Doctor's Review: Medicine on the Move

August 20, 2017
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Laugh it off

How two dentists discovered painkillers and changed the face of medicine

These days, physician and patients alike take pain relief for granted. Since local and general anesthesia techniques were discovered and widely put into practice in the second half of the 19th century, the face of medicine changed for the better.

Combined with the discovery of antisepsis around the same time, conquering pain meant that people could reasonably expect to survive surgery and other previously dangerous procedures. Indeed, instead of being a certain harbinger of doom, the figure of doctor slowly morphed into that of a safeguarder of health.

Of course, nothing was guaranteed. Lots of folks still feared the physician, but at least that nasty case of gout which called for an amputation could at long last be handled with more effective means than a rusty blade, a bottle of booze and a leather strap to bite down on. Ironically, the beginning of the end of pain came courtesy of two individuals whose profession continues to strikes fear into the hearts of millions of people worldwide -- dentists.

Little Shops Of Horrors
Without any needles or topical agents to numb the pain, a visit to the dentist was akin to torture. In the 19th century, people went only in cases of utmost necessity, especially because itinerant, unskilled quacks with makeshift tools and virtually no professional training were the only dentists most people had access to.

Aside from the physicians who also practised dentistry, the entire field was often viewed as being on the fringe until well into the 19th century. The first dental school, the Baltimore College of Dental Surgery at the University of Maryland, didn't even open until 1840. Until then, and for many decades after as well, the art of dentistry was passed down from self-appointed teacher-practitioners to apprentice-students.

It isn't hard to imagine why medicine would be far more appealing to most of those interested in a career in healing. Bleeding pock-marked syphilitics or applying putrid poultices to the chests of tuberculars was one thing. But imagine extracting rotting molars and cracking canines on a daily basis without the benefit of so much as a drop of anesthesia -- what kind of a sadist would want to earn a living that way? For one sensitive soul, the agony he was forced to put his patients through spurred him to try to do something about it.

Horace Wells was born into an affluent Vermont family on January 21, 1815. After completing the traditional dentistry apprenticeships in Boston, he was licensed to practice and hung his shingle outside a shop in Hartford, Connecticut, at the young age of 21. His gentle manner and sense of assuredness led to early success, and he counted many influential politicians and prominent New Englanders among his patients.

Though he presciently touted good oral hygiene as a way to prevent painful procedures later on, he continued to be plagued by the agony his patients endured during extractions. A solution presented itself quite unexpectedly during a night at the theatre on December 10, 1844. Wells and his wife were taking in a popular show put on by Gardner Quincy Colton, a med-school dropout who'd enjoyed great success touring America and demonstrating the humourous effects of nitrous oxide.

Phlogisticated Find
The renowned English chemist Joseph Priestley had discovered the stuff -- which he termed "phlogisticated nitrous air" -- in 1772. Though people were aware of its anesthetic properties, most were even more intrigued by its guffaw-inducing effects. Before long, showmen like Colton were putting on "nitrous-oxide capers" to auditoriums full of people cracking up over the silly antics of onstage gas-huffers. On the night that Wells happened to be in the audience, one of the show's volunteer inhalers fell and sliced his leg open while under the effects of the phlogisticated nitrous air.

The injured but still giggling man slid into a chair next to Wells, who asked him if it hurt. The man laughed and said no. And so the proverbial apple dropped onto Wells' head and the history of medicine would be changed forever. Though the medical community had vaguely understood some of the pain-numbing properties of nitrous oxide since Priestley's experiments 50 years earlier, nobody had put two and two together so that there could be a practical application. The eager dentist approached Colton with his idea, and suggested he join him in an experiment, for who better to administer the gas than a man who'd made a fortune perfecting its use? Colton agreed.

 

In another fortuitous coincidence, Wells had a bit of a toothache himself -- a decaying molar whose extraction he'd been understandably putting off. Wells' partner in his practice at the time, dentist John Riggs, agreed to do the pulling. On December 11, 1844, this unlikely trio became the first to use nitrous oxide as an anesthetic.

