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JMH Online First, published on June 5, 2015 as 10.1136/medhum-2015-010680 Original article
The outlook of physician histories: J. Marion Sims and ‘The Discovery of Anaesthesia’ Julia M Rosenbloom, Robert B Schonberger Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA Correspondence to Dr Julia Rosenbloom, Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street TMP 3, New Haven CT 06520, USA; [email protected] Accepted 20 May 2015
To cite: Rosenbloom JM, Schonberger RB. Med Humanit Published Online First: [ please include Day Month Year] doi:10.1136/ medhum-2015-010680
ABSTRACT The fact that doctors have a long tradition of writing medical history to interpret and direct their profession is well established. But readers ( particularly modern physician readers) can also understand physicianauthored histories as offering commentary and analysis of the world beyond medicine. In this essay, we offer a reading ( perhaps a modern one) of J. Marion Sims’s 1877 article, ‘The Discovery of Anaesthesia’ which exemplifies the stance of looking both inward and outward from the medical field. We begin by discussing Sims, including the complicated legacy he left as a physician. Next, we review late 19th-century history with a focus on Reconstruction. Finally, we show how the modern reader can use Sims’s article both to trace the first use of ether and nitrous oxide for surgical anaesthesia and to provide a window into the 19thcentury medical profession and the post-Civil War period. Through this study, we hope to show how to read both medicine and the world around it in physician histories.
The fact that doctors have a long tradition of writing medical history to interpret and direct their field is well established. Famous and often-cited William Osler, for example, initially penned medical biographies in order to inspire his pupils with ‘timeless values and ideals’ of the profession.1 Likewise, Henry Sigerist wrote medical history to demonstrate his own ideals for his fellow physicians: as the author of Socialised Medicine in the Soviet Union, he believed doctors should consider how economic and social environments affected patients.1 Readers ( particularly modern physician readers) can also understand physician-authored medical histories as offering commentary and analysis of the world beyond medicine. In this essay, we offer a reading ( perhaps a modern one) of J. Marion Sims’s 1877 article on the discovery of surgical anaesthesia which exemplifies the stance of looking both inward and outward from the medical field. There have been many accounts of the discovery of ether and nitrous oxide for surgical anaesthesia in the 19th-century USA. Indeed, the argument over who first discovered and proclaimed these inhalational agents to produce surgical anaesthesia has become an archetype of debates among medical historians. In ‘The Discovery of Surgical Anaesthesia’, Sims offered his interpretation of the event, promising ‘a plain statement of facts’ for his physician audience.2 In addition, the modern reader can view his essay as representing the 19th-century medical profession: how medicine relied upon social factors while insisting on being distinct from them, and how individual motivation and reward were
considered essential to its reformation. Moreover, we can view Sims’s article against the backdrop of the Civil War and Reconstruction in order to depict postbellum social and political spheres of the time, particularly racial tensions and sectionalism. Taken as a whole, we can interpret Sims’s physician history as providing a narrative of the discovery of surgical anaesthesia, a view of the 19th-century medical profession, and a window into the turbulence of postbellum America.
THE 19TH-CENTURY DISCOVERY OF SURGICAL ANAESTHESIA Because surgical anaesthesia marked a turning point in medicine, many physician historians have eagerly delved into the history of ether and nitrous oxide. While both gases have older roots, ether’s origins perhaps dating as far back as the eighth century, most accounts begin in January 1842, when a New York State medical student administered ether to extract a tooth.3–8 Since he did not appreciate the significance of his discovery,i physician historians have focused on four professional men.3 4 6 7 9 10 The first, Crawford Long, was a young Southern doctor practicing in rural Georgia when he successfully administered ether as a surgical anaesthetic in 1842 in order to remove tumours from a young man’s neck.3 4 6 7 9–11 Long did not publish his results, however, and his use of ether for anaesthesia remained unknown for several years.6 7 9–11 In 1845, New England dentist Horace Wells used nitrous oxide to remove his patients’ teeth painlessly, but his attempt to repeat his discovery at Massachusetts General Hospital (MGH) failed when his patient groaned and moved.3 6–9 11 William Thomas Green Morton, a student of Wells, experimented with nitrous oxide and then with ether after meeting Bostonian chemist Charles Jackson.3 4 6–9 In 1846, Morton famously demonstrated the effects of ether at MGH during a surgery performed by Dr J C Warren.3 4 6–9 11 After Morton’s administration, Jackson, however, claimed that he was the original discoverer of ether for surgical anaesthesia—that he had conceived of this use in 1842, but had not pursued it, instead instructing Morton in its potential.3 8 11 12 He even wrote a letter to the French Academy of Sciences detailing the primacy of his role in the discovery.12 The debate over who first discovered and proclaimed these agents to be surgical anaesthetics continued, ironically causing
i
According to Desai et al,9 neither Clarke nor his medical school professor realized they had induced general anaesthesia; rather, they attributed the female patient’s state to ‘hysteria’.
Rosenbloom JM, et al. Med Humanit 2015;0:1–5. doi:10.1136/medhum-2015-010680
Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
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Original article significant pain and personal suffering to many of these early pioneers.3 4 7–9 11 Of these four men, only Long continued to practice medicine until his death by a stroke in 1878.11 Physician historians have offered various interpretations to explain the 19th-century discovery of surgical anaesthesia. Most have noted the contribution made by social usage. Ether and nitrous oxide were popular intoxicants among both lay public and medical professionals.3 4 6–11 As Long’s biographer Francis Boland explains “‘ether parties’ and laughing gas’ demonstrations became popular in parts of the United States in the early part of the nineteenth-century. With no radios and moving pictures the world must be entertained in some fashion.”11 Travelling shows brought nitrous oxide to various cities and allowed their audiences to sample the gas and indulge in its effects.3 6–8 11 Elsewhere, traditional social gatherings such as quiltings and dances often included an ‘ether frolic’ in which attendees would inhale the gas and become intoxicated.3 4 6–11 Other scholars have attributed the discovery of anaesthetic agents to evolving scientific thinking and refinement, including the medical community’s readiness to believe that painless surgery was possible.8 13 Anesthesiologist-historians Nicholas Greene and Emanuel Papper have described the development of empathy and an increased understanding of the individual and his pain as requisite foundations for surgical anaesthesia.8 13 14 Papper, in particular, traced the origins of these sentiments to ‘outgrowths of Romantic subjectivity’.14 A recent essay expanded on this proposed intersection of ether and humanism, suggesting that the engagement between the two flowed in the opposite direction as well: Long’s ability and willingness to provide anaesthesia across social boundaries, such as those of race and class, promoted and led to an understanding of human equality in the face of pain.15 ii Before Sims, others, including the original claimants, had begun documenting the discovery of anaesthesia. In 1847, Horace Wells published A History of the Discovery of the Application of Nitrous Oxide Gas, Ether, and other Vapors, to Surgical Operations;16 Crawford Long produced testimony of his discovery in an 1849 issue of Southern Medical and Surgical Journal;17 JH Abbot described Jackson’s contribution in an 1866 article of The Atlantic Monthly.18 These accounts focused on a chronology of events and assigning responsibility and credit for the discovery of surgical anaesthesia. Thirty years later, J. Marion Sims published his own account in the Virginia Medical Monthly and sought to uphold Long as the original discoverer. In the following paragraphs, we want to step back from chronology and credit. Instead, we offer a reading of Sims’s narrative as a window —perhaps a modern one—into both his profession and the postbellum era. We begin by discussing Sims’s career, including the complicated legacy he left as a physician. Next, we review late 19th-century history with a focus on Reconstruction as well as a few details surrounding the publication of ‘The Discovery of Anaesthesia’. Finally, we show how the modern reader can use Sims’s article both to trace the first use of ether and nitrous oxide for surgical anaesthesia and to provide a window into the 19th-century medical profession and the post-Civil War period. Through this study, we hope to show how to read both medicine and the world around it in physician histories.
