Article of the Month: May/June 2013
Crawford W Long - Still an Enigma
Dr Henry Connor
Honorary Research Fellow, Centre for the History of Medicine, University of Birmingham
Presented at Netherwood Hotel, Grange-over-Sands Meeting, 2nd and 3rd July 2004
Proceedings of the History of Anaesthesia Society 2004; 34: 61-68.
Honorary Research Fellow, Centre for the History of Medicine, University of Birmingham
Presented at Netherwood Hotel, Grange-over-Sands Meeting, 2nd and 3rd July 2004
Proceedings of the History of Anaesthesia Society 2004; 34: 61-68.
This paper describes what is known about Crawford W Long and of the circumstances in which he worked, in an attempt to explain why he delayed publishing his work on the use of ether vapour as a surgcal Anaesthetic.
Long's work on etherisation
If William Clarke really did give a successful dental anaesthetic in January 1842, [1] then Crawford Long of Jefferson, Georgia (USA) was not the first person to use anaesthesia, but he was the first to give ether for a surgical operation, and was certainly the first person to accumulate a series of surgical anaesthetic successes. There is documentary evidence that between March 30th 1842 and prior to October 16th 1846 (the date of Morton's demonstration at the Massachusetts General Hospital), Long had used ether successfully on at least eight occasions. [2] According to his wife, he was also the first to practice obstetric anaesthesia when he gave ether to her during the delivery of their daughter, Frances, on December 27th 1845. [3] Frances Long Taylor gives the year as 1847 (reference 7), but was perhaps being vain about her age.
Long made no secret of his use of anaesthesia but he did not publish his work until 1849, [4] when friends eventually persuaded him to lay claim to the priority in its use. There has been much speculation over this delay in publication. At the very least, Long might have been expected to write a short paper, or even a letter, after he read, as he tells us, [4] an editorial on the operation at the Massachusetts General Hospital in the Medical Examiner of December1846. Long stated that he did start a communication to the editor of the Medical Examiner, but 'was interrupted when I had written but a few lines, and was prevented by a very laborious country practice, from resuming my communication' and that, after reading the January edition of the Medical Examiner which contained several more articles on surgical etherisation, he decided to wait a few months to see if anyone would lay claim to having used the technique before March 30th 1842. [4] He goes on to say that he then delayed further, due to the competing claims of Jackson, Morton and Wells, before he could definitely establish the date when ether was first used. Some years later, when Jackson visited Long on March 8th 1854, Jackson asked Long why he did not make known the results of his own work when he had heard the news from Boston. According to Jackson, Long replied that 'when he saw my dates, he perceived that I made the discovery before him, and that he did not suppose that anything done after that would be considered of much importance, and that he was awakened to the idea of asserting his claim to the first practical use of ether in operations, by learning that that such claims were set up by others for this merit'. [6]
By 'made the discovery' Jackson meant having first had the idea of using ether vapour to relieve pain, rather than having actually used ether for this purpose. He was still trying to claim to priority as late as 1854. Young quotes from a letter written by Long to show that Long did not accept Jackson's claim. Long also stated that, before publishing, he wanted to try ether 'in a sufficient number of cases to fully satisfy my mind that anaesthesia was produced by the ether and was not the effect of the imagination, or owing to any particular insusceptibility to pain in the persons experimented upon'. [4] In fact he already had good evidence on this point in two patients by January 1845. On September 9th 1843 he had removed three tumours from one patient on the same day, using ether for one of these operations but not for the other two. The operation under ether was painless, but 'the patient suffered severely' during the others. [5] Then on January 8th 1845 he amputated two fingers, again on the same day, on a boy with neglected burns. One operation, which was done under ether, was painless whereas the other, without ether, caused pain. [6] Long also said that he was keen to use ether 'in a more severe surgical operation' [4] before he published, but of course capital operations were very infrequent in his practice. He must have known that it could be years before such an opportunity arose, so why did he not publish the very considerable evidence that he had accumulated by early in 1845? Perhaps an answer can be found in a study of the man himself and of the circumstances in which he was working.
Crawford Long: The Man
It is evident that Long was intellectually very bright because he entered college at the unusually early age of fourteen, and graduated second in his class when only nineteen. [7] He then returned to his hometown of Danielsville as principal of the town's academy, before moving to Jefferson as a pupil of a Dr Grant. He then studied for one year in the medical department of Transylvania University in Lexington, Kentucky, followed by a further year in the medical department of the University of Pennsylvania in Philadelphia. After graduating in 1839 he spent a further eighteen months of study and training in hospitals in New York where, according to his daughter, he was held in high regard. He appears to have been ambitious because he wanted to set up in practice in a large city, but deferred to his father's wish that he should return to Georgia. Here he bought the practice of his old teacher, Dr Grant, in what was then the remote and isolated little town of Jefferson, and a far cry from his ambition of practicing in a large city, though his daughter says that he regarded it as a temporary post until a better opening came up. [8] He did move, first to Atlanta, Georgia in 1850, and then in 1851 to Athens, Georgia where he was in partnership with hisyounger brother.
