Anaesthesia, Cholera and the Medical Reading Society of Bristol

 

 

 

The Medical Reading Society of Bristol was founded by 11 Bristol doctors in March 1807, "for the purpose of promoting medical knowledge and a friendly intercourse among its members, and for purchasing medical books". This was some 24 years before there was a medical library in the city.  It soon elected a 12th member and has never had more than 12 members at any one time. With a few exceptions it has met monthly since its foundation. This month it is celebrating its 200th anniversary. 1807 was also the year that the slave trade abolition act was passed; Bristol of course had made much of its wealth from the slave trade.  My interest in this topic of Anaesthesia, Cholera and the Medical Reading Society of Bristol was aroused in November 2005 when I was looking at the minutes from 50 years, 100 years and 150 years ago, which are read out at our meetings, and came across this: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The monthly meeting was held to Dr Swayne's house on November 7, 1855. Absent at 8 o'clock. Mr Morgan, Mr Coe, Mr Smerdon and Mr Cross. Absent at 8¹/₂ o’clock ditto-

Mr Hore proposed Snow on the inhalation of Chloroform in Disease, etc.

Mr Sawer and Dr Budd being proposed as new members to supply the vacancy occasioned by Mr Waldo's resignation, it was decided by the votes of the Society that Dr Budd should be balloted for.  He was accordingly balloted for and elected.

 

 

I was quite excited by this because, although John Snow had long been a hero of mine, I did not recognize the pamphlet mentioned here.  So I sent an email to the secretary of the John Snow Society in London and also one to one of the authors of the definitive biography of John Snow.  I did not realise quite what a reaction I would get.  In the next five days I received 11 e-mails from various parts of the United Kingdom and America, including one that described the minutes of the Society as a historical treasure.  I discovered that professors of history in Michigan knew far more about Bristol physicians of the 19th century than I did. They also told me that between 1848 and 1851 John Snow had written 19 articles On Narcotism by the inhalation of Vapours for the London Medical Gazette and these were later published as three separate pamphlets.  The second contained parts 8 to 16.  Part 8 was specifically about the actions of chloroform in disease states.  This was the pamphlet that Mr Hore, who was the newest member of the Society, had proposed, but which was not actually purchased by the Society.  I wonder why not.  We know the Society took the London Medical Gazette for 10 years from 1927, but it was not currently taking it in 1855.  However, by this time there were other medical libraries in the city, and it may well be that members had already read these articles.

 

The host Joseph Griffith Swayne was physician obstetrician at the Bristol General Hospital.  When he was appointed in 1853 it was on the understanding that he would not undertake any surgery, though this restriction soon lapsed.  He had a great interest in analgesia/anaesthesia in labour and he was also involved in the cholera story.

 

Another member present was Dr Fairbrother. In 1846 he was a physician to the Bristol General Hospital, and it was he who instigated and helped at the first anaesthetic given in Bristol, probably on the 31st of December 1946, possibly the 1st of January 1947, some 11 weeks after Morton's original demonstration in Boston in October. The surgeon was James Goodall Landsdown.  The patient was a young man who underwent left above knee amputation. William Herepath, a professor of chemistry at the University provided the ether, and administered it at first, and then Alexander Fairbrother administered it a second time.  Lansdown reported the Lancet in December 1847 that by then he had used ether 111 times including 30 during labour, one intermittent etherisation lasting 11 hours.  However he went over to using chloroform enthusiastically soon after Simpson had published details of its use.

 

In 1853 Fairbrother resigned suddenly from the Bristol General Hospital and later became a physician at the Royal Infirmary. 

 

We do know that no anaesthetics were given at the Bristol Royal Infirmary until August 1850, when chloroform was used. The six surgeons on the staff all signed the Surgical Consultation Book to say they had agreed jointly that chloroform should be given.  Even then there was a nine-month gap before the second anaesthetic.  As we shall see later at least one of the surgeons at the Infirmary was well informed about anaesthesia, and yet there is no explanation as to why they did not try it out. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                  Joseph Swayne                                                Alexander Fairbrother         

                     1819 - 1895                                                             1809 - ?