Born to a poor family in rural South Carolina, he began his medical studies at the Medical College of the State of South Carolina.19–23 Like fellow Southerner Long, he finished his training in Philadelphia where he graduated from Jefferson Medical College in 1835.19–23 During his medical school days in Philadelphia, Sims developed an interest in surgery.19 23 He then returned to the South to start his career, first in South Carolina and then Alabama where his patient population included the full range of the Southern population: black slaves, free blacks and wealthy whites; men and women; adults and children.19–23 It was here that he invented an operation to treat vesico-vaginal fistulas. In 1845, he began to operate on black slave women—without anaesthesia—who had sustained these pathological connections between the vagina and the bladder during difficult and prolonged childbirth. During his 4-year search for a sustainable repair, Sims invented his now famous speculum and silver sutures.19–23 Beyond these technical advancements, the ethical dilemmas of Sims’s operations have left a lasting legacy. On the one hand, Sims perceived the biological similarities among women’s bodies. He invented his speculum during a physical examination of a white woman and then used it to examine black slave women; he treated both black and later white patients with vesico-vaginal fistulas by means of the same operation.19 20 22 23 On the other hand, Sims, like many of his colleagues, held a deep-seated belief in racial inequality. His medical racism is evidenced both in his use of black slave bodies to experiment and perfect a surgical technique and in his disregard of the patients’ modesty and privacy.19 21 24 Moreover, although Sims did not have access to anaesthesia for his initial surgeries, his ideas about race and pain likely influenced how he conducted his operations.20–22 As was common in his society, Sims believed that susceptibility to pain was based in racialised and gendered categories and that black women were better able to endure pain than white women.15 19 24 Shortly after these operations, Sims left the South due to declining health. Settling in New York in the early 1850s, he helped found the Woman’s Hospital where he continued his work in gynaecologic surgeries.19 20 22 23 By the 1860s, Sims was travelling regularly in Europe where he demonstrated his surgical and obstetrical skill.19 20 22 He was the member of several professional organisations and became the president of the American Medical Association (AMA) in 1876.19 20 22 Throughout his career, Sims remained invested in his Southern roots. He invoked his background in his depiction of his difficulty in establishing himself within New York City’s medical community. In one conversation relayed in his autobiography, Sims denied a friend’s suggestion that ‘it is the Northern prejudice against a Southern man’, and left the comment in the text.23 Biographers and scholars have also suggested that Sims left for Europe due to his feelings regarding the Civil War and its politics.19 20 22 And when Sims received a public rebuke for divulging medical information about actress Charlotte Cushman, he saw himself, at least in part, as the victim of Northern disrespect.19 iii Perhaps Sims’s own words best illustrated his situation: ‘If you applaud so vociferously this
J. MARION SIMS Although he came from humble means, by the time he wrote his article in 1877, Sims had achieved considerable success.
ii
For a list of forces leading to the discovery of surgical anaesthesia.8
2
iii In 1869, Cushman found a breast mass. Although Sims advised her against surgery, she underwent a mastectomy with James Simpson as her surgeon. Sims reported to a New York newspaper about how the actress was faring in the postoperative period. The New York Academy of Medicine brought Sims up on ethical violations for failure to respect a patient’s privacy. Please see McGregor19 for further details.
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Original article sentiment from a citizen of New York, let me tell you that it is from the heart of a red southerner…I sympathized heart and soul with the South in what you miscall a rebellion’.25
POSTBELLUM USA In 1877, the USA was grappling with the aftermath of the Civil War and Reconstruction. Although Reconstruction policies sought to reintegrate the South back into the Union, the rift between North and South persisted. Northern political leaders continued to view the South as rebels and Southern whites saw Northerners as illegitimate tyrants.26 Likewise, the struggle for emancipation that lay at the heart of the Civil War transformed into persistent tension over black civil rights. Conflict over black suffrage, black economic autonomy and integration between blacks and whites found expression on national and local stages.26 And at least some of the time, these struggles played out in violence, such as the 1866 race riot in Memphis and the continued activities of the Ku Klux Klan.26 It was in this context that Sims wrote ‘The Discovery of Anaesthesia’.
PUBLICATION Sims had been interested in publication since his early career in Alabama, seeking, as his biographer suggests, ‘a nationally recognized rather than a locally known career’ and ‘The Discovery of Anaesthesia’ reflected his writing ambitions.19 We do not know why Sims chose to publish in the Virginia Medical Monthly. Perhaps, he wished to honour the journal that featured a biographical sketch of him in an 1877 issue.19 Maybe he found among the magazine staff a group of like-minded Southerners, proud of their region as evidenced in the editor’s letter to Long: ‘I wish all Southerners would stand up and work for their rights’.27 Or perhaps, Sims was impressed by the magazine’s breadth of authors, articles and readership. One of the 1877 issues, for example, featured pieces from professors and local physicians on a wide variety of topics, ranging from medical compensation to eye diseases to phimosis as well as advertisements and medical society proceedings.28 Moreover, the Editorial section boasted that the journal was ‘steadily developing and gaining friends everywhere. Its circulation now extends from Upper Canada, southward throughout the United States into Mexico, and further south into Brazil, while East and West it reaches into countries across the oceans’.29 Whatever his reasons, the Monthly’s Editors eagerly anticipated Sims’s article in the issue preceding its publication.29
MEDICAL AND SOCIAL SPHERES Sims opened his essay by recounting his 1876 meeting with P. A. Wilhite, a South Carolina doctor, in which he learnt that Crawford Long was ‘the real and original discoverer of anaesthesia’.2 Sims then postponed any discussion of Long, proceeding instead to discuss an 1839 ether frolic attended by the then 17-year-old Wilhite in which ‘he (Dr Wilhite) was the first person who had ever profoundly etherized any one’.2 According to the story, ether was a frequent component of popular amusement in the early 19th-century. Its social uses were so common that ‘there was hardly ever a gathering’ without it and young people were ‘in the constant habit of using it’.2 Connecting ‘boys and girls’, it led some to ‘laugh, some cry, some fight and some dance’.2 Although Sims may simply have been reporting the story he heard from Wilhite, the narrative of the ether frolic opens a window through which the modern reader can envision the complex interplay between social and medical spheres in the 1840s. In Sim’s account, Wilhite’s ether frolic preceded any Rosenbloom JM, et al. Med Humanit 2015;0:1–5. doi:10.1136/medhum-2015-010680
