Chapter X: Part 10

Galileo's discovery of the satellites of Jupiter, the rings of Saturn, his experiments with the pendulum, his construction of the telescope, as well as of the thermometer, and many other deeds, have stamped him as one of the great figures in the history of progress and science. It is most interesting to note that this contemporary of Harvey's, like himself, was given to inductions obtained from experimental studies. Another great astronomical light of Harvey's time was Keppler, who was driven from one place to another by religious fanaticism, until he ended his life in 1630. It was he who formulated the great principle which underlies the motions of the planets, and who gave to the world his so-called "laws," which so materially advanced the science of astronomy. It was he who really discovered that comet which was later given Hailey's name, whose periodic return he first foretold.

Such was the spirit of the times in which Harvey lived, and such the influences which surrounded his teachers before him and himself in turn. It makes a long preface to a consideration of what Harvey himself accomplished, but it is not without its interest because men and their deeds must be judged largely by their environment. Now, to speak more particularly of Harvey himself, and what was known of the circulation when he undertook his investigations.

The liver had been considered, from time immemorial, as the principal factor in the production and movement of the blood. The ancients supposed that here the veins took their origin and that through them the blood flowed to all parts of the body, returning to its source by an undulating movement or series of alternate waves. The arteries had been supposed to contain only vital spirits, whose great reservoir was the heart, although Erasistratus had admitted that in certain cases blood might escape into the arterial channels. Later Galen showed that the arteries always contained blood, and he knew that blood was poured into the right side of the heart by the great veins, but believed that only a little of it passed from the right ventricle into the lungs, the greater part of it passing through hypothetical pores in the septum and thus into the left ventricle. This opinion, like Galen's in other respects, remained unchanged until the middle of the 16th century. It was also known that valves existed within the veins, and that if an artery were tied on a living animal blood would cease to flow and pulsation be checked below the ligature, while if a vein were tied it shrunk above the ligature and became distended below.

Three men before Harvey's time came very near to discovering the secret that made him famous; in fact, they made such advances on what was already known that history should accord them a distinguished place. One was _Columbus_, who was born at Cremona in 1490, and died in 1559. He was first a pupil and prosector and then a friend of Vesalius, the great anatomist. Later he succeeded him at The University of Padua and unfortunately, after gaining his position, ungratefully turned upon his old teacher. He was, however, for his day a good anatomist and especially a good osteologist. It was he who first demonstrated experimentally that blood passes through the lungs into the pulmonary veins and that the latter connect with the left ventricle. He thus practically established the fact of the lesser circulation. He suffered, however, as did Servetus, from the prevailing notion that spirits and blood were mixed together. From Padua Columbus went to Pisa, and then to Rome. He wrote with elegance and correctness of style and even described the vessels which penetrate the bone cells, the ossicles of the ear, the minute anatomy of the teeth, the ventricles of the larynx, as well as those valves which prevent the return of blood from the lungs to the heart. In fact, he narrowly missed the significance of the actual facts of the case, simply failing in his final analysis and assembling of those facts which he had already demonstrated.

_Cesalpinus_, who lived a little later, came still nearer the mark, having accepted the teachings of Columbus regarding the course of the blood through the lungs. He added that the ultimate arterial branches connect with those of the veins, and he taught that blood and vital spirits, from which the ancients could never separate themselves, passed from the arteries into the veins during sleep, as was demonstrated by the swelling of the veins and the diminution of the pulse at that time.

A little later came _Michael Servetus_, who figures principally in history as a theologian and a victim of theologians, since he perished a martyr to Calvin's jealousy. He was, in effect, a wisely and widely educated man who did a great deal for science, one of the offences attributed to him being an edition of Ptolemy's geography, in which Judea was described as a barren and inhospitable land instead of one "flowing with milk and honey." This simple statement of a geographical fact was made a tremendous weapon of offence by Calvin, who replied that even if Servetus had only quoted from Ptolemy and, although there were ample geographical proofs, it nevertheless "unnecessarily inculpated Moses and grievously outraged The Holy Ghost." Servetus dared to deny the passage of the blood through the septum of the heart, and contended that that which comes into the right side was distributed to the lung and returned to the left ventricle. He published his views, however, in a religious treatise on Errors concerning The Trinity, a most unfortunate place in which to inject such an important fact, since it gave his enemies a still greater opportunity to vent and ventilate their spleen. Had he been able to leave out that notion of vital spirits, which prevailed with all his predecessors, he might actually have made the great discovery left for Harvey to enunciate. I have not been able to refer to original documents in this matter, but it is claimed by some that his description of the circulation was contained in another religious work concerning the Restitution of Christianity, which was printed in Nuremberg in 1790.

Such was the actual state of knowledge concerning the movements of the blood and the functions of the heart when Harvey published his great work. It behooves us now to proceed with a short account of Harvey's own life and researches.