 

Mr William Francis Morgan was one of the six surgeons at the Infirmary, as was Mr Augustin Prichard who was there that evening, but as he had not been appointed until 1850, he cannot be blamed for the delay in introducing anaesthesia there, though certainly he was suspicious of anaesthesia throughout his career.

 

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         William Morgan                                                                           Augustin Prichard

            1809 - ?                                                                           1818 – 1898

 

 

 

 

 

 

 

Nathaniel Smith, Henry Clark, Thomas Green and John Harrison, who were the other surgeons who signed the agreement to use chloroform at the Infirmary in 1850. All but Clark were members of the Reading Society at one time or another. Smith was one of the founder members.

 

 

 

 

 

           

 

Now we come to John Snow and William Budd.  Born within two years of each other they were men of very different background, personality and lifespan, though both were acutely aware of how little treatment had to offer for the various fevers that ravaged the country in the 19th century and how vital it was to unravel the mode of transmission of these diseases to prevent them occurring. 

 

William Budd has been described by his biographer, Michael Dunnill, as Bristol's most famous physician. He was born in 1811 into a large Devon medical family; his father and five of his brothers were also physicians. During his training in medicine William spent three separate years in Paris, interrupted by his catching typhoid fever.  He qualified at Edinburgh as a doctor of medicine and won a gold medal for his thesis.  In 1841 he moved to Bristol and became a consulting physician to the Bristol Royal Infirmary in 1847.  He was a genial, vivacious, ebullient man, fond of good food, good wine and female company.  An enthusiast in his work he could sometimes be seen running from his home in Park Street to the Infirmary so that he could see more quickly how his patients were getting along.   His interest in epidemiology led him to play an active role in the development of the Bristol Water Company.  Apart from his pioneering work on cholera, 1849, he described the contagious nature and prevention of Diphtheria, 1861; Anthrax, 1862; Tuberculosis, 1867, Scarlet Fever, 1869, and he also studied cattle plague and sheep smallpox. He is perhaps most renowned for his work on the waterborne transmission of Typhoid 1873.  He died when he was 69 having suffered a stroke six years earlier, which had left him hemiplegic.

 

 

 

 

 

 

 

 

 

 

 

 

 

               William Budd                                                              John Snow

                1811- 1869                                                              1813 - 1858

 

 

In contrast John Snow was the son the eldest son of a Yorkshire coal yard labourer.  At the age of 14 he was apprenticed to Dr Hardcastle in Newcastle upon Tyne. He first met cholera in 1831 when at the age of 18 he was caring for miners at Killingworth colliery, before moving to York.  From the age of 17 he was obsessed with the notion of pure water and at 23 gave a public address in which he suggested the numerous stills scattered around the country would be better put to producing distilled water than spirits.  In 1836 he moved to London visiting Liverpool en route, and he walked from Liverpool to London via North and South Wales. In London he lived a frugal life as a bachelor, and was teetotal and a vegetarian. In addition to his pioneering work in on the transmission of cholera, after the discovery of anaesthesia in 1846 he rapidly became the foremost anaesthetist in the British Isles if not further afield. He was certainly the first anaesthetist to approach the subject in a scientific manner. He suffered from nephritis and at one time consulted Richard Bright. He died of a stroke at the age of 45, curiously enough attended in his final illness by William Budd's elder brother George.

 

 

Table 1. Members of Medical Reading Society October 1846, when the successful public demonstration of anaesthesia took place in Boston, Massachusetts. 

 

                                                Years of membership

 

Mr William Mortimer                   1807         -       1850

Mr John Estlin                           1807         -       1855

Mr John Swayne                       1807         -       1847

Mr William Goodeve                   1820         -       1858

Mr Isaac Leonard                      1823         -       1859

Mr William Morgan                     1825         -       1873

Mr Charles Smerdon                  1835         -       1870

Mr George Hetling                      1838         -       1848

Dr Alexander Fairbrother            1839         -       1876

Mr John Colthurst                      1844         -       1856

Mr Augustin Prichard                 1844         -       1876

Dr Joseph Swayne                    1845         -       1858

     Boston 1846. Painting by Robert Hinckley

 

                                                                                                       

Notice that there were still three of the Founder Members still there in 1846 and that despite the predominance of surgeons it was Dr Fairbrother who instigated the first anaesthetic in Bristol.

