THE DOCTOR'S BAG

THE BLESSING OF ANAESTHESIA

By Keith Souter aka CLAY MORE 

Anaesthesia is one of the great blessings of modern medicine. Until an effective means of inducing unconsciousness was devised people had to depend on copious amounts of alcohol, a good strong piece of leather or wood (or a bullet) to bite on and the speed and skill of the surgeon or bonesetter.

The development of anaesthetics (and please put up with the British way of spelling) was not straightforward.  As with most things in the development of medicine it was a mix of chance, bravery and scientific endeavour.

Dr Thomas Beddoes and Pneumatic Medicine

Dr Thomas Beddoes (1760-1808) was a believer in many things in his time and in a way he was a catalyst for some of the spectacular advances that would occur in Victorian science and medicine. Indirectly, he as a place in the history of anaesthesia.

Some of his ideas were decidedly odd. One such was his observation that butchers rarely suffered from consumption (tuberculosis). When he asked some of them why they thought this was the case he received the reply that the inhalation of the odours in the slaughterhouse was heath-giving! He pondered on this and concluded that the air from the lungs of beasts may be the key and so he actually introduced windows into his clinics through which cattle could poke their heads and breathe upon the ill. Some patients, however, were not so happy about the smell of dung that they were also forced to endure.

When he settled in Bristol he set up the Pneumatic Institute for Inhalation Gas Therapy in nearby Clifton. He firmly believed that the various gases that chemists were discovering were just variants of air and that each gas had the potential of healing. Carbon dioxide, for example, had been used to treat consumption. Beddoes planned to extend the range and use hydrogen and other gases.

He decided that the institute needed a chemist to help him and as it happened, the young man that he appointed was the twenty year old Humphrey Davy. This was fortuitous for it gave Davy opportunity to develop his skills as a chemist. Soon Davy was inhaling gases that he produced in the laboratory. One of these was nitrous oxide, which he found was quite intoxicating. Not only that, but on one occasion he was suffering from toothache and he discovered that inhaling the gas actually gave pain relief. Strangely enough, although he was working in a purported medical institute no-one realised the potential that laughing gas would have. It fell to an American dentist to discover this fact forty odd years later.

Surgical humbug and dangerous inhalation

In 1824 Dr Henry Hill Hickman (1801-1830) a young Shropshire country doctor had followed Dr Beddoes’ ideas of inhaling gases and experimented on animals. He induced the state of what he called ‘suspended animation’ in these animals by making them inhale carbon dioxide gas. He then operated upon them in a seemingly painless manner. He advocated that it should be tried on humans, but his suggestion evoked ridicule. Indeed, an article in The Lancet totally derided his work under the title Surgical Humbug.

            Hickman did not leave it there, but took his ideas to France, where he obtained a hearing and actually read a paper to King Charles X. The paper was then forwarded to the Academie Royale de Medicine, but once again nothing came of it.

           

 In fact, carbon dioxide would induce such a state, but it would also induce panic attacks in humans. Worse, it could be fatal! The idea of using gas, however, albeit in this case the wrong one, did have merit as a means of inducing a sleep like state.

            

The big three

By 1831 three anaesthetic agents had been discovered. They were, chloroform, ether and nitrous oxide. In 1842 in the USA Dr Crawford W long (1815-1878) performed three minor operations on humans using ether. Two years later in 1844 a dentist, Dr Horace Wells (1815-1848) used ether on himself and had one of his own teeth removed.

A friend of his, Dr William T G Morton (1819-1868) used it to perform surgery in a demonstration to other doctors. It was the beginning of a new era for surgery and the name ‘anaesthesia’ was devised by Oliver Wendell Holmes.

Back in Britain in 1847, James Simpson started to use chloroform, which was less irritant and more pleasing to be given. He advocated giving it to mothers during labour, but met with opposition from the Calvinist Church, who said that it was natural for a woman to endure pain to bring a child into the world. This view was quickly scotched, however, when in 1853 Dr John Snow (1813-1858) gave chloroform to Queen Victoria herself when she had her son Leopold. He repeated this in 1857 when her majesty gave birth to her daughter Beatrice.

Giving anaesthetic

The casualties of warfare would have been extremely grateful for the benefits that chloroform brought them. But it was a fairly imprecise business and it was not without risk of death. Dosage was based on experience rather than scientific measurement. It was also unpleasant, since it indices a suffocation feeling ad patients were wont to panic. Accordingly, surgeons would be reassuring and sometimes would give brandy or laudanum first. Indeed, this was the regular practice in the Confederate Army during the Civil War. 

Chloroform is a liquid that was given by various methods. Children would be given it by the 'drinking glass method.' This involved putting a wad of cotton in a glass and soaking it with chloroform. The glass was then held over the nose or the mouth by the child or patient and as anaesthesia was induced, the glass fell away. 

Another method was to make a cloth cone and drop it onto this, placed over the nose and mouth. Then a sort of mesh was used as a face mask, rather like a small sword fencer's mask, on top of which a cloth was placed, upon which chloroform was dropped. 

                                                            Chloroform anaesthetic mask

There were two stages of chloroform anaesthesia. The first was a dulling of consciousness, often associated with hallucinatory images, wild-eyed excitement, then sometimes by panic if a suffocative feeling came on. Muscles could go into spasm, and if these included the laryngeal muscles then real suffocation could occur. The second stage resulted in unconsciousness when the muscles could go very floppy in some cases, again risking respiratory paralysis, which could be fatal. 

These were considerable problems with early anaesthesia and late on intubation of the larynx allowed anaesthesiologists to safely deliver oxygen and other gases directly to the lungs, thereby making it a lot safer to be anaesthetised. 

Chisolm's inhaler

During the Civil War the supplies of chloroform were often less than sufficient and there was a need to be more scientific in the application. 

The Confederate surgeon Julian John Chisolm invented a small inhaler consisting of a flattened cylinder, measuring 2.5 by 1 inch, with two tubes which could be inserted into the nostrils. The chloroform was dripped into a perforated disc onto a cloth. It apparently reduced the amount needed to about ten per cent of the amount previously used.

If you have been following the Wolf Creek series you may have seen Doctor Logan Munro using his Chisolm inhaler!

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Hell on the Prairie, the sixth Wolf Creek book features Keith (Clay More's) character Dr Logan Munro, the town doctor in THE OATH, a story about a spectre from his past. Logan has been in Books 1, 4 and 6, and is due to appear in books 8 & 9.

And his other new character, Doc Marcus Quigley, dentist, gambler and occasional bounty hunter continues in his quest to bring a murderer to justice, in THE SHOOTER the fifth in his  ebook short stories THE ADVENTURES OF DOCTOR MARCUS QUIGLEY published by High Noon Press.

And his sixth, RATTLER'S NEST will be out soon.
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Apologies if you comment and I don't reply straight away - my daughter gets married tomorrow and I'll be busy today - (writing my speech!)