The world before anesthesia was brutal — surgeons inflicted torture on largely conscious patients, hoping to finish an operation as quickly as possible. But all of that changed with the introduction of inhaled ether. This episode covers the context behind the discovery of etherization, with myths about screaming medicinal plants, a “missing recipe” of medieval general anesthesia, 19th century recreational drug use, and a controversy carved in granite.

Sources:

1. Brown, M. The Palgrave Handbook of the History of Surgery. 327–348 (2017). doi:10.1057/978-1-349-95260-1_16
2. Dorrington, K. & Poole, W. The first intravenous anaesthetic: how well was it managed and its potential realized? Bja Br J Anaesth 110, 7–12 (2013).
3. Robinson, D. H. & Toledo, A. H. Historical Development of Modern Anesthesia. J Invest Surg 25, 141–149 (2012).
4. Chidiac, E. J., Kaddoum, R. N. & Fuleihan, S. F. Mandragora. Anesthesia Analgesia 115, 1437–1441 (2012).
5. Vargas, I. Ether Frolic: The Day Pain Stopped. Bulletin Anesthesia Hist 28, 53–56 (2010).
6. Whalen, F. X., Bacon, D. R. & Smith, H. M. Inhaled anesthetics: an historical overview. Best Pract Res Clin Anaesthesiol 19, 323–330 (2005).
7. Prioreschi, P. Medieval anesthesia – the spongia somnifera. Med Hypotheses 61, 213–219 (2003).
8. Stallings, S. & Montagne, M. A chronicle of anesthesia discovery in New England. Pharm Hist 35, 77–80 (1993).
9. Litoff, J. & Pernick, M. S. A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth-Century America. Am Hist Rev 91, 176 (1986).
10. Leake, C. D. Letheon: The Cadenced Story of Anesthesia. Science 199, 857–860 (1978).
11. CRAWFORD W. LONG (1815-1878) DISCOVERER OF ETHER FOR ANESTHESIA. Jama 194, 1008–1009 (1965).
12. Riches, E. Samuel Pepys and His Stones. J Urology 118, 148–151 (1977).
13. CWRIGHT, F. The early history of ether. Anaesthesia 15, 67–69 (1960).
14. Insensibility during Surgical Operations Produced by Inhalation. New Engl J Medicine 35, 379–382 (1846).
15. SURGICAL HUMBUG. Lancet 5, 646–647 (1826).

Locations in Boston:

• Ether Monument (https://www.atlasobscura.com/places/ether-monument)
• Ether Dome (https://www.atlasobscura.com/places/ether-dome?utm_source=atlas-forum&utm_medium=referral)
• Warren Anatomic Museum (https://www.atlasobscura.com/places/warren-anatomical-museum)

Transcript

 This is Adam Rodman, and you’re listening to Bedside Rounds, a monthly podcast on the weird, wonderful, and intensely human stories that have shaped modern medicine, brought to you in partnership with the American College of Physicians. This episode is called the Ether Dome. On October 16th, 1846, a group of Boston surgical luminaries gathered in the Bullfinch surgical amphitheater at the Massachusetts General Hospital to witness a thousands-year-old dream finally realized — the first publicized demonstration of anesthesia, erasing the pain from surgery, and changing medical care forever. This episode is about that day — and about deadly, screaming medical herbs, a “missing recipe” of a medieval general anesthesia, 19th century recreational drug use, and a “controversy carved in granite.”

But first I want us to briefly visit the pre-anesthesia world. Surgery prior to the advent of anesthesia was, in a word, gruesome. Surgeons — who prior to the 18th century or so in Europe would often be lay barber-surgeons — inflicted torture on largely conscious patients. Time was the enemy; the most sought after surgeons were as quick as possible.  Take Robert Liston, the famous “fastest knife in the West end”. He was able to amputate limbs — complete with ligature — in under a minute. The historian Richard Gordon reports that Liston’s speed brought a considerable survival advantage — he had a mortality rate of only about 10 percent, far lower than the nearly 25% who died at nearby Guy’s hospital. But you can imagine this speed could have negative consequences; Gordon reports a particularly dramatic (and very likely apocryphal) example is his book. During an amputation of a leg, the patient later died of gangrene, as did Liston’s surgical assistant who accidentally had his fingers amputated by Liston’s blade, and a spectator whose coat was slashed, who died from fright — a 300% mortality rate. 