 

 

Table 2. Pamphlets on anaesthesia bought by the Medical Reading Society 1847 - 1866

 

Purchased	Title	Proposer
1847  Oct	Snow J. On the Inhalation of the Vapour of Ether in Surgical Operations. London: Churchill, 1847.	Mr Morgan
1848  Mar	Curling TB The Advantages of Ether and Chloroform in Operative Surgery, London: Highley, 1848	Mr Morgan
Oct	Simpson JY. Answer to religious objections to the use of chloroform in midwifery. Edinburgh: Sutherland & Knox, 1847.	Dr Swayne
Oct	Protheroe Smith Scriptural authority for the mitigation of the pains of labour, by chloroform and other anaesthetic agents. London: Highley, 1848	Dr Swayne
Oct	Merriman S. Arguments against the indiscriminate use of Chloroform in Midwifery. London: Churchill, 1848.	Dr Swayne
1855	Murphy EW. Chloroform: its properties and safety in childbirth. London: Wilson and Maberley, 1855.	Dr Swayne
1858	Snow J. On Chloroform and other Anaesthetics, ed. Richardson BW. London: Churchill, 1858.	Dr Budd
1866	Ellis R. On the safe abolition of pain in labour and surgical operations by anæsthesia with mixed vapours. London: Hardwicke, 1866.	Mr Leonard

 

  

                       

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Snow’s 1947 paper was bought by the Society just one year after Morton’s successful demonstration in Boston.  This was a 20,000 word, 77 page pamphlet published at Snow's own expense, in which he describes the stages of anaesthesia much as we know them today and the means of giving ether in a controlled manner. It is one of the classic papers and anaesthetic literature.

 

 

 

 

 

 

 

 

 

 

 

 

Snow's 1847 temperature controlled vaporiser and facemask

 

Thomas Blizard Curling was Lecturer on Surgery at Hospital.  His pamphlet was based on a lecture he had given to the Hunterian Society in February 1848.  In it he reflected on pain and how different people responded, including a few remarkable people who allowed surgery to take place without any complaint. I guess that this was the effect of adrenaline rather like people don't feel pain when they are mauled by a tiger.  Overall Curling was very enthusiastic and optimistic about the place of anaesthesia, noting in particular the usefulness of the relaxation produced particularly when reducing dislocations and also that the death rate following amputation was lower in those patients who had been anaesthetised than in those who had not.  However he did caution that ‘the administration of anaesthetic agents should be entrusted to a person, who by practice, has acquired a nice perception of their action and the full knowledge of their powers and varying effects, so as to be able to produce and maintain their influence to a proper degree’.

 

 

 

           Thomas Blizard Curling                              James Young Simpson

    1811 - 1888                                                      1811 - 1870

 

In 1848 James Young Simpson's Answer to religious objections to the use of chloroform in midwifery was written because he was very irritated by what he saw was opposition to the relief of pain in labour by the Church. Subsequently the church denied this saying it was only one or two ministers who opposed him. Simpson emphasised that God became an anaesthetist before he became a surgeon, but a Dr Ashwell countered by pointing out that it was still in the age of innocence when there was no pain.

 

 

 

 

 

 

 

 

 

 

 

 

16th century woodcut     Agnes Anaesthesia Carstares    Simpson’s chloroform bottle

 

In this woodcut Adam appears to be supporting his own chin.  God is working here as an operator anaesthetist, which would be severely frowned on today. I thought you'd like to see Simpson's chloroform bottle and this young lady who 17 years earlier had been the baby born of the first mother to whom Simpson had given chloroform. She was christened Agnes Anaesthesia.

 

Protheroe Smith was an eminent London obstetrician.  He strongly supported Simpson. He actually gave himself some chloroform rectally and found himself sometime later unconscious on the floor.  Unfortunately rectal irritation and severe diarrhoea meant this was not a convenient form of administration.

