The Ether Dome is a surgical operating amphitheater in the Bulfinch Building at Massachusetts General Hospital in Boston, Massachusetts, United States. It served as the hospital's operating room from its opening in 1821 until 1867. It was the site of the first public demonstration of the use of inhaled ether as a surgical anesthetic on October 16, 1846, otherwise known as Ether Day. The Ether Dome event occurred when William Thomas Green Morton, a local dentist, used ether to anesthetize Edward Gilbert Abbott. John Collins Warren, the first dean of Harvard Medical School, then painlessly removed part of a tumor from Abbott's neck. After Warren had finished, and Abbott regained consciousness, Warren asked the patient how he felt. Reportedly, Abbott said, "Feels as if my neck's been scratched". Warren then turned to his medical audience and uttered "Gentlemen, this is no Humbug".The Roots of Critical Care, Jennifer Nejman Bohonak, Massachusetts General Hospital Magazine, 2011 This was presumably a reference to the unsuccessful demonstration of nitrous oxide anesthesia by Horace Wells in the same theater the previous year, which was ended by cries of "Humbug!" after the patient groaned with pain.
History of anesthesia Pain relief The practice of pain relief has existed since the time of civilizations such as Ancient Egypt, China, and Greece, in a multitude of various forms. In Ancient Egypt, natural remedies were often used, while in China, acupuncture was developed as a way to restore an imbalance in the qi, or the life force. In Ancient Greece, medical maladies were often attributed to divine influences, and as such, treatments for these ailments would often include visits to temples dedicated to healing.
The use of vapors, which could be inhaled, became more popular in the 18th century as a potential source of pain relief, especially during surgeries, which up to then were generally gory and extremely painful. One of the earliest mentions of the use of an inhaled gas for pain relief comes from the British chemist Humphry Davys, who in his Researches in 1800 noted that, "As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place."
History of ether's application Horace Wells was a practicing American dentist in Hartford, Connecticut who is considered a pioneer in the use of surgical anesthesia. In 1844, during a laughing-gas roadshow, Wells cited nitrous oxide—colloquially known as "laughing gas"—as having pain-killing properties. After this revelation, Wells used nitrous oxide as a means of performing painless dental work; specifically the extraction of teeth.Britannica Academic, s.v. "Horace Wells," accessed August 1, 2017, http://academic.eb.com.ezpprod1.hul.harvard.edu/levels/collegiate/article/Horace-Wells/76511 . In January 1845, Massachusetts General Hospital (MGH) in Boston allowed Wells to demonstrate the method of anesthesia. Unfortunately, the patient did not respond to the dose of nitrous oxide given, which resulted in Wells' endless contempt. Wells continued with extensive self-experimentation, such as repeated inhalation, with various chemicals. There is evidence that suggests a strong correlation between his inhalation of chemicals to a drastic change in personality. In fact, he was imprisoned for throwing acid at individuals walking in New York City and later committed suicide while the Paris Medical Society named him the discoverer of anesthetic gases."Discovery of anaesthesia by Dr. Horace Wells : memorial services at the fiftieth anniversary : Free Download & Streaming." Internet Archive. Accessed August 01, 2017. https://archive.org/details/discoveryofanaes00phil .
As a former partner in Wells' practice, William T.G. Morton learned the technique and began experimenting on his own, and in October 1846 Morton successfully demonstrated ether anesthesia. However, Morton's interest in surgical anesthesia was not solely influenced by Horace Wells, but also Charles T. Jackson and Nathan Cooley Keep.
Charles T. Jackson was a professor of chemistry at Harvard University after practicing as a medical doctor for four years before establishing his chemistry laboratory to teach analytical chemistry. It is speculated that Jackson suggested administering a higher dosage and grade of sulfuric ether to successfully anesthetize the patient."Charles Thomas Jackson." Encyclopædia Britannica. Accessed August 3, 2017. https://www.britannica.com/biography/Charles-Thomas-Jackson .
For a short period of time, both Horace Wells and William T.G. Morton were taught and employed by dentist, anesthesiologist, and first Dean of the Harvard School of Dental Medicine Nathan Cooley Keep.
Ether Day The operation With the help of MGH surgeon Henry Jacob Bigelow, Morton persuaded Warren to allow him to try his technique on a surgical patient. The trial took place in the Ether Dome on October 16, 1846. The patient was a young printer named Gilbert Abbott, who had a vascular neck tumor. Previous anesthetic approaches had utilized alcohol or even a simple blow to the jaw that would render the patient unconscious. However, this was a more delicate surgery, and Abbott had to be tied to his chair so that he would not choke on his own blood.
Morton used a newly developed apparatus, later called the Morton Etherizer, to deliver the diethyl-ether vapors, holding the mouthpiece to Abbott's lips and instructing him to breathe deeply and slowly. Abbott fell into an unconscious, sleeplike state within three to four minutes, and did not react when Morton made the first incision in his neck for the surgery. During the surgery, Warren noted that the blood of the patient was very dark, and thought that the anesthesia might be producing its effect through carbonization of the blood, a remark which was met with a burst of applause. Upon awakening after the surgery, he announced that he had felt a scratching sensation, but no pain. John Collins Warren turned to the observers and proclaimed, "Gentlemen, this is no humbug." Bigelow immediately published an article describing the event and the news quickly traveled to Europe and other parts of America.
