Scientific American Supplement, No. 275, April 9, 1881

Has it proven in my practice what has been claimed for it–a substitute for the powerful anaesthetics in minor operations in surgery? Most emphatically, yes! So completely has it fulfilled its humble mission in my office, that I can safely assert there has not been more than five per cent. of failures. I have given it under all circumstances of diseased organs, and have seen no other than the happiest results in its after effects. It may well be asked just here: Why has it not been more generally and widely used by the dental profession as well as the medical, if it is really what is claimed for it? The most satisfactory and charitable answer to be given is, the failure upon their part to comprehend the fact as existing in chloroform and ether that there is such a state as analgesia; or, in other words, that the animal economy is so organized, while the sense of touch is not destroyed, but rather increased, the mind of the subject fails to perceive a sense of pain when anaesthetics are given, and the effects are manifested in the primary stage. As I before intimated, such is the knowledge possessed by most of those who administer ether and chloroform. This was enough to cause nearly every one to look upon it as a bubble or air castle. Many gentlemen told me they tried it upon themselves, and, while it affected them very seriously by giddiness, they still retained consciousness; and, such being the case, no effect could be produced for obtunding pain. Others told me they were afraid to continue the breathing alarmed at the vertigo induced. And the practitioner who has adopted it more effectively than any other laughed at me when I first told him of the discovery; but his intimate association with me changed his views after much explanation and argument between us.

It was hardly to be expected that without this knowledge of analgesia, and without any explanation from me as to the modus operandi of rapid breathing, other than a few suggestions or directions as to how the effect was induced, even the most liberal of medical men should be able to make it effective, or have the least disposition to give it a preliminary trial upon themselves, and, of course, would not attempt it upon a patient. Notwithstanding, it found a few adherents, but only among my personal medical friends, with whom I had an opportunity to explain what I believed its physiological action, and the cases of success in my own practice. To this I have submitted as among the inevitable in the calendar of discoveries of all grades.

My own profession have attempted to ridicule it out of its birthright and possible existence, which style of argument is not resorted to by true logicians.

To all this I can truly say I have not for one moment faltered. I could afford to wait. The liberality of this society alone fully compensates for the seeming indisposition of the past, believing that it is proper that every advance should be confronted, and, if in time found worthy, give it God speed.

From its first conception I have diligently labored to solve its modus operandi, and the doubt in my own mind as to whether I could be mistaken in my observations. I asked the opinion of our best chemical teachers if air could have such effect. One attributed it to oxygen stimulation, and the other to nitrogen. Another gentleman told me the medical profession had come to the conclusion that it was possible for me to thus extract teeth, but it was due solely to my strong personal magnetism (which power I was not before aware I possessed).

Now, from what I have related of the successive and natural steps which finally culminated in this process or plan of analgesia induced by an excess of ordinary air taken forcibly into the lungs above what is necessary for life, and from what I shall state as to the apparently anomalous or paradoxical effects, with its physiological action, and the simple tests made upon each of my patients, I shall trust to so convince you of its plausibility and possibility that it will be made use of in hundreds of minor operations where ether and chloroform are now used.

Aside from my assertion and that of its friends, that the effects can be produced by air alone, you must have some light shed upon the causes of its physiological action, which will appeal to your medical reason.

To assign an action to any drug is difficult, and in the cases of ether and the other anaesthetics a quarter of a century still finds many conflicting opinions. This being true, you will deal leniently with me for the opinion I hold as to their analgesic action. Of course it will be objected to, for the unseen is, to a great extent, unknowable. Enough for my argument, however; it seems to suit the case very well without looking for another; and while it was based on the phenomenon resulting from many trials, and not the trials upon it as a previous theory, I shall be content with it until a better one can be found.

What is it I claim as a new discovery, and the facts and its philosophy?

I have asserted that I can produce, from rapidly breathing common air at the rate of a hundred respirations a minute, a similar effect to that from ether, chloroform, and nitrous oxide gas, in their primary stages; and I can in this way render patients sufficiently insensible to acute pain from any operation where the time consumed is not over twenty to thirty seconds. While the special senses are in partial action, the sense of pain is obtunded, and in many cases completely annulled, consciousness and general sensibility being preserved.