 

Samuel Merriman in his Arguments against the indiscriminate use of Chloroform in Midwifery takes the line that nature can cope with labour better than people who intervene. He points out how the mortality of women in childbirth has declined and now is only one in 113.  He says interventions such as forceps and ergot and anaesthesia are used too early and that pain, even severe pain, never actually killed anyone, and before using chloroform they should be sure that the risks were not greater than those of leaving the pain untreated. He refers to his esteemed friend Doctor Snow and says Snow’s papers on the use of anaesthetic vapours should be studied by all who propose to employ them medicinally

 

In Chloroform its properties and safety in childbirth Murphy discusses the properties of chloroform and the opposition to its use. He reports that deaths from chloroform had all occurred in surgical cases, 30 deaths in 9000 cases, and none had occurred in labour.  There had been one death in an obstetric patient occurring one and a half hours after delivery when there had been sudden dyspnoea and death from an unknown cause.  This was the mother's fourth labour and it had been long and tedious due to a narrowing at the diameter of the pelvic cavity.  Long forceps delivery had been necessary.  Recovery from anaesthesia had been speedy and perfect. I wonder if this actually was a case of Mendelssohn's syndrome, which is exudative pulmonary oedema due to aspiration of gastric juice.  If it was then it was not so much a chloroform death as an obstetric anaesthetic death.  He also describes a mouthpiece and box for the administration of chloroform, and sets out 10 rules for its safe use. 

 

On the mechanism of action of chloroform and other anaesthetics was John Snow's final paper on anaesthesia and was not actually published until after his death from stroke at the age of 44 years.  It summarises both theoretical and practical considerations.  Again it is one of the classics of anaesthetic literature.  At post-mortem Snow's kidneys were shown to be small and contracted.  He had earlier consulted Richard Bright and curiously enough was attended in his final illness by William Budd's elder brother George. Incidentally around this time the society bought two books by George, one on diseases of the stomach and another on diseases of the liver.

 

Ellis’s On the safe abolition of pain in labour and surgical operations by anæsthesia with mixed vapours describes anaesthesia using different mixtures of alcohol, chloroform and ether at various times during the anaesthetic to improve the quality and safety anaesthesia.  A.C.E as it was called remained intermittently in use until 1920s.

 

In 1958 there was a death in Bristol due to chloroform and Augustin Prichard reported it in the British Medical Journal.  John Snow commented and incidentally reminding Prichard that a death had occurred in Bristol in 1854.  He also said that if chloroform was a problem why not go back to using ether? In his final letter Augustin Prichard wrote:

 

I venture to prophesy that anaesthetics will more and more fall into disuse and will ultimately be had recourse to only for the most severe or protracted operations

 

Snow disagreed strongly and pointed out that Guy's and St Thomas's hospitals which were very slow to take up anaesthesia were the very places where deaths had occurred before those hospitals that were using it more regularly.  Prichard would no doubt be interested to hear that there were over 3.5 million anaesthetic given in United Kingdom last year.  You can read more about this exchange of letters in a paper by Robin Weller.

 

 

Table 3. Pamphlets on cholera bought by the Medical Reading Society 1832-1856

 

Purchased	Title	Proposer
1832	Lawrie, James. Essay on Cholera founded on observations of the disease in various parts of India and in Sunderland, Newcastle and Gateshead.  Glasgow: Smith and son, 1832	Dr Swayne
1833	Hancock, John. Observations on the origin and treatment of Cholera and other pestilential diseases, and on the Gaseous Oxide of Nitrogen as a remedy in such diseases, etc.. London, 1831.	Mr Estlin
1833	Kennedy, James. History of the Contagious Cholera; with remarks on its character and treatment in England 3rd ed.. 1832, Moxon, all of London,	Mr Estlin
1833	L’Académie de Médicine. Rapport sur le Cholera Morbus  Paris 1831	Mr Prichard
1848	Parkes, Edmund.  Researches into the pathology and treatment of the Asiatic or Algide cholera.  London: Churchill, 1847	Mr Prichard
1849	Scot, William. Report on the Epidemic Cholera as it appeared in the territories subject to the Presidency of Fort St George, abridged from the original report printed at Madras in 1824 with introductory remarks by the author.  Edinburgh: Blackwood; London: Murray,1847	Mr Colthurst
1849	Parkin, John. On the antidotal treatment of the Epidemic Cholera, with a sketch of the physiology of this disease, as deduced from that of intermittent fever.  London, 1846	Mr Goodeve
1856	Simon, John. Report on the Last Two Cholera Epidemics in London, as Affected by the Consumption of Impure Water. London: HMSO 1956	Dr Budd