_William Harvey_ was born at Folkestone on the first of April, 1578. He was the eldest son of a prosperous merchant who raised a large family and who occupied the highest positions of honor in his own town. The son William was born to his second wife, by whom he had seven sons and two daughters. All of these children were helped to remunerative or honorable positions. They became merchants or politicians or secured prominence in some way, but William was the only one to study medicine. He was sent to the King's school at Canterbury, in 1588, and he was admitted at Caius, in Cambridge, in 1593, where he graduated in arts in 1597. The following year he went to Padua, which then had one of the greatest medical schools of the time, and he obtained his medical diploma in 1602, when twenty-four years of age. Returning to England he received a doctor's degree at Cambridge, and shortly afterward married a daughter of a London physician and entered upon the practice of medicine in London.

In the great city his practice as a physician seems to have been from the outset successful, and his knowledge and ability procured him various valuable appointments. He was made a Fellow of The College of Physicians in 1607. This Royal College of Physicians was given a grant of incorporation by Henry VIII in 1518, at the intercession of Chambers, Linacre and Ferdinand Victoria, the King's Physicians, it being under the patronage of Cardinal Wolsey. The first meetings were held at Linacre's house which he bequeathed to the corporation at his death. Until this College was founded practitioners of medicine were licensed to practise by the Bishop of London or by the Dean of St. Paul's.

A few years later Harvey was appointed Physician-Extraordinary to King James I, and later yet, after the publication of his great treatise and its dedication to the King, he was made Physician-in-Ordinary to Charles I, whom he attended during the Civil Wars.

It must have been about 1615 when Harvey first began expounding his views on the circulation of the blood, during lectures which were delivered at The College of Physicians, but it was not until thirteen years later, i. e., in 1628, that his great work DE MOTU CORDIS was published in Latin, as was customary among scholars, and at Frankfort-on-the-Main, since that was then the great center of the book publishing trade.

The treatise was dedicated to King Charles I, in a manner which to us would seem servile, and yet which was according to a custom followed by nearly all of the scholars of the day, who desired to attract not only the attention of royalty, but, in most instances, their benevolent assistance. It is worth while to quote at this point the first sentence or two of his dedication:

"To the
Most Serene and Invincible
CHARLES,
of Great Britain, France and Ireland,
KING: DEFENDER of the FAITH,
Most Serene King,

"The heart of animals is the basis of their life, the principle of the whole, the Sun of their Microcosm, that upon which all movement depends, from which all strength proceeds. The King in like manner is the basis of his Kingdom, the Sun of his World, the heart of the Commonwealth, whence all power derives, all grace appears. What I have here written of the movements of the heart I am the more emboldened to present to your Majesty, according to the Custom of the present age, because nearly all things human are done after human examples and many things in the King are after the pattern of the heart."

The dedication was followed by a Proemium which one may hardly read to-day without emotion. In it he sets forth the mystery that has surrounded the subject of the motion and function of the heart, as well as the attendant difficulties of the subject, speaking of his own early despair that he would ever be able to clear up the subject. He even said that at one time he found the matter so beset with difficulties that he was inclined to agree with Fracastorius "that the movements of the heart and their purpose could be comprehended by God alone." Only later was this despair dispelled by a suggestion when, as he says: "I began to think whether there might not be a movement in a circle" when thus the truth dawned fully upon him.

We shall have to speak later of the opposition provoked by the appearance of this work and its almost general rejection. It is perhaps, however, but just to those who disputed Harvey's discoveries to recall that no complete and actual demonstration of the actual circulation was possible at that time, nor for many years after, and until the introduction of the microscope, the common magnifying glass of that day being the only lens in use. It remained for Malpighi to demonstrate the blood actually in circulation in the lung of a frog some three or four years after Harvey's death, in 1657. But Harvey lived long enough to see his views gain general acceptance, and though at first, and as the result of the opposition provoked by his publication, his practice fell off mightily, he later regained his professional position and rose to the highest eminence, being elected in 1654 to the Presidency of the College of Physicians. To this institution he proved a great benefactor, making considerable additions to the building after its destruction in The Great Fire of 1666 and its subsequent restoration. He also left a certain sum of money as a foundation for an annual oration, to be delivered in commemoration of those who had been great benefactors of the College. This oration is still regularly delivered on St. Luke's Day, i. e., the 18th of October, and is ordinarily known as the Harveian oration. In these orations more or less reference to Harvey's work and influence is always made.

This great man passed away on the 3d of June, 1657, within ten months of his eightieth birthday, thus affording a brilliant exception to the list of men who have rendered great service to the world and not lived long enough to see it appreciated.

As one reads Harvey's own words, the wonder ever grows that it should have remained for him, after the lapse of so many centuries, to not only call attention to what had been said by Galen but apparently forgotten by his successors, namely, that "the arteries contained blood and nothing but blood, and, consequently, neither spirits nor air, as may be readily gathered from experiments and reasonings," which he elsewhere furnishes. He furthermore shows how Galen demonstrated this by applying two ligatures upon an exposed artery at some distance from each other, and then opening the vessel itself in which nothing but blood could be found. He calls attention also to the result of ligation of one of the large vessels of an extremity, the inevitable result being just what we to-day know it must be, and the procedure terminating with gangrene of the limb.

