Smoking Ears and Screaming Teeth - Trevor Norton (2010)
Sniff It and See
‘Should my leg be cut off I would never be chloroformed. I would never want to abdicate myself.’ – Honoré de Balzac
John Hunter made it clear that surgery was the last resort. This had always been the patients’ view. Surgery was calculated violence. To lie on the operating table was a guarantee of agony with a sincere promise of death. The patient had an unfortunate habit of screaming, which was distracting for the surgeon, and of writhing in agony, which made accurate knife-work almost impossible. What if the patient were drugged into a stupor?
A thirteenth-century physician administered a lively cocktail of opium, henbane, hemlock and mandragora (a relative of deadly nightshade). He claimed that it produced ‘a sleep so profound that the patient may be cut and feel nothing as though he were dead’. The patient wasn’t fooling – he probably was dead. More practical medics bled or choked the patients into unconsciousness or put a wooden bowl on their head and whacked them with a mallet.
By the late eighteenth century the medical profession had learned to cope with the agony of surgery. The rules were simple:
1. Site the operating room out of earshot of other patients.
2. Be excessively solicitous over the distress caused to the poor surgeon.
3. Strap the patient down securely.
4. Have the patient bite down on the surgeon’s walking stick.
5. Slice and saw at speed.
Surgeons had to be strong, practical men. John Hunter developed his technique with saws in a timber yard. His brother William called surgeons ‘savages armed with knives’. But at least they were quick. William Cheselden, a protégé of Hunter, extracted bladder stones in less than a minute and Robert Liston, the great British surgeon, amputated a leg in twenty-eight seconds. He loved the idea of the operating theatre and would commence each performance by announcing to the audience, ‘Time me, gentlemen. Time me.’ In striving to break his record he not only detached the patient’s leg but also one of his testicles, along with two fingers from Liston’s assistant.
The author Fanny Burney described the horror of a mastectomy. ‘When the dreadful steel was plunged into my breast – cutting through veins – arteries – flesh – nerves … I began a scream that lasted unremittingly during the whole time of the incision … so excruciating was the agony … all description would be baffled … I felt the knife rackling against my breastbone – scraping it.’
Operations were no less agonising in Japan until a surgeon called Seishu Hanaoka did something about it. He had learned some surgical techniques from European books, but for the control of pain he turned to Chinese medicine. After twenty years of experimentation on animals he thought he had the right mix of plant extracts that dulled pain without dangerous side effects. He confidently tried it on his wife. She went blind.
Undeterred, he continued his research and eventually arrived at a concoction containing compounds that we now know to be sedatives, analgesics and muscle relaxants. In 1804 he painlessly removed a tumour for a woman with breast cancer and went on to perform 150 pain-free operations. Unfortunately Japan’s self-imposed isolation from the rest of the world meant that Seishu Hanaoka’s anaesthetic remained a secret.
In Europe some medics were keen to inhale newly discovered gases to see if they had any therapeutic properties. Someone who was sure that they did was Dr Thomas Beddoes. He was somewhat unconventional and conveyed a cow to invalids’ chambers so that they might inhale the animal’s ‘restorative breath’, but succeeded only in ruining their bedroom carpets. He established the Medical Pneumatic Institution in the spa town of Bristol. It advertised gas-therapy ‘cures’ for everything from venereal disease to paralysis by offering snorts of oxygen, carbon dioxide and even what was to become the suicide’s favourite, carbon monoxide, because it brought colour to the cheeks.
The Institution’s superintendent of research was Humphry Davy. He is best remembered today as the inventor of the miners’ safety lamp, but in his lifetime he was enormously famous. He was a gifted communicator and sold science to industrialists as a tool for the production of wealth. By doing so he changed the world for ever.
When Davy came to the Pneumatic Institution he was only twenty-one, but he soon determined that the benefits of the gases were vastly exaggerated. He tested many vapours on himself. After inhaling carbon monoxide he was ‘sinking into annihilation, and had just power enough to drop the mouthpiece from my unclosed lips … There is every reason to believe, that if I had taken four or five inhalations instead of three, they would have destroyed life immediately.’ Breathing pure oxygen immediately afterwards saved his life. Scares didn’t curb his enthusiasm. A week later he sniffed a volatile solvent that seared his epiglottis and made him choke. During these ordeals he calmly monitored his pulse rate even when he thought he was dying.
