Anaesth Intens Care (1991),19,261-266

History of Anaesthesia Dr. Charles Nathan Anaesthesia M. G.

His Contribution to Colonial Australian

COOPER*

Key Words:

HISTORY:

medicine, anaesthesia

Or. Charles Nathan (Figure 1) was born in London in 1816, the eldest son of Isaac N athan and his first wife Elizabeth (nee Worthington). Isaac Nathan was a famous musician, who, as a contemporary of Lord Byron's, wrote the music for his 'Hebrew Melodies' and was musical instructor to Princess Charlotte, daughter of George IV. Nathan senior is considered to be the Father of Music in Australia, so young Charles developed in an environment of music and culture that contributed to his personality and strength of character in later life. He qualified as Licentiate of the Society of Apothecaries (L.S.A.) and M.R.C.S. with honours from Westminster Hospital in May 1837 and began practice in Belgrave Square. However, at the end of 1840 the family decided to migrate to Australia, and Charles arrived with them on the 'York' on April 7, 1841. He was registered by the New South Wales Medical Board as no. 183 on June 7, 1841. 1 Charles Nathan immediately commenced successful practice in Elizabeth Street, Sydney. In 1845 he was appointed one of the first honorary surgeons to the Sydney Infirmary. Nathan had received his surgical training in the grim years immediately preceding the discovery of anaesthesia, so he was quick to appreciate the enormous benefits of ether, and subsequently chloroform anaesthesia, both to the patient and the surgeon.

quick to implement the use of this wonderful new discovery. The first description of ether in the Sydney press occurred on May 17, 1847, in the Sydney Morning Herald: THE EFFECT OF ETHER IN SURGICAL OPERATIONS - It is ascertained that the inhalation of sulphuric ether renders a patient insensible to pain; and it is now employed with decided advantage in surgical operations. On May 21, 1847, there ran the first of two important editorials III the Sydney Morning

THE FIRST USE OF ETHER IN SYDNEY

Dr. Charles Nathan and Dr. John Belisario (who was later known as the Father of Australian Dentistry) were well known to each other prior to those initial halcyon days of anaesthesia in Sydney. Both were dynamic and innovative men who were *F.F.A.R.A.C.S., Assistant Historian, R.A.C.S., Assistant LibrarianlArchi vistl A.S.A. Address for Reprints: Dr. Michael G. Cooper, P.O. Box 6, Enfield, N.S.W. 2136, Australia. Accepted for publication January 11, 1991

Anaesthesia and Intensive Care. Vol. /9. No. 2, May, /99/

FIGURE I.-Dr. Charles Nathan.

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M. G.

Herald, quoting an extensive extract from the British and Foreign Medical Review describing several cases from Boston and most importantly a detailed description of ... a small two-necked glass globe containing the prepared vapour. No doubt Nathan and Belisario would have studied such a detailed report with great interest and enthusiasm. The editor concluded this report with: Upon the strength ofthese extracts wefind we had opened up the philosophical vein within us, which we were about to work, when we were forced to turn our attention to another subject, and are therefore under the necessity ofpostponing any further notice of this new method aftaking people to pieces until a future occasion. The subsequent newspaper reports of June 1847 give a complex account of the rapidity with which Nathan and Belisario introduced anaesthesia to Sydney, and this is best approached chronologically. On June 8, 1847, there appeared a small paragraph on page 3 of the 'Herald' which was the initial report from an obviously impressed editor, promising to devote greater attention to it in the near future. PAINLESS SURGERY We had an opportunity yesterday of witnessing, at Mr Belisario's, the extraction ofteeth from persons who had inhaled ether, and in two cases the effect was, as described in recent papers from England, almost miraculous. After inhaling the ether for a few minutes, the patients became insensible, and in one instance the tooth was extracted without the slightest emotion being visible, and in the other case there was a scream, but in both cases they declared that they had no knowledge whatever of what had taken place, and would at first scarcely believe that the tooth had been removed. This is such a deeply interesting and important subject that we shall take an early opportunity of referring to it at length. On June 10, a letter from one 'Chirurgicus' (later identified as Nathan) was printed in the 'Herald' in which he gave a boost to public confidence in inhaling ether. PAINLESS SURGERY To the Editors of the Sydney Morning Herald. GENTLEMEN - Thefollowingfacts relative to the inhalation of ethereal vapour may not merely be interesting to your readers generally, but useful to those members of the profession who have not the opportunity of marking its effects in Mr Belisario's numerous operations on the teeth. The discovery may be truly looked upon a.,s an additional blessing. It is an era not in surgery merely but in humanity. In most, if not in all instances, pain may be banished from .the horrors of .a surgical operation, and the physician indeed 'smooth the furrowed couch of