It was terrible for the patients clearly, but surgery took an emotional toll on the surgeons too. Asa Fitch, a young surgeon at Rutgers, kept a detailed journal of his journey to becoming a surgeon. 

“But, oh, how my feelings recoiled at the sight! To behold the keen shining knife drawn around the leg severing the integu- ments, while the unhappy subject of the operation uttered the most heart rending screams in his agony and torment, … to hear the saw working its way through the bone, produced an impression I can never forget.”

But just a few weeks later, he witnessed a “most tedious and painful operation” on a young child. “I had none of the tenderness which I have always felt before on such occasions.” 

I’m describing amputations, and that’s not even the worst surgeries. There’s a reason that the Hippocratic Oath demands that, “I will not cut for stone, even for patients in whom the disease is manifested,” because the removal of bladder stones might be one of the most fraught and dangerous procedures possible in this pre-anesthesia era. So I actually want to warn listeners here — the next several minutes are going to have some gruesome, though clinical, descriptions of urological surgery. If that’s not something you want to listen to, fast forward. I also want to make another note — I am occasionally terrible at pronouncing names. One of the reasons is that many of the names of famous doctors have already been pre-mangled in my medical education — Laennec, not Laennec, Koch not Koch, and Dupuytren, not Dupuytren. But in the last episode, as many of you pointed out, I mangled the name of Samuel Pepys, a name that should be, at least, theoretically in my language. So to redeem myself, I’m going to tell the story of Samuel Pepys’ bladder stone and the operation to remove it. 

A caveat here — Pepys started his famous diary at the age of 27, and his surgery was performed at the age of 25, so all of these descriptions are made with the benefit of hindsight. Kidney stones, of course, suck even in the 21st century. They’re incredibly painful; the spasms that can happen when a stone gets impacted in the ureter have been described as similar to childbirth. And today we have a variety of ways to treat them — medications, ultrasonic beams, thin scopes to place stents and physically remove the stones, or even zap them with lasers. But without all these fancy techniques to remove stones, especially from the bladder, they could get big. Like, really big. I’ll post some pictures of Victorian bladder stones to Twitter if you’re interested.

Anyway, Pepys grew up in East Anglia, which until the early 20th century had an epidemic of both kidney and bladder stones. Contemporaneous doctors didn’t truly had an idea of why this happened — perhaps it was the northeasterly wind from over the sea, the high chalk content in the soil, or the barley beer. Most likely it was diet — relatively high in oxalate, and relatively low in calcium. Apparently East Anglians didn’t drink a lot of milk, and as the region became wealthier with a more varied diet in the early 20th century, stone incidence fall precipitously. In any event, Pepys was very familiar with stones even before his first symptoms — his mother, brother, and aunt all had either kidney or bladder stones during his childhood.

When Pepys was a young man of 20, he went for a stroll through Cambridge on a hot summer day. Prior to returning home he drank a large volume of water from a local well. That evening he became violently ill. He initially assumed it was from the well water, but soon he had the telltale signs of the stone — spasms of pain through his left groin and flank followed by bloody urine. After a few days the symptoms abated, but over the next five years they occured again and again, become more and more debilitating. Eventually, a stone formed in his bladder and would not pass. Pepys would later recall, “I remember not my life without the pain of the stone in the kidneys, even to the making of bloody water upon extraordinary motion”.

His life a living hell, Pepys decided to have his stone removed. He chose the lithotomist Thomas Hollyer, probably the most prominent stone remover in London at the time. The last year he had cut 40 patients, all of whom survived. Of course, after this, the next four died of gangrene, a stark reminder of the risks of any surgery in a pre-germ theory world. Prior to his surgery, he prepared his body with purgatives, laxatives, and bloodletting to best balance his humors. On March 26th, 1658, he met Hollyer at his cousin’s house. He stripped to his waist, then inhaled a supposedly anesthetic substance from a sea sponge. He was placed on a table in what is still today called the lithotomy position — his buttocks raised slightly off the table, and his legs flexed. Differing from today, however, he was held in position by four strong men, and his hands were tightly bound to his legs, lest he interfere with the surgery. 

