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THE FIRST ANAESTHETIC IN THE STRAITS SETTLEMENTS (SINGAPORE, PENANG AND MALACCA)—1847
Brit. J. Anaesth. (1972), 44, 408
THE FIRST ANAESTHETIC IN THE STRAITS SETTLEMENTS (SINGAPORE, PENANG AND MALACCA)—1847 Y. K.
In the 17th century, the English East India Company was ousted by the Dutch from the islands of the East Indies. However, by the end of the 18th century, after having established themselves firmly in India, the East India Company began to take an interest in the Malayan Archipelago again for a number of reasons. There was an urgent need for a naval base on the sheltered side of the Bay of Bengal from which the Royal Navy could operate during the north-east monsoon, to protect British merchantmen. A port was needed along the China trade route, which could be used for refitting and revictualling the merchantmen, and be used as a headquarters by the British merchants in their endeavour to expand trade in south-east Asia. In 1786, Sir Francis Light acquired Penang from the Sultan of Kedah. On February 6, 1819, Sir Stamford Raffles hoisted the Union Jack over Singapore, and in 1824, by the Anglo-Dutch Treaty,
Malacca was transferred over to the British in exchange for Bencoolen on the west coast of Sumatra. Thus by 1824, the three British Settlements were established, and by 1826 were known as the Incorporated Settlements of Prince of Wales Island, Singapore and Malacca, with Prince of Wales Island (Penang) as the capital. The headquarters of the Medical Department was in Penang, and the Government Medical Services of the Settlements were very modest. There was only a senior surgeon and an assistant surgeon at Penang, an assistant surgeon at Singapore, and an assistant surgeon at Malacca. These doctors were assisted by a few medical subordinates, e.g. apothecaries, in the performance of their duties. In the early years, these duties were both military and civil, as the first doctors to serve in the Settlements were army surgeons who came with their regiments. Later on there was a separation of duties, the civil or residency surgeon in government employ at each Settlement did not do military work, and the garrison or cantonment surgeon only looked after the troops and their families. In 1832 the capital was transferred to Singapore, and in 1835 the headquarters of the Medical Department was also moved to Singapore where the senior surgeon made his official residence. By 1847 the Straits Settlements were sufficiently developed to attract a few doctors who set up private practice. On October 16, 1846, W. T. G. Morton, a Boston dentist, successfully anaesthetized a patient upon whom J. C. Warren performed a painless operation of passing a ligature round a vascular tumour in the neck. News of this operation and the hitherto unknown anaesthetic property of sulphuric ether spread rapidly, and on December 21, 1846, Robert Liston performed the first operation under ether anaesthesia in England, when he amputated a patient's leg at University College Hospital. News of this achievement and publications reporting other operations, the safety and efficacy of ether, and describing the apparatus for administering it, Y. K. LEE, A.M., M.D., F.R.C.P.E., M.R.C.P., LL.B., Thomson
Road General Hospital, Singapore.
Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 9, 2015
The old Straits Settlements, comprising Singapore, Penang and Malacca, were British possessions for nearly 130 years. Penang and Malacca are now constituent States in Malaysia, and Singapore is an independent sovereign island Republic. A brief resume of the establishment of the Straits Settlements and its administration is a necessary introduction to this article. The "Straits", of course, refers to the Straits of Malacca, and the Settlements were on the eastern side of the Straits.
LEE
FIRST ANAESTHETIC IN THE STRAITS SETTLEMENTS
The haemorrhage, it may be remarked was unusually trifling. The man is going on very favourably. Sulphuric ether so employed contrasts advantageously with mesmerism and promises to be truly a blessing to suffering humanity by robbing even the most serious operations of their formidable nature; while it assures to the sufferers these advantages without any of the mysticisms attached to mesmerism, which viewed as a science, and yet entails a degree of repugnance to the feelings of many and which must give to the present similar agent the precedence in public opinion and it is inferred in practical utility. The editor of the Singapore Free Press expressed the hope that the success of the "experiment" in performing what was formerly a very painful operation painlessly under the influence of sulphuric ether should encourage Mr Ratton's medical brethren in the Straits and elsewhere "to a use of this important agent wherever it can be employed in sparing pain to the person operated on and giving facility and ease to the operation". This challenge was taken up, and on July 3, 1847, the Penang Gazette (another newspaper) reported the following operation performed in Penang by a surgeon in private practice on June 29, 1847.
