Walter Sutton: Physician, Scientist, Inventor

Walter Sutton: Physician, Scientist, Inventor

    Walter Sutton: Physician, Scientist, Inventor Gregory J. Ramirez M.D., Nancy J. Hulston M.A., Anthony L. Kovac M.D. PII: DOI: Referen...

957KB Sizes 0 Downloads 136 Views

    Walter Sutton: Physician, Scientist, Inventor Gregory J. Ramirez M.D., Nancy J. Hulston M.A., Anthony L. Kovac M.D. PII: DOI: Reference:

S2352-4529(14)00003-6 doi: 10.1016/j.janh.2014.11.002 JANH 2

To appear in:

Journal of Anesthesia History

Please cite this article as: , Walter Sutton: Physician, Scientist, Inventor, Journal of Anesthesia History (2014), doi: 10.1016/j.janh.2014.11.002

This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT 1

Walter Sutton: Physician, Scientist, Inventor

T

Gregory J. Ramirez, M.D.1

RI P

Nancy J. Hulston M.A. 2

SC

Anthony L. Kovac M.D.1

NU

Departments of Anesthesiology1 and History and Philosophy of Medicine2 University of Kansas Medical Center

MA

Kansas City, Kansas

AC

CE

PT

Running head: Walter Sutton

ED

[email protected]

ACCEPTED MANUSCRIPT 2

Abstract:

AC

CE

PT

ED

MA

NU

SC

RI P

T

Walter S. Sutton (1877-1916) was a physician, scientist and inventor. Most of the work on Sutton has focused on his recognition that chromosomes carry genetic material and are the basis for Mendelian inheritance. Perhaps less well known is his work on rectal administration of ether. After Sutton’s work on genetics, he completed his medical degree in 1907 and began a 2year surgical fellowship at Roosevelt Hospital, New York City, NY, where he was introduced to the technique of rectal administration of ether. Sutton modified the work of others and documented 100 cases that were reported in his 1910 landmark paper Anaesthesia by Colonic Absorption of Ether. Sutton had several deaths in his study, but he did not blame the rectal method. He felt that his use of rectal anesthesia was safe when administered appropriately, and believed that it offered a distinct advantage over traditional pulmonary ether administration. His indications for its use included: (1) head and neck surgery; (2) operations when ether absorption must be minimized due to heart, lung, or kidney problems; (3) preoperative pulmonary complications. His contraindications included: (1) cases involving alimentary tract or weakened colon; (2) laparotomies, except when the peritoneal cavity was not opened; (3) incompetent sphincter or anal fistula; (4) orthopnea; (5) emergency cases. Sutton wrote the chapter on "Rectal Anesthesia" in one of the first comprehensive textbooks in anesthesia, James Tayloe Gwathmey's Anesthesia. Walter Sutton died of a ruptured appendix in 1916 at age 39.

ACCEPTED MANUSCRIPT 3

Physician, scientist, inventor. Each of these words could easily describe Walter Stanborough Sutton (1877-1916). Numerous articles have been written about him, but they

RI P

T

have mostly concerned his contributions to genetic research. He accomplished much in his short life and could have possibly changed the face of medicine if given the chance.

SC

Unfortunately, Sutton died at the young age of 39.

NU

Walter Sutton was born on April 5, 1877, in Utica, New York. His initial youthful years were spent there while his father practiced law and served as judge for Oneida County.

MA

Eventually his family moved to rural Kansas in Russell County, where his family bought a ranch of several thousand acres, called “Rutger Farm” and raised livestock near the town of Russell.

ED

“Rutger Farm” achieved a reputation for breeding top quality horses, cattle, and swine. Several

PT

of his brothers stayed to work on the farm as the years passed, and their father followed his

AC

CE

own career to Kansas City as a lawyer. (1)

Sutton showed a remarkable aptitude for inventing and creativity by repairing most of the farm equipment. This area of his life led him to enroll in The University of Kansas School of Engineering on September 9, 1896. However, his life in the field of engineering was a short one, as the following summer would be a life-changing experience and would alter his career path direction. The following summer the family was struck by typhoid fever with Walter being one of the first to fall ill. Upon recovering, he undertook one of his future roles as caregiver. He was not able to help all members of his family, as his 17-year-old brother John succumbed to the disease and passed away in August 1897. In the same year, the Sutton family left Russell County

ACCEPTED MANUSCRIPT 4

and moved to Kansas City, Kansas. Two of Sutton’s brothers remained in Russell County to manage the ranch.