I can’t really bring myself to describe the procedure — the Marian operation — so I’m just going to quote from a urologist who described what would have happened during Hollyer’s operation:

““A curved probe or bougie with a slit on its left side was thrust through the urethra and into the bladder. The scrotum was lifted by an assistant to, leave the left side of the perineum exposed. A cut was made on to the slit in the probe, no larger than the thumb, avoiding the seam of the perineum and the anal orifice. The gorget was inserted into the opened urethra and the channel kept open with the pair of conductors or guiders. The staff was withdrawn. The voracious and vociferous crows-beak or duckbill forceps were passed into the bladder to search for the stone. If the opening was too small Pare’s dilator was inserted and opened until the forceps with the stone could be withdrawn. It was examined for cracks or facets; any blood clot or fragments were removed and no pieces left behind.“

A stone approximately the size of a tennis ball was removed through this hole in Pepys’ perineum, which he carried around with him in a special case for the rest of his life. Remarkably, Pepys survived more or less no worse the wear. Historians have suggested this was because he was the first operation of the day — Hollyer’s tools were therefore clean and not contaminated by another patient.

The whole thing must have been hell, though later in life Pepys was clearly very thankful for the surgery. Could anything have made it less terrible? So let’s talk for a little bit about  ancient anesthesia. What was on that sponge that Hollyer gave to Pepys? 

Analgesia, of course, is actually ancient. The milk of the poppy — opium — has been known since at least the Egyptians. But that doesn’t mean they could be used to make surgery bearable. As pretty much any doctor today will tell you, opiates alone make pretty poor anesthesia without an airway. The doses necessary to cause anesthesia will also cause severe respiratory depression, and not breathing is a pretty quick way to die. So the preferred medicinal plant of the ancient world for anesthesia was mandragora — mandrake. Mandrake was held in such high esteem that is harvest was couched in superstition. It was thought that the plant would scream when dug up and kill all those that heard it. The historian Flavius Josephus described the purported method of harvesting the plant: 

“They dig a trench quite round about it, till the hidden part of the root be very small; they then tie a dog to it and when the dog tries hard to follow him that tied him, this root is easily plucked up, but the dog dies immediately as if it were instead of the man that would take the plant away.”

Man’s best friend indeed. And I should mention that this association has lasted until the 21st century — mandrake plays a part in the Harry Potter films (it was also associated with witchcraft), and perhaps more, well, odd, the Pokemon Oddish is essentially a mandrake, screaming when you dig him up. 

In any event, mandrake mixed with wine was used throughout the ancient world both for sleep and for analgesia. Celsus would give mandrake and opium mixed with wine prior to lancing abscesses or extracting teeth. And from a 21st century pharmacologic perspective, this makes a certain amount of sense. Mandrake contains both atropine and scopolamine, antimuscarinics that act as central nervous system depressants at high doses.

By the medieval era, first in the Arab world, then in Europe, we start to hear about anesthesia. Al-Razi, known in the West as Rhazes, recommended Al Murquid, the sleep medicine, before surgery — ingestion of a mixture of mandrake, opium, cannabis, and henbane. But the sponge that Pepys inhaled — the spongia somnifera, or sleeping sponge, first pops up in the Bamberg Antidotary, dated in the 9-10C CE, as a simple recipe:  

“Helpful hypnotic, that is soporific, compound for he who is going to undergo surgery. Sleeping patients will not feel the pain. Take: Opium oz. I Juice of the leaves of mandrake oz. 8 Hemlock green juice Henbane [hyosciamus] juice oz. 3 Put everything in a sufficient amount of water to make a potion. The potion is to be put on a dry sponge which will then be allowed to dry. When it is needed the same sponge is put for an hour in warm water, then under the nostrils of the patient. He will fall asleep as it were to steal his spirit. When one wants to wake him up, another sponge soaked in warm vinegar is put under his nostrils.”

There are a number of other references from this period, including a famous one from Ibn Sina, Avicenna, all with similar ingredients — and always including opium, mandrake, and henbane. The spongia somnifera also makes prominent appearances in pop culture. Shakespeare includes it in multiple plays, including Anthony and Cleopatra and Othello, where Iago exclaims, “Not poppy, nor mandragora, Nor all the drowsy syrups of the world, Shall ever medicine thee to that sweet sleep Which thou owed’st yesterday.”

