“Ether Day” at the Massachusetts General Hospital is officially October 16 when, in 1846, William T.G. Morton administered inhaled “Letheon” to a patient of surgeon John C. Warren.1 An alternative anniversary date, November 7, was the day that Morton revealed to Warren that the only active ingredient of Letheon was diethyl ether.2 “Beating his professor into print,” 28-year-old Bigelow3 published an account of October 16 in the Boston Med Surg J on November 18. Warren's own article appeared on December 9.4
Before both of those articles, another Boston surgeon independently published his own work on inhaled ether in the same journal on October 28.1,5 The letter came from Elton Romeo Smilie. Smilie came close to the discovery of inhaled ether for surgery, but he did not quite do so. He interestingly timed but misinterpreted that ether experiment is fascinating in the history of medical science. Unfortunately, little information has been collected about the person. McMechan6 pointed out this historical omission in 1915 in a letter requesting information about Smilie from Boston Med Surg J. Unfortunately, the response was only a reprint of Smilie's letter of 1846. The first historian to report investigation into Smilie's biography was probably Wolfe1 in 2001.
Smilie obtained excellent surgical insensibility in patients by having them supposedly inhale opium. Although opium can be smoked, its pharmacological components are not volatile at room temperature or slightly higher. He mistakenly believed that he rendered the opium volatile by mixing it with a volatile liquid. The liquid he chose was diethyl ether. He published his experiences with inhaled ethereal tincture of opium without testing the diethyl ether alone. A controlled experiment would have changed the history of anesthesia.
It is interesting to wonder who might have known of Smilie's work before its publication. Warren, for instance, had previously been the editor of the journal. However, it is unlikely that Warren had been tipped off about ether because of Smilie. If anything, Smilie's article may have helped Morton to inadvertently conceal the active ingredient of Letheon from Warren.2 That is, Smilie's report suggested that additives were also required for Morton's ethereal nostrum to work.
ELTON ROMEO SMILIE (1819–1889)
He was born in Wakefield, Massachusetts, to John and Priscilla Smilie on August 17, 1819, the same year that Morton was born 60 miles away.7 In 1842, he received the degree of Doctor in Medicine from Vermont's Castleton Medical College, one of the largest American medical schools of the mid-1800s. Tooth extraction was the most common surgical procedure at that time, and his dissertation was entitled “Structure and Diseases of the Teeth.”8 He started his practice in Derry, New Hampshire, hometown of his wife, Mary Ann Hall9 and quickly established a reputation for creativity.10–27
In his first article on ether, a “cold ethereal solution of opium” was placed in a glass retort.5 “Moderate heat” was applied to cause “slow evaporation,” “the patient being permitted to breathe the gaseous vapor from an elastic tube fixed to the mouth of the retort.” The surgeries were not specified, but “there was an entire absence of symptoms induced by pain, and those which usually result from the excessive use of opium.” The onset was instantaneous, and ether was, beyond doubt, the best vehicle for the introduction of opium into the system. Somehow, “the dose depends on the judgment of the physician.” As ether boils at 35°C, warming the ether produced a potentially high dose of ether vapor.
Smilie made three incorrect assumptions. The first was that narcotic components of opium are soluble in ether. The second was that dissolved opium would vaporize when its solvent vaporized and thus be contained in the fumes of diethyl ether. The third, and most important, was that the intended carrier vapor had no intoxicating properties. Contrary information was available at the time of Smilie's experiments. It was known that the two most abundant alkaloids of opium are morphine and narcotine. Both were extractable into water, from which nonvolatile morphine had been crystallized. When opium was mixed with ether, the ether took up narcotine but not morphine.28 Despite its name, narcotine (now called noscapine) is not a narcotic. Although narcotine dissolves in ether, ether does not promote the evaporation of narcotine. It was known that after ether leaves an ethereal tincture of opium, solid narcotine (melting point 176°C) remains.28
Smilie's29 second article on ether appeared on May 5, 1847, after both the Bigelow and Warren accounts of Morton's Ether Day. He ceded credit for the invention of ether anesthesia to Jackson and Morton. He wrote, “I trust that I shall not be accounted by the profession and public, one of those parasitic growths, which by extent of foliage seemingly endeavor to conceal the connection of fruit with the legitimate branch.” He explained that his independent work began in the spring of 1846, when he constructed “an instrument for inhaling medicinal vapors in pulmonary complaints.” The first patient to receive ethereal tincture of opium was a clergyman “suffering from extensive bronchial irritation.” Left alone during his treatment, the patient became unconscious and “fell upon the floor, severely injuring his head against the projecting corner of the stove.” Fortunately, the patient found the mishap “far from unpleasant.” The next patient was a young lady suffering from pain and cough due to tuberculosis. She would not relinquish the therapeutic ether inhaler to Smilie until her insensibility ensued, but then she was easily resuscitated with the aid of salts of ammonia. The third patient was deliberately rendered insensible for the draining of a large abscess involving the neck and chest.
The last paragraph of Smilie's29 note of May 1847 is unclear. After giving ether to “hundreds of patients,” he said that he suspended his ether experiments until August 1846. He and his consultants arbitrarily feared that the tincture was potentially injurious, perhaps because of the possibility of opium-induced apnea. He resumed the administration of the drug “with the assurance guaranteed by the experiments of Dr. Morton.” Thus, there is a suggestion that Smilie and Morton communicated about ether in August before Ether Day in October 1846.
