1. Dancing around the pneumatic institute
Playing rugby one day, I mistimed a tackle and dislocated one of my fingers. I felt a stab of pain and sat in the mud staring in disbelief at my hand. One of my fingers was now bent at an unnatural angle. My teammates gathered round, grinning. They made it clear that they expected me to snap my finger back into place. Several of them mimed the action and excitedly made the cracking sound they wanted to hear. This was a test of my toughness, one of many that I have failed in my life.
Instead, I took myself to hospital and sat for hours in a blaze of fluorescent lights in the A&E department, feeling self-conscious with my shorts, muddy legs and odd-looking finger. Later that evening, I was shown into a booth and blue paper curtains were drawn around me for privacy. A young male doctor came in. He seemed distracted, but asked a few questions while consulting a clipboard containing my patient info. “Dislocated finger?” he said. I nodded. He put the clipboard down, took the dislocated finger in his hand and then, with no warning, he yanked it violently. There is an absurd moment from this scene that is freeze-framed in my memory. I am screaming in pain and his face is very close to mine. He is red from the effort of trying to pull my finger back into its socket, but he has failed, and instead has managed to pull me out of my seat and right up close to him. We both fall back towards the wall, like two drunks fighting.
Afterwards, calming me down with a cup of tea, he explained that he was sorry, and that he had been trying to catch me off guard in order to snap the finger back into place – a manoeuvre that had always worked in the past, he said. He then fetched a canister of laughing gas, attached to which were a tube and a mask. He fitted the mask over my nose and mouth, and began fiddling with the valves on the canister. He then asked me to take a deep breath. I did so and felt nothing. The doctor fiddled with the valves some more and asked me to have another go. It felt good, very good. I took another deep breath and soon found myself out of my mind and on a golf course, unable to find my ball.
The story of how a gas that creates delusions became a method of standard pain relief begins in industrial Britain. The air in cities and towns was full of coal smoke and the foul smell of human and animal waste. It was widely believed that bad air could cause disease. This was the miasma theory. It seemed like common sense, because where bad smells were most concentrated, there was the most disease. Outbreaks of cholera, Black Death and other contagious diseases were thought to be caused by clouds of miasma carried in the stench. People died in their millions of respiratory diseases such as consumption (tuberculosis). For thousands of years, it affected rich and poor alike, although because it was an airborne infection, the poor – who lived in crowded conditions – contracted it more often.
If air could carry disease, then perhaps gas could cure them, too. So went the reasoning of Thomas Beddoes, who set up the Pneumatic Institution in 1799 in the city of Bristol. The idea was to find specific gases that could cure specific diseases. Beddoes hired a young chemist called Humphry Davy to carry out the research in gas therapy. Davy tried many gases, none of which seemed to be much help – in fact, quite the opposite: when he tried a new gas called carbon monoxide on himself, he almost died.
Undeterred in his zeal to make great discoveries and help humankind, Davy then inhaled another newly discovered gas, nitrous oxide. The gas tasted slightly sweet and had a very strange effect on him. He started dancing round his laboratory “like a madman”, as he noted later. He laughed. He giggled. It was highly inappropriate, given that he was working in a medical institute, but he couldn’t stop.
The effects did wear off after an hour. But how miraculous, how strange, he reflected. He tried it again, sometimes with the same ludicrous effects, and sometimes he was taken out of his mind in a more transcendental way. After one session, he wrote “nothing exists but thoughts”. Davy described breathing nitrous oxide as a sublime experience, an experience that was beyond language, although he did try to capture the feeling in his poetry, describing his limbs as “clad with new-born mightiness”.
Davy thought he would try the gas out on the institute’s patients to assess if it had any therapeutic value for curing diseases such as consumption. It didn’t. But it did make them laugh. He himself found it so delightful that he could not resist carrying on experimenting with nitrous oxide at night. Davy found that breathing the gas heightened his senses – he felt he could see and hear more vividly. He invited friends, writers and poets, such as Samuel Taylor Coleridge, to his laboratory to inhale the gas. They breathed it in and fell into fits of laughter, too, singing and dancing. The poet Robert Southey grandly declared that Davy had invented a new type of pleasure, which gave “delightful sensation in every limb – in every part of the body – to the very teeth”. More and more people came to try this remarkable laughing gas, including the radical poet Anna Barbauld. These laughing gas gatherings gave the Pneumatic Institution a revolutionary air.
