ALTHOUGH Boston is well known for its place in the history of anesthesiology, many people do not know that a monument in the city exists to commemorate the first public demonstration of ether anesthesia (fig. 1). In fact, in decades past, every Bostonian knew of the monument erected in 1868 to honor the great discovery.1But today, the structure is often overlooked. There are even some in the field of anesthesia who are unaware of its existence. In the historic Boston Public Garden, the Ether Monument sits with its marble and granite images and inscriptions addressing universal themes: the suffering caused by war, the desire on behalf of loved ones to relieve pain, and the triumph of medical science. It is a declaration of the advancements ether brought to society.
Perhaps no other monument related to the origins of American medicine is so rich in history, controversies, and allegories. Unfortunately, both human memory and “what is written in stone have no necessary permanence unless successor generations can be successfully socialized to view [them] as less evanescent than a flag waving in ever-changing winds.”2The purpose of this article is to present a historical overview of the origins and significance of the Ether Monument.§
Why Build a Monument to Ether?
Imagine the sense of awe and pride when news of William Thomas Green Morton’s (1819–1868) public demonstration spread throughout the world in 1846. This event heralded the end of “a time when surgery was torture, and a serious operation to be dreaded only less than death itself.”3For centuries, pain prohibited surgical advances and consumed patients. Ether was praised in relieving mankind of horrific experiences. Johann Friedrich Dieffenbach, M.D. (Professor, Department of Surgery, University of Berlin, Berlin, Germany; 1792–1847), a surgeon in the 19th century, stated, “pain, the highest consciousness of our earthly existence, the most distinct sensation of the imperfection of our body, must bow before the power of the human mind, before the power of ether vapor.”4
The scientific efforts that the discovery represented were noted by Henry Jacob Bigelow, M.D. (Professor Emeritus, Department of Surgery, Harvard Medical School, Boston, Massachusetts; 1818–1890), who was present at Morton’s demonstration. At the dedication of the Ether Monument, he stated that the success of the ether demonstration was a “final and conclusive test in a close and connected series of successful experiments, which proved that pain could be annulled, first, with certainty, no matter who the individual; second, with completeness, no matter how great might be its degree; and third, with safety. These three points were all absolutely involved in the discovery and these alone.”5The historical impact of the experiment was clearly evident.
Naturally, Bostonians wanted to record this achievement for the ages. They chose to erect the Ether Monument to immortalize the success of ether, a discovery that would lead to further triumphs in both surgery and infection control.6How fitting that the actual word “monument” stems from the Latin monere , or “to monitor,” a task that physicians, especially those in the field of anesthesiology, skillfully perform. Monere also means “to remind” or “to warn.”7The monument serves as a reminder of the great things science and medicine have contributed to humankind.
There was great reason for the Ether Monument to be built, but it was not without its controversies and opposition. Morton wanted credit for the discovery, but Horace Wells (1815–1848) and Morton’s advisor, chemist Charles T. Jackson, M.D. (Professor, Harvard Medical School, Boston, Massachusetts; 1805–1880), both claimed the distinction belonged to them. This debate has been referred to as “the ether controversy.”8Oliver Wendell Holmes, M.D. (Professor, Harvard Medical School; 1809–1894) handled the dispute diplomatically, when he famously stated that the monument was to “ether or either,” alluding to the claimants of the discovery.9However, Mark Twain (1835–1910) unambiguously opposed Morton. He believed that “there in Boston is a monument to the man who … stole the discovery from another man … the monument is made of hardy material, but the lie it tells will outlast it a million years.”10But Twain was not entirely correct, because the Ether Monument makes no mention of any of the claimants, but rather is solely a commemoration of the first effective public demonstration of ether anesthesia. It is a tribute to the contribution of ether to greater society.
Although the Massachusetts General Hospital can declare the Ether Dome for itself, Bostonians and society at large can lay claim to the Ether Monument. In a recent article, Jason Campagna, M.D., Ph.D., states, “the uniqueness of the ether event in 1846 Boston rests … not with the fact that it was conceived or occurred at the Massachusetts General Hospital. Rather, it rests on the fact that the demonstration occurred in a place where afterwards it would be understood and accepted. It is this framework of acceptance that ultimately explains why Boston was the venue for the introduction of ether to the world and why history has conferred upon Boston the eternal thanks of man in his quest to relieve suffering.”11
A Gift of Thomas Lee
It was almost 20 years after Morton’s first public demonstration of ether when Thomas Lee, Esq. (1779–1867), commissioned Boston architect Henry Van Brunt (1837–1903), of the distinguished Ware and Van Brunt firm, to build the Ether Monument. Thomas Lee was a private citizen who valued public art. Although Mr. Lee was a friend of Dr. Bigelow and donated funds to Harvard Medical School, there is no indication of any personal experience that might have motivated his commission of the Ether Monument. After much of the basic design was completed, Henry Van Brunt then asked John Quincy Adams Ward (1830–1910), who has been called the “Dean of American Sculpture,” to sculpt the crowning figure of the monument with “some symbol of the relief of suffering, using perhaps the Good Samaritan as the most recognizable type.”12The monument was intended to symbolize the contribution of ether to the well-being of humanity. In February 1866, John Quincy Adams Ward accepted this commission and signed the contract with Thomas Lee. The Albany Institute of History and Art (Albany, New York) maintains the collection of original letters and documents pertaining to the commissioning and design of the Ether Monument.