First hand accounts which tell us much about Long's character and personality have survived from Joseph Jacobs, his pharmacy student in Athens, [9] Dr I M Goss, who was in practice in Jefferson after Long, [10] the Chancellor of the University of Georgia who gave the address at Long's funeral, [11] the editors of the Southern Medical and Surgical Journal, [5] two professors at the University of Georgia, [5], Charles T Jackson [13] and from his wife and daughter. [14] Although one must be cautious about the objectivity of opinions expressed by his wife and daughter, they make no claims about his character which are not corroborated by others. Long is described as a devoted family man, [9] quiet and unassuming, gentle and gracious [9] even-tempered and gentlemanly, [10] a dignified man who scorned boastfulness and pretension, [14] thoroughly truthful [11] and honorable in all respects. [13] However, the attribute that is most striking, because it is mentioned time and again, is his modesty. Jacobs describes him as 'retiring and modest’, [9] Jackson as 'very modest and retiring’, [13] and the editors of the Southern Medical and Surgical Journal as 'exceedingly modest in his pretensions'. [12] In the oration at his funeral it was said that he was 'modest, even to the verge of timidity' and 'reticent of his own merit, reticent, too, of his troubles, lest he should disturb the happiness of others'. [11] Although described by Jacobs and Jackson as 'retiring', this adjective must apply to his aversion to self-pretension, for he was certainly gregarious, [2] was an excellent host in the 'old-fashioned Southern tradition [14] and had many friends. [9] He was fond of dancing and of hunting and fishing, enjoyed horse racing (but did not bet) and was a fine whist player. [14] He was also a man of 'extensive erudition' [10] with a considerable knowledge of Shakespeare's plays, from which he often quoted. [9] He was fond of poetry, especially Burns, Byron, Shelley and Keats, of the novels of Scott, Thackeray and Wilkie Collins, and of Macauley's historical works. [9] Under the pen name of 'Billy Muckle' he wrote humorous sketches for a local newspaper, often gently poking fun at the local politicians, who he never named but who were usually recognisable to those 'in the know.' [9]
Long owned a few domestic slaves who he regarded as 'wards of his care and benevolence'.[15] One of his letters, written when he was away from home, showed considerable concern for one of the slaves who had fallen ill during his absence. [16] He believed that 'the great body of slaves should gradually be emancipated under regulations that would be beneficial to them and equitable to their owners.’ [15] He opposed Georgia's secession from the Union but, when secession was announced, an event which he described as 'the worst day of my life', [17] he cast in his fortunes with his native state and took charge of a military hospital. [15]
Long was 'beloved and respected by all classes' [15] and 'esteemed by everyone'. [10] He was a man of great energy [10] and worked hard. [14] In business, as the co-owner of the largest pharmacy in northeast Georgia at the start of the Civil war, [18] he was 'exacting and particular in business details' and required order and system in the day-to-day management. [9] It was said of him that he 'assumed nothing', [11] an observation which may be relevant to his experiments with ether. Asa doctor, he was always abreast of improvements [10] and read both the American and British journals. [19] In Jefferson he built up a large and lucrative practice and, because he was recognised as a skillful surgeon, was often asked by colleagues to travel long distances to assist in difficult operations. [17] Goss wrote that: 'Long's opinion is sought far and near by the profession from the fact that the people are satisfied with any physician, if he but procure Dr. Long's opinion'. [10] Goss also described Long as: 'a very eminent practitioner and a surgeon of as high repute as any of his age in the South', adding that he was also one of the best pathologists In the South.' [10]
Public and professional attitudes to Long's work with ether
Although the local people evidently respected Long's abilities as a physician and surgeon, they were unsettled, even frightened, by his work on anaesthesia. Dr J K Groves, who was Long's first student and who entered his office in May 1844, later wrote that 'Owing to the prejudice and ignorance of the local populace, Dr Long was prevented from using ether in as many cases as he might have'. [20] Long's daughter described the 'fears of the people, who had become very much excited over the powers of ether', [21] and that 'Long was considered reckless, perhaps even mad. It was rumoured throughout the country that he had a strange medicine by which he could put people to sleep and carve them to pieces without their knowledge'. [22] His daughter also claimed that friends urged him to stop his work with ether for fear that he would be lynched if a fatality occurred, [22] though this was never mentioned by Long or any other contemporaneous source. Two people, one a doctor and the other a doctor's wife, [23] described Long's use of ether as having been 'notorious' throughout the district, but this adjective was probably used to mean that it was well known without necessarily implying any unfavorable connotation. Long's wife wrote that he used anaesthesia 'whenever he could induce his patients to submit to the "dangerous drug" ', [14] and Long himself wrote of his first case that 'As an inducement to Venable to allow himself to be the subject of such experiment, my charge for the operation was merely nominal, $2.00, ether 25 cents’. [24]
If Long had hoped that his discovery might engender a more enthusiastic response from his professional colleagues in Georgia, he was to be disappointed. One college student in Athens, Georgia, later recalled that the wonderful discovery of anaesthesia was the talk of the town and was the subject of a lecture by the professor of chemistry, Dr Le Conte, in 1845, [25] but there is little evidence that practicing doctors were prepared to try ether. In May 1843 Dr R D Moore and Dr Joseph B Carlton of Athens discussed using ether in an operation but, as they had none immediately available, they went ahead without. [23] Subsequently, in November or December 1844, Carlton did use ether for a dental extraction [23] but, as this was done in Long's office, it is likely that the administration was supervised by Long. There is no recorded instance of any other doctor in Georgia using ether before 1847, and indeed Long's daughter was to write later that 'To my father's disappointment, the older medical men of the vicinity and neighbouring towns were skeptical of his claims, all the while expecting a fatal result from one of his experiments'. [26]
Long described how, at this time 'there were physicians high in authority, and of justly distinguished character' who were advocating mesmerism for the prevention of pain during surgery. [4] Long was not impressed by the reports which he had read on the use of mesmerism for this purpose, but the early to mid-1840s were the high tide of enthusiasm for this technique. Elliotson published his results in 1843 [27] and Esdaile in 1846. [28] More importantly, from Long's perspective, there was considerable enthusiasm for mesmerism among senior practitioners in the southern states of America. In particular, as Boland has pointed out, two of the proponents, who Long described as 'high in authority', were L D Dugas and P F Eve, professors of surgery in the Medical College of Georgia in Augusta and co-editors of the Southern Medical and Surgical Journal. [29] Both published reports on painless surgery in mesmerised patients, including two mastectomies by Dugas in 1845. [30] The extent of the confidence in mesmerism in the southern states is reflected in an editorial, quoted by Buxton, [31] in the New Orleans Medical and Surgical Journal in 1846 following publication of the successful use of ether In Boston: 'Why, mesmerism, which is repudiated by the savants of Boston, has done a thousand times greater wonders and without any of the dangers here threatened. What shall we see next?'. The lay public were also familiar with mesmerism through the exhibitions given by itinerant lecturers and, as Long's daughter recorded: 'It was difficult to persuade the people ... that the inhalation of a drug could produce insensibility to pain: that this unconsciousness must be from the mesmeric powers of the young surgeon, they could believe’. [21]
Long's quandary
Having established some facts about Long himself and about the circumstances in which he was working, let us now try to put ourselves in his shoes. It is, let us suppose, the spring of 1844. Long is a bright and ambitious 28 year old. Three years ago he had set up in independent practice in a very rural area, not perhaps what he had been hoping for, but his practice is expanding, he has just taken on his first student, and it cannot be long before a better opportunity comes up. He has been married for two years and he and his young wife have just started a family. It is also two years since he discovered that the inhalation of ether could be used to produce insensibility to pain during surgical operations. Opportunities to substantiate this wonderful discovery have been few and far between, but he has now accumulated four or five cases - surely enough to make people sit up and take notice. Although Long has not published his results, neither has he made any secret of his work which is well known in his native state of Georgia. But there has been no acclaim, no-one is clamouring on his door to congratulate him and to ask how it is done; indeed, quite the opposite. The local people are frightened of this mysterious and powerful drug and unfounded rumours, based on ignorance, are fuelling their anxieties.