But here’s the thing — basically shortly after Pepys’ surgery, the spongia somnifera disappeared. Like, doctors entirely stopped using it. Why? Did physicians essentially throw away effective medieval anesthesia? Are we so arrogant to believe in the idea of medical progress? This has certainly been what some historians have argued. 

But the most likely answer is probably a bit mundane. It probably never really worked, at least not for anesthesia. The historian Prioreschi has published a great paper that goes over all the historical sources for the spongia somnifera, some modern experiments, and performs a pretty good take down on the arguments for medieval anesthesia; I’ll have the paper in the show notes if you’re interested. So first of all, while the active ingredients — opium, atropine, and scopolamine could all certainly cause drowsiness, at anesthesia doses they cause respiratory depression. And pharmacokinetically, inhaling those substances would produce far too small a dose to have any read effect. Plus, the antidote in inhaling vinegar, which clearly is not an antidote for any of those substances. Furthermore, in sources where actual surgeons are writing, most notably Guy de Cualiac, the writers speak about the spongia somnifera with skepticism — he’s heard of it, but never used it in any of his thousands of surgeries. And in fact, illuminated manuscripts and illustrations of medieval surgery shows completely awake patients, often being held down. Take the example of Pepys again. He was given the sponge — but was awake, bound, and held down for the entire surgery. Instead, Prioreschi argues, the prominence of the spongia somnifera for about 500 years speaks more to the hope of surgeons that effect anesthesia truly existed.

In any event, by the early 19th century this dream would come close to realization. And it would come from one of the least likely places you might imagine — recreational drug use. 

In order to talk about anesthesia, we need to talk about ether. Even today the word has an almost magical connotation — the wispy nothingness that surrounds all being. And as you can imagine, there’s been a movement to place its invention in the deep past. Diethyl ether, or sulphuric ether, has been attributed to Jabir ibn Hayyam, or Geber to the West, the Islamic scholar who is known as the father of chemistry. Ibn Hayyan did, in fact, describe vitriol, or sulfuric acid. It has also been attributed to Raymond Lully, a 13th century alchemist, as well as Paracelsus and his student Valerius Cordus, alchemist-cum-physicians. They certainly did create a substance out of the vapors of alcohol and sulfuric acid that contained ether — but was mostly plain old alcohol. It was noted to have sleeping properties — in particular, when added to the feed of chickens, it put them to sleep. This medication became quite widely used orally. I have a fascinating textbook on the materia medica from 1861. Hoffman’s anodyne, or spirit of ether, was used in tetanic wound infections, to relieve migraine headaches, treat asthma, relieve biliary colic, as an antidote to mushroom poisoning — but its most impressive effect was the treatment of hysteria. Hoffman’s anodyne persisted well into the 20th century. Haynes reports having patients in rural Canada using it in very much the same was Paracelsus used it in the 1960s. 

Pure ether was invented during the dawn of chemistry in the 1730s by Wilhelm Godefroy Froben, and he gave the drug its name. Ether means “the upper air,” but also to burn brilliantly — and Froben chose the name, quite appropriately, because ether was incredibly volatile. It boiled near body temperature, and by the 1790s, physicians were starting to use ether vapors to treat chest diseases, asthma in particular, which probably worked since it is an antispasmodic. An effective solvent, it became essential for the burgeoning field of chemistry. It also became essential for recreational drug use. Drinking ether apparently causes a sort of euphoria of dulled senses. Oliver Wendell Holmes described his experience with the drug:

“The mighty music of the triumphal march into nothingness reverberated through my brain, and filled me with a sense of infinite possibilities, which made me an archangel for the moment. The veil of eternity was lifted. The one great truth which underlies all human experience, and is the key to all the mysteries that philosophy has sought in vain to solve, flashed upon me in a sudden revelation. Henceforth all was clear: a few words had lifted my intelligence to the level of the knowledge of the cherubim.”

If there is a universal truth to humanity, it’s that we love to get high. Before its sale was largely banned in the 1930s, different mixtures of ether became popular across the world. In Poland, it was mixed with coffee or juice. In Ireland, “Dr Kelley’s Remedy” started as a treatment for alcoholism, but soon became just as popular. Among the upper classes in England — think Downton Abbey — the go-to beverage was a half a strawberry, impregnated with several drops of ether and dropped into champagne. 

