Thursday, September 25, 2014

Major Discoveries in Medicine before 1900

Major Discoveries in Medicine before 1900

History Book Club
Wednesday, September 24, 2014
NOTE:  Our next meeting will be Wednesday, October 29th:
The History of Art in America-- read a book of your choice on the History of the visual arts in the U.S.
   This can be about an individual artist, an art form as embraced by American artists, art as propaganda, art in advertising, modern art in America, landscape art and the environmental movement, or you can home in on the Rockport or Cape Ann art colonies.  It will be your call!

The Doctors' Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis
(Great Discoveries.) By Sherwin B. Nuland. 191 pp., illustrated. New York, Norton, 2003. $21.95. ISBN: 0-393-05299-0
            This is a simple story, and in 2014 it is hard to imagine that there was a time that this could have happened.
            A girl in Vienna, Austria in the 1840s meets a dashing young college student.  It is such a lovely relationship, but soon, she gives herself to him--- over and over and over.  She becomes pregnant and the dashing student blames himself for his “dallying” with this girl. Of course, he takes no responsibility for this pregnancy.
            The girl’s mother died years ago, but her father has always been so understanding, he will have a solution.  Instead, he flies into a rage. 
            The girl stays with her friend Liesl, and she makes frequent trips to the Allgemeine Krankhausen, a huge hospital, the pride of Vienna.  Since the 18th century fine hospitals had been built all over Europe, coupled with schools of medicine.  Hospitals were a tremendous benefit for the lower classes, but affluent families continued to be treated in their own homes. 
            The girl (author Nuland never gives her a name) scouts out the hospital in her many quiet visits.  From Liesl she learns that there are two obstetric divisions—one run by doctors and the other by midwives.  She should ask for the one run by midwives, Liesl advises. “Stay away from the prying hands of the medical students,” she says.
            The day comes when the girl’s water breaks and she and Liesl walk over a half mile to the Allgemeine Krankenhaus They are greeted by a friendly nurse, and she is assigned to the first division, the one run by doctors.  No, she cannot go to the second division.  This is where she is assigned.
            The girl is given her bed, and visited by nurses, doctors and medical students.  The routine for the students is to visit the “Deadhouse”, where they can examine corpses of those patients who have recently died. Then the students come up to examine these young women, about to give birth.
            The girl has a long labor, but finally delivers a fine young boy, whom she names for her father.  Surely, she thinks, “When I show my father the baby he will forgive me.”
            Shortly after the birth, however, the girl develops a high fever and her body begins to fill with gas.  She vomits, and cannot take food. She becomes cold and clammy, then delirious.  Finally, three days after the delivery, she dies.
            This is 1847, and the author has used this fictional story to lead us into the story of how doctors eventually discovered that they were the very causes of death of so many young women.  Fully one out of every six women in this first division at Allgemeine Krankenhaus died of puerperal fever, or childbed fever. 
            Every morning, young doctors would open up bodies of deceased women and find their uteruses inflamed and filled with pus. Then they would proceed directly to the first division and examine healthy young women about to give birth.  In the second division, midwives examined the young women, but they did not visit the deadhouse.  The mortality rate in second division was much lower.
            At that time no one knew about germs or infection.  They thought that the sickness that swept over these women came from bad vapors or perhaps some mysterious aura.  They thought there might be a connection between the changes in a woman’s body that allow her to give milk to her child, or a blockage of the amniotic fluid (lochia).   Everything but the thought that it could be doctors with filthy fingers!
            When we read about doctors wading in bodily fluids, inflamed flesh, pus and a putrid stench, and then proceeding directly to examine healthy women, we can hardly imagine that anyone could have ever been that stupid. 
            Along comes Ignác Semmelweis.  Born in Hungary in 1818, Ignác starts out learning to become a lawyer, then changes to medicine.  He studies at the University of Vienna one year, then changes to the University of Pest back in Hungary, then back to Vienna to finish and get his degree. Nuland has studied Semmelweis a great deal before writing this book. 
