William T. G. Morton, MD, (1819–1868; dentist, Boston, MA) used several ether inhalers after his initial success with ether on a handkerchief, the anesthetic he administered to Ebenezer H. Frost (1824–1866) on September 30, 1846, for the extraction of a tooth. The precise design and dimensions of the inhaler that Morton used on October 16, 1846, at Massachusetts General Hospital, Boston, MA, are not known. Illustrations of the inhaler he may have used on that day vary from a glass globe with a wooden spigot1 to a glass globe with valves and a glass mouthpiece.2
In 2009, 3 ether inhalers that were associated with Morton were described.3 The whereabouts of one of the inhalers, referred to as inhaler A (Figs. 1 and 2), was not known when the article was written. The photographs of the inhaler (Fig. 2) and an inscribed bookplate (Fig. 3) were published in 1906.2 This was the earliest known documentation of the inhaler. In November 2009, the authors positively identified this inhaler in the Archives and Special Collections, Massachusetts General Hospital, and commenced a renewed search for information relating to it. Correspondence from 1847 that probably relates to the inhaler was found. Table 1 is a summary of known information that may relate to the inhaler. The Morton ether inhaler (Massachusetts General Hospital Catalog of Art and Artifacts, Catalog number 768, Ether Apparatus) is currently on exhibit in the Paul S. Russell, MD, Museum of Medical History and Innovation (opened April 2012), Massachusetts General Hospital. This article will provide a description of this inhaler and information that may relate to it.
Two other inhalers, described as reproductions or replicas, are also discussed because of their historical links to the inhaler at Massachusetts General Hospital. The reader should note that no original written or photographic documentation of the reproduction inhalers was found, and some of the discussion regarding them is speculative. Since 1946, the Morton ether inhaler at Massachusetts General Hospital has been reproduced on 3 or 4 occasions, with several inhalers made each time. These reproduction inhalers will not be discussed in this article.
DESCRIPTION OF THE MORTON ETHER INHALER
There are no identifying tags on the Morton inhaler (Fig. 1), although a tag from the Warren Museum was found in the vintage, leather-covered box that contained the inhaler. The dimensions (in inches) used in the description that follows are taken from scale drawings made by an architect, Carleton N. Goff, in 1965 (Fig. 4). The inhaler has a height of 18.5 cm (7½″) and length of 23 cm (9″). The glass globe has a diameter of 13.5 cm (5⅜″), a slightly concave base with a diameter of 10 cm (4″), and 2 openings. The smaller of the 2 openings, for the entry of room air, has an outer diameter of 4.5 cm (1¾″) and a valve with a removable brass cap. The second opening, with an outer diameter of 6.5 cm (2½″), has a brass cylinder which is attached to a glass mouthpiece. The brass cylinder has a rectangular attachment (2.5 cm [1″] long and 2 cm [⅞″] wide) which contains an expiratory valve. There is a white residue on the inner wall of the globe. The inhaler contains a sponge that bears no resemblance to the conical sponges that were later used to administer ether.
PRESENTATION OF AN ETHER INHALER TO J. MASON WARREN, MD, 1847
Morton’s initial demonstrations of ether at Massachusetts General Hospital were generally successful, and by mid-November 1846, he had secured a patent (U.S. Patent 4848). Confident that he could make money from selling licenses, inhalers, and the anesthetic drug, which he called Letheon, Morton ordered several hundred inhalers from 4 manufacturers.4,5 In January, 1847, he presented an inhaler to Jonathan Mason Warren, MD (1811–1867, Surgeon, Massachusetts General Hospital). J. Mason Warren, MD, was the son of John Collins Warren, MD (1778–1856; Professor of Anatomy and Surgery, Harvard Medical School, Boston, MA, and surgeon at the first public demonstration of ether anesthesia on October 16, 1846).
An unsigned letter (Fig. 5), dated January 18, 1847, relating to an ether inhaler was found in the John Collins Warren papers, Massachusetts Historical Society, Boston, MA. The letter was sent on behalf of Morton to J. Mason Warren, MD, together with an ether inhaler. The text of the letter is:
“Boston January 18. 1847
Dr. J. Mason Warren.
