The Story of How “Gentlemen! This is No Humbug.” Didn’t Actually Happen
Or: Physicians vs. Dentists, Chapter 1
By David E. McCarty, MD, FAASM (but you can call me Dave)
~ ~ ~ ~ ~
One of my favorite stories in the history of medicine is summed up in a five-word quotation that still lands today like a forehead slap.
“Gentlemen! This is no humbug.”
These five words were supposedly uttered by the great Dr. John Collins Warren, that American medical luminary, founding surgeon at Massachusetts General Hospital (MGH), the founding editor of the legendary New England Journal of Medicine, the third president of the American Medical Association.
Warren supposedly bellowed these words to a packed MGH Operating Theatre auditorium, head shaking in disbelief, having been blown away by a miraculous discovery. It was uttered at a fulcrum point in history, a day the Earth sighed relief, a day when the world saw human surgery performed completely without pain.
And it probably never happened.
The story of what actually DID happen is much more interesting, though, and it reads like a crime novel. Let’s start with this: In 1844, Dr. Horace Wells and Dr. William. T.G. Morton were successful dentists practicing near Boston.
Let’s just pick it up from there.
Cue Harp Glissando as Time Travels Backward…
~ ~ ~ ~ ~
December 10, 1844: Dr. Horace Wells witnesses a public demonstration of Nitrous Oxide inhalation. Yup, a newspaper advertisement gathered a crowd, to observe some schmuck doing whiffers. The brave soul doing the inhaling barks his knees on a table whilst stumbling, and doesn’t react to it. When he recovers, he has no recollection of the event and appears befuddled by the bruises on his knees.
A light bulb goes on above Horace Wells’ head, as bright as the sun.
January 20, 1845: Dr. Warren is skeptical, but nevertheless invites Dr. Wells to publicly demonstrate inhalational anesthesia at the MGH Theatre. Dr. Wells brings his Nitrous Oxide.
The guy who was scheduled to have an amputation is a no-show, so Dr. Warren extemporaneously creates the first iteration of an employee health plan, asking if anybody in the audience needs a tooth extracted, and a student fortuitously volunteers. That student happens to be an obese alcoholic, factors which can hamper the effects of Nitrous Oxide, though none of that was known then.
The demonstration couldn’t go worse. Dr. Wells will later admit that he thinks he didn’t apply the gas long enough. The student was not fully anesthetized, and upon completion of the extraction, reported he felt pain. That was enough to send the students into a jeering frenzy: “Humbug! Humbug!”, an event which would eventually drive Wells to an insane and colorful doom involving acid, prostitutes, and a shaving kit.
But I’m getting ahead of myself.
~ ~ ~ ~ ~
Back to our story…
February 15, 1845: Dr. Wells advertises his home for rent. His dental practice becomes more sporadic and his health begins to suffer. He eventually sells his practice to the student of the extracted tooth.
September 30, 1846: Dr. William T. G. Morton performs a painless tooth extraction on a client, behind closed doors. This gets favorably written up as an interest piece in the local paper. Dr. Henry Jacob Bigelow notes the story, and invites Dr. Morton to the MGH theatre for a demonstration in the operating theatre with Dr. Warren. Just a day that ends in “Y” at the great Massachusetts General Hospital. Dr. Morton is just hoping it wouldn’t be another walk down the gauntlet for the field of dentistry.
October 16, 1846: Dr. William T.G. Morton provides inhalational anesthesia while Dr. John Collins Warren operates on a Mr. Edward Abbott to remove a neck tumor. The operation goes smoothly. Dr. Morton is coy about the substance used, calling it Letheon. Dr. Warren wasn’t fooled; the next day in his diary, he notes: Did an interesting operation at the Hospital this morning while the Patient was under the influence of Dr. Morton’s preparation to prevent pain—The substance employed was Sulphuric Ether.
Newspaper accounts make no mention of the apocryphal quote, and everyone who knew anything of Dr. Warren’s character says that it would be unusual for this cautious intellectual to make such a sweeping pronouncement after only one experience.
October 16, 1846: Not a facemask or a glove in the building! Ether anesthesia predated universal acceptance of sterile technique.
November 12, 1846: Dr. Morton applies for—and obtains—a patent for a substance he called Letheon, a substance which renders surgical procedures painless.
November 21, 1846: Oliver Wendell Holmes himself writes a letter to Dr. Morton, declaring Morton a Public Benefactor.
December 7, 1846: Dr. Wells writes to the Hartford Courant to cry foul, saying that he did it first, telling the tale of January 20, 1845. In this letter, he says: “several expressed their opinion that it was a humbug affair.” He is trying to make the public case that he thought of it first, shuddering with increasing rage and resentment, staring at the spot on his wall that did NOT have a framed letter from Oliver Wendell Holmes on it.
1847: Dr. Wells transforms himself into an art dealer. He travels to Paris ostensibly to buy art, and he petitions the Academie Royale de Medicine and the Parisian Medical Society for recognition in the discovery of anesthesia. He is unsuccessful.
January 1848: Dr. Wells leaves his wife and family for New York, addicted to chloroform and ether. In a snowy fog of inhalational stupor on his 33rd birthday, he throws sulfuric acid onto a couple of prostitutes, gets prosecuted for the crime, and bounces into the horrors of Manhattan’s notorious Tombs prison. On January 24, 1848, Dr. Wells slits open his femoral artery with a shaving kit blade, and leaves this life behind.
For the procedure, he supplies his own anesthesia, using chloroform.