description of the discovery of anaesthesia as if to demonstrate how ether for popular entertainment was intimately tied—and foundational—to its anaesthetic function. Indeed, when Sims later turned to his account of Long’s and Wells’s medical discovery, he once again invoked the social use of these inhaled agents. Long noted that ether frolickers suffered ‘falls and blows, and were not conscious of pain at the time’ which ‘suggested to his mind the idea of using ether to prevent the pain of surgical operations’.2 Likewise, Wells watched a man injure himself while intoxicated during a public demonstration of nitrous oxide, leading him to consider it for the extraction of teeth.2 Antebellum social uses of ether thus led to medical application of it. Wilhite’s description of the ether frolic further invites the modern reader to imagine postbellum tensions between social and medical spheres. After Wilhite administered ether to a black boy watching the revelry and was then unable to awaken him, a Dr Reese arrived to help. The physician ‘threw water in the face of the sleeping negro’ and then lectured the white participants ‘on the dangers of such frolics’.2 Whether intended or not, Sims’s description serves as a lens through which the readers can come to appreciate the divide between the lay and the medical; only the medical man understood the ‘dangers’ of ether and only the medical man understood how to take care of someone under its influence. That Sims was writing at a time when the ‘orthodox’ medical profession was seeking to seize control of the field from rival groups of health practitioners further highlights the significance of Dr Reese’s appearance.30 We can thus read the ether frolic as illuminating how the medical world was both dependent on and distinct from the popular sphere. Competing versions of Wilhite’s ether frolic may further help Sims’s modern audience to comprehend the ambiguous relationship between social and professional arenas. In an 1881 book, Henry Lyman recounted Wilhite’s ether frolic and the etherisation of the black boy: ‘the boy was unconscious, motionless, stertorous, evidently dying. But after an hour of consternation on the part of the spectators, he revived and was no worse for his alarming experience’.6 In this version, the boy awoke spontaneously and there was no doctor, but only a ‘party of boys’.6 Later, in an 1895 issue of the New York Medical Journal, L.B. Grandy openly contradicted Wilhite’s story, referring to it as ‘myth’. He reported this set of events: ‘it occurred to him [Wilhite] that sulphuric ether might produce a similar effect, and as an experiment he administered the latter to a negro boy who was in the office [Dr. Long’s office—L.B.G]. … To his surprise and horror the boy became profoundly insensible, and, thinking his death was inevitable, he and a fellow student had their horses caught and brought to the door with the view of fleeing into Tennessee. Before carrying this design into execution the boy aroused from the effect of the anaesthetic and was as well as before’.31
In Grandy’s version, ether was provided in an ‘office’, not at a social gathering. Likewise, the doctor (Wilhite), not the lay public, expressed ‘surprise and horror’ at the ‘insensible’ patient. Finally, as in Lyman’s version, the patient woke up not through a doctor’s manipulations, but spontaneously. In contrast to these latter two versions, Sims’s account allows us to demarcate sharply the lay world from the medical one.
POSTBELLUM RACIAL TENSIONS Modern audiences can also read 19th-century race relations into this episode. At the gathering, the revellers saw a ‘negro boy at the door, who seemed to be enjoying the sport’.2 We do not 3
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Original article learn further details about this boy such as his age (as the contemporary use of ‘boy’ could refer to a black male of any age) nor his status as enslaved or free. Although in 1839 Georgia, he would have likely been a slave, we can perhaps attribute the lack of direct reference in Sims’s essay to the sensibilities of the postemancipation era. And yet the boy was an observer, not part of the party; indeed, he stood in the doorstep, not in the room. When the boy refused invitations to participate, the white revellers violently forced him to inhale the ether. They ‘persisted, thinking it was great fun’, and hoped the boy would ‘get up immediately and say or do some foolish thing for them to laugh at’.2 In this way, experimentation with ether, combined with suggestions of black inferiority and white violence, was reified into racial popular amusement. But unlike the rowdy white party-goers, the boy ‘lay quietly, and with stertorous breathing’.2 He remained outside the community, even when cajoled into participating in it. That he could not partake in this communal activity can be read as reflecting contemporary (white) resistance to integration. We can also interpret the Negro boy’s sleeping as a representation of the interplay between concepts of inferiority, violence and labour so at stake during Reconstruction. Black sleepiness reaffirmed notions of laziness which many whites associated with blacks.26 Such racial stereotypes often served as an excuse for violence, especially during Reconstruction when whites could no longer rely on slavery to enforce black labour.26 In this reading, the description of the white partygoers’ increasing aggression towards the child reflects the era’s violence: they ‘insisted’, then they ‘caught hold of the boy’, then finally they ‘threw him down and held him’.2 When the boy attempted to defend himself, they continued their violence; they stopped only after he fell asleep. And here, the modern reader can sense how Sims’s text betrayed itself. The boy’s sleep proved the Negro to be a perfect patient since the ether subdued, rather than excited, him, as it did the white revellers. From this perspective, the child and his sleep provided a professional service to both Wilhite and Dr Reese, one who went both unacknowledged and unrewarded. The white doctors, and by extension the white community, benefitted from this unpaid use of a black body.
POSTBELLUM SECTIONALISM We can also appreciate postbellum national discord through Sims’s article. As he considered the multiple discoveries of surgical anaesthesia, from Long through Morton, Sims made clear that the conflict over the title of discoverer was fiercely waged in the press and in sessions before Congress.2 Expressing his own opinion, Sims focused on individual achievement: ‘Long ante-dates Wells two years and eight months, and ante-dates Morton four years and six months’.2 Whereas Sims’s treatment of Wells, Morton and Jackson was brief, his discussion of Long’s discovery was more detailed.2 Sims repeated his position as he summarised his facts: ‘Long was the first man to intentionally produce anaesthesia for surgical operations’.2 Yet, Sims championed Long as an individual and as a symbol of the South, thus underscoring the sectional allegiance that dominated 19th-century US society. In his first sentences about Long, Sims repeated ‘Georgia’ several times as if to emphasise his native roots.2 He painted Long nostalgically as ‘a country doctor’ who lived in ‘an obscure little town’ and a ‘contracted world’.2 By contrast, the other men were from the North and practiced in large cosmopolitan cities.2 Morton, for example, ‘was fortunate in showing his patent remedy to the great surgeons of Boston’.2 And while Wells, Jackson and Morton 4
suffered physical and mental illness in their later years, Long’s fate is tied to his region. By standing with the South, he ‘lost all during our great civil war’; in continuing his medical practice, Long, like the South, ‘worked to death for the daily bread’.2 Long then may represent the sectionalism that led Sims to state, ‘I am proud of my country abroad, but ashamed of it at home. The humiliation of the South is inexcusable. Its ruin is unjustifiable’.25
FUTURE RECONCILIATION If we can read Sims’s representation of the discovery of surgical anaesthesia as exposing divisions and rifts in late 19th-century society, we can also see it as a rallying cry for future reconciliation. Although Long was first to discover surgical anaesthesia, Sims declared that all four men had a role in the invention: ‘the names of Long, Wells, Morton and Jackson [should] be inscribed on the Boston column, one on each side, as co-discoverers of anaesthesia’ since ‘no one man can claim this great honor exclusively’.2 They were ‘co-laborers’ and each of them deserved a ‘certain measure of credit’.2 Sims further linked the men by noting the sad outcome of their lives: Long became impoverished, Wells committed suicide, Morton fell fatally ill, Jackson went insane.2 Yet, Sims urged the reader not to dwell on how ‘their lives were embittered with envy, jealousy and uncharitableness towards each other’, but rather to concentrate on ‘the good’, their joint discovery of surgical anaesthesia.2 With his depiction of reconciliation among the discoverers, the reader may imagine that Sims was calling for a cohesive profession. He exhorted that ‘the whole medical profession, North, South, East and West, unite in asking Congress, at its next session, to appropriate this sum, as an anaesthesia fund’ for the families of the discoverers.2 Mid-19th-century medicine was a beleaguered profession—it lacked regulation, its practitioners were often ill-trained and it was divided by rivalling sections and ideologies.30 In his memoir, Sims reported his father’s reaction to his career choice: ‘there is no science in it. There is no honor to be achieved in it; no reputation to be made, and to think my son should be going around from house to house through this country, with a box of pills in one hand and a squirt in the other…is a thought I never supposed I should have to contemplate’.23
