Tuesday, May 26, 2015

The Ether Dome: Guest Post by Sarah Alger

Following is a fascinating guest post about "The Ether Dome" and the world of pre-anesthesia surgery by Sarah Alger, director of the Paul S. Russell, MD Museum of Medical History and Innovation at Massachusetts General Hospital. You can follow her on Twitter at @slodoena.
“The horror of great darkness, and the sense of desertion by God and man, bordering close on despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so ... I still recall with unwelcome vividness the spreading out of the instruments, the twisting of the tourniquet, the first incision, the fingering of the sawed bone, the sponge pressed on the flap, the tying of the blood-vessels, the stitching of the skin, the bloody dismembered limb lying on the floor.”
Such was surgery before anesthesia, as described by George Wilson, who underwent an ankle amputation in 1843. 
When Massachusetts General Hospital in Boston was designed in the early 1800s, its operating theater was placed under a dome at the top of the building both to admit natural light through skylights and windows and to allow surgical patients’ screams to drift up and out of earshot of patients in the wards below. 
Not only was surgery a horror for the patient, it was also a trial for the surgeon. Contending with a conscious, writhing patient, surgeons were forced to be swift. Head surgeon and hospital co-founder John Collins Warren could reputedly amputate a limb in 40 seconds. 
While Warren was wrestling with his patients, about 100 miles away in Hartford, Conn., a dentist named Horace Wells attended a demonstration in which volunteers were given nitrous oxide—laughing gas—to get silly for the audience’s amusement. The gas seemed to dull pain in these volunteers, he observed, so he wondered: Could it help his dental patients? After a dozen successful painless tooth extractions in his practice (including on himself), he persuaded Harvard Medical School to allow him to demonstrate before a crowd. Yet his patient did claim to feel pain, perhaps because of inadequate dosage, and Wells was subjected to cries of “Humbug!” Wells slunk back to Hartford, discouraged. Yet his young apprentice, William T.G. Morton, picked up the research where Wells left off, befriending a Harvard chemist named Charles Jackson, who suggested that Morton experiment with sulfuric ether. (Ether, like nitrous oxide, was used as a party drug in so-called “ether frolics”.) Jackson appeared to know that ether could be useful in surgery, but for reasons lost to history, never acted on that knowledge. After successfully experimenting on family pets, himself and his dental patients, he lobbied to demonstrate on a surgical patient at Mass General. 
On the morning of October 16, 1846, a 21-year-old printer named Gilbert Abbott was brought into the operating theater. Warren, who was to operate on a vascular malformation on Abbott’s neck, and the assembled crowd in the tiered seats above waited for Morton to arrive. Finally, half an hour late, Morton arrived toting a glass inhaler he had commissioned for the demonstration. Warren, with impatience, stated: “Sir, your patient.” Morton used the inhaler to administer the gas, and when it appeared that Abbott had dropped off, he replied to Warren: “Sir, your patient.” Warren performed the surgery without incident, and the assembly waited for Abbott to awaken. When he did, he was asked: Did he feel any pain? “Has the procedure begun yet?” he responded, for he had felt only a dull scratching. At this Warren turned to the crowd and intoned: “Gentlemen, this is no humbug.” (For a 1936 silent reenactment of the event, starring contemporary Mass General staff in fake sideburns, click here.) 
Just a month later, Mass General surgeon Henry Jacob Bigelow published a paper in the Boston Medical and Surgical Journal about the demonstration, and from there the word spread. In Paris, the first operation using ether occurred December 15; in London, December 21. By 1847 the news had carried worldwide. Meanwhile, in Boston, dentist Nathan Cooley Keep became the first to administer ether for obstetrics—to poet Henry Wadsworth Longfellow’s wife Fanny. “I am very sorry you all thought me so rash and naughty in trying the ether,” she wrote to her family. “I feel proud to be the pioneer to less suffering for poor, weak womankind.” It wasn’t just her family who had feared for her—it took a while for her to find someone who would administer ether. The embrace of anesthesia was not universal—physicians and the public alike had their qualms. Little was known about dosage, so the risk of death from anesthesia did exist, as did worries about ether’s flammability. Moreover, religious objections abounded—pain, not least in childbirth, was viewed as God’s will. Robert Liston, before performing that first surgery under ether in London, deemed ether a “Yankee dodge.” Yet upon witnessing how well it worked, he said: “This Yankee dodge beats mesmerism [a previous medical fad] hollow.” 
In 1853, Queen Victoria was administered chloroform at the birth of Prince Leopold, further legitimizing anesthesia’s use in obstetrics, and in the United States, the battlefield injuries of the Civil War sped its adoption. 
Yet as this miracle took hold, the key players in its discovery descended into controversy. Horace Wells, Charles Jackson and William T.G. Morton waged bitter pamphleteering wars for 20 years over who should get the credit. (Jackson, it must be noted, also claimed to have given Samuel Morse the idea for the telegraph—to what extent that’s true, we’ll never know.) The debate reached Congress, which ruled in favor of Morton because he had published first. Wells moved to New York, was arrested for throwing acid on prostitutes, and killed himself in jail after taking chloroform; Jackson died at McLean Asylum outside Boston; and Morton, becoming feverish after reading a newspaper article arguing that Jackson should get most of the credit, threw himself into a pond in Central Park and died soon after. Meanwhile, a Georgia country doctor named Crawford Long, having attended ether frolics, had conducted a successful painless surgery in March 1842, but did not publish his news until well after the Mass General demonstration, escaping both the limelight and the concurrent misery. 
The surgical theater at Mass General, which came to be known as the Ether Dome, still stands in the hospital’s original building. A teaching skeleton, a plaster cast of the Apollo Belvedere, and an Egyptian mummy named Padihershef, who was a gift to the hospital in the 1820s, all keep watch over the Dome as they did in 1846. A newer addition is a 2000 oil painting recreating a moment during the surgery. Abbott is bound to the surgical chair by a leather strap, as was typical practice then, but there is no need for it: His hands are slack. He is at peace. 
Image: Ether Dome. Massachusetts General Hospital.

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