COOPER

care'. The emaciated patient, writhing under the agonies ofchronic disease, and losing strength under the fearful anticipation of a formidable surgical operation - his only chance, the only remedy leftmay now sink into a pleasant dream, and waking, find the danger over; his recovery even, not retarded by any shock upon the nervous system. However, the initial view of the newly founded Australian Medical Journal was rather critical and condemnatory, and, in a biting editorial of June 1847 stated, There is a fashion in medicine and the rage just seems to be after the means of rendering the use of the knife free from pain. Few practitioners, we imagine, would willingly, if they could avoid it, operate on a patient dead drunkfram liquor, yet we find it seriously proposed and practised Wilfully, to make him drunk previous to the operation. We have no hesitation in predicting for this process a transient popularity. It will have its day, ultimately to be abandoned as useless and injurious. This dissention in the medical establishment of the Colony prompted Nathan to reply strongly, and in the Herald of June 15 (this time under his own name!), Nathan unequivocally supported the use of ether, and showed his dedicaton to his patients' safety and well-being by inhaling it first! To the Editors of the Sydney Morning Herald. GENTLEMEN - It having been asserted, and by some persons believed, that the inhalation ofether is dangerous, and that the surgeon who permits its use is careless of the welfare of his patient, allow me, through the columns, to state that I have within the last few days witnessed nearly forty painless operations from it, having myself inhaled before I experimented upon anyone, and in no instance did mischief or even unpleasantness follow. On June 16, 1847, came the promised comprehensive editorial of the events that occurred at Mr Belisario' s surgery on June 7, when ether was applied for two dental cases. One of these patients was Nathan's younger brother, Alfred,2 who had previously been exposed to ether, prior to June 7: 3

. .. another patient stepped in - a younger brother ofMR NATHAN'S) who had two stumps ofdecayed teeth in his head, which were to be pulled out this morning. We saw these stumps, which being nearly level with the gums, required to be punched out, and if the reader has ever had or seen a stump punched out, he need not be informed, that it is one of the most painful operations in the history of human torture. The patient, having on a previous occasion undergone the operation of painless surgery, with extraction, under the ether application, willingly took the chair for the second operation. * He inhaled for • Author's bold type. Anaesthesia and Intensive Care. Vol. 19. No. 2. May. 1991

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HISTORY OF ANAESTHESIA

about five minutes, when he fell back apparently quite unconscious, MR NATHAN held the patient's mouth open, whilst MR BELlSA RIO, with quiet rapidity that almost eluded observation, drew forth one of these stumps, and quickly extracted the other, the patient the while reclining back, and breathing easily, as ifin a calm and deep sleep. In three or four minutes he woke up, rubbed his eyes, and smiled. One would expect that Nathan, having stated that he had inhaled ether first, would certainly have done so before his own brother's exposure! The editor of the Sydney Morning Herald at this time was Charles Kemp, a contemporary and immediate neighbour of Nathan at Macquarie St. He supported his close friend fully in this editorial saying,4 We have been informed that since the experiments above described, several others have been performed, and that in every case where the ether has been administered in sufficient quantity to reduce the patient to the thoroughly comatose state, he has felt no pain whatsoever, even in cases, where under ordinary circumstances, have been considered most painful. By the reports which have reached the colony, as to the application ofthis discovery to most surgical operations at the Westminster Hospital, it appears that the most respected medical authorities are there agreed, that no dangerous or injurious results are to be apprehended either at the time of, or subsequent to the application of the ether. It is both impossible and irrelevant to deliberate whether Belisario or N athan actually first administered ether. The two men were intimately involved, both in the development of the appropriate apparatus: 5 Mr Belisario's apparatus was constructed by himself in conjunction with an experienced medical gentleman of this city, who was also kind enough to superintend his first operations. ... and in the administration of ether,6 . . . the mouthpiece of the anaesthetic apparatus was skilfully inserted by Mr Belisario. But, Charles Kemp obviously felt that Nathan deserved some of the glory, as Kemp's diary, held in the Mitchell Library, narrates his impression of that momentous occasion: 7 It seems almost miraculous that by the inhalation of an impalpable vapor a person should be entirely free from the effects of pain, but this is the case, as was envinced by persons of various ages having teeth taken out, who were perfectly insensible, and who, when they came-to, would scarcely believe that they had been operated on. Nathan deserves great credit for having so speedily availed himself of the slight information which has yet reached usfram England. THE FIRST USE OF CHLOROFORM