 

 

 

James Adair Lawrie was educated in Glasgow and in 1822 became surgeon to the East India Company.  Unfortunately the climate did not suit him and he returned to Glasgow in 1829.  When cholera arrived in Sunderland in 1831 it was assumed the young doctor who had served in India would know all about it. This brought panic stricken crowds to his door and he used to say that he went to bed unemployed and found himself in the morning in the enjoyment of a large practice.  It is actually difficult to know just how much cholera he had actually seen in India.  His biographer suggests that he had seen no cases at all while there but in this paper he says “I suppose I saw as much as other people who were not there in the major epidemics of 1817, 1818 and 1819”.  He accepted that person-to-person spread did happen on occasions but he thought that cholera was not a very contagious disease compared to typhus, smallpox or scarlet fever. He certainly felt it was not “actively contagious” by which he meant the cholera poison did not somehow increase inside the body of the affected person. He was very taken with the fact that when the disease reached Newcastle from Sunderland it must have got there by water because if it had been spread by land then Gateshead would have been affected first before Newcastle.                           

 

The pamphlet by John Hancock is quite remarkable.  He managed to get every single thing wrong. He was a passionate anti-contagionist, proving his points by inserting exclamation marks instead of arguments.  He wrote his pamphlet before cholera actually arrived in England, on the basis of his 22 years experience in the tropics. He even suggested that nitrous oxide might be a cure for or even prevent not only cholera, but for other pestilential diseases, and also be a remedy for asphyxia from suffocation or drowning.  Bear in mind that this was 1931, 13 years before Horace Wells had his tooth pulled under the influence of nitrous oxide. Hancock had to add a note in press about the cholera that arrived in Sunderland in November that year, brought by a sailor from Hamburg. Other people, he said, thought this proved cholera was contagious, but he personally blamed miasmas brought by the wind crossing in a direct line from the Baltic Sea.  I do not know if it was the same Hancock who introduced anti-cholera galoshes the following year.  If it was then maybe he had been converted to contagionism after all.

 

I could only find James Kennedy’s History of the contagious cholera, 3^rd ed. in the Wellcome Foundation library in London, though the full text of the 2^nd edition, published earlier the same year, available online and this describes in detail the spread of cholera within the country. Kennedy thought cholera could occur in any climate, but that it was contagious only to those who are predisposed to get it, i.e. he was a  contingent contagionist. The 3^rd edition has an extra section dealing with treatment  Kennedy felt bloodletting was the mainstay, but he reported that two German physicians working in St Petersburg had given a salt solution, two tbsp of common salt in 6 oz of hot water, with further smaller doses, to 30 patients all of who had recovered.  As they had bled the patients before giving the saline Kennedy felt that the bleeding might well have been the treatment that had succeeded.  He also commented on a report by Dr Steevens in the Lancet about the successful treatment of 226 men with cholera at Coldbath Fields Prison.  Dr Steevens had used a mixture of ½ drachm of carbonate of soda, 1 scruple of muriate of soda, 7 grains of chlorate of potash in a tumbler of water.  There had only been 26 deaths.  Kennedy was also unconvinced by this report and said that saline draughts could never be more than a humble accessory to other forms of treatment.  Clearly though we have here two examples of 1830' s Dioralite.  He also discusses the use of intravenous saline.  With it Dr Latta of Leith turned a moribund woman into a jocular one within an hour, but sadly she died later.  Lawrie, see above, tried it on six patients in Glasgow but had no success. In Edinburgh they used a solution of 120 grains of common salt, 40 grains of carbonate of soda, in 5 lbs and water heated to 110/115°F.  They gave up to 40 lbs of this solution in two days and noted that ‘rigor was apt to follow’. In all cases there was an immediate improvement but then ‘reaction fever’ leading to death would follow. Other forms of treatment at this time included emetics, blistering, rubbing with hot towels, opium, calomel, purgatives, brandy, stimulants and even fluid restriction.    