To accomplish this, each patient must be instructed how to act and what to expect. As simple as it may seem, there is a proper and consistent plan to enable you to reach full success. Before the patient commences to inhale he is informed of the fact that, while he will be unconscious of pain, he will know full, or partially well, every touch upon the person; that the inhalation must be vigorously kept up during the whole operation without for an instant stopping; that the more energetically and steadily he breathes, the more perfect the effect, and that if he cease breathing during the operation, pain will be felt. Fully impress them with this idea, for the very good reason that they may stop when in the midst of an operation, and the fullest effects be lost. It is obligatory to do so on account of its evanescent effects, which demand that the patient be pushed by the operator's own energetic appeals to "go on." It is very difficult for any person to respire more than one hundred times to the minute, as he will become by that time so exhausted as not to be able to breathe at all, as is evidenced by all who have thus followed my directions. For the next minute following the completion of the operation the subject will not breathe more than once or twice. Very few have force enough left to raise hand or foot. The voluntary muscles have nearly all been subjugated and overcome by the undue effort at forced inhalation of one hundred over seventeen, the normal standard. It will be more fully understood further on in my argument why I force patients, and am constantly speaking to them to go on.

I further claim that for the past four years, so satisfactory has been the result of this system in the extracting of teeth and deadening extremely sensitive dentine, there was no longer any necessity for chloroform, ether, or nitrous oxide in the dental office. That such teeth as cannot be extracted by its aid can well be preserved and made useful, except in a very few cases, who will not be forced to breathe.

The anaesthetics, when used in major operations, where time is needed for the operation, can be made more effective by a lesser quantity when given in conjunction with "rapid breathing." Drs. Garrettson and Hews, who have thus tried it, tell me it takes one-half to three-fourths less, and the after effects are far less nauseating and unpleasant.

As an agent in labor where an anaesthetic is indicated, it is claimed by one who has employed it (Dr. Hews) in nearly every case for three years, he has used "rapid breathing" solely, and to the exclusion of chloroform and ether. For this I have his assertion, and have no doubt of it whatever, for if any agent could break down the action of the voluntary muscles of the parts involved, which prevent the involuntary muscles of the uterus from having their fullest effect, it is this. The very act of rapid breathing so affects the muscles of the abdomen as to force the contents of the uterus downward or outward, while the specific effect of the air at the end of a minute's breathing leaves the subject in a semi-prostrate condition, giving the uterus full chance to act in the interim, because free of the will to make any attempt at withholding the involuntary muscles of the uterus from doing their natural work. It is self evident; and in this agent we claim here a boon of inestimable value. And not least in such cases is, there is no danger of hemorrhage, since the cause of the effect is soon removed.

In attestation of many cases where it has been tried, I have asked the mother, and, in some cases, the attendants, whether anything else had been given, and whether the time was very materially lessened, there has been but one response, and that in its favor.

Gentlemen, if we are not mistaken in this, you will agree with me in saying that it is no mean thing, and should be investigated by intelligent men and reported upon. From my own knowledge of its effects in my practice, I am bound to believe this gentleman's record.

I further claim for it a special application in dislocations. It has certainly peculiar merits here, as the will is so nearly subjugated by it as to render the patient quite powerless to resist your effort at replacing, and at the same time the pain is subdued.

It is not necessary I should further continue special applications; when its modus operandi is understood, its adaptation to many contingencies will of a sequence follow.

It is well just here, before passing to the next point of consideration, to answer a query which may arise at this juncture:

What are the successive stages of effects upon the economy from its commencement until the full effect is observed, and what proof have I that it was due to the amount of air inhaled?

The heart's action is not increased more than from seventy (the average) to eighty and sometimes ninety, but is much enfeebled, or throwing a lesser quantity of blood. The face becomes suffused, as in blowing a fire or in stooping, which continues until the breathing is suspended, when the face becomes paler. (Have not noticed any purple as from asphyxia by a deprivation of oxygen.) The vision becomes darkened, and a giddiness soon appears. The voluntary muscles furthest from the heart seem first to be affected, and the feet and hands, particularly the latter, have a numbness at their ends, which increases, until in many cases there is partial paralysis as far as the elbow, while the limbs become fixed. The hands are so thoroughly affected that, when open, the patient is powerless to close them and vice versa. There is a vacant gaze from the eyes and looking into space without blinking of the eyelids for a half minute or more. The head seems incapable of being held erect, and there is no movement of the arms or legs as is usual when in great pain. There is no disposition on the part of the patient to take hold of the operator's hand or interfere with the operation.

Many go on breathing mechanically after the tooth is removed, as if nothing had occurred. Some are aware that the tooth has been extracted, and say they felt it; others could not tell what had been accomplished. The majority of cases have an idea of what is being done, but are powerless to resist.

With the very intelligent, or those who stop to reason, I have to teach them the peculiarities of being sensible of touch and not of pain.

