Ether Day: The 1846 Operation That Ended Surgical Pain

Until the autumn of 1846, surgery was something done to a conscious person who had to be held down.

That single fact organised the whole discipline. Operations were chosen for what could be finished in seconds, not for what would help the patient most. Robert Liston in London could take a leg off in about half a minute and was celebrated for it, because speed was the only mercy available. Surgeons worked in a room full of noise, and the descriptions written by patients who survived are not reproduced lightly.

The change happened in a single morning, in one room, in front of witnesses.

16 October 1846

The operating theatre on the top floor of Massachusetts General Hospital in Boston is now called the Ether Dome, and it is still there.

The patient was Edward Gilbert Abbott, who had a vascular tumour on the left side of his neck and jaw. The surgeon was John Collins Warren, sixty eight years old, the most senior figure in American surgery, who had agreed to the demonstration with open scepticism. The gallery was full.

William Thomas Green Morton, a dentist in his late twenties, arrived late because his glass inhaler was still being finished by the instrument maker. He administered ether vapour through it until Abbott stopped responding, and then told Warren that his patient was ready.

Warren cut. Abbott did not cry out and did not struggle. Afterwards he said he had felt a sensation like scraping but no pain.

Warren turned to the gallery and said: “Gentlemen, this is no humbug.”

That sentence carried the weight it did because of what had happened in the same room twenty months earlier.

The Man Who Tried First and Was Laughed At

In January 1845 Horace Wells, a dentist from Hartford and Morton’s former partner, had demonstrated nitrous oxide at Massachusetts General. He had seen a man at a travelling show injure his leg while intoxicated on the gas and feel nothing, had tested it on himself for a tooth extraction, and believed he had solved pain.

The demonstration went wrong. The dose was probably insufficient and the gas was probably withdrawn too early. The patient cried out. The students jeered “humbug” and Wells left the room humiliated.

He was right, and the failure destroyed him. Nitrous oxide is a genuine anaesthetic agent still in use, and his method worked in his own practice. He became dependent on chloroform while experimenting on himself and took his own life in a New York jail in 1848, at thirty three, having been told in the meantime that Morton had succeeded with a different gas.

There was another claimant with a better case still. Crawford Long, a country doctor in Jefferson, Georgia, had removed a cyst from a patient under ether on 30 March 1842, four and a half years before Boston, and had used it repeatedly afterwards. He did not publish until 1849. In a priority dispute, silence loses.

The Ugly Part: Trying to Own It

Morton’s conduct immediately after the demonstration is the least admirable episode in the story and the most instructive.

He refused at first to say what the gas was, added aromatics to disguise the smell of ether, called it Letheon and applied for a patent. The idea was to license it to hospitals.

The patent was worthless. Ether was a substance chemists had known for centuries and any physician who could recognise the smell could use it, which within weeks most of them could. The attempt did lasting damage to Morton’s standing, and he spent the rest of his life in litigation, principally against Charles Jackson, a chemist who had suggested ether to him and claimed the discovery as his own.

Morton died in 1868, poor, still fighting. Jackson died in an asylum. Wells was dead by 1848. Of the four men with a claim, only Crawford Long had an untroubled later life, and he was the one who had never pressed his.

The word itself came from someone who wanted nothing out of it. Oliver Wendell Holmes wrote to Morton in November 1846 proposing that the state be called anaesthesia, from the Greek for without sensation. That is the name that stuck, not Letheon.

How Fast It Spread

Word reached England by ship within two months. On 21 December 1846, Robert Liston amputated a leg at University College Hospital with the patient under ether, and remarked to the theatre: “This Yankee dodge, gentlemen, beats mesmerism hollow.”

Within a year ether was being used across Europe and America. Almost nothing in nineteenth century medicine moved that quickly, and the reason is that the demonstration required no theory to accept it. You did not have to believe anything about the nature of pain or the mechanism of the gas. You watched an operation happen quietly and drew the obvious conclusion.

In November 1847 James Young Simpson in Edinburgh introduced chloroform, which was easier to administer and smelled better, and which turned out to be considerably more dangerous to the heart. He also took on the religious objection to relieving the pain of childbirth, which was argued from Genesis and the curse of Eve, by pointing out that God had put Adam into a deep sleep before removing his rib.

The argument ended socially rather than theologically. In 1853 John Snow administered chloroform to Queen Victoria for the birth of Prince Leopold, and after that it was respectable.

That John Snow is the same man who, five years later, mapped the cholera deaths around the Broad Street pump. He became the first physician to practise anaesthesia as a speciality, worked out dosage properly, designed inhalers and wrote the first serious book on the subject. The founder of epidemiology and the founder of anaesthesiology were one careful man who measured things.

The Consequence Nobody Wanted

Here is the part that is usually left out of the celebration, and it is the reason this anniversary sits so oddly next to the others.

Anaesthesia removed the time limit on surgery. Operations that had been impossible because no human being could endure them became possible, and surgeons began opening abdomens and chests and working for an hour or more.

Antisepsis did not exist yet. Surgeons operated in coats stiff with old blood, with unwashed hands and instruments wiped on aprons, in wards where hospital gangrene was routine. Mortality after major surgery in some hospitals ran between forty and sixty per cent.

So for twenty years, the effect of abolishing pain was that far more patients survived the operation and died of infection a week later. Semmelweis had already shown in Vienna in the 1840s that washing hands cut deaths dramatically and had been driven out of the profession for saying so. Lister’s carbolic acid only arrived in 1867.

Those two inventions are what made modern surgery, and they had to arrive in that order to produce the twenty year gap in which anaesthesia made things statistically worse. A patient in 1860 was more likely to be operated on and more likely to die than a patient in 1840.

What Was Actually Discovered

Ether had been synthesised in the sixteenth century. Its effects were known well enough that students held ether frolics for entertainment, and Humphry Davy had suggested in 1800 that nitrous oxide might be used in surgery and then not pursued it.

The chemistry was old. What was missing was the thought that unconsciousness could be produced deliberately, held at the right depth, and then ended, on purpose, to allow somebody to be cut open. Several people had that thought in the 1840s and one of them staged it in front of the right audience.

Nobody in that gallery understood how ether worked, and to a large extent nobody does now: the molecular action of general anaesthetics on consciousness is still an open research question. We have been putting people reliably to sleep for a hundred and eighty years without a settled account of what we are doing to them.