Nutritional Value and Chemical Composition of Selected Fodders; Feed Intervention in Smallholder Dairy Farms in Kenya

This study evaluated the nutritional value and chemical composition of five selected fodder; Boma Rhodes, lucerne, greenleaf Desmodium, chicory, and sweet potato vines which were collected from three geographically distinct regions: Bomet, Nyandarua, and Nyeri, and taken for chemical analysis in the Animal Nutrition laboratory in Animal Science department at Egerton University. These fodder species were analysed for their proximate composition, metabolisable energy, and van Soest composition. All these analyses were done on a dry matter basis. All these results were analysed at P< 0.05. The results revealed significant variations in the nutritional profiles of these diets across the three regions. Bomet exhibits specific trends in crude protein and dry matter, while Nyandarua showcases variability in ether extract and total ash content. Nyeri emphasises differences in crude protein and ash content. These findings provide valuable insights into the regional variations in the chemical composition of fodder, highlighting the importance of tailoring dietary strategies for livestock based on the local environment. The study contributes to the existing literature by offering a comprehensive analysis of the nutritional value of common livestock diets in diverse regions, aiding farmers and researchers in optimizing animal nutrition and enhancing overall agricultural practices.

Keywords: Boma Rhodes; lucerne; greenleaf Desmodium; chicory; sweet potato vines

The livestock industry in Kenya is vital to the country's economy, providing jobs, income, and food security. The livestock industry generates 12% of the GDP, while the dairy industry, which has been expanding at a rate of 4%, contributes 4-8% of the gross domestic product (GDP) [1]. In Kenya, smallholder dairy farmers generate around 1.8 million jobs along the value chain and produce 80% of the nation's milk. The high cost of producing milk, which is mostly caused by the poor quality of animal feed, and the limited availability of high-quality forages throughout the year limit the growth of the dairy industry [2]. In Kenya, tropical grasses supplemented with legumes and residues from crops make up the majority of the forages used in livestock diets.

The goal of this study is to thoroughly investigate the nutritional makeup of the chosen fodders listed below. The principal aim is to acquire a comprehensive comprehension of the ways in which these particular fodders influence the amount and quality of milk produced. By comparing the income over feed cost linked with the use of these particular fodders, the study also explored the economic side. This study aims to offer important insights that can guide and improve feeding procedures within the context of dairy farming through a thorough analysis of their nutritional content and their consequent effect on milk production efficiency.

Only 25 per cent of dairy cows in Kenya produces over 8 litres of milk per day. In comparison, 60 per cent which produces between 1 to 4 litres, and 15 per cent that produces 4 to 8 litres of milk per day based on a study that was done. Nutritional constraints in dairy cow farming have been cited as the primary cause of low milk productivity: inadequate feeds, high feed costs, lack of supplements, poor feeding practices and low-quality feedstuffs have all contributed to low milk productivity. Feed factors are major obstacles to dairy cow production for more than 70 per cent of small-scale dairy farm holders. The solution to the aforementioned issue may lie in the development and utilization of high-quality non-conventional feedstuffs to formulate a feeding model that is economically affordable and readily available, such as a total mix ratio of Boma Rhode hay, lucerne, greenleaf Desmodium, chicory and sweet potato vine

Figure 1 presents a visual depiction showcasing the morphological characteristics of alfalfa (Medicago sativa). This image provides a detailed glimpse into the distinctive features of the alfalfa plant, including its leaves, stems, and any other relevant structures. The visual representation serves as a valuable resource for understanding the physical attributes of alfalfa, contributing to a comprehensive insight into the plant's morphology.

For years, lucerne has been pivotal in animal production, but changing climate dynamics necessitate a reassessment of its role. Understanding the drawbacks of existing systems and realizing the potential of lucerne as a ruminant food source is essential [3]. The frequency of leaf defoliation emerges as a critical factor influencing the quality, yield, and persistence of lucerne grasslands, impacting forage biomass and pasture longevity [4]. Considering these factors can optimize forage harvesting and pasture preservation [5]

Lucerne acknowledged for its acquired taste, has secured a place in diverse human recipes, such as puree sauté, tortilla, tea, croquettes, soufflé, pudding, and both raw and cooked salads [6]. Despite its distinctive flavour, it is recommended to persevere due to its nutritional value. In traditional medicine across regions like Iraq, Turkey, America, and even in traditional Chinese medicine, lucerne has been recognized for its nutritional benefits. It has been used to stimulate appetite, alleviate boils and abscesses, promote healthy blood circulation, and enhance resistance to diseases [7, 8]. Lucerne's leaves contain essential nutrients, including ß-carotene, calcium, iron, phosphorus, potassium salts, and vitamins B, C, D, E, and K. Notably, its chlorophyll content contributes to its anticarcinogenic and detoxifying properties, particularly in the gastrointestinal tract [9].

Beyond its traditional applications, lucerne's aerial parts contain plant protein, sugars, mineral salts, and vitamins [8]. In a comparative study, ruminants fed lucerne pasture showed higher concentrations of vitamin E, essential omega-3 fatty acids, and carcass weight compared to those on a feedlot diet or grazing yearly pastures with concentrate supplements [10]. This underscores lucerne's potential to enhance the nutritional profile of animal products in agricultural settings. Thus, lucerne stands as a versatile resource, benefiting both human nutrition and animal husbandry. The timing of when forage is available is affected by a plant variety's degree of dormancy, which causes the plant to grow later in the spring and finish earlier in the autumn [11].

After wheat, rice, corn, potato, barley and cassava, sweet potatoes (Ipomoea batatas L.) are the most significant crop [12]. It is an important staple that is widely grown throughout many parts of Nigeria and is a member of the Morning Glory family, Convolvulaceae. Due to their enormous starchy, sweet-tasting storage roots that can be used as human food, animal feed, and seed vines for commercial root production, sweet potatoes are well-established in savanna and rainforest regions as shown in Figure 2 [13].

Sweet potato leaves, constituting 27% real protein, 8% starch, 4% sugar, and 10% ash on a dry weight basis, are rich in pro-vitamin A, vitamins B and C, calcium, potassium, and sodium, with variations in vegetative morphology and leaf shapes [13]. The diminishing agricultural land for forage production has led to the exploration of dual-purpose crops like sweet potatoes, which thrive in semi-arid environments. Research by the International Potato Centre (C1P) in 2008 highlighted the preference for dual-purpose sweet potato varieties among farmers, offering both human consumption and livestock feed. These cultivars, harvestable throughout the growing season, hold promise for enhancing the nutritional and food security of resource-limited households in rural areas [14]. Despite concerns about genetic selection for high storage root yield in sweet potatoes, additional efforts are underway to release varieties like Kenspot 1-5, addressing the gap in research on biomass production and nutritional value for farm animals [15, 16].

The robust tropical forage legume, Greenleaf Desmodium, exhibits perennial growth with branched, decumbent stems measuring 1.5 to 7.5 m long and 7 mm in diameter. Featuring trifoliate leaves with ovate reddish-brown to purple leaflets (2-7 cm long by 1.5-5.5 cm wide), it has climbing pubescent stems rooting at the nodes. Terminal compact racemes bear flowers in deep lilac to deep pink hues. Pods, 5 cm long, contain 8–12 kidney-shaped seeds (1.5 mm wide, 3 mm long) that cling to clothing. Notably, Greenleaf Desmodium, in contrast to Silverleaf Desmodium, is characterized by its rounder leaflets as shown in figure 3.

Greenleaf Desmodium, originating from Central and North-Western America, is a versatile fodder legume with applications in cutting for hay, silage, fresh feeding, or as a long-term fodder option [17]. Thriving in subtropical regions between 30°N and 30°S, it exhibits adaptability to various elevations and regions with heavier rainfall [18]. Resilient to diverse soil types, except those excessively saline or extremely acidic, it proves valuable in agriculture [17]. Boasting a notable 24% protein content [19], Greenleaf Desmodium serves as a valuable plant protein source with no reported cases of toxicity. Beyond its agricultural applications, certain Desmodium species are employed in herbal medicine for treating conditions like rheumatism and wounds [17, 20].

Cichorium intybus L., commonly known as chicory or kasni in Hindi, is a significant medicinal herb belonging to the Asteraceae family. The aerial parts, flowers, seeds, and roots of this plant are extensively utilized for their medicinal properties as shown in Figure 4 [21]. Rich in essential compounds such as lactones, volatile oil, fatty acids, coumarins, alkaloids, unsaturated sterols, cardiac glycosides, sesquiterpene, anthocyanins, and phenols, each part of the plant contributes to its overall medicinal value [22].

Cichorium intybus, commonly known as chicory, is a valuable medicinal herb with uses in various parts, including aerial parts, flowers, seeds, and roots. Rich in compounds such as lactones, volatile oil, fatty acids, coumarins, alkaloids, sterols, glycosides, sesquiterpene, anthocyanins, and phenols, the plant exhibits medicinal properties across its entirety. Chicory roots, containing inulin with a minimal impact on blood sugar, are beneficial for diabetics. Traditionally, it has been employed to address conditions like gallbladder stones, jaundice, diarrhoea, and high fever. Additionally, C. intybus demonstrates a range of pharmacological activities, including antibacterial, anthelmintic, antimalarial, liver-protective, antidiabetic, gastroprotective, antioxidant, anti-inflammatory, analgesic, tumor-inhibitory, and antiallergic properties, as reported by [23, 24].

