A lecture given to a meeting marking the bicentenary of Humphry Davy’s researches into nitrous oxide, Bristol May 1999. Reprinted from The History of Anaesthesia Society Proceedings, 1999; 45: 80-84.

　

The Eclipsed Dawn of Anaesthesia in Bristol

Dr JA Bennett

Past Hon Secretary History of Anaesthesia Society

The first surgical procedure to be carried out in Bristol under general anaesthesia was on Wednesday 30 December 1846 at the hands of an anaesthetist who was a university professor - a probably unique and certainly remarkable circumstance for that period. Equally unique was the method of administration which was by means of a 'common, but very large, bladder fitted with a collar to which an ivory mouthpiece with a very large bore can be screwed without the intervention of any stopcock'.1 This was in contrast to the apparatus being then promoted by Boott and Robinson2, sometimes known as the Squire or Hooper inhaler, which was adopted by all the early administrators throughout the kingdom.

The Bristol technique probably arose from the system for nitrous oxide inhalation formerly employed at the Medical Pneumatic Institution in Hotwells, Clifton, Bristol, by Humphry Davy and seen in pictorial descriptions of his later demonstrations at the Royal Institution in London3. William Herepath, Professor of Chemistry and Forensic Pathology at Bristol Medical School, adopted the technique for his public demonstrations of the effects of nitrous oxide during his courses on domestic chemistry4. In applying the method to the inhalation of ether it could be postulated that Herepath had considered its vaporisation by this means for quite some time. As a forensic chemist, his knowledge of the mode of entry and exit of drugs would outstrip many who would be charged with introducing ether into hospitals throughout the land. Herepath’s expertise was not retained beyond this first occasion. Clearly he was not a member of the Hospital Staff, and there were, as we now know, both surgeon and physician interested in promoting the effects of ether - but perhaps from opposing standpoints.

One such physician was Alexander Fairbrother who was appointed to the Bristol General Hospital in 1838, some six years after its opening in Guinea Street. Little is known about his early career but he became increasingly well known for being at variance with his colleagues on many matters. A point of particular irritation to him was the failure of the Hospital Committee, of which he was a member, to allow its proceedings into the public domain. This was eventually to become a resignation issue when in 1853 Dr Fairbrother wrote to the local press:5

‘To the editor, etc Sir, be so good as to insert the following;

Yours Alexander Fairbrother

As Dr Fairbrother will never consent to belong to any institution seeking to hide from the public, to whom it owes its means of existence, the Proceedings of Committee, he at once resigns his office of Physician to Bristol General Hospital.

36 Park Street May 16th 1853’

During his time at the Hospital, Fairbrother had fulfilled in abundance the tenets of the institution - the 'devotion to his professional engagements, and the enlargement of the boundaries of general science to advance the happiness and welfare of mankind’6. He was an active member of the influential Bristol Medical Reading Society and in 1856 he was elected as Physician to the Bristol Infirmary the city's older, more influential and rival institution, holding office for a further twenty years. Of his professional zeal there is no doubt:

‘He spent a great deal of his time at the Infirmary, and liked nothing better than a chat or gossip in the wards or corridors, either about the cases or any local events. He was often seen at the Commercial Rooms, which he frequented from his love of picking up the latest news. He had a peculiarity which many of the students of those days noted; he would never enter a ward (or indeed any room) without using the tail of his coat as a covering to his hand when turning the handle of the door’. 10

This brief profile is necessary to set in context the events occurring in late 1846 and early 1847 and the early use of ether for surgical anaesthesia at the Bristol General Hospital.

In a letter to the Lancet dated 11 January 1847, Mr Joseph Goodale Lansdown, Surgeon to the Bristol General Hospital wrote:

‘I find, from Dr Fairbrother, that he has sent you a letter respecting the operation I performed on the 30th ult, whilst under the influence of ether. I suppose he has described the exhibition of the ether and its results.’7

This refers to the mid-thigh amputation performed by him under ether anaesthesia administered by Dr William Herepath. It is left to the reader's judgement as to whether this represents an air of approval or irritation.

