Origins: Who Really Invented Anesthesia

Before anesthesia, the great constraint on surgery was not skill. It was time. A patient awake and in agony will only be still for so long before pain and shock overwhelm everything else. Surgeons in the early 19th century were therefore evaluated primarily on speed. The Scottish surgeon Robert Liston, operating in London in the 1840s, was famous for completing a thigh amputation in under ninety seconds from first incision to bandage. He held the knife in his teeth to free both hands. Speed was mercy. A slower, more careful surgeon was a crueler one.

The operating theaters of the pre-anesthetic era were not quiet rooms. They were rooms where patients screamed, and where the screaming was understood as a necessary part of what was happening.

The discovery that changed this came, in its several independent versions, from a drug that had already been available for decades and had been used primarily as a party entertainment.

The entertainments that preceded the discovery

Diethyl ether was synthesized in the 16th century by Valerius Cordus, a German botanist, though early chemists called it by various names and its precise history is confused by inconsistent nomenclature across several centuries of records. By the early 19th century it was a known substance, commercially available, and used recreationally.

"Ether frolics" were a documented social phenomenon in the United States and Britain in the 1830s and 1840s. Groups of students, medical men, and curious parties would inhale ether from soaked cloths for the euphoric, dissociative, and occasionally hilarious effects. The participants were typically uninjured even when they fell or struck things, because ether's analgesic properties prevented them from registering impact as pain. This was noticed and remarked upon. Nobody appears to have immediately connected it to surgery.

Nitrous oxide had a parallel and even more visible career as entertainment. Humphry Davy, the British chemist, had documented its pain-relieving properties as early as 1799 in a published work that explicitly mentioned its potential surgical application. He wrote that it might be useful in operations requiring some loss of consciousness. The suggestion was ignored for more than four decades while nitrous oxide became a fixture of popular science demonstrations and traveling shows. A showman named Gardner Colton was touring American cities in the 1840s, charging admission for demonstrations of "laughing gas" that were a mixture of chemistry lecture and comedy performance.

The gap between Davy's 1799 suggestion and the first serious surgical application is approximately 45 years. In that interval, ether parties and nitrous oxide shows were common enough that most educated people in the English-speaking world had either attended one or heard about them.

Crawford Long in Jefferson, Georgia

On March 30, 1842, a physician named Crawford Williamson Long removed a small cyst from the neck of a patient named James Venable at his practice in Jefferson, Georgia. Venable had previously attended ether frolics and was familiar with the substance's effects. He had been reluctant to have the cyst removed because of the expected pain. Long, who had also attended ether frolics and had observed their analgesic properties, suggested ether inhalation as an alternative to simply bearing the pain.

Venable inhaled ether from a cloth, lost consciousness, and the cyst was removed. He reported no pain. Long charged 25 cents for the ether.

Long performed several additional operations using ether over the following years, charging modest fees and keeping records. He did not publish his results. His reasons were practical and cautious: he wanted more cases before making a public claim, and he was uncertain whether to attribute the results to ether specifically or to a combination of factors including the power of suggestion. This caution, which was professionally reasonable, meant that when he finally published in 1849, four years after Morton's public demonstration had already changed medicine, Long was entering a priority dispute he had technically won but publicly lost.

The historical consensus among medical historians is that Long did it first. The scientific community of 1846 did not know that.

Horace Wells and the failed demonstration

Horace Wells was a dentist practicing in Hartford, Connecticut, who attended one of Gardner Colton's nitrous oxide shows in December 1844. During the demonstration a volunteer who had inhaled the gas injured his leg on a bench and seemed not to notice the wound. Wells, who had been observing as a professional rather than a participant, immediately grasped the implication.

He arranged for a tooth extraction while under nitrous oxide the following day, with Colton providing the gas and a dental colleague performing the extraction. It worked. Wells felt nothing. Over the following weeks he used nitrous oxide for more than a dozen extractions in his Hartford practice.