Rhodes grass is a versatile tropical grass that can be annual or perennial, growing 1-2 meters tall. Its diverse features include culms that can be decumbent or erect, tufted or creeping, and roots that extend up to 4.5 meters below the surface. The glabrous linear leaves are 12–50 cm long and 10–20 mm wide, with a tapering tip. The seed head resembles an open hand with two to ten racemes, maturing from light greenish-brown to darker brown. The spikelets, numbering more than 32, are strongly imbricated and feature two awns. The fruit is a caryopsis with longitudinal grooves as shown in figure 5 [25].

Rhodes grass, a versatile fodder, is used for grazing, hay, and deferred feed. Cultivars cater to different environments, and their deep roots make them valuable for soil enhancement [25]. Thriving in temperatures of 25–30°C, Rhodes grass tolerates climates with lows of 16.5^°C and highs of 26^°C, with ideal annual rainfall from 600 to 750 mm [18]. Drought-tolerant, it endures up to 6 months of dry spells, with a yield range of 10 to 16 T DM/ha [18]. Adaptable to various soils, it prefers well-structured ones with pH levels of 5.5–7.5 [25]. Both vegetative and seed propagation are possible, with seeds sown in autumn and rapid germination on well-prepared seedbeds [25, 26].

The first experiment, fodder samples were obtained from Olubutyo Dairy Cooperative demonstration farm which is found in Tagiamin village, in Kongasis ward, Chepalungu sub-county in Bomet County-0.7942421° 47' 8.0196'' S, 35.3478951° 20' 20.8968'' E, 223 Km from Nairobi In according to Latlong. In 2019, its population was 875,689, and its total area was 1,630.0 square kilometres. Bomet Town is the county seat of Bomet County as shown in Figure 6. As the country's centre, the capital is easily accessible from across all corners and districts of the area. The Narok-Kisii road, where the town is situated, is very busy.

Bomet experiences brief, warm, and cloudy summers and long, cool, mostly clear winters. The average yearly temperature ranges from 11.67°C to 26.11°C, with only a few exceptions when it drops below 10°C or rises above 28.89°C. There is an average daily temperature of 25.56°C during the warm season, lasting from January 13th to March 21st. With an average maximum temperature of 26.11°C and low temperature of 12.22°C, the month of February is the hottest of the year in Bomet. The summer season, with a mean daily maximum temperature of 22.78°C or less, runs from April 29 to August 29. With an average minimum temperature of 11.67°C and high temperature of 22.22°C, July is the coldest month in Bomet [27].

The second comparing experiment fodder samples were obtained from Ndaragwa Central constituency, Ngamini Ward, Kahothia Village in Nyandarua County located between geographical coordinates -0.480098611S, and 36.54974917E as shown in Figure 7. Kenya's Nyandarua County was formerly part of the Central Province. Ol Kalou is its largest town and capital. Nyahururu, which is now a part of Laikipia County, served as the capital once. Nyandarua County is 3,304 km2 in size and home to 596,268 people.The Aberdare Ranges are located in the county, which is situated in the northwest of the former Central Province

3,107.7 km2 makes up its whole area (1,199.9 sq mi). 638289 people call it home, according to the 2019 general census. Farming, including potato, dairy, and crop cultivation, is the primary economic activity in Nyandarua. According to the Köppen-Geiger classification, this area has a Cfb climate. Here, the average temperature is 15.8 °C. This area receives about 2276 mm, or 89.6 inches, of rainfall annually. The Aberdare Ranges are located in the northwest of the county, which was once part of the Central Province. The road distance between Nyandarua and Nakuru is 295.4 km, while the distance between the two towns is 48 km. Nitosols, andosols, leptosols, luvisols, phaezems, and planosols are the most common types of soils.

Nyeri County provided the fodder samples for the third comparison experiment. The two Sub-Counties—Mathira West, Ngandu location, and Kieni East—were chosen for this research based on the number of dairy farmers in each Sub-County as shown in Figure 8. The Kenya National Bureau of Statistics (KNBS) estimated the population in 2019 to be 759,164 people living in 207.8/km2. Its common borders are with five counties: Meru to the north, Laikipia to the north, Nyandarua to the west, Murang'a to the south, and Kirinyaga to the east. It is located between latitudes 0°25′12′′ S and 36°56′51′′ E. It has become a premier centre for agricultural innovation as a result. The county is situated between 3,076 and 5,199 metres above sea level, about 150 kilometres north of Nairobi. In the hot months of January through March and September through October, the county's average temperature is 20.8°C, and in the cold months of June and July, it is 12.80°C. 500–1600 millimetres of precipitation fall there annually, with April and May seeing the heaviest amounts.

Fodders for laboratory analysis were collected using a systematic random sampling technique and packed in well-labelled khaki bags.

The samples were examined at the Animal Nutrition Laboratory in the Department of Animal Science at Egerton University in Kenya. The following techniques were employed to evaluate the selected fodder samples' proximate chemical composition: ether extracts by continuous extraction performed on a dry sample in a Soxhlet extractor without previous acid hydrolysis (EE; AOAC Official method 934.01); crude protein was computed by multiplying the nitrogen content by 6.25 and determining the amount of nitrogen using the Kjeltec 2300 Foss Tecator apparatus (Hanganäs, Sweden). The AOAC standard procedures [28] were employed to determine crude ash (Ash; AOAC Official Method 942.05) and crude fibre (CP; Kjeldahl method, AOAC Official method 984.1); additionally, crude fibre was determined in accordance to the Henneberg-Stohmann method by hydrolyzing animal fodder samples with acid and base solution using a Fibertec Tecator (Haganäs, Sweden) apparatus (CF; AOAC Official method 978.10). Samples of dry matter were dried using the weight method and dried in a forced air oven at 105oC (DM; AOAC Official method 934.01).

The fibre component was analysed using an apparatus made by Fibertec Tecator (Haganäs, Sweden) and the [29] method for acid detergent lignin (ADL; method 973.18 of AOAC), neutral detergent fibre (NDF; method 2002.04 of AOAC), and acid detergent fibre (ADF; method 973.18 of AOAC) [30]. Also, the metabolizable energy levels of the feed were determined using the bomb calorimeter. Before feeding, this was done to know how much to feed the animal in terms of its daily nutrient requirement and to have an impression of their contribution to the milk yield per experimental animal.

All variables were subjected to analysis of variance (ANOVA) in a completely randomised design utilizing the SAS (2002) version 9.4. Statistical Package's General Linear Model Procedures (proc glm). The New Duncan's multiple range test was used to declare significant means at the 5% confidence level [31]. The linear model for the completely randomised design (CRD) was:

Y_ij= µ + T_i+ e_ij

where Y_ij= dependent variables (nutrient composition/digestibility/ME).

µ= overall mean due to all observations

T_i= effect of i^th treatment diet {i=1,2,3,4}

e_ij = Random error effect.

Table 6 shows the compounded chemical composition (% DM basis) of selected fodder species in Bomet County, from proximate analysis to van Soest analysis to metabolizable energy

No significant difference in dry matter % was found between lucerne, green leaf Desmodium, and boma Rhodes at P>0.05. Similarly, the dry matter content of sweet potato vines, green leaf Desmodium, and chicory showed no significant difference at P>0.05. However, a significant difference was observed between lucerne's dry matter % and that of sweet potato vine and chicory at P < 0.05. There was a significant difference in crude protein % across all five experimental fodders—lucerne, green leaf Desmodium, sweet potato vines, chicory, and boma Rhodes at P< 0.05. Ether extract % showed no significant difference between sweet potato vine, green leaf Desmodium, chicory, and boma Rhodes at P>0.05. However, ether extract % of lucerne differed significantly from all four fodders at P< 0.05.

A significant difference in ash content was observed across all five fodders—lucerne, green leaf Desmodium, sweet potato vines, chicory, and boma Rhodes at P< 0.05. Crude fibre % also showed a significant difference across all five fodders at P< 0.05. Neutral detergent fibre content level had no significant difference between sweet potato vine and chicory at P>0.05, while lucerne, green leaf Desmodium, and boma Rhodes differed significantly at P< 0.05. Green leaf Desmodium and boma Rhodes also showed a significant difference in neutral detergent fibre content level from sweet potato vine and chicory at P< 0.05. Lucerne had a significant difference in neutral detergent fibre content level from sweet potato vine and chicory at P< 0.05. No significant difference was found in acid detergent fibre % among sweet potato vines, green leaf Desmodium, and chicory at P>0.05, while lucerne and boma Rhodes differed significantly at P< 0.05. Lucerne also differed significantly in terms of acid detergent fibre % with sweet potato vines, green leaf Desmodium, and chicory at P< 0.05. Boma Rhodes had a significant difference in acid detergent fibre % from sweet potato vines, green leaf Desmodium, and chicory at P< .05.

