Anaesthesia comes to Toronto in the mid-19th century.
In October 1846, Dr. William T. G. Morton and Dr. John Collins Warren conducted a successful public demonstration of the surgical use of ether at Massachusetts General Hospital. “The discovery of a mode of preventing pain in surgical operations has been an object of strong desire among surgeons from an early period,” explained Warren, in an article in the Boston Medical and Surgical Journal, reprinted in the (Toronto) Globe the following January. Warren went on to “[congratulate] my professional brethren on the acquisition of a mode of mitigating human suffering, which may become a valuable agent in the hands of careful and well-instructed practitioners.”
The importance of a viable anaesthetic was immediately understood by Western medicine; within months, surgeons and dentists around the world were using ether. In his 1975 history of Toronto General Hospital, Waring Gerald Cosbie writes that “prior to the development of anaesthesia in 1846, the surgeon had to remain oblivious to the appalling suffering of his patient while he hastened to complete his operation. Now, with the conquest of pain, it became possible for him to undertake procedures of a scope hitherto denied him.” Not only did the new anaesthesia increase the comfort of many patients, it enabled surgeons to perform operations of greater number and growing complexity.
It is unclear just how quickly anaesthesia first reached in Toronto, although there are reports of ether being used in other parts of Canada as early as January 1847. In an 1858 letter to the Globe, Dr. William Rawlins Beaumont wrote that “it is about ten years since we first used…anaesthetic agents in the Toronto General Hospital, and we have continued their use in all, or almost all, important surgical operations.” However, research by David J. Steward in the 1970s shows that most of the first recorded uses of anaesthesia in Upper Canada did not take place in hospitals, but in the private surgeries of country doctors who had read about ether in newspapers and early Canadian medical journals. Stewart writes that “the use of ether for tooth extraction and surgical operations was probably widespread throughout rural Upper Canada within six months of Morton’s original demonstration.”
Only one year after Morton and Collins’ demonstration of ether, Scottish obstetrician Dr. James Young Simpson began popularizing the use of another viable surgical anaesthetic: chloroform. In her 2003 book Chloroform: The Quest for Oblivion, Linda Stratmann writes that whereas ether was comparatively “slow to take effect, creating an initial state of violent excitement undesirable in delicate operations,” chloroform worked more quickly, without exciting the patient. Chloroform was also less flammable than ether, considered easier to manufacture, and could induce adequate anaesthesia in far lesser quantities. In February 1848, in an article announcing the first medical use of chloroform in Montreal, the Globe included instructions on how chloroform could be prepared, noting that “we understand that the chloroform is [already being] manufactured by Lyman, Kneeshaw, & Co., of this city [Toronto].”
Early advocates of ether found it necessary to design various inhalation devices in attempts to regulate the quantity used and to keep the ether from irritating the face or throat of their patients. While some similar devices were also designed for chloroform anaesthesia, most early anaesthetists found that chloroform could be effectively administered simply by applying a few drops of it to a damp cloth, which was then held close to the patient’s face until they succumbed to its effects. Linda Stratmann writes that “within a year of its introduction, chloroform was a worldwide phenomenon, and the anaesthetic of choice everywhere, save the North-eastern United States,” where doctors maintained a preference for ether.
There was just one problem with chloroform anaesthesia: In rare instances, for reasons which doctors could not explain, a patient under chloroform would die. The first known case of a chloroform death occurred in England in January 1848, when an otherwise healthy 15-year-old girl died during an operation to remove a toenail. Over the next 15 years, more than 100 chloroform deaths occurred around the world; this was a relatively small number when compared with the thousands of patients who, while undergoing surgical operations or tooth extractions, received chloroform with no apparent ill effects, but the deaths were nevertheless troubling and became the subject of much medical debate. In her book Blessed Days of Anaesthesia: How Anaesthetics Changed the World, Stephanie J. Snow writes that “medical and public concern about chloroform fatalities was strong…Deaths under anaesthetics were subject to coroners’ inquests and the doctor who gave the anaesthetic had to take the stand and defend his actions.”
