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of the Royal College of Surgeons of England (1984) vol. 66
Consultant Anaesthetist, Royal Hallamshire Hospital, Sheffield
J D ALDERSON
Consultant Anaesthetist, Northern General Hospital, Sheffield
An account is given of the early days of anaesthesia in Sheffield with reference to articles published in local newspapers.
Sheffield has been described as the largest village in Europe but it recently became the fourth largest city in England after London, Birmingham and Liverpool (The Times).
In 1847 the future city was recovering from a severe depression of trade in the early forties, was poorly connected to the inland waterway network and not yet on a main line railway to London. Sheffield's population had doubled since the turn of the century and by 1851 when the first efficient census was carried out just over 100,000 people resided in the four contiguous parishes of Sheffield, Upper and Nether Hallam and Ecclesall-Bierlow. The population of England and Wales at this time was nearly 18 million of whom 2,362,236 persons resided in London, 250,000 each in Liverpool and Manchester and getting on for 200,000 in Bristol and in Birmingham.
Previous reports have shown the value of studying local newspapers for information on early anaesthesia. A search of Sheffield newspapers has provided valuable information on the early days of anaesthesia in Sheffield.
The weekly Sheffield Times in its edition of 2nd January, 1847 carried a headline 'New and Important Discovery in Surgery'. This headed an important and long article which began by giving details of the early surgical operations performed under ether in Boston USA in October 1846, quoting from the letter written by Dr. Jacob Bigelow of Boston to Dr. Francis Boott of London, of which a full record can be found elsewhere.
The Sheffield Times article then proceeded by referring to a letter written by Dr. Boott to the Morning Chronicle in which he reported that ether inhalation had been tried in London 'with the most perfect success in the extraction of teeth': and that two surgical operations (one the amputation of a thigh) had been performed by Mr. Robert Liston 'with highly satisfactory results, and without the patient having been in the least conscious of what had been done'.
It is of interest that the Sheffield Times credited the authors of the discovery of ether anaesthesia to 'Dr. C. T. Jackson' in addition to 'Dr. Morton of Boston' an early reference to a controversy which was to persist for many years. The article continued by quoting from an account of Liston's amputation by Dr. John Forbes, a witness of the London surgical operations and himself editor of the British Foreign Medical Review.
The following week the Sheffield Times once again carried an article on anaesthesia. In the issue of 9th January 1847 under the heading 'Use of Aether in Surgery' came a paragraph quoting from a letter written to the London Times by Mr. Herapath, a chemist, describing a vaporiser of his own design. Herapath continued by suggesting that nitrous oxide would 'have a similar effect upon the nerves of sensation as the vapour of aether, 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 would embarrass the operator'. Herapath was obviously aware of the analgesic effects of nitrous oxide.
Surgeons in Sheffield were not slow to realise the importance of the news on ether, for the Sheffield Times of 23rd January 1847 carried the news of the first operation under an anaesthetic in Sheffield, performed using ether on 22nd January 1847 by Mr. Beckitt, assisted by Mr. Porter. The operation was for the removal of the middle finger and portion of the hand of a female patient. The article was headed 'Surgical operation in Sheffield While Under the Influence of Ether', and it describes the event as follows:
'The vapour was inhaled from an apparatus belonging to the infirmary for a quarter of an hour before any effect was produced, when at length the usual phenomena was manifested, and the operation was commenced. During the course of the operation the patient uttered no expression of pain, but after it was completed said, that although she had not been altogether free from pain, yet it was very much less than what she had experienced a few weeks before in the opening of an abscess in the hand. We believe that this is the first attempt that has been made by Sheffield to apply this method of producing insensibility to pain by means of this invaluable discovery.'