During all the partying and dancing, Humphry Davy still had the acumen to deduce something scientifically important about laughing gas: it was not just funny and distracting – it could eliminate pain.
2. Hysteria on demand
Up until this point, surgery and dentistry had been largely carried out without anaesthetic. For most people, this meant living with the agony of toothache until they could stand the pain no more. They would then reluctantly go to a dentist or doctor, who would remove the tooth by kneeling on their chest and tugging it out with a pair of pliers. Similarly, those with the excruciating pain of gallstones often preferred to live with the pain rather than go for surgery to remove them. Alcohol and herbal concoctions containing opium and henbane (psychoactive substances derived from plants) were offered as sedatives, but patients still felt excruciating pain and writhed in agony because these substances didn’t effectively block pain receptors. To carry out surgery or amputations, the patients were tied down, with a piece of wood or leather in their mouth to stop them screaming.
There was also a belief among western surgeons that pain might be important to the success of the surgery. They thought it might be required for nature’s healing powers to be triggered. Thus there was no obvious demand from medical doctors for the development of anaesthetics. So although Davy discovered nitrous oxide to be a fast-acting anaesthetic, the medical profession wasn’t interested.
A self-taught engineer, Samuel Colt, spotted the potential of Davy’s laughing gas. He had an idea for a new type of gun, but needed money to develop it. In 1832, he decided to tour the US performing laughing gas demonstrations on stage. It wasn’t hard for Colt to learn how to make laughing gas. The formula is N₂O, which means it is made of two nitrogen atoms and one oxygen atom. Since the air we breathe is mostly made up of nitrogen (78%) and oxygen (21%) you might expect that laughing gas would occur naturally. But although the oxygen in the air is very reactive, the nitrogen is not. It occurs as a molecule, N2, which is to say two nitrogen atoms chemically bound together into a single molecule. This molecule is very stable and reacts with very few things – not even the oxygen in air.
The method Colt used to produce nitrous oxide was to heat up ammonium nitrate, which decomposes to produce N₂O gas. But he needed to be careful. Heating it too fast causes a different reaction, creating enormous amounts of nitrogen and nitrogen dioxide gas very quickly. When large amounts of gas are produced, it has to go somewhere, and so it expands outwards. This creates a pressure wave, destroying objects in its path and carrying the smashed pieces along with it. In other words, an explosion.
To avoid blowing himself up, Colt carefully heated ammonium nitrate, keeping the temperature below 300C, and collected the gas that was created in a fine silk bag, which gradually expanded into a balloon. In his stage shows, he would invite volunteers on to the stage to inhale the gas, whereupon they would fall into hysterics, sing and dance. The spectacle of a prim middle-aged nurse suddenly bursting into song, or a shy gentleman transforming into a comedian, provided entertainment to the paying audience.
Keeping the spectacle in the realms of good family entertainment was a priority given the dubious reputation of laughing gas, and so Colt pretended to be a doctor. He stopped doing the shows once he had raised enough cash for his real passion, the development of a hand held pistol with a rotating cylinder: the Colt revolver.
3. The birth of anaesthesia
In 1844, a dentist called Horace Wells attended a laughing gas show and wondered whether it might work as pain relief during teeth extraction. He tried it on himself while having a wisdom tooth extracted. He giggled while spitting blood, and realised laughing gas really did block pain.
After trying it on more than 10 other patients, he decided to go public, and performed a tooth extraction in Massachusetts general hospital, before a small audience. Unfortunately for Wells, the patient let out a small cry during the procedure, and although afterwards he said he felt very little pain, the conservative medical establishment who had been in attendance pounced on this as proof of frivolous fairground trickery. They dismissed nitrous oxide and ridiculed Wells. He would later fall into addiction, and killed himself in 1848, but he had ignited an interest in anaesthesia.
Two years after his demonstration, another dentist, William Morton, used a different substance to anaesthetise a patient in the same hospital. The gas was a vapour of a mysterious liquid called ether.
Ether is a clear but very powerful liquid. If you sniff a bottle of ether you will immediately feel woozy. Like ethanol, the alcohol in beer and wine, it is made of two carbon atoms, six hydrogen atoms and one oxygen. But the two molecules differ in the way the atoms are bonded together, which has a big impact on their properties. For instance, their boiling points, the temperatures at which they change from liquid into a gas, are very different. The boiling point of ether is 35C, while the boiling point of ethanol is 78C.
