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Early Anesthesia at Jefferson, Or, "Get a whiff of this..."

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William G. Morton

For millennia, the prospect of surgery without anesthesia (a modern word constructed from the Greek “an” and “esthesia,” meaning, “no sensation”) was a guarantee of unbearable pain for the patient. Attempts to only slightly ameliorate the torture were meted out by overdoses of spirits or drugs, or occasional attempts at Mesmerism or hypnosis. Most scientific inquiries ended up as drawing room amusements. A safe and reliable anesthetic was not to be available until the mid-nineteenth century.

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Thomas Dent Mütter, MD
 
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Edward R. Squibb, MD
 
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Early ether inhaler

On October 16, 1846 the world witnessed the first public demonstration of the administration of ether as an anesthesia during an operation at Massachusetts General Hospital. William Morton, a dentist, is celebrated as the principle in the experiment although the question of what constitutes a “first” has resulted in a wide field of claimants. As early as 1841 or 1842, doctors and dentists had privately etherized patients and the first recorded American use of surgery with nitrous oxide administered to a patient occurred in 1844. But Morton’s well-attended demonstration was to make a huge impact on the future of surgery.

The news spread quickly and Philadelphia recorded its first operational use of ether by Jefferson faculty. Professor of Surgery, Thomas Dent Mütter, performed surgery on an etherized patient for the removal of a tumor from a cheek at his Jefferson clinic on December 23, 1846. Philadelphia’s first obstetrical delivery under ether was directed by Dr. John K. Mitchell, Jefferson’s Professor of Medicine, shortly thereafter.

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John K. Mitchell, MD

In the spring of 1845, Philadelphia Quaker, Edward Robinson Squibb (1819-1900) graduated from Jefferson Medical College and submitted his thesis titled, “Tetanus.” Retained by his alma mater as clerk of clinics, assistant demonstrator of anatomy, curator of the (medical specimens) museum and librarian, he combined these posts with his private practice and his private tutoring business.

By 1848 Squibb had joined the US Navy as a ship’s physician and abandoned his practice and, in taking his military oath, refuted his faith. He spent four years with the Atlantic and Mediterranean Squadrons, silently noting the Navy’s egregious treatment of the men under his care. He published critical accounts of the shabby diet, shameful tradition of flogging, and poor quality of medicines dispensed aboard Navy ships.

During a six-month leave to attend refresher courses at Jefferson, Squibb copiously detailed all of the faculty’s operations utilizing the new “sulphuric ether” in his notebook. He studied chemistry under Dr. Franklin Bache and socialized with these leading physicians from whom he learned of the shortcomings of impure ether as a “wild card” in surgery. Meanwhile, Squibb’s critical words had struck a sympathetic chord with the Navy’s Bureau of Medicine and Surgery for they empowered him to establish a Naval Laboratory in Brooklyn’s shipyard to produce drugs of quality.

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William T. Lemmon, MD

Squibb approached the ether problem in 1853 when he purchased all the brands of commercial ether and found them to be wildly variable in purity and strength. He set a goal to produce pure, consistent, and reliable ether and by 1854 he had perfected his apparatus for distilling ethyl ether by use of steam rather than the dangerously combustive open flame. In contrast to Dr. Morton (who claimed a 10% royalty on each use of ether anesthesia), Dr. Squibb refused to patent the process or apparatus, and (in honorable Quaker fashion) allowed humanity to profit by his labor when he published detailed diagrams and full text of his discovery in the September 1856 issue of the American Journal of Pharmacy.

Budget cuts eventually closed the naval factory and Squibb went on to establish his own giant pharmaceutical company, which dragged the U.S. and other governments toward mandating policies requiring manufacturers to produce uniform and pure drugs. As a member of the 1860 Committee for the Revision of the U.S. Pharmacopoeia, he and his former professors helped lay the groundwork for the healthful production and distribution of drugs which would be crucial to saving lives during the Civil War. In 1906, six years after Edward Squibb’s death, Congress finally passed the Pure Food and Drugs Act.

Throughout the nineteenth century, dispensing anesthesia was viewed by the American medical world (unlike European counterparts) as a task only proper for lowly assistants or nurses to practice. A letter to the editor of the journal, American Medicine, dated October 26, 1901* sheds some light on education and ether:

INSTRUCTION IN ANESTHESIA.

To the Editor of AMERICAN MEDICINE: -- In your magazine of July 20 you say in an editorial that so far as you know the Johns Hopkins is the only medical institution that gives practical instructions in anesthetics. This is entirely untrue. Having graduated from the Jefferson Medical College of Philadelphia in 1900, I wish to say from personal knowledge that in that institution a thorough course of lectures on anesthetics is given by Professor H.A. Hare. Practical instruction, in which the Seniors are allowed to administer the anesthetic, is given in lectures under the direction of Drs. DaCosta, Hearn, Spencer, Horwitz and others.

         E.O. PEARSON, M.D.
         Sheraden, Allegheny Co., Pa.
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Early chloroform inhaler

In the last century, Jefferson’s greatest contribution to this field was due to Dr. William T. Lemmon (1896-1974, JMC 1921). In 1939, as a junior faculty member in the Anatomy Department, Lemmon presented a paper on a method for continuous spinal anesthesia, which extended an earlier technique to provide blocks for lengthier surgeries. The concept, popularized at Jefferson, led to the “continuous epidural” now commonly used in childbirth.

*Thanks to former TJU Archivist Judith Robins for this citation.

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