            In 1847, as Semmelweis concluded that doctors and students were conveying the disease, he set up bowls of chloride solution at the entrance to the maternity ward and ordered students to wash their hands before entering the ward.
            Johann Klein, Semmelweis’ chief at the Vienna lying-in hospital, was an Austrian doctor who followed all the rules and was beholden to the royal apparatus, had been a stern teacher of young doctors and insisted on thorough autopsies and clinical observations of cadavers. He did everything in his power to suggest that puerperal fever, and all the deaths, were caused by the ventilation, the walls, anything but by his doctors.
            Semmelweis had a lot of characteristics that made him hard to get along with.  He had a habit of really haranguing any students or doctors who failed to use the chloride solution upon entering the maternity ward.  And he failed to put his theories about infection into print.  He soon moved to the lying-in hospital in Pest, Hungary.  There he found the same problem—doctors handling a cadaver filled with pus and stinking to high heaven, and then proceeding to operate on a theretofore uninfected patient.  He nagged them about using the chloride.  And still, they resisted.
            Back in Austria, someone wrote an article in the Vienna Medical Weekly, saying that one would expect that now (several years after Semmelweis had departed) this chloride-washing theory had been discredited.
            Semmelweis was not easy to get along with. He was impatient, impetuous, single-minded and blustery. He did not make friends easily. Yet, in 1856, at the age of 38, he married a beautiful young woman, daughter of a prosperous Hungarian merchant.
            Finally, in 1861 Semmelweis published his book, The Etiology, the concept and the prophylaxis of Childbed Fever. It was met with indifference and opposition by leading obstetricians, which set Semmelweis into a rage. 
            Soon, Semmelweis’ behavior became more bizarre than usual, with strange sex habits, including openly consorting with a prostitute, and rambling speech.  He was clearly suffering from some sort of dementia. He was committed to a hospital for the insane and died in August 1865.  Four years later, scientists discovered microbes in chains, later to be called streptococci, and in 1879 Louis Pasteur connected Semmelweis’ work with the streptococci to pronounce that “it is the doctor and his staff that carry the microbe from a sick woman to a healthy woman.”
--Samuel W. Coulbourn


Title: Western Medicine: An Illustrated History
Author: edited by Irvine Loudon
Publisher: Oxford University Press
Date: 1997
There is growing concern worldwide about the severe outbreak of ebola in Liberia, Sierra Leone, and Guinea. Will the spread of the disease reach epidemic proportions? Some estimates are frightening. Now, with concerted intervention by the United States and other countries with well-developed medical systems, there is hope of bringing the crisis in West Africa under control.
Most significantly, that intervention is not going to bring a cure for victims of ebola. More than anything, it will mean providing highly structured, modern medical care for infected patients in isolation from the general population. Currently, there is no cure for ebola. It can be stopped only by keeping patients from infecting their caregivers, both at home and in medical facilities, with their bodily fluids.
Tragically, we live in a time of extraordinary unequal access to medical treatment. Modern hospitals in America are well-prepared to provide life-saving regimes of medical care. In West Africa threadbare medical systems have been overwhelmed from the beginning of the current outbreak. History places us in a difficult period of a great divergence between rich and poor countries. It begins with Greek civilization and continues for twenty-five hundred years into the eighteenth and nineteenth centuries with the rise of modern medical practice in Western Europe and America as part of the Enlightenment and the Industrial Revolution. It is a remarkable history which, unfortunately, is not given the attention it deserves in competition with wars and revolutions and political and
religious conflict. Yet, the lessons of history could go a long way toward avoiding a crisis like the deadly spreading of ebola in West Africa.
One of the best sources for understanding the long arc of the history of medicine is an artfully developed text, Western Medicine: An Illustrated History, superbly edited by Irvine Loudin and published in 1997 by Oxford University Press. A medical doctor who became an historian of medicine in mid-career, Loudin worked with a group of nineteen highly qualified historians of medicine or individuals otherwise knowledgeable in a medical specialty to create the text for the book.