One or two of his younger medical colleagues have expressed some interest, but none of them has tried using ether. As for his senior colleagues, they are skeptical of his claims and are predicting that, sooner or later and probably sooner, one of his patients will die from the effects of the ether. Moreover, most of them can see no need for it, because the work being done in the local medical college by two of the most respected surgeons in the state is confirming that mesmerism is not only effective for the relief of surgical pain, but is also perfectly safe. Long is in a quandary. He is as skeptical of the value of mesmerism as his older colleagues are of his use of ether. A less reticent man would publish his results and set the scene for what might well prove to be a bitter argument, rather than a scientific debate, with the older men; but this is not a scenario which the modest, unpretentious Long can contemplate with equanimity.
There is also, still, a niggling uncertainty at the back of his mind. Perhaps his small group of patients is, by chance, in some way atypical in their responses to either pain or to the ether itself. There was, of course, the lady from whom he had removed three tumours in the fall of last year and in whom only the operation done under ether had been painless. That had made an atypical response to pain improbable, but it was only the one case. Long is a man who assumes nothing and one who is particular and exacting in matters of detail. His mind is made up; he must collect more cases before he can publish.
Long has to wait from the spring of 1844 until January 1845 before he is again able to test the effects of ether, but the case which then presents is ideal for his purpose. It is the boy who requires amputation of two fingers. Long amputates one finger, painlessly, under ether and the other, without ether, but with considerable suffering. Now, surely, he has irrefutable evidence of the efficacy of ether but, as he prepares to start writing he receives news which causes him further uncertainty. Only a fortnight or so after he has amputated the boy's finger, Long hears of Horace Wells' disastrous demonstration of nitrous oxide which took place in late January 1845. [32] Southern courtesy forbids that the advocates of mesmerism should taunt Long about the failure of this pharmacological method of inducing insensibility to pain, but Long knows that they are triumphant. Yet it is not Wells' failure in itself which haunts Long, but the fact that Wells had previously used nitrous oxide successfully on fifteen occasions. [33] For Long, who has still only used ether on five or six occasions, the lesson is obvious; he must collect still more cases and preferably at least one capital operation.
Then, sometime in December 1846 or early January 1847, when he still has only eight cases, Long reads the editorial in the Medical Examiner on Morton's use of Letheon, described as an 'ethereal solution of some narcotic substance'. [4] Long knows that it is ether itself which 1s the active agent. He starts writing a letter to the editor of the Medical Examiner, but tells us later that pressure of work prevented him from completing it. [4] Can this really be so? We know that Long has a busy practice, but he is an energetic, hard working 31 year old and this is a subject on which, in the face of considerable local opposition, he has been working for the last three a half years. It would not take long to write the letter. He has only to say that it is ether itself which induces the insensibility to pain and that he has used it on eight occasions, giving some brief details of his cases. I suggest that it is not pressure of work but disappointment, bitter disappointment, which prevents Long from completing his letter. He does not admit this, of course, this man who is always 'reticent, too, of his own troubles'. [11] Inwardly, however, he is brooding and frustrated. If only he had had the courage of his convictions and had published his results sooner; if only the local people had not been so irrational in their fear of ether, he would have been able to accumulate the necessary experience so much more quickly; if only he, too, had had access to a major teaching hospital where colleagues would have understood and appreciated his work; if only...
A few days later Long receives the January number of the Medical Examiner whichcontains accounts of further etherisations. He decides that he will wait a few months to see if anyone will lay claim to having used ether before March 30th 1842. [4] Perhaps he is also aware of some of the failed attempts with ether, and he certainly knows that the proponents of mesmerism are still scornful of the benefits of ether. [31] At this stage, Long decides there is nothing further to be lost by waiting. As he waits, the dispute over Morton's patent is followed by the bitter squabble over priority between Jackson, Morton and Wells. All of this is intensely distasteful to Long, a man who is honourable in all respects [13] and who detests pretension. [14] He wants no part in this unseemly debacle, and comes to accept that he has missed his chance of fame. The retiring and unassuming Long learns to be content with his own knowledge of what he achieved, and is fully occupied with his thriving practice and growing family. As etherisation becomes an established fact his patients, once so fearful and suspicious of his experiments with ether, now treat their clever and able young doctor with growing respect and affection; this alone is sufficient reward for the innately modest young doctor.
It is not, however, sufficient for his previously unsupportive medical colleagues, who tell him repeatedly that he will not be doing himself justice if he does not press his claim for priority in the use of etherisation. Perhaps they are also keen to see that honour bestowed on a fellow Georgian rather than on a cocky northerner. Long initially resists their persuasion but then, sometime in 1848, he is invited by Professor Paul Eve, one of those 'high in authority' and co-editor, with Dugas, of the Southern Medical and Surgical Journal, to visit him in Augusta to discuss how he might prosecute his claim. [29] There is no record of their meeting but Long is persuaded and his paper is published by Eve the following year, [4] bringing, no doubt, a certain kudos to Eve's journal as well as to Long. Subsequently Long gives at least two further lectures in Georgia to re-inforce his claim, [34,35] but they contain no new information.