There was a significant difference in acid detergent lignin% across all five fodders—lucerne, green leaf Desmodium, sweet potato vines, chicory, and boma Rhodes at P< 0.05. However, no significant difference was observed between the metabolizable energy (J/kg) of lucerne and that of boma Rhodes at P< 0.05. Sweet potato vine, green leaf Desmodium, and chicory exhibited a significant difference in metabolizable energy (J/kg) at P>0.05. Sweet potato vine differed significantly in terms of metabolizable energy (K/kg) from lucerne and boma Rhodes at P< 0.05. Similarly, green leaf Desmodium differed significantly in terms of metabolizable energy (K/kg) from lucerne and boma Rhodes at P< 0.05, as did chicory, which differed significantly in terms of metabolizable energy (K/kg) from lucerne and boma Rhodes at P< 0.05.

Table 7 shows the Compounded chemical composition (% DM basis) of selected fodder species in Nyandarua County, from proximate analysis to van Soest analysis to metabolizable energy.

No significant difference in dry matter % was observed across all five fodders-lucerne, green leaf Desmodium, sweet potato vines, chicory, and boma Rhodes at P>0.05. Sweet potato vines and chicory showed no significant difference in crude protein % at P>0.05. However, there was a significant difference in crude protein % among lucerne, green leaf Desmodium, and boma Rhodes at P< 0.05. Lucerne also differed significantly in crude protein % from sweet potato vines and chicory at P< 0.05. Similarly, green leaf Desmodium and boma Rhodes exhibited a significant difference in crude protein % from sweet potato vines and chicory at P< 0.05. A significant difference in ether extract % was observed between lucerne and sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes at P< .05. However, there was no significant difference in ether extract % between sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes at P>0.05. All five fodders-lucerne, sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes—differed significantly at P< 0.05 in terms of ether extract content.

All five fodders-lucerne, sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes—differed significantly at P< 0.05 in terms of ash content. Similarly, all five fodders differed significantly at P< 0.05 in terms of neutral detergent fibre content. A significant difference in acid detergent fibre content was observed among sweet potato vines, green leaf Desmodium, and boma Rhodes at P< .05. However, chicory and sweet potato vines showed no significant difference in acid detergent fibre content level at P>0.05. Chicory and sweet potato vines had a significant difference in acid detergent fibre content level compared to sweet potato vine, green leaf Desmodium, and boma Rhodes at P< 0.05.

All five fodders—lucerne, sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes—differed significantly at P< 0.05 in terms of acid detergent lignin. There was no significant difference in metabolizable energy (J/kg) between lucerne and boma Rhodes at P>0.05. Green leaf Desmodium, sweet potato vines, and chicory exhibited a significant difference in metabolizable energy (J/kg) at P< 0.05. However, each of these three fodders—green leaf Desmodium, sweet potato vines, and chicory-differed significantly in metabolizable energy (J/kg) from both lucerne and boma Rhodes.

Table 8 shows the Compounded chemical composition (% DM basis) of selected fodder species in Nyeri County, from proximate analysis to van Soest analysis to metabolizable energy

There was no statistically significant difference in dry matter % between lucerne and boma Rhodes at P< 0.05. Additionally, lucerne, sweet potato vine, green leaf Desmodium, and chicory did not exhibit a significant difference in terms of dry matter % at P>0.05. However, the latter three fodders—sweet potato vine, green leaf Desmodium, and chicory—each showed a significant difference in dry matter % compared to both lucerne and boma Rhodes at P< 0.05. All five fodders—lucerne, sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes—differed significantly at P< 0.05 in terms of crude protein %. Sweet potato vines, green leaf Desmodium, and chicory did not show a significant difference in ether extract % at P>0.05, while lucerne and boma Rhodes differed significantly in ether extract content at P< 0.05. Each of the former three fodders—sweet potato vines, green leaf Desmodium, and chicory—differed significantly in terms of ether extract from both lucerne and boma Rhodes at P< 0.05.

There was no significant difference in ash content between Boma Rhodes and lucerne at P>0.05. However, sweet potato vines, green leaf Desmodium, and chicory each exhibited a significant difference in ash content at P< 0.05. Each of the latter three fodders—sweet potato vines, green leaf Desmodium, and chicory—differed significantly in terms of ash content from the former two fodders—boma Rhodes and lucerne at P< 0.05. All five fodders—lucerne, sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes—differed significantly at P< 0.05 in terms of crude fibre %. There was no significant difference in neutral detergent fibre % between sweet potato vines and chicory. However, lucerne, sweet potato vines, green leaf Desmodium, and boma Rhodes each showed a significant difference in neutral detergent fibre % at P< 0.05. Lucerne, green leaf Desmodium, and boma Rhodes each differed significantly in terms of neutral detergent fibre % from sweet potato vines and chicory at P< 0.05.

There was no significant difference in acid detergent fibre % between sweet potato vines, green leaf Desmodium, and chicory. Additionally, green leaf Desmodium, chicory, and boma Rhodes did not show a significant difference in terms of acid detergent fibre % at P>0.05. Lucerne differed significantly from each of the other four fodders—sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes. All five fodders—lucerne, sweet potato vines, green leaf Desmodium, chicory, and boma Rhodes—differed significantly at P< 0.05 in terms of acid detergent lignin %. There was no significant difference in metabolizable energy (J/kg) between sweet potato vines and boma Rhodes at P>0.05. However, lucerne, green leaf Desmodium, and chicory differed significantly at P< 0.05 in terms of metabolizable energy (J/kg). The latter three fodders—lucerne, green leaf Desmodium, and chicory—each had a significant difference in metabolizable energy (J/kg) compared to sweet potato vines and boma Rhodes at P< 0.05.

The meticulous analysis of forage composition across the distinct regions of Bomet, Nyandarua, and Nyeri offers a nuanced understanding of the inherent similarities and intriguing discrepancies. These variations are reflective of multifaceted interactions involving environmental conditions, agricultural practices, and regional peculiarities influencing forage growth and nutritional content.

The evaluation reveals a notable commonality in dry matter content across all three regions. The absence of significant differences suggests potential similarities in environmental conditions, harvesting practices, or forage management strategies that collectively contribute to consistent moisture levels. A shared aspect emerges in the realm of crude fibre content, showcasing significant differences in all regions. This could indicate a commonality in the impact of plant maturity or similar processing methods affecting the fibre composition of forage as clearly elaborated in the finding of Moore [32], on how various factors affect fodder nutrient composition.

While Bomet exhibits pronounced differences in crude protein content across fodders, Nyandarua and Nyeri showcase uniformity in certain fodders. This disparity hints at potential variations in soil fertility, fertilization practices, or the inherent genetic makeup of forage plants specific to each region. Notably, Bomet displays significant differences in ether extract content for Lucerne, whereas Nyandarua and Nyeri do not. This discrepancy could be rooted in variations in lipid synthesis influenced by sunlight exposure, soil conditions, or the genetic composition of forage plants. The results of [33] on plant factors that contribute to diversity in plant nutrient composition are consistent with this finding.

Nyandarua and Nyeri present significant differences in total ash content, contrasting with Bomet. These disparities may be linked to variations in soil mineral composition, fertilization practices, or regional geographical influences shaping the nutritional makeup of forage. Bomet exhibits distinctive differences in NDF, ADF, and ADL across fodders, while Nyandarua and Nyeri display variations in specific fodders. These discrepancies may be attributed to regional differences in forage plant genetics, growth conditions, or processing methods employed, these findings concur with the work of Jangra & Madan [34].

Bomet and Nyeri manifest significant differences in metabolizable energy, whereas Nyandarua does not. This discrepancy may be related to differences in the composition of carbohydrates, plant metabolism, or regional climatic conditions influencing forage quality. In delving deeper into the observed discrepancies, several factors warrant consideration. Geographical and climatic variances stand out as influential determinants, as the three regions encompass diverse climates, soil types, and altitudes. These factors collectively impact plant growth, nutrient absorption, and forage composition. Agronomic practices also contribute to the observed variations. Differences in fertilization practices, crop management, or harvesting techniques may introduce discrepancies in forage composition. The genetic makeup of forage plants can play a pivotal role, with regional variations influencing nutrient content and composition, as it is with the findings of López-Angulo [35].

Furthermore, processing methods, such as drying or chopping, may introduce variations in nutritional content. Soil fertility emerges as a critical factor, with differences in nutrient levels potentially contributing to variations in mineral content across regions. The observed variations in forage composition across the regions of Bomet, Nyandarua, and Nyeri are intricately linked to the subsequent impact on the milk output of Friesian cows, as discussed earlier. The nutritional content of forage directly influences the dietary intake and, consequently, the performance of dairy cows.