Many of the contributors, including Loudin, were connected at the time to the Wellcome Institute for the History of Medicine in London. Supported by the Wellcome trust established by Sir Henry Wellcome, co-founder of a major pharmaceutical company, Burroughs Wellcome, the Wellcome Institute committed substantial resources to the study of the history of medicine for many years, primarily sponsoring academic research in universities and other institutions. Western Medicine: An Illustrated History is very much a product of the medical historians supported by the Wellcome Institute.
As a sign of the times, however, it must be noted that changes in the law have made it possible to shift money away from Sir Henry Wellcome’s wish to support historical research in medicine. The Wellcome Institute for the History of Medicine no longer exists and support for research in the history of medicine is meager, not only in Europe but also the United States. Additionally, Wellcome’s pharmaceutical company has been swallowed into the giant drugmaker GlaxoSmithKline.
The Wellcome name may be disappearing but Western Medicine: An Illustrated History remains an excellent survey of the history of medicine, available not only in print but also online for easy fee-based downloading. A good choice for distribution in this era of web based sources of information.
Irvine Loudin and his contributors focus their attention on two revolutionary periods in the history of Western medicine. One was the invention of rational
medicine. In the fifth century BC the Greeks evolved rational systems of medicine free from supernatural and religious causes, establishing in their medical theories and practices that sickness and disease originated in natural causes. What an extraordinary shift in understanding for the world it was.
James Longrigg, a reader in ancient philosophy and science at the University of Newcastle at the time of publication, explained thusly:
“Rational modes of explanation based upon formal, deductive reasoning, and sustained by logical argument were employed to account for disease within an ordered world whose laws were discoverable. (Men and women were) regarded as part of that world, a product of their environment, made of the same substances and subject to the same laws of cause and effect that operates within the cosmos at large.”
A medical practitioner and author in early fifth century BC Greece by the name of Alcmaeon of Croton is credited with opening the way to these new concepts of disease. He rejected belief that certain diseases possessed a separate existence, making them subject to the whims of the gods. Instead, disease was the result of disturbances of the body’s natural equilibrium and thus part of nature. While his theory of the body’s equilibrium eventually proved inadequate, his remedies to restore health and reduce imbalances were positively modern and I subscribe to them wholeheartedly: baths, massage, gymnastic exercises, and even changes in climate.
Situated at the center of the Greek revolution in rational medicine was Hippocrates who lived in the second half of the fifth century. He is credited with the magnificent work called the Corpus, which includes sixty some treatises on the origin and treatment of diseases. The work is virtually free of magic and supernatural intervention. A new era of rational medicine had begun.
Only it must be admitted that it is almost certain that Hippocrates did not write the treatises that make up the Corpus. There are a multitude of styles and approaches in this huge body of medical work. Scholars cannot decide if any of them can be attributed to Hippocrates. Even the sections on medical ethics and
etiquette, including the famous Hippocratic Oath, are unlikely written by the great medical teacher himself. He was nevertheless accorded the title Father of Greek Medicine.
Perhaps the most important part of the Corpus is the development of the Hippocratic theory of four humours, a philosophical explanation of the natural workings of the body. The four humours are blood, phlegm, black bile, and yellow bile. Over the centuries the theory took hold and was expanded in its reach and complexity which I will not attempt to explain further. Needless to say, it still held sway in the Western world through the Middle Ages, due in large part to the support of empirical observation. As a philosophical theory, it made sense of the natural world even if it was wrong.
In the Middle Ages, about 1000 AD, there were three significant systems of medical ideas and practices in the world: the Chinese, Indian, and Western, which then was more appropriately Mediterranean because it reflected Roman and Islamic additions to the elaborate Greek system based on the foundational principles established by Hippocrates and the many contributors to the Corpus. From the Renaissance onward Western medicine began to diverge from the other systems in its beliefs and organization. Then in the seventeen hundreds humoral ideas were abandoned and replaced by a view of the body as made up of parts ---- organs, tissues, and cells ---- where disease is due to structural abnormalities or physiological malfunctions.
The second big revolutionary period was underway. Science and technology were soon in the forefront of medical discovery and practice. It was now truly Western medicine. And it is still evolving.