The article concluded with an illustrated description of the modified Nooth's apparatus produced earlier by Hooper of Pall Mall for Dr. Boott and Mr. James Robinson (the dentist) and used by them for the first dental anaesthetics in London on 19th December 1846. It is not clear from the article whether the Sheffield inhaler was of this type. The article mentions that the inhaler had been borrowed from the infirmary. This may possibly have been a printer's error for Infirmary, designating the Sheffield General Infirmary, which opened in 1797, and finally closed in 1981 as the Sheffield Royal Infirmary, or it may have been referring to the Sheffield Public Hospital and Dispensary - certainly the centenary history of 1932 mentions the purchase of an ether inhaler for £7.4.0 (£7.20) in 1847 but sadly the volume of minutes for 1843-53, is lost. Little is known about the surgeons involved. Mr. C. W. Beckitt had been appointed in 1844 as a surgeon accoucheur to the Sheffield Public Dispensary (which opened in 1832, was later renamed the Royal Hospital and finally closed in 1978). Mr. J. T. Porter, Mr. Beckitt's assistant, was appointed surgeon to the Dispensary in 1853.
Further information on the first ether anaesthetic in Sheffield is to be found in the Quarterly Medical Journal of 1895 in which a lady then aged 82 claimed to have been the patient described. The operation was apparently performed at her house by Mr. Beckitt and she had been told by him, at that time, that she was the first person in Sheffield to have ether as an anaesthetic, and that it had only then been given in two or three cases in London. Tantalisingly, she was not named in either report.
Whilst the surgeons at the Public Dispensary gain credit for giving the first Sheffield anaesthetic the surgeons at the General Infirmary were not slow to take advantage of ether anaesthesia. The Sheffield and Rotherham Independent of 6th February 1847 contained an article headed 'The use of Vapour of Ether in Surgical Operations' and described the anaesthesia of three patients at the General Infirmary on 30th January and is quoted here as a lovely example of Victorian prose:
'It is so natural for mankind to desire the extinction of pain that all feel a lively interest in any discovery by which it may be averted or mitigated. Hence it is that all readers peruse with pleasure the reports of surgical operations performed on patients under the influence of the vapour of ether, of which so many have been published within the last few weeks. On Saturday last three operations were performed at the Sheffield Infirmary by Mr. Thomas, one of the surgeons of that establishment, in the presence of the medical staff and of a large number of the professional gentlemen of the town and neighbourhood.' A description of the apparatus (a modified Nooth apparatus manufactured by Messrs Horne & Co. of Newgate Street) followed, concluding with '... A gentle warmth from the fire, (!) and afterwards the warmth of the hands of the person who holds the bottle, suffices to produce the vapour. To inhale the vapour for two or three minutes usually produces perfect insensibility'.
The first operation was upon a boy 9 years old, who needed an amputation through the thigh for an incurable disease of the knee joint. He was carried into the room, crying bitterly , and begging that his knee might not be taken off. Insensibility having been produced, the limb was removed in two or three seconds less than a minute. About a minute and a half more was occupied in taking up the arteries. The patient showed not the slightest degree of consciousness while the limb was being removed, but when the arteries were being taken up he awoke. Being in a sitting position he at once saw that his leg was removed and exclaimed, 'Oh! I'm thankful! I'm thankful! I'm thankful!'. He was asked if he had felt any pain, and he replied, 'None at all'. 'What! none?' 'No, not a bit'. He was carried away exulting. The patient in the next case was a muscular man, a farmer, 38 years of age. The operation necessary in this instance was of a very disagreeable and painful character. It was to remove a tumour from the upper jaw, with part of the jaw itself. This it is obvious would prevent any further inhaling of the vapour after the commencement of the operation, which occupied from 12 to 15 minutes. The first part of the operation was to lay open the cheek, and dissect the integuments from the jaw bone; and the next, to cut through the bone, with remarkably small saws, and bone forceps. The patient remained unconscious during the cutting part of the operation, which lasted about 2 minutes. He then opened his eyes, felt the sawing of the bone, and heard and understood what took place about him during the remainder of the time. But though sensible, he remained remarkably calm and immovable, evincing little perception of' pain, and convincing the bystanders that his sufferings were trifling compared with what they would have been had he not been under the influence of the ether.
