Sunday, January 8, 2012

Genius, Madness, and Addiction: The Tragic Life and Death of the Mad Dentist

Before the development of anesthesia, surgery was rarely performed.  In the instances where surgery was the only possible solution to a medical emergency, the patient had to be restrained.  There was the ever-present possibility that the patient would vomit and choke during surgery.  Operating rooms – often makeshift places for medical procedures – reverberated with the screams of patients.  The likelihood of long-term trauma from the surgery itself was ever-present. 

Medieval dental extraction

Even what we would today consider a simpler procedure, a tooth extraction, was a dangerous and painful procedure.  In the medieval and early modern eras, extractions were often performed by barbers – whose occupation was quite different from modern-day barbers who focus on beards and hair. 

Victorian dentistry kit

In areas where barbers were not available, the only other man with the correct tools for pulling teeth was the local blacksmith.  Neither the barber nor the blacksmith offered sanitary conditions or painless procedures.  Until the nineteenth century, however, these were often the only options for dental patients. 

Victorian advertisement for laughing gas

Adequate pain relief was also beyond the reach of science until the Victorian age.  During surgeries prior to the development of anesthesia, patients were often given alcohol or similar narcotics to dull the pain. 
The mid-eighteenth century saw the discovery of nitrous oxide, or laughing gas, though the practical use as an anesthetic didn’t catch on immediately.  From the moment of its discovery, laughing gas was popular as a parlor trick, with groups of partygoers using the gas to humor themselves since the effects often leave users light-headed and flighty. 

How the Royal Society perceived laughing gas

In the mid-nineteenth century, a young man names Horace Wells attended a travelling circus show and partook of the show’s laughing gas.  Though most of the audience was likely there for amusement, one participant injured himself during the performance, and Wells noticed that the man seemed to suffer no pain from his injury. 

Miniature portrait of Horace Wells

Wells began to experiment with nitrous oxide, initially using it to extract one of his own teeth and then in his practice as a dentist.  Excited by the results, the Connecticut dentist travelled to Boston in 1845 to demonstrate his findings at Massachusetts General Hospital, where his former apprentice William W.G. Morton now worked and studied. 

Victorian tooth extraction

The presentation was terrible, and lead to a downward spiral for Wells, who described the failure in 1846:

“A large number of students, with several physicians, met to see the operation performed – one of their number to be the patient. Unfortunately for the experiment, the gas bag was by mistake withdrawn much too soon, and he was but partially under its influence when the tooth was extracted. He testified that he experienced some pain, but not as much as usually attends the operation. A there was no other patient present, that the experiment might be repeated, and as several expressed their opinion that it was a humbug affair (which in fact was all the thanks I got for this gratuitous service) I accordingly left the next morning for home.”

Horace Wells demonstration of nitrous oxide

Wells appears to have understated the events, although his description of the procedure is accurate.  Students booed and mocked the results, yelling “Humbug! Humbug!” when the patient expressed pain.  Wells returned home to Hartford, sold his dental practice, and became a travelling salesman.  Tragically, his former apprentice stole his idea, modifying it slightly in October of 1846, and presented his findings to the very same hospital.  Where Wells found only disappointment, Morton’s demonstration was lauded.

The Morton-Hinkley demonstration of anesthesia

Determined to continue, Wells moved to Paris to present his ideas, and this time, he was successful.  Several Parisian monuments to Wells’ innovation were raised in Paris, where they can still be seen today. 

Wells returned to the States, but he was now a full-blown addict, using chloroform on a daily basis.  While surviving records do not indicate when this habit began, most historians suggest that his inability to gain recognition for his findings and Morton’s deception contributed to his addiction.  Such an assumption is difficult to prove; Wells’ surviving letters suggest that he was deeply depressed.  Additionally, it appears he believed he was merely experimenting with the drug.

Within four weeks’ time, however, Wells began to suffer extreme mental decay, a side effect of using the drug.  Chloroform is highly addictive and its repeated use leads to hallucinations.  Paranoid, Wells began to arm himself with scalpels and vials of sulfuric acid. 

New York streets, 19th century

Wells’ confession in his letters to his wife details the sad events of his final days.  Wells claimed that he had initially created a vial of sulfuric acid for a friend of his who wanted to exact revenge on a prostitute.  Armed with the vial, the two men found the prostitute on Broadway in New York and threw the acid on her dress, ruining her clothing.  The men appeared to enjoy the “sport,” and decided to continue it another time. 

Two days after this initial incident, Wells again took chloroform and again threw acid on prostitutes.  “I lost all consciousness before I removed the inhaler from my mouth,” Wells wrote after his arrest.  “How long it remained there I do not know, but on coming out of the stupor I was exhilarated beyond measure, exceeding anything I had ever before experienced, and seeing the phial of acid, I seized it and rushed in to the street and threw it at two females, I may have thrust it at others, but I have no recollection farther than this.  The excitement did not leave me for some time after my arrest.” 

The Tombs prison, New York

This time, Wells was arrested and committed to Tombs prison for trial and sentencing.  In his final letter to his wife, dated January 24, 1848, Wells is humiliated and depressed.  He writes his suicide letter, lamenting that he is ruined, “Oh what misery I shall bring on all my near relatives, and what still more distresses me is the fact that my name is familiar to the whole scientific world as being connected with an important discovery.”

Wells explains that he has procured the “instrument of my destruction” – one of his scalpels – when he was allowed to go to his residence.  He also procured more chloroform while he was there.  To my dear Wife.—I feel that I am fast becoming a deranged man, or I would desist from this act.  I can’t live and keep my reason, and on this account God will forgive the deed.  I can say no more,” Wells writes.[1]

Horace Wells' death mask

An 1848 journal on Wells’ findings details his tragic death: “The deceased, as it is supposed, previously to committing the rash act, saturated a new silk handkerchief with the chloroform, and placed it to his mouth, where it was found tied by another silk handkerchief round his head…the cell in which he was confined was a pool of blood.”[2] Wells used the scalpel to cut his femoral artery; the chloroform would dull the pain, as Wells knew it would.

Monument to Horace Wells, Connecticut

A week before his death, Wells had finally been acknowledged as the discoverer of anesthesia.  Sadly, the dentist took his life before learning of his triumph.

[1] See Wells, Horace.  The Life and Letters of Horace Wells: Discoverer of Anesthesia.  Ed. W Harry Archer. 
[2] Providence Medical Surgery May 31, 1848 12(11): 305-6.