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“Gentlemen, This Is No Humbug”
The single greatest medical discovery of the last century began as a parlor game, and brought tragedy to nearly everyone who had a hand in it
August/September 1979 | Volume 30, Issue 5
“Mr. Colton, Cooley & … two others stood by the open door ready to run out if Wells jumped up from the chair & made any hostile demonstrations. You may ask—Why did he not get up? Simply because he could not. Our agreement, the night previous, was to push the administration to a point hitherto unknown. We knew not whether death or success confronted us. It was a terra incognita we were bound to explore—the result is known to the world. No one but Wells & myself knew to what point the inhalation was to be carried—the result was painfully problematical to us but the great law of Nature, hitherto unknown, was kind to us & a grand discovery was born into the world.”
Nature had, indeed, been kind, and Wells had been luckier than he may have realized. He was fortunate in the chemical agent used. Nitrous oxide, if properly administered, has always been considered to be one of the safest of inhalation anesthetics. It is inert, inorganic (unable to combine with body tissues), nontoxic and nonirritating. In fact, nitrous oxide is even used as the propellant in cans of prepared whipped cream found in supermarkets.
Fortunate also was the brevity of the operation. Although, as indicated by its chemical designation, N2O, nitrous oxide contains oxygen in considerable quantity, the oxygen is not in a form that the body can use. Administered for the length of time some operations require, pure nitrous oxide would cause brain damage and death; it must be mixed with oxygen when used as an anesthetic.
And there were other problems unknown to Wells and Riggs. The effects of an inhalation anesthetic proceed in four stages. Stage one is simply analgesia, which, in the case of nitrous oxide, is rather pleasant. Toward the end of stage one sensations of pain may greatly diminish or disappear. If inhalation continues, a brief second stage may ensue: delirium excitement. Then the patient passes into the third stage, that of “surgical anesthesia.” Here there are hazards, even with a nitrous-oxide-oxygen mixture. The patient may become nauseated, throw up, aspirate some of the vomit, and choke to death if surgical appliances for clearing the windpipe are not available and in the hands of someone who knows how to use them. Or air supply to the lungs can be cut off by relaxation of the muscles of the tongue or pharynx, which would allow the tongue or epiglottis to cover the glottic opening. And there are other possible difficulties, including stage four, if the patient is allowed to enter it; this can mean respiratory failure, “vasomotor collapse,” and death. The administration of anesthesia is not a job for amateurs.
So much for the terra incognita into which Horace Wells ventured. His conclusion, after this brief exploration, was that the insensibility to pain was caused by the “excitement effect” of the gas. As he put it later, “While reasoning from analogy, I was led to believe that the inhaling of any exhilarating gas, sufficient to cause a great nervous excitement, would so paralyze the system as to render it insensible to pain, or nearly so; for it is well known, that when an individual is very much excited by passion, he scarcely feels the severe wounds which may at the time be inflicted…. I accordingly resolved to try the experiment of inhaling an exhilarating gas myself, for the purpose of having a tooth extracted.”
It must be obvious that Wells did not go through all this reasoning during the few seconds or minutes when Samuel Cooley was dashing around the stage and barking his shins. One must believe that he had been thinking about his hypothesis for a long time; that the word “ EXHILARATING ,” which he saw in large type near the top of Colton’s advertisement, suggested a chance to explore his theory; and that, once in Union Hall that evening, he overcame his natural reticence to go up on the platform and experience for himself the effects of the advertised exhilarant, much to his wife’s astonishment and displeasure. It had not been his own reaction, however, but the experience of Samuel Cooley that put all the pieces together.
Of course, this “excitement theory” did not quite comport with the way Wells had behaved in the chair. He had not become excited but had simply fallen into unconsciousness. Wells later made an explanatory comment. “When I commenced giving the gas, I noticed one very remarkable circumstance attending it, which was, that those who sat down resolving to have an operation performed under its influence, had no disposition to exert the muscular system in the least, but would remain quiet as if partially asleep. Whereas, if the same individuals were to inhale the gas under any other circumstances, it would seem impossible to restrain them from over exertion.”