Medical ideas and practices have changed faster in the last three hundred years than at any time in human history. In the process of these huge advances, Western medicine has come to dominate the world, both in rich and poor countries. The Chinese and Indian systems are now viewed simply as alternative, nativist approaches with little scientific validity.
But modern, scientific medicine designed to cure diseases is not the only emphasis in Western Medicine: An Illustrated History. Loudin and the many contributors discuss how illness can be prevented by healthful living habits. Ruefully, they point out that obesity, alcoholism, and drug addiction keep medical practitioners busy in wealthy nations. Moreover, they suggest that finding answers to poverty, unemployment, and homelessness is likely to bring more benefits to a greater number of people than cures for disease available in high priced, scientific, high technology medicine.
The same logic can be applied to poor countries. One contributor, Stephen Lock, a longtime editor at the British Medical Journal, observes that in developing countries “most authorities have preferred to pursue a goal of Western-style medicine, rather than adopt proven and cost-effective methods for ensuring good health in the population: a piped water supply, simple education of mothers, childhood immunization, and simple health care delivery by indigenous aides.”
The overriding issue is one of seeking high priced cures for disease instead of high quality care that can be provided for much less expense. In the case of the ebola outbreak in West Africa, there is no cure. High technology Western medicine is not going to end the crisis. The only way to halt the growing epidemic is through high quality care. None of the countries affected by the outbreak was prepared. Hopefully, it is not too late to avoid a catastrophic epidemic as intervention comes from the United States and Europe. Once again, the lessons of history have been ignored. For all of miracles provided by Western medicine, we still are confronted with the threat of widespread epidemics.
--Richard Heuser

Yellow Fever
James L. Dickerson
Prometheus Books   2006

In 1793, Philadelphia with a population of 29,000 had the distinction of being the new nation’s capital. It was the indisputable heart and soul of the new American democracy. As the nation’s first capital Philadelphia was home to President George Washington during both his terms and the meeting place for Congress.
 Philadelphia’s Dr Benjamin Rush, a signer of the Declaration of Independence and the most prominent physician in the country, became alarmed at the rising number of pockets of yellow fever illnesses around the drought stricken city.There was considerable disagreement among the town’s doctors as to the cause of the disease. Some blamed poor sanitation, noxious air, or the climate. Others attributed it to flood of immigrants fleeing the Haitian slave uprisings.
Rush was called by two other doctors to the home of a wealthy importer whose dying wife was in great pain and also displaying the classic unmistakable grim symptoms of yellow fever. He used her illness to persuade the city fathers that Philadelphia was in the beginning of an epidemic. Philadelphians understood what that meant. Over the past one hundred years there had been four documented yellow fever epidemics in the city, all of which had produced staggering death counts.
As the 1793 summer waned and the death rate rose to over a 150 victims a day, panic followed, and more than 20,000 Philadelphians, including George Washington, Thomas Jefferson, and the entire executive branch of the government fled the city, helter shelter. The State of Pennsylvania legislature also moved their deliberations to Lancaster. The new nation came to a standstill: appropriations, appointments, judicial decisons,or foreign matters could be legally decided upon.
Yellow fever was terrifying because it killed at random, striking all ages and economic groups. Now we know that a vaccine developed only in 1934, plus eradication of the disease source (infected mosquitoes, finally revealed in 1900) are the only means of controlling the spread of yellow fever .Both controls were unknown in Colonial America. Today, it is still a worldwide killer of over 200,000 deaths a year.
The yellow fever virus attacks the liver and kidneys, causing lingering and agonizing death, even today, in well over 20% of those bitten. The only good result of those stricken survivors is that they are usually immune from future attacks of the yellow fever virus.
Yellow ever is an infectious viral disease that aggressively attacks the liver and digestive tract. In mild cases the symptoms are similar to the flu, but in the often continuing toxic phase, the patient develops a high temperature and encounters a series of life-threatening conditions such as internal bleeding, kidney failure, liver failure, and meningitis.