Not long before Harvey's own publication, Fabricius, he of Aquapendente, had published a work on respiration, stating that, as the pulsation of the heart and arteries was insufficient for the ventilation and refrigeration of the blood, therefore were the lungs fashioned to surround the heart. Harvey showed how the arterial pulse and respiration could not serve the same ends, combating the view generally held, that if the arteries were filled with air, a larger quantity of air penetrating when the pulse is large and full, it must come to pass that if one plunge into a bath of water or of oil when the pulse is strong and full it should forthwith become either smaller or much slower, since the surrounding fluid would render it either difficult or impossible for air to penetrate. He also called attention to the inconsistencies between this view and the arrangement of the prenatal circulation; also to the fact that marine animals, living in the depths of the sea, could under no circumstances take in or emit air by the movements of their arteries and beneath the infinite mass of waters, inasmuch as "to say that they absorb the air that is present in the water and emit their fumes into this medium, were to utter something very like a figment;" furthermore "when the windpipe is divided, air enters and returns through the wound by two opposite movements, but when an artery is divided blood escapes in one continuous stream and no air passes."

Discussing further the views which he stigmatized as so incongruous and mutually subversive that every one of them is justly brought under suspicion, he reverts again to the statements of Galen, calling attention to the fact that from a single divided artery the whole of the blood of the body may be withdrawn in the course of half an hour or less, and to the inevitable consequences of such an act; also that when an artery is opened the blood is emptied with force and in jets, and that the impulse corresponds with that of the heart; again that in an aneurism the pulsation is the same as in other arteries, appealing for corroboration in this matter to the recent statements of Riolan, who later became his avowed enemy. Harvey also called attention to the fact that while ordinarily there was a seemingly fixed relation between respiration and pulse-rate, this might vary very much under certain circumstances, showing that respiration and circulation were two totally different processes. Harvey utilized also the results of his researches in comparative anatomy and physiology, for early in his work he called attention to the fact that every animal which is unfurnished with lungs lacks a right ventricle.

In his Proemium he then proceeds to ask certain very pertinent questions which can only be briefly summarized in this place. He asks: First, why, inasmuch as the structure of both ventricles is practically identical, it should be imagined that their uses are different, and why, if tricuspid valves are placed at the entrance into the right ventricle and prove obstacles to the return of blood into vena cava, and if similar valves are situated at the commencement of the pulmonary artery, preventing return of blood into the ventricle, then why, when similar valves are found in connection with the other side of the heart, should we deny that they are there for the same purpose of prevention "here the egress" and "there the regurgitation of the blood?"

Secondly, he asks why, in view of the similarity of these structures, it should be said that things are arranged in the left ventricle for the egress and regress of spirits, and in the right ventricle for those of blood?

Thirdly, he enquires why, when one notes the resemblance between the passages and vessels connected with the opposite sides of the heart, one should regard one side as destined to a private purpose, namely, that of nourishing the lungs, the other to a more public function? Furthermore, he enquires, since the lungs are so near, and in continual movement, and the vessels supplying them of such dimensions, what can be the use of the pulse of the right ventricle, which he had often observed in the course of his experiments? He sums up his inability to accept the explanations previously offered with a phrase which reads rather strangely, even in original Latin: "Deus bone! Quomodo tricuspides impediunt aëris egressum, non sanguinis." i. e., "Good God! how should the mitral valves prevent the regurgitation of air and not of blood?"

He then takes up the views of those who have believed that the blood oozed through the septum of the heart from the right to the left side by certain secret pores, and to them he replied "By Hercules, no such pores can be demonstrated, nor, in fact, do any such exist." Again, "Besides, if the blood could permeate the substance of the septum, or could be emptied from the ventricles, what use were there for the coronary artery and vein, branches of which proceed to the septum itself, to supply it with nourishment?"

Further on in the treatise Harvey sets forth his motives for writing, stating how greatly unsettled had become his mind in that he did not know what he himself should conclude nor what to believe from others. He says: "I was not surprised that Laurentius should have written that the movements of the heart were as perplexing as the flux and reflux of Euripus had appeared to Aristotle." He apologizes for the crime, as some of his friends considered it, that he should dare to depart from the precepts and opinions of all anatomists. He acknowledged that he took the step all the more willingly, seeing that Fabricius, who had accurately and learnedly delineated almost every one of the several parts of animals in a special work, had left the heart entirely untouched.

Passing more directly to the actual work of the heart, he shows that not only are the ventricles contracted by virtue of the muscular structure of their own walls, but further that those fibers or bands, styled "Nerves" by Aristotle, that are so conspicuous in the ventricles of larger animals when they contract simultaneously, by an admirable adjustment, help to draw together all the internal surfaces as if with cords, thus expelling the charge of contained blood with force. Later on he says that if the pulmonary artery be opened, blood will be seen spurting forth from it, just as when any other artery is punctured, and that the same result follows division of the vessel which in fishes leads from the heart. He furnishes a very happy simile to prove that the pulses of the arteries are due to the impulses of the left ventricle by showing how, when one blows into a glove all of its fingers will be found to have become distended at one and the same time. He quotes Aristotle, who made no distinction between veins and arteries, but said that the blood of all animals palpitates within their vessels and by the pulse is sent everywhere simultaneously, all of this depending upon the heart.