Ether as a recreational drug never caught on much in the United States — except in the South, where there was already a strong tradition of distilling your own liquor, essentially moonshine. By the 1830s, it was common for university educated southern gentlemen to attend “frolics” where ether and the newly discovered nitrous oxide gas would be consumed or inhaled for fun. And it was at one of these “Ether Frolics” that a 26 year-old Georgian physician named Crawford Long would make history. Fortunately, Long has recorded the experience that inspired him:

“In the month of December 1841 or January 1842, the subject of the inhalation of nitrous oxide gas was introduced in a company of young men assembled at night in this village (Jefferson) and several persons present desired me to prepare some for their use. I informed them that I had no apparatus for preparing or preserving the gas, but that I had a medicine (sulphuric ether) which would produce equally exhilarating effects that I had inhaled it myself, and considered it as safe as the nitrous oxide gas. One of the company stated that he had inhaled ether while at school, and was then willing to inhale it. They were anxious to witness its effects. The ether was introduced: I gave it first to the gentleman who had previously inhaled it, then inhaled it myself, and afterwards gave it to all persons present. They were so much pleased with the exhilarating effects of ether, that they afterwards inhaled it frequently, and induced others to do so, and its inhalation soon became quite fashionable in this country, and in fact extended from this place through several counties in this part of Georgia.”

After this particular Frolic, Long had a realization:

“On numerous occasions I have inhaled ether for its exhilarating properties and would frequently, at some short time subsequent to its inhalation, discover bruised or painful spots on my person, which I had no recollection of causing, and which I felt satisfied were received while under the influence of ether. I noticed my friends, while etherized, received falls and blows which I believed were sufficient to produce pain on a person not in a state of anesthesia, and on questioning them, they uniformly assured me that they did not feel the least pain from these accidents.”

Long had an idea. He had a friend named James M Venable, who had often complained of two fatty tumors — probably lipomas — on the back of his neck. Long had recommended having them cut out, but Venable very reasonably was worried about the extreme pain this procedure would entail. But Venable had attended ether frolics with his friend, and therefore was willing to give “etherization a try”. So on March 30th 1842, Long soaked a towel in ether, placed in over his friend’s face, and “extirpated” the tumor. When Venable woke up, he refused to believe that the surgery had actually happened — until he saw the tumors in Long’s hand. 

Effective surgical anesthesia had just been discovered. But while Long held local demonstrations, he would not widely publicize his findings for another seven years, and in the meantime got beaten to the punch by a group of Boston dentists. In Boston, a young dentist named William Morton was becoming frustrated at the lack of acceptable analgesia in his practice. In particular, he had a new, effective method of fitting dentures — but it was apparently quite painful. Morton figured that if he could dull the pain, business would take off. Morton’s first thought was actually what we use today,and what Long’s Georgian friends had originally wanted him to procure — nitrous oxide. But he was quickly scared off of this approach by the experience of his fellow dentist and friend Horace Wells. 

Nitrous oxide started to become popular about the same time as ether. Wells had first encountered the gas in a public demonstration in Hartford; these public demonstrations were popular in the 1840s, and, if you’re noticing a major theme, a great chance to get high. But Wells, like Long, was inspired by the fact that those under the gas’ effect seemed to feel no pain. The next day, in a fit of chutzpah, he inhaled the gas himself, and had a colleague remove one of his teeth. He felt no pain, and Wells started to use nitrous oxide on his patients. Wells actually approached Morton about giving a public demonstration at the Massachusetts General Hospital on January 20, 1845. The original patient to have his tooth extracted got cold feet, so a medical student volunteered and was given nitrous oxide. During the extraction, however, he cried out in pain; later, he admitted that he did not remember crying out, nor the surgery itself, but no matter. Wells was jeered out of the auditorium. His dental practice collapsed, he became addicted to chloroform, and by the age of 33, he had killed himself in jail after trying to douse two prostitutes with sulfuric acid. 

