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 Proceedings, 1999; 45: 80-84.
THE FIRST GENERAL ANAESTHETIC IN BRISTOL
Dr R Weller
Consultant Anaesthetist, Frenchay Hospital, Bristol
Bristol was among the cities that reported the use of ether as an anaesthetic within the first weeks of it being demonstrated in London, although there is some doubt about the precise date when the operation took place.
The suggested dates of first ether anaesthetic in Bristol:
30th December 1846 Lancet
31st December 1846 London Medical Gazette and Bristol Mirror
1st January 1847 Bristol Gazette, Felix Farley's Bristol Journal and The Times
4th January 1847 Development of Inhalational Anaesthesia
31st August 1850 Short History of the Bristol General Hospital
The last two dates are clearly wrong. Since no hospital records remain, one is left with a choice of three days, 30th December and 31st December 1846, and 1st January 1847. We can eliminate 30th December. The only letter referring to this date was written two weeks later, appearing in the l,ancet of 16th January.1 It was written by the surgeon, J G Lansdown, and started: 'Sir, I find, from Dr Fairbrother, that he has sent you a letter respecting the operation I performed on the 30th ult, whilst the patient was under the influence of ether'
The letter that Dr Fairbrother had sent to the Lancet was acknowledged in an earlier issue2 but was never published. However, it did appear in the London Medical Gazette3This letter started: 'Surgical operation without pain: - Thursday, 31st December, a young man… Dated 4th January, this is obviously better evidence; Fairbrother is more likely to have remembered the actual day of the operation after four days, than Lansdown after two and a half weeks. The newspapers vary in their detailed accounts of the procedure as much as they vary in the day they said it occurred. Not only do they disagree about the date, the 31st or the 1st, but compound the disagreement by specifying Thursday and Friday.
The Place
There is no doubt that the anaesthetic was given at the Bristol General Hospital. The hospital occupied 11, 12 and 13 Guinea Street, having been founded in 1832. It was expanded in 1858, and again in 1875. A Bristolian of one hundred and forty years ago would easily recognize the buildings that the NHS inherited, and still occupies today.
The patient
The patient was a young man who had a left above-knee amputation: 'rendered necessary by a white swelling of three years duration'3. As far as can be ascertained, he did well after his operation, and at the end of January was 'quite well, and in a state to leave the hospital; no unfavourable symptoms of any kind having manifested themselves'4. The surgeon, James Goodall Lansdown was, in 1846, the senior surgeon to the Bristol General Hospital. He is dealt with more fully in Dr Bennett's paper (see comment below).
The anaesthetic
The method of administration of the ether, using a common bladder, was described in a letter to The Times5 written by a well known Bristol chemist, William Herapath, and dated 1st January 1847:
'No complicated apparatus is necessary, nor any extraordinary care in purifying the ether. A common, but very large, bladder should be fitted with a collar to which an ivory mouthpiece with a very large bore can be screwed without the intervention of any stopcock; pour in about an ounce of good common ether (mis-spelt in The Times as either), and blow up the bladder with the mouth till it is nearly full; place the thumb on the mouthpiece, and agitate the bladder so as to saturate the air in it with the vapour; as soon as the patient is ready for the operation, close his nostrils, introduce the mouthpiece and close the lips around it with the fingers. He must now breathe into and out of the bladder, and in about one or two minutes the muscles of his lips win lose their hold. This is the moment for the first cut to be made. In two or three minutes, the effect will begin to disappear; the mouthpiece should again be introduced, and this repeated as often as required. If the pulse should indicate a sinking of the patient, a little wine will restore him.'
Significantly, Herapath then added:
'1 have no doubt but the inspiration of nitrous oxide (laughing gas) would have a similar effect upon the nerves of sensation as the vapour of ether, as I have noticed that persons under its influence are totally insensitive to pain, but I do not think it would be advisable to use it in surgical cases, from its frequently producing an ungovernable disposition to muscular exertion, which would render the patient unsteady, and embarrass the operator.'
