Dr. J. Mason Warren's March 13, 1847 surgery recorded the twenty-third classical ether operation at MGH and the eighth for which he was the operator. There are a number of compelling visual correlates that link his report with the patient portrayed in the "reenactment" daguerreotype: 1.) Warren occupies the lead surgeon's station for a parotid surgery. 2.) Unless it a trick of the lighting, a tumor "the size of a hen's egg" is faintly visible over the ramus angle of the jaw below the ear. 3.) The tumor festered on the right side of the subject's head, reversed by the lens. 4.) The patient matches the description of a powerfully built, "full-blooded" man. 5.) The age of the patient, thirty-four, is correct. 6.) Surface abrasions are visible in the daguerreotype over the tumor side of the face, caused by later clumsy viewers trying to bring out the image. 7.) With the exception of John Collins Warren, the members of the surgical team who can be identified are in the daguerreotype.
In the report Warren states, "Ether was given him by Dr. Morton, who was desirous of seeing its effects on so powerful a patient." (75 »») Morton supervised etherization less and less frequently at Massachusetts General Hospital over the months following the Abbott and Mohan surgeries. However, the hospital and Harvard medical school communities remained very much promotional toward his reputation and against that of his adversaries. If his identity and function in the "reenactment" daguerreotype can be verified, it would represent his final appearance as the etherizer at MGH. The March surgery also coincides with the first printing that month of Edward Warren's pamphlet defending Morton, paying credence to a promotional intent in the taking of the daguerreotype.
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CASE XI.--A large, powerful, full-blooded man, 34 years of age, consulted me for a tumor in the right parotid gland. A tumor had been removed from the same spot twenty years ago, which shortly afterwards re-appeared in the form of a small, hard tubercle under the ear. For fifteen years it remained stationary, and then began to increase. It is now about the size of a hen's egg, of a bluish color, lobulated, and having a hard base surrounded by small cysts. The lobe of the ear is pushed upward by the tumor, which extends inward and apparently involves the lower half of the parotid gland. As the patient was very desirous of an operation, I determined on its removal. It was a question, whether it would not be advisable to apply first a ligature to the carotid. On examination by a number of medical gentlemen, it was thought possible to remove it without having recourse to this means. Drs. J.C. Warren, George Parkman, S. Parkman, Briggs and Mr. Slade, were present at the operation. Ether was given him by Dr. Morton, who was desirous of seeing its effects on so powerful a patient. The pulse, before its exhibition, was 90. On commencing the inhalation, the eyes and face were much injected with blood, but as it was continued he gradually became pale, and in about the ordinary time was quite insensible. The tumor required a very slow and careful dissection; the base of it was found to have undergone osseous degeneration, and pressed upon the facial nerve as it crossed the styloid process. This was the cause of a paralysis, which was gradually taking place, a fact I omitted to state in the history of the case. Towards the middle of the operation, the patient began to make strong muscular exertions, indicative of returning consciousness, and which somewhat interfered with the dissection. As soon as he complained of pain, a second dose of ether was administered, which took effect speedily, and prevented him from suffering for the remainder of the time. The operation occupied about half an hour; and although it was severe, not the slightest constitutional trouble followed. In the course of a week he was able to return home to Maine. |
Ten years later, Warren included an abstract of the case in a paper on parotid tumors published in the BMSJ, wherein the patient is described as maybe a little less powerful, but still a "robust, hearty-looking man" from Maine.(76 »») The other five cases in the paper all involved recent surgeries in his practice. Recrudescence and ossification of the tumor caused a partial facial palsy, obligating a second operation circa early 1860's, and a third operation approximately three years subsequent. The latter operation Warren was reluctant to prosecute, but the patient was insistent, and so he tied off the tumor with "two double ligatures, the size of whipcords," and "powerful caustic applications." Warren covered all three successful procedures for the Maine man, in his monumental epitome of surgical cases.(77 »»)