I have the pleasure to forward you the following brief particulars of an operation I performed at this Station The inhalation of the vapour of Sulphuric Ether comon the 28th instant, the patient being previously placed under the influence of sulphuric ether and thereby bined with atmospheric air was tried on Tuesday last by rendered perfectly insensible to pain or the steps of the Mr. Smith, Surgeon, in the presence of several other operation. I will feel obliged by your giving this com- persons, upon a patient from whom he removed a fibromunication insertion as it may be of service to some of cartilaginous tumour, and proved completely successful in your professional readers by directing attention to the rendering the patient insensible to the pain of the operasimple means employed which are at hand in every tion. The party operated upon is a respectable Chinese hospital, and prevent the necessity of waiting for or having merchant of this place, about 30 years of age, and of a any special or complicated apparatus. The present case spare habit of body. The tumour began to make its being perhaps the first serious operation performed in the appearance on the inner side of the upper lip several years ago; it had attained the size of a common walnut, was free Straits in connection with the inhalation of ether. The man, a Malay, a lascar on board the topay Sri from pain, but inconvenient from its bulk and situation, Melaka, had his right hand blown away from a gun on and as latterly it had been growing quickly, the patient the morning of the 28th instant. The bones of the forearm was desirous to have it removed. When informed of the being also extensively fractured and the parts otherwise effects which have been usually observed from ether injured, circumstances which call for an amputation above administration as above, he said, "that was the sort of the elbow. He was at first put under the influence of medicine for him", and requested that it might be used. ether by inhaling the vapour from a simple Mudges Everything being prepared and the patient seated for the inhaler attached to the hospital (containing small pieces of operation, a common bladder fitted with an ivory tube, as sponge saturated with the ether), common care only being recommended by Mr. Herapath, was the apparatus used. taken by compressing the nostrils during the act of inspira- Into this was poured half an ounce of good sulphuric tion and making the mouth piece pass through a piece of ether, the bladder was then blown up and well agitated sponge to secure its full inhalation into the lungs. This so as to saturate the air in it with the vapour, after which was effected in about 4 minutes when his eyes being closed, the patient was desired to receive the pipe into his mouth, his head sank upon his chest in an apparent state of to embrace it with his lips, and breathe freely through it. insensibility; the operation was now immediately com- His nostrils were held perfectly closed. After a very few menced by the flap operation. The man at the moment of inhalations, and certainly in a space not exceeding a minute transfixation by the knife merely exclaimed, "What are you and a half, the patient slightly groaned, his lips let go their doing to me?" when he relapsed into his comatosed state hold and the pipe fell from his mouth. He appeared in a and though he moaned twice remained in this state of deep sleep and there was total suspension of motion. The insensibility and unconsciousness during the operation, operation was now commenced and completed in about and after the steps of tying the arteries, securing the flaps four minutes, during which he continued to groan but by sutures and removal to bed. And in this quiet somno- never uttered a word or moved a muscle, and his breath lent state I left him, breathing naturally with a quiet was remarked to be extremely cold. natural pulse of 80. The patient's condition after the operation merits When seen three hours afterwards and questioned relative to the operation, he stated that he was aware of my attention. The patient had a bradycardia of 40 beats/ intention to remove his arm, but of the operation itself, pain or of any of the circumstances connected with it, he min. This must have been due to vagal overaction. Nobody knew of preanaesthetic medication in 1847. was perfectly unconscious.
Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 9, 2015
soon reached the Straits Settlements by the "overland route". It took about forty days for the mail to go by sea to Egypt, then overland to the Red Sea, and again from there by sea to Bombay, Ceylon and the Straits. By February or March 1847 at the latest, the surgeons in the Straits Settlements knew of ether anaesthesia. Before long the first operations under anaesthesia in the Straits were performed. It is of interest to study and comment on the original reports. On April 30, 1847, Mr A. J. Ratton, the assistant surgeon at Malacca, wrote to the Singapore Free Press, describing the "first serious operation performed in the Straits in connection with the inhalation of ether" on April 28, 1847. Medical ethics was different in those days! He drew attention to the fact that he used "the simple means which are at hand in every hospital", and mentioned that there was no necessity to use special or complicated apparatus, apparently referring to the various inhalers then being invented. He also expressed the opinion that ether was superior to hypnotism. He wrote as follows:
409
410 The surgeon was lucky in that he did not have a case of fatal vagal inhibition of the heart on his hands: At the termination of it (the operation) he was still insensible and as he continued in this condition two minutes afterwards with a pulse of 40, extremities cold, general pallor, lips and conjunctivae especially pale, some wine was administered and water sprinkled over the face and these repeated several times before he began to recover his powers of sensations and motions—altogether the effects continued fully ten minutes.