RI P

T

It was this family experience that led him to change his studies in school. The following semester, he enrolled in biology to prepare for medicine as a career.(1) Through the study of

SC

biology, Sutton met one of his lifelong friends and colleagues, Clarence Erwin McClung (1870-

NU

1946), who was a zoology professor at the University of Kansas. The first day in class, Sutton helped McClung set up for his presentation. This experience brought them close together.

MA

McClung and Sutton continued to work closely in the biology lab, an educational experience which continued into a correspondence between semesters. During the summer break, Sutton

ED

enjoyed sending McClung biological samples that he found on his father’s farm. It was one of

PT

these samples, the “lubber” grasshopper (Brachystola magna), which would be an important

CE

discovery and aid in Sutton’s future work on chromosomal inheritance. (Figure 1) The time spent on his education was not always filled with discovery. The time was right

AC

for many individuals to come together at the University of Kansas as the birth of basketball had begun. James A. Naismith, M.D. (1861-1939; Inventor of Basketball, Basketball Coach and Athletic Director, University of Kansas, Lawrence, Kansas, USA), was a medical doctor who had studied physical education in Montreal, Canada, before coming to the United States. He created the game of “basket ball” in 1891while teaching at the International YMCA training school in Springfield, MA, to provide physical education and distraction for students during the long winter months when it was more difficult to find strenuous activity (2). It was a blessing that Naismith eventually found his way to the University of Kansas. The game was not as

ACCEPTED MANUSCRIPT 5

popular as it is today, but did involve many students and faculty. McClung wrote in one of his letters, “there was plenty of work to do, but time for play remained and the game that caught

RI P

T

our fancy was basketball, then being introduced by its originator, Doctor Naismith. There were faculty-class tournaments and we both [McClung and Sutton] “made our teams,” some years

SC

playing against each other and later on the same team. With the establishment of the varsity team, Walter, with (his brother) Will, was chosen as a member and acquitted himself with

NU

credit (1).” (Figure 2)

MA

Sutton was graduated Phi Beta Kappa in 1900 from the University of Kansas. Sutton’s education continued as he received his Master of Arts degree, and on the advice of McClung

ED

eventually began post graduate study at Columbia University in New York in the fall of 1901

PT

under the pioneering geneticist Professor Edmund Beecher Wilson (1895-1972; Professor of Zoology, Columbia University, New York City, NY, USA). Wilson was one of the first cell

CE

biologists and wrote the landmark textbook, The Cell. Sutton continued his work in genetics

AC

and eventually published “The Chromosomes in Heredity (3).” Sutton recognized that chromosomes carry genetic material and are the basis for Mendelian inheritance. Due to similar contemporaneous independent work by Wilson’s close friend Theodor Boveri (1862-1915; Biologist, Germany), it is known as the Boveri-Sutton Chromosome theory. Sutton’s plan at the time was to finish his Ph.D., but this never came to be. He took a leave of absence as he was again having financial trouble. He became foreman of an oil rig in Chautauqua County, in southeastern Kansas. He continued to use his creative nature designing inventions and making improvements in existing drilling methods.

ACCEPTED MANUSCRIPT 6

While working in the oil fields, his father called, telling young Sutton it was time to return to his studies. In 1905, Sutton made his way back to the College of Physicians and

RI P

T

Surgeons at Columbia University to finish the remaining two years of his medical degree. Upon completion of his degree, he was offered a two-year surgical fellowship at the Roosevelt

SC

Hospital in New York City, where he was introduced to the idea and technique of rectal

NU

anesthesia and developed his own methods of administration on surgical patients (1). The general principle of colonic absorption of gases to and from the bloodstream was

