The troubled life and death of William Thomas Green Morton has been described in several texts. His first public demonstration of ether anesthesia was the highpoint of a life that was less than successful in many of his endeavors. Close examination of this life reveals a pattern of behavior that progresses from narcissistic traits to narcissistic personality pathology. This retrospective psychiatric analysis of Morton's life was undertaken to theorize as to why Morton, after having successfully demonstrated ether anesthesia, did not continue to develop anesthesia as a clinical specialty. Biographies about Morton were used to explore details of his life. The Diagnostic and Statistical Manual of Mental Disorders classification of narcissistic personality disorder was used to analyze his life. We conclude that Morton progressed from displaying narcissistic personality trait to disorder over his lifetime.
THE first demonstration of anesthesia for a surgical procedure on October 16, 1846, was a fortunate coincidence of clinical needs of patients and surgeons, openness to trying a new technique and the recognition of a new treatment modality. Also influencing the demonstration were opportunistic gain and possible personality pathology. Ether Day and the lives of the participants are well described in several books.1,2,3What has not been explored is the reason why William Thomas Green Morton, M.D. (hc ) (dentist, Boston, Massachusetts) (1819–1868), figure 1, did not develop anesthesia as a clinical specialty, which also speaks to aspects of his character. His life, before and after October 16, 1846, was disordered; hence the labels of tragic, troubled, or tarnished were used by his biographers. Putting his life in the context of personality traits(s)/disorder(s) will allow some understanding as to why he did not fully collaborate with Dr. Horace Wells (dentist, Hartford, Connecticut) (1815–1848), figure 2, Charles Thomas Jackson, M.D. (physician/geologist, Boston, Massachusetts) (1805–1880), figure 3, and the surgeons at the Massachusetts General Hospital; did not continue to provide anesthesia regularly to relieve pain during surgical procedures; and did not refine the practice of anesthesia. We will summarize the main features of narcissistic and antisocial personality traits/disorders, and how they may be applicable to Morton's life. Retrospective psychiatric evaluations are inherently speculative and not diagnostic, but they do offer a useful lens with which to assess personal attributes. Personality traits are on a continuum of severity from adaptive to maladaptive, with disorders of personality on the most severe maladaptive end. Although a historical review of a person's life cannot make a reliable diagnosis, important character traits can be identified and contextualized within the framework of personality disorders to illustrate the key features of a life narrative and their potential impact on medical science.
Personality disorders are behavioral patterns that are associated with disturbances that deviate from personal and social norms. General diagnostic criteria, listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)4Classification, are:
An enduring pattern of psychological experience and behavior that differs from cultural expectations.
The pattern is inflexible and pervasive across a wide range of situations.
The pattern is stable and long-lasting, having started as early as adolescence.
The pattern must not be better accounted for as a manifestation of another disorder.
Because the diagnosis of personality disorders stems from prevailing cultural expectations, there is good reason to wonder whether a retrospective psychological analysis is valid. If, however, the cultural, social, and economic conditions at the time are considered, then enlightening information can be gained. Joshua Shenk examined Abraham Lincoln's episodes of melancholy, diagnosed depression, and demonstrated how this affected Lincoln's presidency.5Henry Murray analyzed Adolph Hitler's personality in 1943 and made suggestions about how best to interact with him.6
The specific types of personality disorders are grouped into three clusters, based on characteristics and symptoms. Cluster A (odd, eccentric thinking or behavior) is paranoid, schizoid, and schizotype. Cluster B (dramatic, overly emotional thinking or behavior) is antisocial, borderline, histrionic, and narcissistic. Cluster C (anxious, fearful thinking or behavior) is avoidant, dependent, and obsessive-compulsive. These disorders of character can be seen on a continuum from adaptive to maladaptive.