Three further procedures under ether anaesthesia are described, namely orchidectomy, resuture of scrotum and resuture of amputation stump in a young boy. No reference is made to the presence of an anaesthetist. However, the method employed was the Herepath bladder which, prior to the orchidectomy, was observed to have an obstructed mouthpiece resulting in failure. The quality of anaesthesia achieved in the other two cases would rate only as analgesia, with oral communication being maintained throughout. This is in sharp contrast to his next case:

‘Today I removed the right leg of a woman, aged 62. This time Dr Fairbrother used an apparatus constructed under the direction of Dr Boott and Mr Robinson. The time occupied before the ether had taken effect was longer than upon the previous occasions; when it was produced, it was most perfect ... we could not convince the old lady that she had lost her leg. The gentlemen present, to the number of about twenty-five were perfectly astonished.

Yesterday, a second operation was performed, at the Bristol General Hospital, upon a female aged sixty-three years. Her leg was amputated by Mr J G Lansdown, the operating surgeon, and completed in less than five minutes. In this case I administered the ether by means of Robinson's apparatus, with the most complete success. It took about eight or ten minutes to procure a state of insensibility .... nor could she believe her leg was removed. During the operation, alternately brandy was given with the inhalation of the ether.’

Both accounts are in accord, but clearly an induction time of 8 to 10 minutes, almost double the operating time, exceeded the surgeon's expectations; today it would probably receive less favourable surgical comment. It is apparent that Fairbrother had no involvement with or knowledge of the three surgical cases receiving ether on the two preceding days. However it does seem that he can be credited with presiding over the second case in Bristol to achieve full surgical anaesthesia. It also seems that he did not favour the Herepath inhaler, which he either chose to ignore, or tried and then abandoned.

In contrast, Lansdown spent the remainder of January 1847 obtaining further experience with Herepath's inhaler, using it for a variety of procedures. As far as can be ascertained these were conducted without the presence of another physician or surgeon, at locations outside hospital- either in his or the patient's home. All these made a rapid and uneventful recovery In a letter to the Lancet in February he gave an account of thirty cases.

‘In the introduction of any novelty in our profession, I consider the best mode of forming a correct judgement of its merits is to procure a collection of unvarnished facts bearing upon the point. This is most particularly applicable with regard to the operations while the patients are under the influence of ether. Since my last letter, I have had frequent opportunities of trying its effects and will give the cases according to their several dates. I have now administered the ether thirty times.’ 9

I have made a tabulated summary of these administrations.
 

c

Anaesthetist

Anaesthesia

Administrations

 & Apparatus

Patient

Surgery

Good Partial Fail

 

 

 

 

 

30

JG Lansdown

M

Orchidectomy

                     1

 

SURGEON

M

Suture scrotum

 1

 

Herepath app

M

Suture Amputation

 1

 

 

F  12yrs

Dental Neuralgia

 1

 

 

M  60

Ca Lip

          1

 

 

F  26

Dental Extraction

 1

 

 

M  12

Attempt Toenail Extraction

                     1

 

 

M  12

Toenail Extraction

 1

 

 

M  14

Dental Extraction

 1

 

 

F  20

Dental Extraction

 1

 

 

M  64

Urethral Bougiesx19

 18                1

 

 

F  15

T/K Amputation

            1

 

 

 

 

 

1

WB Herepath

M

Leg Amputation

 1

 

CHEMIST

 

 

 

 

Herepath app

 

 

 

 

 

 

 

 

1

A Fairbrother

F

Leg Amputation

 1

 

PHYSICIAN

 

 

 

 

Robinson app

 

 

 

 

 

 

 

 

Total: 32

 

 

 

 

Surgical Cases with Ether Anaesthesia Bristol, 30 December 1846 to 28 January 1847

It is evident that Lansdown's thirty must include the three minor cases already referred to and not overseen by Fairbrother.