(Above: The death of Hannah Greener, the first known instance of chloroform narcosis. Wikimedia Commons.)
The first known chloroform death in Canada occurred in Toronto, on February 1, 1858. Local lumber merchant John McChesney visited the dental surgery of brothers Tobias and Mortimer French, at Bay and Melinda, in order to have six teeth extracted. At the subsequent coroner’s inquest, the French brothers said that McChesney had specifically asked about the safety of the chloroform anaesthetic ahead of time; Dr. Mortimer French informed McChesney that he had been performing dental extractions in Toronto with the aid of chloroform for quite some time and was in the habit of calling on local doctors for the administration of the anaesthesia. In this instance, French summoned Dr. James Richardson, whom French claimed to be the doctor who “had administered it in my office more than any other.”
According to the depositions of the French brothers and Richardson, McChesney then asked whether Richardson would take all the responsibility for the chloroform’s use; Richardson explained to the coroner’s jury that he had flatly refused to do so, and made reference to the reports from England of occasional, unexplained chloroform deaths. McChesney, it was claimed, nevertheless chose to receive the chloroform, saying that “he supposed he would have to take it some time, and he might as well take it then as at any other time.”
In accordance with his usual method, Richardson administered the chloroform by applying it to a wet sponge and holding it to McChesney’s face until the patient appeared to be feeling its effects. The extractions apparently proceeded without much incident, although McChesney was said to have remained conscious during the work; at one point, when he appeared to wince, Richardson had applied additional chloroform. Once all six teeth had been removed, McChesney was able to respond to a command to spit into a bowl, at which point Mortimer French observed “a change pass over his countenance such as to startle me.” McChesney’s body grew limp. Richardson had the window opened, and summoned several medical colleagues to help attempt to revive the patient. Efforts to resuscitate John McChesney with a “galvanic battery” failed, however, and he was pronounced dead a few moments later.
(Above: A device for administering nitrous oxide. Frank Coleman, The Nasal Administration of Nitrous Oxide [Claudius Ash, 1908: London].)
Additional evidence was given by McChesney’s brother, and by the other doctors who had participated in the resuscitation attempts, but no useful insights emerged. According to the Leader, the jury reached the verdict “that [the] deceased came to his death in Dr. French’s operating room while under the influence of chloroform, which he had voluntarily inhaled for the purpose of getting some teeth extracted, and that more than ordinary care was used in the administration of the chloroform.”
The Globe was particularly concerned with the circumstances of McChesney’s death. On the same day as its coverage of the inquest, they ran an editorial, which concluded that “however numerous the cases in which [chloroform] has been used without harm, it is not the perfectly safe agent which it is usually considered.” Over the subsequent weeks, the Globe also printed a series of letters written by several Toronto physicians and at least one person who had served on the jury at the inquest, debating the merits of chloroform and whether it had been administered properly to John McChesney. (One of the letters also questioned the wisdom of attempting to remove six teeth at one sitting.)
One of the Globe letters came from Dr. James Bovell, in which he described, in detail, an autopsy which he had conducted on John McChesney’s body in the days after the inquest. Bovell found that McChesney’s heart appeared very weak on one side, and suggested that this could have contributed to McChesney’s death. “Even under the most advantageous circumstances and under the most skilful hands, untoward results have followed the use of much less potent agents than chloroform,” Bovell wrote, indicating that he saw no reason at the time to restrict its use as an anaesthetic in future. “Common observation teaches us that some persons are especially susceptible of the intoxicating and poisonous effects of spirituous drinks or of opium, so it is with chloroform…there must always be some risk attendant on its administration.”
In January 1863, the second Toronto death under chloroform took place, this time at Toronto General Hospital. A patient named Richard Humphreys, otherwise described as “hale,” underwent an operation to have a tumour removed. The surgeon was veteran physician Dr. Edward Hodder and, acting as anaesthetist, was his colleague Dr. James Bovell, who had conducted the autopsy on John McChesney five years before. At the inquest, Bovell described seeing Humphreys spasm unexpectedly during the operation, and observed bulging in the veins around Humphreys’s neck. The jugular vein was opened in an attempt to relieve pressure on the brain, and unsuccessful attempts were made to revive the patient, first using cold water, and then, once again, the galvanic battery.