Narcissistic Personality Disorder and Antisocial Personality Disorder
Narcissistic personality disorder (NPD) is listed in the Cluster B of personality disorders. The distinguishing characteristics of NPD are: an inflated evaluation of oneself, interpersonal exploitation, expansive imagination, displaying supercilious imperturbability (nonchalance), and a defective social conscience (does not value personal integrity and the rights of other people).
Another consistent trait throughout Morton's life was the ability to deceive and to solicit money for his own personal gain. This aspect of his life is consistent with antisocial personality disorder (APD), the characteristics of which are: failure to conform to social norms with respect to lawful behaviors, deceitfulness, impulsivity, aggressiveness, reckless disregard for safety of self or others, consistent irresponsibility, and lack of remorse.
These traits overlap frequently with NPD,7and this combination of narcissistic and antisocial traits may be at the core of Morton's ability to proceed with the first surgical anesthetic, driven by a belief that he could succeed where Horace Wells failed and others might be reticent. These narcissistic and antisocial traits may have also been the reason why Morton decided to capitalize on his demonstration of ether, rather than either to expand his dental practice (using ether to attract patients), to provide anesthesia for surgical patients, or to eventually expand surgical anesthesia and to develop anesthesiology as a clinical specialty.
The American Psychiatric Association is revising the criteria for both narcissistic and antisocial personality disorders. These revisions will be incorporated in the DSM-V.8Although the descriptions for both disorders are divided into impairments of self- and interpersonal functioning, the pathologic personality traits are basically the same, so that the characteristics listed above from DSM-IV will be used in our discussion.
The causes for NPD are not known. Narcissism is, to a degree, a common phase of development in childhood. When childhood is associated with overindulgence by parents, severe emotional abuse, or unreliable care, narcissistic traits may become manifest in adulthood.9
Since very little information is available about Morton's childhood, we explore subsequent segments of his life, starting with adolescence and continuing on to adulthood (1836–1841), his return to Charlton, Massachusetts, in 1842, his training as a dentist with a developing interest in ether, and finally his life after the demonstration of ether as an anesthetic. We will illustrate how narcissistic traits, coupled with an undercurrent of deception for financial gain, rather than altruism, were consistent with his behavior and how these circumstances propelled Morton to provide the first anesthetic.
Morton was born August 9, 1819, in Charlton, Massachusetts. During his teenage years, his parents sold their farm and home in order to start a dry goods store. Unfortunately, the enterprise was not successful and the family's financial circumstances forced Morton to quit school and take up work as a laborer in a tavern in Worcester, Massachusetts, at the age of 16 or 17 yr. Here, he was caught stealing money and was sent away from Worcester on the sheriff's order to never return.2This was the first known event in a lifelong pattern of deception and embezzlement.
In 1836, at the age of 17, Morton moved to Rochester, New York, and found a job at a dry goods store. Two years later, he formed a partnership with Loran Ames in the dry goods business. Within 4 months, the partnership dissolved because Morton was caught passing bad checks and making phantom entries in the order books.10He ran the business under his own name, but within 3 months he was in debt. Becoming desperate, he secured a loan from Phineas Cook, a businessman, but did not repay the borrowed funds and was compelled to leave Rochester for Cincinnati, Ohio.11He also left behind a fiancée from a prominent family and an unpaid bill at the Seward Academy, a private school where he had enrolled his sister, having brought her to Rochester.12He was also excommunicated from his church for “dishonesty to his fellowman.”13
In Cincinnati, he continued the same pattern of behavior, falsifying receipts in a dry goods partnership with Charles Pomeroy.14Within a year, he departed, leaving behind another fiancée. He managed to acquire a set of U.S. Mail seals which he used to backdate forged promissory notes to dupe his creditors.15Over the next 2 yr, he moved from St. Louis, Missouri, to New Orleans, Louisiana, to Baltimore, Maryland, and finally on to Washington, D.C., where he continued to embezzle in the dry goods business until he was discovered.