The anaesthetist
There are two candidates for the honour of giving the first anaesthetic in Bristol. They have both been mentioned already - Dr Alexander Fairbrother and Mr William Herapath. As with the date, the evidence differs as to whom the honour is due. Three sources, the London Medical Gazette3, the Bristol Mirror6 and Felix Farley's Bristol Journal7 use the same wording:
'At the suggestion of Dr Fairbrother, the senior physician to the hospital, Mr Lansdown, the operating surgeon, was induced to try the effect upon the patient of the inhalation of the vapour of sulphuric ether. By this mode, the patient is thrown into a state of utter insensibility, by means of the bladder used in imparting the laughing gas, into which Mr Herapath introduced the ether, and caused the patient to inhale the vapour. After one minute and a half the patient was unconscious; the surgeon then commenced his incision. After the lapse of two or three minutes, Dr Fairbrother again administered the vapour, keeping his fingers on the patient's pulse, and watching his breathing.'
From this it would seem that Mr Herapath induced anaesthesia, and Dr Fairbrother then took over and maintained it. The word 'again' in 'Dr Fairbrother again administered the vapour' must refer to the administration, and not the administrator. The Times report5 is identical, except that by omitting the sentence 'by this mode …. inhale the vapour', all mention of Herapath administering the ether is also omitted. This is compensated for by the long letter from Herapath on the method of administration which then followed.
The Brislol Gazette8 under the headings: 'Painless Surgical Operations' and 'Successful application in Bristol' gives Dr Fairbrother the honour of suggesting the use of ether, but Mr Herapath the sole honour o(the administration. It seems relevant to compare the careers of these two protagonists, to see which was the more likely to have had the foresight to recognise the huge new net who am not anything outside of the new discovery of ether as employed in London, and then the courage to use it in Bristol.
Dr Alexander Fairbrother
Fairbrother was born in 1809, graduating at Edinburgh in 1836. He was appointed Physician to the Bristol General Hospital in 1838 and held the post until 1853. He must either have read the reports of the use of ether in the Lancet, or heard by word of mouth. In his letter to the London Medical Gazette,3 he first describes the events and then makes a few comments. After citing the temporary insensibility produced by the America authorities, he states:
'In the present case, by keeping my fingers upon the pulse, and closely watching his respiration, varying the process by giving wine (leaving off at intervals all the means, and allowing him to breathe the atmospheric air), he was kept exactly in that state of unconsciousness that was desired, from which he awoke directly after the operation was completed and the man appeared as though he had suffered no pain. I should not hesitate to superintend a case requiring a longer duration of the application than the present, which occupied from fifteen to twenty minutes.'
I leave Fairbrother also to Dr while this but if he really was the instigator of the use of ether in Bristol, surely the authors of his various obituaries, both medical and lay, would have recorded the fact, as they did the interest in the subject shown by J G Lansdown.
Mr William Herapath
William Herapath was a man of rare distinction, who rose from a very humble background to follow two very separate but equally important careers. He was born in Bristol in 1796, his father being a maltster in the St Phillip's area of the city. Initially, he joined the family business but soon became more interested in chemistry, and it was in this field that he achieved national fame. In 1828, he started to give lectures at the Bristol Medical and Surgical School, which had been started by Henry Clark in 1826. The Apothecaries' Hall recognised these lectures immediately, while the College of Surgeons waited until 1831. He was thus one of the founding professors of the Medical School, holding the post of Professor of Chemistry and Toxicology from 1828 until his death. His lectures were regularly advertised In the local press, and were open to the public. A series of public lectures during the autumn of 1836 were particularly popular, so much so that they had to be repeated twice. These have been described before9 so I will limit myself to two quotations. With respect to nitrous oxide, on 16 November 1836 he:
... expatiated on its discovery, and more particularly on the fact that in our native city the discovery of its laughable properties was first discovered by Sir Humphry Davy, whilst with Dr Beddoes, whose work written at the time on this important discovery he recommended all present to read.'
'In the majority of those who took the Gas it occasioned a pugnacious tendency .... it was a matter of congratulation that a magistrate was present to prevent a breach of the peace. The scene was, in fact, as truly comic as can well be conceived - one dancing with the greatest enthusiasm, another bowing with the most perfect grace, a third standing in 'solemn silence'. Not the least amusing exhibition was that of a gentleman who on taking the gas was seized with a fit of the most excessive politeness, several times thanking Mr Herapath for his kindness, and accosting everyone with whom he came in contact with the most polite thanks for some supposed act of civility. It is impossible to depict the varied effects of this singular gas as displayed that evening. To form any correct idea of the effect we would recommend our readers to visit the Mechanics Institution on Wednesday, the 30th instant, when Mr Herapath, at the request of the Company and with a view to benefit the funds, has kindly consented to repeat the experiments at the conclusion of his fifth and last lecture.'