MA

not a new topic. Some of the early published works on rectal anesthesia were by Nikolay Pirogov (1810-1881; Surgeon, Russia) in 1847(4). Further use of this method did not turn up

ED

until much later as some of the earlier work had unfavorable results which led to its

PT

discontinued use. Sutton noted that Paul Bert (1833-1886; Professor of Physiology, Sorbonne, Paris, France) in 1870 had performed experiments on kittens in which the trachea was clamped

CE

and the kitten died of asphyxiation (5). In the same experiment, kittens’ intestines were inflated

AC

with air and their life was sustained for a few minutes longer compared to their counterparts. The practice of rectal anesthesia was not revived until John H. Cunningham, Jr., M.D., was able to change the method of administration and improved the safety of this technique. The problem with earlier attempts was in the delivery process. Prior investigators had attempted to inject pure ether as a liquid or vapor, carried into the bowel as a solution. The novel approach developed by Cunningham was the use of air as a vehicle to deliver the ether into the intestine (7). Further modification of the apparatus led to changes utilized by Noel B. Leggett, M.D., (1879-1924; Assistant in Surgery, Columbia University College of Physicians and

ACCEPTED MANUSCRIPT 7

Surgeons). Leggett added an exhaust tube connecting the efferent tube to the gut and two additional tubes for the collection of any condensing vapor as it passed from the generator to

RI P

T

the rectum. This design represented the “state of the art” and was actually used by Sutton in some of his earlier cases (6). Further experimentations led to Sutton’s redesign of the

SC

apparatus. One of his main concerns with the original device was the obstruction of the tubing with semi-solid fecal matter upon opening the exhaust tube. Sutton used additional tubing to

NU

prevent the collection of this debris. He also made changes to the caliber and length of the

MA

rectal tube and the number of outlet ports at the end to prevent obstruction by the rectal mucosa. Sutton also noted that the pressure at which the gas was administered was very

ED

important. Too much pressure led to compression of blood vessels in the gut leading to ischemia and decreased absorption. A mercury manometer was added in order to prevent this

PT

from occurring. (Figures 3 and 4)

CE

Sutton took meticulous notes on the many surgical patients he cared for and operated

AC

upon. Some of these notes are still available (8). The same applied to his experiments with rectal anesthesia. At Roosevelt Hospital, he had documented 100 cases which were noted in his manuscript “Anaesthesia by Colonic Absorption of Ether” in Annals of Surgery in April 1910 (6). He had an additional 40 cases for which he did not keep records because they were private cases. He noted that no “untoward results occurred.” It is interesting to note the diverse group of patients that were part of his cases. These included men and women, young and old, as well as a multitude of different operations (total of 28). The operations themselves lasted anywhere from minutes to two hours. Not all patients were able to get by with only the rectal form of

ACCEPTED MANUSCRIPT 8

ether administration. Approximately half of the 100 patients required supplemental inhaled ether or chloroform (6,8).

RI P

T

Some of the noted complications which Sutton experienced included: (a) belching of gas from the stomach indicating distension of the small intestine with gas; (b) perspiration but no

SC

profuse sweating; (c) vomiting after the operation in four patients; (d) abdominal pain in twelve

NU

patients; (e) bloody or blood streaked stools occurred up to three days later in five patients; (f) a case where a new ether generator was employed which made it difficult to control the

MA

amount of “narcosis.” This same patient also experienced several bloody stools within three

ED

days of the operation, but made an uneventful recovery and went home on the fifth day. Death was always a notable complication, especially when it took place perioperatively.

PT

Sutton was not unique in this regard, and he had several deaths occur during his study (8). It is

CE

interesting to note that he did not blame the rectal method of anesthesia for these mishaps. A total of 5 deaths were reported. The first involved a large, heavy man, who was an alcoholic.