In January 1845 he traveled to Boston to demonstrate the technique before medical students at Harvard Medical School, with the prominent surgeon John Collins Warren in attendance. The demonstration failed. The patient, a young man, groaned or cried out during the extraction. Whether he was genuinely in pain or was reacting to the extraction process while still adequately sedated is disputed. Warren, unimpressed, dismissed the demonstration. The students reportedly jeered.

Wells returned to Hartford. The Harvard demonstration had discredited nitrous oxide as a surgical tool in the estimation of Boston's medical establishment precisely when it needed endorsement.

William Morton and Ether Day

William T.G. Morton was a Massachusetts dentist with commercial instincts and a long record of disputed dealings with partners and creditors. He had been briefly a student of Horace Wells's and was aware of the nitrous oxide experiments. By 1846 he had shifted his attention to ether.

Morton consulted with Charles Thomas Jackson, a Boston chemist, about the properties of ether, a consultation that would later become the subject of an extraordinarily bitter dispute about who deserved credit for what. Morton conducted private experiments on himself and on his dog. By September 1846 he was satisfied enough to use ether on dental patients.

He then requested permission to demonstrate ether before the surgical staff at Massachusetts General Hospital. John Collins Warren, the same surgeon who had watched Wells's failed demonstration, agreed to provide a patient.

October 16, 1846. The operating theater at Massachusetts General Hospital, in the room now called the Ether Dome. A 20-year-old patient named Gilbert Abbott, who had a vascular tumor on his jaw. Morton arrived late, having been detained finishing a dental appliance to hold the ether-soaked sponge in place for the inhalation. Warren had been about to begin without him.

Morton administered the ether. Abbott lost consciousness. Warren removed the tumor. Abbott reported no pain during the procedure.

Warren turned to the assembled observers and said, in the account that has been repeated in every history of anesthesia since: "Gentlemen, this is no humbug."

The word and the war

The physician Oliver Wendell Holmes Sr., better known as a poet and essayist than a medical figure, wrote a letter to Morton in November 1846 proposing names for the new state. He suggested "anesthesia" from the Greek, meaning insensibility. The word was adopted immediately and has been the technical term ever since.

The priority war that followed the success of the demonstration was one of the most prolonged and damaging disputes in the history of medicine. Morton spent years seeking a government payment for his role in the discovery, convinced that he had been cheated of proper recognition and financial reward. Charles Jackson, his onetime consultant, filed competing claims. Horace Wells, who had been first with nitrous oxide, competed for recognition until his death in 1848 - by suicide, in circumstances that suggested profound psychological deterioration. Crawford Long waited until 1849 to publish his 1842 cases and found himself entering a dispute that had already been decided by public events.

Morton died in 1868 in relative obscurity, still pursuing recognition. Jackson spent his final years in an asylum. The priority dispute left all of its major participants worse off than they had been before the demonstration succeeded.

James Young Simpson, the Scottish obstetrician who introduced chloroform as an anesthetic in 1847, sidesteps most of this dispute by being a different person in a different country using a different drug. Queen Victoria's use of chloroform during the birth of her eighth child in 1853 effectively legitimized surgical anesthesia for the British public in the way that no professional debate had managed.

What changed

The transformation of surgery in the years following 1846 was not gradual. It was rapid enough to be visible in a single surgical generation. Operations that had been considered too slow, too painful, or too traumatic to attempt became standard procedure. Surgeons who had spent careers perfecting speed as the measure of mercy could now spend time on precision. Internal surgery, where speed was structurally impossible, moved from the realm of occasional desperate attempts to routine possibility.

The death toll of surgery dropped. Survival rates improved. The entire discipline changed its standards because the fundamental constraint had been removed.

Crawford Long is honored with a statue in the United States Capitol's National Statuary Hall, representing Georgia. William Morton's tombstone at Mount Auburn Cemetery in Cambridge, Massachusetts, carries an inscription identifying him as the discoverer of anesthesia. Both inscriptions are defensible. Neither is complete.

The discovery was made at an ether frolic, applied first in a Georgia country practice, and announced to the world from a Boston operating theater by a man who was almost late. That is how it actually happened.