The third case was a girl 16 years of age. It was the ordinary operation for the cure of harelip. She remained perfectly unconscious of pain during the operation for cutting the two sides of the lip, to cause them to unite; but when the last part of the operation was performed, which consists of passing a pin through the lip to hold the two edges together, she suddenly exclaimed, 'It pricks'. It is gratifying to learn that all the patients have since been going on favourably, and that there has been nothing in the influence of the ether to militate against their recovery. The effect of the ether is considered to have been successful in each case. In the first and third its success was complete. In the secondits influence might have been renewed excepting for the fact that the operation was being performed upon the mouth.'
It is obvious from this account that only the first stage of anaesthesia i.e. analgesia, was reached but that this facilitated in the second and third patients what would have been more difficult surgery to manage at a deeper level of anaesthesia without the benefit of airway control. The remarkable reactions of the patients illustrate the stoicism of the era when the alternative was forcible restraint following premedication with strong drink or opiates.
Mr. Henry Thomas was an experienced Sheffield surgeon. He was born in Sheffield in 1809 his father being a general merchant. He went to school in Wakefield, after which he was apprenticed for four years to his brother-in-law, the surgeon Mr. Thomas Waterhouse. After studies in London and Paris he qualified MRCS and LSA in 1831 at the age of 22 and started practice in Sheffield. In 1832 he was elected as one of the three surgeons to the newly opened Sheffield Public Dispensary, where he served for two years. He became a surgeon to the Sheffield General Infirmary in 1835 and resigned following a severe illness in 1848 at the age of 39.
Also reported in the Sheffield and Rotherham Independent of 6th February, 1847 was the use of ether in obstetrics. Under the heading 'Application of the Sulphuric Ether to Midwifery' came a report of the use of ether in obstetrics by Dr. James Young Simpson of Edinburgh which begins thus: 'Dr. Simpson, of Edinburgh has applied this new and wonderful discovery to the purposes of midwifery, and with the most signal success. This is the most wonderful of all the applications of this surprising alleviator of the ills that flesh is heir to. If it should be found to succeed on further trials, it will make the discovery one of the greatest blessings ever conferred by science on humanity.'
The article continued by quoting directly from the Edinburgh Weekly Chronicle of January, 1847 of the description of the use of ether for anaesthesia for the delivery of a child from a 'lame and deformed woman' after internal podalic version. Of interest in this article is Simpson's observation that whilst breathing the ether the mother's labour 'pains' continued, but without the mother feeling the pains.
Simpson's later advocacy and success with chloroform have overshadowed his earlier use of ether in labour, and it is apparent that the Sheffield and Rotherham Independent held out great hopes for the future use of anaesthesia during obstetrics.
In their editions of 25th February 1854 the two weekly newspapers the Sheffield Times and the Sheffield and) Rotherham Independent carried reports on an inquest held before the coroner Mr. Badger on the previous Tuesday 21 st February.
The inquest was on 45-year-old Mrs. Harrop, a builder's wife from West Street who received chloroform for the excision of a cancerous left breast on Saturday 18th February 1854, and the case attracted much medical publicity, being further reported by the Association Medical journal in a Periscopic Review, and also by John Snow as case number 39 in his book 'On Chloroform' Both these publications used the Sheffield Times report as basis for their articles.
The patient had first felt the tumour 3 years previously, it continued to enlarge and medical advice had then been sought over the last 9 months. The testimony of a friend was reported in the Sheffield Times as follows:-
'Caroline Oates, wife of William Oates, of Charlotte Street, blade maker, said she was present when the chloroform was administered to the deceased. Mrs. Harrop appeared very much frightened about the chloroform. She said to witness in the morning that she thought she should never get over it, and she appeared very nervous. Witness had before seen chloroform administered by Dr. Hall, Mr. W. Jackson, and his son, to her sister, Hannah Farest, and the administration to Mrs. Harrop was conducted in the same way. In the latter case, the chloroform did not at first take any effect. After about twenty minutes or half an hour it began to operate, and Mrs. Harrop died directly. The chloroform was applied first on a sponge, and afterwards on a pocket handkerchief.'