 

After the great epidemics in India cholera became endemic there it began to spread outward. When it invaded Eastern Europe in 1830, France sent four commissions to observe the disease in Poland and Russia, two of them sponsored by the Academies of Sciences and of Medicine. In June 1831 cholera was added to the list of importable diseases, but in July L’Académie de Médicine in its Rapport sur le cholera morbus provisionally declared the disease not essentially contagious, but able to become so, and advised the government to take both sanitary and hygienic measures.  When the epidemic arrived in 1832 it was catastrophic; in Paris alone 18,000 died. Medical remedies proved as futile as quarantines.  Worse, the calamity signaled the breakdown of public order in France.

 

 

 

 

 

Edmund Parkes studied medicine at University College London, qualifying, bemedalled, in 1841. The following year he joined the army as a lowly Assistant Surgeon with the 84th (York and Lancaster) Regiment and was posted with them first to Madras and later to Moulmein, Burma. While there he experienced the 1842 and 1843 epidemics of cholera and dysentery where he had seen no evidence of contagion from person to person, but insisted ‘I by no means wish to generalise this observation and to conclude that the poison of cholera is never reproduced in the human body’. His researches provided material for publications, which appeared after his return to England and his resignation from the army. He believed that the cholera poison entered the bloodstream first, the alimentary canal secondarily, if at all. He thought cholera was caused by a specific morbid agent or virus that was presumably one of the more subtle gases undetectable by the chemical means then available. He argued that the blood was affected in cholera, secondarily to related changes that occurred in the hearts and lungs, but that it was a fibrin in the blood rather than the fluid and salt content that was altered.

He also mentioned in passing that intravenous saline injections had been tried by some Indian practitioners with notable lack of success. In 1855 he went to the Crimea to take charge of a prefabricated hospital designed by Brunel.  It was this year that he was dismissive of John Snow's theory of the faecal-oral transmission of cholera, though he did admit that it was difficult to explain away the Hampstead widow and her niece. In 1860 he became the Professor of Military Hygiene. 

 

An abridged version of Scot’s 1924 report was published in 1831 and then again in 1849. In his introductory remarks in 1849 he says that the mortality from cholera continued to be as great, opinions even more unsettled, rules of practice as undefined, men's minds as much adrift as ever.  He thought dysfunction of the ganglionic system of nerves formed the primary seat of the disease.  He recognized that bodies of men travelling through the country could catch the disease while passing through affected areas and then carry cholera along with them.  He discussed the role of the rivers, which were generally thought to have a great influence on the prevalence and intensity of cholera.  However he says Dr Lorimer reports that out of 121 outbreaks only 37 occurred on the banks of rivers and he comments that cities are built on rivers, which are the lowest, and often most squalid, parts of any city.  In the UK cholera clearly is an imported disease.  He discusses treatment by opium, calomel, bloodletting and stimulants.  Bloodletting might be all right on general principles early in the disease, but in the collapsed patient it was often deleterious.

 