Davy’s colleagues were always relieved to see him the next morning. One commented that he risked his life ‘as if he had two or three others in reserve, on which he could fall back in case of necessity’.
Following reports that nitrous oxide was a ‘principle of contagion’ that would be instantly lethal to animals, Davy gave it a try. ‘I was aware of the danger of this experiment,’ he admitted. Nitrous oxide is an intoxicant and in those days impurities might render even the most innocuous gas lethal. He increased the dose progressively until he was breathing it three or four times a day for a week.
Luckily there were no ill effects, indeed the gas produced a ‘highly pleasurable thrilling … I lost all connection with external things: I existed in a world of newly connected and newly modified ideas. I theorised, I imagined, I made discoveries.’ Davy enjoyed theorising so much that he was soon taking a staggering twenty-five litres a day. He thought the gas might also improve his poetry (it didn’t). He gave the gas to his friends, Roget of Thesaurus fame and the poets Southey and Coleridge. Southey wrote: ‘It made me laugh and tingle in every toe and finger tip. Davy has actually invented a new pleasure … I am sure the air in heaven must be this wonder-working gas of delight.’ Delight was just what the well-to-do of Bristol were seeking and the number of customers at the Institution increased substantially.
Then serendipity, the researcher’s friend, took a hand. Davy’s emerging wisdom teeth caused a painful inflammation of the gums, but when he breathed nitrous oxide the pain vanished. Never slow to spot an application, he wrote that as nitrous oxide ‘appears capable of destroying physical pain, it may probably be used with advantage during surgical operations’. Here was the miracle that every patient craved: a pain-free operation. Inexplicably, Davy never followed this up and although many medical students also embraced nitrous oxide as a bringer of euphoria, no one thought of it as a practical painkiller for well over forty years.
Nitrous oxide, which Davy called laughing gas, became a party staple. The naturalist Schoenbein attended a garden party at which the gas-fuelled antics of guests laid waste to the flower beds. ‘Maybe,’ he mused, ‘it will be the custom for us to inhale laughing gas at the end of a dinner party, instead of drinking champagne, and in that event there would be no shortage of gas factories.’ Nothing has changed. In July 2007 the BBC news reported concerns that the latest craze for clubbers was breathing nitrous oxide from balloons.
Laughing gas also became a fairground favourite. Just as nowadays hypnotists cajole volunteers onto the stage to make fools of themselves under the influence, showmen once extracted amusing antics with a whiff of gas. The volunteer was told to pinch his nose and inhale gas from a bag. When the bag was withdrawn he sat in a trance ‘still holding his nose. You can imagine how this comical posture sent the audience into roars of laughter which increased when the intoxicated man leapt smartly from his chair and then made astonishing bounds all over the stage.’
In 1844 ‘Professor’ Colton brought such excitements to the entertainment-starved folk of Hartford, Connecticut. In the audience was Horace Wells, a local dentist. He had developed improved dentures but failed to make the fortune he anticipated, for to fit the false teeth all the remaining rotting stumps and roots had to be extracted. In those days tooth-pulling was an excruciating and bloody business. Toothache was often dulled at the mere sight of a dentist.
During Colton’s show one of the volunteers making astonishing bounds cracked his shin. When he returned to his seat, Wells asked about his leg. Although he’d received a nasty gash he felt nothing. Wells immediately grasped that the gas had dulled the pain. He persuaded Colton to bring the apparatus to his house the next day. Colton administered nitrous oxide to Wells himself and a fellow dentist yanked out one of his teeth. Wells rejoiced: ‘It is the greatest discovery ever made. I didn’t feel as much as the prick of a pin.’ He could banish pain and bring love at last to dentists.
