‘Gentlemen, this is no humbug’: A history of anesthesia

If the history of anesthesia is the story of trying to manage pain, then it is indeed a long one.

If the history of anesthesia is the story of trying to manage pain, then it is indeed a long one. One of the earliest documented examples dates to the late 13th century, when an Italian physician used sponges soaked in opium to relieve pain.

Whatever timeline you use for the history of anesthesia, one event stands out as the game-changer: The Ether Dome surgery of Oct. 16, 1846. That event was not the first use of inhaled ether for surgery, but it was the first successful and publicly demonstrated use, and it changed the way physicians cared for patients around the world.

Much earlier, diethyl ether was first distilled in 1540 by the German physician and pharmacist Valerius Cordus. The substance was then used to sedate animals. In the late 18th century, Joseph Priestley isolated nitrous oxide; concurrently, other scientists were trying to identify the properties of the compound and develop practical uses for it. Experiments in Bristol, England, in 1799-1800 revealed that nitrous oxide had anesthetic properties in low doses and was lethal in high doses. Through the early 1800s, many physicians were experimenting with the use of inhaled substances to ease the pain of surgery, but most of this research was informal and nonstandardized, and the results were not published.

During the mid-19th century, increasing interest and experimentation with inhaled anesthetic gases became popular with dentists. They would give a patient a few whiffs of gas and then quickly pull a tooth. A Boston dentist, Horace Wells, had successfully used nitrous oxide to reduce pain during dental extractions, so in 1845, he attempted to demonstrate the use of nitrous oxide anesthesia to Harvard medical students during a dental procedure in the Bulfinch Building amphitheater. Unfortunately, the nitrous oxide was improperly administered and the patient was screaming in pain. The medical students walked out of the amphitheater deriding Dr. Wells with the taunt, “Humbug!”

The following year, on Oct. 16, 1846, another Boston dentist, William Morton, wanted to demonstrate his anesthetic capability with ether. It was arranged that the dean of Harvard Medical School, John Collins Warren, MD (a relative of Joseph Warren, MD, of Revolutionary War fame), would remove a neck mass from a patient in the same amphitheater used the previous year by Dr. Wells, while Dr. Morton administered ether anesthesia, using a glass bulb filled with ether-soaked gauze. This allowed him to gauge the dose of anesthetic and proved to be a successful means of titration. On this occasion, the procedure went smoothly and the patient, Edward Abbott, woke up after the surgery calm and not in pain. Dr. Warren then addressed the audience in the auditorium, saying, “Gentlemen, this is no humbug!” The auditorium was later christened the “Ether Dome,” in honor of this event.

News of this success story—the public demonstration of painless surgery—spread quickly. The very next day another Massachusetts General Hospital surgeon, George Hayward, MD, removed an extremity tumor painlessly from a patient with the aid of ether. A few weeks later he performed a leg amputation under ether anesthesia. Within the following 2 months, ether anesthesia was used successfully in Paris and London. Quickly, other European countries begin using ether anesthesia for surgical procedures. By 1847, more experimentation with inhaled anesthetics included the use of chloroform; chloroform anesthesia quickly became popular in obstetrical practice and was most famously used for the birth of Queen Victoria's eighth child.

We owe a debt of gratitude to these pioneers. The whole world benefited from the development of safe and effective means of controlling pain. Although the history of pain control and anesthesia was not actually “conceived” in the Ether Dome on Oct. 16, 1846, one could argue that it was (painlessly) born there.