So back to Morton. As you can imagine, he quickly decided to forgo nitrous oxide, and he approached the Harvard pharmacist Chales Thomas Jackson for advice on what else he could use. Jackson was aware of ether frolics — though it’s controversial as to whether he was aware of Long’s work — and he recommended trying the substance. Morton started experimenting in the traditional manner with his patients — applying small amounts of ether to the teeth and gums, but that had no strong effect. He had to try inhalation. He started experimenting on his pet cocker spaniel, and had good effect anesthetizing the dog. That is, until his wife walked in on him with a towel over his mouth. After that he moved his experiments to his dental assistants. Morton’s first patient to be etherized was Even Frost. Like Long’s first patient, he refused to believe the procedure was over, until he saw his extracted tooth sitting beside him. With this reputation, Morton’s practice grew, and he started to become quite wealthy. It was time to perform a public demonstration. 

Morton discussed with Henry Bigelow, prominent both as a surgeon at MGH, and as a medical writer to the entire country, who connected him to Dr. Warren, the Chief of Surgery of Mass Gen. Warren reportedly told Morton, “Ever since I performed my first operation, I have been longing for some such means as you describe. I will let you know when I have a suitable case.”

Warren had a suitable case within days — Gilbert Abbott, a young man with a vascular tumor in his neck. On October 16th, 1846, the amphitheater again filled up with prominent surgeons from around Boston, as well as Harvard Medical Students. Morton was actually late to his own case. Instead of simply using a towel soaked in ether, as he had in the past, he would be demonstrating a new type of inhaler, now called a Morton inhaler. It consisted of a glass bulb containing a sea sponge soaked with ether. A mouthpiece on one side allowed the patient to inhale; an intake hole on the other allowed for free flow of air. And a note about the ether — Morton and Jackson knew they had something big on their hands, so they attempted to hide it. Ether, after all, was in wide use, if not yet for anesthesia. They called their substance letheon, named for the mythical river of forgetfulness, and apparently instilled perfume in it, hoping to disguise its true nature. 

The story of “Ether Day” has been considerably embellished over time. My description here is based on two primary sources — the publication by Henry Bigelow, who later published the account in the Boston Medical and Surgical Journal, the precursor to NEJM, and Warren, the surgeon’s journal. Abbott breathed in through the mouthpiece. His face became flushed, and he fell asleep.

Bigelow wrote, “during the operation the patient muttered, as in a semi-conscious state; and afterwards stated that the pain was considerable, though mitigated; in his own words, as though the skin had been scratched with a hoe.”

The story has often been promoted as an unmitigated success, but Bigelow’s account is probably right, since Warren does not brag of a great success, only saying that he is “intrigued.” The next day, etherization was repeated with a higher dose on a woman with a large lipoma in her shoulder. This, however, was a complete success — while she looked uncomfortable during the procedure, after it was all done, she stated she hadn’t felt anything; if she looked uncomfortable it was because she had left her child at home. 

I should add that Morton and Jackson’s attempt to disguise letheon clearly fooled no one. Ether had quite a distinct smell. Bigelow should know; he wrote, “In my own former experience the exhiliration has been quite great, though perhaps less pleasure than that of nitrous oxide, or the Egyptian hashish.” Like I said, if there’s a universal in human history, it’s that people love drugs.

By December of 1847, etherization was being performed in London, Paris, and Philadelphia. Liston, the fastest surgeon in London quickly adopted the drug. He reportedly said, “This Yankee dodge beats mesmerism hollow.” Within two years, ether, and then nitrous oxide, had largely spread across the world. The age of anesthesia had begun. The word anesthesia, by the way, was coined again by Oliver Wendell Holmes. Other terms he had proposed — antineurotic, aneuric, neuroleptic, neurolepsia, and neurostasis, but anesthesia — Greek for without sensation — was the catchiest. 

At this point, it’s more or less indisputable that Crawford Long discovered etherization — he demonstrated it in his clinic for prominent surgeons throughout Georgia, and in 1849, when he formally published his results and defended his legacy, he included almost a dozen signed affidavits by prominent community members saying that had witnessed his innovation. In fact, the Southern Medical Journal itself states that the “reputation of a gentleman” is enough for them — but goes on to publish them anyway. So why did he wait? In a word, the mesmerism that Liston had mentioned. So if you’ll recall from episode 41, Animal Magnetism, mesmerism was a treatment invented by Franz Mesmer in the late 18th century that involved essentially ritualized hypnosis theoretically through magnetism. Despite Mesmer himself being discredited, mesmerism itself enjoyed a resurgence in England and the United States in the early 19th century, and was even used in surgery. Long pointed out that there were people “high in authority” who advocated mesmerism. Long himself thought mesmerism was due to the placebo effect — “strong imagination and weak minds,” as he called it, and he wanted to do a number of experiments to prove that ether was no placebo. He performed two such rather horrible experiments. The first was a woman with three tumors. In the first operation, he used no ether and she “suffered terribly.” In the second, he did, with great effects. In the second case, a slave required two fingers to be amputated. For the first, no ether was used — and for the second, he was etherized. The results, as you imagine, speak for themselves.