In the following days Wells pulled teeth painlessly from fifteen patients. He realised that he must demonstrate pain-free extraction to a medical audience and within a month of his discovery he was scheduled to do so at the prestigious Massachusetts General Hospital in Boston. It was too soon. He did not yet understand that unconsciousness did not necessarily mean insensitivity to pain, nor did he realise that different people might respond differently to the same dose of gas. The audience of medical students was restless, and Dr J. C. Warren, the surgeon who introduced him, was clearly sceptical: ‘This gentleman,’ he announced, ‘who pretends he has something which will destroy pain in surgical operations, wants to address you.’ The word ‘pretends’ made Wells nervous. The trial patient, also understandably nervous, accidentally knocked the instruments onto the floor and the audience laughed. Wells hastily anaesthetised the patient and pulled the tooth. Although there were none of the usual screams and struggles, the patient emitted a loud groan that echoed round the auditorium. The audience responded with jeers and cries of ‘Humbug!’
Wells had given too little of the gas and the patient was not fully under. It was a disaster; a public humiliation from which Wells never recovered. The rest of his life was spent in regret and recrimination and seeking solace by sniffing nitrous oxide. The gas that was supposed to make his fortune ruined his life.
Ironically, nitrous oxide would become the dental anaesthetic of choice. By 1883 the Poe Chemical Works, owned by Edgar Allan Poe’s cousin George, supplied it to 5,000 dentists across the United States, including one enthusiast in Cleveland who ordered 4,000 gallons.
To add insult to Wells’s indignation, it was a former colleague who brought anaesthesia to the public’s notice. William Morton was a dentist and an opportunist. Morton’s old chemistry tutor, Dr Charles Jackson, suggested that sulphuric ether (derived from mixing sulphuric acid and alcohol) might be a better bet than nitrous oxide.
As the growing temperance movement began to hit sales of liquor, sipping diluted ether gained popularity. Communal ether ‘frolics’ were commonplace. The patients treated for chronic ether intoxication by a famous London doctor included ‘persons of education and refinement … mostly women; the men were all doctors’. Morton called ether the ‘toy of professors and students’, and its widespread social use convinced him that it was safe. Perhaps he was ignorant of the numerous complications that ranged from vomiting to death. Ether vapour was also said to be explosive – not ideal in a world lit by naked flames. So Morton inhaled it and then breathed out into a flame. Luckily there was no explosion. It only ignited when lit by a taper.
Before testing its effects on a human, he decided to try it on something disposable – his wife’s pet dog and her goldfish. Both they and his marriage survived, just. He then went out in search of volunteers to be knocked out by the gas and have a tooth yanked to see if it hurt. Not surprisingly there were none, not even for five dollars per head. So Morton shut himself in his office, soaked a cloth in ether and put it over his mouth. With ether it was easy to overdose. A single breath could take in a dangerously large amount of vapour. He collapsed almost immediately, alone with no hope of resuscitation. Fortunately, the cloth fell from his face and about eight minutes later he regained consciousness. When told of his risky experiment, his wife was distraught. The next trial was for his assistant to extract one of Morton’s teeth under ether. By chance a ‘cracker maker’ with severe toothache came to the surgery and willingly took his place. The rotten bicuspid was wrenched out and the patient felt no pain.
The confident Morton arranged a demonstration at the very same hospital where Horace Wells had been humiliated. Morton was late and the operation was due to begin. Dr Warren, who had chaired Wells’s disastrous demonstration, was impatient, but Morton anaesthetised the patient quickly and, with the flourish of an actor, announced, ‘Your patient is ready, sir.’ The surgeon cut into the neck and removed a tumour almost the size a billiard ball. To everyone’s amazement the patient was silent and when the operation was finished Dr Warren declared, to loud applause, ‘Gentlemen, this is no humbug.’ The patient said he had felt no pain; it was merely as if his neck were being ‘scraped with a hoe’.
Three weeks later a young woman called Alice became the first to have a leg amputated under anaesthesia. As the surgeon finished the job he roused her and said, ‘Are you ready?’ She replied, ‘Yes, sir.’ The surgeon responded with, ‘Well, it’s done!’ and brandished her detached leg. Alice fainted with shock.
