We live in an age when there seems to be a medical breakthrough
in the headlines every few days, when new discoveries
are immediately -- and sometimes prematurely -- put
into practice. It is easy for us, therefore, to assume
that this same enthusiasm for novelty characterized
medicine in the past as well. But that is not what history
shows.
Medicine became recognizably “modern” in
the nineteenth century, producing new inventions, new
theories, new curative powers, and a rebirth of professionalism
(for both doctors and nurses). Scientific developments
played a role in all these changes, gradually replacing
the trial-and-error inventiveness that had long characterized
medical practice.
By a quirk of history, we can even pick a symbolic birthday
for modern medicine, October 16, 1846 -- the date of
the first publicly reported use of ether for surgical
anesthesia. This particular discovery was also America's
first major contribution to international medical practice.
The path-breaking operation took place in Boston’s
Massachusetts General Hospital (MGH). Following the
custom of the time, surgical suites and surgical amphitheaters
for student observation were located on a hospital's
uppermost floor to maximize natural illumination. At
MGH, that attic room is still called The Ether Dome.
On this red-letter day, Harvard Professor of Surgery
John Collins Warren removed a tumor on the jaw for a
patient named Gilbert Abbot as the first test of a new
inhaled anesthetic invented and administered by a dentist
named William Thomas Green Morton. Many of those watching
the operation were skeptical since earlier experiments
at MGH had faltered and because no solution had been
found in thousands of years. When Dr. Warren finished
his work without any screaming or thrashing from his
patient, he is said to have announced to those in attendance,
"Gentlemen, this is no humbug." (Fenster 2001;
Wolfe 1993).
Before this date, physicians had repeatedly tried and
failed to find an adequate means to instill a temporary
suspension of pain. Without any way to control pain,
most surgery simply could not be undertaken. Even if
physicians proved willing to inflict horrible pain,
a patient writhing from it could not be held still enough
for the surgeon's scalpel to do its delicate work. Surgery
had thus been limited to a few types of procedures:
cataract removal, extirpation of superficial growths
on the skin, and amputation of a badly damaged limb
(such as a foot crushed by a wagon wheel or an arm blasted
apart by a bullet).
Amputation, often on the battlefield, did save lives,
since a crushed foot or arm would almost always lead
to a fatal systemic infection. Working very quickly,
a skillful surgeon could cut through the flesh, saw
completely through the bone, and apply a red hot iron
to cauterize the stump's raw surface and stop the bleeding
-- sometimes performing the entire operation in less
than two minutes. The amputation of a limb carried a
mortality risk of about fifty percent -- a depressing
figure, to be sure. But even a fifty-fifty chance of
survival was a fair gain over an almost certain death
without such treatment.
The ability to banish pain during surgery (though not
during the recovery period) was a medical breakthrough
of the highest order and a landmark eminently visible
in retrospect. But to gain a more complete picture of
the historical significance of a medical innovation,
we must understand not only who discovered it and how
it worked, but also, and perhaps more importantly, who
used it, how quickly and how widely it became known,
and what further changes it made possible.
For example, the world barely took notice of ether surgery
in 1846. There was no medical revolution. There were
no headlines. Even over several years, only a handful
of newspaper reports appeared. The public image of the
doctor did not change. There was no wholesale adoption
of this technique by the medical profession despite
reports published in medical journals and the occasional
use of ether by other surgeons. Surgeons used it or
avoided it in individuals cases for a variety of reasons,
including notions of which patients (by ethnicity or
gender or social class) would be more sensitive to pain
and thus more in need of the anodyne (Pernick, 1985).
Although the use of ether ultimately triumphed, its
acceptance was slow and uneven for several decades.
For us today, a large oil painting of the first American
operation using ether and a few daguerreotype photographs
of early operations are fascinating historical images.
(Wolfe 1993; Lowry and Lowry 2005). But the impression
they create – that is, that the public immediately
recognized ether surgery as a momentous breakthrough—is
false. All the early photographs were posed re-enactments
taken after the fact; and none of them was published
at the time.
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Southworth
& Hawes, "Early Operation Using
Ether for Anesthesia," Late Spring
1847, Daguerreotype. Not to be reproduced
without written permission from the J. Paul
Getty Museum. |
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Consider, for example, Harvard Medical School’s
impressive painting, First Operation Under Ether by
William Hinckley (http://www.anesthesiadoc.net/History%20Section.htm).
This painting has also been widely reproduced in more
recent times. Because of its naturalistic style and
its methodical attention to detail, the canvas is easily
taken for a contemporary recording of the event. Yet
Hinckley only began the painting in 1882 while in Paris.
His research efforts to get the scene right were prodigious,
and he continued work on the painting until 1893—some
47 years after Dr. Warren’s path-breaking surgery.