Dr. John Parkin is something of an enigma. In 1832 he had suggested using a charcoal as a water filter, because he thought the cholera poison, having been generated in the earth, found its way into various springs and then into the stomach. Later he became a fanatical opponent of the water-borne theory and ridiculed the suggestion that cholera was caused by a living organism. In his 1846 paper he claimed to have a specific remedy, namely carbonic acid gas, to prevent collapse in cholera patients. He mixed 30 gr sesquicarbonate of soda or potash, 20 gr citric or tartaric acid, 1½ wine glasses of water and 1 dessertspoonful of syrup. This was given every 15 minutes for the first hour; less often thereafter. Fluids were allowed as the patient wished. Sesquicarbonate is a naturally occurring mixture of carbonate and bicarbonate.  So what Parkin was actually doing was giving alkali therapy with fluids and plenty of sodium or potassium, a 1840s dioralite.  In a collapsed apnoeic patient sodium bicarbonate therapy can be very harmful because carbon dioxide can diffuse readily into the cells and add to the acidosis.  Here however the patient is getting rid of carbon dioxide by burping and he is also able to breathe it out. I guess this treatment is not as bizarre as it first sounded. The syrup was added to stop the carbon dioxide gas bubbling away before the patient had swallowed the medicine, because Parkin thought this was the active agent.

 

Before I tell you about the last pamphlet bought by the Society I need to refer to three papers that it did not purchase.  In September 1849 John Snow published his pamphlet On the mode of communication of cholera and this was followed 29 days later by William Budd’s Malignant Cholera: Its Mode of Propagation and Prevention. The two men agreed that cholera was a disease of the gut, that other features were from dehydration and that water contaminated with cholera evacuations was a major source of spread. They disagreed in that Budd thought transmission by inhalation was feasible and that the causative agent was a fungus, one that had been identified by Joseph Swayne and his colleague Dr Frederick Brittan, who later became a member of the Reading Society.  Budd was always meticulous in giving priority to Snow.

 

In 1954 John Snow had the opportunity of further studies on cholera, especially those where he related deaths from cholera to houses with piped water supplies from different water companies, or alternatively houses who got their water from different pumps, especially during the epidemic in the neighbourhood of Golden Square.  Beside those who questioned whether Snow’s theory was true were those who said it wasn't original.  Snow however had approached the matter in a scientific manner and had produced substantial statistical evidence to support his theory.

 

 

 

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Bibliography and References

 

Michael Dunnill. Dr William Budd, Bristol's most famous physician ,. Bristol: Redcliffe Press, 2006.

Vinten-Johnansen P., Brody H., Paneth N., Rachman S., Rip M. Et al. Chloroform, Cholera, and the Science of Medicine, a Life of John Snow. Oxford: University Press, 2003.

Munro Smith G. A History of the Bristol Royal Infirmary.  Bristol: Arrowsmith, 1917.

Odery Symes, J. A Short History of the Bristol General Hospital.  Bristol: Wright, 1932.

Bennet JA.  The eclipsed dawn of anaesthesia in Bristol.  The History of the Anaesthesia Society Proceedings, 1999; 25: 85-89.

Weller R. The first general anaesthetic in Bristol. The History of the Anaesthesia Society Proceedings, 1999; 25: 80-84.

Weller R. Death in Bristol. An exchange of views between Augustin Prichard and John Snow   Anaesthesia, 1976; 31: 90-96.

Stratmann L. Chloroform, the Quest for Oblivion.  Stroud: Sutton, 2003.

Griffiths LG. The Medical Readng Society.  Brist Med-Chi J. 1907,XXV.97:222-23.

 

Appendix  A

 

Books proposed by William Budd at the Medical Reading Society.

 

1855                 Transactions of the Pathological Society lst vol*

1856                 Polarized Light 2^nd ed                                                     Pereira

                        Pathology of Urine                                                         Heller

                        Present state of the theory and practice of medicine*       Bennett                           

    Lecon’s de physiologie experimentale appliquée à la

    Médecine, nos. 1 and 2                                                  Bernard

                        Physicians and Physic                                                   Simpson

                        Report on last two cholera epidemics in London               Simon

                        Gazette médicale

 1857                Sewerage of London and other large cities                      Copland

               L’histoire de le decouverte de la circulation du sang         Flourens          

                        Chemistry of wine                                                          Mulder

 1858                La vie et l’intelligence                                                     Flourens

                        Papers on the health of the people                                  a blue book

                        On chloroform and other anaesthetics                             Snow

                        Researches on epilepsy                                                 Braun-Séquard

