Henry Jacob Bigelow (1818–1890)

Abstract

Prior to the advent of anesthesia, surgery was limited in scope due to the excruciating pain experienced by patients. This raised challenges for surgeons who were distressed by the inadvertent suffering caused by surgery. The first successful use of ether anesthesia by William Thomas Green Morton (1819–1868) in 1846 at Massachusetts General Hospital was a turning point for the profession. The innovation and proliferation of operations catalyzed by the introduction of anesthesia altered the landscape of surgical practice. Initially, the introduction of ether into the field was met with hesitation and resistance by several parties in the medical field. It took the efforts of prominent surgeons to ensure that ether achieved its full potential. The greatest supporter of ether during this epoch was the young surgeon Henry Jacob Bigelow (1818–1890), who spent 30 years of his career advocating for and experimenting with anesthesia. The efforts of Bigelow, a gifted surgeon renowned for his contributions to orthopedic surgery, were instrumental in the promotion of anesthesia and the advancement of the surgical profession. In this article, we discuss the life, career, and contributions of Bigelow, particularly in the context of the introduction of modern anesthesia.

INTRODUCTION

October 16, 1846, subsequently referred to as Ether Day, marked a new era in the surgical treatment of disease. On this momentous day, William Thomas Green Morton (1819–1868) conducted the first successful public demonstration of surgical anesthesia at Boston’s Massachusetts General Hospital (MGH). The events that occurred on Ether Day were reported by surgeon Henry Jacob Bigelow (1818–1890) (Fig. 1) in an article published in the Boston Medical and Surgical Journal, the predecessor of the New England Journal of Medicine (NEJM). Bigelow was a surgeon in the mold of his time with the mind of a youthful visionary who envisaged the opportunity to expand the scope of surgery. He had been following Morton’s progress and saw in ether the opportunity to bring surgical practice into a new era. Bigelow considered pain as a major barrier to surgical progress; thus, he was determined to continue Morton’s legacy.

FIGURE 1.

Henry Jacob Bigelow (1818–1890). Portrait by J.H. Lazarus. Courtesy of the Trustees of the Boston Medical Library.

Among his colleagues, Bigelow was an early proponent who was the driving force behind the implementation of anesthesia in surgical practice. He would subsequently carve out a successful career with a focus on orthopedic surgery: he is credited with the first descriptions of the anatomical structure and function of the iliofemoral ligament. In this article, we describe the life, career, and contributions of Bigelow, particularly as they relate to the introduction of modern anesthesia.

EARLY LIFE AND EDUCATION

Henry Jacob Bigelow was born on March 11, 1818, in his family home on Summer Street in Boston.¹ He was the oldest of 5 children: 3 boys and 2 girls, born to Jacob Bigelow (1787–1879) and Mary Scollay Bigelow (1793–1882).^1,2 Jacob Bigelow was an esteemed physician, scientist, academic, and botanist who graduated from Harvard College in 1806 and received the Doctor of Medicine degree from the University of Pennsylvania in 1810. He was professor of Materia Medica in the Medical School of Harvard University, a post he held from 1815 to 1865.² A several-time recipient of the Boylston Prize for essays on various medical topics, Jacob Bigelow was renowned in Boston and the field of medicine at large.³ His medical inclinations, ambitions, and career success were passed on to his oldest son.

Henry Jacob Bigelow began his education at a children’s school before attending a private school under Gideon F. Thayer (1793–1855) that later became Chauncy Hall School.⁴ Bigelow then became a pupil of Frederick P. Leverett (1803–1836) at the Boston Public Latin School and subsequently followed Leverett when he established his own private school in 1831. It was here that Bigelow completed his secondary schooling.⁵ Following the footsteps of his father, Bigelow entered Harvard College in 1833 and graduated in 1837.¹ His school peers described him as handsome, thin, athletically gifted, and charismatic.² Bigelow traveled to Europe to study in Paris and London in pursuit of his medical degree, which he received from the Medical School of Harvard University in 1841.¹