Adulthood, Dentistry, and the Use of Ether
In 1842, Morton returned to Charlton, Massachusetts, and took up residence on land owned either by his late father or a relative. He met Dr. Horace Wells, from whom he learned the practice of dentistry and set up an office in Farmington, Connecticut. Wells and Morton also set up an office in Boston, Massachusetts, but the partnership failed after 4 months because of financial irregularities by Morton.16
In Connecticut, he made the acquaintance of Elizabeth Whitman, whose wealthy family preferred a physician over a dentist as a husband for Elizabeth. In order to upgrade his social status and win approval from Whitman's family, Morton contacted Dr. Charles Jackson in Boston to study medicine at the Massachusetts Medical College of Harvard University. Morton began his studies, but after marrying Whitman, he did not pursue the study of medicine any further. However, he did continue to consult with Jackson on the use of ether and how to administer it. On September 30, 1846, he performed a successful dental extraction under ether anesthesia. Figure 4is a picture of the home, Etherton, where Morton and his family lived.
Events Surrounding Ether Day
On October 1, 1846, Morton consulted attorney R.H. Eddy about filing a patent for the use of ether to relieve surgical pain. Morton added tincture of orange to mask ether's odor and make it unique.17In addition, he consulted instrument makers Joseph M. Wightman and Nathan B. Chamberlain, to craft a suitable apparatus for administering the vapor.18
Details of the first successful demonstration of ether anesthesia for surgery on October 16, 1846, are well described,1,2and Morton returned to Massachusetts General Hospital (MGH) the next day to anesthetize another patient.
Morton applied for a patent for ether. Once the patent was granted, he circulated a notice to surgeons and physicians, offering a license (for which he would be paid royalties) to use the vapor, which he marketed as Letheon. The name is adopted from Lethe, one of the five mythological rivers of the Greek underworld. Drinking Lethe's waters causes souls to lose their memory. In the Aeneid , Virgil writes that such eradication of memory was necessary before the dead could proceed with reincarnation.18Although the patent was officially granted on November 17, 1846, surgeons at MGH insisted on knowing the composition of the agent. By January 1847, it was discovered that tincture of orange had been added to ether and Morton's claim to his patent collapsed.
After Ether Day
The next 21 yr of Morton's life were spent attempting to gain official recognition and financial reward for his demonstration of ether as an anesthetic. Morton petitioned Congress on several occasions, beginning in 1849, for a sum of $100,000 to compensate him for his achievement.19These attempts were unsuccessful despite the backing of the surgeons at MGH. He also petitioned the French Academy of Sciences for recognition, but the Academy awarded the credit jointly to him and to Charles Jackson.20The State of Connecticut legislature recognized Horace Wells as the founder of etherization.21In June 1868, Atlantic Monthly magazine recognized Jackson as the primary developer of the use of ether as an anesthetic.22The next month, Morton traveled to New York to prepare a rebuttal, but during his stay he probably developed heat stroke and succumbed on July 15, 1868.
A review of Morton's life shows that his crowning achievement was the public demonstration of ether as an anesthetic. Events before and after it suggest a pattern of behavior consistent with narcissistic personality trait, as well as exhibiting manifestations of antisocial personality trait. In addition, there seems to be a progression from narcissistic personality trait to narcissistic personality disorder after Ether Day, as Morton was frustrated by his inability to gain public acclaim and monetary compensation for his achievement. What follows is an examination of his life as it fits into the characteristics of these personality disorders.
Morton was full of confidence and probably had an inflated self-image as he repeatedly presented himself as a young, successful dry goods merchant in several cities, and also as a socially upper-class person who could be trusted in business and social liaisons. He certainly thought himself quite capable of carrying out the first surgical anesthetic only 2 weeks after using ether for a dental extraction. He expected the accolades to come just as quickly and easily.
