‘Anaesthesia – A Pictorial History’
Dr Bill Bickerstaffe, Southport
Dr John Chambers introduced the speaker, Dr Bill Bickerstaffe, whom he had first met as the son of a dentist whose practice he had visited to anaesthetise patients in the chair. Young ‘Billy’ was often in the back garden playing football. Dr Bickerstaffe introduced himself and spoke of his background, education and current post as a consultant anaesthetist in Southport. Having always been interested in general history, his particular interest in the history of anaesthesia had been catalysed when he had been given Professor Utting’s slide collection to catalogue whist a lecturer in the University Department.
Dr Bickerstaffe described the birth of modern anaesthesia on October 16th 1846 when William Morton successfully demonstrated the anaesthetic properties of ether in the Bullfinch building at Massachusetts General Hospital, Boston. The surgeon, John Collins Warren removed a tumour from a patient called Gilbert Abbott. An intermittent technique was used with an apparatus designed by Morton. News of this event was carried across the Atlantic on the Cunard Liner ‘Arcadia’ which landed in Liverpool. Although the first use of ether was by a dentist in Gower St, London on 19th December, the first public demonstration in Britain was on 21st December 1846, when Robert Liston persuaded a medical student, William Squire, to administer ether to Frederick Churchill for an above knee amputation. Despite this event, it took 25 years for anaesthesia to become widely used for surgery.
Dr Bickerstaffe spoke about important dates and personalities that had lead to the events of 1846. These included Henry Hill Hickman, who described CO2 narcosis, Charles Waterton, who demonstrated the effects of curare on his donkey, and Crawford Long who had preceded Morton in 1842. The first reported anaesthetic death was in 1848 after the administration of Chloroform. John Snow wrote the first scientific description of ether anaesthesia but it was Chloroform that was popularised in Britain after its introduction by James Simpson when it was administered to Queen Victoria for childbirth in 1853 by Snow. In 1862, Joseph Clover, a pupil of Snow’s, developed an inhaler that could give chloroform in a measured concentration and advocated patient monitoring by always having a finger on the patient’s pulse.
Other names mentioned by Dr Bickerstaffe, included Carl Kohler who, in 1884, introduced cocaine for topical anaesthesia of the eye, Heinrich Quincke who demonstrated lumbar puncture for the first time in 1891, August Bier who then went on to perform the first clinical spinal anaesthetic in 1898 and Whittaker, in 1951 who produced a non-cutting spinal needle.. Edmund Boyle, who in 1917, described a portable N2O and O2 apparatus, the forerunner of today’s machines and a mouth gag subsequently modified by Davies. Arthur Guedel’s paper, in 1920, on the signs of anaesthesia supplanted Snow’s original description and he also advocated the use of anaesthetic charts and designed an oro-pharyngeal airway still in use today.
Dr Bickerstaffe highlighted the contributions of Ivan Magill who described endotracheal anaesthesia, designed forceps for tube placement and was instrumental in the introduction of the first professional examination in anaesthesia (Diploma of Anaesthesia) in 1935. Ralph Waters’ contribution was then covered. He was the first professor of anaesthesia with a chair at the University of Wisconsin and described the use of the CO2 absorber in a breathing system and the development of cyclopropane. In 1937 in Oxford, Robert Macintosh was appointed as the first professor of anaesthesia in Europe and his use of draw-over vaporisers and design of laryngoscope blades were described.
Two other important but contrasting dates were given with the founding of the College of Physicians in 1518 and the more recent emergence of the College of Anaesthetists in 1991. Other names that were touched upon by Dr Bickerstaffe included Curtis Mendelson the professor of obstetrics who first described the syndrome of acid reflux, Brian Sellick whose 1961 paper described the application of cricoid pressure, William Mapleson who, in 1954, characterised the properties of gas flow in various anaesthetic breathing systems, Archie Brain, the inventor of the laryngeal mask airway and finally Sydney Ringer and Alex Hartmann, the inventor and developer of Hartmann’s or Ringer’s Sodium Lactate solution, the crystalloid of anaesthetic practice.
In the final section of the talk, Dr Bickerstaffe spoke about ‘Great Liverpool Men’ in anaesthesia. First he talked about Robert J. Minnitt who produced a machine for delivering gas and air for the relief of pain in labour and the background behind it’s development. As well as being the first lecturer in the University Department of Anaesthesia, he later became the President of the LSA between 1953 and 1955. Cecil Gray was then described with his various achievements, initially with the use of curare developing the ’Liverpool Technique’ of muscle relaxation, hyperventilation and the avoidance of potent volatile anaesthetic agents, his appointment to a Chair in the University Department in 1959, his Presidency of the LSA in 1962-1964 and becoming Dean of the Medical School in 1970. Finally Jackson Rees was characterised. Having been trained by Macintosh, he arrived in Liverpool in 1947 and was asked to develop the anaesthetic service at Alder Hey hospital. This lead to many achievements in the field of paediatric anaesthesia and intensive care including the modification of the Ayre’s T-piece for the ventilation of children during surgery. Jack Rees was President of the LSA between 1966-1968.
After a number of questions and ‘corrections’ by the more senior members of the society, David Gray gave the vote of thanks and the meeting finished at 20.45.
Dr Bill Bickerstaffe and Dr John Chambers.
Ewen Forrest, Hon Secretary
Dr John Chambers, President