AC

The surgery involved partial excision of the tongue secondary to an epithelioma. It was noted that the patient was “somewhat blue and pulse was small and rapid throughout the operation.” (8) The patient made it through the surgery but died of “operative shock” two hours after the procedure. “Operative shock” had a broad list of causes as noted from the “Studies on Experimental Surgical Shock” by F.C. Mann (1887-1962; Associate Professor of Experimental Surgery and Pathology, The Mayo Foundation, Rochester, MN, USA) in 1918 in The American Journal of Physiology (9). In the text, it indicates that with a high tension of ether, signs and

ACCEPTED MANUSCRIPT 9

symptoms of shock can be produced. Deep anesthesia, hemorrhage, exposure of the abdominal viscera, use of excessive heat or cold, isolation of large vascular areas causing partial occlusion

RI P

T

of the vena cava, production of cerebral anemia, and injection of drugs were also noteworthy causes of operative shock.

SC

A 35-year-old large, heavy man was the second fatality. His death from pneumonia

NU

occurred two days after his operation for tracheotomy and removal of the cervical glands as a preliminary surgery for laryngectomy. His anesthetic was felt to be shallow, and the patient was

MA

noted to be coughing and groaning throughout the case. A third patient, a 53-year-old wellnourished and moderately alcoholic man, died from hemorrhage. His operation for epithelioma

ED

consisted of hemi-excision of the tongue and removal of right cervical glands. Sutton’s records

PT

indicated that the patient took his anesthetic slowly, and was markedly cyanotic. This improved when the administration of ether was moved to the rectal form. At that time, the patient’s

CE

anesthesia was shallow throughout, which was indicated by his frequent swallowing. Traumatic

AC

brain injury took the life of the next patient. He was a young male of 24 years who arrived at the hospital moribund with a depressed skull fracture. While he made it through surgery seemingly improved, he died two days later without regaining consciousness. The next patient, a 31-year-old African American male who presented with dyspnea, died from complications from a false aneurysm in the descending arch of the aorta. A low tracheostomy was performed while the patient was in the sitting position. This position made it difficult to administer rectal ether due to compression of the bowel. The patient recovered from his anesthetic but died two days later. Surprisingly, the last case was not performed by Sutton himself but was observed by him at Roosevelt Hospital using his machine and techniques. It involved a well-nourished five-

ACCEPTED MANUSCRIPT 10

year-old female child undergoing staphylorrhaphy for a hare-lip operation. She had received prior operations with no adverse events. Throughout the operation it was noticed that it was

RI P

T

difficult to maintain a “smooth narcosis.” During the lighter phases of her anesthetic, chloroform was used as supplementation. A very poor color, small and rapid pulse were noted

SC

at the conclusion of surgery. When surgery was finished, the patient was returned to the ward. A short time later she became restless and talkative but was unable to recognize anyone. Just

NU

like any child after surgery, she requested to have something to drink and to go home. Her

MA

pulse continued to be rapid and an intravenous fluid administration was started. This was a temporary fix, and she relapsed into unconsciousness dying two hours after surgery (10).

ED

Sutton felt that his use of rectal anesthesia was safe when used appropriately, and

PT

believed that it should be used when it offered a distinct advantage over the traditional pulmonary administration of ether. Clearly he felt that this method should be employed by a

CE

trained anesthetist. Some of the indications for its use include: (a) surgery about the head and

AC

neck region; (b) operation upon patients whom ether absorption must be minimized due to heart, lung, or kidney lesions; (c) cases in which there were pulmonary complications present (6). There were several situations in which Sutton would not use rectal anesthesia. These included cases involving: (a) the alimentary tract or cases which might cause a weakening of the colon; (b) laparotomies, except those in which the peritoneal cavity was not opened; (c) cases involving a patient with an incompetent sphincter or anal fistula; (d) orthopnea present due to

ACCEPTED MANUSCRIPT 11

the required positioning in order to reduce the present symptoms; (e) emergency cases due to the inability to properly prep the colon prior to surgery (6).

RI P

T

Sutton’s contributions to rectal anesthesia were definitely noted at the time. A letter after Sutton’s death by Joseph A. Blake, M.D., to Sutton’s parents on December 12, 1916,

SC

declared that “Sutton then interested himself in the question of rectal anesthesia and designed

NU

a very clever apparatus, making a great deal of it himself, by which the ether was vaporized, the vapor warmed and introduced into the rectum in known quantity, the apparatus being so

MA

arranged that not only was the amount given measured, but could be regulated readily at the will of the anesthetiser. By his apparatus, a large number of rectal anesthesias were performed

ED

without any harmful results (11).” Blake was not the only one to note Sutton’s work. John F.