The word soon spread and within two months of Morton’s demonstration Robert Liston, the lightning leg-lopper in England, used ether for an operation and exclaimed: ‘This Yankee dodge beats mesmerism hollow.’ Oliver Wendell Holmes wrote to Morton coining the word ‘anaesthesia’ (Greek for ‘without feeling’) and wrote in an essay: ‘Inhale a few whiffs of ether, and we cross over into the unknown world of death with a return ticket.’
Morton was in it for the money or, as he put it, ‘personal rights and benefits’. But there was a problem. Ether was as ‘free as God’s sunshine’. He could not patent a chemical that had been known since 1540 so he tried to sell it under the name of Letheon (after Lethe, the stream of oblivion running through Hell). But doctors soon twigged that it was nothing more than good old ether. Morton abandoned dentistry to pursue recognition for having invented anaesthesia, but rival claimants were appearing on all sides. Crawford Long, a doctor in Georgia, had four years earlier successfully excised tumours under ether and had affidavits to prove it, but he had not published and brought his findings to the attention of the medical profession.
Charles Jackson, who had suggested the use of ether to Morton, declared himself to be the discoverer of anaesthesia. However, he was also claiming to have invented gun cotton and was suing Samuel Morse, asserting that he had given him the idea of the electric telegraph. He was staking more claims than an excited gold prospector.
Morton’s battle to establish his priority wrecked his health and reading an article in support of Jackson’s case almost precipitated a nervous breakdown. He died of a stroke, penniless and as yet unrecognised. But Jackson did not triumph. He became an alcoholic and was found at Morton’s graveside screaming at his dead rival. He died in an asylum.
Morton’s former partner, Horace Wells, fared no better. He was incensed that amid all the rival claims for ether his earlier work with nitrous oxide had been forgotten. He was now a chloroform salesman busily sniffing away his profits. In an apparent attempt to rid the streets of prostitutes he threw acid at two women and was arrested. In prison, under the influence of chloroform, he slashed the main artery in his leg and bled to death. He was only thirty-three years old. His estranged wife accused Morton of having stolen Wells’s discovery and driven him to madness and suicide. On the day she heard of his death a letter arrived stating that the Medical Society of Paris had recognised him as the discoverer of anaesthesia. Now his only recognition is on his tombstone, and a plaque on the wall of the Burger King restaurant in his home town of Hartford.
Today in the USA alone five to ten million patients per year receive nitrous oxide in the cocktail of anaesthetics given during operations. But, at least for major surgery, its days may be numbered. Recent research has shown that replacing it in the mix with oxygen greatly reduces the frequency of life-threatening complications.
Although ether also became widely used in surgery, it had an awful smell, it irritated the lungs and before patients were fully under they tended to thrash about. At Edinburgh University the young Professor of Midwifery James Simpson, a protégé of Lightning Liston, began to use ether to relieve the pain of women during childbirth. But he felt there must be a better, as yet undiscovered, anaesthetic. So he began sniffing anything that had a vapour. His solvent soirées with medical friends, and relations too, culminated not in passing the port but in breathing whatever solutions he had come across since the last party. This was exceedingly dangerous as he often had little knowledge of the properties or toxicity of the substances concerned. Among the solutions tested were acetone, now familiar as nail-polish remover, ethyl nitrate, a constituent in rocket fuel, and benzene, a poison and potent carcinogen. Such horrors were rejected largely because they smelled bad, caused headaches or irritated the lungs. With less luck, they might easily have been marked down for having killed the entire gathering. During one sniffing session in 1847 they tried sweet-smelling chloroform. Simpson’s first impression was: ‘This is far stronger and better than ether.’ He then realised that he was lying on the floor. Indeed, ‘We were all under the mahogany in a trice.’ They tried it again and down they went. Even his wife’s young niece, who had only the slightest whiff, exclaimed, ‘Oh, I’m an angel.’