Now, 35C is not a high temperature: a glass of ether will boil in front of you on a very hot summer’s day. Although a bottle of pure alcohol will not boil on that same summer’s day, you will be able to smell it, and that means it is still releasing some of its molecules into the air. In fact, as with all liquids, molecules jump into the air and become a gas even before they reach the boiling point: this is called the vapour of a liquid, and is why you can smell liquids – it is the bouquet of wine, the warming aroma from a bowl of soup, a waft of perfume. The lower the boiling point compared with room temperature, the more vapour you get from it, and generally the smellier it is. Ether is very smelly, and no one would describe it as having a pleasant bouquet. It is not dissimilar to the smell of diesel and petrol – to which it is chemically related – and it will knock you out.
If you breathe ether vapour, it goes straight to your lungs, where it infiltrates the bloodstream and causes rapid intoxication in a matter of minutes. As with alcohol, the effect can be pleasant, but there are differences that make the gas useful for anaesthesia. When surgeons gave alcohol to patients being cut open, patients still felt pain, often babbling incoherently and striking out, arms flailing around. Ether’s molecular structure means it affects different pathways in the brain, causing a patient to lose consciousness rapidly and become insensitive to the pain of being cut open. Crucially, they lie still.
Because the boiling point of ether is so low, it can be easily delivered by getting a patient to breathe in the vapour using a vial of the warmed liquid. The trick, of course, is to get the dose of vapour inhalation right. Too much and the patient is poisoned, causing severe side-effects such as breathing difficulties and heart rate abnormalities. Too little and the patient will wake up while being cut open.
Beyond this, the use of ether as an anaesthetic was effective, but not ideal. For a start, like alcohol, it is addictive. So once there was general acceptance of the idea that the benefits of anaesthetics might outweigh the risks, scientists started to explore the vapours of other substances.
4. A royal knockout
One of these experimenters was John Simpson, a Scottish obstetrician living in Edinburgh. Every evening, he and two assistants would gather in his sitting room and sniff chemicals to assess their anaesthetic effect. This was a risky thing to do, because the toxicity of these chemicals was completely unknown. On a dark November evening in 1847, they gathered to inhale a sweet-smelling, volatile liquid called chloroform. At first they found it pleasant and were put “into a good humour”, but then they all collapsed.
When they regained consciousness the next morning, Simpson was elated: had he found a new anaesthetic? Not realising he could have killed himself, he next tried it on his niece, who said she felt happy, began singing “I am an angel” and then dropped to the floor unconscious. She survived, and, deeming it safe, Simpson went on to use chloroform in his medical practice, successfully administering it to mothers in labour to ease their pain. It was a miracle he didn’t kill some of them, as getting the dose wrong, as with ether, can be lethal.
Other doctors were outraged, but not about the safety issues. The mostly male medical establishment argued that alleviating the pain of childbirth was morally wrong, and that God had ordained that women should suffer while giving birth. The moral issues around pain relief became a hot public debate until Queen Victoria in 1853 was administered chloroform while giving birth to Prince Leopold, after which it received the royal stamp of approval. The queen later wrote to a friend who had also inhaled chloroform for pain relief: “Very glad to hear Minnie is going on so well & had the inestimable blessing of chloroform w. no one can ever be sufficiently grateful for.”
5. Laughing gas goes legit
By the turn of the 20th century, chloroform’s use as a medical anaesthetic was being phased out. It was too toxic, damaging to the liver and kidneys in high doses, but also caused unexpected deaths in surgery by interfering with the rhythm of the heart – the so-called “sudden sniffing death” – which is a dangerous side-effect associated with inhaling many solvents.
This balance between effective pain relief and the risk of side-effects brought laughing gas back into the picture. No, it didn’t knock you out, but yes, it did allow you to experience less pain with fewer side-effects. However, it was unregulated, and the form of administration – a silk or rubber balloon – was not ideal for dentists or medics because balloons are bulky and leak gas over time into the room where they are stored, which, in the case of nitrous oxide, makes everyone giddy. One person who took up the challenge to solve this engineering problem was George Poe, a cousin of the poet and master of the macabre Edgar Allan Poe. He created a factory in New Jersey for the mass manufacturing of nitrous oxide in a liquid form, which he then sold in canisters.