The extraction was a breeze: Wells felt no pain despite the fact that pulling the tooth required a substantial amount of elbow grease from Riggs. Wells rededicated himself to his task, and began experimenting with other painkillers as well, including ether. But although his patients certainly appreciated his efforts, the dental and medical communities failed to take note.

Showtime Shame
To remedy this situation, Wells was eager to put on a public demonstration of his own. On the night of January 20, 1845, a crowd of doctors and medical students had assembled at the Massachusetts General Hospital amphitheatre to witness the by-then widely rumoured effects of the miracle drug.

The plan was to have Wells apply the gas and then have surgeons amputate a man's leg but, at the last minute, the patient backed out. A volunteer from the audience with a toothache was prepped instead, and a now-unsettled Wells administered the nitrous oxide.

All was going smoothly, or so Wells thought, until the man screamed in pain upon the application of Wells' forceps. Apparently the gas wasn't up high enough or maybe the man's expectations were a tad unreasonable -- without the gas he would have experienced sheer agony -- but his loose lips cost Wells his reputation. The audience erupted in laughter, and people began walking out, leaving Wells utterly humiliated.

Interestingly, it was one of Wells' former partners and students, the well-connected William T.G. Morton who had helped set up the disastrous show at Mass General. Morton had been by Wells' side during his earlier experimentations and was equally enthusiastic about the possibilities of anesthesia, though Morton's drug of choice was ether.

Morton would enjoy far more success with his promotion of ether as a dental anesthetic, perhaps in part because he left dentistry early on to pursue medicine at Harvard and therefore had much greater credibility within the local medical community.

Not long after Wells' failure, Morton dedicated himself to mastering anesthesia. He would become the first to put on a successful public display of anesthesia -- this time, with ether -- during a dental procedure, on September 30, 1846. In collaboration with another physician, Harvard surgery professor John Collins Warren, Morton would also be part of the first team to use ether as an anesthetic during a surgical procedure -- the removal of a neck tumour -- on October 16, 1846.

Tragic Turnaround
Unlike Wells, who simply wanted to spare the world some pain by sharing his discovery, Morton was a businessman at heart and fiercely guarded his surgical secret weapon. He even tried to prevent others from knowing that his miracle drug was ether, and unsuccessfully tried to patent it under another name - Letheon.

Despite his failure to profit from owning ether, he did get other doctors to sit up and take notice. Morton spent the remainder of his life in court, trying to lay claim to the financial benefits of anesthesia (a $100,000 prize had been promised by the US Congress to the first person able to make pain go away). He died alone and impoverished in 1868, having failed in his attempts to bribe both Wells' partner and wife to support his goal. Morton's old mentor, however, fared far worse, despite the purity of his intentions.

After 1845, Horace Wells struggled to come to terms with his failure in Boston. For a while, he continued to preach the benefits of nitrous oxide, but to no avail. Morton's success overshadowed his own, he believed. Eventually, Wells completely gave up dentistry -- according to some accounts, after one of his patients actually died from nitrous oxide complications -- and then took to the road as a travelling salesman hawking household items and art. He sank deeper and deeper into a depression.

In 1848, he tried in vain to revive his experiments and achieve some success, this time using chloroform instead of nitrous oxide. Alas, his principal subject was himself, and he soon grew addicted to the dangerous chemical. Things quickly went from bad to worse. In January of 1848, after a weeklong chloroform bender, a psychotic Wells attacked two women who were reportedly prostitutes with a vial of sulphuric acid. While he was in jail, despite the fact that he'd snuck in some of his precious chloroform, he sobered up just long enough to realize what he'd done. He wrote a note apologizing to his wife, and then sliced into his femoral artery with a razor blade. On the night of January 24, 1848, Horace Wells bled to death at the age of 33.

If only Wells had stuck around a little longer to see his baby take off -- and to bask in the recognition heaped upon him by medical societies and institutions around the world mere weeks after his suicide -- he surely would have died a happier man. But at least he was feeling no pain at the time.

 

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