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When Technique Outpaced Evidence: The Rise and Fall of Rectal Ether

August 24, 2026

By Austin Zheng

The CSA Committee on the History of Anesthesia congratulates the 3rd-place winner of the CSA 2026 History of Anesthesia Essay Contest: Austin Zheng, BA, author of “A Story About the Discovery of Dexmedetomidine.” 

Austin Zheng, a third-year medical student at UCSF, is originally from Modesto, California. He studied neuroscience, psychology, and philosophy at Johns Hopkins University. Before medical school, he opened a sushi restaurant with his cousin.

When Technique Outpaced Evidence: The Rise and Fall of Rectal Ether

By: Austin Zheng, BA, Alexander Junxiang Chen, BA, Jeremy Juang, MD, PHD

Ether Day: October 16, 1846

On that fateful Friday morning in 1846, a demonstration took place at what is now Massachusetts General Hospital’s Ether Dome: an event now widely recognized as the advent of inhalational anesthesia and modern surgery.

The clinical breakthrough at the Ether Dome introduced a new set of problems, however. Inhaled ether irritated the airway. Masks obstructed access to the face and mouth. The search for solutions led physicians away from the lungs and, improbably, toward the bowel, for it appeared that rectal administration could spare the airway, quiet respirations, and leave the surgical field unobstructed.1 The rectal ether technique emerged in this context and, despite signs from the beginning of questionable efficacy and safety, would persist long after its outcomes could justify its use.

Though it reads today as medical farce, rectal ether was taken seriously enough that the identity of its original inventor is no longer clear. What is clear is who made it visible: James Gwathmey, one of the architects of modern American anesthesia. As co-author of the first major U.S. anesthesia textbook and the inaugural president of the American Association of Anesthetists, his endorsement of rectal ether in the early 1900s secured it a place in early anesthetic practice.1 But even decades before Gwathmey lent the technique legitimacy, rectal ether had already undergone early trials that should have ended serious interest in it. Instead, it endured, sustained less by evidence than by the authority of its proponents.

Specifically, within years of Ether Dome, American clinicians had already begun experimenting with the rectal route, persuaded that it might offer a superior alternative.2,3 Across the Atlantic, early experimental work appeared to validate these claims. In France, Marc Dupuy’s studies in dogs and rabbits suggested that rectal ether produced rapid insensibility without the coughing and mucus production typical of inhalation. Animals recovered quickly, and Dupuy concluded that the rectal route was physiologically gentler and possibly safer than ether vapor.2 Meanwhile, in Russia, the surgeon Nikolai Pirogov described similarly calm administrations and emphasized the route’s usefulness in operations of the head and face.3 He became one of rectal ether’s earliest and most forceful advocates, even as he recorded two deaths among eighty-one cases. His enthusiasm also encouraged the technique’s adoption by colleague Anna Morosow, who reported sixty-eight successful head and neck operations, albeit accompanied by frequent complications ranging from bloody diarrhea to abdominal distention and occasional fatalities from gangrenous bowel injury.2,4,5

This uneven record did little to slow rectal ether’s advance. By 1884, American physician John S. Miller reported four cases using vapor insufflation, each marked by burning, distention, and discomfort, yet still judged the method “worthy of further trial.”This posture, candid about harm yet confident in promise, became rectal ether’s chief defense.6

Moreover, at the turn of the century, the method found new champions. In 1910, Walter Sutton of Roosevelt Hospital engineered elaborate vaporizing devices for rectal ether and published a series of one hundred consecutive cases with this setup. Complications were common, half of the patients required supplemental inhaled ether, and six deaths occurred, but Sutton attributed no faults to the method itself.7 Faith in rectal ether once again outran the evidence.

What Sutton normalized in the United States soon echoed in Britain. In the early 1920s, Arthur Joseph O’Leary would introduce rectal ether to Liverpool Royal Infirmary, deeming it a useful tool for breast amputations, cholecystectomies, and jaw resections.8 At the same time, he reported that patients sometimes expelled the rectal mixture forcefully, requiring the administration of chloroform to suppress the reflex, as well as a fatal case in which rectal ether appeared to reactivate occult amebic dysentery. O’Leary concluded nonetheless that the method had its “supreme advantages.”9