The recording, in a provincial city, of no less than 32 administrations for a wide variety of conditions all within the first month, is probably unmatched in the annals of early British anaesthesia. At present it is only possible to speculate as to why such apparent enthusiasm for anaesthesia in Bristol seemed to fade away. (but see comment by JP below)

Bristol may have been the victim of the general apathy and caution which greeted anaesthesia. Many centres in London were actively against its extensive adoption. The Bristol situation may have been a reflection of local, political and personal factors. Firstly, William Herepath could not reasonably support or promote a process which was largely regarded as experimental, and not at that time widely acclaimed. Secondly, without the support of the medical staff of the city's more important and older hospital, the Bristol Infirmary, any initiatives from Herepath and the Medical School were likely to fail. Finally, Herepath having withdrawn from the more politically divergent hospital following his first and apparently only administration of ether, a vacuum was created at that institution. To Lansdown, the surgeon, would go the credit, if any, for the pioneering of painless surgery with the less satisfactory means of administration, whilst Fairbrother, the physician and less endearing colleague, had the means of promoting a more conventional and reliable technique.

Lansdown saw the anaesthetic process as being merely an adjunct to surgery, entirely within the scope of the surgeon to achieve. Having attempted to perfect the Herepath technique, his recorded cases were undertaken in the home or in his 'consulting room'. They were, in the main, minor procedures and the patients were often described as being responsive to commands and questions. His observations importantly demonstrated how light anaesthesia, or more accurately analgesia, could be appropriate for ambulatory patients - the forerunner of day case surgery as we know it today.

Meanwhile, at Bristol Infirmary, the dawn of anaesthesia failed to occupy the minds or stir the souls of the physicians and surgeons, unless it was simply to be rejected. It would be nearly four years until, on 31 August 1850, the first anaesthetic was administered, for a lithotomy.11 The surgeon, John Harrison, had been a keen resurrectionist in his earlier days, but was one of few among his fellows who conscientiously undertook his lecturing duties to students. He became Senior Surgeon in 1850 and may thereby have had some influence in persuading his colleagues, some of whom were known to be mesmerists, to agree to general anaesthesia. The six members of the Bristol Infirmary Honorary Surgical Staff - William Francis Morgan, Nathaniel Smith, Henry Clark, Thomas Green, Augustin Prichard and John Harrison - all signed this minute in the consultation book:

‘Cons. Room, Aug 31 1850. A consultation was held upon Samuel Edgar, a patient with Calculus as to the propriety of administering Chloroform previous to the operation of lithotomy, and it was agreed that chloroform should be administered.’

The 50 year old patient did well, but a further nine months were to elapse before the next administration. This was again to a patient of Mr Harrison, on 20 May 1851.

From this short enquiry, the full explanation for the eclipse of anaesthesia's dawn in Bristol remains unclear. This is a less than satisfactory conclusion for a city which was so prosperous and outgoing and had been the setting for the forthright prediction of surgical anaesthesia by Humphry Davy some fifty years previously. However, at the appointed time, in late 1846, the complexity of having the choice of two techniques - one born out of Davy's researches - and the influential views of men with differing perceptions and character, may have been significant local factors. While advances were being made elsewhere in the country, four years were to elapse before anaesthesia in Bristol would emerge from the darkness.

  1. The Times. 4 January 1847

  2. Robinson 1. A Treatise on the Inhalation of the Vapour of Ether. London: Webster & Co, 1847.

  3. Gillray 1. Scientific Researches. New Discoveries in Pneumatics or an Experimental Lecture on the Powers of Air. Cartoon of a lecture at the Royal Institution. Published by Hanna Humphrey, 1801 (etching) New College, OxfordlBridgeman Art Library, LondonlNew York

  4. Bristol Gazette. 15 December 1836.

  5. Odery Symes A Short History of the Bristol General Hospital. 1932; 26.

  6. Ibid; 13.

  7. Operations without pain. Lancet 1847;1: 79.

  8. Ibid; 79.

  9. Operations without pain. Lancet 1847;1: 159-160.

10 Munro Smith G. A History of the Bristol Royal Infirmary. Bristol: J W Arrowsmith Ltd,1917; 318.

11 Ibid; 320.

Note by JP

Since Tony Bennett gave this paper to the History of Anaesthesia Society I have found another letter from Joseph Landsdown to the Lancet describing his experiences with Ether and Chloroform. It is dated December 1847 and was printed in the Lancet Jan 1848, p.10-11. It shows continued enthusiasm for anaesthesia on his part and includes his claim to be the first person in England to administer chloroform to a woman in labour. Go there