SELECTED PAPERS Horace Wells: Discoverer of Anesthesia Peter H. Jacobsohn, DDS Division of Oral and Maxillofacial Surgery, Marquette University School of Dentistry, Milwaukee, Wisconsin

Few great discoveries are ever totally the result of only become the first Dean of the newly organized Harvard one individual's labors. In this presentation, a num- Dental School in 1868. ber of names associated with the discovery of anesthesia In 1836 Wells moved to Hartford, Connecticut where will surface. All deserve mention and honor. However, it he built a highly successful practice in a short time. He remained for Horace Wells in 1844 to realize the full invented and constructed most of his own instruments. significance of the discovery of inhalation anesthesia by He was soon ranked among the best dentists in the city. observing the effects of nitrous oxide, realizing the po- His patients included the elite of the Hartford business, tential of nitrous oxide for providing pain-free surgery, social, and political communities; the govemor and his applying the concept successfully to himself and his den- family were among his patients. Late in 1836 he wrote tal patients, and demonstrating his technique to the world home that his profits were from $5 to $20 per day. By for use in surgery with no strings attached. As he said, 1838 he reported clearing $100 per week. It is possible "Let it be as free as the air we breathe." Who was this that before Wells settled in Hartford, he might have been individual whom history records as the discoverer of an- a "traveling" or "itinerant" dentist-a common practice esthesia, and how did his place in immortality become of the day. He would relocate his "operating rooms" six assured? times between 1836 and 1845. Horace Wells was born in January 1815 in Hartford, Moving an office in that day certainly was not as com- Vermont. He descended from aristocratic New England plex as it would be today. There was no plumbing or stock. His ancestors were among the early settlers of Ver- electricity to worry about and almost no mechanical mont. His patemal grandfather, Captain Hezekiah Wells, equipment. Wells would have had the most basic needs, served with honor in the American Revolution and was such as rooms with reasonable natural light and perhaps prominent in affairs of state. His grandmother was related a whale oil lamp to supplement the natural light. He to Jonathan Trumbull, who served as the governor of probably used a chair like the Snell chair invented in Connecticut during the Revolution. 1832. His instruments and supplies would have included Wells' parents were intelligent, cultured, affluent land forceps, hand-held burs and drills, teeth, and gold. More owners and were able to give their three children every than likely he used a Chevalier-type instrument case. He advantage. Horace attended private schools in New also designed and built an instrument case that won an Hampshire and at Amherst, Massachusetts. In his early award from the Massachusetts Mechanics Association at a years, Wells demonstrated inventive and mechanical abil- local exhibition. ity. At maturity he became known as an inventor. He is At 23 he wrote and published a booklet, "An Essay on described as having had a mind of "uncommon restless- Teeth." It described tooth development and oral diseases ness, activity and intelligence." and their treatment. His sound reasoning concerning diet, In 1834 he began to study dentistry at the age of 19 in infection, and oral hygiene were advanced theories for Boston. He trained in a 2-yr preceptership or apprentice- the time. Wells was a strong believer in preventive den- ship, as was common for the day. The first dental school tistry and devoted a full chapter to it in his book. He did not open its doors until 1840 in Baltimore. Although strongly advocated the use of the brush and wrote "those there are no records to indicate who might have been his teeth which are frequently cleansed with a brush seldom teachers, it is probable that his affluent parents would or never decay." have secured the best schooling available with the most He had a good reputation for working with children. reknowned practitioners in the Boston area. It is possible He understood the insidious nature of sugar and wrote, that one of his mentors might have been Dr. N. C. Keep, "There is nothing more destructive to teeth than a com- a well-known Boston dentist, who at the age of 68 would pound sold at nearly every corner of the streets, under the name of candy." He was also well ahead of his time in appreciating the benefits of preserving the primary Received January 5, 1995; accepted for publication March 21, 1995. dentition. He saw the complications of premature loss or Address correspondence to Dr. Peter Jacobsohn, 3819 W. Le removal and cautioned that the primary teeth be "al- Grande Blvd., Mequon, WI 53092. lowed to remain until they are ready to fall out of them- Anesth Prog 42:73-75 1995 ISSN 0003-3006/95/$9.50 © 1995 by the American Dental Society of Anesthesiology SSDI 0003-3006(95)00067-4 73 74 Horace Wells Anesth Prog 42:73-75 1995 selves unless they become too troublesome to be en- a knife." Pain was such a prominent part of surgery that dured." many authorities believed it to be a necessary part of In contrast to most practitioners of his day, Wells rec- surgery and that it was God's will. ognized that filling carious teeth was the most important On December 10, 1844, Wels read in the local newspa- part of the dental art. He wrote, "However simple the per, the Hartford Courant, that