Will you please accept from Dr. Morton the accompanying apparatus for administering the Letheon. Your readiness & liberality in recommending this important discovery to the public confidence induces him to make this tender as a faint recognition of the many obligations he felt himself under to you for your encouragement & support.”
On January 19, 1847, J. Mason Warren, MD, wrote to Morton thanking him for the inhaler (letter in John Collins Warren papers, Massachusetts Historical Society). A handwritten note on the back of the letter states that it is a copy of the letter that was sent to Morton. Attached to the letter is an undated typewritten note: “Apparatus now in Warren Anatomical Museum, Harvard Medical School.” The Warren Anatomical Museum, established in 1847, is now part of the Francis A. Countway Library of Medicine, Harvard Medical School, Boston, MA. Parts of the letter are not legible, and it is not known whether the original letter still exists. Fortunately, this letter was quoted in Nathan P. Rice’s biography of Morton (Rice recorded the date incorrectly as January 15)4:
“My Dear Sir:-I beg to acknowledge the receipt from you of a very handsome apparatus for the inhalation of sulphuric ether. Be so kind as to accept my best thanks for it, and believe me,
Very truly, your obedient servant,
J. Mason Warren.
Boston, Jan. 15th [sic], 1847.”
J. Mason Warren, MD, used this inhaler until he discovered in March 18476 that an ether-soaked sponge was easier to use and safer than the inhaler (a conical-shaped sponge soon became the preferred way of administering ether).
Apart from the correspondence from January 1847, and the inscribed bookplate of J. Mason Warren, MD (Fig. 3), there are no other known documents from the nineteenth century that relate to this inhaler. One nineteenth century photograph that may relate to this inhaler is an undated daguerreotype in the Fogg Museum, Harvard Art Museums, Cambridge, MA, of a reenactment of the first administration of ether at Massachusetts General Hospital on October 16, 1846 (Fogg Museum, Object no. 3.1979, on loan from Massachusetts General Hospital).7 Morton was represented by an unidentified person holding an ether inhaler. Also absent was John Collins Warren, MD, the surgeon who performed the historic operation. The presence of J. Mason Warren, MD, in the daguerreotype may indicate that it was commissioned by him, and the inhaler in the photograph may be the one he received from Morton.
WARREN ANATOMICAL MUSEUM
The inhaler that was presented to J. Mason Warren, MD, was donated, at an unknown date, to the Warren Anatomical Museum. No ether inhaler was listed in an extensive catalog of the Warren Anatomical Museum published in 1870.8 In 1911, William Fiske Whitney, MD (1850–1921), curator of the Warren Anatomical Museum from 1879 to 1921, published a 13-page booklet on the arrangement of the collection of the Warren Anatomical Museum.9 The booklet contains a brief note regarding an ether inhaler: “In the same case (case 12) is one of the original inhalers used by Dr. Morton in the administration of ether.”9 This is the earliest known record of the inhaler being in the Warren Anatomical Museum, although it was at that time thought to have been used by Morton. Case 12 was in the entrance hall of the Warren Anatomical Museum, the museum was then in the Administration Building of the Harvard Medical School on Longwood Avenue.
In 2008, a specimen tag from the Warren Anatomical Museum was found in the Archives at Massachusetts General Hospital, although it was not clear to which inhaler it referred. A handwritten note found with the tag states, “Morton Etherizer (original) Identifying tag on case when in custody of Harvard.” The cardboard tag (7.0 × 4.3 cm) has the words, “NO” (presumably for number), “WARREN ANATOMICAL MUSEUM,” and “12-1” (the numbers are stamped upside down to the words).
