E is for Ether

Suffering so great as I underwent cannot be expressed in words...but the blank whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, which swept through my mind, and overwhelmed my heart, I can never forget.   -J. Ashhurst1

This was the experience of surgery before October 16, 1846.  Operations were limited to what was considered superficial, survivable procedures.  Amputations, drainage of abscesses,  and tooth extractions were the usual agonizing fare.  It took another 21 years (Joseph Lister's publication of Antiseptic Principle of the Practice of Surgery in The Lancet in 1867) for infection control to be introduced into modern surgical practice.

Anesthesia, in the form of ether, was not the no-brainer most of us would expect.  Eliminating pain during surgery was controversial.  After the first public demonstration of ether at Massachusetts General Hospital by William T.G. Morton, debate and controversy ignited.  In 1847, the New York Journal of Medicine published "pain is essential to the surgical procedure, its removal is harmful to the patient".  The American Dental Association wrote, in response to the "alarming" dissemination of ether anesthesia outside of Boston, that "pain is evidence of God's love of humanity, to alleviate it is to do the work of the devil".2  This was not a minority opinion at the time.

Oliver Wendell Holmes, in the 19th century, wrote "disease itself, the offspring of sin and penalty of a poisoned nature, was for them [17th and 18th century persons] a theological entity rather than a disturbed physiological process".3  It was Holmes who first called the administration of ether "anaesthesia".

It wasn't until 1853, when Queen Victoria elected to have chloroform for the birth of her eighth child that anesthesia gained respectability.

This is a device used to administer ether, circa ~1905.  You can see the beautifully machined copper mask, and the brass reservoir for the gas.  The scale on the bottom calibrated the width of an opening between the reservoir and the mask, on a scale of 1-8.  We do it differently now.

Every person who has ever had an ether anesthetic can remember the nightmare that falling asleep used to represent.  All I can say to those who cursed that darkness, is that it beat the alternatives of the time:  uncorrected disease, or death.

 

1.  Ashhurst, J. Surgery before the days of anesthesia. In:  Warren JC, White JC, Richardson WL, Beach HH,  Shattuck FC, Bigelow WS, editors. Massachusetts General Hospital: The semi-centennial of anesthesia. Oct 16, 1846-Oct 16, 1896, H.O. Houghton & Co, 1897, p27.
2.  Glucklich A.  Anesthesia and the end of good pain.  In:  Sacred pain:  hurting the body for the sake of the soul.  Oxford:  Oxford University Press; 2001, p278.
3. Green, SA, Holmes, OW.  Medicine in Boston.  In: Memorial History of Boston 1630-1880.  Boston:  Ticknor and Co., 1886 p526-70.
4.  Thanks to J. Campagna, M.D., PhD. for his monograph "The end of religious fatalism:  Boston as the venue for the demonstration of ether for the intentional relief of pain"

Comments

[Cassie]

Ok, this is very very cool. I had no idea about the attitudes towards pain alleviation in the early days. And considering that that device is photographed on top of roving, its obviously yours. ;-)) Neat.

Wow, we've come a long way.

[Carole]

I love the subtlety of "we do it differently now". Perfectly you, Laurie. Thanks for this post - I didn't know that the first introduction of pain alleviation was considered wrong. I would have thought doctors would jump at the chance to ease the pain of the patients. So, do you collect antique medical equipment like that ether device? I'm curious now!

[melanie]

Thanks for the little history lesson! I love hearing stuff like that, and I love antique cool copper contraptions even more. What a beautiful and terrifying mask thingee!

[PumpkinMama]

Fascinating stuff. I had no idea early anesthesia was so controversial.

[Marcia]

Well, of course E is for Ether! What else would it be? Very interesting historical perspective on something we take for granted. Dental work without anesthesia? I think not.

[Rachel H]

Great post. Very cool that you know the history of anesthesiology so well. Thank you.

[Chris]

So glad to have the option of anaesthesia now!

[claudia]

I do believe this is the first blog post I've ever seen with end notes.

;-)

[Kellee]

Such beautiful things, both the contraption and the ability to relieve suffering.

[--Deb]

Boy, learn something new every day . . . should have seen that "E" coming, too! (grin)

[Martha]

Fascinating post. And thank you for the end notes. Do you collect antique anesthesiology equipment? And do anesthesiologists still use ether at all?

[colleen]

Hmmm, the anethesia debate sounds a lot like some debates happening now. Hopefully in 160 (or 16) years we'll look back at some of them and think "now why was that even debated?"