One very interesting case I will state. In extracting seven teeth for a lady who was very unwilling to believe my statement as to touch and no pain, I first removed three teeth after having inhaled for one minute, and when fully herself, she stated that she could not understand why there was no pain while she was conscious of each one extracted; it was preposterous to believe such an effect could be possible, as her reason told her that there is connected with tooth extracting pain in the part, and of severe character, admitting, though, she felt no pain. She allowed one to be removed without anything, and she could easily distinguish the change, and exclaimed, "It is all the difference imaginable!" When the other three were extracted, there was perfect success again as with the first three.

One of the most marked proofs of the effects of rapid breathing was that of a boy of eleven years of age for whom I had to extract the upper and lower first permanent molars on each side. He breathed for nearly a minute, when I removed in about twenty seconds all four of the teeth, without a moment's intermission or the stopping the vigorous breathing; and not a murmur, sigh, or tear afterward.

He declared there was no pain, and we needed no such assertion, for there was not the first manifestation from him that he was undergoing such a severe operation.

Another case, the same day, when I had to extract the superior wisdom teeth on both sides for an intelligent young lady of eighteen years, where I had to use two pairs of forceps on each tooth (equivalent to extraction of four teeth), and she was so profoundly affected afterward that she could; not tell me what had been done other than that I had touched her four times. She was overcome from its effects for at least a minute afterward. She was delighted.

With such severe tests I fear very little the result in any case I can have them do as I bid.

There can be no mistake that there is a specific action from something. It cannot be personal magnetism or mesmeric influence exerted by me, for such cases are rare, averaging about 10 per cent, only of all classes. Besides, in mesmeric influence the time has nothing to do with it; whereas, in my cases, it cannot last over a half minute or minute at most. It cannot be fear, as such cases are generally more apt to get hurt the worse. It is not diversion of mind alone, as we have an effect above it.

There is no better way of testing whether pain has been felt than by taking the lacerated or contused gums of the patient between the index finger and thumb and making a gentle pressure to collapse the alveolar borders; invariably, they will cry out lustily, that is pain! This gives undoubted proof of a specific agent. There is no attempt upon my own part to exert any influence over my patients in any way other than that they shall believe what I say in regard to giving them no pain and in the following of my orders. Any one who knows how persons become mesmerized can attest that it was not the operator who forces them under it against their will, but it is a peculiar state into which any one who has within themselves this temperament can place themselves where any one who knows how can have control. It is not the will of the operator. I therefore dismiss this as unworthy of consideration in connection with rapid breathing.

Then you may now ask, To what do I attribute this very singular phenomenon?

Any one who followed, in the earlier part of this paper, the course of the argument in my soliloquy, after twenty years had elapsed from my observation upon myself of the analgesic effects of chloroform, can almost give something of an answer.

That you may the more easily grasp what I shall say, I will ask you, If it be possible for any human being to make one hundred inhalations in a minute and the heart's action is not increased more than ten or twenty pulsations over the normal, what should be the effect upon the brain and nerve centers?

If the function of oxygen in common air is to set free in the blood, either in the capillaries alone, or throughout the whole of the arterial circulation, carbonic acid gas; and that it cannot escape from the system unless it do so in the lungs as it passes in the general current–except a trace that is removed by the skin and kidneys–and that the quantity of carbonic acid gas set free is in exact relation to the amount of oxygen taken into the blood, what effect must be manifested where one hundred respirations in one minute are made–five or six times the normal number–while the heart is only propelling the blood a very little faster through the lungs, and more feebly--say 90 pulsations at most, when to be in proportion it should be 400 to 100 respirations to sustain life any length of time?

You cannot deny the fact that a definite amount of oxygen can be absorbed and is absorbed as fast as it is carried into the lungs, even if there be one hundred respirations to the minute, while the pulsations of the heart are only ninety! Nature has made it possible to breathe so rapidly to meet any emergency; and we can well see its beautiful application in the normal action of both the heart and lungs while one is violently running.

What would result, and that very speedily, were the act of respiration to remain at the standard–say 18 or 20–when the heart is in violent action from this running? Asphyxia would surely end the matter! And why? The excessive exercise of the whole body is setting free from the tissues such an amount of excretive matter, and carbon more largely than all the others, that, without a relative action of the lungs to admit the air that oxygen may be absorbed, carbonic acid gas cannot be liberated through the lungs as fast as the waste carbon of the overworked tissues is being made by disassimilation from this excess of respiration.

You are already aware how small a quantity of carbonic acid in excess in the air will seriously affect life. Even 2 to 3 per cent, in a short time will prove fatal. In ordinary respiration of 20 to the minute the average of carbonic acid exhaled is 4.35.