there would be "a Grand operation of filling the teeth may appear, it is, in reality, Exhibition of the effects produced by inhaling Nitrous Ox- the most complicated, as well as the most important ide" that evening in Union Hal presented by Mr. G. Q. branch of the profession." Colton. This wpe of nitrous oxide demonstration was a Wels' skills and knowledge are even the more remark- fonn of entertainment of the day. Nitrous oxide, although able when we consider the state of the art of medical and discovered by Priestly in 1776, had found very litfle practi- dental science of that day. During Wells' time the life ex- cal use other than as a recreational drug. Itinerants, such as pectancy of a newbom baby was 35 yr; the best medical Colton, would stage exhibitions in various communities. skill could cure almost no diseases; major surgery was a Colton at one time had been a medical student and pre- virtual death sentence; smalpox was the only communica- sumably had come in contact with nitrous oxide during his ble disease for which there was a known preventive; Pas- medical school years. Wells and his wife attended the ex- teur and the golden age of bacteriology were yet to come, hibition that evening. Wels even volunteered to be one of and the surgeons carried virulent organisms on their hands, Colton's subjects. During the exhibition, Wels observed instruments, clothes, and dressings from patient to patient that some of those who inhaled the nitrous oxide often and from operation to operation. Hospitals in his time were stumbled and injured themselves with no sign of discomfort known as "houses of death." Oliver Wendell Holmes, Sr., Notable among them was Sam Cooley, a local drugstore in an address before the Massachusetts Medical Society clerk, who had sustained a severe injury to his leg, but upon proclaimed; "If all the materia medica as now used could questioning admitted having no pain. Colton described sink to the bottom of the sea, it would be al the better for what happened next "When the audience was going out, mankind and all the worse for the fishes." Dr. Wels came to me and said, 'Why cannot a man have a During Wells' years of practice in Hartford he provided tooth extracted and not feel it under the effects of the gas?' instruction in dentistry to many students. Some would I said I did not know. 'Well,' said he, 'I believe it can be gain considerable renown in their own right. Prominent done. Mr. Cooley did not know that he hurt himself until the among these students were Drs. William T. G. Morton effects of the gas passed off.' Said he, 'I have a big molar and John M. Riggs of "Riggs Disease" fame. Morton and that is decayed and I should be glad to have it pulled.' " Wells would practice together for a short time in Boston. That same evening Wells had a conference wAth his Riggs had offices adjacent to those of Wells in Hartford. colleague, John Riggs. The two men stayed up late into Both of these former students of Wells would play a role the night discussing the possibility of preventing suffering in the discovery of anesthesia. during tooth extraction and surgery by means of the gas A large part of Wells' practice consisted of extracting Wells had just experienced. Riggs would later write that teeth. This is evidenced by the entries in his day book and Wels decided to try to have a bothersome tooth ex- also by the large number of forceps listed on his probate tracted under the influence of nitrous oxide if Riggs would inventory. Wells agonized over the pain and discomfort do the extraction. Riggs agreed to do this on the following that accompanied the extraction of teeth. He knew there day, December 11, 1844. had to be a better way of providing this service and was Riggs described the events of December 11 as follows: always thinking about how he might alleviate the pain of Accordingly, the next moming Dr. Wells came with Mr. tooth extraction. As early as 1840, in a discussion with Colton and his bag of gas to his, Dr. Wells's, office and Linus P. Brockett, a physician of Hartford, Wells was called me in. There were present, besides Dr. Wells and "deeply impressed with the idea that some discovery myself, Mr. Colton, Mr. Samuel A. Cooley, and some would yet be made by which dental and other operations others, whose names I cannot now recall. Dr. Wells, after might be performed without pain." seating himself in the operating-chair, took the bag and Anesthesia for surgery was as yet unknown, therefore inhaled the gas, and after he had been brought suffi- surgery was largely undeveloped. Few surgeons at- ciently under its influence, he threw back his head, and I tempted invasive procedures. Surgery was largely con- extracted the tooth. It was a large molar tooth, in the upperjaw, such as is sometimes called a "wisdom tooth." fined to surface lesions or removal of limbs with patients It required great force to extract it. Dr. Wells did not being physically restrained. The skill of a surgeon was manifest any sensibility to pain. He remained under the measured by the speed of his knife. John Hunter (1728 influence of the gas some time after, and immediately to 1793), a leading anatomist and surgeon of the day, upon recovering from it, he swung his hands and ex- described surgery as a "humiliating spectacle of the futil- claimed, "A new era of tooth-pulling." He remarked he ity of science" and the surgeon as "a savage armed with did not feel any pain from the operation. Anesth Prog 42:73-75 1995 Jacobsohn 75