The first draught of the vapour produced a sensation of coldness which spread upwards to the different parts of the body; the hands and feet became numb and destitute of feeling, then there were giddiness and a feeling of confusion in the head, noise in the ears, and lastly a total loss of power and feeling in every part, but still a pleasant sensation of most perfect ease and quiet, altogether different from that kind of stupor occasioned from an overdose of spiritous liquors. He could draw no comparison between its effects and those produced by smoking chandoo (opium) never having himself on any occasion tried the latter. He was not conscious of having groaned, but he knew when the operation was commenced and when it was completed, during it he was sensible of a scratching in the part, which however, he described not so much as a feeling of pain as a sense of the sound of that, and it was, at all events, not so disagreeable as the slight pain which on recovery he felt in the wound. A tingling sensation was experienced in all the extremities when the influence of the Ether began to subside, and which spread through them to the body before the sense of feeling and power of motion was perfectly restored. He felt a little drowsy afterwards, laid down, and had two hours sleep, from which he arose, feeling in every respect comfortable and on the same day he followed his usual avocations.
The editor, a layman, also ventured to explain the action of ether as follows: The modus operandi of Ether, thus used, we have never seen explained. Its powerful influence over the vascular and nervous system is most probably attributable to the absorption of the poisonous (defiant) gas of which the fluid chiefly consists. At least its effects are similar to those which have been observed from the inspiration of air charged with carbonic acid, or with the various combinations of carbon and hydrogen, of which olefiant gas is one. The languid circulation, the numbness and coldness of the extremities, the loss of power and feeling, the general pallor, and ultimately, the torpor and insensibility, as noticed in the case above reported, remind one forcibly, however, of the sedative effects of a protracted exposure to intense cold. Large draughts of cold fluids taken into the stomach have sometimes almost instantaneously been followed by fatal consequences; and why should not cold of the same intensity, when suddenly brought in contact with an important part of the vascular system as by being applied to the delicate texture of the extreme ramifications of the air tubes, not produce a like effect? The vapour of Ether, although not much colder than the surrounding atmosphere, may, when inspired, undergo some chemical change in the lungs by which a considerable degree of cold may be produced and the extreme coldness of the breath in the case above related could almost induce the belief of some
such operation. We offer these hints for the consideration of those who may be able better to handle the subject than ourselves.
He was bold enough to mention the contraindications to ether and the need for resuscitation in cardiac arrest, and correctly predicted that anaesthetics could be used in tetanus: From the powerful influences which this agent has in diminishing the force of the circulation, we would deem it hazardous to use it on those who are naturally of a delicate constitution, or on those who are suffering from certain kinds of organic disease of the heart. Perhaps in the event of an overdose being administered so as completely to suspend the action of the heart, should the usual stimulants fail, a fatal effect might be avoided by artificial respiration continued until the circulation was restored. On the other hand, it appears to us it will be found a very useful therapeutical agent in a variety of complaints consequent on an over-excited state of either the vascular or nervous systems. For example, in fevers and inflammations of the different viscera; in discharge of blood from the lungs and from inordinate discharge from the alimentary canal; also in hysteria, tetanus or lockjaw and the like.