The patient Among the revolving door of noted physicians and important figures supposedly present on the historic Ether Day, one figure remains constant: Edward Gilbert Abbott, the man upon whom the ether and surgery was administered. Abbott was born in Middlesex County, MA in September 1825. His parents, victims of tuberculosis, left him an orphan in 1832. After a career as a printer and editor, in September 1846, he went in to receive a medical evaluation for a tumor he had on the left side of his jaw, even though it had been present his whole life and did not cause him any pain.
Abbott was given enough ether to make him fall unconscious; he left the hospital with an unremarkable change in the size of the tumor. He was assured—as he probably knew, that it was a benign growth and that he had contributed greatly to the history of medicine. He died in 1855 at the age of 30, leaving behind a wife, a daughter, and a son. The Boston Herald included a mere three sentence summary of his life and descendants in its December 1 issue.
The original Morton Etherizer
Commissioned by William Thomas Green Morton, the Original Morton Etherizer was used on Ether Day as a means of inhalation anesthesia. The Etherizer was made of blown glass with brass fittings at the two open ends, a middle chamber, and a mouthpiece. The middle chamber held a sponge that was soaked in ether, and the chamber would create gaseous conditions thereby making inhalants. The two brass fittings serve as ventilation so that the concentration of the gaseous ether the patient would inhale via the mouthpiece gives the appropriate dose to be safely anesthetized."MassGeneral Home." Ether Inhaler and Case - Massachusetts General Hospital, Boston, MA. Accessed August 03, 2017. http://history.massgeneral.org/catalog/Detail.aspx?itemId=768&searchFor=Medical and Surgical Equipment.
The improved ether inhaler On April 9, 1898 Messrs, Mayer, and Meltzer unveiled the newly designed Clover's smaller ether inhaler. The inhaler was modified from the previous inhaler used on Ether Day by adding two circular apertures on both sides of the apparatus located near two small viewing windows. The apertures and windows were used to view the interior of the chamber to facilitate the quantity of ether being administered. Further modifications included the same plated and polished surfaces on the interior as on the exterior. All fixtures on the apparatus are fitted to ensure there is no leakage of chemicals in the chamber or hot-water from the hot-water jacket. The hot-water jacket serves as an insulator to heat the water which then produces condensation. When the condensation is mixed with the ether and is inhaled, it develops the chemical properties of an anesthetic. The hot-water jacket has a detachable screw-stopper that allows the metal cap, chamber, and bag used to anaesthetize the patient to be cleaned of verdigris. All the above-mentioned features were combined with knowledge gained after practice using this inhaler—such as that the slot located near the bag needs to be opened for ventilation after the induction of the patient—combined to develop the new improved ether inhaler.
Legacy The ether controversy
Wells, Jackson, Morton and a Georgia doctor, Crawford W. Long, each claimed credit for the innovation of using ether as an anesthetic.
In either December 1841 or January 1842, Long had introduced the use of sulphuric ether as a substitution to nitrous oxide for the use of entertainment at parties. Long was possibly the first to use ether as a way to alleviate pain during surgery. Long had been using ether in surgery since 1842. On March 30, 1842, he removed a tumor from the neck of a young man named James Venable. Over the following years, Long would use ether in his obstetrical practice, however, he never published any of his findings until seeing the December 1846 issue of a Medical Examiner about Morton, who claimed to have used ether as an anesthetic. Long then began to record his findings and write his account of the discovery. He also collected notarized letters from former patients, but after presenting his findings to the Medical College of Georgia, he discovered two others also claimed to be discoverers: Horace Wells and Charles Jackson. When Long entered his claims, this controversy was already in process.
Prior to Morton's public demonstration of ether, he had supposedly met with Jackson (who was known as attempting to steal others inventions) to discuss questions surrounding anesthesia. It is at this meeting where, supposedly, Jackson had suggested to use ether as a means of alleviating surgical pain. Morton had previously experimented with ether, but never on a patient. Jackson and Morton tangled in a bitter legal dispute and pamphleteering war, that lasted 20 years. In 1868 Morton read a newspaper item asserting that Jackson deserved the lion's share of credit. Morton became feverish, threw himself into a pond in New York's Central Park and died, probably from a stroke, soon thereafter. Jackson died insane at McLean Asylum in Belmont, Massachusetts.
In 1845 Wells had attempted to demonstrate the use of nitrous oxide as anesthesia at MGH but it was "dismissed as humbug" because the patient cried out during the procedure although later, the patient denied feeling any pain. His career then began to spiral down. Wells left the practice of dentistry and his family, and went to New York, where he was arrested for throwing acid on prostitutes. He killed himself in jail by slashing an artery after taking chloroform.
The First Operation with Ether