All of this debate on who discovered etherization would soon reach a fever pitch, as Morton attempted, and failed, to patent “letheon”. The “Ether Controversy” was fought out in the medical world, in the press, and even in the halls of Congress. There was a huge outcry from the medical community, who was scandalized that Morton would attempt to patent such a medically important — and common — substance such as ether. So after his patent attempt failed, Morton petitioned Congress for an award of 100,000 dollars — a huge sum in 1849 — to reward him for his work on conquering pain. He would never get complete recognition. The Paris Academy awarded both Jackson and Morton a joint prize for discovery, which Morton then refused since he felt he alone was owed it. Morton’s attempts to profit from his discovery were looked down upon in his own time as well.  After a group of wealthy Bostonians collected money to build a monument to ether in the Public Garden, Mark Twain viciously weighed in: “there in Boston is a monument to the man who … stole the discovery from another man … the monument is made of hardy material, but the lie it tells will outlast it a million years.” Morton would die penniless in 1868, still feeling he had never been given proper compensation for his demonstration of ether.

I very conveniently live in Boston, so last week, before I got to work to round on the wards, I biked up to the Public Garden to take a look at the monument to ether and man’s conquest over pain.

I understand why the city of Boston, in the 1860s, just coming off the horrors of the Civil War, decided to erect a monument to the first public demonstration of ether. The imagery on the monument starts with the explicitly religious, going to classical medicine, then what was then modern medicine — an amputation during the civil war — finally to the triumph of science over pain. In a way, the monument feels antiquated — I’ve been to the Public Garden countless times, and I don’t think I’ve ever really stopped to look at it. It’s 40 feet tall, with columns and a fountain, and is by far the oldest statue in the garden. Make Way for Ducklings, on the other side of the park, gets far more visitors. But it also feels old because ether truly did change our relationship with pain. Guidebooks talk about the monument almost tounge-in-cheek — isn’t it quaint to have a monument to a pharmaceutical? But that’s why I can’t really agree with Mark Twain. Despite the drama and controversies surrounding ether’s discovery, despite the exaggerated stories, the recreational drug use, the questionable ethics behind some of the first ether experiments, the world really did change that day in the Ether Dome.

That’s it for the show! But hold on, because I have Liam Conway-Pearson, one of the talented medical students who helps write Tweetorials for the Bedside Rounds Twitter account, to talk about one of the subjects that I’m asked about the most — the Plague of Justinian!

TEXT GOES HERE

And that’s really it for the show! You can read Liam’s thread on the Twitter account @BedsideRounds, as well as all the amazing histmed Tweetorials by the team. I’ll retweet it myself as well.

If you’re in Boston, all the places in this story are open to the public — I’ll have links in the shownotes if you want to visit. The Ether Monument is in the Public Garden, the Ether Dome is at MGH, and if you visit the Countway Library of Harvard Medical School in my part of town, you can see the painting of Ether Day, as well as Morton’s inhalers and other ether ephemera. The Countway’s Center for the History of Medicine and Warren Anatomical Museum is an amazing visit as well.

You can get CME/MOC credit just for listening if you are an ACP member. Go to www.acponline.org/BedsideRounds. All of the episodes are online at www.bedsiderounds.org, or on Apple Podcasts, Spotify, Google Podcasts, or the podcast retrieval method of your choice. I’m also on facebook at /BedsideRounds. The Bedside Rounds Twitter account is @BedsideRounds. And I’m personally @AdamRodmanMD, where I like to tweet about medical history, high-value care, and generally other nerdy internal medicine things. Come say hi!

All of the sources are in the show notes. And finally, while I am actually a doctor and I don’t just play one on the internet, this podcast is intended to be purely for entertainment and informational purposes, and should not be construed as medical advice. If you have any medical concerns, please see your primary care provider.