Mr Robert Little, M.D.EDIN., F.R.C.S.EDIN., was a well-known surgeon in private practice in early Singapore. On August 2, 1847, he successfully operated on a patient under the influence of ether, and this event was reported in the Singapore Free Press of August 5, 1847. Medical ethics was not against this sort of thing in the early 19th century. On Monday last, a Kling (Indian) boatman was brought to Mr. Little, Surgeon, with a large splinter of wood run in his hand, and suffering much pain. He was employed pushing a cargo boat when his pole broke, and a splinter 4y inches long, and half an inch in thickness, entered his hand betwixt the forefinger and thumb, passing through the muscles of the thumb and below the tendons of the wrist, and fixing itself betwixt the bones of the forearm. Mr. Little tried to extract the splinter by means of a common dressing forceps, but could not move it. He then tried a powerful pair of tooth forceps, but so firmly was the wood fixed that it would not come away. The patient during these attempts suffered much pain, as to compel one or two of those present to retire in order to avoid the sight of his sufferings. It was now resolved to try Ether as this appeared a good case to test its powers. The man's own hubble-bubble was then brought, into which a few ounces of Ether were poured, and his nostrils being effectually closed by means of a flat letter clip, he was desired to inhale as if enjoying the hookah. This was done and the patient speedily became insensible. In order to ascertain if he was quite unconscious a slight cut was made in his hand, but he winced not. The wood was then carefully dissected from the tendons, vessels and nerves which covered it, and the splinter, not without some force, was pulled out. The wound was searched for any small pieces of wood which might have been left and was stitched up and bandaged. During the whole of the operation the man displayed no feeling and when all was over he still seemed insensible, returning no answers to questions put to him. The compression was then removed from his nose, cold water thrown in his face and hartshorn applied to the nostrils, when he presently awoke, but with no knowledge of what had happened. He declared he had
Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 9, 2015
The patient's description of his feelings while under the influence of ether also makes interesting reading:
BRITISH JOURNAL OF ANAESTHESIA
FIRST ANAESTHETIC IN THE STRAITS SETTLEMENTS felt no pain during the operation nor then felt any, and was much struck with the sight of his bandaged hand.
and held the patient's nostrils perfectly closed. Little's method was even more ingenious. He poured a few ounces of ether into the patient's hookah and clipped the patient's nostrils with a flat paperclip! And he did not remove the compression until after the operation. The problem of anoxia while under anaesthesia was then unknown. Times have certainly changed. REFERENCES
Penang Gazette (1847). Microfilm. National Library Archives, Singapore. Singapore Free Press (1847). Microfilm. National Library Archives, Singapore.
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Many of the patient's friends who were spectators attributed this "miracle" to the Devil! From the above descriptions of the three cases, one cannot help coming to the conclusion that the doctors were very brave men, and were very resourceful in the way they improvised the apparatus used. Ratton used a "Mudges inhaler" with small pieces of sponge saturated with ether, and compressed the patient's nostrils, presumably with his fingers. Smith, who performed his operation with his patient seated, used a "common bladder fitted with an ivory tube"
411
THE FIRST ANAESTHETIC IN THE STRAITS SETTLEMENTS (SINGAPORE, PENANG AND MALACCA)—1847 Y. K.
In the 17th century, the English East India Company was ousted by the Dutch from the islands of the East Indies. However, by the end of the 18th century, after having established themselves firmly in India, the East India Company began to take an interest in the Malayan Archipelago again for a number of reasons. There was an urgent need for a naval base on the sheltered side of the Bay of Bengal from which the Royal Navy could operate during the north-east monsoon, to protect British merchantmen. A port was needed along the China trade route, which could be used for refitting and revictualling the merchantmen, and be used as a headquarters by the British merchants in their endeavour to expand trade in south-east Asia. In 1786, Sir Francis Light acquired Penang from the Sultan of Kedah. On February 6, 1819, Sir Stamford Raffles hoisted the Union Jack over Singapore, and in 1824, by the Anglo-Dutch Treaty,
Malacca was transferred over to the British in exchange for Bencoolen on the west coast of Sumatra. Thus by 1824, the three British Settlements were established, and by 1826 were known as the Incorporated Settlements of Prince of Wales Island, Singapore and Malacca, with Prince of Wales Island (Penang) as the capital. The headquarters of the Medical Department was in Penang, and the Government Medical Services of the Settlements were very modest. There was only a senior surgeon and an assistant surgeon at Penang, an assistant surgeon at Singapore, and an assistant surgeon at Malacca. These doctors were assisted by a few medical subordinates, e.g. apothecaries, in the performance of their duties. In the early years, these duties were both military and civil, as the first doctors to serve in the Settlements were army surgeons who came with their regiments. Later on there was a separation of duties, the civil or residency surgeon in government employ at each Settlement did not do military work, and the garrison or cantonment surgeon only looked after the troops and their families. In 1832 the capital was transferred to Singapore, and in 1835 the headquarters of the Medical Department was also moved to Singapore where the senior surgeon made his official residence. By 1847 the Straits Settlements were sufficiently developed to attract a few doctors who set up private practice. On October 16, 1846, W. T. G. Morton, a Boston dentist, successfully anaesthetized a patient upon whom J. C. Warren performed a painless operation of passing a ligature round a vascular tumour in the neck. News of this operation and the hitherto unknown anaesthetic property of sulphuric ether spread rapidly, and on December 21, 1846, Robert Liston performed the first operation under ether anaesthesia in England, when he amputated a patient's leg at University College Hospital. News of this achievement and publications reporting other operations, the safety and efficacy of ether, and describing the apparatus for administering it, Y. K. LEE, A.M., M.D., F.R.C.P.E., M.R.C.P., LL.B., Thomson
Road General Hospital, Singapore.
Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 9, 2015
The old Straits Settlements, comprising Singapore, Penang and Malacca, were British possessions for nearly 130 years. Penang and Malacca are now constituent States in Malaysia, and Singapore is an independent sovereign island Republic. A brief resume of the establishment of the Straits Settlements and its administration is a necessary introduction to this article. The "Straits", of course, refers to the Straits of Malacca, and the Settlements were on the eastern side of the Straits.
LEE
FIRST ANAESTHETIC IN THE STRAITS SETTLEMENTS
The haemorrhage, it may be remarked was unusually trifling. The man is going on very favourably. Sulphuric ether so employed contrasts advantageously with mesmerism and promises to be truly a blessing to suffering humanity by robbing even the most serious operations of their formidable nature; while it assures to the sufferers these advantages without any of the mysticisms attached to mesmerism, which viewed as a science, and yet entails a degree of repugnance to the feelings of many and which must give to the present similar agent the precedence in public opinion and it is inferred in practical utility. The editor of the Singapore Free Press expressed the hope that the success of the "experiment" in performing what was formerly a very painful operation painlessly under the influence of sulphuric ether should encourage Mr Ratton's medical brethren in the Straits and elsewhere "to a use of this important agent wherever it can be employed in sparing pain to the person operated on and giving facility and ease to the operation". This challenge was taken up, and on July 3, 1847, the Penang Gazette (another newspaper) reported the following operation performed in Penang by a surgeon in private practice on June 29, 1847.
I have the pleasure to forward you the following brief particulars of an operation I performed at this Station The inhalation of the vapour of Sulphuric Ether comon the 28th instant, the patient being previously placed under the influence of sulphuric ether and thereby bined with atmospheric air was tried on Tuesday last by rendered perfectly insensible to pain or the steps of the Mr. Smith, Surgeon, in the presence of several other operation. I will feel obliged by your giving this com- persons, upon a patient from whom he removed a fibromunication insertion as it may be of service to some of cartilaginous tumour, and proved completely successful in your professional readers by directing attention to the rendering the patient insensible to the pain of the operasimple means employed which are at hand in every tion. The party operated upon is a respectable Chinese hospital, and prevent the necessity of waiting for or having merchant of this place, about 30 years of age, and of a any special or complicated apparatus. The present case spare habit of body. The tumour began to make its being perhaps the first serious operation performed in the appearance on the inner side of the upper lip several years ago; it had attained the size of a common walnut, was free Straits in connection with the inhalation of ether. The man, a Malay, a lascar on board the topay Sri from pain, but inconvenient from its bulk and situation, Melaka, had his right hand blown away from a gun on and as latterly it had been growing quickly, the patient the morning of the 28th instant. The bones of the forearm was desirous to have it removed. When informed of the being also extensively fractured and the parts otherwise effects which have been usually observed from ether injured, circumstances which call for an amputation above administration as above, he said, "that was the sort of the elbow. He was at first put under the influence of medicine for him", and requested that it might be used. ether by inhaling the vapour from a simple Mudges Everything being prepared and the patient seated for the inhaler attached to the hospital (containing small pieces of operation, a common bladder fitted with an ivory tube, as sponge saturated with the ether), common care only being recommended by Mr. Herapath, was the apparatus used. taken by compressing the nostrils during the act of inspira- Into this was poured half an ounce of good sulphuric tion and making the mouth piece pass through a piece of ether, the bladder was then blown up and well agitated sponge to secure its full inhalation into the lungs. This so as to saturate the air in it with the vapour, after which was effected in about 4 minutes when his eyes being closed, the patient was desired to receive the pipe into his mouth, his head sank upon his chest in an apparent state of to embrace it with his lips, and breathe freely through it. insensibility; the operation was now immediately com- His nostrils were held perfectly closed. After a very few menced by the flap operation. The man at the moment of inhalations, and certainly in a space not exceeding a minute transfixation by the knife merely exclaimed, "What are you and a half, the patient slightly groaned, his lips let go their doing to me?" when he relapsed into his comatosed state hold and the pipe fell from his mouth. He appeared in a and though he moaned twice remained in this state of deep sleep and there was total suspension of motion. The insensibility and unconsciousness during the operation, operation was now commenced and completed in about and after the steps of tying the arteries, securing the flaps four minutes, during which he continued to groan but by sutures and removal to bed. And in this quiet somno- never uttered a word or moved a muscle, and his breath lent state I left him, breathing naturally with a quiet was remarked to be extremely cold. natural pulse of 80. The patient's condition after the operation merits When seen three hours afterwards and questioned relative to the operation, he stated that he was aware of my attention. The patient had a bradycardia of 40 beats/ intention to remove his arm, but of the operation itself, pain or of any of the circumstances connected with it, he min. This must have been due to vagal overaction. Nobody knew of preanaesthetic medication in 1847. was perfectly unconscious.