    Archives de physiologie normale et pathologique1,2,3      Braun-Séquard                         

    Transactions of the Odontological Society

 1859                Yellow fever*                                                                 Pym

                        Seaside Studies                                                            Lewes

1860                   On the classification and geographical

    distribution of the Mammalia                                           Owen

    Report on yellow fever at Lisbon*                                           Lyons

                        Palaeontology                                                                Owen

                        L’annee scientifique et industrielle 1859                           Figuier

                        L’Institut

    L’Heterogenie                                                                Pouchet

 1861                Clinique Médicale   1^st vol                                               Trousseau

                        Sur la Societé Anthropologie vol 1                                   Merm

 1862                Transactions of the Epidemiological Society

                        Natural History Review  from start of new series       WB to buy at half price

                        Meteorology                                                                  Herschel

                        Scientific Essays                                                           Holland

                        Popular Science Review

 1863                Emphysema and Bronchitis                                            Waters

                        Australian Climate and its influence in prevention and

    arrest of consumption                                                    Palmer

 1864                Horses of the Sahara                                                     Daumas                 

                        Map of Geographical Distribution of Disease                    Johnstone        

1865                   Trichines a l'usage des médecins et des gens                                                     

                        du monde                                                                      Virchow 

                        Gazette Médicale                                                                                 

1867                    Report upon the epidemic at Maplewood Young  

1868                    Ladies Institution                                                            Palmer

               Cattle Plague                                                                 Gamgee

                            Leçons sur la physiologie générale et comparée

    du système nerveux                                                       Vulpian

 1868                Variation  under domestication*                                      Darwin

    Revue des deux Mondes                                                          

    Criminal Abortion                                                           Storer

 

*   not purchased by the Society.

** not purchased in 1868, but was in 1869 when proposed by Mr Leonard soon after Budd had resigned from the Society.

 

 

 

 

William Budd

 

 

 

·        Born 1811 North Tawton, Devon

·        Father: retired naval surgeon, general practitioner, North Tawton

·        Faculté de Médicine de Paris, 1828-29, 1833-34 and 1836-37

·        Edinburgh University, 1837-38, gold medallist

·        Moved to Bristol 1841

·        Lecturer to Bristol Medical School, 1842-55

·        Physician to St Peter's Hospital, 1843-47

·        Physician to Bristol Royal Infirmary 1847-62

·        Malignant cholera: its mode of propagation and its prevention, 1849

·        Director of Bristol Water Co., c. 1850

·        Medical Reading Society, 1855-69

·        Describes the contagious nature and prevention of Diphtheria, 1861; Anthrax, 1862; Tuberculosis*, 1867: Scarlet Fever, 1869; also studied cattle plague and sheep smallpox

·        Gave evidence to the Sanitary Commission, advocating the establishment of a Public Health Service, 1871

·        Elected FRS, 1871

·        Typhoid fever: its nature, mode of spread and prevention, 1873

·        Died 1880, hemiplegic for his last six years

 

William Budd Health Centre; Blue Plaque 89 Park St.; Ward at BRI 

 

             

*even in his home city of Bristol Budd’s ideas were not universally accepted. In 1883 two members of the Medical Reading Society wrote articles in the Bristol Medico-Chirurgical Journal about Budd’s views on tuberculosis – Shingleton Smith supporting them, and Markham Skerritt concluding that ‘clinical experience is strongly opposed to the theory that phthisis is a contagious disease’. See Michael Dunnill. Dr William Budd. Bristol: Redcliffe Press, 2006.

 

 

Appendix  B

 

To read LG Griffiths's paper on the first 100 years of the Society click here

Members of the Medical reading Society 1807 - 1907 click here

Medical Reading Society home page click here

John Powell's homepage click here

To see PowerPoint presentation of this lecture click here

 

 

Acknowledgements

 

I have received help from many people but I am particularly grateful for help in obtaining material to Louise Bruton of the medical library in Bristol, Leslie Greig and her staff at Southmead, Julianne Simpson of the Welcome Foundation, Clive Hurst of the Bodleian library, and Trish Willis, archivist at the Association of Anaesthetists. My thanks to you all.

 

 

John Powell's Home  (to visit other articles/book on the history of anaesthesia)