Mr. John Lewis, surgeon, gave evidence reported as follows by the Sheffield and Rotherham Independent:
'I have attended Mrs Harrop latterly for about three months, for a cancerous tumour of the left breast. On one occasion, Mrs. Harrop asked me if it would be necessary to remove the tumour. I told her I was afraid that it was the only way to get rid of it, and she asked me if she might have chloroform administered. I told her she might, and it was decided that an operation should be performed, and that chloroform should be administered. It was arranged to make the operation on Saturday morning, and Dr. Law, Mr. Wright, and myself, met together at Mr. Harrop's for that purpose. It had been previously arranged that Dr. Law should administer the chloroform, that I should watch the pulse during the administration, and that Mr. Wright and myself should conduct the operative proceedings after the induction of insensibility. The inhalation of chloroform began at a quarter before one o'clock, and was administered with all the usual, and indeed, with more than the usual precautions. After the administration had gone on without any effect for twenty minutes, it was thought that possibly fresh chloroform would succeed; and an ounce was procured from the Dispensary. After the inhalation had been conducted with the fresh chloroform for about twenty minutes, the usual effects of the vapour began to manifest themselves. The pulse, which was 136 before any chloroform was given, had been very gradually decreasing, though improving in strength, and was now 104. At this moment muttering, half articulate delirium came on; but this ceased in a few moments, and was immediately followed by the conclusive signs of the satisfactory action of the chloroform. Dr. Law now desired Mr. Wright to begin the operation, and before he could do so, Dr. Law seeing an alarming change in the countenance of the patient, cried "Stop! Mr. Lewis; how is the pulse?" I replied, "It is gone". The sash windows of both chambers were instantly thrown open, ammonia was administered, and artificial respiration practiced; but the heart had ceased to beat, and after a few slow and laboured inspirations, life became extinct.
Efforts to resuscitate the deceased were continued until it became evident that she was quite dead. Death took place at half-past one. An apparatus was used in administering the chloroform, but whether Dr Simpson's or not I do not know.'
Post mortem examination performed by Mr. Lewis in the presence of Dr. Law and Mr. Wright led them to reach the conclusion that death was from the effects of chloroform and spinal apoplexy, but that powerful predisposing factors were the ossification of the costal cartilages, and the flabby degeneration of liver and kidneys.
Questioned about the quality of the chloroform used Dr. Law stated that there was a case recorded in Christison's Dispensatory in which Dr. Simpson of Edinburgh had administered 8 oz of chloroform to a patient in 13 hours, and that he himself knew of instances in which chloroform was used for several hours continuously. Mr. Lewis commented that less than 1 oz had been used in this case.
The jury accepted the medical testimony, and recommended a verdict in accordance with it.
Of interest in the comments by the witness is the use of sponge followed by pocket handkerchief to vaporise the chloroform, whereas the surgeon comments on the use of an inhaler, possibly of the type used by Dr. Simpson. The several references to Dr. Simpson in the coroner's court reveal the authority in which he was held on anaesthetic practice.
Dr Joseph Law, the anaesthetist in this case, had a distinguished medical career in Sheffield. He was house surgeon at the General Infirmary from 1841 until 1852. In 1854 he was appointed to the staff of the Sheffield Public Dispensary, from where he retired in 1876. He then rejoined the staff of the General Infirmary to become Apothecary and he carried on a more or less good natured rivalry with his colleague Dr. Bartolomé. Dr Law used to dye his hair black. Bartolomé meeting Law in the corridor one morning turned to his students and said 'Gentlemen, grey hairs are honourable.' Quick came the response from Law 'Yes Bartolomé if they are found in the way of righteousness, but all are not.'
The authors would like to thank Mrs. J. deSouza and Mrs. C. King for their invaluable secretarial assistance, the Sheffield Central Library for access to early newspapers within 'The Sheffield Collection' and Dr. H. Swan, Consultant Haematologist, Royal Hallamshire Hospital, Sheffield, for supplying the photograph of Dr. Law.