SURGICAL CAREER AND CONTRIBUTIONS

In the following years, H.J. Bigelow continued his studies in Europe. He returned to Boston in 1844 and began his surgical practice on Summer Street, close to his childhood home. Later that same year, he was awarded the prestigious Boylston Prize for his essay entitled “In what cases, and to what extent, is the division of muscles and tendons, or other parts, proper for the relief of deformity or lameness?” This essay was published the following year in the Manual of Orthopedic Surgery.⁶ In 1845, another honor bestowed upon Bigelow was his election as President of the Boylston Medical Society, an organization involving Harvard medical students. Around this time, Bigelow and his colleague Henry Bryant established a charitable surgical institution in the basement of the First Church on Chauncy Place with the aim of caring for and operating on patients for free.²

On January 28, 1846, Bigelow was appointed as a visiting surgeon at MGH. The hospital had recently increased its capacity by nearly twofold; hence, there was a pressing need for the recruitment of new physicians.² The opportune timing of this appointment enabled Bigelow to be present for W.T.G. Morton’s display of ether anesthesia at the hospital later that same year.

Throughout his career, Bigelow made numerous contributions to the field of orthopedics and medicine in general, including descriptions of types of fractures and dislocations, reports of novel cases, and summaries of the techniques and instruments used in his procedures.⁷ He famously described in detail the structure and function of the iliofemoral ligament, which carries his name. He is also credited with the development of the Bigelow maneuver for closed reduction of hip dislocation, as well as an unrelated technique termed lithotrity. This technique allowed surgeons to crush and remove stones from the bladder in a single procedure, thereby reducing potential pain and complications arising due to the displacement of stone fragments.⁸

Bigelow viewed himself and the medical field of his time within its historical context, which was a contributing factor to his incessant quest for novel procedures and anesthetics. He was dissatisfied with the prevailing zeitgeist and oriented his vision toward the future. During one after-dinner speech in London, he remarked that “it is well sometimes to look forward and ask what the medical men of a hundred years hence will probably think of the medical attainments of our generation. […] If the inevitable progress of the next century is going to place our descendants as far in advance of us as we believe ourselves to be in advance of our forefathers, the self-congratulations of the present occasion might be chilled by a premature vision of what the future has in store for our children.”² Bigelow’s fascination with and promotion of anesthesia would ultimately exert the greatest impact in the field of surgery.

ETHER ANESTHESIA: A WINDOW FOR SURGICAL EXPANSION

Bigelow considered pain and infection as the primary barriers preventing the widespread use of surgery for treating a wider range of diseases. He was frustrated by the limited indications for surgery and began searching for ways to increase the number and effectiveness of surgical procedures.⁹ At the time, the study of pathology was in its infancy and the relationship between physiology and surgery was poorly understood. Bigelow recognized that surgery promised greater breadth of applicability with significant advancements. He was driven to lead the field of surgery into a new era. When he heard of Morton’s experimentation with ether anesthesia, he saw the opportunity to permanently change the way surgery would be performed.

Bigelow’s article, published on November 18, 1846, was the first to announce the successful use of ether for general anesthesia during surgery (Fig. 2). The article was entitled “Insensibility During Surgical Operations Produced by Inhalation” and was published in the Boston Medical and Surgical Journal that subsequently became NEJM, one of the most renowned medical journals in the world.¹⁰ In the article, Bigelow described the operation performed by John C. Warren (1778–1856) on October 16, 1846, in which a mass of blood vessels was removed from below the patient’s jaw. The patient, Edward Gilbert Abbott (1825–1855), had presented at MGH on September 25, 1846, for evaluation of a tumor on the left lobe of his tongue that had plagued him since birth.¹¹ He was admitted to the hospital for 22 days as preparations were performed for the procedure. W.T.G. Morton had prepared the anesthetic agent to be inhaled in a glass globe and administered it as such prior to the first incision.¹² According to Warren, the patient did not seem to experience pain while the incision was made but did start to move and make noises during the dissection of the veins.¹³ Bigelow recounted similar details, and they both confirmed that following the operation, the patient reported awareness of what had transpired. This use of the anesthetic agent was considered only a moderate success by Bigelow; however, it was employed again on the following day, an endeavor that he referred to as a “complete success.”¹²

FIGURE 2.