Ironically, Long's work is now forgotten, at least by those who do not know him, until a year before his death when it is revived by Dr J Marion Sims (of the Sims speculum) in a paper in the Virginia Medical Monthly in 1877. [36] This paper causes Long some annoyance because, through no fault of Sims, it contains a claim by Dr P A Wilhite, one of Long's former students, that it was he who first suggested to Long that ether could be used as an anaesthetic. This would have been impossible because Wilhite had not entered Long's office until at least two years after Long first used ether. Long writes to Wilhite to point out his mistake for which Wilhite subsequently apologises, but neither of them writes to correct it in the Virginia Medical Monthly, and as Sims has by this time left for Europe, the error is not publicly corrected until 1893. [37] In the meantime Wilhite's claim is reiterated by Foy in 1889 [38] and subsequently perpetuated by Nevius in 1894, [39] Burroughs Wellcome in 1907 [40] and Fulop- Miller in 1938. [41]
A Final Conundrum
We shall never know whether the suppositions in the preceding section are correct. They are, perhaps, as near as we shall ever get to the truth, and the story of Crawford Long will always remain an enigma. Three of his biographers have left us with a further conundrum. Young, writing in 1897, stated that a statue had been erected to his memory in Paris. [42] In 1908 Goss wrote that 'a report has been circulated that a statue to the honor of Dr Long has been placed in the City of Paris, France, but I am not informed as to the accuracy of such report’, [43] and in 1912 Buxton stated that there was a memorial to Long in Paris. [44] Was there ever a statue or memorial to Long in Paris? If so, where is it now? It is unlikely that there had been confusion with the statue of Horace Wells in Paris because Young was writing thirteen years before the statue of Wells was unveiled on March 27th 1910. [45]
References
1. Wolfe RJ. Tarnished Idol: William Thomas Green Morton and the Introduction of Surgical Anesthesia: a Chronicle of the Ether Controversy. San Anselmo, California: Norman Publications, 2001; 498-500.
2. Young HH. Long, the discoverer of anaesthesia: a presentation of his original documents. 22pp. Reprint from John Hopkins Historical Bulletin 1897; 77-78. (Wellcome Library pamphlet WZ 6:29:6): 2-3.
3. Boland FK. The First Anesthetic: the Story of Crawford Long. Athens: University of Georgia Press, 1950; 60.
4. Long CW. An account of the first use of Sulphuric Ether by Inhalation as an Anesthetic in Surgical Operations. Southern Medical and Surgical Journal 1 849,5(NS):705-13. Reproduced in Boland op cil;35-37.
5. Young op. cit,13.
6. ibid; 22.
7. Taylor K . Crawford W. Long and the discovery of ether anaesthesia. New York: PB Hoeber 1928;25-40.
8. ibid; 33.
9. Jacobs J. Some Personal Recollections and Private Correspondence of Dr Crawford Williamson Long. Atlanta, Georgia, 1919. (Wellcome Library pamphlet WZ 6:29:7); 4.
10. ibid; 9-10.
11. ibid 16-17.
12. Nevius LW. The Discovery of Modem Anesthesia: by Whom was itMade? A Brief Statement of Facts. New York: GW Nevius, 1894; 24-25.
13. Jacobs op cit;43-45.
14. ibid; 5-6.
15. ibid; 14
16. ibid; 8-9.
17. Taylor op cit; 118.
18. ibid; 119.
19. ibid; 55.
20. Young op cit;21-22.
21. Taylor op cit;52
22. ibid; 49.
23. Boland op cit; 64-65.
24. Taylor op cit;47.
25. ibid; 68.
26. ibid; 67.
27. Elliotson J . Numerous Cases of Surgical Operations Without Pain in the Mesmeric State. London: H Bailliere, 1843.
28. Esdaile J. Mesmerism in India and its Practical Application in Surgery and Medicine. London: Longman, Brown, Green and Longmans, 1846.
29. Boland op cit; 53.
30. Young HH. Crawford W Long: the pioneer in ether anesthesia. Bulletin of the History of Medicine 1942; 12;191-225. (This paper contains references to publications on mesmerism by Eve and Dugas).
31. Buxton DW. Crawford Williamson Long (1815-1879). Proceedings of the Royal Society Medicine 1912; 519-45.( Wellcome Library pamphlet 6:29:8); 4.
32. Wolfe RJ. I sleep to awaken: an appreciation of Elizabeth Wales Wells in: l Awaken to Glory: Essays Celebrating the Discovery of Anesthesia by Horace Wells, RJWolfe and LF Menczer (Eds). Massachusetts: Boston Medical Library, 1994; 227.
33. American Dental Association, Horace Wells Centenary Committee. Horace Wells, Dentist, Father of Anesthesia. Hartford, Connecticut: 1948; 3
34. Jacobs op cit;13.
35. Boland op cit; 47.
36. Sims M. The Discovery of Anaesthesia. Virginia Medical Monthly 1877; 4:81-100.
37. Young op cit;16-17.
38. Foy G. Anaesthetics, Ancient and Modern. London: Baillere, Tindall & Cox, 1889, 51-52
39. Nevius op cit; 4, 10-12.
40. Anonymous. Anaesthetics, Ancient and Modern: an Historical Sketch of anaesthesia. London:Burroughs Wellcome, 1907; 47. See also Wellcome Library MSS WA/HMM/CO/Ear/284 which contains correspondence relating to the error.
41. Fulop-Miller R. Triumph over pain. Translated by E and C Paul. New York: Literary Guild of America,l938; 265.
42. Young op cit; 18.
43. Goss M. Long and his discovery. Reprint from Record of Medicine, Athens, Georgia. November 1908. (Wellcome Library pamphlet WZ6:295); 6-7.