For nearly eighty years, such qualified endorsements kept rectal ether alive, but as the science of anesthesia rapidly advanced in the early 1900s, a new generation of proponents, including Gwathmey, sought to stabilize the reputation of such an old technique by recasting it within a new pharmacologic theory. In 1913, Gwathmey began promoting what he called “synergistic colonic analgesia,” a regimen that added morphine and magnesium sulfate to rectal oil-ether for the ostensible purposes of potentiation and reducing the risks of deep etherization.9, 12 Although his method required large-volume magnesium sulfate hypodermoclysis and repeated morphine injections before rectal ether was administered, Gwathmey promised that quieter respirations, warmer skin, less vomiting, and reduced surgical shock would follow.12

The evidence never matched the confidence of these claims. Animal studies by Harry Beckman confirmed the absence of pharmacologic potentiation and found no reliable dose reduction when magnesium was added, while clinical reports that appeared favorable to Gwathmey’s innovations were undermined by inconsistent dosing and vague outcome measures.10,12

A death finally forced the proverbial hand. In 1921, A. H. Curtis reported a fatality following magnesium sulfate hypodermoclysis, morphine, and nitrous oxide–oxygen anesthesia.11 Autopsy revealed extensive hepatic injury and 5.33 grams of magnesium sulfate in the liver, an unmistakable toxicologic finding that Curtis attributed directly to the synergistic method. For decades, fatalities associated with rectal ether had dissolved into the background noise of surgical risk. But now, for the first time, a death could be traced directly to Gwathmey’s own methodology, unraveling the very theory he claimed made rectal ether safer.

These concerns prompted the American Medical Association’s Council on Pharmacy and Chemistry to commission a formal investigation. In 1927, pharmacologist Robert Hatcher delivered this report in JAMA, concluding that magnesium sulfate’s anesthetic dose lay dangerously close to its lethal dose, that evidence for synergism was unconvincing, and that no responsible clinician could rely on such claims without far stronger data.12 With synergism collapsing under scrutiny, rectal ether had lost its final scientific defense. Already marked by inconsistent results and recurrent harm, it now stood exposed for what it had long been: a technique sustained less by evidence than by conviction. By the early 1930s, rectal ether had disappeared quietly from practice.

References

  1. Wood Library-Museum of Anesthesiology. Anesthesia per rectum: Gwathmey’s oil-ether approach. Anesthesiology. 2024;141(6):1064. doi:10.1097/ALN.0000000000005264
  2. Hendriks IF, Bovill JG, Boer F, Houwaart ES, Hogendoorn PCW. Nikolay Ivanovich Pirogov: a surgeon’s contribution to military and civilian anaesthesia. Anaesthesia. 2015;70(2):219-227.
  3. Proskauer C. The simultaneous discovery of rectal anesthesia by Marc Dupuy and Nikolai Ivanovich Pirogov. J Hist Med Allied Sci. 1947;2(3):379-384.
  4. Ivy RH, Melching H. Ether oil colonic anesthesia: some recent experiences. Am J Nurs. 1926;26(8):605-607. doi:10.2307/3409124
  5. Gwathmey JT. Anesthesia by colonic absorption of ether. In: Gwathmey JT, ed. Anesthesia. New York, NY: D Appleton and Company; 1914:436-437.
  6. Miller JS. Etherization by the rectum: report of four cases by Yversen’s method. Read before the Philadelphia County Medical Society; June 18, 1884. National Library of Medicine Digital Collections.
  7. Sutton W. Anaesthesia by colonic absorption of ether. Ann Surg. 1910;51(4):457-479.
  8. O’Leary AJ. Rectal administration of ether. Br J Anaesth. 1924;1(4):185-186. doi:10.1093/bja/1.4.185
  9. Gwathmey JT. Original descriptions of the oil-ether rectal method. Cited in: Wood Library-Museum of Anesthesiology. Anesthesia per rectum. Anesthesiology. 2024;141(6):1064.
  10. Beckman H. The alleged synergism of magnesium sulphate and morphine. JAMA. 1925;85(5):332–336. doi:10.1001/jama.1925.02670050016006
  11. Curtis AH. Magnesium sulphate solution as an aid in anesthesia. JAMA. 1921;77(19):1492–1493. doi:10.1001/jama.1921.02630450034011
  12. Hatcher RA. The rectal administration of ether and oil: and morphine, magnesium sulphate and ether in surgery and obstetrics. JAMA. 1927;89(25):2114-2117.

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