The last three decades of the 19th century, however, witnessed the beginning of reforms that led to upheavals in the profession lasting well into the next century. Changes centred on the consolidation of medical school curricula, the restructuring of daily practice to include fees and identify appropriate consultants and the reappearance of state licensing laws.30 In his 1876 presidential address before the AMA, Sims added his own notion of reform by asking, ‘but why should not the physician reap the reward due to talent and inventive genius as well as any other man?’32 Sims’s call for ‘an anaesthesia fund’ may have flown in the face of the AMA’s standing ban on patents and advertising, both of which were associated with quackery.30 Nevertheless, it was closely linked to Sims’s ideals for his profession in which individuals would benefit from their own creativity and ingenuity. This belief in individual recognition and compensation was important enough to Sims that he repeated it twice in his account of the discovery of surgical anaesthesia; in both instances, he suggested that the lack of acknowledgement was a sign of ingratitude, especially on the part of the national government.2 Here, Sims may have wanted to contrast his expectations of reward against Morton’s efforts at deception (his Rosenbloom JM, et al. Med Humanit 2015;0:1–5. doi:10.1136/medhum-2015-010680
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Original article concealment of the composition of the ‘Letheon’ potion for the sake of profit)2 in order to emphasise the importance for the medical profession’s legitimate membership to stand up for itself. The discovery of surgical anaesthesia can thus be read as a recruitment tool for a changed, unified profession. Sims’s account of the discovery of surgical anaesthesia can also be seen as a call for national unity. At both the beginning and the end of his paper, he acknowledged the European contributions of James Priestly, Humphrey Davy and James Simpson.2 But Sims reserved ‘the honor of discovering anaesthesia’ for Americans.2 Although divided by the Civil War and its economic, political and social consequences, it was the USA that had produced these innovators. In his declaration that ‘America should recognize the labors of Long, Wells, Morton, and Jackson’, ‘America’ superseded personal and regional divisions. In this way, the nation can ‘rise above all party, all prejudice, all sectionalism’.2 As Sims explained in 1876, the post-War USA was resilient: ‘it passed safely through the fiercest civil war the world has ever witnessed, and now it bids fair to endure for ages’.32 But one figure does not reappear in Sims’s text: the Negro boy in Wilhite’s story. If we are allowed to speculate on the meaning of this absence, we can offer several possible interpretations (but certainly not a definitive one). Perhaps the boy is missing because he was not a central part of Sims’s main subject, the discovery of anaesthesia. Or perhaps the boy’s absence suggests that Sims’s appeal for cohesion, nationally or professionally, did not include racial cohesion. In this view, the boy remains asleep, symbolising either an incongruous being in white society or a passive patient in the hands of white doctors. Or perhaps the boy is not present to indicate the changing position of black Americans. In 1876, Sims acknowledged that ‘if any colored man should rise to the dignity of representing a State or County Medical Society, we must receive him as such’.32 In this context, the black boy does not reappear because his status has evolved—perhaps from patient to doctor. The black child’s disappearance can thus be interpreted as mirroring the multiple readings of Sims’s article: an account of the discovery of anaesthesia, a reflection of needed reforms of the medical profession, or a symbol of the turbulence of the postbellum era.
Provenance and peer review Not commissioned; externally peer reviewed.
CONCLUSION
21
‘The Discovery of Anaesthesia’ delves into the origins of surgical anaesthesia in the mid-19th century, the medical profession, and the author’s contemporary postbellum era. Reading the essay invites modern audiences to a greater appreciation of how physician-authored histories do not have to be confined to the provincialism of medicine, but may speak to the world around them. In so doing, Sims’s narrative operates on many levels, particularly but not exclusively for its intended audience of physicians, to remind us that history stems from the particular vantage point—both professional and personal—of the historian. As Sims told Long, ‘the facts are historical. They are as I relate them’.33 Acknowledgements The authors wish to acknowledge the generous financial support of the Mentoring Program of the American Society of Anesthesiologists Committee on Professional Diversity in addition to the support of the Clinical Scientists Track training programme of the Department of Anesthesiology, Yale School of Medicine. Contributors JMR conceived of the idea for this paper while under the mentorship of RBS. JMR performed the research and archival work. JMR and RBS co-wrote the paper. JMR is the guarantor. Competing interests None declared. Rosenbloom JM, et al. Med Humanit 2015;0:1–5. doi:10.1136/medhum-2015-010680
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Fee E, Brown TM. Using medical history to shape a profession: the ideals of William Osler and Henry E. Sigerist. In: Huisman F, Warner JH, eds. Locating medical history: the stories and their meanings. Baltimore, MD: JHUP, 2004:139–64. Sims JM. The discovery of anaesthesia. V Med Mon 1877;4:81–100. Bergman NA. Forerunners of modern anesthesiology: dwarfs and giants. Pharos 1985;48:8–12. Jacob AK, Kopp SL, Bacon DR, et al. The history of anesthesia. In: Barash PB, Cullen BF, Stoetling RK, et al., eds. Clinical anesthesia. 7th edn. Philadelphia, PA: Lippincott, Williams, & Wilkins, 2013:3–27. Eger EI, Saidman LJ, Westhorpe RN. History to 1798. In: Eger EI, Saidman LJ, Westhorpe RN, eds. The wondrous story of anesthesia. New York, NY: Springer, 2014:3–10. Lyman HM. Artificial anaesthesia and anaesthetics. New York, NY: W Wood and Company, 1881:1–8. Bergman NA. The genesis of surgical anesthesia. Park Ridge, IL: Wood Library-Museum of Anesthesiology, 1998. Eger EI, Saidman LJ, Westhorpe RN. 1844–1846: The discovery and demonstration of anesthesia. In: Eger EI, Saidman LJ, Westhorpe RN, eds. The wondrous story of anesthesia. New York, NY: Springer, 2014:17–26. Desai SP, Desai MS, Pandav CS. The discovery of modern anaesthesia— contributions of Davy, Clarke, Long, Wells and Morton. Indian J Anaesth 2007;51:472–6. Eger EI, Westhorpe RN, Saidman LJ. The half century before ether day. In: Eger EI, Saidman LJ, Westhorpe RN, eds. The wondrous story of anesthesia. New York, NY: Springer, 2014:11–16. Boland FK. The first anesthetic: the story of crawford long. Athens, GA: UGa Press, 1950. Bause GS. C.T. Jackson’s sealed 13 November 1846 letter to J.B.A.L.L. Elie de Beaumont: translated (1847), back-translated (1861), and accurately transcribed for the first time (2014). J Anesth Hist 2015;1:9–13. Greene NM. A consideration of factors in the discovery of anesthesia and their effects on its development. Anesthesiology 1971;35:515–22. Papper EM. Romance, poetry, and surgical sleep: literature influences medicine. Westport, CT: Greenwood Press, 1995. Rosenbloom JM, Schonberger RB. Toward an understanding