It is in Chapter Five of the treatise that he gives, probably for the first time, an accurate published account of just what transpires with one complete cycle of cardiac activity. The passage need not be quoted here, but deserves to be read by everyone interested in the subject, as who should not be? One sentence, however, is worth quotation or, at least, a summary, as follows: "But if the divine Galen will here allow, as in other places he does, that all the arteries of the body arise from the great artery, and that this takes its origin from the heart; that all the vessels naturally contain and carry blood; that the three semilunar valves situated at the orifice of the aorta prevent the return of the blood into the heart, and that they were here for some important purpose,--I do not see how he can deny that the great artery is the very vessel to carry the blood, when it has attained its highest triumph of perfection, from the heart for distribution to all parts of the body."

His Chapter Six deals with the course by which blood is carried from the right into the left ventricle, and here one must admire the large number of experimental demonstrations which Harvey had undertaken upon all classes of animals, for he speaks even of that which occurs in small insects, whose circulation he had studied so far as he could with the simple lens. Furthermore he described the prenatal circulation, omitting practically nothing of that which is taught to-day, showing that in embryos, while the lungs are yet in a state of inaction, both ventricles of the heart are employed, as if they were but one, for the transmission of blood. In concluding this chapter he again states briefly the course of the blood, and promises to show, first, that this may be so and, then, to prove that it really is so.

His Chapter Seven is devoted to showing how the blood passes through the substance of the lungs from the right ventricle and then on into the pulmonary vein and left ventricle. He alludes to the multitude of doubters as belonging, as the poet had said, to that race of men who, when they will, assent full readily, and when they will not, by no matter of means; who, when their assent is wanted, fear, and when it is not, fear not to give it. A little later on he says: "As there are some who admit nothing unless upon authority, let them learn that the truth I am contending for can be confirmed from Galen's own words, namely, that not only may the blood be transmitted from the pulmonary artery into the pulmonary veins and then into the left ventricle of the heart, but that this is effected by the ceaseless pulsation of the heart and the movements of the lungs in breathing." He then shows how Galen explained the uses of the valves and the necessity for their existence, as well as the universal mutual anastomosis of the arteries with the veins, and that the heart is incessantly receiving and expelling blood by and from its ventricles, for which purpose it is furnished with four sets of valves, two for escape and two for inlet and their regulation.

Harvey then noted a well-known clinical fact, that the more frequent or forcible the pulsations, the more speedily might the body be deprived of its blood during hemorrhage, and that it thus happens that in fainting fits and the like, when the heart beats more languidly, hemorrhages are diminished and arrested. The balance of the book is practically devoted to further demonstration and corroboration of statements already made. A study of this work of Harvey's illustrates how much respect even he and his contemporaries still showed for the authority of Galen. It shows still further how nearly Galen came to the actual truth concerning the circulation. Had the latter not adopted too many of the notions of his predecessors concerning the nature of the soul (Anima) and the spirits (Pneuma) of man, he might himself have anticipated Harvey by a thousand years, and by such announcement of a great truth have set forward physiology by an equal period. Independent and original as Harvey showed himself, he seems to have failed to get away from the notion of the vapors and spiritual nature of the blood which he had inherited from the writings of Galen and many others. Nevertheless he also alludes to this same blood as alimentive and nutritive. We must not forget, however, that this was years before Priestly's discovery of oxygen and that Harvey had, like others, no notion of the actual purpose of the lungs, believing that the purification and revivification of the blood was the office of the heart itself.

Along with its other intrinsic merits Harvey's book possesses a clear and logical arrangement, the author first disposing of the errors of antiquity, describing next the behavior of the heart in the living animal, showing its automatic pumplike structure, its alternate contractions and the other phenomena already alluded to, thus piling up facts one upon another in a manner which proved quite irresistible. The only thing that he missed was the ultimate connection between the veins and the arteries, i. e., the capillaries, which it remained for Malpighi to discover with the then new and novel microscope, which he did about 1657, showing the movement of the blood cells in the small vessels, and confirming the reality of that ultimate communication which had been held to exist. Malpighi discovered the blood corpuscles in 1665, but it remained for Leeuwenhoek, of Delft, in 1690, by using an improved instrument to demonstrate to all observers the actual movements of the circulating blood in the living animal. One historian has said that with Harvey's overthrow of the old teachings regarding the importance of the liver and of the spirits in the heart "fell the four fundamental humors and qualities" while Daremberg exclaims: "As in one of the days of the creation, chaos disappeared and light was separated from darkness."

It remains now only to briefly consider how Harvey's great discovery was received. To quote the words of one writer: "So much care and circumspection in search for truth, so much modesty and firmness in its demonstration, so much clearness and method in the development of his ideas, should have prepossessed everyone in favor of the theory of Harvey; on the contrary, it caused a general stupefaction in the medical world and gave rise to great opposition."

During the quarter of a century which elapsed after Harvey's announcement there probably was not an anatomist nor physiologist of any prominence who did not take active part in the controversy engendered by it; even the philosopher Descartes was one of the first adherents of the doctrine of the circulation, which he corroborated by experiments of his own.