(Wolfe 1993).
Popular recognition of the value of ether anesthesia
for surgery did not come until the 1890s. And Ether
Day did not come to be celebrated in Boston on an annual
basis until about 1903. That recognition owed much to
a profound revolution in thinking among doctors and
laypeople alike about the importance of novelties in
medicine.
What happened in the mid-1880s to cause such a change?
It was rabies shots, invented by the great chemist Louis
Pasteur in France. But it was in America, rather than
in Europe, that this innovation had its greatest impact
and garnered its greatest enthusiasm and publicity.
It was the first medical advance accorded "breakthrough"
status, and the ensuing cultural excitement helped to
create starkly new expectations of medical progress
(Hansen, 1998).
Prior to this breakthrough, few people thought the medical
care they received should be different from what their
grandparents had received. In fact, those with wealth
did not choose young doctors with the latest training;
they chose older doctors educated decades earlier, doctors
who had never been in a laboratory, but who knew their
Galen and Hippocrates, often in Greek and Latin versions.
The general public's low regard for medicine at that
time may be illustrated by a delightfully bitter cartoon
on the cover of Puck magazine in 1884. William
Vanderbilt had just proposed a gift of $500,000 to Columbia's
College of Physicians and Surgeons. Puck, a popular
American magazine of political and social satire, mocked
this kind of medical philanthropy, suggesting that it
was simply producing more young doctors likely to kill
more patients and generate more work for the happy undertakers.
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"Our Merciless Millionaire.
Vanderbilt: The Public Be -- Doctored!"
cover of Puck, October 29, 1884 (author's
collection). |
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Puck was not opposed to medical charity; it campaigned
annually to raise donations for the hospital care of indigent
patients. But none of this money went for research and
education. And yet the following year, the low expectations
about medical care were overturned—and even Puck
would publicize the change.
Rabies was not a common disease in humans. Tuberculosis,
typhoid and diphtheria cases numbered in the thousands,
but rabies victims numbered only in the dozens. Yet it
was among the most feared of diseases since it was uniformly
fatal, and everyone knew that. After a child was bitten,
its parents could do nothing but worry and wait as the
wound healed and the weeks went by. Most victims would
have no further problems. But, in roughly six weeks, a
small number of those victims would develop symptoms of
nerve and muscle problems, swallowing difficulties (and
thus the hesitation to drink that provided the name hydrophobia),
and paroxysms of agitation and wild behavior that required
their being tied to their beds. Patients became exhausted
and died of asphyxiation and nervous collapse. This discouraging
course of symptoms was not an esoteric medical fact, but
a familiar reality in the popular consciousness. Rabies
deaths were regularly reported in the daily press with
articles detailing all these symptoms. Any new treatment
that would successfully pull victims of dog bites back
from death's door was an invention that ordinary people
could enthusiastically endorse. But how did a small-scale
experimental treatment in Paris become America's first
medical breakthrough?
In October 1885, newspaper articles on Pasteur's feat
were scientific reports, respectful if not large or prominent.
Then in early December a mad dog ran furiously through
the streets of Newark, New Jersey, biting several other
dogs and six young children. In an era when hundreds of
thousands of stray dogs lived in large cities, such events
were commonplace. But this was the first such calamity
since Pasteur's announcement. Within hours, a local doctor
told the newspapers that the children's parents should
take them to Paris immediately. If the families could
not afford the trip, he said, there should be a public
campaign to raise the necessary funds. Within a few hours
the doctor received a collection from the employees of
a local manufacturing plant. Within 24 hours, sufficient
funds arrived as nickels, dimes, and dollars from ordinary
folks. The penny press loved the story and all the newspapers
of New York competed for special angles on it. Their articles
were reprinted in out-of-town papers all across the US.
The trip to Paris by four working class boys was an enormous
media sensation. For example, on some days a full ten
percent of the New York Herald was given over to
one rabies story or another.
The pictorial press grabbed the story too. News drawings
and humorous cartoons appeared in Harper's Weekly,
Frank Leslie's Weekly, The New York Daily Graphic,
and the National Police Gazette.
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"M. Pasteur. An Inoculation
for Hydrophobia," Harper's Weekly,
December 19, 1885 (author's collection). |
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Puck quickly ran jokes about the excitement
of going to Paris for the latest cure, of rich folks
taking their pet dogs to Paris for treatment to prevent
their getting or giving rabies, about doctors putting
the skeleton aside in medical education and studying
virus and inoculation instead, along with laboratory
experiments on rabbits.