“Insensibility During Surgical Operations Produced by Inhalation” by Henry Jacob Bigelow. Courtesy, The New England Journal of Medicine.

This second operation was the removal of a fatty tumor from the arm of a patient performed by George Hayward (1791–1863). Hayward recounted that the patient remained insensible during the entire, albeit short, operation.¹⁴ As a result of these 2 operations, Bigelow became convinced of the efficacy of ether for producing insensibility and anesthesia during surgery. In the remainder of the published article, Bigelow described the methods by which ether was employed, comprising experiments that he subsequently conducted and dentistry cases of Morton’s that he had observed, during which patients did not experience pain. Bigelow recounted a third procedure that was conducted on November 7, 1846, in which Hayward performed an amputation with ether. This operation was remarkable in that it was the first time Morton officially announced that the anesthetic agent he was using was indeed ether.¹⁵ Due to this fact and the depth of anesthesia observed in this patient, this third operation was regarded by some as the true proof of the anesthetic benefits of ether.¹⁶

Bigelow’s article marked a major turning point in the historical course of surgery. In the years following Morton’s demonstration, Bigelow would administer most of the ether used at MGH.² The late Edward Clarke (1820–1877) remarked: “He did more than any other living person to bring it before the medical public of this country and of Europe, to assert its real value, and to point out the best methods of utilizing it.”² Bigelow recognized the value of ether as a drug that would enhance the scope of surgical practice by catalyzing the use of anesthesia during invasive procedures. Of his first 34 contributions to medical literature mentioned in his memoir, 13 were primarily concerned with anesthetic techniques. He was deeply committed to fostering the use of anesthesia in surgical practice.

The advent of anesthesia, along with growing awareness of several causes and mitigating practices for sepsis, resulted in rapid growth of treatment options available to surgeons.¹⁷ The use of anesthetic agents facilitated the innovation of many complex surgical operations, some of which had been attempted for decades. While these new anesthetics were being developed, surgical techniques continued to evolve at a remarkable pace. The exchange of information and ideas regarding surgical practice was expanding internationally, and surgical innovation was on the cusp of a large surge.¹⁸ Shortly after Bigelow’s report was published, the first successful hysterectomy was performed using chloroform in 1855.^19,20 This was followed by the first thyroidectomy in 1880, and the first brain tumor resection was performed by Rickman J. Godlee (1849–1925) in 1884.²¹

Access to the abdomen has a long and controversial history in the field of surgery. Many critics denounced surgeons who performed abdominal operations as “belly-rippers.” Ovariotomies have been performed since the early 19th century, with mixed results and substantial disagreement among surgeons themselves.²² Although patient comfort was improved with the introduction of anesthesia, the rates of performing these procedures remained largely unaffected. The surgeon Thomas Spencer Wells (1818–1897) performed 104 ovariotomies between 1842 and 1863, both before and after Morton’s demonstration.²² Although it is difficult to ascertain the extent of the contribution of anesthesia to the development of abdominal procedures, anesthetic agents were soon implemented as standard tools in the operating room. New and intricate abdominal operations began to emerge, such as the first successful gallbladder lithotomy performed using chloroform in 1868.²³