of the equality of pain: Crawford Long and the development of anesthesia in antebellum Georgia. J Anesth Hist 2015;1:14–17. Wells H. A history of the discovery of the application of nitrous oxide gas, ether, and other vapors, to surgical operations. Hartford, CT: J. G. Wells, 1847. Long CW. Account of the first use of sulphuric ether by inhalation as an anesthetic in surgical operations. South Med Surg J 1849;5:705–13. Abbott JH. The discovery of etherization. Atlantic Montly 1868:21:718–25. McGregor DK. From midwives to medicine: the birth of American gynecology. New Brunswick, NJ: Rutgers UP, 1998. de Costa CM. James Marion Sims: some speculations and a new position. MJA 2003;178:660–3. Ojangua D. The medical ethics of the ‘Father of Gynecology,’ Dr. J Marion Sims. J Med Ethics 1993;19:28–31. West MJ, Irvine LM. The eponymous Dr James Marion Sims, MD, LLD (1813–1883). J Med Biogr 2015;23:35–45. Sims JM. The story of my life. With a new preface by C. Lee Buxton. Reprinted ed. New York, NY: Da Capo Press, 1968. Savitt TL. Race and medicine in nineteenth- and early twentieth-century America. Kent, OH: Kent State UP, 2007:77–8. Sims JM. Response to toast on board Steamer Atlantic. Reprinted In: Sims JM, ed. The story of my life. With a new preface by C. Lee Buxton. Reprinted ed. New York, NY: Da Capo Press, 1968:418–21. Foner E. A short history of reconsrtuction 1863–1877. New York, NY: Harper and Row, 1990. Edwards LB. Crawford Williamson Long Papers, 1837–1930. Manuscript Division. Library of Congress. Washington DC; folder 3. Va Med Mon 1877;4. Editorial. V Med Mon 1877;4:74–6. Numbers RL. The fall and rise of the American medical profession. In: Leavitt JW, Numbers RL, eds. Sickness and health in America. 2nd edn. Madison, WI: University of Wisconsin Press, 1985:185–96. Grandy LB. The discovery of anaesthesia and the alleged relations between Dr. C. W. Long and Dr. P.A. Wilhite. N Y Med J 1895:79–81. Sims JM. Address of J. Marion Sims, M.D., President of the Association. In The Transactions of the American Medical Association 6-06-1876. Philadelphia. http:// ama.nmtvault.com (accessed 1 Oct 2014). Sims JM. Crawford Williamson Long Papers, 1837–1930. Manuscript Division. Library of Congress. Washington DC; folder 3.
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The outlook of physician histories: J. Marion Sims and 'The Discovery of Anaesthesia' Julia M Rosenbloom and Robert B Schonberger Med Humanities published online June 5, 2015
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JMH Online First, published on June 5, 2015 as 10.1136/medhum-2015-010680 Original article
The outlook of physician histories: J. Marion Sims and ‘The Discovery of Anaesthesia’ Julia M Rosenbloom, Robert B Schonberger Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA Correspondence to Dr Julia Rosenbloom, Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street TMP 3, New Haven CT 06520, USA; [email protected] Accepted 20 May 2015
To cite: Rosenbloom JM, Schonberger RB. Med Humanit Published Online First: [ please include Day Month Year] doi:10.1136/ medhum-2015-010680
ABSTRACT The fact that doctors have a long tradition of writing medical history to interpret and direct their profession is well established. But readers ( particularly modern physician readers) can also understand physicianauthored histories as offering commentary and analysis of the world beyond medicine. In this essay, we offer a reading ( perhaps a modern one) of J. Marion Sims’s 1877 article, ‘The Discovery of Anaesthesia’ which exemplifies the stance of looking both inward and outward from the medical field. We begin by discussing Sims, including the complicated legacy he left as a physician. Next, we review late 19th-century history with a focus on Reconstruction. Finally, we show how the modern reader can use Sims’s article both to trace the first use of ether and nitrous oxide for surgical anaesthesia and to provide a window into the 19thcentury medical profession and the post-Civil War period. Through this study, we hope to show how to read both medicine and the world around it in physician histories.
The fact that doctors have a long tradition of writing medical history to interpret and direct their field is well established. Famous and often-cited William Osler, for example, initially penned medical biographies in order to inspire his pupils with ‘timeless values and ideals’ of the profession.1 Likewise, Henry Sigerist wrote medical history to demonstrate his own ideals for his fellow physicians: as the author of Socialised Medicine in the Soviet Union, he believed doctors should consider how economic and social environments affected patients.1 Readers ( particularly modern physician readers) can also understand physician-authored medical histories as offering commentary and analysis of the world beyond medicine. In this essay, we offer a reading ( perhaps a modern one) of J. Marion Sims’s 1877 article on the discovery of surgical anaesthesia which exemplifies the stance of looking both inward and outward from the medical field. There have been many accounts of the discovery of ether and nitrous oxide for surgical anaesthesia in the 19th-century USA. Indeed, the argument over who first discovered and proclaimed these inhalational agents to produce surgical anaesthesia has become an archetype of debates among medical historians. In ‘The Discovery of Surgical Anaesthesia’, Sims offered his interpretation of the event, promising ‘a plain statement of facts’ for his physician audience.2 In addition, the modern reader can view his essay as representing the 19th-century medical profession: how medicine relied upon social factors while insisting on being distinct from them, and how individual motivation and reward were
considered essential to its reformation. Moreover, we can view Sims’s article against the backdrop of the Civil War and Reconstruction in order to depict postbellum social and political spheres of the time, particularly racial tensions and sectionalism. Taken as a whole, we can interpret Sims’s physician history as providing a narrative of the discovery of surgical anaesthesia, a view of the 19th-century medical profession, and a window into the turbulence of postbellum America.
THE 19TH-CENTURY DISCOVERY OF SURGICAL ANAESTHESIA Because surgical anaesthesia marked a turning point in medicine, many physician historians have eagerly delved into the history of ether and nitrous oxide. While both gases have older roots, ether’s origins perhaps dating as far back as the eighth century, most accounts begin in January 1842, when a New York State medical student administered ether to extract a tooth.3–8 Since he did not appreciate the significance of his discovery,i physician historians have focused on four professional men.3 4 6 7 9 10 The first, Crawford Long, was a young Southern doctor practicing in rural Georgia when he successfully administered ether as a surgical anaesthetic in 1842 in order to remove tumours from a young man’s neck.3 4 6 7 9–11 Long did not publish his results, however, and his use of ether for anaesthesia remained unknown for several years.6 7 9–11 In 1845, New England dentist Horace Wells used nitrous oxide to remove his patients’ teeth painlessly, but his attempt to repeat his discovery at Massachusetts General Hospital (MGH) failed when his patient groaned and moved.3 6–9 11 William Thomas Green Morton, a student of Wells, experimented with nitrous oxide and then with ether after meeting Bostonian chemist Charles Jackson.3 4 6–9 In 1846, Morton famously demonstrated the effects of ether at MGH during a surgery performed by Dr J C Warren.3 4 6–9 11 After Morton’s administration, Jackson, however, claimed that he was the original discoverer of ether for surgical anaesthesia—that he had conceived of this use in 1842, but had not pursued it, instead instructing Morton in its potential.3 8 11 12 He even wrote a letter to the French Academy of Sciences detailing the primacy of his role in the discovery.12 The debate over who first discovered and proclaimed these agents to be surgical anaesthetics continued, ironically causing
i
According to Desai et al,9 neither Clarke nor his medical school professor realized they had induced general anaesthesia; rather, they attributed the female patient’s state to ‘hysteria’.