PT

Binnie, M.D., noted in his letter in 1916, “While still in New York, Dr. Sutton devoted much of his thought to the development of rectal anesthesia and succeeded in laying the foundation for

AC

(11)

CE

the method which is today standardized and for which he does not receive sufficient credit.”

Several others appreciated his work and his publications on rectal anesthesia. He had many correspondences (Table 1) (11) with James Tayloe Gwathmey (1863-1944; PhysicianAnesthetist, New York City, NY) founder and first president of the American Association of Anesthetists, and author of one of the first comprehensive textbooks on anesthesia. In one of his letters prior to the publication of his book, Gwathmey wrote, “I am writing a book on anesthesia and have selected you to write the chapter on Rectal Anesthesia.” Several months and correspondences later, Sutton stated, “I am just in receipt of a beautifully bound copy of

ACCEPTED MANUSCRIPT 12

your work on Anesthesia (12), for which I wish to extend my most cordial thanks. …It certainly far over-tops any previous efforts in this direction, both in scope and substance…” Sutton’s

RI P

T

contribution was so appreciated by Gwathmey that Sutton was invited by him to speak at the annual meeting of the American Association of Anesthetists on June 12, 1916, in regards to his

SC

contributions and recent publication on rectal anesthesia (11).

NU

William Stanborough Sutton was born in the year 1877 and lived to the age of 39. He accomplished so much in such a short amount of time. Taking his talents of invention all the

MA

way from the oil fields of Kansas to the battlefields of Europe, to using his analytical and deductive reasoning to treat his numerous patients, Sutton proved that he was well ahead of

ED

his time. It is difficult to predict what might have occurred had Sutton survived the ruptured

PT

appendix that took his life. One can only speculate on his further contributions to medicine and

AC

CE

science in general and genetics, surgery, and specifically anesthesiology

ACCEPTED MANUSCRIPT 13

References 1. Archives of the University of Kansas Medical Center, Kansas City, KS. Box 1. Folder 1.

University Press: Philadelphia, PA:2009. p 105.

RI P

T

2. Rains R, Carpenter H, James Naismith: The Man Who Invented Basketball. Temple

SC

3. Sutton, Walter S. “The Chromosomes in Heredity.” Biological Bulletin 1903; 4:231-51.

NU

4. Bert P. Physiol. Comp. de la respir., Paris, 1870: p 173.

5. Secher O. Nikolai Ivanovich Pirogov. Anaesthesia 1986; 41(8):829-37.

MA

6. Sutton WS. “Anaesthesia by Colonic Absorption of Ether.” Annals of Surgery 1910, 51(4):457-79.

ED

7. Cunningham JH. Boston Med and Surg Journal, Sept. 12, 1907.

PT

8. Archives of the University of Kansas Medical Center, Kansas City, KS. Box 5. Folder 5. 9. Mann FC “Studies on Experimental Surgical Shock.” The American Journal of Physiology.

CE

1918. Vol. 47. No 2. Pg 231.

AC

10. Archives of the University of Kansas Medical Center, Kansas City, KS. Box 4. Folder 7. 11. Archives of the University of Kansas Medical Center, Kansas City, KS. Box 3. Folder 5. 12. Gwathmey JT, Basker C. Anesthesia. D. Appleton and Co.: New York: 1914.

ACCEPTED MANUSCRIPT 14

FIGURE LEGENDS Figure 1 Kansas specimen of Brachystola magna. (photo courtesy of the Division of Entomology, KU Biodiversity Institute, University of Kansas, Lawrence, KS)

SC

RI P

T

Figure 2 Kansas University Men’s Basketball team, 1899. Walter Sutton (arrow) in 3 rd row, second from right. James Naismith (coach), inventor of the game of basketball, in 3 rd row, far right. (photo courtesy of the University of Kansas Archives, Spencer Research Library, Lawrence, KS)

NU

Figure 3 Parts of the vapor generator designed by Sutton. ( photo courtesy of the University of Kansas Medical Center Archives, Kansas City, KS, Sutton collection)