Downloaded from http://bja.oxfordjournals.org/ at University of Bath Library & Learning Centre on July 9, 2015
soon reached the Straits Settlements by the "overland route". It took about forty days for the mail to go by sea to Egypt, then overland to the Red Sea, and again from there by sea to Bombay, Ceylon and the Straits. By February or March 1847 at the latest, the surgeons in the Straits Settlements knew of ether anaesthesia. Before long the first operations under anaesthesia in the Straits were performed. It is of interest to study and comment on the original reports. On April 30, 1847, Mr A. J. Ratton, the assistant surgeon at Malacca, wrote to the Singapore Free Press, describing the "first serious operation performed in the Straits in connection with the inhalation of ether" on April 28, 1847. Medical ethics was different in those days! He drew attention to the fact that he used "the simple means which are at hand in every hospital", and mentioned that there was no necessity to use special or complicated apparatus, apparently referring to the various inhalers then being invented. He also expressed the opinion that ether was superior to hypnotism. He wrote as follows:
409
410 The surgeon was lucky in that he did not have a case of fatal vagal inhibition of the heart on his hands: At the termination of it (the operation) he was still insensible and as he continued in this condition two minutes afterwards with a pulse of 40, extremities cold, general pallor, lips and conjunctivae especially pale, some wine was administered and water sprinkled over the face and these repeated several times before he began to recover his powers of sensations and motions—altogether the effects continued fully ten minutes.
The first draught of the vapour produced a sensation of coldness which spread upwards to the different parts of the body; the hands and feet became numb and destitute of feeling, then there were giddiness and a feeling of confusion in the head, noise in the ears, and lastly a total loss of power and feeling in every part, but still a pleasant sensation of most perfect ease and quiet, altogether different from that kind of stupor occasioned from an overdose of spiritous liquors. He could draw no comparison between its effects and those produced by smoking chandoo (opium) never having himself on any occasion tried the latter. He was not conscious of having groaned, but he knew when the operation was commenced and when it was completed, during it he was sensible of a scratching in the part, which however, he described not so much as a feeling of pain as a sense of the sound of that, and it was, at all events, not so disagreeable as the slight pain which on recovery he felt in the wound. A tingling sensation was experienced in all the extremities when the influence of the Ether began to subside, and which spread through them to the body before the sense of feeling and power of motion was perfectly restored. He felt a little drowsy afterwards, laid down, and had two hours sleep, from which he arose, feeling in every respect comfortable and on the same day he followed his usual avocations.
The editor, a layman, also ventured to explain the action of ether as follows: The modus operandi of Ether, thus used, we have never seen explained. Its powerful influence over the vascular and nervous system is most probably attributable to the absorption of the poisonous (defiant) gas of which the fluid chiefly consists. At least its effects are similar to those which have been observed from the inspiration of air charged with carbonic acid, or with the various combinations of carbon and hydrogen, of which olefiant gas is one. The languid circulation, the numbness and coldness of the extremities, the loss of power and feeling, the general pallor, and ultimately, the torpor and insensibility, as noticed in the case above reported, remind one forcibly, however, of the sedative effects of a protracted exposure to intense cold. Large draughts of cold fluids taken into the stomach have sometimes almost instantaneously been followed by fatal consequences; and why should not cold of the same intensity, when suddenly brought in contact with an important part of the vascular system as by being applied to the delicate texture of the extreme ramifications of the air tubes, not produce a like effect? The vapour of Ether, although not much colder than the surrounding atmosphere, may, when inspired, undergo some chemical change in the lungs by which a considerable degree of cold may be produced and the extreme coldness of the breath in the case above related could almost induce the belief of some
such operation. We offer these hints for the consideration of those who may be able better to handle the subject than ourselves.