In conclusion, the nutritional analysis of the diverse forages comprising lucerne, green leaf Desmodium, sweet potato vines, chicory, and boma Rhodes grass in Bomet, Nyandarua, and Nyeri Counties reveals significant variations in their composition. The variations in total ash, crude fibre content, ether extract, dry matter content, crude protein, and Van Soest composition show how these forages have different nutritional profiles depending on the region. The results emphasise how crucial it is to comprehend and modify dietary plans in accordance with the local availability of forage and nutritional composition. Overall, the nutritional analysis provides a foundation for informed decision-making in optimizing dairy cow diets for enhanced milk production in smallholder farming systems.

The study aimed to find out the qualitative and quantitative effect of feeding Friesian dairy cows with a mixture of lucerne, greenleaf desmodium, sweet potato vine and chicory supplemented to Boma Rhodes on dairy performance in smallholder dairy farms in Bomet County. It also focused on the cost-benefit profile of utilizing the experimental diets. The study was prone to suffer from some limitations like the occurrence of diseases affecting the dairy cows and fodders as well as weather conditions challenges affecting fodder establishment.

Based on our nutritional analysis of various forages in Bomet, Nyandarua, and Nyeri Counties, we highly recommend farmers consider incorporating homegrown fodders into their cattle diets. Homegrown fodders, when properly cultivated and managed, can offer cost-effective and nutritionally balanced alternatives for livestock feeding. Furthermore, we suggest conducting additional studies on a broader range of leguminous and grass fodders. This expanded research would provide a more comprehensive understanding of locally available forages, enabling farmers to make informed decisions regarding the optimal composition of cattle diets. By exploring a diverse array of forages, we can identify additional options that may enhance milk production efficiency and overall economic viability for farmers in these regions.

This research was made possible through the generous financial support of the RUFORUM -TAGDev program at Egerton University and the Milk Africa project. Both initiatives provided critical funding for the design, execution, and analysis of the study.

The authors, C. W. Oktoto, J. O. Ondiek, and O. A. Ndambi, collectively declare that there is no conflict of interest influencing the publication of this manuscript. The research was conducted with utmost integrity and objectivity.

The datasets supporting the findings of this study are available upon reasonable request. Interested parties may contact any of the authors, CW Oktoto, JO Ondiek, or OA Ndambi, for access to the data sets used in this research.

All authors, CW Oktoto, JO Ondiek, and OA Ndambi, contributed significantly to all aspects of this manuscript. Specific contributions include:

Conceptualization: CW Oktoto, JO Ondiek, OA Ndambi

Methodology: CW Oktoto, JO Ondiek, OA Ndambi

Data Collection: CW Oktoto

Analysis and Interpretation: CW Oktoto,

Writing – Original Draft Preparation: CW Oktoto

Writing – Review and Editing: CW Oktoto, JO Ondiek, OA Ndambi

Funding Acquisition: CW Oktoto, JO Ondiek, OA Ndambi

Carbon dioxide: The story of carbon dioxide was brief. In 1824, British surgeon, Henry Hill Hickman (1800-1829 AD), found in animals that inhalation of Carbon dioxide gas produced insensibility to pain.

In 1824, he submitted the results of his research to the Royal Society in a short treatise titled “Letter on suspended animation: with the view of ascertaining its probable utility in surgical operations on human subjects”. “…………..Something has not been thought of whereby the fears(of the patient) may be tranquilized and suffering relieved”[29].

In an article entitled “Surgical Humbug”, published in The Lancet in 1826 his work was ruthlessly criticized.Since he had failed to convince his colleagues he wrote to Charles X, King of France, asking for permission to demonstrate his experiment. His Majesty referred the matter to “Academic de Medecine Paris” where the famous French surgeon Dominique Jean Larrey (1766-1842 AD), inventor of “Flying Ambulance”, was the only one to support Hickman’s request. In addition, he offered himself as a subject for experiment. But the others disagreed, and the matter was dropped. Rejected and dejected, he committed suicide at 31 years of age. It was a tragic end of a researcher whose goal was to search for a pain free surgery.

Nitrous Oxide: “I have sometimes experienced from nitrous oxide, sensations similar to no others, and they have consequently been indescribable”.

Sir Humphrey Davy (1778-1829 AD)

British chemist Joseph Priestley (1733-1804 AD), discoverer of “dephlogisticated air” (later known as oxygen) on August 1, 1774, had the additional honor of isolating Nitrous Oxide in 1772. Sir Humphrey Davy,from Pneumatic Institute in Bristol, expanded the work on his assistants and friends, including the famous poets Samuel Taylor Coleridge and William Wordsworth. Amongst the earlier subjects were Dr.Thomas Beddoes and his wife Anna Edgeworth.She remarked: “the gas made me feel that I was ascending the ballon”. The others also reported dizziness, loss of pain, relaxation of muscles and a tendency to laugh (hence the popular name “laughing gas”) and “the dreams of misemployed genius”. Sir Davy, in his treatise published in 1800, remarked: “As Nitrous Oxide, in its extensive operation, seems capable of destroying physical pain; it may probably be used with advantage during surgical operations in which no great effusion of blood takes place” [30].

Dr. Horace Wells (1815-1848 AD), an American dentist, attended a Grand Exhibition of “laughing gas”by Dr. Gardner Quincy Colton (Founder of Colton Dental Association) at Union Hall in Hartford, Connecticut on December 10, 1844. He was impressed by the effects of the gas and thought of using it in surgical practice. Dr. Wells discussed with Colton and then planned to become “the first guinea pig”. Eventually Dr. John Riggs of “Riggs Disease” fame extracted his ailing erupting tooth. After waking, Dr. Wells exclaimed: “It is the greatest discovery, ever made. I did not feel as much as the prick of a pain”. A news appeared in “Boston Bee” on January 20, 1845, “A dentist in Hartford has adopted the use of nitrous oxide gas in tooth pulling. It is said that after taking this gas the patient feels no pain”. That was the earliest known announcement of use of nitrous oxide in surgical practice.

Later on, after successful experimentation of its efficacy in significant number of cases, he planned to make a public demonstration on January 20, 1845, at Massachusetts General Hospital. When he pulled the infected tooth, the patient groaned. At that moment the hall erupted with cries of “humbug” and “swindler”. Dejected and depressed, Dr. Wells left the hall. The patient later explained that he “practically felt no pain”. Dr. Wells in his communication on December 7, 1846 to the Editor of the “Connecticut Courant” narrates the event, “Unfortunately for the experiment the gas bag was, by mistake, withdrawn much too soon, and the patient was partially under its influence when the tooth was extracted. He testified that he experienced some pain, but not as usually attends the operation. As there was no other patient present, the experiment could not be repeated and as several expressed their opinion that it was a ‘humbug affair ‘(which in fact was all the thanks I got)”.

Although the demonstration did not meet the expectations of many, Dr. Pinckney Webster Ellsworth, a prominent Hartford, Connecticut surgeon, wrote an article in support of Dr. Wells’ assertion that appeared in the Boston Medical Surgical Journal June 18,1845. The other practitioners expanded work on the gas. Unfortunately, reports of suboptimal response and even failure shattered the confidence of the public and the professionals. The gas had been condemned, dead and forgotten as an anesthetic from 1848 to 1863.

In 1863, through long continued efforts of Dr.Colton, nitrous oxide was reintroduced into American surgical practice. He pleaded that the gas was, beyond all comparisons (with ether and chloroform), the safest of all anesthetics as it was pleasant to inhale and the patient was quickly under its influence and quickly over it. He claimed to having given to over 15,000 patients without a single death [31]. In 1868, Edmond Andrews, a Chicago surgeon introduced administration of nitrous oxide in combination with oxygen. The same year nitrous oxide in cylinders was marketed in United Kingdom.

Ether: “The history of medicine has presented no parallel to the success that has attended the use of Ether”

(Exeter Flying Post June 24,1847)

The following is an account of the historical record of use of ether in the United States and Europe.

There is some disagreement who discovered Ether. Jaber Ibn Hayyan (721-815 AD), an Arab Polymath, known as “Father of Modern Chemistry” was the first to prepare oil of vitriol which we now all sulphuric acid, from distillation of alum [32]. Spaniard Raymond Lullius (1235-1315 AD), known as “Doctor Illuminatous” synthesized a new preparation by distillation of sulphuric acid with spirit of wine.The German herbalist ValeriusCordus (1515-1544 AD), well remembered for authoring one of the greatest pharmacopeia, named it “Sweet oil of vitriol (oleum dulce vitrioli)” [33]. However, Sigmund Frobenius (1700-1741 AD), a German chemist renamed it “Ether” (Latin aether:the upper pure, bright air), in 1729 [34].

Paracelsus (1493-1541 AD),a Swiss physician, described the anesthetic effects of sulphuric ether on chickens. He says,“it quiets all suffering without any harm, and relieves all pain, and quenches all fevers, and prevents complications in all disease” [35].

In 1818, Professor Michael Faraday (1791-1867), discoverer of electromagnetic induction and inventor of induction coil, further studied ether and concluded that its effects were very similar to those of nitrous oxide [36].

