of one of them. He was immediately arrested, and the judge seeing that he was an educated and polished person, allowed him to go to his living quarters, accompanied by a policeman, to retrieve some personal effects. These effects included a bottle of chloroform and a knife. On Sunday 23, he attended the jail's church and was profoundly impressed by the priest's sermon. That night, in his cell and under the influence of chloroform, Wells committed suicide by severing his femoral artery.
This is how the discoverer of anesthesia died, on January 24, 1848. He was 33 years old.
Wells left two letters. One to the editor of the Journal of Commerce in which, in an obvious state of desperation, he explained that his attack on the women was caused by the delirium brought about by the chloroform. The other letter, very short, was to his wife, asking for forgiveness and saying that he was rapidly losing his mind.
After his death, the news arrived that the Medical Society of Paris had honored him as the discoverer of anesthesia and had made him an honorary member. Numerous other honors were bestowed upon Wells, In 1864, the American Dental Association and, in 1872, the American Medical Association recognized Wells as the discoverer of anesthesia.
After Wells death, the implacable dispute between Morton and Jackson continued, since both wanted to be the recipients of the 100,000 dollars award promised by the U.S. Congress to the discoverer of anesthesia The senator from Connecticut, Truman Smith, derailed in two occasions Morton's attempts to obtain the award with passionate discourses in favor of Wells, citizen of his state.
Both Morton and Jackson mobilized legions of lawyers, lobbyists, newspapermen and politicians to defend their respective causes Morton tried to bribe John Riggs to support him but Riggs responded that his integrity was not for sale. Morton tried also unsuccessfully to obtain the support of Wells' widow, offering her one half of the reward.
The expenses and aggravation caused by this bitter dispute cost Morton all his fortune and also his physical and mental health. He died in 1868, as a consequence of a heart attack. He was 48.
Jackson continued his incessant but fruitless pursuit of the U.S. Congress award, even after Morton's death. Finally, he lost his mind, and was confined for several years to an insane asylum where he died in 1880.
After the first demonstrations of general anesthesia with nitrous oxide or ether by Wells in 1845 and Morton in 1846, its use was rapidly adopted in Europe and the rest of the world. Initially there was some resistance from those who believed that it was "not moral" to eliminate pain, particularly in childbirth. This resistance was overcome when, in 1853, the English physician John Snow used chloroform to eliminate the pain of Queen Victoria at the birth of her eighth child, Prince Leopold. For many years, ether and chloroform, the latter introduced by the Scotsman James Young Simpson in 1847, were the drugs of choice, for both childbirth and surgical interventions.
Gardner Quincy Colton, the "professor" who had introduced Wells to the use of nitrous oxide, went to California during the gold rush. Unsuccessful in finding gold he returned East in 1863. He associated with two dentists to administer anesthesia for tooth extractions and eventually founded a company for this purpose, which was very successful, opening branches in many U.S. cities. Between 1864 and 1897 he and his colleagues administered anesthesia to tens of thousands of persons with no fatalities.
The intuition and decision of Horace Wells that led to the discovery of nitrous oxide as an anesthetic agent started an era of constant progress in anesthesiology and surgery. Anesthesia by inhalation continues to be, a century and a half later, an important avenue of administration of anesthetics. Many anesthetics have been tried and discarded, including ether and chloroform, but nitrous oxide continues to be frequently used.
The contribution of Horace Wells constitutes a milestone of exceptional importance in the progress of surgery and dentistry. After Wells and Morton the dental office (and the operating room) ceased to be a last desperate resource, feared and terrifying, and became a real health service.
1 - Riggs later became interested in Periodontics and he occupies a very prominent place in the history of this specialty of Dentistry, to the point that in the latter part of the 19th century periodontal disease was known as Riggs disease.
2 - Nitrous oxide induces a stage of excitement and relaxation before the stage of sedation and loss of consciousness. Numerous shows in theaters used this property of the gas to entertain the public. This property was also well known in universities and medical colleges where students used it in frolics, not knowing that if its action continued they would enter a stage of painlessness.
3 - Both Davy and Faraday were prominent scientists. Sir Humphry Davy (1778-1829) was an important chemist, Professor of the Royal Institute of London, discoverer of electrochemistry, and inventor of the safety lamp for miners. Michael Faraday (1791-1867) was also a famous chemist, who described the laws of electrochemistry and discovered electromagnetism.
4 - Charles Jackson considered himself not only the discoverer of anesthesia but also the inventor of the telegraph. On his return trip from Europe, in 1832, he met Samuel P. Morse and told him about the experiments on electromagnetism that he had seen in Paris performed by the physicist Andre Marie Ampere. The two men also discussed the experiments performed several decades before by Benjamin Franklin on transmission of electricity. Years later, when Morse invented the telegraph, Jackson sued him saying that Morse had conceived the idea after their conversation and claimed part of the profits.
5 - Simpson was Professor of Obstetrics in Edinburgh, and was the first to use, on January 19, 1847, an anesthetic, ether, to eliminate childbirth pains. Several months later he discovered the anesthetic properties of chloroform.