36 Temporarily heavenward

Key words/phrases: anaesthetics, ether, chloroform, Valerius Cordus, W. Frobenius, Richard Pearson, Thomas Beddoes, Paracelsus, Crawford William Long of Georgia, USA, ether frolics, James Venable, Prof. James Young Simpson, Hannah Greener, Emergency Medical Service hospitals, Joyce Green Hospital theatres, Mr Catchpole, Henry David Thoreau.


No. 36

Today is the 165th anniversary of the occasion on which ether - the first anaesthetic - was first used during surgery and I found myself thinking about the use of anaesthetics at Joyce Green Hospital.

Ether (diethyl ether) is cheap to manufacture because it is often made from sugar cane using alcohol and recycled sulphuric acid but it is also very cheap because it is non-halogenated (i.e. unmixed with fluorine which would render it more stable and safer to use).

It seems that it is still used today in developing countries for several reasons. Firstly it is economical to produce and use, secondly it is relatively safe as an anaesthetic and finally because it is simple to administer either intravenously or using the inhalation method. Of course it is still as highly volatile and inflammable and as potentially explosive in the presence of oxygen as it ever was.

In terms of its disadvantages, rendering patients unconscious and recovering them was remains a slow process when ether is the used as the sole agent. It’s strong, unpleasant smell, plus its tendency to cause bronchial irritation and coughing, tends to make induction using a mask more difficult. Finally most nurses will remember having to give patients atropine pre-operatively because of the likelihood of bronchial irritation creating excess mucus secretions … and of course post-operative nausea and vomiting was a frequent event on theatre days, wasn’t it ?

Ether’s history extends back to 1540 when Herr Valerius Cordus, a German physician, discovered his revolutionary technique for synthesizing ether which involved adding sulfuric acid to ethyl alcohol, but it was another German scientist called W.G. Frobenius who changed its original name (“sweet vitriol”) to ether in 1730.

Up until then scientists and physicians had used it for other things but not as an anaesthetic agent. In 1794, two English physicians, Richard Pearson and Thomas Beddoes in Bristol were using ether in the treatment of phthisis, catarrhal fever, bladder calculus and scurvy and in 1805 American physicians were using it to treat pulmonary inflammation.

The Swiss physician and alchemist known as Paracelsus had discovered its hypnotic effects but it was Crawford Williamson Long (1815-1878) the American physician who first used ether as an anaesthetic for surgical purposes.

Apparently Long’s use of ether came from observations made at social gatherings known as “ether frolics”. Since ether produces exhilaration rather than unconsciousness when used in small amounts the inhalation of ether for fun and recreational purposes seems to have been quite common at that time. Long noticed however, when he was present at this type of party, that whenever the participants sustained twisted ankles, bumps and bruises they didn’t seem to experience any pain.

But it was on March 30, 1842, when he was 26yrs old, that Dr. Long - a rural general practitioner in Jefferson, Georgia, USA - first used ether for a surgical procedure. In the presence of several medical students and various on-lookers he administered sulfuric ether via a towel to a 21yr old patient, James Venable, for the removal of a tumour on the back of his neck.

The ‘lumpectomy’ was so successful that the patient had to be shown the specimen before he would believe that the operation had actually finished. Despite this and even though he continued to use ether in his surgical work Dr Long apparently didn’t make the effort to record his ‘first’ until 1849.

In fact not only had several American dentists pipped him to the post by using ether in a number of dental extractions prior to his innovation but several other doctors had ‘written up’ their experiences relating to the surgical use of ether long before Dr Long got round to putting pen to paper. Nonetheless C.W. Long is now generally credited with having introduced modern inhalational anaesthesia.

James Simpson, who was Professor of Midwifery at the University of Edinburgh and physician to Queen Victoria had already discovered chloroform by this time (back in 1831) and it quickly replaced ether in Great Britain.

Unfortunately, chloroform is not as safe an agent as ether, especially when administered by untrained practitioners and sadly the first fatality attributed to anaesthesia was recorded on 28 January, 1848 when Hannah Greener, a 15-year-old girl from Newcastle upon Tyne, who was undergoing the resection of a toenail on a table in her home, died when she was being operated upon. Chloroform, it seems, was being administered to her via a cloth held to her face when she suddenly became pulseless and died.

It’s not exactly clear who was involved in this young woman’s “care” but it is worth recalling that medical students, nurses and sometimes even members of the public were pressed into administering anaesthetics during this newly enlightened era - each of these groups being considered capable of participating in these newly approved 'frolics'.

But switching attention now to the many surgical procedures which we recognise as having taken place at Joyce Green Hospital I seem to have found myself with more questions than answers.

Did specific operating rooms exist during Joyce Green’s life as a smallpox hospital (1903 -1931) or were any minor surgical procedures that were necessary carried out at patient’s bedsides via either a local anaesthetic or a short ether-induced period of unconsciousness ? Then later on, when the hospital was re-opened as a Medical Emergency Service general hospital in 1939 with an increase in the number of beds available from 986 to 1,900, where exactly were the operating rooms or theatres established ?

In 1940 war casualties started to arrive from France and Belgium. Without a doubt there must have been surgical facilities but where were the theatres located ? Were they established in the same area of the hospital that most readers will recognise as the old surgical corridor and if not, when did “theatres” begin functioning in the Theatre suit between Ward Blocks 1 and 3 ?

And when was the “twin-theatre suite” opened and the Honeywell theatre suite commissioned ?

Sadly Mr. Catchpole, the Theatre Superintendent, is no longer here to provide us with any further historical information but there may be some of you reading this who will perhaps be able to provide some further detail on the evolution of the JGH theatres ?

In closing do you know what the philosopher, writer and naturalist Henry David Thoreau (1817-1862) once said about ether ? He apparently underwent a transcendental experience while having several of his teeth extracted and he said this: "If you have an inclination to travel take the ether - you go beyond the furthest star...".

Thus it appears that the enjoyment of mind-bending frolics is something that some of our predecessors also set out to experience ?