The first recorded use of ether anesthesia occurred on January 20, 1842, which was administered by William E Clarke, a chemist (pharmacist) from Rochester, New York to a person referred to as Miss Hobbie while Dr. Elijah Pope extracted a tooth [37]. Clarke, however, did not opt to publish or to pursue this technique any further.

Crawford Williamson Long (1815-1878 AD) gives an interesting account of the story of “etherisation”. In December 1841, some of his friends frequently assembled in the village of Jefferson to experience the exhilarating effects of ether. The practice even became fashionable and an “essential” component of the dinner parties in the locality. He was convinced of the efficacy and safety of the substance, so he decided to employ it for a surgical procedureon March 30, 1842. The patient was Mr. James Venable from nearby Cobb County who presented with two tumors on back of his neck. The first tumor was successfully removed while he “continued to inhale ether during the time of the operation”. The second tumor was excised on June 6, 1842. Both the procedures were reported as being pain free. The third case was a negro boy whose diseased toe was amputated uneventfully, on July 3, 1842.

It was Charles T. Jackson (1805-1880 AD) who suggested to Boston dentist William Thomas Green Morton (1819-1868 AD), that the application of ether could relieve pain in tooth pulling. Having found it successful, Morton thought of trying ether inhalation in other surgical procedures.John Collins Warren (1778-1856 AD), Professor of Surgery at Harvard and Chief Surgeon Massachusetts General Hospital,was kind enough to allow him to make the first public demonstration of “etherisation” on October 16, 1846.The patient was Gilbert Abbott presenting with a congenital tumor on left side of neck extending along the jaw to maxillary gland and into mouth embracing the margin of tongue.

The silence, in that crowded operating room, was broken by the words of Professor Warren “that a test of some preparation was to be made for which the astonishing claim had been made that it would render the patient operated upon free of pain”. Dr. Morton asked the patient to inhale vapor “for about three minutes at the end of which he sunk into a state of insensibility. He showed no sign of pain, yet he was alive and breathing”. After the successful removal of the tumor, ProfessorWarren turned to the amazed audience and exclaimed “gentlemen! there is no humbug”. Dr. Henry Jacob Bigelow, an eminent surgeon of that Brigham and Women’s Hospital assisting the operation, remarked: “I have seen something today that will go around the world”.The operating room “Ether Dome” at Massachusetts General Hospital remains a “memorial” to that moment of a wonderful discovery.

This successful demonstration and appreciation by Professor Warren, a commanding figure in the world of surgery, played a pivotal role in overall acceptance of “etherisation” by the medical profession. The next day, October 17, 1846, another surgical procedure (removal of a fatty tumor from the deltoid region of a female patient) was performed, under ether inhalation, by George Hayward (1791-1863 AD), a forgotten pioneer of reconstructive pelvic surgery.

It was the historic day of December 21, 1846, that the first widely witnessed surgical procedure, under ether anesthesia, was performed by renowned British surgeon Robert Liston (1794-1847 AD) at University College Hospital London on Frederick Churchill, a butler from Harley Street, for amputation of his leg. The Ether was administered by William Squire.Shortly after, On December 30, 1846, James Goodall Lansdown did a successful above-knee amputation in Bristol General Hospital. On January 12, 1847, French surgeon Joseph-Francois Malgaigne (1806-1865 AD) reported to the “Paris Academia de Medecine” three successful cases of “etherisation”. There were similar reports from Professor James Syme (1799-1870 AD), a pioneering Scottish surgeon, and Nikolai IvanovichPirogov (1810-1881AD),a prominent Russian surgeon.

On January 19, 1847, Sir James Young Simpson (1811-1870 AD), Professor of Midwifery at University of Edinburgh, championed etherization in obstetric practice in women with deformed pelvis. On November 19, 1847, he wrote a note of appreciation to the BostonianDr. Morton saying: “Of course, the great thought is that of producing insensibility to pain, and that the world is, I think, indebted to you”.

The first use of ether in obstetrics, in Germany,was by Adam Hammer (1818-1878 AD) on February 18, 1847.The first patient in United States was Fanny Appleton Longfellow (wife of famous poet Henry Ward-worth Longfellow), to receive obstetric anesthesia,by Nathan Cooley Keep, on April 7,1847.Shewrote: “I feel proud to be the pioneer to less suffering.This is certainly the greatest blessing of the age and I am glad to have lived the time of its coming”. That sentiment was echoed by Professor Holmes, while recounting blessings of obstetric anesthesia that “it lifted the primal curse”.John Snow (1813-1858 AD),a towering figure in clinical medicine, epidemiology and obstetric anesthesia,started administering ether as early as 1847 [38].Later on, he switched to chloroform “on the request of the operating surgeons”.

Chloroform: “With a few exceptions, almost all over the earth, nothing else was used to produce anesthesia but chloroform”.

(Adolf Gusserow (1836-1906 AD)-Professor of Obstetrics)

The story of chloroform involves interesting medical and theological debate. It was isolated in 1831 by three independent investigators, of different countries;

1. Samuel Guthrie (1782-1848 AD) - American physician [39] 2. Eugene Soubeiran (1797-1858 AD) - French pharmacist [40] 3. Justus Von Liebig (1803-1873 AD) - German chemist [41]

Its composition was first accurately ascertained by the distinguished French chemist Jean-Baptiste-Andre Dumas (1800-1884 AD), in 1835 [42]. Marie-Jean-Pierre Flourens (1794-1867 AD), French physiologist, championed to demonstrate its anesthetic properties in animals [43]. Dr.Robert Mortimer Glover (1815-1859 AD), British physician, provided additional evidence [44]. Sir James Young Simpson has the credit of introducing it to routine clinical practice. On November 10, 1847 he presented a paper, in the meeting of Edinburgh Chirurgical Society, discussing the employment of chloroform to replace ether in obstetrical procedures [45].

Chloroform was first used by British Army Surgeons during Crimean War(October 1853-February 1856) [46]. In the United States it was used by Paul Fitzsimmons Eve (1806-1877 AD), who is well remembered for authoring “A Collection of Remarkable Cases in Surgery 1857” [47]. The preferential adoption of Chloroform in the army, was because of economy (comparatively small amount required to produce the desired effect), convenient portability (during march or engagement),rapidity of action and value of time(which was of paramount importance for the field surgeons with crowded wounded). Most of the military surgeons had the consensus that it was a “soldier’s best friend during a painful surgery” [48].

“It is a lamentable fact that every great improvement and discovery in Medicine and Science has brought persecution upon its author”.

(Atlantic monthly)

As already pointed out, surgery in pre-anesthesia era was a terrifying procedure. The surgeons were trying to finish their task at break-neck speed certainly compromising the quality. “The quicker the surgeon, the greater the surgeon” was the professional and popular belief during the the first half of (nineteenth) century” [49].The results were disastrous in significant cases and the hospitals, in those days, were known as “Houses of Death”.Although the concept of pain relief and even total insensibility to pain was not unfamiliar to medical profession, it is a melancholic reality that the speed of work on discovery of the anesthetics was far from exemplary. The delay, according to Gray et al, is attributed to the “old belief in the west that pain and suffering was the price paid by humans for sins” [50].

Whatever may be the reason(s), the search of anesthetics was, seemingly, not a priority among researchers of west. Hans von Gerssdorff (circa 1456-1517 AD),author of a traumatic surgery “Feldbuch der Wundarznei- Strasbourg 1517” wrote: “There has been much said and often written how you give a drink and make one sleep whom you wish to cut. I leave it alone. I have never used it or seen it even at that I have cut off a hundred or two members”. How pessimistic were the giants of the medical profession can be assessed from the words of Alfred-Armand-Louis-Marie Valpeu (1795-1867 AD), the distinguished French Surgeon and a voluminous writer who, in 1839 wrote: “Excluding pain from surgeries is a chimera which today is no longer possible to pursue. ‘Knife’ and ‘Pain’ in surgery are two words which are always inseparable in the minds of the patients, and this necessary association must be conceded.” The remarks of Sir Benjamin Collins Brodie 1st Baronet (1783-1862 AD), well known for pioneering research on bone and joint diseases,in 1846, were more disappointing “physicians and surgeons have been looking in vain from the days of Hippocrates (460-370 BC) down to the present time for the means of allaying or preventing pain” [51].

Pain, in the process of parturition, was thought to be “a desirable, salutary and conservative manifestation of life force” [52]. Why they were sensitive on the issue of pain? Why they insisted that pain is a “Must”? needs to be explored.Pain, one of the universalism of existence, has a long and venerable history.It is a personalized,immeasurable and unsharable experience [53]. The word “pain” is derived from “poena”, the Roman Spirit of Punishment, who serves Nemesis (the goddess of indignation against and redistribution for, evil deeds and undeserved good fortune). In Greek mythology the goddess of revenge “poine” was sent to punish mortal man who had dared to anger god [11]. This was the philosophy that surgical pain was considered to be the integral part of surgery, as God’s Will.