Two years after the appearance of Harvey's book appeared an attack, composed in fourteen days by one Primerose, a man of Scotch descent, born and educated in France, but practising at Hull, in which he pronounced the impossibilities of surpassing the ancients or improving on the work of Riolan, who already had written in opposition to Harvey, and who was the only one to whom the latter vouchsafed an answer. It was Riolan who procured a decree of the Faculty of Paris prohibiting the teaching of Harvey's doctrine. It was this same Riolan who combated with equal violence and obstinacy the other great discovery of the age, namely,--the circulation of the lymph.

One of the earliest and fiercest adversaries of Harvey's theory was Plempius, of Louvaine, who, however, gave way to the force of argument and who finally publicly and voluntarily passed over to the ranks of its defenders in 1652, becoming one of Harvey's most enthusiastic advocates.

Harvey's conduct through the controversy was always of the most dignified character; in fact, he rarely ventured to reply in any way to his adversaries, believing in the ultimate triumph of the truths which he had enunciated. His only noteworthy reply was one addressed to Riolan, then Professor in the Paris Faculty and one of the greatest anatomists of his age, to whose opinion great value was always attached. Even in debating or arguing against him, Harvey always spoke of him with great deference, calling him repeatedly The Prince of Science. Riolan was, however, never converted, though whether he held to his previous position from obstinacy, from excess of respect for the ancients, or from envy and jealousy of his contemporary, is not known.

Another peculiar spectacle was afforded by one Parisunus, who died in 1643, a physician in Venice, who, like Harvey, had been a pupil of Fabricius of Aquapendente, who had been stigmatized by Riolan as an ignoramus in anatomy, but who joined with others in declaring that he had seen the heart beat when perfectly bloodless, and that no beating of the heart and no sounds were to be heard as Harvey had affirmed.

With the later and more minute studies into the structure and function of the heart we are not here concerned. The endeavor has been rather to place before you the sentiments, the knowledge and the habits of thought of the men of Harvey's time, with the briefest possible epitome of what they knew, or rather of how little they knew, to account for this later slavish adherence to authority by unwillingness to reason independently, or to observe natural phenomena intelligently, still less to experiment with them. It is, then, rather the brief history of an epochal discovery than an effort to trace out its far-reaching consequences that I have endeavored to give.

Here must close an account which perhaps has been to you tedious, and yet which is really brief, of Harvey's life and labors. He lived to see his views generally accepted and to enjoy his own triumph, a pleasure not attained by many great inventors or discoverers. Lessons of great importance may be gathered from a more careful study of this great historical epoch, but they must be left to your own powers of reasoning rather than to what I may add here. I commend it to you as a fertile source of inspiration, and a line of research worthy of both admiration and imitation. Few men have rendered greater service to the world by the shedding of blood than did Harvey, in his innocent and wonderful studies of its natural movement. Perhaps it might be said of him that he was the first man to show that "blood will tell." What he made it tell has been thus briefly told to you.

I know not how I may better close this account than by quoting the concluding words of his famous book, and especially repeating the lines which he has quoted from some Latin author whom I have not been able to identify. His paragraph and his quotation are as follows:

"Finally, if any use or benefit to this department of the republic of letters should accrue from my labors, it will, perhaps, be allowed that I have not lived idly, and, as the old man in the comedy says:

'For never yet hath anyone attained
To such perfection, but that time, and place,
And use, have brought addition to his knowledge;
Or made correction, or admonished him,
That he was ignorant of much which he
Had thought he knew; or led him to reject
What he had once esteemed of highest price.'"

XIII

HISTORY OF ANAESTHESIA AND THE INTRODUCTION OF ANAESTHETICS IN SURGERY[10]

[10] Commemorative Address delivered at the Medical Department, University of Buffalo, October 16, 1896.

IN COMMEMORATION OF THE SEMI-CENTENNIAL OF THE INTRODUCTION OF ETHER AS AN ANAESTHETIC AGENT

Fifty years ago to-day--that is to say, on the 16th of October, 1846,--there occurred an event which marks as distinct a step in human progress as almost any that could be named by the erudite historian. I refer to the first demonstration of the possibility of alleviating pain during surgical operations. Had this been the date of a terrible battle, on land or sea, with mutual destruction of thousands of human beings, the date itself would have been signalized in literature and would have been impressed upon the memory of every schoolboy, while the names of the great military murderers who commanded the opposing armies would have been emblasoned upon monuments and the pages of history. But this event was merely the conquest of pain and the alleviation of human suffering, and no one who has ever served his race by contributing to either of these results has been remembered beyond his own generation or outside the circle of his immediate influence. Such is the irony of fate. The world erects imposing monuments or builds tombs, like that of Napoleon, to the memory of those who have been the greatest destroyers of their race; and so Cæsar, Hannibal, Genghis Khan, Richard the Lion-hearted, Gustavus Vasa, Napoleon and hundreds of other great military murderers have received vastly more attention, because of their race-destroying propensities and abilities, than if they had ever fulfilled fate in any other capacity. But the men like Sir Spencer Wells, who has added his 40,000 years of life to the total of human longevity, or like Sir Joseph Lister, who has shown our profession how to conquer that arch enemy of time past, surgical sepsis, or like Morton, who first publicly demonstrated how to bring on a safe and temporary condition of insensibility to pain, are men more worthy in our eyes of lasting fame, and much greater heroes of their times, and of all time,--yet are practically unknown to the world at large, to whom they have ministered in such an unmistakable and superior way.