PUBLICATION OF A PHOTOGRAPH OF THE INHALER, 1906
A photograph of the Morton ether inhaler (Fig. 2) and a photograph of a bookplate of J. Mason Warren, MD, (Fig. 3) were published in a book2 by John Collins Warren, MD (1842–1927, Professor of Surgery, Harvard Medical School; hereinafter referred to as J. Collins Warren, MD, to distinguish him from his grandfather of the same name). J. Collins Warren, MD, was the son of J. Mason Warren, MD. The handwritten inscription at the top of the bookplate of J. Mason Warren, MD, reads, “Dr T. G. Morton to” (Fig. 3). The handwritten words, “Original Ether Inhaler 1846,” are at the bottom of the bookplate. The book also contains a photograph of another ether inhaler (illustration V, opposite page 18). The legend for this photograph is, “Apparatus used by Morton, October 16, 1846,” but this inhaler was described earlier in the book as a reproduction.2 The locations of the 2 ether inhalers were not recorded. An earlier edition of this book, published in 1900, does not include photographs of the 2 ether inhalers or the bookplate.10
The words, “Original Ether Inhaler 1846” (Fig. 3), have several possible meanings:
- The first inhaler used by Morton. This explanation is the least likely to be correct because it is believed that Morton used inhalers without valves before October 16, 1846.3
- The inhaler used by Morton on October 16, 1846. This explanation is unlikely to be correct, because it was reported that Morton had broken this inhaler on November 4, 1846.11 Nevertheless, in 1911, Whitney described the inhaler in the Warren Anatomical Museum as one of Morton’s ether inhalers,9 and 2 other inhalers have also been described as the inhaler that Morton used on October 16, 1846.1,12,13
- The inhaler was similar to the inhaler that Morton used on October 16, 1846, but was made for Morton for distribution under license to dentists and physicians. The authors believe that this is the correct interpretation of the word “original.”
JOURNAL ARTICLES BY ROTH AND FORD
In 1932, Roth14 stated that the Morton ether inhaler (Fig. 5 in his article)14 was in “the museum of the Medical School of Harvard University” (he was probably referring to the Warren Anatomical Museum). Discussing the bookplate, he wrote (incorrectly), “It has attached to it the signature of the surgeon Dr. John Collins Warren, together with the inscription, apparently in his handwriting, stating that the inhaler was the one originally used by Dr. Morton at the first public demonstration of ether anesthesia.”14 The inhaler photographed for Roth’s article14 is the same inhaler that was photographed for Warren’s book in 19062 (Fig. 2), but the 2 photographs are not identical. Roth also stated that there is, “an identical inhaler in the museum of the Massachusetts General Hospital which is also considered to be the historic inhaler used by Dr. Morton.”14 This inhaler has not been located, and no written documentation of it was found at Massachusetts General Hospital. It may be the inhaler that J. Collins Warren, MD, referred to as a reproduction.2 The “museum” at Massachusetts General Hospital to which Roth refers was probably the exhibit area in the old surgical amphitheater (this amphitheater is now known as the Ether Dome). An article by Ford15 does not provide any information on the location of the inhaler, but reproduces the same photograph of the Morton ether inhaler (Fig. 2) that was published by J. Collins Warren, MD.2
LOAN OF THE INHALER TO MASSACHUSETTS GENERAL HOSPITAL, 1946 REPLICA
Cora F. Holbrook, formerly the Archivist at Massachusetts General Hospital, made typewritten notes on a card file in 1950, which provided vital information on the inhalers (Fig. 6). Her notes indicate that the Warren Anatomical Museum sent its Morton ether inhaler to Massachusetts General Hospital in 1946 with the understanding that a replica inhaler would be sent to the museum. Holbrook also documented an unsuccessful search for the 1946 replica, which was sent to the Boston Medical Library instead of the Warren Anatomical Museum. “Mr. Fallon, in the museum at Harvard Medical School, said they had never received the 1946 replica of Morton’s inhaler, which they were to get in exchange for the original.” Mr. Ballard, in the Boston Medical Library, confirmed that they had received a replica ether inhaler from Massachusetts General Hospital after the centennial celebrations in 1946. This replica was then lost. Also recorded on the card was the fact that the original inhaler was “now in the old safe in the office of The News” (Fig. 6).
Although more than 1 replica may have been made in 1946, the authors believe that only 1 was made. On July 5, 1950, Holbrook wrote to Frederick Stenn, MD, (Physician, Chicago, IL, and member of Society of Medical History of Chicago) that a replica inhaler was made by Massachusetts General Hospital for the ether centennial celebrations in 1946 (a copy of the letter was found in Archives and Special Collections, Massachusetts General Hospital). A few months later, she noted on the card file (Fig. 6) that the Warren Anatomical Museum “never received the 1946 replica.”