Whereas the “ether” has its origin attributable to United States of America, the “chloroform” is a British product. The battle, against both of them, was fought at both fronts: American and British. Crawford Williamson Long in the United States was the first to successfully operate on a patient on March 30, 1842. The interesting detail of his three cases of painless surgery has already been described. It was unfortunate that he had to face severe opposition, both from the professional and religious sectors. The co-citizens started criticizing him and demanded that he should be prevented from going ahead.They accused him of using “a diabolical drug to insensibilizing the patients”. Getting disgusted, he stopped etherisation and reverted to old barbarous surgery which was more acceptable to them and they returned him the trust and esteem which he enjoyed earlier.Neither he did (nor he could do) anything to universalize the revolutionary achievement, for fear of severe public reaction.This was the most important reason for his silence till 1848 when he presented a lucid account of his first case at the annual meeting of the Georgia Medical Society. The statement of Mr.James Venable (the first patient who was operated twice), recorded under oath on July 23, 1849 in the Cobb County, Georgia sworn to before Alfred Mane(Justice of the Peace), “I did not feel the slightest pain from the operation (on March 30, 1842) and could not believe the tumor was removed until it was shown to me”, was astonishing.Later on, all his cases were reported in Southern Medical and Surgical Journal in December 1849.This inordinate delay on his part (a blunder ?) made him out of the battle of “Ether Controversy” [54].

An account of the first publicized case of “etherisation” in United States, authored by Professor Bigelow, in “Boston Medical and Surgical Journal November 18, 1846”, provoked a debate in “Philadelphia Medical Examiner” accusing Boston surgeons of encouraging quackery adding: “if this tendency was not checked; physicians and quacks will soon constitute a fraternity”. The practice of etherisation, despite the negative attitude, continued to flourish. American military doctors began using anesthesia in the battlefield between Mexican-American War (1846-1848 AD) and by 1849 it was officially issued by the United States Army.

Returning to the “battle” in Edinburg; Sir Simpson had to face opposition on two fronts, medical and religious. As rightly pointed out by Dr.Ron Jones, the opposition to anesthesia for laboring women came from the medical community,often disguised in religious terms …….. No objector was a women [55]. The words uttered by mouths of some doctors “Pain serves as a purpose.It is wrong to try to avoid pain” fascinated opposing clergymen who hastened to further sharpen their weapons against Simpson. It is recorded that Simpson’s use of chloroform in labour was denounced “as impious and contrary to Holy Writ”. Henry Ward Beecher (1813-1887 AD), America’s most famous preacher,was a proponent of women’s suffrage to say: “The less pain,the less life-capacity.The less pain power, the less life-power”. The Scottish Calvinist clergy declared him “An Agent of Evil” because of the “seriousness of his offence”, arguing that Lord God had said to Eve “……..In sorrow thou shalt bring forth children………. (Genesis III: 16-KJV)” . At this, Simpson referred to John Calvin (1509 – 1564AD - French Protestant reformer), founder of Calvinism, who himself had written in “Commentaries’ – “it ought to be noted, that Adam was sunk into a profound sleep, in order that he might feel no pain”. In addition, Simpson (a Bible scholar as well as a physician) brought forward another reference: “And the Lord God caused a deep sleep to fall upon Adam; and he slept and He took one of his ribs and closed up the flesh instead there of - Genesis II: 21-KJV”. Simpson continued his arguments by advocating that “the above was the first surgical operation ever performed on man”. Lord God Himself was the first anesthetist of the universe [4].

In addition to opposition at religious front, Simpson had to “fight” with professional colleagues. In a letter to him, published in the Buffalo Medical Journal 3:677, Charles DeluceansMeigs, Obstetrician at Jefferson Medical College, also put forward arguments against obstetric anesthesia: “But should I exhibit the remedy for pain to a thousand patients in labour, merely to prevent the physiological pain...and if I should in consequence destroy the life of only one of them, I should feel disposed to clothe me in sack-cloth, and cast ashes on my head for the remainder of my days. What sufficient motive have I to risk the life or death of even one in a thousand?”

Fortunately, Sir Simpson proceeded with his work, first with ether and later on with chloroform, unshaken by negative criticism.Fortified by confidence of knowledge, expertise, zeal and enthusiasm he stood firm and undaunted in his battle against pain.Eventually, he was recognized as “the apostle of chloroform”.The plaque dedicated to him in Westminster Abbey reads:

The world owes the blessings derived

From the use of chloroform for

The relief of suffering

“Laus Deo” (Praise be to God)

April 7, 1853 was a particularly historic day in the specialty of anesthesiology when chloroform (inhaling for 53 minutes from a handkerchief) was given to Her Majesty Queen Victoria for the birth of her 8th child (Prince Leopold) by Professor John Snow. Despite the apparent “cease fire”,severe criticism arose; so much so that the editor of Lancet showed his anger as“In no case could it be justifiable to administer chloroform in perfectly ordinary labour” [56]. But Her Majesty’s joyful remarks “the effect was soothing, quieting and delightful beyond measure” were a severe blow to the critics. After the royal approval, the acceptability of the chloroform was enormously elevated. In 1857, at the birth of Princess Beatrice (the 9th and the last child), the Queen received chloroform again to the best of her satisfaction [57]. This made the critics silent.Cartwright wrote “it was the acceptance by the Queen herself that changed the minds of opponents [58]. Walker added “it was the Queen who finally settled the ethics of the question” [59].

At the end of the Congress of Italian Society of Anesthesiologist, in October1956, Prof. Piero Mazzoni, Secretary General, submitted to the Sovereign Pontiff, the following questions [60]

• Is there a general moral obligation to refuse analgesia and to accept physical pain in a spirit of faith?

• Is the deprivation of consciousness and of the use of higher faculties, caused by narcotics, compatible with the spirit of the Gospel?

• Is the use of narcotics licit for the dying or for patients in danger of death, supposing that there exists for that a clinical indication? Can one use them even if the attenuation of the pain is probably accompanied by a shortening of life?

His Holiness Pius XII was kind enough to treat the questions, from religious and moral points of view, on two separate occasions.He addressed the Italian Society of Anesthesiologists on February 24, 1957 and the Austrian Anesthesia Society on November 24, 1957 at an international assembly of 500 physicians and surgeons, as following [61,62]:

• The fundamental principles of anesthesiology, as science and art, and the end that it pursues, are not objectionable. They struggle with forces that, in many ways, produce harmful effects and block a greater good.

• The doctor, who accepts these methods, enters in contradiction neither with the natural moral order, nor with the specifically Christian ideal. He seeks, according to the order of the Creator (Gen. 1, 28), to subject pain to the capacity of man, and uses for that the acquisitions of science and technology, according to principles which We have stated and which will guide his decisions in particular cases.

• The patient desirous of avoiding or calming the pain can, without anxiety of conscience, use the means found by science and which, in themselves, are not immoral. Some particular circumstances can impose another line of conduct; but the duty of self-denial and interior purification, which falls to the Christian, is not an obstacle to the use of the anesthesia, because one can fill it by another way. The same rule also applies to the supererogatory exigencies of the Christian ideal.

The conclusion of the preceding considerations can thus be formulated as follows: within the indicated limits and if one observes the proper requirements, narcosis involving a decrease or a suppression of consciousness is allowed by the natural moral law, and is compatible with the spirit of the Gospel.

The conclusion of the preceding considerations can thus be formulated as follows: within the indicated limits and if one observes the proper requirements, narcosis involving a decrease or a suppression of consciousness is allowed by the natural moral law, and is compatible with the spirit of the Gospel.

In short, you ask Us: “is the suppression of pain and of the consciousness by the means of narcosis (when it is demanded by a medical indication), allowed by the religion and morals to the doctor and to the patient (even with death approaching, and with the knowledge that the use of narcosis will shorten life)?”. The answer will be: “If there are no other means and, if, in the given circumstances, that does not prevent the fulfillment of other religious and moral duties: Yes”

As we already explained, the ideal of Christian heroism does not impose, at least generally, the refusal of a justified narcosis, not even with the approach of death; all depends on the concrete circumstances. The more perfect and more heroic resolution can be as well in the acceptance as in the refusal.

“If circumstances lead me,I will find Where truth is hid, though it were hid indeed Within the centre”

(William Shakespeare —1564-1616 AD)

The successful application of, self-formulated, general anesthetic was first documented on October 13, 1804, by Dr. Seishū Hanaokain Wakayama, Japan, during a breast lumpectomy.It was unfortunate that the amazing news of this tremendous medical achievement could not cross the international borders because “the act of leaving or entering the country of Japan was punishable by death as “Sakoku”(literally “country in chains” or “lock up of country”) Law [28]. The tragic story of his wife’s blindness from “tsusensan” inspired a book and a movie, both entitled “The Doctor’s Wife”.

The embalm of The Japanese Society of Anesthesiology (JSA) features a flower of datura which is the same species of Datura that SeishūHanaoka had used for tsusensan. It was in 1954 (119 years after his death) that his achievement was presented at a meeting of International College of Surgeons, held in Chicago.His documents are still exhibited in the Hall of Honor there.However, neither he nor any of his admirers ever claimed his priority in discovery of anesthesia. He is, therefore, out of the contest of pride.