In addition to innovation in operations, the field of surgery also witnessed cultural and stylistic changes. Prior to the advent of anesthesia, the speed and strength of the surgeon played a key role in the demonstrative aspects of the operation. Surgeons were celebrated for the amount of time it took them to complete an operation such as a limb amputation.²⁴ In the case of amputation, the surgeon’s ability to wield the sawing instrument and even the number of strokes needed were lauded.²⁵ The introduction of anesthesia, along with antiseptic practices, moved the field away from the “performance” of the operating theater. Physically, operations were moved into smaller rooms with fewer observers, allowing for more precise control. Surgical practice became slower and more meticulous, with a focus on discipline and scientific reproducibility.²⁴

SUPPORT OF MORTON

In the years following the demonstration on October 16, 1846, Bigelow was an ardent supporter of Morton’s claim to the discovery of ether as an anesthetic agent. This sentiment was evident in his writing and speaking engagements. One such piece, entitled “A History of the Discovery of Modern Anaesthesia,” was published in 1876 as part of the composite work “A Century of American Medicine.” In this work, Bigelow discussed 3 of the 4 claimants of the discovery of modern anesthesia, Horace Wells (1815–1848), Charles T. Jackson (1805–1880), and Morton. He proposed that in order to receive credit for the discovery of an anesthetic agent, the individual must have proven that the agent possessed 3 qualities: completeness, inevitability, and safety.²⁶

In 1844, Wells began studying nitrous oxide as an anesthetic. Bigelow recounted that Wells had requested permission from Warren to demonstrate the anesthetic properties of nitrous oxide to the medical school class in December 1844, prior to Morton’s demonstration. Wells’ demonstration involved the pulling of a tooth and was a complete failure according to Bigelow. He conjectured that Wells used a dose that was too low, as nitrous oxide was commonly used in dentistry. Bigelow performed a breast excision at MGH in April 1848 using nitrous oxide and recognized its anesthetic properties. However, he believed that Wells had not proven that nitrous oxide met the 3 requirements previously outlined. Wells demonstrated that nitrous oxide only occasionally caused insensibility, and he focused exclusively on tooth-pulling. Bigelow also referenced written correspondence between Morton and Wells, which transpired following Morton’s demonstration with ether. Morton wrote to Wells to inform him of his success. Wells replied immediately, cautioning him about managing the discovery appropriately such that Morton could maximize his profits from ether. Bigelow considered this letter as proof that Wells did not believe nitrous oxide had any anesthetic value. Ultimately, Bigelow believed that Wells had not made a significant contribution to the discovery of modern anesthesia and stated that “Wells’ anesthesia had no value to patient, dentist, or surgeon.”²⁶

Jackson, who claimed to have discovered ether in 1842, similarly received no credit from Bigelow. Multiple accounts claimed that it was Jackson who suggested sulfuric ether as an agent that could induce anesthesia to Morton in 1846.²⁷ However, Bigelow remained skeptical that Jackson was aware of the effects of ether at this time. Indeed, he did not believe that Jackson would have discovered this anesthetic agent without publishing it or putting it to use.²⁶

Bigelow believed that Morton was the person who deserved credit for the discovery of ether anesthesia. In “A History of the Discovery of Modern Anesthesia,” Bigelow praised Morton, labelling him as “earnest” and “persevering,” and highlighting his “determined persistence.”²⁶ He argued that Morton proved that ether met all 3 benchmarks of certainty, safety, and completeness.²⁶ In a letter from Bigelow to Speaker of the House, Robert C. Winthrop, on January 26, 1848, Bigelow argued that merely suggesting an agent should not confer credit to an individual and that it was Morton’s demonstrations that made him the worthy recipient.²⁸ He also testified in favor of Morton and his claim to the discovery in a deposition in 1853.¹⁵ Bigelow wrote candidly about his perspective on the discoveries regarding ether in no uncertain terms: “All that is new belongs to Morton.”²⁶