Smilie30 reiterated his concession of the invention of ether anesthesia to Jackson and Morton in a lecture to his medical school. However, not everyone felt that the concession was entirely fair. For instance, Flagg,31 a student of Warren, argued strenuously against the Morton-Jackson legal patent on ether anesthesia. He said that it was like a patent on sunlight and pointed out that Smilie had demonstrated the power of Morton's supposedly “new gas.” (Interestingly, Flagg mentioned that he himself had given ether as an oral or inhaled drug to “hundreds” of patients, although he did not claim its use as an aid to surgery.) Dr. John Clough of Boston was compelled to write that Smilie had told him, in the spring of 1846, about insensibility from inhaled ethereal tincture. According to Clough,32 “It is true that Dr. S. had used the ether, to be inhaled, for some purposes, and had suggested the use of it in the same way for overcoming pain while dental operations were being performed, before it was made public by Dr. Morton.” An anonymous note signed by “Justice” chided Bigelow for claiming the first public article on etherization. Justice credited Smilie and mentioned that Smilie's article of October 28, 1846, had been reprinted in the Edinburgh Med Surg J.33
Smilie remained on friendly terms with Morton, and he helped Morton to examine chloroform anesthesia. Morton34 explained, “ . . . being out of health myself, I called upon Dr. E. R. Smilie, a person of some reputation in chemical science, and invited him to my laboratory.” Smilie helped Morton with his first chloroform patient and then invented an improved inhaler for ether or chloroform. As described, “The mouth piece is of glass, and is connected with the receiver by a silver tube, within which are the valves that prevent the passage of the breath from the lungs into the retort, and allow of its escape.”35 “Like Connecticut washing machines,” there was a plethora of types of chloroform inhalers put forth, but the Smilie device garnered a good review.36 Unfortunately, there is no image of Smilie's non-rebreathing valve system of 1848. The dangers of chloroform were often ascribed to impurities, so Smilie,37 having communicated with James Y. Simpson, published Simpson's recipe for a “superior article” in Boston.
Smilie enjoyed a sterling reputation. In 1849, the Philadelphia College of Medicine conferred on him the courtesy (ad eundem) degree of Doctor of Medicine. He was then admitted into the Massachusetts Medical Society.38
On January 30, 1850, it was announced in the Boston Med Surg J “Dr. E. R. Smilie, a frequent contributor to this Journal, who has invented several novel and approved surgical instruments, sailed from Boston to California, a few weeks since.”39 He went to the Gold Rush. His preparations included the invention of an apparatus for isolating particles of gold from sand (www.rcsed.ac.uk/site/PID=2312004161515/761/default.aspx).
Smilie wrote of dentistry and medicine while in California. One of his case reports exemplifies the California Gold Rush literary license.40 He describes a 49er whose hair turned white overnight. The man was bled for a fever and lapsed into sleep. The rapid blanching of his hair was supposedly caused by his awakening to a grizzly bear lapping up the spilled blood.
Smilie41,42 had many stories to tell, and he penned two science fantasy novels. He is considered a forerunner of H. Rider Haggard and Edgar R. Burroughs and a pioneer of the genre (www.erbzine.com/mag18/soong.htm). As R. Elton Smilie, he published The Manatitlans. Therein, despite dangerous ape-men and other hazards, Andean explorers discovered a lost world of ant-sized people. Next was Investigations and Experience of M. Shawtinback, at Saar Soog, Sumatra. Humans in that novel were improved surgically to a nobler state of health resembling those enjoyed in Eden. The improvement was affected by the transplantation of anatomically correct monkey tails onto the humans. The surgery required, of course, an “anesthetic.” To that end, the inventor of “ethereal tincture of opium” invented “etherial [sic] tincture of bang”42 where bang is an inebriating hemp product.
It is interesting to speculate as to who read the Smilie's article on ether before its publication. Warren was the inaugural editor of the first incarnation of the journal. In 1846, the editor was Jerome V.C. Smith. Smith had many personal connections (and went on to become the mayor of Boston). A professional chemist such as Jackson should have seen Smilie's misinterpretation at a glance. Whether or not Smilie's manuscript tipped off the producers of Ether Day, his publications show that ether anesthesia was about to happen anyway. The other pioneers of inhaled anesthesia were colorful characters, and Smilie certainly shared that characteristic. Alas, no visual image of the person seems to have been preserved.
William Clarke used ether for dental extraction before Morton,43 Crawford Long used ether for surgery before Morton, and Smilie published before Morton. Alas, Clarke and Long did not publish before Ether Day, and Smilie did not quite get the idea correctly.
The Boston Med Surg J was electronically provided by Harvard University. Historical journals and books were electronically available at books.google.com or otherwise available online. Reviewer comments and discussions with Prof. Carl Rosow are much appreciated.
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19. Keeping fresh wounds in apposition. Boston Med Surg J 1844;31:167
20. Revolving gum lancet. Boston Med Surg J 1844;31:145
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27. Ear-trumpets. Boston Med Surg J 1850;41:485
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33. Justice. Boston Med Surg J 1848;38:290
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35. Dr. Smilie's improved instrument for inhaling chloroform or ether. Boston Med Surg J 1848;38:26–7
36. Chloroform inhalers. Boston Med Surg J 1848;38:65
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38. Philadelphia College of Med. Boston Med Surg J 1849;40:126
39. Medical miscellany. Boston Med Surg J 1850;41:527
40. Smilie ER. Blanched hair from sudden emotions. Boston Med Surg J 1851;44:438–40
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