PT

ED

MA

a. Oxygen (or air) inlet; b. connection to afferent tube system. c. by-pass for inflating intestine with pure oxygen (or air); d. clip for closing by-pass; e. H-tube connecting oxygen tank and air bulb with generator and by-pass; f. connection of H-tube with air bulb. g. connection of H-tube with oxygen tank; k. disc forming top of spiral wire; l. spiral wire; m. manometer; n. thermometer projecting out of water-jacket; r. tubular incandescent bulb for heating waterjacket; s. ether reservoir; t. ether can inverted in reservoir; with upper part of generating chamber; w. glass tube connecting ether reservoir with generating chamber below lever of ether; x. flattened spike for perforating seal of ether can; g’ metal brace between reservoir and generating chamber; z. cover over hole for filling water-jacket; zz. cover of generating chamber.

CE

Figure 4 Schematic section of the vapor generator designed by Sutton. (photo courtesy of the University of Kansas).

AC

Figure 5a and 5b. Walter S. Sutton. (photos courtesy of the University of Kansas Medical Center Archives, Kansas City, KS, Sutton collection)

ACCEPTED MANUSCRIPT 15 (Editor’s NOTE: this is correctly punctuated. Please do not change anything. )

T

Table 1: Correspondence between Walter S. Sutton and James Tayloe Gwathney, M.D. (11)

RI P

Note that Sutton used the spelling anaesthesia.

SC

Oct 10th, 1910 Dear Sutton,

MA

NU

I am writing a book on anesthesia and have selected you to write the chapter on Rectal Anesthesia; giving first the history and then an account of it up to and including your own work. Your most interesting reprint received some time ago would contain about all that is necessary…. Sincerely Yours,

ED

James T Gwathmey

PT

Oct 15th, 1910 Dear Doctor Sutton:--

CE

Your letter of the 13th inst. received and I was very much gratified to know that you entered so heartily into the plan. A little delay will be all right.

Sincerely Yours,

AC

I am glad of the opportunity of placing in permanent form your most valuable contribution to anesthetics.

James T Gwathmey

Dec 19th, 1910 My dear Dr Gwathmey:-Am sorry to have run so far behind my schedule in the preparation of manuscript…have prepared a number of new illustrations….

ACCEPTED MANUSCRIPT 16 I read your article in the Journal A.M.A with great pleasure. The Apparatus sounds O.K. and I should like to see it work. I gave a demonstration of anaesthesia per rectum at the General Hospital a couple of days ago which seems to please the clinic.

RI P

T

[Unsigned]

SC

October 5, 1914

NU

My dear Doctor [Gwathmey]:-

MA

I am just in receipt of a beautifully bound copy of your work on Anaesthesia [sic] for which I wish to extend my most cordial thanks. I have had an opportunity so far merely to look over the general scope of the work….I am proud to have been a contributor in a small way to the end results.

ED

WSS

February 25, 1916

PT

My dear Dr. Gwathmey: (add colon, otherwise correct)

WSS

AC

CE

In reply to your letter of February 16th inviting me to be present at the meeting of the American Association of Anesthetists and to read a paper, I must say that I am highly delighted with the invitation….The only possibility is to present, perhaps with a few lantern slides, the subject of Colonic Anaesthesia….

ACCEPTED MANUSCRIPT

NU

SC

RI P

T

17

AC

CE

PT

ED

MA

Figure 1

ACCEPTED MANUSCRIPT

AC

Figure 2

CE

PT

ED

MA

NU

SC

RI P

T

18

ACCEPTED MANUSCRIPT

PT

ED

MA

NU

SC

RI P

T

19

AC

CE

Figure 3

ACCEPTED MANUSCRIPT

PT

ED

MA

NU

SC

RI P

T

20

AC

CE

Figure 4

ACCEPTED MANUSCRIPT

PT

ED

MA

NU

SC

RI P

T

21

AC

CE

Figure 5a

ACCEPTED MANUSCRIPT

AC

CE

PT

ED

MA

NU

SC

RI P

T

22

Figure 5b