44. Buxton op cit; 13.
45. Foure J. Horace Wells and his Paris Startle in: I Awaken to Glory: Essays Celebrating the Discovery of Anesthesia by Horace Wells. W Wolfe and LF Menczer (Eds). Massachusetts: Boston Medical Library. 404-4 17.
Long's work on etherisation
If William Clarke really did give a successful dental anaesthetic in January 1842, [1] then Crawford Long of Jefferson, Georgia (USA) was not the first person to use anaesthesia, but he was the first to give ether for a surgical operation, and was certainly the first person to accumulate a series of surgical anaesthetic successes. There is documentary evidence that between March 30th 1842 and prior to October 16th 1846 (the date of Morton's demonstration at the Massachusetts General Hospital), Long had used ether successfully on at least eight occasions. [2] According to his wife, he was also the first to practice obstetric anaesthesia when he gave ether to her during the delivery of their daughter, Frances, on December 27th 1845. [3] Frances Long Taylor gives the year as 1847 (reference 7), but was perhaps being vain about her age.
Long made no secret of his use of anaesthesia but he did not publish his work until 1849, [4] when friends eventually persuaded him to lay claim to the priority in its use. There has been much speculation over this delay in publication. At the very least, Long might have been expected to write a short paper, or even a letter, after he read, as he tells us, [4] an editorial on the operation at the Massachusetts General Hospital in the Medical Examiner of December1846. Long stated that he did start a communication to the editor of the Medical Examiner, but 'was interrupted when I had written but a few lines, and was prevented by a very laborious country practice, from resuming my communication' and that, after reading the January edition of the Medical Examiner which contained several more articles on surgical etherisation, he decided to wait a few months to see if anyone would lay claim to having used the technique before March 30th 1842. [4] He goes on to say that he then delayed further, due to the competing claims of Jackson, Morton and Wells, before he could definitely establish the date when ether was first used. Some years later, when Jackson visited Long on March 8th 1854, Jackson asked Long why he did not make known the results of his own work when he had heard the news from Boston. According to Jackson, Long replied that 'when he saw my dates, he perceived that I made the discovery before him, and that he did not suppose that anything done after that would be considered of much importance, and that he was awakened to the idea of asserting his claim to the first practical use of ether in operations, by learning that that such claims were set up by others for this merit'. [6]
By 'made the discovery' Jackson meant having first had the idea of using ether vapour to relieve pain, rather than having actually used ether for this purpose. He was still trying to claim to priority as late as 1854. Young quotes from a letter written by Long to show that Long did not accept Jackson's claim. Long also stated that, before publishing, he wanted to try ether 'in a sufficient number of cases to fully satisfy my mind that anaesthesia was produced by the ether and was not the effect of the imagination, or owing to any particular insusceptibility to pain in the persons experimented upon'. [4] In fact he already had good evidence on this point in two patients by January 1845. On September 9th 1843 he had removed three tumours from one patient on the same day, using ether for one of these operations but not for the other two. The operation under ether was painless, but 'the patient suffered severely' during the others. [5] Then on January 8th 1845 he amputated two fingers, again on the same day, on a boy with neglected burns. One operation, which was done under ether, was painless whereas the other, without ether, caused pain. [6] Long also said that he was keen to use ether 'in a more severe surgical operation' [4] before he published, but of course capital operations were very infrequent in his practice. He must have known that it could be years before such an opportunity arose, so why did he not publish the very considerable evidence that he had accumulated by early in 1845? Perhaps an answer can be found in a study of the man himself and of the circumstances in which he was working.
Crawford Long: The Man
It is evident that Long was intellectually very bright because he entered college at the unusually early age of fourteen, and graduated second in his class when only nineteen. [7] He then returned to his hometown of Danielsville as principal of the town's academy, before moving to Jefferson as a pupil of a Dr Grant. He then studied for one year in the medical department of Transylvania University in Lexington, Kentucky, followed by a further year in the medical department of the University of Pennsylvania in Philadelphia. After graduating in 1839 he spent a further eighteen months of study and training in hospitals in New York where, according to his daughter, he was held in high regard. He appears to have been ambitious because he wanted to set up in practice in a large city, but deferred to his father's wish that he should return to Georgia. Here he bought the practice of his old teacher, Dr Grant, in what was then the remote and isolated little town of Jefferson, and a far cry from his ambition of practicing in a large city, though his daughter says that he regarded it as a temporary post until a better opening came up. [8] He did move, first to Atlanta, Georgia in 1850, and then in 1851 to Athens, Georgia where he was in partnership with hisyounger brother.