On 22 December 1836, it was noted how Herapath:
‘roasted a piece of beef weighing nine pounds, a couple of fowls, a plum pudding, and boiled some potatoes by means of a gas apparatus. The viands were pronounced by the company, who all partook of them, to be excellently well done, and from ere long gas fires will be found in the house of all grate economists, as gastronomy be, as it should, the science of cooking by gas. On Friday next, the Laughing Gas is to be administered to several happy youths home for the holidays'
As a forensic expert, he came to prominence after his evidence at the trial of Mrs Burdock in 1835. She had used arsenic to poison her lodger, a Mrs Smith, and was hanged, largely as a result of Herapath's chemical examination of the corpse, exhumed fourteen months after burial. After that, he was asked to make analyses in all the great poisoning causes celebres culminating in 1856 in the case of William Palmer, the notorious Rugeley poisoner. On this occasion he appeared for the defence, which lost.
It was in the role of local politics that he was best known to the population of Bristol. He held, from his youth, extreme liberal views. 1831 found him as Vice-President of the Bristol Political Union, a strongly radical club, actively working for the Great Reform Bill. When, on 29 October, the Bristol Riots broke out, it was noted that while the posters of the authorities, urging the crowds to disperse, were torn down, Herapath's were left up. Indeed, the many reactionary Tory elements in the town blamed his organisation for much of the trouble. After the Municipal Refonn Act became law in 1835, Herapath was among the few liberals who were elected to the reformed Council, and he held various seats until 1863. However, his pretensions to public office, and the fading of his radical views, gradually lost him much of his support. He had a strong interest in the Bristol General Hospital. He was present and spoke at a public meeting calling for its formation, held on 21 September 1831. 10 His connection with the radical element in the city, though, meant that when the election of the committee to run the hospital took place, an event actually postponed by the riots, he was not chosen.
Our main interest, however, is in his brief involvement with anaesthesia, which was not confined to the hospital. Having induced the first general anaesthetic in Bristol, Herapath did not entirely withdraw from the scene:
'On Tuesday (i.e 11th January), a young lady from Stoke Bishop, who for some time has been suffering from toothache, was induced to try the expedient of inhaling ether, and Mr Herapath kindly undertook to administer it. She went to Mr Gordon's, in Park Street, and being rendered insensible to pain, the operation of extraction was successfully performed without the least pain to the lady.' 11
William Herapath died on 13 February 1868, at his home, the US Manor House, Old Park, aged 71, and is buried in Amos Vale Cemetery. Bristol has not entirely forgotten Herapath. A rather scruffy street in the Barton Hill area of the city is named after him.
References
1. Lansdown JG. Bristol General Hospital. Lancet 1847; 1:79.
2. Correspondence. Lancet 1847; 1:54.
3. Fairbrother A. Painless surgical operations. London Medical Gazette 1847; 4:81.
4. Fairbrother A. Remarks on Inhalation of the Vapour of Ether. London Medical Gazette 1847; 4:364.
5. The Times. 1847; 4th January
6. Bristol Mirror and General Advertiser 1847; 2nd January.
7. Felix Farley's Bristol Journal 1847; 2nd January.
8. Bristol Gazette and Public Advertiser 1847; 7th January.
9. Weller RM. Nitrous oxide in Bristol in 1836. Anaesthesia 1983; 38:678-682.
10. Bristol Gazette 1831; 22nd September.
11. Bristol Mirror 1847; 16th January.
Note by JP: a paper by Tony Bennett, The Eclipsed Dawn of Anaesthesia in Bristol, followed immediately after Robin Weller's paper. Actually there was no such eclipse - see Lansdown, On the Use of Ether and Chloroform in Surgery and Midwifery, Lancet January 1848, p. 10-11. Here Landsdown describes his anaesthetic practice over the 11 months following the first general anaesthetic in Bristol. By December 1847 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.