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History of Anaesthesia in the Midlands

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The Beginning of Surgical Anaesthesia in Birmingham

Edward T. Matthews

In the history of medicine, anaesthesia is a late arrival but once it started it made up for lost time. Reports of the successful demonstration of surgical anaesthesia at the Massachusetts General Hospital, Bostom, U.S.A., on 16th October 1846, spread rapidly around the world.

The first anaesthetic in Birmingham was given by Professor Samuel Langston Parker at The Queen's Hospital in the 15th January 1847. It is noteworthy that the first anaesthetist in Birmingham was a very senior and highly respected medical practitioner of professorial status. He approached the subject in an academic manner giving the patient, Mary Ann Chambers, two experimental trials with ether, which he found to produce "complete temporary insensibility", before he administered ether for surgery.The surgeon was Professor Knowles, the operation was amputation of the foot.

In the middle of the operation,when the foot had been severed,the patient was awakened and vigorously questioned as to if she had felt pain. When the required information had been obtained she was anaesthetised again and the flaps of the amputation stump were sutured. It was reported that she was comfortable after the operation and did remarkably well. The following week, Professor Parker gave a lecture and demonstration of anaesthesia at Queen's College. The demonstration was on one of the students. This young gentleman did not take the ether as smoothly as Mary Chambers."He clenched his fists and endeavoured to strike and kick everyone within his reach and was so violent in his struggles that six or eight of the students could, with difficulty, keep him down in the chair". At the close of the lecture Professor Parker was warmly applauded.

The advent of surgical anaesthesia was perhaps more important in Birmingham than in many other centres because Birmingham was the workplace of Lawson Tait, the father of modern abdominaI surgery. By 1884, he had performed 1000 abdominal operations, by 1888 - 2000 and in the succeeding 10 years added another 2000 to the list - numbers unequalled by any other surgeon of his time.

Lawson Tait had been a pupil of Sir James Young Simpson, famous for the introduction of chloroform anaesthesia and Tait maintained a close interest in the development of anaesthesia. Sir Francis Shipway, the eminent London anaesthetist, gave Tait the credit for the first published account of "open ether" and of "warmed ether" and regretted that Tait's methods were not more widely practised. In 1873, Tait organised the first national educational meeting on anaesthesia in Birmingham, he invited Benjamin Ward Richardson F.R.S. and Dr. Norris to speak on their studies.

Unfortunately, Tait's role in the development of the speciality was marred by his personal financial greed. He paid his anaesthetists poorly and was not averse to pocketing the anaesthetic fee for himself. Regrettably, this practice was so widespread amongst the surgeons that it was said that if you decided to specialise in anaesthesia you must either have a private income or be a fool. Tait's principal anaesthetist was Dr. Ann Elizabeth Clark, MD Berne 1877, LKQCPI 1878, MRCPI 1883. She as one of the pioneer women to qualify in medicine and a daughter of the founder of Clark's Shoes. She was a most skilful anaesthetist and a respected physician. Contemporaries recorded that "Dr. Annie" was a woman of great courage when any principle was at stake. She was not richly endowed with the gifts and graces which make it easy to gain popularity in social life. Her habit of speaking the truth without any equivocation or evasion was carried far beyond what was usual in everyday life. Clearly she had a private income.

The first anaesthetists formally appointed to the Birmingham Teaching Hospitals had to have alternative sources of income, many were engaged in general practice. A Director of Anaesthetics, Dr. Mackey, was appointed to the Children's Hospital in 1871. Dr. Mary Darby Sturge was appointed Anaesthctist to the Women's Hospital in 1895. Two Visiting Anaesthetists, Mr. C. Leedham Green, FRCS, and Dr. Sydney W. Hayes, MD, CM Edin., were appointed at the General Hospital in 1896 and Dr. L. Kirkby Thomas was appointed to The Queen's Hospital in 1913.

A most important event was the appointment of William Joseph McCardie to the visiting staff of the General Hospital. Dr. McCardie was the first anaesthetist outside London to practise solely as an anaesthetist. He was persuaded to specialise in anaesthesia by Sir Gilbert Darling who had decided on the necessity of a specialist anaesthetist after he narrowly escaped a death on the table when performing an operation on a distinguished colleague with anaesthesia provided by a house surgeon. It is perhaps significant that the colleague who nearly died on the table was Lawson Tait, at that time, the most famous surgeon in Europe and North America.

McCardie became an institution in the Midlands. His practice was very extensive for he was Invited to give anaesthetics at private houses as well as at hospitals in all parts of the Midlands when special skill was required or it was felt that his personality and manner would inspire confidence. Well informed patients did not ask for an anaesthetic, they asked that Dr. McCardic should attend them. His status at one time was such that he was consulted before the surgeon was selected and he received fees equal to those of the surgeon. his knowledge of the anaesthetic literature was exceptionally wide. Some of his annotated copies of foreign language papers arc now in the library of The Nuffield Departmcnt of Anaesthetics, in Oxford.

McCardie was appointed to the staff of the General Hospital in 1897 as a Visiting Anaesthetist; in 1919 he was made the Honorary Anaesthetist and in 1926 Consulting Anaesthetist. He made many original contributions to the practice of anaesthetics and played leading roles in the Society of Anaesthetists and the Section of Anaesthetics of the Royal Society of Medicine, of which he was President soon after its formation. He was Secretary' of the Section of Anaesthetics of the British Medical Association in 1910, Vice-President in 1912 and President in 1922. But possibly his greatest contribution to anaesthesia was that his enthusiasm for the speciality served as "a beacon to guide younger men along the pathway of their vocation". One of these younger men was Henry Walter Featherstone.