This much, then, by way of preface and reason for commemorating in this public way the semi-centennial of this really great event. Because the world does scant honor to these men we should be all the more mindful of their services, and all the more insistent upon their public recognition.

Of all the achievements of the Anglo-Saxon race, I hold it true that the two greatest and most beneficent were the discovery of ether and the introduction of antiseptic methods,--one of which we owe to an American, the other to a Briton.

The production of deep sleep and the usual accompanying abolition of pain have been subjects which have ever appeared, in some form, in myth or fable, and to which poets of all times have alluded, usually with poetic license. One of the most popular of these fables connects the famous oracle of Apollo, at Delphi, whence proceeded mysterious utterances and inchoate sounds, with convulsions, delirium and insensibility upon the part of those who approached it. To what extent there is a basis of fact in this tradition can never be explained, but it is not improbable from what we now know of hypnotic influence.

From all time it has been known that many different plants and herbs contained principles which were narcotic, stupefying or intoxicating. These properties have especially been ascribed to the juices of the poppy, the deadly nightshade, henbane, the Indian hemp and the mandrágora, which for us now is the true mandrake, whose juice has long been known as possessing soporific influence. Ulysses and his companions succumbed to the influence of _Nepenthe_; and, nineteen hundred years ago, when crucifixion was a common punishment of malefactors, it was customary to assuage their last hours upon the cross by a draught of vinegar with gall or myrrh, which had real or supposititious narcotic properties. Even the prophet Amos, seven hundred years before the time of Christ, spoke of such a mixture as this as "the wine of the condemned," for he says, in rehearsing the iniquities of Israel by which they had incurred the anger of the Almighty: "And they lay themselves down upon the clothes laid to pledge by every altar, and they drink the wine of the condemned in the house of their God," (Chap. II, verse 8), meaning thereby undoubtedly that these people, in their completely demoralized condition, drank the soporific draught kept for criminals. Herodotus mentions a habit of the Scythians, who employed a vapor generated from the seed of the hemp for the purpose of producing an intoxication by inhalation. Narcotic lotions were also used for bathing the people about to be operated upon. Pliny, who perished at the destruction of Herculaneum, A. D. 79, testified to the soporific power of the preparations made from mandrágora upon the faculties of those who drank it. He says: "It is drunk against serpents and before cuttings and puncturings, lest they should be felt." He also describes the indifference to pain produced by drinking a vinous infusion of the seeds of eruca, called by us the rocket, upon criminals about to undergo punishment. Dioscorides relates of mandrágora that "some boil down the roots in wine to a third part, and preserve the juice thus procured, and give one cyathus of this to cause the insensibility of those who are about to be cut or cauterized." One of his later commentators also states that wine in which mandrágora roots have been steeped "does bring on sleep and appease pain, so that it is given to those who are to be cut, sawed or burnt in any parts of their body, that they may not perceive pain." Apuleius, about a century later than Pliny, advised the use of the same preparation. The Chinese, in the earlier part of the century, gave patients preparations of hemp, by which they became completely insensible and were operated upon in many ways. This hemp is the cannabis Indica which furnishes the _Hasheesh_ of the Orient and the intoxicating and deliriating _Bhang_, about which travelers in the East used to write so much. In Barbara, for instance, it was always taken, if possible, by criminals condemned to suffer mutilation or death.

According to the testimony of medieval writers, knowledge of these narcotic drugs was practically applied during the last of the Crusades, the probability being that the agent principally employed was this same hasheesh. Hugo di Lucca gave a complete formula for the preparation of the mixture, with which a sponge was to be saturated, dried, and then, when wanted, was to be soaked in warm water, and afterward applied to the nostrils, until he who was to be operated upon had fallen asleep; after which he was aroused with the vapor of vinegar.

Strangely enough, the numerous means of attaining insensibility, then more or less known to the common people, and especially to criminals and executioners, do not appear to have found favor for use during operations. Whether this was due to unpleasant after-effects, or from what reason, we are not informed. Only one or two surgical writers beside Guy de Chauliac (1498) refer in their works to agents for relief of pain, and then almost always to their unpleasant effects, the danger of producing asphyxiation, and the like. Ambrose Paré wrote that preparations of mandrágora were formerly used to avert pain. In 1579, an English surgeon, Bulleyn, affirmed that it was possible to put the patient into an anaesthetic state during the operation of lithotomy, but spoke of it as a "terrible dream." One Meisner spoke of a secret remedy used by Weiss, about the end of the XVII Century, upon Augustus II., king of Poland, who produced therewith such perfect insensibility to pain that an amputation of the royal foot was made without suffering, even without royal consent. The advice which the Friar gave Juliet regarding the distilled liquor which she was to drink, and which should presently throw her into a cold and drowsy humor, although a poetic generality, is Shakespeare's recognition of a popular belief. Middleton, a tragic writer of Shakespeare's day, in his tragedy known as "Women beware Women," refers in the following terms to anesthesia in surgery:

"I'll imitate the pities of old surgeons
To this lost limb, who, ere they show their art,
Cast one asleep; then cut the diseased part."