Symptoms appear about six days after infection. In the first stage, the patient will experience a high fever, headaches, and a rapid pulse. Later the patient will his pulse will fall below normal and he will have terrific pain in his limbs and back. This second stage may create a false sense of recovery. The disease then escalates into the third often death stage where the all the body orifices seep blood accompanied by black bile vomit. 
 Yellow fever is difficult to diagnose, since symptoms often overlap with those related to malaria, typhoid, hepatitis, and various poisons. In its most toxic phase, in the 1800’s,the mortality rate was often around 50%,
Yellow fever is transmitted by the AEDES AEGYPTI mosquito. A mosquito can pick up a virus if it bites an infected person, but it must incubate inside the mosquito before the insect can give the disease to another human. After 12 days, the newly infected mosquito can transmit the virus as long as it lives. It only takes a few infected mosquitoes to instigate an epidemic. That’s because   non-infected mosquitoes can become infected simply by biting an infected person.
The Philadelphia Yellow Fever Epidemic of 1793 petered out with the onset of the winter months. More than 5000 residents perished that summer and fall. Unfortunately the limited and often counterproductive medical approaches contributed to a large percentage of the agonizing deaths.
 In the nearly deserted city, heroic roles were repeated many times over by free blacks who remained. They had no place run to, so they stayed and tended he often abandoned ill. Many physicians and other care givers died, themselves stricken.  Those that survived the fever toiled on, helping the newly stricken. Death was most acute among the young and the old.
The city was quarantined by neighboring communities. Inflation, thievery, and alcohol abuse caused near starvation conditions. The dead often went unburied for days. Almost no family was spared. The onset of the colder weather gradually brought the city back but Philadelphia never recovered its prominent first place in the growth of America.
The fever’s presence was evident in most of the eastern seaboard as far north as Maine in the summer time.
The American fever plague of the late 18th century then exploded upon the deep south with terrifying swiftness. The panics and recovery phases of the soon to be infected yellow fever areas of the U.S. followed identical scenarios  through the 19th century.
The first recorded yellow fever epidemic in New Orleans occurred 1796, just three years after the Philadelphia nightmare. The disease burst out of the southern delta at the turn of the century, when France took over control of this immense territory from Spain.  Then Napoleon became disenchanted with the New World in 1801, when his French invasion force of 29,000, intent on bringing Haiti back under the French flag, was decimated.  20,000 soldiers perished of yellow fever and malaria on the Caribbean island of Santo Domingo.
Thomas Jefferson then brokered a deal with him for the Louisiana Territory which  unknowingly included uncountable numbers of infected Acedes aegyti mosquitoes, free of charge. With the accelerated growth of the port city of New Orleans, swelled by the arrival of a flood of immigrants from the carnage of the Haitian slave rebellion, yellow fever returned to New Orleans, slowly at first, in 1812, 1817, and 1818, claiming no more than 300 lives in those years, but building built its death toll each year until when in 1847; another major American epidemic appeared in N.O., claiming 2,306 lives.
Here again, as happened in Philadelphia, the medical community was unable to agree on the causes and treatment of the disease. Ineffective measures were enforced.
Burials of the fever victims were again a huge problem in New Orleans, exasperated by high water table of the river city.
The population of N.O. had soared to 120,000 by1853, with the medical community lulled into thinking Yellow Fever an “obsolete Idea”. However in May, suspicious cases were thought to be yellow fever.  Health authorizes investigated a cargo ship that had docked from Jamaica that had five crew members admitted to a on arrival. The five died. Stevedores unloading that ship and others nearby fell ill and ultimately died.
Yellow Fever became relentless throughout the city in claiming many daily victims during June. No alarm bells were sounded because death from infectious diseases was a common occurrence throughout America in the years before the arrival of antibiotics. The mood changed drastically in that 1853 July. New Orleans went from 27 yellow fever deaths a week to more than 500 a week.  The papers said no need to panic because most of the deaths were Irish and German immigrants who neglected medical care. The newspapers further soothed the native-born residents’ fears, telling them they were too medically knowing to be at risk to succumb to a lower-class disease such as yellow fever.