This was a clever choice. Liquids are denser than gases, and so a lot of nitrous oxide could be crammed into a small cylinder. The boiling point of nitrous oxide is –88C, which means that liquid nitrous oxide immediately boils at room temperature. However, pressurising a gas increases its boiling point, allowing it to be kept as a liquid in a pressurised container (such as gas bottles used to store butane for camping). Opening the valve of the canister released the pressure, instantly transforming the liquid into vapour for use in dentists’ practices and hospitals. By 1883, George Poe was supplying 5,000 dentists with medical-grade anaesthetic nitrous oxide in canisters.
Poe was passionate about the power of gases to help people in pain. He patented a respirator as a safe and systematic way of administering gas to a patient. A canister fed gas into brass cylinders and then into a face mask placed over the patient’s nose and mouth. Using this procedure, he claimed it was possible, using pure oxygen, to bring people back from the dead.
Once gases could be compressed cheaply and put in convenient cylinders, they were put to all sorts of unexpected uses throughout the 20th century. For instance, if you add cream to a nitrous oxide gas cylinder, some of the compressed gas dissolves in the fat. If you then open the cylinder, the gas pressure squirts the cream out of the dispenser. As it does this, the gas inside the fat expands rapidly and blows trillions of little bubbles – this instantly whips the cream into a fluffy foam. This delicious messy process was discovered accidentally in the 1930s by a chemistry student who was studying the preservation of dairy cream using compressed gas. He tried other gases too, but nitrous oxide works best for cream because it doesn’t affect the taste. It is also easy and safe to compress into a convenient form called a nitrous oxide whippet, used in commercial kitchens. These look like little bullets that you might load a revolver with, but instead they are designed to fit into a whipped cream gun. Press the trigger and out comes instant and perfect whipped cream: it’s delightful, it’s delicious, it’s a kind of magic.
The nitrous oxide used in modern hospitals is stored in cylindrical steel bottles. It was one of those that was used by my doctor on the day I dislocated my finger. I breathed in the gas using a respirator mask, like those pioneered by George Poe. These days it is delivered as a mixture of oxygen and nitrous oxide called “gas and air”. If you give birth in hospital, you are very likely to be offered this mixture to relieve the pain. It is a simple and easy to use system, and a much milder painkiller than the epidurals that are the alternative when someone in labour is in extreme agony. This gas really is part of the life support system of modern hospitals.
Young people, in their endless quest for different ways to inhabit their own minds, have rediscovered laughing gas. They buy boxes of whippets online and use them to blow up balloons of nitrous oxide. They then inhale the gas through the necks of the balloons as a recreational drug. I sometimes find tangible evidence of their hilarious, mad, dangerous (illegal in the UK) and life-changing trips. These are clusters of bright silver whippets that shine in the green grass of our local park.
My own nitrous oxide trip occurred that day in hospital during my dislocated-finger episode. I floated completely out of my mind. Hearing a “clack” sound, I mistook it for the sound of a ball being hit, and became puzzled as to why someone was playing golf in the hospital. Returning to consciousness a few seconds (or minutes?) later, I saw the doctor standing in front of me, but there was no sign of his golf clubs. Instead, my finger was back where it should be. I had felt no pain this time. The doctor looked pleased.
On the way home from hospital, and despite my injury, I felt elated. I was sitting on the top deck of a bus. It was a dark night and London’s grimy streets raced by in the orange glow of the sodium street lamps. Every now and again the bus passed a room on the upper floor of a house in which the occupant had not closed their curtains. I saw snapshots of people in their rooms, some sitting in bed reading a book or working on a computer. Then I saw a woman staring out of her window and we locked stares for an instant. I felt as if I was inside her head, momentarily transported into her consciousness, looking out of her window and seeing a young man on the top deck of a doubledecker bus staring at me.
Later I rationally attributed this out-of-body experience to the residual effects of laughing gas inhalation. My subconscious mind hangs on to this memory, returning to it frequently, feeling its strangeness like a tongue exploring the hole left after dental extraction. Once you have experienced moments like this, and had the idea that you have accessed a different realm of consciousness, it is impossible to let go of them.
This is an edited extract from It’s a Gas: The Magnificent and Elusive Elements That Expand Our World by Mark Miodownik, published by Viking and available at guardianbookshop.com