Chloroform had been discovered by an inadvertent self- experimenter, Samuel Guthrie. He was an inventor fascinated by explosives and determined to improve on gunpowder. By his own admission his experiments caused hundreds of accidental explosions, one so violent that it blew the roof off his workshop and demolished walls. Guthrie frequently had to run for his life. There was hardly a bit of his body that hadn’t been partially barbecued at one time or another.
In 1831 he began to investigate the commercial potential of chloric ether, a supposed stimulant, which is now used as a pesticide. When he brewed up the constituents he made not chloric ether, but an alcoholic solution of chloroform – although he didn’t know it. It was an ‘intensively sweet and aromatic’ tipple when diluted with water so he sold it locally as Guthrie’s Sweet Whiskey. It became so popular that even respectable old ladies were passing out at the roadside. He little guessed that its ability to bring oblivion was its most commercial property.
Sixteen years later, and only four days after his first sniff of chloroform, James Simpson administered it to a pregnant woman who had on a previous pregnancy endured a three-day labour and had lost the baby. When she came to, the patient couldn’t believe she had given birth. She christened her new daughter Anaesthesia. Within weeks chloroform was being used in all operations at Edinburgh Royal Infirmary.
Although most surgeons embraced anaesthetics, a vociferous minority insisted that pain was good for you. One wrote to a medical journal that anaesthesia was a ‘decoy by which the credulous may be induced to give up their senses as well as their cash’. Another wrote that: ‘Knife and pain in surgery are words which are inseparable in the minds of patients and this necessary association must be conceded.’ The strongest objections were against giving anaesthetics to women during labour. ‘Pain,’ another male doctor declared, ‘was the mother’s safety, its absence her destruction.’ Charles Meigs, Professor of Midwifery at Jefferson Medical College in Philadelphia, assured women that labour pains were ‘a most desirable salutary and conservative manifestation of the life force’ and that there was a ‘needful and useful connection of the pain and the powers of parturition, the inconveniences of which are really less considerable than has by some been supposed’. But then, I don’t think he had ever given birth himself. He seems not to have held a high opinion of women, having pronounced that their heads were ‘almost too small for intellect and just big enough for love’.
It didn’t matter what the doubters said; expectant women began to demand chloroform. They were encouraged when notables gave it their blessing. After his wife Catherine had a pain-free delivery, Charles Dickens wrote that chloroform was ‘as safe in its administration as it is miraculous in its effects’. When Queen Victoria opted for chloroform for her last two births and called it ‘delightful beyond measure’, its popularity was assured.
It was nowhere more popular than at parties in Professor Simpson’s Edinburgh residence where ‘instead of music and dancing … every guest was treated to a trip to the realms of insensibility’. The widow of a local physician later recalled that in her youth ‘the Professor used to try his experiments with chloroform on us girls. Our mother feared nothing, and was only too delighted to sacrifice, if unavoidable, a daughter or two to science.’
Simpson became the apostle of chloroform and even enlisted God as the first anaesthetist. When extracting a rib to create woman, He ‘caused a deep sleep to fall upon Adam, and he slept: and he took one of his ribs and closed up the flesh’.
Simpson extolled chloroform’s virtues at every opportunity and was blind to its faults. When a young girl died within two minutes of chloroform being administered for an operation on an ingrowing toenail, Simpson dismissed suggestions that the anaesthetic was to blame. He knew it was safe – after all, he had tested it on himself.
But the death rate mounted. Eventually, a review of over 800,000 operations under anaesthetic revealed that the death rate from chloroform was four and a half times higher than for ether. Many of these deaths, even those of vigorous young people, were almost instantaneous, as if the patient had been shot through the heart. It was many years before medics established that with chloroform there was a fine line between anaesthetisation and a fatal overdose that caused heart failure.
Though ether and nitrous oxide gradually came back into favour, Simpson never failed to champion chloroform, even though it probably killed one in ten of his patients. He also continued to jeopardise his health with further self-experimentation. ‘I am ill and quite undone,’ he wrote, ‘from breathing and inhaling some vapours I was experimenting upon last night, with a view to obtaining other therapeutic agents.’ His servant found him unconscious on the floor and feared for his life. He wondered why Simpson took such risks, for he will ‘never find anything better than “chlory”’. Obsession is the hallmark of many self-experimenters.