[Juno]

I read this amazing book a few years ago, about the development of geology as a science and the beginnings of archeology in Victorian England - sort of concurrent with Darwin's voyages.
The thing that struck me was the absolute terror that the notions of epochs of the earth and fossil life were greeted by some because a contradiction to the book of Genesis wasn't just an amusing curiosity or a source of semi-civilized debate, but a terribly violation of the natural order and undermining of the foundations of religion and society.
It was an interesting perspective shift, a lesson on how much the world truly has changed.

I've said it before and I'll say it again - you are a remarkable woman.

[chris]

Bits and pieces of screams and pain and horrors flashed through my mind as I read this, combined with profound gratitude to those who persisted against the naysayers. Great post, Laurie!

[mamacate]

Wow.

We are but the merest rank above savagery. I wonder how future generations will look to us in horror. Maybe I don't wonder.

Sometimes I think about how we roll our eyes at our parents, but they were the product of their parents, and their parents were raised by people who had battlefield amputations in the civil war (my great-grandfather) and lived in a world of incredible brutality (that same set of great-gradparents both escaped Ireland during the starvation). Go back three generations in other families and you'll find pogroms or enslavement or conscription or...the list goes on.

We think about post-traumatic stress disorder today--who among our ancestors could have escaped it? A little alcoholism, some rage issues--they seem a small response to the realities of the day. With that legacy, it's amazing we can function at all, really.

Alleviation of pain--what a concept.

[Bookish Wendy]

I am in love with your citations. In total love.

;)

[Debbie]

Ok, Laurie. Now you've gone and done it. I'm now totally consumed with the idea that your house is chock full of super cool, old-timey medical stuff. Please tell me it is.

[christine]

having had a few surgeries, thank goodness for ether...............

[Beth S.]

Our Calvinist roots run deep, don't they? I think a strong thread of it still persists in contemporary attitudes toward childbirth--that it's somehow "better" or "nobler" or "more natural" to endure the pain without any relief. I always figured that was a patriarchal notion that somehow was internalized by modern women (who forget how hard their foremothers had to lobby to have pain relief made available to them in the first place) but to see that the same attitude once applied to amputations (!) and other surgeries is frankly astonishing.

[Vicki]

Thank you. I love it all! The copper, the brass, the roving, the citations, the knowledge and insight...

[Sylvia]

The same phenomenon happened over a thousand years ago in music when people wanted to play augmented fourths and the Pope decreed that it was the work of the Devil to make such an interval. Later, when such things began to be accepted, the notes were still written with red ink amongst the black, lest people become complacent.

As I read your post my mind ran the memory of an eye surgery where the lovely nurse said, "I think a you need a bit of morphine" and pressed a button and I was transported from hell to heaven. Then there was the guy who gave me an epidural after three days of labor and solved ALL my problems in a blessed moment.

If there isn't an Honor Your Anesthesiologist Day, there should be!

[mamacate]

I'm back. Because as things like this always do, this post stuck with me.

Am I the only one who *worries* about the past? I suppose my belief in reincarnation may be the culprit, or perhaps it's the reverberations I reference above. But it seems like a singularly irrational thing to do. But that's what it is. I worry about the past. I worry about those poor people. And the stupidity of the powerful. And the nasty, brutish, and shortness of it all.

[Norma]

Oh.NO. I can feel an obsession coming on. I am exactly like Cate....I worry about the past.... and I've had....let's just call them "weird moments" and some relevant experiences. I'll tell you more in person.

Fabulous, fabulous eye-opening post, and the perfect "e" choice.

[June]

Hmm, I guess you are an anesthetist?

What is it like to fall asleep under ether? I've smelled ether fumes (made me feel kind of icky when someone was doing experiments and not operating a fume hood correctly), but that's about the extent of my experience.

[Lee Ann]

Personally, I worry about the future more than the past. However, if I were surrounded by that roving, it would certainly make going under a lot more pleasurable and a lot less freaky.

That said, whiskey, a spoon between the teeth, and a smack upside the head are not really a fabulous alternative, are they?

And funny you should mention the controversy over whether or not it is acceptable to want relief of pain. Having had a bazillion people say to me, after my emergency early delivery via c-section and my request for the epidural very early on before we knew they had to cut, "Oh, Lee Ann, how sad that you didn't do things naturally, you missed out on natural labor," I think in that particular field of medicine, many people still think it's not okay to alleviate pain, at all. And my epidural didn't even work (found this out after they cut. It's really hard to yell when you're under anaesthesia, but I managed it...).

The notion of relief, to me, is rather precious. Thanks for such a thoughtful (and end-noted!) post.