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Copyright Article author (or their employer) 2015. Produced by BMJ Publishing Group Ltd under licence.
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Original article significant pain and personal suffering to many of these early pioneers.3 4 7–9 11 Of these four men, only Long continued to practice medicine until his death by a stroke in 1878.11 Physician historians have offered various interpretations to explain the 19th-century discovery of surgical anaesthesia. Most have noted the contribution made by social usage. Ether and nitrous oxide were popular intoxicants among both lay public and medical professionals.3 4 6–11 As Long’s biographer Francis Boland explains “‘ether parties’ and laughing gas’ demonstrations became popular in parts of the United States in the early part of the nineteenth-century. With no radios and moving pictures the world must be entertained in some fashion.”11 Travelling shows brought nitrous oxide to various cities and allowed their audiences to sample the gas and indulge in its effects.3 6–8 11 Elsewhere, traditional social gatherings such as quiltings and dances often included an ‘ether frolic’ in which attendees would inhale the gas and become intoxicated.3 4 6–11 Other scholars have attributed the discovery of anaesthetic agents to evolving scientific thinking and refinement, including the medical community’s readiness to believe that painless surgery was possible.8 13 Anesthesiologist-historians Nicholas Greene and Emanuel Papper have described the development of empathy and an increased understanding of the individual and his pain as requisite foundations for surgical anaesthesia.8 13 14 Papper, in particular, traced the origins of these sentiments to ‘outgrowths of Romantic subjectivity’.14 A recent essay expanded on this proposed intersection of ether and humanism, suggesting that the engagement between the two flowed in the opposite direction as well: Long’s ability and willingness to provide anaesthesia across social boundaries, such as those of race and class, promoted and led to an understanding of human equality in the face of pain.15 ii Before Sims, others, including the original claimants, had begun documenting the discovery of anaesthesia. In 1847, Horace Wells published A History of the Discovery of the Application of Nitrous Oxide Gas, Ether, and other Vapors, to Surgical Operations;16 Crawford Long produced testimony of his discovery in an 1849 issue of Southern Medical and Surgical Journal;17 JH Abbot described Jackson’s contribution in an 1866 article of The Atlantic Monthly.18 These accounts focused on a chronology of events and assigning responsibility and credit for the discovery of surgical anaesthesia. Thirty years later, J. Marion Sims published his own account in the Virginia Medical Monthly and sought to uphold Long as the original discoverer. In the following paragraphs, we want to step back from chronology and credit. Instead, we offer a reading of Sims’s narrative as a window —perhaps a modern one—into both his profession and the postbellum era. We begin by discussing Sims’s career, including the complicated legacy he left as a physician. Next, we review late 19th-century history with a focus on Reconstruction as well as a few details surrounding the publication of ‘The Discovery of Anaesthesia’. Finally, we show how the modern reader can use Sims’s article both to trace the first use of ether and nitrous oxide for surgical anaesthesia and to provide a window into the 19th-century medical profession and the post-Civil War period. Through this study, we hope to show how to read both medicine and the world around it in physician histories.
Born to a poor family in rural South Carolina, he began his medical studies at the Medical College of the State of South Carolina.19–23 Like fellow Southerner Long, he finished his training in Philadelphia where he graduated from Jefferson Medical College in 1835.19–23 During his medical school days in Philadelphia, Sims developed an interest in surgery.19 23 He then returned to the South to start his career, first in South Carolina and then Alabama where his patient population included the full range of the Southern population: black slaves, free blacks and wealthy whites; men and women; adults and children.19–23 It was here that he invented an operation to treat vesico-vaginal fistulas. In 1845, he began to operate on black slave women—without anaesthesia—who had sustained these pathological connections between the vagina and the bladder during difficult and prolonged childbirth. During his 4-year search for a sustainable repair, Sims invented his now famous speculum and silver sutures.19–23 Beyond these technical advancements, the ethical dilemmas of Sims’s operations have left a lasting legacy. On the one hand, Sims perceived the biological similarities among women’s bodies. He invented his speculum during a physical examination of a white woman and then used it to examine black slave women; he treated both black and later white patients with vesico-vaginal fistulas by means of the same operation.19 20 22 23 On the other hand, Sims, like many of his colleagues, held a deep-seated belief in racial inequality. His medical racism is evidenced both in his use of black slave bodies to experiment and perfect a surgical technique and in his disregard of the patients’ modesty and privacy.19 21 24 Moreover, although Sims did not have access to anaesthesia for his initial surgeries, his ideas about race and pain likely influenced how he conducted his operations.20–22 As was common in his society, Sims believed that susceptibility to pain was based in racialised and gendered categories and that black women were better able to endure pain than white women.15 19 24 Shortly after these operations, Sims left the South due to declining health. Settling in New York in the early 1850s, he helped found the Woman’s Hospital where he continued his work in gynaecologic surgeries.19 20 22 23 By the 1860s, Sims was travelling regularly in Europe where he demonstrated his surgical and obstetrical skill.19 20 22 He was the member of several professional organisations and became the president of the American Medical Association (AMA) in 1876.19 20 22 Throughout his career, Sims remained invested in his Southern roots. He invoked his background in his depiction of his difficulty in establishing himself within New York City’s medical community. In one conversation relayed in his autobiography, Sims denied a friend’s suggestion that ‘it is the Northern prejudice against a Southern man’, and left the comment in the text.23 Biographers and scholars have also suggested that Sims left for Europe due to his feelings regarding the Civil War and its politics.19 20 22 And when Sims received a public rebuke for divulging medical information about actress Charlotte Cushman, he saw himself, at least in part, as the victim of Northern disrespect.19 iii Perhaps Sims’s own words best illustrated his situation: ‘If you applaud so vociferously this
J. MARION SIMS Although he came from humble means, by the time he wrote his article in 1877, Sims had achieved considerable success.
ii
For a list of forces leading to the discovery of surgical anaesthesia.8
2
iii In 1869, Cushman found a breast mass. Although Sims advised her against surgery, she underwent a mastectomy with James Simpson as her surgeon. Sims reported to a New York newspaper about how the actress was faring in the postoperative period. The New York Academy of Medicine brought Sims up on ethical violations for failure to respect a patient’s privacy. Please see McGregor19 for further details.
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Original article sentiment from a citizen of New York, let me tell you that it is from the heart of a red southerner…I sympathized heart and soul with the South in what you miscall a rebellion’.25
POSTBELLUM USA In 1877, the USA was grappling with the aftermath of the Civil War and Reconstruction. Although Reconstruction policies sought to reintegrate the South back into the Union, the rift between North and South persisted. Northern political leaders continued to view the South as rebels and Southern whites saw Northerners as illegitimate tyrants.26 Likewise, the struggle for emancipation that lay at the heart of the Civil War transformed into persistent tension over black civil rights. Conflict over black suffrage, black economic autonomy and integration between blacks and whites found expression on national and local stages.26 And at least some of the time, these struggles played out in violence, such as the 1866 race riot in Memphis and the continued activities of the Ku Klux Klan.26 It was in this context that Sims wrote ‘The Discovery of Anaesthesia’.