It is estimated that over 100,000 people died from the medical use of chloroform. Simpson used it for the last two years of his life to control his angina. He died in 1870, worn out by overwork and self-experimentation. He was lucky to make it to the age of fifty-nine.
Anaesthesia revolutionised surgery. It prevented the patient having to undergo a terrible ordeal and succumbing to what Joseph Lister called ‘mortal shock’. There were those who believed that the patient suffered just as much pain but forgot about it on awakening. Dr Warren at Massachusetts General, the first surgeon to operate with an anaesthetic, had a singular idea of what the patient felt: ‘Who could have imagined that drawing a knife over the delicate skin of the face, might produce a sensation of unmixed delight? That the turning and twisting of instruments in the most sensitive bladder, might be accompanied by a delightful dream?’
Longer and more invasive operations could now be attempted, but it would be forty years before the first local anaesthetics came along. Cocaine was first promoted as a treatment for morphine addiction. It was an early ingredient of Coca-Cola, which was marketed as a remedy for depression and hysteria. No doubt it also attracted many new drinkers. It is amazing how blasé we once were about powerful drugs. During the First World War the famous London store Harrods offered ‘a gift box for our friends abroad’. It contained vials of morphine and heroin with a syringe.
The young Sigmund Freud, with his self-styled ‘explorer’s temperament’, began taking cocaine to test its effects as a stimulant and an aphrodisiac. His trials led him to extol its virtues and to assure his readers unwisely that ‘even repeated doses produce no compulsive desire to use the stimulant further’. It was one of the greatest blunders of his career. He went on to turn several of his patients and himself into addicts.
He did, however, notice its tendency to numb the tongue and mentioned this to an ophthalmologist. If Freud had devoted his time to following up this observation, the world might have been spared countless hours of psychoanalysis and outbreaks of the Oedipus complex. It is amazing how many medical men also noted the numbing effect of cocaine but failed to appreciate its possible significance. Freud’s ophthalmologist, Carl Koller, wondered whether cocaine might also numb the eye to allow surgery. So he and a colleague drizzled a solution of cocaine into their eyes and then jabbed the cornea with a pin and felt nothing but pressure. Koller established cocaine as the ideal anaesthetic for eye surgery and became known as ‘Coca Koller’.
This may have encouraged two New York surgeons, Richard Hall and William Halsted, to inject each others’ limbs and gums to produce localised areas of insensitivity to pain. Both became addicted to cocaine. Halsted took morphine to ‘cure’ his dependency on cocaine and became addicted to morphine for the rest of his life.
In 1886 the lumbar puncture (spinal tap) was first used to collect spinal fluid from a living patient. A German surgeon, August Bier, realised that this technique might allow cocaine to be introduced into the spinal cord to block the nerves serving muscles below the point of injection. So his assistant, August Hildebrandt, pushed a hollow needle through the membranes that protected Bier’s spinal cord and into the fluid-filled cavity beneath. While he fumbled to attach the needle to a syringe of the wrong size, Bier’s spinal fluid was spurting out onto the floor. The horrified assistant plugged the leak and became the next volunteer. His injection went well. During the following half an hour Bier enthusiastically tickled the soles of Hildebrandt’s feet with a feather, pinched his skin with hooked forceps, jabbed his thigh to the bone with a surgical lance, plucked hair from his pubes, stubbed out a lighted cigar on his skin, whacked his shins with a heavy hammer and for a finale violently squashed and yanked his testicles. A thorough man, Bier left no place untortured. Fortunately the whole lower half of Hildebrandt’s body was insensitive to pain – until the effects of the cocaine wore off. This experiment transformed surgery on the lower body. Bier went down in medical history and Hildebrandt is remembered as the man whose testicles he tugged.
For medical and dental purposes cocaine has been replaced by less addictive synthetic substances that have been developed by self-testing newly synthesised drugs. When not at the dentist, however, we prefer the addictive version. Around eighty per cent of all banknotes in circulation in Britain are contaminated with cocaine or heroin, rising to ninety-nine per cent in London. More than fifteen million pounds’ worth of notes are destroyed each year to protect the non-snorting public.