With plans to build the monument in the works, Thomas Lee wrote a letter to the Mayor of Boston at the time, Frederick W. Lincoln, Jr. (1817–1898). He described the proposed monument “as an expression of gratitude for the relief of human suffering occasioned by the discovery of … ether.”13Boston notables appreciated the ramifications of the discovery and quickly approved the plans to commemorate the event in the form of a public statue. Bostonian sentiment was expressed on March 19, 1866, when Mayor Lincoln wrote that the monument serves as a “commemoration of the greatest medical discovery of our time—the application of the properties of ether to the alleviation of pain and human suffering…. The benefits of ether are for all mankind; it is used throughout the world, wherever scientific medical and surgical treatment is practiced; and while its early history might seem to justify a certain degree of local pride, yet the monument in itself will be an expression of gratitude and thanksgiving.”13The monument was not only a gift for the people of Boston, but is rather a gift to all of those who would benefit from the discovery’s lasting effects.
Not only were Bostonians proud of the anesthetic, but they understood the far-reaching implications of the demonstration, which proved that the relief of suffering was possible. In his speech at the dedication of the Ether Monument, Dr. Bigelow did not overvalue the importance of ether when he said, “… and in grateful and unhesitating recognition of [ether] the entire civilized world simultaneously rose up to hail it with acclamatory welcome.”5
The Allegories of the Monument
Because the Ether Monument stands to recognize the impact of anesthesia on society, the details of the monument also serve as symbols of the medical profession and the intended use of ether. At the base of the monument, a series of lion-faced fountains feed into a large basin. Mayor Lincoln likened this basin to the pool of Bethesda, a Biblical place where the sick waited to be cured of their diseases. Similarly, at the crest of the monument stands the figure of the Good Samaritan, from the Gospel of Luke (10:25–37), which encompasses the notion of helping a neighbor in need or bestowing mercy on others (fig. 2). The artists left no written interpretations of the allegories used in the Ether Monument, except for Henry Van Brunt’s suggestion to John Quincy Adams Ward to use the Good Samaritan motif.
John Quincy Adams Ward also designed the four marble reliefs that were set on each side of the monument. The reliefs facing north, south, east, and west depict a wounded soldier in a field hospital (fig. 3), a patient undergoing an operation in a civic hospital (fig. 4), the Angel of Mercy descending to relieve suffering humanity (fig. 5), and the Triumph of Science (fig. 6), respectively.
At the time the Ether Monument was commissioned, memories of the Civil War were still fresh. Therefore, the reliefs facing the north and south address the significance of general anesthesia during wartime.5In fact, the first anesthetic in a military conflict was administered 6 months after Morton’s demonstration. In the spring of 1847, Edward H. Barton, M.D. (1790?–1859), gave anesthetic relief to an injured teamster whose legs had been shattered by the accidental firing of a loaded musket during the Mexican-American War.14At that time, however, ether was not universally used because of accounts of exsanguination and poisoning and a belief that ether in the war setting was “universally injurious.”14It took the American Civil War, beginning in 1861, to propel the widespread use of anesthesia.15Fifteen years after Morton’s demonstration, he was authorized by the Surgeon General and General Ulysses S. Grant (1822–1885) to deliver anesthesia in the battlefield.16In fact, Morton is considered to be among the first military anesthetists, because he dedicated himself exclusively to administering anesthetics during the war.17,18Contrary to the concerns regarding ether in the Mexican-American War, the number of anesthetic mishaps during the Civil War, in which both ether and chloroform were used, was remarkably low. Despite the flammability of ether and its danger on the battlefield,19only 43 deaths were reported out of 9,000 cases where the specific anesthetic agent used was known. Most of these cases were attributed to the use of chloroform.16Civic hospitals were often also filled with wounded soldiers on whom anesthesia was used in the surgical theater, which is depicted in the south-facing relief of the monument. Considering how much pain and suffering were alleviated during war, it would be unthinkable to return to the period of preanesthetic surgery when “the band was ordered to play, so that the lamentations could not be heard.”14
More abstractly, the allegorical bass-relief on the east-facing side of the monument depicts the Angel of Mercy descending upon humanity to relieve suffering. The inscription below reads “neither shall there be any more pain” from Revelation 21:4. Another allegory of the benefit to society is shown on the west-facing side of the monument, which portrays a female figure in classical robes to personify the Triumph of Science.12
Ironically, although religious symbolism is used to memorialize the demonstration of ether, at the time when ether was introduced, there was initial religious and moral uncertainty regarding the relief of physical pain. Some people believed that eliminating pain was the work of Satan because historically pain was considered a manifestation of salvation and a means of divine punishment for sin.20In the 1840s, the opponents to anesthesia greatly anticipated that without pain, the fear of God would vanish and humankind would sin.11Even William Henry Atkinson (1815–1891), the American Dental Association’s first president, strongly resisted the use of ether when he remarked, “I think anesthesia is of the devil, and I cannot give my sanction to any satanic influence which deprives a man of the capacity to recognize the law! I wish were there no such thing as anesthesia! I do not think that men should be prevented from passing through what God intended them to endure.”21Science and religion were at odds over the discovery of ether.