PUBLICATION Sims had been interested in publication since his early career in Alabama, seeking, as his biographer suggests, ‘a nationally recognized rather than a locally known career’ and ‘The Discovery of Anaesthesia’ reflected his writing ambitions.19 We do not know why Sims chose to publish in the Virginia Medical Monthly. Perhaps, he wished to honour the journal that featured a biographical sketch of him in an 1877 issue.19 Maybe he found among the magazine staff a group of like-minded Southerners, proud of their region as evidenced in the editor’s letter to Long: ‘I wish all Southerners would stand up and work for their rights’.27 Or perhaps, Sims was impressed by the magazine’s breadth of authors, articles and readership. One of the 1877 issues, for example, featured pieces from professors and local physicians on a wide variety of topics, ranging from medical compensation to eye diseases to phimosis as well as advertisements and medical society proceedings.28 Moreover, the Editorial section boasted that the journal was ‘steadily developing and gaining friends everywhere. Its circulation now extends from Upper Canada, southward throughout the United States into Mexico, and further south into Brazil, while East and West it reaches into countries across the oceans’.29 Whatever his reasons, the Monthly’s Editors eagerly anticipated Sims’s article in the issue preceding its publication.29
MEDICAL AND SOCIAL SPHERES Sims opened his essay by recounting his 1876 meeting with P. A. Wilhite, a South Carolina doctor, in which he learnt that Crawford Long was ‘the real and original discoverer of anaesthesia’.2 Sims then postponed any discussion of Long, proceeding instead to discuss an 1839 ether frolic attended by the then 17-year-old Wilhite in which ‘he (Dr Wilhite) was the first person who had ever profoundly etherized any one’.2 According to the story, ether was a frequent component of popular amusement in the early 19th-century. Its social uses were so common that ‘there was hardly ever a gathering’ without it and young people were ‘in the constant habit of using it’.2 Connecting ‘boys and girls’, it led some to ‘laugh, some cry, some fight and some dance’.2 Although Sims may simply have been reporting the story he heard from Wilhite, the narrative of the ether frolic opens a window through which the modern reader can envision the complex interplay between social and medical spheres in the 1840s. In Sim’s account, Wilhite’s ether frolic preceded any Rosenbloom JM, et al. Med Humanit 2015;0:1–5. doi:10.1136/medhum-2015-010680
description of the discovery of anaesthesia as if to demonstrate how ether for popular entertainment was intimately tied—and foundational—to its anaesthetic function. Indeed, when Sims later turned to his account of Long’s and Wells’s medical discovery, he once again invoked the social use of these inhaled agents. Long noted that ether frolickers suffered ‘falls and blows, and were not conscious of pain at the time’ which ‘suggested to his mind the idea of using ether to prevent the pain of surgical operations’.2 Likewise, Wells watched a man injure himself while intoxicated during a public demonstration of nitrous oxide, leading him to consider it for the extraction of teeth.2 Antebellum social uses of ether thus led to medical application of it. Wilhite’s description of the ether frolic further invites the modern reader to imagine postbellum tensions between social and medical spheres. After Wilhite administered ether to a black boy watching the revelry and was then unable to awaken him, a Dr Reese arrived to help. The physician ‘threw water in the face of the sleeping negro’ and then lectured the white participants ‘on the dangers of such frolics’.2 Whether intended or not, Sims’s description serves as a lens through which the readers can come to appreciate the divide between the lay and the medical; only the medical man understood the ‘dangers’ of ether and only the medical man understood how to take care of someone under its influence. That Sims was writing at a time when the ‘orthodox’ medical profession was seeking to seize control of the field from rival groups of health practitioners further highlights the significance of Dr Reese’s appearance.30 We can thus read the ether frolic as illuminating how the medical world was both dependent on and distinct from the popular sphere. Competing versions of Wilhite’s ether frolic may further help Sims’s modern audience to comprehend the ambiguous relationship between social and professional arenas. In an 1881 book, Henry Lyman recounted Wilhite’s ether frolic and the etherisation of the black boy: ‘the boy was unconscious, motionless, stertorous, evidently dying. But after an hour of consternation on the part of the spectators, he revived and was no worse for his alarming experience’.6 In this version, the boy awoke spontaneously and there was no doctor, but only a ‘party of boys’.6 Later, in an 1895 issue of the New York Medical Journal, L.B. Grandy openly contradicted Wilhite’s story, referring to it as ‘myth’. He reported this set of events: ‘it occurred to him [Wilhite] that sulphuric ether might produce a similar effect, and as an experiment he administered the latter to a negro boy who was in the office [Dr. Long’s office—L.B.G]. … To his surprise and horror the boy became profoundly insensible, and, thinking his death was inevitable, he and a fellow student had their horses caught and brought to the door with the view of fleeing into Tennessee. Before carrying this design into execution the boy aroused from the effect of the anaesthetic and was as well as before’.31
In Grandy’s version, ether was provided in an ‘office’, not at a social gathering. Likewise, the doctor (Wilhite), not the lay public, expressed ‘surprise and horror’ at the ‘insensible’ patient. Finally, as in Lyman’s version, the patient woke up not through a doctor’s manipulations, but spontaneously. In contrast to these latter two versions, Sims’s account allows us to demarcate sharply the lay world from the medical one.
POSTBELLUM RACIAL TENSIONS Modern audiences can also read 19th-century race relations into this episode. At the gathering, the revellers saw a ‘negro boy at the door, who seemed to be enjoying the sport’.2 We do not 3
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Original article learn further details about this boy such as his age (as the contemporary use of ‘boy’ could refer to a black male of any age) nor his status as enslaved or free. Although in 1839 Georgia, he would have likely been a slave, we can perhaps attribute the lack of direct reference in Sims’s essay to the sensibilities of the postemancipation era. And yet the boy was an observer, not part of the party; indeed, he stood in the doorstep, not in the room. When the boy refused invitations to participate, the white revellers violently forced him to inhale the ether. They ‘persisted, thinking it was great fun’, and hoped the boy would ‘get up immediately and say or do some foolish thing for them to laugh at’.2 In this way, experimentation with ether, combined with suggestions of black inferiority and white violence, was reified into racial popular amusement. But unlike the rowdy white party-goers, the boy ‘lay quietly, and with stertorous breathing’.2 He remained outside the community, even when cajoled into participating in it. That he could not partake in this communal activity can be read as reflecting contemporary (white) resistance to integration. We can also interpret the Negro boy’s sleeping as a representation of the interplay between concepts of inferiority, violence and labour so at stake during Reconstruction. Black sleepiness reaffirmed notions of laziness which many whites associated with blacks.26 Such racial stereotypes often served as an excuse for violence, especially during Reconstruction when whites could no longer rely on slavery to enforce black labour.26 In this reading, the description of the white partygoers’ increasing aggression towards the child reflects the era’s violence: they ‘insisted’, then they ‘caught hold of the boy’, then finally they ‘threw him down and held him’.2 When the boy attempted to defend himself, they continued their violence; they stopped only after he fell asleep. And here, the modern reader can sense how Sims’s text betrayed itself. The boy’s sleep proved the Negro to be a perfect patient since the ether subdued, rather than excited, him, as it did the white revellers. From this perspective, the child and his sleep provided a professional service to both Wilhite and Dr Reese, one who went both unacknowledged and unrewarded. The white doctors, and by extension the white community, benefitted from this unpaid use of a black body.