From experiments long ago made by Vierordt–see Carpenter, p. 524–you will see the relative per cent, of carbonic acid exhaled from a given number of respirations. When he was breathing six times per minute, 5.5 per cent of the exhaled air was carbonic acid; twelve times, 4.2; twenty-four times, 3.3; forty-eight times, 3; ninety-six times, 2.6.

Remember this is based upon the whole number of respirations in the minute and not each exhalation–which latter could not be measured by the most minute method.

Let us deduct the minimum amount, 2.6 per cent, of carbonic acid when breathing ninety-six times per minute, from the average, at twenty per minute, or the normal standard, which is recorded in Carpenter, p. 524, as 4.35 per minute, and we have retained in the circulation nearly 2 per cent. of carbonic acid; that, at the average, would have passed off through the lungs without any obstruction, and life equalized; but it not having been thrown off as fast as it should have been, must, of necessity, be left to prey upon the brain and nerve centers; and as 2 to 3 per cent., we are told, will so poison the blood, life is imperiled and that speedily.

It is not necessary we should argue the point as to whether oxygen displaces carbonic acid in the tissues proper or the capillaries. The theory of Lavoisier on this point has been accepted.

We know furthermore, as more positive, that tissues placed in an atmosphere of oxygen will set free carbonic acid, and that carbonic acid has a paralyzing effect upon the human hand held in it for a short time. The direct and speedy effects of this acid upon the delicate nervous element of the brain is so well known that it must be accepted as law. One of the most marked effects is the suspension of locomotion of the legs and arms, and the direct loss of will power which must supervene before voluntary muscular inactivity, which amounts to partial paralysis in the hands or feet, or peripheral extremities of the same.

Now that we have sufficient evidence from the authorities that carbonic acid can be retained in the blood by excessive breathing, and enough to seriously affect the brain, and what its effects are when taken directly into the lungs in excess, we can enter upon what I have held as the most reasonable theory of the phenomenon produced by rapid breathing for analgesic purposes; which theory was not first conceived and the process made to yield to it, but the phenomenon was long observed, and from the repetition of the effects and their close relationship to that of carbonic acid on the economy, with the many experiments performed upon myself, I am convinced that what I shall now state will be found to substantiate my discovery. Should it not be found to coincide with what some may say is physiological truth, it will not invalidate the discovery itself; for of that I am far more positive than Harvey was of the discovery of the circulation of the blood; or of Galileo of the spherical shape of the earth. And I ask that it shall not be judged by my theory, but from the practice.

It should have as much chance for investigation as the theory of Julius Robert Mayer, upon which he founded, or which gave rise to the establishment of one of the most important scientific truths–"the conservation of energy," and finally the "correlation of forces," which theory I am not quite sure was correct, although it was accepted, and as yet, I have not seen it questioned.

In all due respect to him I quote it from the sketch of that remarkable man, as given in the Popular Science Monthly, as specially bearing on my discovery:

"Mayer observed while living in Java, that the venous blood of some of his patients had a singularly bright red color. The observation riveted his attention; he reasoned upon it, and came to the conclusion that the brightness of the color was due to the fact that a less amount of oxidation was sufficient to keep up the temperature of the body in a hot climate than a cold one. The darkness of the venous blood he regarded as the visible sign of the energy of the oxidation."

My observation leads me to the contrary, that the higher the temperature the more rapid the breathing to get clear of the excess of carbon, and hence more oxygenation of the blood which will arterialize the venous blood, unless there is a large amount of carbonized matter from the tissues to be taken up.

Nor must it be denied because of the reasoning as presented to my mind by some outside influence in my soliloquy when I first exclaimed, "Nature's anaesthetic," where the argument as to the effects of nitrous oxide gas being due to an excess of oxygen was urged, and that common air breathed in excess would do the same thing.

I am not sure that it was correct, for the effects of nitrous oxide is, perhaps, due to a deprivation of mechanically mixed air.

Knowing what I do of theory and practice, I can say with assurance that there is not a medical practitioner who would long ponder in any urgent case as to the thousand and one theories of the action of remedies; but would resort to the practical experience of others and his own finally. (What surgeon ever stops to ask how narcotics effect their influence?) After nearly thirty years of association with ether and chloroform, who can positively answer as to their modus operandi? It is thus with nearly the whole domain of medicine. It is not yet, by far, among the sciences, with immutable laws, such as we have in chemistry. Experimentation is giving us more specific knowledge, and "practice alone has tended to make perfect." (Then, gentlemen will not set at naught my assertion and practical results. When I have stated my case in full it is for you to disprove both the theory and practice annunciated. So far as I am concerned I am responsible for both.)