The fourth claimant to the discovery of modern anesthesia, Crawford W. Long (1815–1878), was not afforded the same recognition by Bigelow. Long reportedly began using ether as an anesthetic during surgical operations in March 1842, years before Morton. He documented his use of ether in an article in the Southern Medical and Surgical Journal published in December 1849. His first operation using ether as an anesthetic was a tumor removal performed on March 30, 1842, in a patient named James M. Venable. He later removed a second tumor from the neck of the same patient on June 6, 1842. Long reported that the patient did not experience pain during the first operation and only experienced slight pain during the second operation. In the second operation, ether administration was ceased prior to the first incision. Hence, Long decided to continue administration throughout the operation for subsequent cases. Long performed 1 more operation using ether in 1842 and at least 1 operation per year in subsequent years.²⁹

It remains unclear why Long did not publish his work prior to 1849 or enter the race for recognition sooner. In the Southern Medical and Surgical Journal article, he explained that he wanted to be certain that the effects he observed were indeed due to ether. He also notes that the opportunities for operations in which he could experiment were limited since he worked in the countryside in Georgia.²⁹ Long’s claims had staunch supporters, although Bigelow was not among them. In 1852, the Georgia Medical Society unanimously stated that “this society is of the opinion that Dr. Crawford W. Long was the first person who used sulphuric ether as an anaesthetic in operations.”³⁰

PROMOTION AND RESERVATIONS ABOUT ETHER ANESTHESIA

Bigelow stated that “dying is nothing, but pain is a very serious matter. The two great evils of life are ignorance and pain.”² Bigelow and Warren were both highly concerned by the often gruesome and painful sessions that accompanied surgery. They were eager to ease the suffering of patients to make surgery a more attractive and tolerable profession and to expand the scope of possibilities in surgical practice. Bigelow described his revulsion to accept that his patients may experience pain as follows: “In a surgical practice of twenty-five years, I have never intentionally given a patient, unless by his own choice, any unnarcotized pain, nor have I allowed a patient to die a death of pain, when opium would lull him into his long sleep.”³¹ Arthur T. Cabot (1852–1912) stated that “Dr. Bigelow’s own aversion to giving pain must have caused him to look back with peculiar pleasure upon his share in alleviating surgical suffering.”² Bigelow criticized the notion that surgeons must progressively become desensitized to the pain inflicted on patients: “It should not for a moment be supposed that cultivation of the intellect leads a man to shrink from inflicting pain. Many educated men are no more humane, are in fact far less so, than many comparatively uneducated people.”³²

Bigelow was perhaps the staunchest advocate of sulfuric ether, and he designed many of his own experiments under anesthesia. As an undergraduate student at Harvard, Bigelow developed nitrous oxide preparations to test on himself and his peers.³³ This may have piqued an early interest in anesthetic agents. In addition to writing an article announcing the events of Ether Day, he also wrote the first letter to Europe describing the discovery of ether. Indeed, he wrote on the subject of anesthesia for 30 years (1846–1876), leading the defense and proclamation of the immense benefits of surgical anesthetics. In one of his works, Bigelow discussed the physiologic properties of several hypothesized anesthetic agents that had been attempted. He described in detail how ether could best be utilized in different types of surgical operations and shared his experiences in an effort to encourage his colleagues to embrace it just as he had.³⁴ He publicly asserted his belief in the value of ether, stating “For the sake of humanity, if not of science, it is to be hoped that no hospital gates are barred against ether.”³⁵

There was scattered and intermittent resistance toward the acceptance of surgical anesthetics after Morton’s demonstration. This occurred for several reasons, including unfounded medical beliefs and complications that caused safety concerns. The discovery of ether was followed by that of chloroform in 1847. During this time, the use of anesthetic agents was decentralized, partly due to longstanding divisions within the medical field. A lack of clear guidelines on dosing and administration made it difficult to systematically investigate the effects of anesthesia. The performance of physicians and the condition of patients were rarely considered when reporting negative outcomes, and accounts of sudden cardiac death with chloroform administration led to significant uncertainty surrounding its use. Unexpected deaths were often attributed to the use of these new drugs, even several days after the operation. Some physicians were concerned about overdose, especially in children and pregnant patients, often due to religious viewpoints. Others opined that anesthetic agents poisoned blood and contributed to poor wound healing. It was not until the early 20th century that British hospitals began teaching anesthesia during their clerkships. In the following years, the side effects of anesthetic agents would become better understood and improved due to greater regulation.³⁶