When the American Congress, in 1853, decided to offer a prize of a hundred thousand dollars to the discoverer of the anesthetic powers of ether, described as the earliest anesthetic, James Esdaile (1808-1859 AD),a notable surgeon and mesmerist, addressed to the Congress an indignant protest, not claiming the dollars, but denying that ether preceded mesmerism.His claim was based on his experience in British India, where he worked with East India Company for 20 years [63]. His assertion was not unfounded as may be evident from the following incident.On December 21, 1847, at the first successful etherization in University College Hospital London (described above), the surgeon Robert Liston addressed to the amazed crowd in the operation theatre:

“This Yankee Dodge,gentlemen beats mesmerism hollow”.

The term “Yankee Dodge” seems to be a nickname or expression coined to describe anesthesia. “Beat something hollow” means to be far better, compared to something else.The notable point is that the surgeon compared ether with mesmerism which was practiced widely in Europe and United States, in those days.

There had been a long debate as to who was the discoverer of surgical anesthesia, the four contestants being Horace Wells (1815 - 1848 AD), William T. G. Morton (1819 - 1868 AD), Charles Thomas Jackson (1805 - 1880 AD) and Crawford Williamson Long (1815 - 1878 AD). Although not involved in the early portions of the Ether Controversy, in 1849 Long reported that he had first administered sulfuric ether during a surgical procedure on March 30, 1842. Long may not have been as much involved in the Ether Controversy as the other claimants, but he is certainly a stakeholder of this historical conflict.

Each one of the three active contestants, had arguments in favor of priority. Since the present paper is intended to be historical rather than judicial, it is therefore, neither possible nor feasible to attempt to give verdict in favor of any of them. Interestingly, in Boston’s Public Garden stands a monument which is called “Ether Monument” or “The Good Samaritan”. At the base of the statue are inscriptions explaining the significance of the discovery of the use of ether as an anesthetic. There are four inscriptions, which include Biblical quotations from Isaiah 28:29 and Revelation 21:4:

“To commemorate that the inhaling of ether causes insensibility to pain. First proved to the world at the Massachusetts General Hospital in Boston, October A.D. MDCCCXLVI This also cometh forth from the Lord of Hosts which is wonderful and excellent in working. Isaiah. In gratitude for the relief of human suffering by the inhaling of ether a citizen of Boston has erected this monument A.D. MDCCCLXVII. Neither shall there be any more pain. Rev”

Notably, no name appears on the monument to give credit for the discovery. During the unveiling Mayor Nathaniel Bradstreet Shertleff, who was a Harvard medical graduate, refrained from mentioning any name, to memorialize the discoverer of anesthesia.

Consequent upon successful public demonstration on October 16, 1846, Morton and Jackson jointly got patented the compound (# 4848 for 14 years) as “Letheon” (Lethe-Greek Spirit of Forgetfulness and Oblivion) on November 12,1846.It was generally believed that “Jackson was the Head behind the Hands (Morton)” [64]. Professor Emeritus Henry Jacob Bigelow (1818-1890 AD) of Harvard Medical School, on November 18,1846, published a detailed account of the series of events giving credit of the discovery to both of them.This article, unintentionally, led to a vicious debate that became known as the “Ether Controversy” [65].

When Dr. Horace Wells (Morton’s former teacher and a partner) read this article and saw that Morton and Jackson were taking credit for the discovery, he wrote a rebuttal in the form of a letter dated December 9, 1846 to the Editor of the Hartford Courant. He claimed that it was he who had discovered the property of the compound, two years earlier. In an attempt to strength his assertion, he published a treatise “History of Discovery of Application of Nitrous Oxide – 1847”.Early In 1847, he sailed for Europe where he petitioned the Academy of Science, Academic Royals de Medicine and the Parisian Medical Society,all located in Paris, for his recognition in the discovery of anesthesia. To his misfortune, Wells’s efforts to get him have his due were unsuccessful, during his lifetime. He died unaware that just 12 days earlier, the “Parisian Medical Society” had recognized him as the inventor of anesthesia, made him an honorary member and awarded an honorary MD degree [66].

In a letter to Editor The New York Times,published on February 5,1862,Prof.CH Haywood of Massachusetts General Hospital gave Dr. Wells the credit of discovery saying: “To the spirit of Dr.Horace Wells belongs the honor of having given to suffering humanity the greatest boon it ever received from science” [67].In a Full Meeting of American Medical Association in June 1864, the resolution of American Dental Association that “Dr. Horace Wells, of Hartford,now deceased, belongs the credit and honor of introduction of anesthetics in the United States” was unanimously adopted. The Baltimore College of Dentistry awarded him an honorary doctorate, posthumously, on October 10, 1990. The ceremony was organized in Ether Dome,where he had made his first public demonstration of efficacy of nitrous oxide on January 20, 1845.

In the course of initial joint venture of Morton and Jackson, there was a dramatic twist that Morton demanded exclusive right of the discovery, throwing Jackson out of field.Both Wells and Jackson stepped to challenge him but untimely death of Wells,in 1848, halved the number of rivals and Morton came in a stronger position. Morton and Jackson entered into a protracted legal dispute in their attempts to validate either one’s claim and spent the next two decades fighting bitterly before the Congress.

The French Academy of Art and Science appointed a nine members Commission of eminent scientific and medical men to examine the evidence of the various claimants of the discovery.The decision was in favor of both Jackson (for his observations and experiments on the anesthetic effects of Ether) and Morton (for introducing this method in surgical practices).The verdict was conveyed to both the parties on May 17, 1852 and they gladly accepted the monetary award of francs 2,500 each [68].

The Committee of Inquiry appointed by Massachusetts General Hospital ruled that Morton, not Jackson, should be given the credit for painless surgery. He was also awarded a silver casket containing one thousand dollars, by the Trustees [69]. Moreover, his alma mater, University of Washington (later merged with College of Physicians and Surgeons Baltimore), awarded him honorary doctorate in 1852. The other honors, conferred upon him, were “Cross of Order of St.Vladimir-Russia” the Order of the Red Eagle by King of Prussia and “Cross of Order of Vasa-Norway and Sweden”. The King of Italy and the Sultan of Turkey also decorated him [70]. On July 6, 1868, while reading a column in “Atlantic Monthly”, in favor of Jackson,Morton being extremely agitated, suffered a stroke not to recover. He breathed his last on July 15, 1868, just after a week’s hospitalization.

On July 18,1854, Dr.Jackson recorded his protest to the Congress, against the bill provided for recompense of the discoverer of practical anesthesia.He added that the proposed bill would compel him, against his will,to abandon the scientific labors and enter in legal battle [71]. His protest and the legal battle could not get him what he thought of his due. In 1873, Jackson, one day, while walking through the cemetery saw the tomb of Morton, read the inscription and became extremely shocked. He was found raving at the stone and carried out to McLean Asylum where he remained, completely insane, for seven years until he breathed last on August 28, 1880. Wolfe and Patterson recognize Jackson as “one of the most talented scientists of his time”.In addition, they claim to prove beyond a shadow of doubt that “he was the hero and not the villain in all of these controversial and acrimonious affairs” [64].

The closing chapter of the story of Ether Controversy is disheartening. Wells,Morton and Jackson, all the three furious claimants of the honor of discovery, met tragic end,while at the ages of 33 years, 48 years and 75 years respectively.

Dr.Horace Wells committed suicide,on January 24,1848, while in a New York detention centre. When discovered, he was quite dead and, on the floor, there scattered papers containing series of events which led to the fatal act. The letters exhibit the state of his mind as: “If I were to go free tomorrow I could not live and be called a villain. God knows I am not………………what more still distresses me is the fact that my name is familiar to the whole scientific world as being connected with an important discovery……….O my dear wife and child whom I leave destitute of the means of support………O my God protect them…………..To Mr. Dwyer: Please to attend my burial and let me be interred here in the most secret manner possible” [72].

This was the dreadful end of a person who was described as having the mind of“uncommon restlessness, activity and intelligence”.Although, according to the medical report the cause of death was cutting the left femoral artery with razor, the true cause could have been described by one of the famous Rubaiyat of Omar Khayyam (1048-1131 AD), the Astronomer Poet of Persia , in “Shears of Fate” as:

Khayyam, who stitched the tents of science, Has fallen in grief's furnace and been suddenly burned; The shears of Fate have cut the tent ropes of his life, And the broker of Hope has sold him for nothing!' [His name means a tent maker.] (Translated into English byEdward FitzGerald)

The long lasting battle of pride and monetary gain impoverished Dr.Morton.His long suffering wife, Elizabeth Whitman Morton, who claimed to have allowed Morton to pour everything in the pursuit of his goal said “ ……………….The greatest personal tragedy in my husband’s life was his discovery of ether” [73].