Of course, of all the narcotics in use by educated men, opium has been, since its discovery and introduction, the most popular and generally used. Surgeons of the last century were accustomed to administer large doses of it shortly before an operation, which, if serious, was rarely performed until the opiate effect was manifested. Still, in view of its many unpleasant after-effects, its use was restricted, so far as possible, to extreme cases.

Baron Larrey, noticing the benumbing effect of cold upon wounded soldiers, suggested its introduction for anesthetic purposes, and Arnott, of London, systematized the practice, by recommending a freezing mixture of ice and salt to be laid directly upon the part to be cut. Other surgeons were accustomed to put their patients into a condition of either alcoholic intoxication or alcoholic stupor. Long-continued compression of a part was also practised by some, by which a limb could, as we say, be made to "go to sleep." A few others recommended to produce faintness by excessive bleeding. It was in 1776 that the arch-fraud Mesmer entered Paris and began to initiate people into the mysteries of what he called _animal magnetism_, which was soon named mesmerism, after him. Thoroughly degenerate and disreputable as he was, he nevertheless taught people some new truths, which many of them learned to their sorrow, while in the hospitals of France and England severe operations were performed upon patients thrown into a mesmeric trance, and without suffering upon their part. That a scientific study of the mesmeric phenomena has occupied the attention of eminent men in recent years, and that hypnotism is now recognized as an agent often capable of producing insensibility to pain is simply true, as these facts have been turned to the real benefit of man by scientific students rather than by quacks and charlatans.

In 1799, Sir Humphrey Davey, being at that time an assistant in the private hospital of Dr. Beddoes, which was established for treatment of disease by inhalation of gases, and which he called The Pneumatic Institute, began experimenting with nitrous oxide gas, and noticed its exhilarating and intoxicating effects; also the relief from pain which it afforded in headache and toothache. As the results of his reports, a knowledge of its properties was diffused all over the world, and it was utilized both for amusement and exhibition purposes. Davey even wrote as follows of this gas:

As nitrous oxide, in its extensive operation, appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.

It is not at all unlikely that Colton and Wells, to be soon referred to, derived encouragement, if not incentive, from these statements of Davey. Nevertheless, Velpeau, perhaps the greatest French surgeon of his day, wrote in 1839, that "to escape pain in surgical operations is a chimera which we are not permitted to look for in our day."

Sulphuric ether, as a chemical compound, was known from the XIII Century, for reference was made to it by Raymond Lully. It was first spoken of by the name of ether by Godfrey, in the Transactions of the London Royal Society, in 1730, while Isaac Newton spoke of it as the ethereal spirits of wine. During all of the previous century it was known as a drug, and allusion to its inhalation was made in 1795 in a pamphlet, probably by Pearson. Beddoes, in 1796, stated that "it gives almost immediate relief, both to the oppression and pain in the chest, in cases of pectoral catarrh." In 1815, Nysten spoke of inhalation of ether as being common treatment for mitigating pain in colic, and in 1816 he described an inhaler for its use. As early as 1812 it was often inhaled for experiment or amusement, and so-called "ether frolics" were common in various parts of the country. This was true, particularly for our purpose, of the students of Cambridge, and of the common people in Georgia in the vicinity of Long's home. It probably is for this reason that a host of claimants for the honor of the discovery appeared so soon as the true anesthetic properties of the drug were demonstrated.

There probably is every reason to think that, either by accident or design, a condition of greater or less insensibility to pain had been produced between 1820 and 1846, by a number of different people, educated and ignorant, but that no one had the originality or the hardihood to push these investigations to the point of determining the real usefulness of ether. This was partly from ignorance, partly from fear, and partly because of the generally accepted impossibility of producing safe insensibility to pain. So, while independent claims sprang up from various sources, made by aspirants for honors in this direction, it is undoubtedly as properly due to Morton to credit him with the introduction of this agent as an anesthetic as to credit Columbus with the discovery of the New World, in spite of certain evidences that some portions of the American continent had been touched upon by adventurous voyagers before Columbus ever saw it.

The noun "anesthesia" and the adjective "anesthetic" were suggestions of Dr. Oliver Wendell Holmes, who early proposed their use to Dr. Morton in a letter which is still preserved. He suggests them with becoming modesty, advises Dr. Morton to consult others before adopting them, but, nevertheless, states that he thinks them apt for that purpose. The word anesthesia, therefore, is just about of the same age as the condition itself, and it, too, deserves commemoration upon this occasion.

As one reads the history of anesthesia, which has been written up by a number of different authors, each, for the main part, having some particular object in view, or some particular friend whose claims he wishes especially to advocate, he may find mentioned at least a dozen different names of men who are supposed to have had more or less to do with this eventful discovery. But, for all practical purposes, one may reduce the list of claimants for the honor to four men, each of whose claims I propose to briefly discuss. These men were Long, Wells, Jackson and Morton. Of these four, two were dentists and two practising physicians, to whom fate seems to have been unkind, as it often is, since three of them at least died a violent or distressing death, while the fourth lived to a ripe old age, harassed at almost every turn by those who sought to decry his reputation or injure his fortunes.