There was also a prevailing fear that rendering patients unconscious would lead to increased surgical errors. In many operations, patients were previously able to advocate for themselves and direct surgeons toward surgical sites. Patients could also request to alter the extent of the surgery intraoperatively. In this regard, unconscious patients would not be able to make such contributions. In some cases, rivalries delayed the introduction of anesthesia. In the United Kingdom, regional preferences between ether and chloroform emerged. Philadelphia had a long-running medical rivalry with Boston, and anesthesia was considered a “Boston phenomenon.” Philadelphia Hospital prevented its physicians from providing anesthesia for 7 years, it “being considered by the judicious surgeons of that institution as a remedy of doubtful safety,” as reported by the Philadelphia Medical Examiner.³⁷ In the 9 years following the introduction of anesthesia to Pennsylvania Hospital in 1853, approximately a third of limb amputations were still performed without the use of anesthetic agents.³⁶ In 1847, the New York Journal of Medicine and the Collateral Sciences warned that ether “is not safe even when administered in a skillful manner. […] Serious and almost fatal consequences have followed the inhalation of it.”³⁷

Many notable physicians feared that ether was poisonous when inhaled in amounts that were necessary to produce an anesthetic effect. For example, the American Journal of the Medical Sciences published several articles written by army surgeon John B. Porter, who stated that “the blood is poisoned, the nervous influence and muscular contractility is destroyed or diminished. […] Hemorrhage is much more apt to occur, and union by adhesion is prevented.”³⁷ Some physicians also doubted whether anesthetics eliminated pain at all or whether the effects could be described more accurately as a partial paralysis followed by amnesia.³⁷

These issues were compounded by personal rivalries, religious biases, and sectarian divisions among American physicians that precluded the widespread acceptance of innovations in medicine.³⁷ In this regard, Bigelow’s role in advancing the use of ether anesthesia cannot be overstated. As Henry G. Clark (c1804–1892) stated in his annual address at the Massachusetts Medical Society in 1868, “the world does not know, nor will it until the true history of the use of ether in this case comes to be written, how near to a lost opportunity this was; nor how much it was indebted for its triumphant success … to the sagacity, the adroitness, and the energetic remonstrances against the obstructive etiquette and red tape which imperiled everything, of the then junior, and now senior, surgeon of the hospital, Henry J. Bigelow.”² By all accounts, Bigelow was a surgeon who was exceptionally gifted, took great pleasure in his work, and was deeply affected by the often-torturous experiences of his patients. He dedicated significant time and attention to ensuring that surgical anesthesia would gain a permanent foothold in his profession.

At his home institution, Bigelow endeavored to convince his fellow surgeons to use ether for their surgical cases immediately after Morton’s demonstration. He was instrumental in promoting the use of ether in the amputation performed by Hayward on November 7, 1846, which was described in the announcement article. According to Bigelow, Morton had been requested not to be present for this operation, but Bigelow invited him regardless and successfully convinced Hayward that ether should be used.²⁶ His influence extended beyond his colleagues, as he also promoted the use of ether in lectures he gave at Harvard Medical School. He argued for ether as the preferred anesthetic agent, especially over chloroform; indeed, he cited the dangers of the latter and referred to the former as “a perfect anesthetic.”³⁸