The N.O.  Board of Aldermen, even after the weekly death toll reached over 800, declared that the city was not in the throes of an epidemic. Then they adjourned, and the city administration, aldermen and their families leading the trek, abandoned the river city. The only leadership that remained came from physicians, ministers and priests to care for the needs of the people.
To combat the epidemic, cannons were fired in an attempt to purify the atmosphere and barrels of tar also were burned into order to cleanse the air of disease.   A nauseating putrid stench enveloped the Quarter.
 Remaining sanitation and health powers that remained were determined to contain the spread of the fever. A beginning point was: quick burials, burning contaminated and soiled bedding, quarantining new ship arrivals and cleaning up the streets and alleys. However, nothing seemed to have an effect on the death count.
When a news paper reporter investigated as to why the streets were so quiet and seemingly healthy, he was told because all the neighbors were dead.
Again when cool weather arrived, estimates of the death count varied from 7800 to 11,000. Many had been buried hurriedly in unmarked graves.
 In the mid 19th, century    American medical community was baffled by the epidemics.  They knew the symptoms would disappear with the arrival of cold weather which would curb the fever.They also knew that they would lose half of their patients. But they had no idea about the cause of the disease or how to alleviate the symptoms.
The following year 1854, they lost 2425; in 1855, 2770. Deaths dropped way back until 1857 taking 5000 lives of the then 160,000 N.O. residents Until the 1880’s, however, they still believed that yellow fever was a “foreign threat”, caused by outside human influences. Yet in 1878, by the end of August, quarantine or not, yellow fever again hit. 40,000 residents fled the city. 1878 health lists totaled 27,000 stricken survived and 4000 died. Cold weather saved the city once again.
All the towns along the Mississippi River were devastated at one time or another through the1800’s by “Yellow Jack “.In 1878. Memphis almost disappeared when the fever hit. For the most part, only the black inhabitants remained. There again as in Philadelphia, PA.  they thanklessly  attended the sick and dying, and paid a heavy price. Misinformation through the years had erroneously labeled the black,  mostly immune from the scourges of  the fever.
Memphis had some experience with Yellow Fever, but nothing prepared the fast growing port for attack of 1878. 1873 was bad with 5000 cases reported and 2000 plus deaths. Five years later little had changed n the city. None of the planned health improvements to combat disease had been implemented.
When Memphis residents found out that the town of Grenada, 100 miles to the south was in the midst of a yellow fever epidemic, (5000 died) pandemonium followed. Half of the Memphis’s 40,000 residents fled.    When frost stopped the spread of the fever in late October, 1878, most of17,800 inhabitants remaining who could not flee, had contracted the disease and over 7000 died.
In the Natchez area epidemics were recorded along with Vicksburg with all the attending horror stories. Jackson, Mississippi’s population was reduced by half by fever, and the devastated delta town of Philadelphia, Miss. was overwhelmed on every street by illness and death
The town of Greenville, Miss. had been through hell in the  Civil War ,but nothing matched the horrors brought on by yellow fever in 1878.For most of its history, Greenville had existed as a fever free oasis. This quiet backwater river town had 2500 inhabitants and never experienced an epidemic. When a relief boat finally docked in September, 1878, 400 remained, and 200 of these were still sick. 
These were some of the towns in 1878 that shared the horrors of the worst epidemic in American history. This was a scourge not to be controlled until the onset of the 20th century. Yellow Jack disease eradication was led by heroic and stubborn medical investigators putting aside personal risk and fortune to eliminate yellow fever. Their stories denote the onset of a new era in superb medical achievement.
 ----Dick Verrengia


Ether Day: The Strange Tale of America’s Greatest Medical Discovery and the Haunted Men Who Made It.   Julie M. Fenster Harper Collins 2001

On the morning of October 16, 1846, a day celebrated as Ether Day, anæsthetic gas was first demonstrated in a surgical operation at Massachusetts General Hospital in Boston.  Julie Fenster writes that “on that day, the mind of man had an answer to pain.  But pain was not through, and with some sort of vengeance, pain itself also turned sharply that day to conquer the men who dared to conquer it.”  