The most distressing aspect, in her opinion, was “In spite of various efforts that were made during subsequent years to obtain recognition from United States Government of Dr.Morton’s services to the country and to the world, nothing was ever done”. She describes last moments story of Morton in St.Luke’s Hospital where he was shifted while unconsciousas: “The Chief Surgeons at a glance, recognized him as Dr. Morton (and after confirming from me) said to the surrounding group of pupils - “Young gentlemen! you see lying before you a man who has done more for humanity and for the relief of suffering than any man who has ever lived” [73].

Charles Dalton, President of the Massachusetts General Hospital, in his welcome address at “50th Anniversary of First Public Demonstration of Surgical Anesthesia on October 16, 1846 said “Of the infinite blessings which followed this the greatest gift of century to mankind is Surgical Anesthesia” [74]. Although, the fate of three “Giants in Medicine”, behind the discovery of anesthesia was mournful, could we (or should we) ever forget the good that has resulted from their untiring and dedicated struggle to relieve the sufferings of humanity?

The details of “Ether Controversy” are very saddening. Certain things were unfairly assumed to be factual, inferences having been drawn from preconceived notions, one-sided reasoning and discussion.At occasions, unethical, impolitic and even pungent remarks,aimed at character assassination, were used for either of the three active claimants.As may be truly gathered, all of them,at one stage or the other, were severely bruised by their folk men, to meet tragic ends. During their lifetime each one of them publiclyargued that he was not given his due. However, their grievances were redressed posthumously, by creating monuments in their honor. How fitting are the lines of an Urdu Poet:

My thankless folks held me all my life guilty However, on my death they declared me a hero (Urdu Poetry by. Ahmad Nadeem Qasmi—English Translation by Naeem Ameen)

Monuments related to the discovery of inhalation anesthesia were created in honor of the four active claimants to this discovery, by their supporters. Each monument avouches that the distinction for the discovery of surgical inhalation anesthesia belongs to the person it represents [75].

Dr. Horace Wells: The grave site of Horace Wells is equally famous for the relief artwork of the Wells Memorial.

Dr. Horace Wells - Cedar Hill Cemetery - Hartford, CT

Grave of a Famous Person

“HORACE WELLS 1815-1848 Discoverer of Anesthesia” The sides have statue of a woman with the inscription I SLEEP TO AWAKEN and I AWAKEN TO GLORY. The front has a relief sculpture of an angel delivering anesthesia to a patient with the inscription THERE SHALL BE NO PAIN.

Dr. William Morton: The citizens of Boston erected a monument over the grave of Morton in M. Auburn Cemetery, with following inscription written by Professor Bigelow:

William TG Morton Inventor and Revealer of Anesthetic Inhalation Before Whom, in All Time, Surgery was Agony By Whom Pain in Surgery Was Averted and Annulled Since Whom Science Has Control of Pain

Dr.Charles Jackson: The base of Jackson’s headstone includes a passage from Lord Byron’s (1788–1824) poem “Prometheus”:

Thy Godlike crime was to be kind, To render with thy precepts less The sum of human wretchedness, And strengthen man with his own mind.

Ortega et al have shared interesting explanation of the above philosophical lines. Prometheus who is said to have created man, in defiance of the gods, and provided the gift of fire, is considered to be benefactor of mankind, by many.He was a Byronic hero.These lines fit the personality of Jackson who freed the world from darkness of pain,through gift of anesthesia [ 75].

Crawford Williamson Long:Following monument was erected in Jefferson, Georgia by the Jefferson County Medical Society and Georgia Medical Association, on April 21,1910

In the memory of Dr. Crawford W. Long. The first discoverer of Anesthesia, the Great Benefactor of the human race. Born in Danielsville, Madison County, GA Nov 1, 1815. Died in Athens, Georgia June 16, 1878. Sulphuric Ether Anesthesia was discovered by Crawford W. Long March 30, 1842, at Jefferson, GA. Administered to James M. Venable for removal of a tumor. Given by Dr. Lamartine Griffin Hardman, in the name of his father and mother.

In 1864, consequent upon the introduction of legislation by Congressman Justin S Morrill (1810-1898 AD) allowing each stateto recognize two individuals to be memorized in Washington DC,Long was one of the two selected for Georgia.The statue was unveiled on March 30,1926.

The base of the statue reads:

Crawford W. Long, M.D. Discoverer of the use of sulphuric ether As an Anesthetic in surgery On March 30, 1842 At Jefferson Jackson County, Georgia, USA., “My profession is to me a ministry from God”— a sentiment that his “parishioners” must have thought described him best.

Divinum sedare dolorem

(It is Divine to alleviate pain) - Slogan of Royal College of Anaesthetists

The renowned Arab surgeon Ibn al Quff (1232-1286 AD), in the description of surgical anesthesia advocates: “Pain relief during surgery should be the responsibility of a second medical man other than the surgeon, performing the operation” [5]. This is the first known report in literature, on the role of anesthetist. He was the first to recognize anesthesia as an independent speciality. Unfortunately, it took almost 700 years for his dream to come true. Sir Ivan Whiteside Magill (1888-1986 AD) is well remembered for his remarkable contribution to academic anesthesia and its recognition as a Speciality through founding of the Association of Anaesthetists of Great Britain and Ireland, in 1932, by Dr.Henry Featherstone (1894-1967 AD).The first Diploma program in anesthesia (DA) was introduced in 1935, under the auspices of the Royal Society of Medicine.

Lord William Morris Nuffield (1877-1963 AD), justifiably called the “Benefactor of Anesthesia “has the credit to get established anesthesia as an academic subject and creating the first chair of Anesthesia in Britain, the British Commonwealth and Europe. Archibald Daniel Marston (1891-1962 AD) was the Founder Dean of the Faculty of Anaesthetists of the Royal College of Surgeons of England, having its first meeting on March 23, 1948. It was, however, in 1988 that the Faculty became the “College of Anaesthetists” within the Royal College of Surgeons of England.The granting of the ‘Royal’ accolade by Charter on March 16,1992developed an independent body responsible for “Educating, Training and Setting of Standards in Anesthesia in Britain”. It is important to mention Joseph Thomas Clover (1825-1882 AD) whose contribution has been acknowledged in the Royal College of Anaesthetists crest (besides John Snow) because of his dedication in training other practitioners,developing equipments and improving safety measures in induction of anesthesia.

March 30,1933 was a historic day that the first public salute was given to doctors by the ladies of Barrow County Medical Auxiliary in Winder Georgia.Later on, it became the national event, as Doctors’Day.The anesthesiologists feel a proprietary attachment to that event because it was March 30, 1842 that Dr.Long made the first successful public demonstration of etherisation, hailed as “America’s Greatest Gift to Mankind”.Secondly the national event started from Georgia, the place to which he belonged.The first National Anesthesia Day, organized by the Royal College of Anaesthetists, was held in Great Britain on May 25, 2000. On a global scale, the World Anesthesia Day takes place every year, on October 16 (originally named ‘Ether Day’).Itcommemorates William Morton’s first successful demonstration of ether anesthesia at the Massachusetts General Hospital,on October 16, 1846 [64]. Today, as a “Perioperative Physician”,the anesthesiologist has a very important role in fast -track surgery.

“The story of Surgical Anesthesia illustrates how long it takes an idea to become effective………..Before October 16,1846, surgical anesthesia did not exist-within a few months it became a worldwide procedure”.

Sir William Osler (1849-1919 AD)

The anguish of painful surgical procedures has been defeated. The long continued battle for “Pain-free Surgery”; extending over centuries, has been won. The horror of surgery is a closed chapter of the past as is evident from the words uttered by Edward H Clark: “It is impossible to estimate or form any adequate conception of the amount of human suffering which anesthetics have relieved or prevented” [76] .The cry made by Sir JamesSimpson “Can nothing be done to prevent this suffering (of the patients subjected to barbarous surgery)………..A patient preparing for an operation was like a condemned criminal preparing for execution” has met the fruit of success.Professor John Collin Warren’s communication to the Board of Trustees of Massachusetts General Hospital, in 1848, embodies the matured results of his own experience “Who could have imagined that drawing the knife over the delicate skin of the face might produce a sensation of unmixed delight! - that the turning and twisting the instruments in the most sensitive bladder might be accompanied by a beautiful dream.” [4,77].

Today, once the patient in operation theatre is asleep, the anesthetist repeats the historical words, first spoken by Morton on October 16, 1846:“Your patient is ready,Sir”

Enjoying the comforting, dense shade, Shall oblivious generations ever reckon, That those who’d planted these trees, Melted away in the scorching sun? (Urdu Poetry of Saleem Kausar - English Translation by Naeem Ameen)

The fitting closing of this tale would be a question raised by Professor Bigelow: “No one will deny that he who benefits the world should receive from it an equivalent. The only question is, of what nature the equivalent be?” [78]. The authors of this article leave the answers with the readers.

Dr.Murad Ahmad Khan (Vancouver, Canada) and Dr. Hamza Iltaf Malik (Coventry, United Kingdom) deserve special thanks for their kind motivation and stimulating discussions throughout the conduct of study.