Unfortunately, Nathan's optimism with regards Anaesthesia and Intensive Care. Vo/. 19. No. 2. May. 1991

to ether was not to persist. He was involved in the administration of ether to one Ann Ryder, who subsequently died on Sunday, April 9, 1848. 8 However, Nathan was undeterred by this disaster. Two days later, the inquest was held at which he gave evidence. That very day, Nathan also administered the first chloroform anaesthetic at the Sydney Infirmary to a young girl. This was reported in the Sydney Morning Herald of the following day, Wednesday, April 12, 1848: CHLOROFORM This new agent, for rendering the operations of surgery painless, was, yesterday, in the presence of some visitors, most successfully tried by the Surgeons of the Sydney Infirmary. The subject, a little girl, had to submit to a most tedious, difficult, and hither to excruciating operation. Dr McEwan operated; Mr Nathan administered the anaesthetic agent. After one minute's inhalation the child became affected, and the operation was commenced and completed without any manifestation ofpain. The effects ofthe chloroform lasted some time after the operation was finished; and on their passing away the child seemed perfectly herself, and gladly shook hands on finding she was to be taken out ofthe room. The advantages of chloroform over ether appear to be these: 1. The inhalation is not disagreeable to anyone. 2. There are none of the symptoms of intoxification which sometimes appear with ether. 3. There is no odour or taste afterwards, as all traces of chloroform immediately pass away. It is worthy of note that the first chloroform death in Australia occurred quite soon after, on July 19, 1848, at Windsor, N.S.W.9 SUBSEQUENT CAREER

Nathan's subsequent career was no less illustrious. He was appointed F.R.C.S. in 1857 and was called upon when the Duke of Edinburgh was wounded in Clontarf on March 12, 1868. He was a founder of the N.S.W. branch of the British Medical Association, a foundation member of the Senate of the University of Sydney and on the first Board of Examiners. In the last three years of life he also held the position of Honorary Consulting Surgeon to St. Vincent's Hospital, and also Honorary Surgeon to the Sydney Female Refuge. On a personal level, an article in the Bulletin of February 1959 by Nathan's great grand-daughter, Catherine MacLaurin, states that he married Harriet Fisher of age sixteen years when he moved to Macquarie Street and that she bore him fifteen children in her thirty years of marriage. Yet, again Charles Nathan let a member of his family experience his anaesthetic technique, with Harriet being the first woman in Australia to receive

M. G. COOPER

264 TABLE

1

ACKNOWLEDGEMENTS

I wish to thank Dr. Gwen Wilson and Dr. Richard Bailey for their encouragement. Also, Brenda Heagney, Librarian, Royal Australasian First report of ether in the Australian College of Physicians, the State Library ofN.S.W. press (The South Australian) and the Medical Illustrations Department, The First ether anaesthetic in Australia Children's Hospital, Camperdown, N.S.W.

Events in the development of colonial Australian anaesthesia May 4, 1847 May/June, 1847 March 31,1848

April 9, 1848 April 11, 1848 July 19, 1848

First report on chloroform in the Australian press (The Sydney Morning Herald) First death associated with ether First use of chloroform in Australia First chloroform death in Australia

chloroform in childbirth, 1,2 this being even prior to Queen Victoria's anaesthetic debut in 1853. Nathan died at his home on September 20, 1872, aged 56,10, .. the classical death ofthe pre-antiseptic surgeon - as a result of a prick in the finger while operating. The respect he was held in by the community, both public and medical, was reflected in his obituaries. 11,12 Charles Nathan played a prominent part in the development of surgery and medical education in this country. His contributions to the early days of ether and chloroform anaesthesia (Table 1) were enormous, and he did much to bring it to public acceptability, despite initial opposition.

REFERENCES 1. Nairn B, Serle G, Ward R. Australian Dictionary of Biography. 1851-1890. Melbourne University Press 1974; 5:327. 2. Nathan CV. Grim Times at the Infirmary. Med J Aust 1968; 2:688-692. 3. Sydney Morning Herald: 16 June, 1847; p2. 4. Ibid. p3. 5. Ibid. 15 June, 1847; p3. 6. Wilson G. The Pioneering Anaesthetists of Australia. Anaesth Intens Care 1979; 7:311-321. 7. Kemp C. Diary. Mitchell Library, State Library of N.S.W. 8. Cooper MG. The First Reported Death Associated with Anaesthesia in Australia, Anaesth Intens Care 1991; 19:265-266, 9. Emmanuel ER. The First Fatal Case of Chloroform Anaesthesia in Australia (letter). Anaesth Intens Care 1973; 1:549. 10. Miller D. The Medical Pioneers of St. Vincent's Hospital. Bull Post Grad Comm Med University of Sydney 1957; 13:61-76. 11. Sydney Morning Herald: September 21, 1872: pI. 12. Obituary. Charles Nathan, F.R.C.S. N.S.W. Medical Gazette 1872; 3:43.

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Anaesthesia and Intensive Care, Vol. 19, No. 2, May, 1991

Dr. Charles Nathan--his contribution to colonial Australian anaesthesia.

Anaesth Intens Care (1991),19,261-266 History of Anaesthesia Dr. Charles Nathan Anaesthesia M. G. His Contribution to Colonial Australian COOPER*...
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