Interpersonal exploitation for personal gain was another hallmark of Morton. As a young adult, he turned every business and social contact into an opportunity to gain money, often unethically. Wells provided the instruction for Morton to become a dentist and Jackson taught him about the use of ether. Yet after Ether Day, Morton wanted the accolades only for himself. Henry Bigelow, M.D. (Professor, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; 1818–1890), and the other surgeons at MGH repeatedly supported Morton financially as well as with supportive petitions in his quest for recognition and monetary reward.
His expansive imagination was evident after the success of Ether Day. He learned from the failed demonstration of nitrous oxide in 1845 of his onetime dental partner, Wells. Although he had little experience with the apparatus that was constructed and modified at the last hour, he knew very well the importance of demonstrating a successful anesthetic. With a patent in hand for Letheon, Morton had grandiose expectations of public accolades and quick financial return on the sale of licenses and vaporizers.
Morton's confidence and peripatetic ability to move effortlessly from one location to another provide evidence of supercilious imperturbability. This nonchalance was also evident immediately after Ether Day, when his financial schemes to market Letheon fell through. Growing older, facing mounting criticism, and seeing no financial return for his achievement probably were factors most likely responsible for his deteriorating from narcissistic personality trait to narcissistic personality disorder. This led to a decisive crack in the veneer of his imperturbability.
Although Morton realized the importance of ether in relieving surgical pain, his main concern was to capitalize on this discovery for personal gain, rather than to develop anesthesia as an established specialty. His immediate plans were to make money from a patent by licensing the use of Letheon. Offering Jackson the opportunity to sell Letheon, Morton also persuaded him to join Morton as a copatentee in return for a portion of the revenue from the compound's sale.23In addition, Morton had contracted for the construction of vaporizers for Ether, to add to his financial return. There was little thought to providing pain relief during surgery as a part of Morton's own personal agenda. This was simply a means for him to make his mark and capitalize on the demonstration, as was seen in the weeks after Ether Day, when the surgeons at MGH wanted Morton to come back and share with them the identity of his agent. These actions give evidence for and demonstrated his defective social conscience.
Although NPD is probably the primary psychiatric diagnosis applicable to Morton, there is a coexisting undercurrent of lying and stealing, as well as a disregard for others that makes a strong case for an associated diagnosis of antisocial personality trait/disorder. Other aspects of antisocial personality trait/disorder, such as aggressive, almost violent behavior, disregard for the safety of others, and repeatedly violating the rights of others, are not found in examining Morton's life. Although some characteristics of antisocial personality trait/disorder are not present, there is enough in Morton's behavior to justify this as a secondary diagnosis.
As an adolescent and young adult, Morton showed remarkable resiliency in the face of repeated discoveries of his embezzlement. He simply packed up and moved to a different location to start all over again. After the successful demonstration of ether, he was consumed by his unmet desire for monetary compensation, and devoted all of his efforts to this. The resiliency of his youth was less evident over time as Morton persisted in his alliance with and use of the surgeons at MGH to write letters of support for his repeated applications to Congress for an award. He continued to make appearances at public forums to not only promote himself, but to also refute any allegations made against him. Beneath this veneer of persistence, as a listener at one of Morton's lectures described, was a man who had “health impaired, business destroyed, property gone, embarrassed by annoying debts.”24The dissociation widened between Morton's persistent, grandiose claims for fame and fortune and the persistent criticism, rather than the accolades and rewards that Morton's narcissism craved. That dissociation and his socially maladaptive inability to function marked the progression of his narcissistic personality from trait to disorder.
What Morton did on Oct 16, 1846, was truly momentous, a gift to medicine and mankind, a discovery that allowed pain-free surgical intervention. The removal of this apparently unshakable barrier of pain altered the disciplines of surgery and obstetrics forever and later gave birth to the specialty of anesthesia. Although Morton understood the importance of his contribution, he craved personal gain and self-recognition. His narcissistic personality demanded these accolades and recognition. When they were denied him, he became increasingly dysfunctional.