An attribution identifying Figure 3 as William Augustus Briggs, although also circumstantial, is credible if the "reenactment" daguerreotype represents the March 13th operation. Warren only gave the surname Briggs as one of the attending physicians, but I was able to winnow his full name from among five "Briggs" who graduated from Harvard Medical School in the first half of the nineteenth century. William Augustus Briggs trained in medicine at Tremont Medical School under Drs. Jacob Bigelow, Edward Reynolds, David Humphreys Storer, Oliver Wendell Holmes, and took his M. D. at Harvard in 1841. (78 »») Briggs, like Heywood, failed to contribute to the medical canon, having been forced into early retirement by consumptive tuberculosis that cut short his life at age thirty-nine. His family was wealthy and he could have dedicated his life to a field of research in the natural sciences but chose instead to practice surgery in Boston. Briggs was consulting or attending physician in a number of Warren's private surgeries, and probably many in which he was not named. Those I have found include the following:
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J. Mason Warren's parotid surgery was the twenty-third classical ether operation at MGH and the eighth for which he was the operator. Interestingly it was his second
The significance of a surgical intervention for the delicate removal of a parotid tumor, and the resonance it would evoke of the Abbott operation, would not have been lost on the MGH surgical staff. And if the operation were prosecuted by John Warren's son, the surgery would present an opportunity to make a visual document, not of a reenactment, but rather a redux of the Abbott operation, celebrating the junior Visiting-surgeons most responsible for introducing etherization into the medical canon. Circumstances favor the redux scenario. With the closing of the lecture season at Harvard Medical a week earlier, the bleachers in the Dome would be free of student spectators and J. J. Hawes could move about freely to work his camera. March 2 was also the day of J. Collins Warren's final lecture and his official retirement from the College, marking the passing of an era at MGH. A testimonial collation was given in his honor after the lecture, sponsored by the "opulent and kind hearted" George Parkman, who sat at the head of the table and delivered the accolades.(85 »») It would also be an opportunity to honor Morton, coinciding with the release of a pamphlet defending his place in the history of ether, written by Edward Warren, the brother of John Collins.(86 »») The roster of surgeons arrayed around the patient supports the redux scenario for the surgery, with Morton in the center holding his glass globe apparatus and the recently appointed junior Visiting-surgeons, Parkman, J. Mason Warren, and Bigelow, forming a phalanx on one side of the patient; and Townsend, Heywood, and Gould on the other side.
When I began this study on the first Ether Dome daguerreotype I was charmed into the conviction that Jonathan Mason Warren's March 13th surgery was the view being presented. It would be a powerful and meaningful association copy of his father's Abbott surgery, but like the reenactment scenario, the redux scenario also breaks down upon careful examination. Arguably it is John Call Dalton, not Morton, who is the etherizer. Slade was still a student and wouldn't join the MGH staff until his graduation the following year, at which time he was appointed House-surgeon. The presence of Townsend without Hayward or especially John Collins Warren, is incongruous for a pictorial version of the ether saga, even for a redux. And finally, the identities of attending surgeons Briggs and George Parkman in the daguerreotype, if they can be confirmed, are incongruous for a redux scenario. A simple depiction of an actual surgery similar to EDD Nos 2-5 also fails because Dalton is likely the etherizer portrayed, and Heywood, not Briggs, is most likely in the frame while attending J. Collins Warren is missing. Furthermore, both the surgery and photo session would have been scheduled under favorable circumstances, confuted by the lack of sunlight when Southworth and Hawes took the shot.
75.) Warren, JM (1847); p. 155-156. "Case XI."
76.) Warren, JM (1857), "Tumors in the parotid region." In: Boston Medical and Surgical Journal; vol. 56, p. 291. See "Case II."
77.) Warren, JM (1867); p. 497-498. See "Case CCLXXXV."
78.) Palmer, J (1864), "Necrology of Alumni of Harvard College, 1851-52 to 1862-63." Boston: John Wilson and son; p. 277.
79.) Warren, JM (1848), "Operation for Fissure of the Soft and Hard Palate, with the result of Twenty-four Cases." In: The American Journal of the Medical Sciences. Philadelphia: Lea & Blanchard. London: Wiley & Putnam and John Miller; ns., vol. 15, no. 30 (April), p. 149-62. See Case I, p. 331.
80.) Ibid; Case IV, p. 333.
81.) Ibid; Case VI, p. 334. Full name of "B. Brown" is Buckminster Brown.
82.) Warren, JC (1846), "Inhalation of ethereal vapor for the prevention of pain in surgical operations." In: Boston Medical & Surgical Journal. Boston: David Clapp; vol. 35, no. 19 (December 9), p. 378. Reprint also issued. "The patient lying upon a bed, the vapor was administered by Dr. Morton in the presence of Drs. Charles T. Jackson Reynolds, JVC Smith, Flagg, Gould, Shurtleff, Lawrence, Parsons, Briggs, and others." This is Dr. John Collins Warren's classical treatise on etherization that includes his report on the Abbott operation, which established modern anesthesia in the medical canon.
83.) Warren, JM (1847); p. 155-156. Case XI: Warren's parotid surgery for the full-blooded man.
84.) Warren, JM (1867); p. 41.
85.) Anonymous notice printed in the BMSJ; vol. 36, no. 6 (March 10, 1847), p. 123.
86.) Warren, E (March 1847).