Despite his unequivocal support for Morton and the use of ether, Bigelow had reservations about how anesthesia would be used in the years to come. He saw in anesthesia the opportunity for exponential growth in surgical techniques, but equally, the opportunity for misuse and malpractice. He supported a reasonable introduction of anesthesia into the surgical field, supported by clear data and indications. In a lecture given on November 6, 1849, he described that in the past, pain was the major factor that prohibited many operations. As this was no longer the case due to the use of anesthesia, Bigelow cautioned against operating unnecessarily. He encouraged future physicians to continue the practice of avoiding surgery whenever possible by suggesting that they consider the risks they would be willing to endure if they themselves were patients.³⁹ Despite his cautionary remarks, Bigelow’s stance on the importance of introducing anesthesia to the field of surgery was never in question. He characterized it as “the discovery which annulled the physical suffering of man.”³⁹

At Bigelow’s death, the physician Oliver Wendell Holmes (1809–1894) starkly highlighted this achievement when he said of the surgeon: “No person took hold of Dr. Morton’s discovery with such far-seeing, almost prophetic appreciation, as the young surgeon who had been but a few years in practice, and who threw all the energy of his early manhood into his advocacy of the new and startling innovation which was destined to change the whole aspect of surgery. It was not merely by his sagacious foresight that he recognized the importance of this epoch-making novelty, but throughout its subsequent history he was the foremost champion of artificial anaesthesia,” an anesthesia that would breathe new life into surgery.²

DISCUSSION

As a bright young surgeon at MGH in the fall of 1846, Henry Jacob Bigelow was in prime position to observe the events of Ether Day and shape their impact thereafter. His article announcing the success on that day is known as one of the most influential articles ever published in NEJM. This was the turning point for the use of anesthesia in the surgical treatment of disease. Bigelow recognized anesthesia as a critical tool to alleviate the suffering of surgical patients; hence, he was eager to promote the use of such an agent. When ether anesthesia faced resistance from multiple directions, he was a strong proponent of its use among his contemporaries. He was critical of the various claims regarding the discovery of anesthesia and advocated only for the claimant that he believed deserved credit: Morton. The acceptance of ether anesthesia met resistance on the basis of safety concerns, fear of altering the landscape of surgical practice, and rivalries among the medical field. Bigelow faced this opposition by continuing to assert his position and encouraging his colleagues to adopt the use of anesthesia. Nevertheless, he had concerns about how anesthesia would be used in the future and cautioned against its abuse for unnecessary surgery. He believed that the onus lay with the surgeon to operate only when necessary and to always consider the risks, stating, “in the annihilation of pain, let not an equal force be now brought to bear against vitality alone.”³⁹ It was this quest to annihilate pain that fueled his passion for anesthesia. He believed that these advances necessitated the establishment of new standards for the surgical treatment of disease. To Bigelow, the role of the physician was not limited to medical care. Indeed, he stated that “science alone is inadequate to the duties of common practice. When the body is diseased the mind falters, and the invalid looks for sympathy, for heart as well as head, for the philanthropist and not the philosopher.”²

CONCLUSIONS

For most of its history, surgery as a profession was limited in its achievements, partly due to the inevitable suffering that its patients had to endure. The introduction of ether anesthesia and subsequent formulation of surgical anesthetics by pioneers such as Morton, Bigelow, and Warren contributed substantially to the diversification of surgery into the profession it is today. Surgeons found themselves with more time and precision to practice procedures that were once inconceivable, and the field became attractive to a new cohort of young physicians who may have otherwise been driven away by what they perceived as its gruesome nature. Henry Jacob Bigelow was an unrelenting supporter of anesthesia during a time when it faced significant resistance from traditional sections of the surgical field. Just 28 years old during the events of Ether Day, he was prescient enough to recognize the potential of anesthesia for alleviating patient suffering and unlocking the potential of his profession. It is imperative to recognize his contributions to both these fields and to celebrate the ways in which anesthesia has contributed to surgery since its inception. These fields are inseparable and in conjunction have pushed the boundaries of medicine to greater heights.

ACKNOWLEDGMENTS

E.M.M. and K.G.M. participated in the performance of the research and writing of the article. T.B.L. participated in the performance of the research. M.S.D. participated in the research design, performance of the research, and writing of the article.