The inhaler from the Warren Anatomical Museum may have been displayed at Massachusetts General Hospital during the ether centennial celebrations in 1946, although no photographs of the centennial celebrations showing this inhaler have been found.
Nathaniel W. Faxon, MD, (1880–1972; Director Emeritus, Massachusetts General Hospital) wrote to Joseph B. Howland, MD, on September 5, 1946, that it was believed by Frederic A. Washburn, MD, (1869–1949; Director Emeritus, Massachusetts General Hospital) that the inhaler Morton used at the first operation under ether at Massachusetts General Hospital had broken, and the inhaler on display in the Ether Dome had been used at a later date by Morton (a copy of the letter was found in Archives and Special Collections, Massachusetts General Hospital). It is not known which inhaler was on display in the Ether Dome at the time that Faxon wrote this letter.
On August 29, 1947, Henry Knowles Beecher, MD, (1904–1976; Henry Isaiah Dorr, Professor of Anaesthesia Research, Harvard Medical School) wrote to Faxon regarding the “original ether inhaler,” then in the Warren Anatomical Museum (H. K. Beecher papers, Countway Library of Medicine, H MS c64, box 9, folder 34). Beecher proposed that the inhaler “which played such an important part in the Hospital’s history be returned to its first home.”
Confirmation of the loan of the inhaler was found in handwritten notes in a loan book of the Warren Anatomical Museum: the “Original Ether Inhaler” was loaned to Massachusetts General Hospital in October 1946 and placed on permanent loan to Massachusetts General Hospital in April 1948 (Dominic W. Hall, M.A., Curator, Warren Anatomical Museum, Francis A. Countway Library of Medicine, Harvard Medical School, personal communication, e-mail, August 3, 2012). In the following decades, its history was forgotten by successive curators, archivists, and senior anesthesiologists. In 2008, most of the documentation presented here was not known to historians,3 and the provenance of the inhaler at Massachusetts General Hospital was not known.
Holbrook’s notes on the card file also record that the “original” inhaler was stored in a safe in the office of “The News” (Fig. 6). This card file was the last written documentation of the inhaler before it was lost. The authors are aware of a rumor that a Morton ether inhaler was stored in a bank safe in Boston, MA. This rumor cannot be verified or disproved, but it may have originated from the knowledge that the “original” ether inhaler was once stored in a safe at Massachusetts General Hospital.
SCALE DRAWING COMMISSIONED, 1965
A scale drawing (Fig. 4) (dated January 20, 1965) of the inhaler in Archives and Special Collections, Massachusetts General Hospital was made by an architect, Carleton N. Goff. A copy of this drawing was later acquired by Elliott V. Miller, MD, (retired Assistant Professor of Anesthesiology, Harvard Medical School) for the Wood Library-Museum of Anesthesiology, Park Ridge, IL.
IDENTIFICATION OF THE INHALER, 2009
Images of the Morton ether inhaler (Fig. 2) and the inscribed bookplate (Fig. 3) were published in an article by Haridas.3 The location of this inhaler was not known at the time of this study.3 The inhaler in Archives and Special Collections, Massachusetts General Hospital was thought to be a reproduction. In November 2009, the inhaler in Archives and Special Collections, Massachusetts General Hospital was examined by Haridas and identified as the same inhaler that was photographed for the book by J. Collins Warren, MD.2 The primary evidence used to match this inhaler to the one that was photographed in 1906 was the pattern of the white residue on the inner wall of the inhaler. A triangular pattern was clearly visible in the lower midportion of the globe in the photograph published in 1906 (Fig. 2); remarkably, this distinctive pattern was still clearly visible when the inhaler was examined in 2009 (Fig. 1). The nature of the residue has not been determined. It may be a residue of the additives that were used with ether or from impurities in the ether. The 2 letters from 1847 were discovered in November, 2009, in the John Collins Warren papers in the Massachusetts Historical Society.
PUBLIC DISPLAY OF INHALER AND DISCOVERY OF THE INSCRIBED BOOKPLATE, 2012
In April 2012, the Morton ether inhaler was placed on exhibit in the Paul S. Russell, MD, Museum of Medical History and Innovation, Massachusetts General Hospital. Two significant discoveries were made in August 2012. The inscribed bookplate of J. Mason Warren, MD, (Fig. 3) was finally located. It was found pasted to the red fabric on the undersurface of the carrying case (catalog number MUS003) for the inhaler. The case is covered by tan leather (except on the undersurface), and the inside is lined with velvet. Also discovered in August 2012 was the documentation of the temporary loan of the inhaler in 1946, and its permanent loan in 1948, in a loan book of the Warren Anatomical Museum.