First hand accounts which tell us much about Long's character and personality have survived from Joseph Jacobs, his pharmacy student in Athens, [9] Dr I M Goss, who was in practice in Jefferson after Long, [10] the Chancellor of the University of Georgia who gave the address at Long's funeral, [11] the editors of the Southern Medical and Surgical Journal, [5] two professors at the University of Georgia, [5], Charles T Jackson [13] and from his wife and daughter. [14] Although one must be cautious about the objectivity of opinions expressed by his wife and daughter, they make no claims about his character which are not corroborated by others. Long is described as a devoted family man, [9] quiet and unassuming, gentle and gracious [9] even-tempered and gentlemanly, [10] a dignified man who scorned boastfulness and pretension, [14] thoroughly truthful [11] and honorable in all respects. [13] However, the attribute that is most striking, because it is mentioned time and again, is his modesty. Jacobs describes him as 'retiring and modest’, [9] Jackson as 'very modest and retiring’, [13] and the editors of the Southern Medical and Surgical Journal as 'exceedingly modest in his pretensions'. [12] In the oration at his funeral it was said that he was 'modest, even to the verge of timidity' and 'reticent of his own merit, reticent, too, of his troubles, lest he should disturb the happiness of others'. [11] Although described by Jacobs and Jackson as 'retiring', this adjective must apply to his aversion to self-pretension, for he was certainly gregarious, [2] was an excellent host in the 'old-fashioned Southern tradition [14] and had many friends. [9] He was fond of dancing and of hunting and fishing, enjoyed horse racing (but did not bet) and was a fine whist player. [14] He was also a man of 'extensive erudition' [10] with a considerable knowledge of Shakespeare's plays, from which he often quoted. [9] He was fond of poetry, especially Burns, Byron, Shelley and Keats, of the novels of Scott, Thackeray and Wilkie Collins, and of Macauley's historical works. [9] Under the pen name of 'Billy Muckle' he wrote humorous sketches for a local newspaper, often gently poking fun at the local politicians, who he never named but who were usually recognisable to those 'in the know.' [9]
Long owned a few domestic slaves who he regarded as 'wards of his care and benevolence'.[15] One of his letters, written when he was away from home, showed considerable concern for one of the slaves who had fallen ill during his absence. [16] He believed that 'the great body of slaves should gradually be emancipated under regulations that would be beneficial to them and equitable to their owners.’ [15] He opposed Georgia's secession from the Union but, when secession was announced, an event which he described as 'the worst day of my life', [17] he cast in his fortunes with his native state and took charge of a military hospital. [15]
Long was 'beloved and respected by all classes' [15] and 'esteemed by everyone'. [10] He was a man of great energy [10] and worked hard. [14] In business, as the co-owner of the largest pharmacy in northeast Georgia at the start of the Civil war, [18] he was 'exacting and particular in business details' and required order and system in the day-to-day management. [9] It was said of him that he 'assumed nothing', [11] an observation which may be relevant to his experiments with ether. Asa doctor, he was always abreast of improvements [10] and read both the American and British journals. [19] In Jefferson he built up a large and lucrative practice and, because he was recognised as a skillful surgeon, was often asked by colleagues to travel long distances to assist in difficult operations. [17] Goss wrote that: 'Long's opinion is sought far and near by the profession from the fact that the people are satisfied with any physician, if he but procure Dr. Long's opinion'. [10] Goss also described Long as: 'a very eminent practitioner and a surgeon of as high repute as any of his age in the South', adding that he was also one of the best pathologists In the South.' [10]
Public and professional attitudes to Long's work with ether
Although the local people evidently respected Long's abilities as a physician and surgeon, they were unsettled, even frightened, by his work on anaesthesia. Dr J K Groves, who was Long's first student and who entered his office in May 1844, later wrote that 'Owing to the prejudice and ignorance of the local populace, Dr Long was prevented from using ether in as many cases as he might have'. [20] Long's daughter described the 'fears of the people, who had become very much excited over the powers of ether', [21] and that 'Long was considered reckless, perhaps even mad. It was rumoured throughout the country that he had a strange medicine by which he could put people to sleep and carve them to pieces without their knowledge'. [22] His daughter also claimed that friends urged him to stop his work with ether for fear that he would be lynched if a fatality occurred, [22] though this was never mentioned by Long or any other contemporaneous source. Two people, one a doctor and the other a doctor's wife, [23] described Long's use of ether as having been 'notorious' throughout the district, but this adjective was probably used to mean that it was well known without necessarily implying any unfavorable connotation. Long's wife wrote that he used anaesthesia 'whenever he could induce his patients to submit to the "dangerous drug" ', [14] and Long himself wrote of his first case that 'As an inducement to Venable to allow himself to be the subject of such experiment, my charge for the operation was merely nominal, $2.00, ether 25 cents’. [24]
If Long had hoped that his discovery might engender a more enthusiastic response from his professional colleagues in Georgia, he was to be disappointed. One college student in Athens, Georgia, later recalled that the wonderful discovery of anaesthesia was the talk of the town and was the subject of a lecture by the professor of chemistry, Dr Le Conte, in 1845, [25] but there is little evidence that practicing doctors were prepared to try ether. In May 1843 Dr R D Moore and Dr Joseph B Carlton of Athens discussed using ether in an operation but, as they had none immediately available, they went ahead without. [23] Subsequently, in November or December 1844, Carlton did use ether for a dental extraction [23] but, as this was done in Long's office, it is likely that the administration was supervised by Long. There is no recorded instance of any other doctor in Georgia using ether before 1847, and indeed Long's daughter was to write later that 'To my father's disappointment, the older medical men of the vicinity and neighbouring towns were skeptical of his claims, all the while expecting a fatal result from one of his experiments'. [26]
Long described how, at this time 'there were physicians high in authority, and of justly distinguished character' who were advocating mesmerism for the prevention of pain during surgery. [4] Long was not impressed by the reports which he had read on the use of mesmerism for this purpose, but the early to mid-1840s were the high tide of enthusiasm for this technique. Elliotson published his results in 1843 [27] and Esdaile in 1846. [28] More importantly, from Long's perspective, there was considerable enthusiasm for mesmerism among senior practitioners in the southern states of America. In particular, as Boland has pointed out, two of the proponents, who Long described as 'high in authority', were L D Dugas and P F Eve, professors of surgery in the Medical College of Georgia in Augusta and co-editors of the Southern Medical and Surgical Journal. [29] Both published reports on painless surgery in mesmerised patients, including two mastectomies by Dugas in 1845. [30] The extent of the confidence in mesmerism in the southern states is reflected in an editorial, quoted by Buxton, [31] in the New Orleans Medical and Surgical Journal in 1846 following publication of the successful use of ether In Boston: 'Why, mesmerism, which is repudiated by the savants of Boston, has done a thousand times greater wonders and without any of the dangers here threatened. What shall we see next?'. The lay public were also familiar with mesmerism through the exhibitions given by itinerant lecturers and, as Long's daughter recorded: 'It was difficult to persuade the people ... that the inhalation of a drug could produce insensibility to pain: that this unconsciousness must be from the mesmeric powers of the young surgeon, they could believe’. [21]
Long's quandary
Having established some facts about Long himself and about the circumstances in which he was working, let us now try to put ourselves in his shoes. It is, let us suppose, the spring of 1844. Long is a bright and ambitious 28 year old. Three years ago he had set up in independent practice in a very rural area, not perhaps what he had been hoping for, but his practice is expanding, he has just taken on his first student, and it cannot be long before a better opportunity comes up. He has been married for two years and he and his young wife have just started a family. It is also two years since he discovered that the inhalation of ether could be used to produce insensibility to pain during surgical operations. Opportunities to substantiate this wonderful discovery have been few and far between, but he has now accumulated four or five cases - surely enough to make people sit up and take notice. Although Long has not published his results, neither has he made any secret of his work which is well known in his native state of Georgia. But there has been no acclaim, no-one is clamouring on his door to congratulate him and to ask how it is done; indeed, quite the opposite. The local people are frightened of this mysterious and powerful drug and unfounded rumours, based on ignorance, are fuelling their anxieties.