He was bold enough to mention the contraindications to ether and the need for resuscitation in cardiac arrest, and correctly predicted that anaesthetics could be used in tetanus: From the powerful influences which this agent has in diminishing the force of the circulation, we would deem it hazardous to use it on those who are naturally of a delicate constitution, or on those who are suffering from certain kinds of organic disease of the heart. Perhaps in the event of an overdose being administered so as completely to suspend the action of the heart, should the usual stimulants fail, a fatal effect might be avoided by artificial respiration continued until the circulation was restored. On the other hand, it appears to us it will be found a very useful therapeutical agent in a variety of complaints consequent on an over-excited state of either the vascular or nervous systems. For example, in fevers and inflammations of the different viscera; in discharge of blood from the lungs and from inordinate discharge from the alimentary canal; also in hysteria, tetanus or lockjaw and the like.
Mr Robert Little, M.D.EDIN., F.R.C.S.EDIN., was a well-known surgeon in private practice in early Singapore. On August 2, 1847, he successfully operated on a patient under the influence of ether, and this event was reported in the Singapore Free Press of August 5, 1847. Medical ethics was not against this sort of thing in the early 19th century. On Monday last, a Kling (Indian) boatman was brought to Mr. Little, Surgeon, with a large splinter of wood run in his hand, and suffering much pain. He was employed pushing a cargo boat when his pole broke, and a splinter 4y inches long, and half an inch in thickness, entered his hand betwixt the forefinger and thumb, passing through the muscles of the thumb and below the tendons of the wrist, and fixing itself betwixt the bones of the forearm. Mr. Little tried to extract the splinter by means of a common dressing forceps, but could not move it. He then tried a powerful pair of tooth forceps, but so firmly was the wood fixed that it would not come away. The patient during these attempts suffered much pain, as to compel one or two of those present to retire in order to avoid the sight of his sufferings. It was now resolved to try Ether as this appeared a good case to test its powers. The man's own hubble-bubble was then brought, into which a few ounces of Ether were poured, and his nostrils being effectually closed by means of a flat letter clip, he was desired to inhale as if enjoying the hookah. This was done and the patient speedily became insensible. In order to ascertain if he was quite unconscious a slight cut was made in his hand, but he winced not. The wood was then carefully dissected from the tendons, vessels and nerves which covered it, and the splinter, not without some force, was pulled out. The wound was searched for any small pieces of wood which might have been left and was stitched up and bandaged. During the whole of the operation the man displayed no feeling and when all was over he still seemed insensible, returning no answers to questions put to him. The compression was then removed from his nose, cold water thrown in his face and hartshorn applied to the nostrils, when he presently awoke, but with no knowledge of what had happened. He declared he had
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The patient's description of his feelings while under the influence of ether also makes interesting reading:
BRITISH JOURNAL OF ANAESTHESIA
FIRST ANAESTHETIC IN THE STRAITS SETTLEMENTS felt no pain during the operation nor then felt any, and was much struck with the sight of his bandaged hand.
and held the patient's nostrils perfectly closed. Little's method was even more ingenious. He poured a few ounces of ether into the patient's hookah and clipped the patient's nostrils with a flat paperclip! And he did not remove the compression until after the operation. The problem of anoxia while under anaesthesia was then unknown. Times have certainly changed. REFERENCES
Penang Gazette (1847). Microfilm. National Library Archives, Singapore. Singapore Free Press (1847). Microfilm. National Library Archives, Singapore.
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Many of the patient's friends who were spectators attributed this "miracle" to the Devil! From the above descriptions of the three cases, one cannot help coming to the conclusion that the doctors were very brave men, and were very resourceful in the way they improvised the apparatus used. Ratton used a "Mudges inhaler" with small pieces of sponge saturated with ether, and compressed the patient's nostrils, presumably with his fingers. Smith, who performed his operation with his patient seated, used a "common bladder fitted with an ivory tube"
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