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"The Pasteur Boom -- High
Time for Hydrophobists," back cover of
Puck, December 23, 1885 (author's collection). |
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When the boys returned hale and hearty from Paris a
few weeks later, they became the toast of the town --
and the country! The new celebrities were exhibited
in theaters and dime museums not only in New York City,
but as far west as Chicago and St. Louis. Crowds paid
ten cent just to hear the boys tell of their Atlantic
voyages and how Pasteur had saved their lives. (for
more information, visit http://www.pasteurfoundation.org/index.html
and click on "Pasteur and the United States a History.")
The media bonanza lasted for months and took many forms.
New York's famous wax museum, the Eden Musée,
created a Pasteur Group, showing the great chemist supervising
a physician injecting rabies virus into a child. Judge
magazine ran a political cartoon in which reforming
President Grover Cleveland was portrayed in the guise
of Louis Pasteur, vaccinating the Democratic Party to
protect it from the spoils system.
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"Pasteur Cleveland Vaccinating
Democracy," detail from "Judge's
Wax-Works -- The Political Eden Musée,"
centerfold in Judge, February 20, 1886
(author's collection). |
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Such human interest stories gave the main momentum
to the media bonanza that continued for several months.
But thousands of words and quite a few pictures were
devoted to explaining this new kind of laboratory-based
scientific research. And less than a month after the
dog bites on the streets of Newark, groups of physicians
in three different cities (New York, Newark, and St.
Louis) began efforts to establish American Pasteur institutes
in which the immunizing material for the rabies shots
could be produced. Such a supply would save the lives
of the countless victims who could not afford to go
to Paris, or would not get there in time for the treatment
to work.
All this publicity and the public conversations that
ensued had a profound effect on people's thinking. It
reversed the assumption that older doctors and older
medicines were better than new ones. It created a new
expectation that medicine can and should change, that
progress is to be expected, that the new advances would
come from laboratory experiments on animals, and that
specific injections would be a major tool of the new
medicine.
The rabies breakthrough set this paradigm in place,
and new medical discoveries soon followed it: tuberculin
treatment for consumption, diphtheria antitoxin, and
the X-ray. The press and the public saw these innovations
as part of the new model of constantly improving medicine.
(Hansen 1999, Howell 1995). After the turn of the century,
injections for typhoid and meningitis were added to
the list of innovations. Vitamins then emerged as another
powerful product of laboratory research. In the 1920s
injectable insulin saved emaciated patients and restored
them to blooming health.
Living as we do after the introduction of penicillin
in the 1940s, followed by polio vaccines in the 1950s,
and then organ transplants and artificial organs, the
medical inventions of the nineteenth century cannot
easily compete for our attention or that of our students.
But the stories of ether surgery and of rabies shots
-- and especially of public reactions to them at the
time -- offer intellectual tools for understanding the
present as well as the past. These inventions make clear
that a full appreciation of a medical invention (then
or now) requires that we attend carefully to social
and cultural meanings of the device, to the rate of
implementation by specialists, and to the feedback the
specialists get from the wider community. Sometimes
the biggest inventions had only limited effects at the
time. And at least once, a modest discovery caused enormous
transformations in ideas and institutions far beyond
the disease it aimed to cure.
# # #
| For links
to further resources, including additional
images and paintings of nineteenth century
medicine, visit our Additional
Resources Page |
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REFERENCES CITED
Fenster, Julie M. (2001). Ether Day: The Strange
Tale of America's Greatest Medical Discovery and the
Haunted Men Who Made It (HarperCollins Publishers,
2001)
Hansen, Bert (1998). "America's First Medical
Breakthrough: How Popular Excitement about a French
Rabies Cure in 1885 Raised New Expectations of Medical
Progress," American Historical Review
103:2 (April 1998), 373-418.
Hansen, Bert (1999). "New Images of a New Medicine:
Visual Evidence for Widespread Popularity of Therapeutic
Discoveries in America after 1885," Bulletin
of the History of Medicine 73:4 (December 1999),
629-678.
Howell, Joel D. (1995). Technology in the Hospital:
Transforming Patient Care in the Early Twentieth Century
(Johns Hopkins University Press, 1995).
Lowry, Bates, and Isabel Lowry (2005). "Simultaneous
Developments: Documentary Photography and Painless Surgery,"
a chapter in Grant B. Romer and Brian Wallis, Young
America: The Daguerreotypes of Southworth and Hawes
(New York: International Center of Photography, 2005).
Pernick, Martin S. (1985). A Calculus of Suffering:
Pain, Professionalism, and Anesthesia in Nineteenth-Century
America (Columbia University Press, 1985).
Wolfe, Richard J. (1993). Robert C. Hinckley and
the Recreation of The First Operation Under Ether
(Boston: Boston Medical Library in the Frances A. Countway
Library of Medicine, 1993).
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