One or two of his younger medical colleagues have expressed some interest, but none of them has tried using ether. As for his senior colleagues, they are skeptical of his claims and are predicting that, sooner or later and probably sooner, one of his patients will die from the effects of the ether. Moreover, most of them can see no need for it, because the work being done in the local medical college by two of the most respected surgeons in the state is confirming that mesmerism is not only effective for the relief of surgical pain, but is also perfectly safe. Long is in a quandary. He is as skeptical of the value of mesmerism as his older colleagues are of his use of ether. A less reticent man would publish his results and set the scene for what might well prove to be a bitter argument, rather than a scientific debate, with the older men; but this is not a scenario which the modest, unpretentious Long can contemplate with equanimity.
There is also, still, a niggling uncertainty at the back of his mind. Perhaps his small group of patients is, by chance, in some way atypical in their responses to either pain or to the ether itself. There was, of course, the lady from whom he had removed three tumours in the fall of last year and in whom only the operation done under ether had been painless. That had made an atypical response to pain improbable, but it was only the one case. Long is a man who assumes nothing and one who is particular and exacting in matters of detail. His mind is made up; he must collect more cases before he can publish.
Long has to wait from the spring of 1844 until January 1845 before he is again able to test the effects of ether, but the case which then presents is ideal for his purpose. It is the boy who requires amputation of two fingers. Long amputates one finger, painlessly, under ether and the other, without ether, but with considerable suffering. Now, surely, he has irrefutable evidence of the efficacy of ether but, as he prepares to start writing he receives news which causes him further uncertainty. Only a fortnight or so after he has amputated the boy's finger, Long hears of Horace Wells' disastrous demonstration of nitrous oxide which took place in late January 1845. [32] Southern courtesy forbids that the advocates of mesmerism should taunt Long about the failure of this pharmacological method of inducing insensibility to pain, but Long knows that they are triumphant. Yet it is not Wells' failure in itself which haunts Long, but the fact that Wells had previously used nitrous oxide successfully on fifteen occasions. [33] For Long, who has still only used ether on five or six occasions, the lesson is obvious; he must collect still more cases and preferably at least one capital operation.
Then, sometime in December 1846 or early January 1847, when he still has only eight cases, Long reads the editorial in the Medical Examiner on Morton's use of Letheon, described as an 'ethereal solution of some narcotic substance'. [4] Long knows that it is ether itself which 1s the active agent. He starts writing a letter to the editor of the Medical Examiner, but tells us later that pressure of work prevented him from completing it. [4] Can this really be so? We know that Long has a busy practice, but he is an energetic, hard working 31 year old and this is a subject on which, in the face of considerable local opposition, he has been working for the last three a half years. It would not take long to write the letter. He has only to say that it is ether itself which induces the insensibility to pain and that he has used it on eight occasions, giving some brief details of his cases. I suggest that it is not pressure of work but disappointment, bitter disappointment, which prevents Long from completing his letter. He does not admit this, of course, this man who is always 'reticent, too, of his own troubles'. [11] Inwardly, however, he is brooding and frustrated. If only he had had the courage of his convictions and had published his results sooner; if only the local people had not been so irrational in their fear of ether, he would have been able to accumulate the necessary experience so much more quickly; if only he, too, had had access to a major teaching hospital where colleagues would have understood and appreciated his work; if only...
A few days later Long receives the January number of the Medical Examiner whichcontains accounts of further etherisations. He decides that he will wait a few months to see if anyone will lay claim to having used ether before March 30th 1842. [4] Perhaps he is also aware of some of the failed attempts with ether, and he certainly knows that the proponents of mesmerism are still scornful of the benefits of ether. [31] At this stage, Long decides there is nothing further to be lost by waiting. As he waits, the dispute over Morton's patent is followed by the bitter squabble over priority between Jackson, Morton and Wells. All of this is intensely distasteful to Long, a man who is honourable in all respects [13] and who detests pretension. [14] He wants no part in this unseemly debacle, and comes to accept that he has missed his chance of fame. The retiring and unassuming Long learns to be content with his own knowledge of what he achieved, and is fully occupied with his thriving practice and growing family. As etherisation becomes an established fact his patients, once so fearful and suspicious of his experiments with ether, now treat their clever and able young doctor with growing respect and affection; this alone is sufficient reward for the innately modest young doctor.
It is not, however, sufficient for his previously unsupportive medical colleagues, who tell him repeatedly that he will not be doing himself justice if he does not press his claim for priority in the use of etherisation. Perhaps they are also keen to see that honour bestowed on a fellow Georgian rather than on a cocky northerner. Long initially resists their persuasion but then, sometime in 1848, he is invited by Professor Paul Eve, one of those 'high in authority' and co-editor, with Dugas, of the Southern Medical and Surgical Journal, to visit him in Augusta to discuss how he might prosecute his claim. [29] There is no record of their meeting but Long is persuaded and his paper is published by Eve the following year, [4] bringing, no doubt, a certain kudos to Eve's journal as well as to Long. Subsequently Long gives at least two further lectures in Georgia to re-inforce his claim, [34,35] but they contain no new information.