That quote symbolizes the two themes -- the two types of pain -- in Julie Fenster’s book.   Most of the book details the self-inflicted pain,  mostly mental anguish, suffered by the three contenders for the glory of discovering ether to combat physical pain.  But running throughout the book are comments about how people 200 years ago dealt with physical pain.  
An Internet search for the history of pain reveals a wide variety of treatments including electric eels, bloodletting, hypnosis, herbs, alcohol …  and acceptance.  The last choice was popular with people who perceived pain as God’s punishment for sins – or in the case of childbirth, the price one paid for the miracle of procreation.   In the early 1800s  these treatments and attitudes were still in play despite the fact that nitrous oxide and ether were already known.  
In setting the background for the worldwide excitement about Ether Day, the author devotes a chapter to describing the agony patients experienced in first half of the 19th century while have abscessed teeth pulled, life-threatening growths removed, and smashed limbs sawed off.  She also tells of patients who backed out of a planned surgery in a last minute panic.  Most horrendous of all are the anecdotes about how doctors dealt with the patients who writhed and thrashed.  If strapping the patient’s arms and legs to the table didn’t work, they would encase the patient in a form-fitting box with a hole that allowed access to the excision site. 
It was no wonder that highly respected Dr. John C. Warren, head of surgery at Mass. General, willingly risked his reputation to perform the surgery on October 16th, 1846, saying “What surgeon has not .. been inspired with a wish to find some means of lessening the sufferings he was obliged to inflict!.”  Dr. Warren removed a tumor from the neck of a Mr. Gilbert Abbott, who later confirmed that he felt no pain whatsoever.  The surgery was no different than what Dr. Warren had done many times before.  The man who eliminated the suffering was William Morton, who had Mr. Abbott inhale a mixture of sulfuric ether and oil of orange, sucked up through a tube inserted in a glass ball outfitted with two valves that controlled the flow of air that mixed with the sweet-smelling ether.  
Many years later Mass. General commissioned a mural to commemorate this historic occasion. Hovering over Mr. Abbott is William Morton with the glass ball containing the ether he is credited with discovering.  What the painting doesn’t show is twenty-five years of suffering –physical, emotional and financial -- that Morton inflicted on himself and two former friends.  Julie Fenster gives us a much bigger picture of the facts behind Ether Day and how they contributed to a benefit for mankind and a tragedy for the contributors. 
William Morton was only 27 when he became famous for bringing ether to Mass. General Hospital, but he was already well-known in several major cities … not as a hero but as a scoundrel.  The author’s extensive research into this little-known period in Morton’s life supports a fascinating chapter filled with quotes from his victims. As a teenager from a poor family in Charlton, Mass. all he had going for him was the ability to make a positive first impression:  handsome, enterprising, confident, and intelligent.  Those who got to know him better learned that he used his basically unschooled intellect to defraud business partners that he left holding the bag while he absconded to another city to entice another rich man into investing in another dry goods business.  
When he was 21, he returned to Charlton where, by chance, he met a travelling dentist, Dr. Horace Wells of Hartford.  Perhaps seeing dentistry as a better way to achieve the social stature he aimed for, Morton persuaded Wells to be his teacher.  This casual beginning was the first step in Morton’s journey to Mass. General.  In 1842 Wells set his pupil up in a dental practice in Farmington, CT.  Soon Morton partnered with Wells to sell dental bridgework that the latter had invented.  To increase the range of business prospects Morton moved his practice to Boston.  And to give scientific approval to their product they paid a brilliant and highly respected doctor and scientist for his endorsement.  Thus in 1843 Dr. Charles Jackson, Horace Wells and William Morton – three men, each nonconformists with distinctive talents – met for the first time.  