The details of the inquest were again reported in the local newspapers with considerable interest. Edward Fawcett, a fellow patient at the hospital, described speaking to Humphreys before the operation. According to Fawcett, Humphreys “desired to be placed under the influence of chloroform, previous to being operated on. He remarked, at the same time, that he should go to the operating theatre, and was prepared to die, as all should be who get operated on under the influence of chloroform.” The Leader described the coroner’s jury as “composed of six men from amongst the intelligent patients in the hospital, and six from the neighbourhood.” As in the 1858 case, the jury concluded only that the patient had died under the influence chloroform, and laid no blame on the doctors, deeming it to have been properly administered.
Describing Humphreys’s death in a 1964 article, Dr. Charles G. Roland noted how little was still known about anaesthesia in the 1860s. At that time, fewer than 2,000 operations had been performed under anaesthesia at Toronto General Hospital, and the role of an anaesthesia specialist did not yet exist. “Generally,” Roland writes, “the surgeon would relegate the task of anaesthesia to whoever was available and willing. Training or interest were not prerequisites.”
Speculation as to what caused deaths under chloroform continued for several decades. Many of the deaths appeared to be heart attacks or respiratory problems. Some in the medical profession believed that the key to eliminating chloroform deaths lay in finding better means of administering the chloroform, so they tried to design safer inhalers, with little apparent effect. Others noted that many of those who died under chloroform were reported to have expressed fear prior to their operations, and suggested that the deaths were caused not by the effects of chloroform itself, but were actually heart attacks and strokes brought on by terror. In a 1903 letter to the British Medical Journal, R. D. Rudolf, a Toronto doctor, lent his support to this theory, writing: “In Canada, where every death which occurs during the administration of chloroform gets into the daily papers, the public greatly dread the administration of the drug. This very dread is, I believe, the chief danger with which we have got to contend.”
Historian Linda Stratmann observes that, despite the unexplained deaths, chloroform remained immensely popular. “It was already obvious that in major surgery it saved lives, and while it was perhaps not as safe as had originally been thought…it seemed that all that was required to make it safe was a little care in administration, and a prior examination of the patient for potential heart or lung disease.”
In the late 1860s, a third anaesthetic became widely available. Although the euphoric effects of nitrous oxide, or “laughing gas,” had been known for quite some time, the gas had initially enjoyed more popularity as a form of public entertainment. Showmen would tour the continent, and audiences would pay money to inhale the gas, or to watch others do so. In his diary for August 7, 1841, John Howard, the prominent Toronto civil engineer and long-time resident of High Park, wrote that he “went to see the laughing gas.” According to a notice in the Toronto Patriot, what Howard appears to have attended was an evening at City Hall (then located at St. Lawrence Market) where “Messrs. Fitch & Seppell” provided an evening of “Philosophical Entertainment,” consisting of a magic lantern show, an astronomy lecture, an exhibition of botanical paintings, and “an opportunity of experiencing or witnessing that most wonderful, mysterious, and intensely interesting of all natural phenomena, the effect of the exhilarating gas upon the animal system.” Eight years later, Torontonians had the opportunity to spend an amusing evening at the Temperance Hall, where Mrs. Clarke performed on the piano, after which Mr. Clarke demonstrated the effects of laughing gas, “exhibiting the interesting and amusing effects produced by it on the different organization of individuals.”
(Above: The Toronto Patriot, August 6, 1841.)
Although experiments with using nitrous oxide as an anaesthetic had taken place in the 1840s, it did not come into popular use for another 20 years. Its effects were not as strong or as enduring as those of either ether or chloroform, making it ill-suited for complicated surgeries, but it proved useful in minor operations, and soon became particularly popular amongst dentists. A classified ad in the April 25, 1866, Globe announced that a Toronto dentist, Mr. George L. Elliot, “has made arrangements with Dr. S. P. May to administer Nitrous Oxide Gas every day at five o’clock p.m., Sundays excepted.” When The Canada Journal of Dental Science, the country’s first dental journal, produced its first issue in June 1868, its first ever article was a brief piece by Dr. Barnabas Day of Kingston, who wrote that nitrous oxide “has been used in all the principal cities of the United States and in the Dominion of Canada, with great success, for the last five years…I am of the opinion that the day is not far distant when nitrous oxide, or protoxide of nitrogen, will be placed in our materia medica as a remedial agent for cure of diseases, as well as an anaesthetic.”