1856: Dr. John Collins Warren dies, making it hard to fact-check a certain quote.
1859: W.T.G. Morton commissions Nathan P. Rice to ghost-write Trials of a Public Benefactor, as Illustrated in the Discovery of Etherization. Rice later makes angry personal notes about having his name listed as the author, and about unauthorized changes to his manuscript.
It is in this adulterated biography that the heralded quotation attributed to Dr. Warren is seen for the first time.
1849-1860s: Morton unsuccessfully applies four times to Congress for what he called a “National Recompense” in the amount of $100,000. When these efforts fail, he tries to sue the government for compensation. In the end, he gets nothing.
…one…hundred…thousand…dollars…
1862: Dr. Morton is roundly condemned by the Medical community for conspicuous greed in maintaining his ongoing narrative of ownership and patent-rights over use of Ether. In medical circles, he becomes a pariah.
1868: Whilst riding in a carriage in Central Park, New York City, Morton suffers a stroke which alters his temperature control apparatus. He clambors out of the cab “to cool off” and goes to soak himself in a Lake. He dies soon after.
And so it goes.
~ ~ ~ ~ ~
This story spoke to me for complicated reasons.
It’s a story of greed and jealousy, of pain and relief, of reputations and rivalry. It’s a story of how a drive to be first or best can ironically drive catastrophic consequences. It’s a story of how innovation can create a chasm of communication. It’s a story of what happens when the Narrative of Personal Validation conflicts with those of Public Good and Medical Inertia.
It’s also a very personal story of a tension that still exists between two similar—but distinct—professions: medicine and dentistry. In the anecdote above, doctors are the establishment, and it’s the dentists coming up with something new, seemingly at grave personal risk. In this strange place, failure is met by banishment and madness. It doesn’t get any more Grimm’s Fairy Tale than that.
This story stuck to my ribs, because today, a similar story is currently unfolding in Sleep Medicine.
Some of the most exciting work these days on Sleep Apnea is being done by dentists, though it is difficult to get the established medical community to pay attention.
Some new game-changing techniques are out there, but it’s still early in the game. One of these strategies is a seemingly magical innovation called Morphogenic Functional Appliance Therapy (MFAT). This strategy, pioneered by super-genius Dr. Ted Belfor (whom James Nestor describes in his best-seller Breath: The New Science of a Lost Art) makes use of retainer-like devices that can nonsurgically change the shape of the bones of the upper airway, enlarging the oral vault and midface dimensionally, making the tongue’s living space much larger, and allowing an easier time breathing through the nose. The best adjunctive methods to optimize the technique are still being explored, but can include airway resistance breathing training, tongue mobilization surgery (for those with tongue-tie), breathing rehabilitation exercises, and myofunctional therapy.
Here’s the thing, Life-Fans: There are anecdotal reports of complete reversal of Sleep Apnea over the course of 18-24 months as a result of using these techniques. The providers who are doing it are sure they are on to something.
The pioneers in this field are developing a new type of healthcare identity, something distinct from pulling, filling, and straightening teeth. Some call it Airway-Centered Dentistry. It’s bleeding-edge new, and really, really cool.
As of yet, though, very little has been published. Most of this is still happening by doing what dentists and orthodontists do, with an engineering mindset, outside the hallowed halls of Academic Medicine. Some of these techniques have been evaluated in isolation, and some haven’t, and data for these isolated techniques hasn’t shown much.
The perfect combination is yet to be defined.
Today, these techniques are not supported by that angel-choir of scientific studies, the Randomized Controlled Trial. Getting past the anecdotal stage is going to require coordination, patience, time, and a healthy dose of humility. It’s going to require physicians overcoming an overwhelming desire to chant “Humbug!” It’s going to require dentists to collectively craft a research agenda, so their work can be validated.
In short, it’s going to require teamwork, and just a small bit of…dare I say it?
Love.
Here’s my point, when it comes to science, Life Fans.
Absence of peer-reviewed data is not the same thing as absence of signal. Sometimes the things that matter most in the process of scientific discovery are, in fact, human emotions and human frailty.
Dr. Wells went to his grave a raving madman, on account of this.
As for me, I’m no John Collins Warren, but I’m watching the development of Airway Centered Dentistry with keen interest.
Personally, I think it’s no humbug.
Recommended Reading
Niazi SA, Riggs JE. “Gentlemen, this is no humbug.” Hektoen International. A Journal of Medical Humanities. Vol 13, Issue 3. Summer 2021. Accessed online 6/22/22: https://hekint.org/2020/11/23/gentlemen-this-is-no-humbug/
Haridas RP. “Gentlemen! This Is No Humbug!” Did John Collins Warren, MD, Proclaim These Words on October 16, 1846, at Massachusetts General Hospital, Boston? Anesthesiology. 2016. 124:553-60. To view this compelling piece, click HERE!
Kezierian EJ, Simmons M, Schwab RJ, Cistulli P, Li KK, Weaver EM, Goldberg AN, Malhotra A. Making Sense of the Noise: Toward Rational Treatment for Obstructive Sleep Apnea. Am J Respir Crit Care Med. Vol 202. Issue 11. pp 1503-1508. Dec 1 2020. To read the AASM position, click HERE!
Price RL. Sleep Disorders—Another Perspective. Journal of Lung, Pulmonary & Respiratory Research. 2015. 2(4).00052. DOI: 10.15406/jlprr.2015.02.00052. To provoke your own thoughts with this piece, click HERE!
Nestor, J. Breath: The New Science of a Lost Art. Riverhead Books, New York, 2020