As no anaesthetics were entirely safe, surgeons continued to operate rapidly rather than expose the patient to long periods of anaesthetisation. What was needed was some way of reducing the large amount of anaesthetic needed to relax the muscles. Perhaps a non-anaesthetic might do the job. The solution came from aboriginal tribes in South America whose hunting arrows and darts were tipped with curare. Its ability to kill almost instantly – it was called the ‘flying death’ – did not suggest it would be useful for surgery. But even the natives knew that though it was lethal when it penetrated the skin, it was usually harmless when eaten in small quantities. Animal experiments in Europe showed that curare paralysed the breathing muscles but did not still the heart; with artificial respiration the animal could recover.
In 1944 the drug company Burroughs Wellcome isolated tubocurarine, the active ingredient of curare. Frederick Prescott, its head of clinical research, was not averse to testing new drugs on himself. He had taken a combination of morphine and methamphetamine (‘speed’) to test a theory that they might help to control blood pressure. In fact Prescott’s blood pressure soared to double the normal level and he had to be hospitalised until his hypermania subsided.
Undeterred, he volunteered to see whether curare might have some benefit for surgery. He also consented to be the human guinea pig. Perhaps he didn’t anticipate just how hazardous this might be.
The initial tests gave no hint of the ordeal to come. To see if curare could reduce pain, large strips of sticking plaster were ripped from Prescott’s body. This, he said, ‘caused considerable pain’. Curare was certainly no anaesthetic.
Then the trials got serious. To ensure a cosily realistic atmosphere Prescott lay on the table in an operating theatre. He was injected with tubocurarine, the medical equivalent of the poison dart. At intervals over a period of two weeks, with an anaesthetist and doctors in attendance, the dosage was progressively increased. Within two minutes of the final experiment commencing, Prescott’s face, neck and all his limbs were totally paralysed. A minute later his breathing muscles were also paralysed – and no one noticed. ‘I felt I was drowning in my own saliva because I couldn’t swallow or cough … I had the feeling I was suffocating.’ He could hear his colleagues chatting but was unable to move a finger or even an eyelid. He was helpless, terrified and sinking into unconsciousness.
Although the rest of the team were monitoring Prescott’s blood pressure and his super-fast pulse, they were unaware of his terror. He had not turned blue because they were pushing air into him by squeezing a rubber bladder. When at last they decided they had collected enough data, they injected him with an antidote to reverse the effects of the curare. But the dose was too small and it took a further seven agonisingly long minutes of artificial respiration before Prescott could breathe for himself. It was over half an hour before he could speak and four hours before he could see properly. Other ill effects lasted for days.
The experiments had been carefully planned, but no one had established a system by which the human guinea pig could signal if he was in distress. In more recent experiments the volunteer has a tourniquet on one arm to isolate it from the curare in his system. Thus he can communicate with the team through pre-arranged finger signals.
Despite his ordeal, Prescott volunteered for another experiment that lasted for forty-five minutes. It took six weeks for him to steel himself for the trial, but he did it and as a consequence compounds like curare are now used universally as an adjunct to anaesthetics to incapacitate patients undergoing surgery.
Four of the pioneers of anaesthesia became addicted to the drugs they were testing. Many of them died prematurely as disappointed men, having failed to achieve the recognition they thought they deserved. In contrast, Frederick Prescott was a modest chap who expected no praise outside the circle of his colleagues. Most of his family only learned of his risky adventures when they read the details in his obituaries many years later.
Anaesthesia has come a long way since the whack on the head with a mallet, but it is still a tricky business. In the United States no less than a hundred patients a day are said to regain consciousness while under the knife. Carol Weihrer has recently recommended the use of a wakefulness monitor in operating theatres after she ‘awoke’ during an eye-removal operation. ‘I didn’t feel any pain,’ she said, ‘but I felt tremendous pulling. It takes a lot of torque to get an eye out.’