Morton was justifiably impressed with Dr. Jackson’s medical credentials from both Harvard and the University of France, so, ever the opportunist,  he persuaded Jackson to teach him medicine.  As an indication of the complexity of this story, neither Morton nor Jackson put any effort into that proposed instruction.  Morton only wanted the Jackson deal to satisfy his fiancée’s parents who wanted more than a dentist for their daughter.  Jackson at that time was totally distraught by the claim of Samuel F.B. Morse that he, not Jackson, first had the idea for the telegraph.  Wells was busy trying to get past the disappointment at Morton’s failure to live up to their bargain in the bridgework venture.  One of Well’s efforts was to explore the latest fads in mind-altering such as the use of hypnotism or nitrous oxide.   By 1845 Wells was using nitrous oxide in dental surgery, had freely shared his success with all the dentists in Hartford, and given a demonstration of its use at Mass. General.  Sadly, the procedure was flawed, the doctors called it humbug and Wells went home in despair, soon gave up dentistry, tried three other businesses and eventually went broke.   
Morton was the only spectator of Wells’s fiasco at Mass. General who saw an opportunity to make a profit. He quickly advertised himself as a pain-free dentist and gained fame and money.  He attracted the attention of a young doctor at Mass. General who persuaded Dr. Warren to allow Morton to add anesthesia to his next surgery.  The rest, as they say, is history.. medical history.  This book details the history of the three men and their supporters who fought over the credit and potential profits for discovering anesthesia.  The drama and confusion that followed in the next 22 years makes Julie Fenster’s work outstanding   .  
A deeply depressed Wells turned back to the one aspect of his life that he felt good about – the inspiration to use nitrous oxide.  Knowing that both that chemical and sulfuric ether had drawbacks, he became interested in reports that a Scottish doctor was using chloroform instead.  Wells began to test it, using himself as a guinea pig.  By 1847 he was addicted, arrested, and committed suicide in jail.  Chloroform went on to become the anesthetic of choice into the 20th century.
Morton, on the other hand, delighted with his new celebrity and flush with the profits from his painless dentistry,  applied for a patent.  To add some scientific weight to the application, he had Dr. Jackson join in the request. The patent was quickly awarded, but before Morton could profit from it, the use of ether became common …AND a firestorm of criticism erupted from the medical community, protesting the effort to make a profit from easing the pain of mankind.  William Morton spent the rest of his life trying to find a way to make that profit. In 1867 he  died in New York City while preparing a rebuttal of an article in Atlantic Monthly that gave Dr. Warren full credit for the discovery of etherization and reduced Morton’s role to the person who merely gave ether to the patient on October 16, 1846. 
Dr. Walter Jackson spent those same two decades trying to persuade the top scientists in Paris that he was the discoverer of ether. He admitted explaining its use to Morton and excused his failure to promote the use himself, claiming the obligations of his other professions:  consulting chemist and geologist.  His rationalizations for signing on for potential financial gain were lame and unconvincing.  In 1872 Dr. Jackson had another in a series of strokes.  This time there was no recovery of his speech nor control over his emotions.  He  became a patient at McLean Asylum for seven years before he died there.  Ironically both Jackson and Morton are buried in Mt. Auburn Cemetery.
The history of anesthesia is long and complex.  Even in the short term of the 18th and 19th centuries several people in several countries claim to have been the first to use it in eliminating pain... or in just creating a temporary euphoria.  None of the three combatants who fought for the honor in Ether Day succeeded, but each received some recognition.
Both the state of Connecticut and the American Dental Association honored Wells as the discoverer of modern anesthesia.  Mass. General Hospital underwrote the cost of Jackson’s  care at McLean “in recognition of his services in connection with the discovery and use of ether.”  And the hospital’s Ether Dome features a 7’ mural of the famous operation with Charles Morton front and center.
 Julie Fenster ends with this comment:  Ether Day, October 16th, 1846, was celebrated far and wide.  It is said to mark the dawn of modern surgery – that is, surgery in which anesthesia frees the patient from the fear and pain of a doctor’s effort to remove a problem ..  and frees the surgeon and his staff from the patient’s screams of agony.   It’s sad to think that Ether Day could have happened decades earlier.  Gasses that blocked the experience of pain had been known for many years, but the right mix of attitudes and personalities didn’t come together until the 1840s.”
---Beverly Verrengia