POSTBELLUM SECTIONALISM We can also appreciate postbellum national discord through Sims’s article. As he considered the multiple discoveries of surgical anaesthesia, from Long through Morton, Sims made clear that the conflict over the title of discoverer was fiercely waged in the press and in sessions before Congress.2 Expressing his own opinion, Sims focused on individual achievement: ‘Long ante-dates Wells two years and eight months, and ante-dates Morton four years and six months’.2 Whereas Sims’s treatment of Wells, Morton and Jackson was brief, his discussion of Long’s discovery was more detailed.2 Sims repeated his position as he summarised his facts: ‘Long was the first man to intentionally produce anaesthesia for surgical operations’.2 Yet, Sims championed Long as an individual and as a symbol of the South, thus underscoring the sectional allegiance that dominated 19th-century US society. In his first sentences about Long, Sims repeated ‘Georgia’ several times as if to emphasise his native roots.2 He painted Long nostalgically as ‘a country doctor’ who lived in ‘an obscure little town’ and a ‘contracted world’.2 By contrast, the other men were from the North and practiced in large cosmopolitan cities.2 Morton, for example, ‘was fortunate in showing his patent remedy to the great surgeons of Boston’.2 And while Wells, Jackson and Morton 4
suffered physical and mental illness in their later years, Long’s fate is tied to his region. By standing with the South, he ‘lost all during our great civil war’; in continuing his medical practice, Long, like the South, ‘worked to death for the daily bread’.2 Long then may represent the sectionalism that led Sims to state, ‘I am proud of my country abroad, but ashamed of it at home. The humiliation of the South is inexcusable. Its ruin is unjustifiable’.25
FUTURE RECONCILIATION If we can read Sims’s representation of the discovery of surgical anaesthesia as exposing divisions and rifts in late 19th-century society, we can also see it as a rallying cry for future reconciliation. Although Long was first to discover surgical anaesthesia, Sims declared that all four men had a role in the invention: ‘the names of Long, Wells, Morton and Jackson [should] be inscribed on the Boston column, one on each side, as co-discoverers of anaesthesia’ since ‘no one man can claim this great honor exclusively’.2 They were ‘co-laborers’ and each of them deserved a ‘certain measure of credit’.2 Sims further linked the men by noting the sad outcome of their lives: Long became impoverished, Wells committed suicide, Morton fell fatally ill, Jackson went insane.2 Yet, Sims urged the reader not to dwell on how ‘their lives were embittered with envy, jealousy and uncharitableness towards each other’, but rather to concentrate on ‘the good’, their joint discovery of surgical anaesthesia.2 With his depiction of reconciliation among the discoverers, the reader may imagine that Sims was calling for a cohesive profession. He exhorted that ‘the whole medical profession, North, South, East and West, unite in asking Congress, at its next session, to appropriate this sum, as an anaesthesia fund’ for the families of the discoverers.2 Mid-19th-century medicine was a beleaguered profession—it lacked regulation, its practitioners were often ill-trained and it was divided by rivalling sections and ideologies.30 In his memoir, Sims reported his father’s reaction to his career choice: ‘there is no science in it. There is no honor to be achieved in it; no reputation to be made, and to think my son should be going around from house to house through this country, with a box of pills in one hand and a squirt in the other…is a thought I never supposed I should have to contemplate’.23
The last three decades of the 19th century, however, witnessed the beginning of reforms that led to upheavals in the profession lasting well into the next century. Changes centred on the consolidation of medical school curricula, the restructuring of daily practice to include fees and identify appropriate consultants and the reappearance of state licensing laws.30 In his 1876 presidential address before the AMA, Sims added his own notion of reform by asking, ‘but why should not the physician reap the reward due to talent and inventive genius as well as any other man?’32 Sims’s call for ‘an anaesthesia fund’ may have flown in the face of the AMA’s standing ban on patents and advertising, both of which were associated with quackery.30 Nevertheless, it was closely linked to Sims’s ideals for his profession in which individuals would benefit from their own creativity and ingenuity. This belief in individual recognition and compensation was important enough to Sims that he repeated it twice in his account of the discovery of surgical anaesthesia; in both instances, he suggested that the lack of acknowledgement was a sign of ingratitude, especially on the part of the national government.2 Here, Sims may have wanted to contrast his expectations of reward against Morton’s efforts at deception (his Rosenbloom JM, et al. Med Humanit 2015;0:1–5. doi:10.1136/medhum-2015-010680
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Original article concealment of the composition of the ‘Letheon’ potion for the sake of profit)2 in order to emphasise the importance for the medical profession’s legitimate membership to stand up for itself. The discovery of surgical anaesthesia can thus be read as a recruitment tool for a changed, unified profession. Sims’s account of the discovery of surgical anaesthesia can also be seen as a call for national unity. At both the beginning and the end of his paper, he acknowledged the European contributions of James Priestly, Humphrey Davy and James Simpson.2 But Sims reserved ‘the honor of discovering anaesthesia’ for Americans.2 Although divided by the Civil War and its economic, political and social consequences, it was the USA that had produced these innovators. In his declaration that ‘America should recognize the labors of Long, Wells, Morton, and Jackson’, ‘America’ superseded personal and regional divisions. In this way, the nation can ‘rise above all party, all prejudice, all sectionalism’.2 As Sims explained in 1876, the post-War USA was resilient: ‘it passed safely through the fiercest civil war the world has ever witnessed, and now it bids fair to endure for ages’.32 But one figure does not reappear in Sims’s text: the Negro boy in Wilhite’s story. If we are allowed to speculate on the meaning of this absence, we can offer several possible interpretations (but certainly not a definitive one). Perhaps the boy is missing because he was not a central part of Sims’s main subject, the discovery of anaesthesia. Or perhaps the boy’s absence suggests that Sims’s appeal for cohesion, nationally or professionally, did not include racial cohesion. In this view, the boy remains asleep, symbolising either an incongruous being in white society or a passive patient in the hands of white doctors. Or perhaps the boy is not present to indicate the changing position of black Americans. In 1876, Sims acknowledged that ‘if any colored man should rise to the dignity of representing a State or County Medical Society, we must receive him as such’.32 In this context, the black boy does not reappear because his status has evolved—perhaps from patient to doctor. The black child’s disappearance can thus be interpreted as mirroring the multiple readings of Sims’s article: an account of the discovery of anaesthesia, a reflection of needed reforms of the medical profession, or a symbol of the turbulence of the postbellum era.
Provenance and peer review Not commissioned; externally peer reviewed.
CONCLUSION
21
‘The Discovery of Anaesthesia’ delves into the origins of surgical anaesthesia in the mid-19th century, the medical profession, and the author’s contemporary postbellum era. Reading the essay invites modern audiences to a greater appreciation of how physician-authored histories do not have to be confined to the provincialism of medicine, but may speak to the world around them. In so doing, Sims’s narrative operates on many levels, particularly but not exclusively for its intended audience of physicians, to remind us that history stems from the particular vantage point—both professional and personal—of the historian. As Sims told Long, ‘the facts are historical. They are as I relate them’.33 Acknowledgements The authors wish to acknowledge the generous financial support of the Mentoring Program of the American Society of Anesthesiologists Committee on Professional Diversity in addition to the support of the Clinical Scientists Track training programme of the Department of Anesthesiology, Yale School of Medicine. Contributors JMR conceived of the idea for this paper while under the mentorship of RBS. JMR performed the research and archival work. JMR and RBS co-wrote the paper. JMR is the guarantor. Competing interests None declared. Rosenbloom JM, et al. Med Humanit 2015;0:1–5. doi:10.1136/medhum-2015-010680
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The outlook of physician histories: J. Marion Sims and 'The Discovery of Anaesthesia' Julia M Rosenbloom and Robert B Schonberger Med Humanities published online June 5, 2015
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