THE MORTON INHALER AT MASSACHUSETTS GENERAL HOSPITAL BEFORE 1946
In 1932, Roth stated in an article that a Morton ether inhaler at Massachusetts General Hospital was “also considered to be the historic inhaler used by Dr. Morton.”14 This inhaler may have been the inhaler that was described by Warren as a reproduction.2 The location of this inhaler is presently not known, and no written documentation of it has been found. The authors have located 2 photographs of the ether centennial celebrations at Massachusetts General Hospital in 1946 that show this inhaler, or one very similar to it (photographs in Archives and Special Collections, Massachusetts General Hospital). Duncum used a photograph of this type of inhaler in an article12 and in her book, The Development of Inhalation Anaesthesia.13 According to Duncum, this inhaler was in the possession of Massachusetts General Hospital and was believed to have been used by Morton on October 16, 1846. The glass globe of this inhaler does not appear to be perfectly round, and the opening in the globe for admission of room air was not covered by a cap. A remarkably similar inhaler, that belongs to the Wellcome Trust, London, United Kingdom (Wellcome Images, image number L0058159), is on display in the Science Museum, London, United Kingdom.
THE MORTON ETHER INHALER IN THE COUNTWAY LIBRARY OF MEDICINE
The provenance of the ether inhaler (catalog number WAM 20289), currently on display in the Countway Library of Medicine, is not known. There are no known documents that relate to its origin or acquisition by the library. A handwritten note, dated 1989, on the back of a photograph of the inhaler states that the inhaler is a reproduction, “ca. 1920’s??” (photograph in possession of the Francis A. Countway Library of Medicine, Harvard Medical School). The authors believe that there are 2 other possible explanations for its origin. First, the correspondence and notes from 1950 may relate to this inhaler, i.e., this inhaler may be the replica that was made in 1946, and sent that year to the Boston Medical Library. In 1950, Holbrook noted that the location of the replica inhaler was not known. Another possible explanation is that this inhaler was made around 1970 or later, when a number of replicas were made.
The Morton ether inhaler at Massachusetts General Hospital (Fig. 1) can be traced back to 1906, when a photograph of it (Fig. 2) was published in a book.2 This inhaler was in the Warren Anatomical Museum for most of the first half of the twentieth century, but the authors could not determine when it was acquired by the museum. The inhaler was loaned to Massachusetts General Hospital in 1946, probably for the ether centennial celebrations. Beecher seems to have been instrumental in negotiating the permanent loan of the inhaler to the Massachusetts General Hospital in April 1948.
The authors believe it is likely that this inhaler was sent by Morton to J. Mason Warren, MD, in January 1847. Although the correspondence from 1847 (Fig. 5) and the inscribed bookplate (Fig. 3) suggest that this inhaler once belonged to J. Mason Warren, MD, another inhaler could have been substituted for it.
If the Morton ether inhaler at Massachusetts General Hospital (Fig. 1) was made in late 1846 or early 1847, it is the only known example of this type of Morton ether inhaler. Morton probably retained the basic design of his first inhaler with valves for the inhalers that were later made for distribution to dentists and physicians. Several manufacturers made ether inhalers for Morton, and dimensions of these inhalers may not have been identical. If the assumption about the basic design of the inhalers is correct, the Morton ether inhaler in the possession of Massachusetts General Hospital (Fig. 1) is probably similar to the ether inhaler that Morton used on October 16, 1846.
Name: Rajesh P. Haridas, MBChB, FANZCA.
Contribution: This author was involved in the research for the manuscript and preparation of the manuscript.
Attestation: Rajesh Haridas approved the final manuscript.
Name: Jeffrey A. Mifflin, MSLIS.
Contribution: This author was involved in the research for the manuscript and preparation of the manuscript.
Attestation: Jeffrey Mifflin approved the final manuscript.
This manuscript was handled by: Steven L. Shafer, MD.