Crawford W. Long was born in Danielsville, Ga., in 1816. In 1839 he graduated from the Medical Department of the University of Pennsylvania. In the part of the country where Long settled it was a quite common occurrence to have what were known as "ether frolics" at social gatherings, ether being administered to various persons to the point of exhilaration, which in some instances was practically uncontrollable. Long's friends claim that he had often noticed that when the ether effect was pushed to this extent the subjects of the frolic became oblivious to minor injuries, and that these facts, often noticed, suggested to his mind the use of ether in surgical operations. There is good evidence to show that Long first administered ether for this purpose on the 30th of March, 1842, and that on June 6th he repeated this performance upon the same patient; that in July he amputated a toe for a negro boy, but that the fourth operation was not performed until September of 1843. In 1844 a young man, named Wilhite, who had helped to put a colored boy to sleep at an ether frolic in 1839, became a student of Dr. Long's, to whom Long related his previous experiences. Long had never heard of Wilhite's episode, but had only one opportunity, in 1845, to try it, again upon a negro boy. Long lived at such a distance from railroad communication (130 miles) as to have few advantages, either of practice, observation or access to literature. Long made no public mention of his use of ether until 1849, when he published An Account of the First Use of Sulphuric Ether by Inhalation as an Anesthetic in Surgical Operations, stating that he first read of Morton's experiments in an editorial in the _Medical Examiner_ of December, 1846, and again later; on reading which articles he determined to wait before publishing any account of his own discovery, to see whether anyone else would present a prior claim. No special attention was paid to Long's article, as it seemed that he merely desired to place himself on record. There is little, probably no reasonable doubt as to Long's priority in the use of ether as an anesthetic, although it is very doubtful if he carried it, at least at first, to its full extent. Nevertheless Long was an isolated observer, working entirely by himself, having certainly no opportunity and apparently little ambition to announce his discovery, and having no share in the events by which the value of ether was made known to the world. Long's strongest advocate was the late Dr. Marion Sims, who made a strong plea for his friend, and yet was not able to successfully establish anything more than has just been stated. As Dr. Morton's son, Dr. W. J. Morton, of New York, says, when writing of his father's claim: "Men used steam to propel boats before Fuller; electricity to convey messages before Morse; vaccine virus to avert smallpox before Jenner; and ether to annul pain before Morton."

But these men are not generally credited with their introduction by the world at large and, he argues, neither should Long or the other contestants be given the credit due Morton himself. In fact, Long writes of his own work that the result of his second experiment was such as to make him conclude that ether would only be applicable in cases where its effects could be kept up by constant use; in other words, that the anesthetic state was of such short duration that it was to him most unsatisfactory. Sir James Paget has summed up the relative claims of our four contestants in an article entitled Escape from Pain, published in the _Nineteenth Century_ for December, 1879. He says:

"While Long waited, and Wells turned back, and Jackson was thinking, and those to whom they had talked were neither acting nor thinking, Morton, the practical man, went to work and worked resolutely. He gave ether successfully in severe surgical operations; he loudly proclaimed his deeds and he compelled mankind to hear him."

Horace Wells was born in Hartford, Vt., in 1815. In 1834 he began to study dentistry in Boston, and after completing his studies began to practise in Hartford, Ct. He was a man of no small ingenuity, and devised many novelties for his work. In December, 1844, he listened to a lecture delivered by Dr. Colton, who took for his subject nitrous oxide gas, the amusing effects of which he demonstrated to his audience upon a number of persons who visited the platform for that purpose. Wells was one of these. Wells, moreover, noticed that another young man, who bruised himself while under its influence, said afterward that he had not hurt himself at all. Wells then stated to a bystander that he thought that if one took enough of that kind of gas he could have a tooth extracted and not feel it. He at once called upon a neighboring dentist friend and made arrangements to test the anesthetic effects of the gas upon himself the next morning. Accordingly Colton gave him the gas, and Riggs, the friend, extracted the tooth; and Wells, returning to consciousness, assured them both that he had not suffered a particle of pain. He began at once to construct an apparatus for its manufacture. Dr. Marcey, of Hartford, then informed Wells that while a student at Amherst he and others had often inhaled nitrous oxide as well as the vapor of ether, for amusement, and suggested to Wells to try ether. After a few trials, however, it was found more difficult to administer, and Wells accordingly resolved to adhere to gas alone. This was in 1844, two years after Long's obscure experiments, of which, of course, they were ignorant. In 1845, Wells visited Boston for the purpose of introducing his discovery, and among others called upon his former partner, Morton, trying to establish the use of the gas. He soon became discouraged, however, and returned to Hartford, resuming his practice. There he continued to use gas for about two years, but failed to secure its introduction into general surgery, owing to prejudice and ignorance on the part of dentists and physicians alike.

Wells's claims have been advocated by many of his fellow-citizens, and in Bushnell Park, in Hartford, stands a monument erected by the city and the state, dedicated to Horace Wells, "who discovered anesthesia, November, 1844."