Ironically, Long's work is now forgotten, at least by those who do not know him, until a year before his death when it is revived by Dr J Marion Sims (of the Sims speculum) in a paper in the Virginia Medical Monthly in 1877. [36] This paper causes Long some annoyance because, through no fault of Sims, it contains a claim by Dr P A Wilhite, one of Long's former students, that it was he who first suggested to Long that ether could be used as an anaesthetic. This would have been impossible because Wilhite had not entered Long's office until at least two years after Long first used ether. Long writes to Wilhite to point out his mistake for which Wilhite subsequently apologises, but neither of them writes to correct it in the Virginia Medical Monthly, and as Sims has by this time left for Europe, the error is not publicly corrected until 1893. [37] In the meantime Wilhite's claim is reiterated by Foy in 1889 [38] and subsequently perpetuated by Nevius in 1894, [39] Burroughs Wellcome in 1907 [40] and Fulop- Miller in 1938. [41]
A Final Conundrum
We shall never know whether the suppositions in the preceding section are correct. They are, perhaps, as near as we shall ever get to the truth, and the story of Crawford Long will always remain an enigma. Three of his biographers have left us with a further conundrum. Young, writing in 1897, stated that a statue had been erected to his memory in Paris. [42] In 1908 Goss wrote that 'a report has been circulated that a statue to the honor of Dr Long has been placed in the City of Paris, France, but I am not informed as to the accuracy of such report’, [43] and in 1912 Buxton stated that there was a memorial to Long in Paris. [44] Was there ever a statue or memorial to Long in Paris? If so, where is it now? It is unlikely that there had been confusion with the statue of Horace Wells in Paris because Young was writing thirteen years before the statue of Wells was unveiled on March 27th 1910. [45]
References
1. Wolfe RJ. Tarnished Idol: William Thomas Green Morton and the Introduction of Surgical Anesthesia: a Chronicle of the Ether Controversy. San Anselmo, California: Norman Publications, 2001; 498-500.
2. Young HH. Long, the discoverer of anaesthesia: a presentation of his original documents. 22pp. Reprint from John Hopkins Historical Bulletin 1897; 77-78. (Wellcome Library pamphlet WZ 6:29:6): 2-3.
3. Boland FK. The First Anesthetic: the Story of Crawford Long. Athens: University of Georgia Press, 1950; 60.
4. Long CW. An account of the first use of Sulphuric Ether by Inhalation as an Anesthetic in Surgical Operations. Southern Medical and Surgical Journal 1 849,5(NS):705-13. Reproduced in Boland op cil;35-37.
5. Young op. cit,13.
6. ibid; 22.
7. Taylor K . Crawford W. Long and the discovery of ether anaesthesia. New York: PB Hoeber 1928;25-40.
8. ibid; 33.
9. Jacobs J. Some Personal Recollections and Private Correspondence of Dr Crawford Williamson Long. Atlanta, Georgia, 1919. (Wellcome Library pamphlet WZ 6:29:7); 4.
10. ibid; 9-10.
11. ibid 16-17.
12. Nevius LW. The Discovery of Modem Anesthesia: by Whom was itMade? A Brief Statement of Facts. New York: GW Nevius, 1894; 24-25.
13. Jacobs op cit;43-45.
14. ibid; 5-6.
15. ibid; 14
16. ibid; 8-9.
17. Taylor op cit; 118.
18. ibid; 119.
19. ibid; 55.
20. Young op cit;21-22.
21. Taylor op cit;52
22. ibid; 49.
23. Boland op cit; 64-65.
24. Taylor op cit;47.
25. ibid; 68.
26. ibid; 67.
27. Elliotson J . Numerous Cases of Surgical Operations Without Pain in the Mesmeric State. London: H Bailliere, 1843.
28. Esdaile J. Mesmerism in India and its Practical Application in Surgery and Medicine. London: Longman, Brown, Green and Longmans, 1846.
29. Boland op cit; 53.
30. Young HH. Crawford W Long: the pioneer in ether anesthesia. Bulletin of the History of Medicine 1942; 12;191-225. (This paper contains references to publications on mesmerism by Eve and Dugas).
31. Buxton DW. Crawford Williamson Long (1815-1879). Proceedings of the Royal Society Medicine 1912; 519-45.( Wellcome Library pamphlet 6:29:8); 4.
32. Wolfe RJ. I sleep to awaken: an appreciation of Elizabeth Wales Wells in: l Awaken to Glory: Essays Celebrating the Discovery of Anesthesia by Horace Wells, RJWolfe and LF Menczer (Eds). Massachusetts: Boston Medical Library, 1994; 227.
33. American Dental Association, Horace Wells Centenary Committee. Horace Wells, Dentist, Father of Anesthesia. Hartford, Connecticut: 1948; 3
34. Jacobs op cit;13.
35. Boland op cit; 47.
36. Sims M. The Discovery of Anaesthesia. Virginia Medical Monthly 1877; 4:81-100.
37. Young op cit;16-17.
38. Foy G. Anaesthetics, Ancient and Modern. London: Baillere, Tindall & Cox, 1889, 51-52
39. Nevius op cit; 4, 10-12.
40. Anonymous. Anaesthetics, Ancient and Modern: an Historical Sketch of anaesthesia. London:Burroughs Wellcome, 1907; 47. See also Wellcome Library MSS WA/HMM/CO/Ear/284 which contains correspondence relating to the error.
41. Fulop-Miller R. Triumph over pain. Translated by E and C Paul. New York: Literary Guild of America,l938; 265.
42. Young op cit; 18.
43. Goss M. Long and his discovery. Reprint from Record of Medicine, Athens, Georgia. November 1908. (Wellcome Library pamphlet WZ6:295); 6-7.
44. Buxton op cit; 13.
45. Foure J. Horace Wells and his Paris Startle in: I Awaken to Glory: Essays Celebrating the Discovery of Anesthesia by Horace Wells. W Wolfe and LF Menczer (Eds). Massachusetts: Boston Medical Library. 404-4 17.