The role of anesthesia in childbirth was particularly controversial because the Western Christian belief was that God intended for women to endure pain during childbirth as the “Curse of Eve.”20Genesis 3:16 states, “in sorrow thou shalt bring forth children.” On the other hand, religious supporters of anesthesia argued that God Himself performed the first operation under anesthesia, citing Genesis (2:21) as well: “the Lord God caused a deep sleep to fall upon Adam and he slept: and he took one of his ribs, and closed up the flesh instead thereof” to create Eve.22It must be noted that although early and widespread religious opposition to anesthesia is frequently mentioned, there is scant evidence supporting this claim. The religious antagonism may have been exaggerated and has been referred to a “myth of historiography.”23In any event, the bulk of controversy came to an end in 1853 when John Snow, M.D., L.R.C.P. (1813–1858), administered chloroform to Queen Victoria (1819–1901) during the birth of Prince Leopold (1853–1884).11Afterward, it was considered entirely proper and socially acceptable to treat obstetric pain.20By the time the Ether Monument was erected, the use of anesthesia was no longer considered religiously abominable, and inscribed on the western face of the monument is a quote from Isaiah 28:29 that reads, “This also cometh forth from the Lord of Hosts.”
The Current State of Affairs
Although the monument itself and its inherent philosophies and ideals conjured up some controversy, it was accepted by the City of Boston with pride. On the day of its dedication, Mayor Nathaniel B. Shurtleff, M.D. (1810–1874), promised that the Ether Monument “shall be watched with care and protected from injury.”13He expressed his hope that “this elegant structure long remain unimpaired by time—a memorial of the greatest boon ever vouchsafed to suffering humanity, and a monument of the gratitude of one of Boston’s most worthy citizens.”13Despite these early sentiments, the monument has deteriorated over the years. This meaningful piece of public art has not been wholly maintained because of insufficient funding.
During the late 1970s, the late Leroy Vandam, M.D. (Professor Emeritus, Department of Anesthesia, Harvard Medical School; 1914–2004), and others recognized the monument’s misfortunes and led a restoration effort with donations from private individuals and professional anesthesiology organizations. Enough money was raised to restore the fountain’s broken water line. At that time, Henry Lee, a descendent of Thomas Lee, stated that once more the “monument looked bright” (written communication, Henry Lee, President, Friends of the Public Garden, Boston, Massachusetts, January 2006). Nevertheless, it was only a matter of time before the monument again deteriorated without upkeep. Soon, the water line broke, and the fountain needed a new pump. The “Bethesda pool” became a refuge for litter and stagnant rainwater. Therefore, in the mid-1990s, a new generation of anesthesiologists initiated another fund-raising campaign for the monument’s restoration, which will be contributed to current restoration efforts.24Recently, the City of Boston has committed to the monument’s complete restoration, including reengineering the fountains, reconditioning the surface, and adding illumination for night viewing. There is renewed enthusiasm since the municipal government has allocated funds for the restoration project, which is scheduled to be completed in the fall of 2006.
However, the Ether Monument must be routinely maintained to preserve its majesty for future generations. It has become increasingly clear that past restoration efforts, although commendable, have only been palliative treatments to periodic crises. Since its erection, the Ether Monument has endured a vicious cycle of neglect and periodic crises before money is raised for restoration. The Heritage Preservation of Washington, D.C., a national historical conservation organization, states that this kind of intermittent care results in the further loss of original material and necessitates more expensive stone treatments. The Parks Department of the City of Boston has allocated approximately $250,000 for the renovation of the Ether Monument and will reengineer the fountains, recondition the granite and marble surfaces, and add lighting for night viewing. The Solomon Fund, the Massachusetts Society of Anesthesiologists, the Friends of the Public Garden, Anesthesia Associates of Massachusetts, and private individuals have also committed to continuing the endeavor to preserve the Ether Monument by dedicating significant resources. An endowment has been created to ensure the continuous maintenance of this symbol for anesthesiology. The Ether Monument commemorates a universal appreciation for the relief of suffering with the introduction of anesthesia, now common practice, but it also symbolizes community and altruism, enduring ideals that will hopefully be long preserved in granite.