Marcy EE. Removal of a large scirrhous testicle from a man

while under the influence of nitrous oxide gas. Boston

Medical and Surgical Journal 37(5):97-99, September 1, 1847

The subject of the operation was a young man, 24 years

of age. He had been afflicted with an enlargement of the

testicle for about a year past. Within the last few weeks the

disease progressed so rapidly that the lower portion of the

gland and scrotum became gangrenous and sloughed. The case

was highly unfavorable in every respect, yet believing

extirpation to be the only means which could save the man's

life, the operation was performed on the 17th of August, the

protoxide of nitrogen haviing been previously administered by

Dr. Wells, the discoverer. The patient commenced inhaling the

gas at half past 1 o'clock P.M., and after about one minute

from this time the operation was commenced. At the first

incision there was a slight manifestation of pain (the full

effect of the gas not having yet been received), but from

this instant until the diseased mass was removed, and all the

bloodvessels [sic] secured (there being quite a number which

required ligatures), there was not the slightest conscious-

ness of pain on the part of the patient. We were satisfied

that this was the fact during the operation, from the placid

and happy expression of his countenance, from the entire ab-

sence of all muscular efforts, and from the natural and un-

excited state of the pulse (this having remained without any

apparent variation during the whole period). The operation

was necessarily tedious and protracted on account of the

great size of the gland, the extensive and firm adhesions of

the integuments to the diseased structure, and the unnatural

enlargement of several arteries which required ligature. The

whole period consumed, from the commencement of the operation

until the vessels were secured, was not far from fifteen

minutes. On questioning the patient afterwards, he asserted

that he experienced a _slightly_ painful sensation at the

commencement of the first incision, but from that time until

the dressings were applied he was entirely unconscious of any

pain!

After the operation, he expressed himself as feeling

perfectly well, except some smarting in the wound; no pain or

other unpleasant feeling in the head or any other part of the

body; pulse regular and natural, as before the operation.

August 18th.--Since the operation, the patient has

suffered no pain or other unpleasant symptoms. Pulse 82, and

moderately firm. Expresses a strong affection for the gas-

bag, and an earnest desire to retain it in his possession as

the grand balm for the pains and troubles of this life.

The above case affords additional testimony (if this

was required) that the nitrous oxide is capable of banishing

sensibility in _the most severe operations_, and that, too,

without exposing the patient to any of the untoward effects

which result from the use of ether. The latter article exerts

a more deleterious effect upon the nervous system than the

former, as is indicated by the pain in the head, lassitude,

&c., which follow its use. Another still more important ob-

jection to the use of ether, arises from its injurious effect

upon the blood. It has been found by experiment that the

arterial blood becomes slightly charged with carbon after the

inhalation. The effect of this upon the system must be very

injurious; for unless the due proportion of oxygen be

retained in the arterial blood, diminshed nervous force and

vital energy, with other states which _at least_ predispose

to disease, must be induced.

The above objections will not hold good in relation to

nitrous oxide, as its constituents are the same as common air

with an increased proportion of oxygen; while the ether bears

no analogy to air, and will therefore be more prone to give rise

to injurious consequences. The effect of ether upon the circulatory

vessels is in the first instance exremely violent, succeeded by an

alarming state of depression in their action. The effect of the

gas is much milder upon these vessels, and never need by carried

to such an extent as to be followed by any depression.

When Dr. Wells made the great discovery, in 1844, that the

inhalation of nitrous oxide gas would render the body entirely

insensible to the pain of surgical operations, the question suggested

itself to me, as well as some others in this city, whether sulfuric

ether might not answer as good a purpose as the gas. This subject

was fully discussed at that time by a number of professional men here,

and a trial made with the ether; but the general opinion was then

formed, that the nitrous oxide was on many accounts preferable.

Numerous trials with both these substances, from that period to the

present time, have demonstrated conclusively that this opinion was

correct.

I am informed by Dr. J.M. Riggs, of this city, that he has used

the gas constantly since Nov., 1844, and with uniform success. He has

performed more than one hundred dental operations on patients while

under is influence, and with more uniform success than has resulted

from the use of ether.

Dr. Wells has used the gas in only about fifty instances, on

account of his relinquishing his professional business for a time.

We are assured by both these gentlemen, that in no instance have they

been troubled by muscular efforts on the part of their patients. Indeed,

it may be asserted with safety, that so far as muscular action is con-

cerned, it possesses a decided advantage over the ether. We are aware

that it has been impudently asserted by certain interested persons who

have never given the protoxide a trial in an operation, that the patient

will become "dancing mad," &c. &c. But facts prove this to be far from

the truth. So far, then, the gas is preferable to the ether.

Another superiority which it possesses over the ether, is that its

after-effects are far less unpleasant--less headache, less lassitude, and

less depression of the nervous system, always resulting from its use.

Ether generally causes troublesome choking and cough; the gas scarcely

ever. Ether is objectionable on account of the unpleasant smell which it

communicates to the room; the gas possesses no disagreeable odor. Ether

abstracts largely from the oxygen of the arterial blood, thus becoming

a direct source of disease; the gas has no such effect. Ether gives rise

to pains in the head, lassitude, impaired vital energy, and other symptoms

indicating serious depression of the nervous system; the gas rarely pro-

duces any of these effects, and if _ever_, only in a slight degree. In

order to produce the full effect of the ether, it is customary to reduce

the patient to a state of _stupor_; the gas is capable of rendering the

body _entirely insensible to the pain of the most severe surgical opera-

tion, without putting the patient to sleep, or causing any stupor_! We

have often observed patients watch the progress of severe operations upon

their own persons, with countenances as smiling and happy as if they were

enjoying a delightful treat.

We firmly believe that the gas would have long since entirely su-

perseded the use of the ether, had it not been for the trouble attending

its preparation. We trust, however, that in future this slight inconvenience

will not prevent the surgeon, who has the welfare of his patient at heart,

from making use of the agent so manifestly superior in its effects.

The State Legislature of Connecticut, which has just closed its

session, has, after a due consideration of the evidences, fully recognized

Dr. Horace Wells, of Hartford, as the sole discoverer, and have passed

him a vote of thanks for this great discovery, which consists, as the

vote expresses it, in the use of "_nitrous oxide gas or ether in surgical

operations_." Thus the question of priority is finally settle by legisla-

tive enactment.

E.E. Marcy, M.D., Hartford, August 21, 1847

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