Riggs went on to say, "We were so elated by the suc- proud and pleased with his student's accomplishment cess of this experiment that we immediately turned our had it not been for the fact that Morton was claiming attention to the extraction of teeth by means of this agent priority for the discovery of anesthesia. To make matters and continued to devote ourselves to this subject for sev- worse, Morton's medical school mentor, Charles Jack- eral weeks, almost exclusively." Riggs also noted that son, claimed that it really was his idea and he should be "two young physicians of Hartford approved of the ad- credited with the discovery of anesthesia. ministration of the gas and performed several painless Much of the remainder of Wells' short life would be operations under the influence of the gas with Wells ad- occupied with the issue of primacy in the discovery of ministering it himself." anesthesia or as his wife would call it, "the gas war." Wells wrote, "On making the discovery I was so elated In late 1846, with the encouragement of some of his respecting it that I expended my money freely and de- supporters, Wells traveled to Europe, the center of med- voted my whole time for several weeks in order to ical knowledge and innovation in those days. In February present it to those who were best qualified to investigate of that year he presented his claim to the French Acad- and decide upon its merits, not asking or expecting any- emy of Sciences, the Academy of Medicine, and the Pa- thing for my services, well assured that it was a valuable risian Medical Society. discovery. I was desirous that it should be as free as the Wells retumed home in late February 1847. During air we breathe." March he wrote and published a pamphlet entitled, "His- It was with this purpose in mind that Wells arranged a tory of the Discovery of the Application of Nitrous Oxide demonstration of nitrous oxide at the Massachusetts Gen- Gas, Ether and Other Vapours to Surgical Operations." eral Hospital in Boston. Wells made the arrangements In it he set forth his claims. He sent copies to be presented through his former student and partner, William Morton, before the medical and scientific societies of Europe to who was now a medical student at Harvard. On January establish his priority in the discovery of anesthesia. 20, 1845, Wells lectured on and demonstrated nitrous In January of 1848 the Parisian Medical Society voted oxide to the senior medical students of Dr. John Collins that "to Horace Wells of Hartford, USA is due all the Warren. He administered nitrous oxide to one of the stu- honors of having first discovered and successfully applied dents and then extracted a tooth. The demonstration was the uses of vapors or gases, whereby surgical operations considered less than successful when the student who could be performed without pain." In addition they later admitted he felt no pain, cried out during the oper- elected him an honorary member of the Society and ation. Wells in self-criticism would reveal that he probably awarded him an honorary MD degree. withdrew the gas bag too soon. By this time Wells had moved to New York City where Dejected and disappointed, Wells returned to Hartford he began to self-experiment with, and undoubtedly be- where he continued to use nitrous oxide in his practice came addicted to chloroform. One evening while under and taught other dentists how to use it. the influence of chloroform, Wells took a vial of sulfuric By April of 1845 Wells had given up his dental practice acid from his office and threw it at two, as he called them, and referred his patients to Dr. Riggs. Wells states that the "abandoned females." He was arrested and jailed. He "excitement of this adventure (Boston) brought on an was allowed to retrieve some personal effects from his illness from which I did not recover for many months, residence including a bottle of chloroform and a razor. In being thus obliged to relinquish entirely my professional deep remorse over what he had done, Wells took the business." chloroform and then severed his femoral artery. There is evidence to indicate that Wells would again Horace Wells, the discoverer of anesthesia, was dead practice sporadically both in Hartford and New York City at 33. He never knew of the honors that would be be- until 1848. In fact, between 1846 and 1848 Wells would stowed on him, including those from Paris just prior to his provide anesthesia for local surgeons for procedures in- death. Once clear thinking and fair mindedness pre- volving amputation and tumor removals. vailed, it was obvious that to Horace Wells belonged the In addition, Wells became involved with other inter- credit for discovering a principle or a concept-that of ests. In 1845 he arranged a "Panorama of Nature," or inhalation anesthesia. natural history exhibition, in Hartford. In 1846 he pat- In 1864, the American Dental Association passed a ented a new type of shower bath and stopped practicing resolution stating "that to Horace Wells, of Hartford, again to devote full time to this project. Connecticut belongs the credit and honor of the intro- But it was a fateful year for Horace Wells; his world duction of anesthesia in the U.S.A." In May of 1870, the began to fall apart. On October 10, 1846, Wells' former American Medical Association at its annual session in student and partner, William Morton, successfully dem- Washington, D.C. resolved "that the honor of the discov- onstrated ether inhalation anesthesia at the Massachu- ery of practical anesthesia is due to the late Horace Wells setts General Hospital. Wells, I believe, would have been of Connecticut."