Not all were immediately convinced that nitrous oxide had a future, however. In the second issue of The Canada Journal of Dental Science, Toronto dentist J. W. Elliott compared the three principle available anaesthetics of the day, and claimed that “Nitrous Oxide Gas does not possess the power of chloroform and ether, and is equally dangerous to life, often causing the patient to say or do that which, in their natural senses, would make them blush. It would never stand the test that chloroform has done, and after a while will only be heard of as an exhibition for schoolboys.”
As more was learned over the subsequent decades about the effect that chloroform could have on the human heart and respiratory system, it gradually fell out of favour with surgeons. By the 1920s, ether was the preferred general anaesthetic in most hospitals, and would remain so until the development of new drugs and new techniques. “Thirty-five years ago, when I first became interested in anaesthesia, the whole equipment in this department of the average small hospital consisted of a bottle of ether, a bottle of chloroform, and a gauze-covered wire mask,” wrote Dr. Harold R. Griffith in a 1953 Globe and Mail article. “Formerly, anaesthesia was a mostly uncomfortable and sometimes dangerous blessing. Quite rightly, patients often dreaded the anaesthetic more than the operation. Now, one can come to the operating room with assurance that the anaesthetist will perform his merciful duty painlessly, skilfully, and that his service will include watchful care of the patient throughout all the perils of surgery.”
Additional material from: W. G. Cosbie, The Toronto General Hospital, 1819–1965: A Chronicle (Macmillan, 1975: Toronto); B. W. Day, “Nitrous Oxide, or Protoxide of Nitrogen, as an Anaesthetic” in The Canada Journal of Dental Science (Vol. 1, No. 1 – June, 1868); J. W. Elliott, “Anaesthetics” in The Canada Journal of Dental Science (Vol. 1, No. 2 – July, 1868); The Globe (and Mail) (December 23, 1846; February 12, February 16, 1848; June 30, July 3, 1849; February 2, February 4, February 8, February 11, February 17, February 18, February 20, 1858; January 18, 1860; January 14, January 15, January 16, April 25, 1866; March 15, July 9, 1867; February 9, 1869; July 20, 1882; March 17, 1923; March 12, 1930; December 18, 1953); The Journal of John George Howard, 1833–49, Shirley G. Morriss, ed. (Ontario Heritage Foundation, Ministry of Citizenship and Culture); Toronto Leader (February 2, 1858; January 15, 1863); Akitomo Matsuki and Elemer K. Zsigmond, “The First Fatal Case of Chloroform in Canada,” in Canadian Anaesthetists’ Society Journal (Vol. 20, No. 3 – May 1973); The Medical Chronicle (Vol. 5, No. 9 – February 1858); Toronto Patriot (August 4, 1841); Charles G. Roland, “The First Death from Chloroform at the Toronto General Hospital,” in Canadian Anaesthetists’ Society Journal (Vol. 11, No. 4 – July 1964); R. D. Rudolf, “Fright and Chloroform Deaths,” in The British Medical Journal (Vol. 1, No. 2214 – June 6, 1903); Stephanie J. Snow, Blessed Days of Anaesthesia: How Anaesthetics Changed the World (Oxford, 2008: New York); David J. Steward, “The Early History of Anaesthesia in Upper Canada: The Introduction of Ether to Upper Canada, 1847,” in Canadian Anaesthetists’ Society Journal (Vol. 24, No. 2 – March 1977); Linda Stratmann, Chloroform: The Quest for Oblivion (Sutton, 2003: Stroud, Gloucestershire).
Historicist looks back at the events, places, and characters that have shaped Toronto into the city we know today.