SA’S MEDICAL MILESTONE: PG 7
Patrick Coyne tells the story of William Atherstone, a South African who marked a medical milestone by pioneering painless operations.
IN THE early 1800s, if you were unlucky enough to have a limb amputated, you would feel every slash of the surgeon’s scalpel and every rasp of his saw.
No jovial anaesthetist would prepare you beforehand with a soothing drip and sleep-inducing injection. Instead, you would be filled up with brandy and held down by muscular male nurses.
“Painless operations? Impossible!”
This is what the famous French surgeon Dr Alfred Velpeau wrote in 1839: “The abolishment of pain in surgery is a chimera. It is absurd to go on seeking it… Knife and pain are two words in surgery that must for ever be associated in the consciousness of the patient.”
A few years later, you might have been given a shot of opium, which was rather hit and miss. If taken in excess, it could lead to nightmares and even addiction.
South African surgeons, like heart-transplant pioneer Dr Chris Barnard have made their names as pioneers in medical science. But not many people have heard of the equally brilliant, physician Dr William Guybon Atherstone, whose fearless achievement took place on June 16, 1847, 170 years ago.
William’s story starts on a romantic note. At the age of 6 he sailed from Britain with his family as 1820 Settlers in the SS Ocean.
Part of his schooling was at the famous academy run by Dr James Rose Innes. William qualified as a doctor in 1836.
In 1839 he married his cousin, Catherine, and in the same year he started his practice in partnership with his father, Dr John Atherstone, the district surgeon of Grahamstown.
In 1846 the Atherstones read an article in an American newspaper. It described an operation carried out by a Massachusetts dentist, William Morton, the first person to use ether as an anaesthetic, while removing a tumour from a patient’s jaw. Later, a few surgeons around the world tried chloroform; one patient died from heart failure.
William made up his mind to look for a suitable patient on whom he could operate using ether. In 1847 he told his doubtful father that he thought he had found one, and that he proposed to amputate the patient’s leg using ether as an anaesthetic. William later described the events:
John warned his son against the risk he would be taking, saying it would be a very dangerous experiment. How would he know how much ether to use? Or how long to use it? It was, after all, a poison… The patient might easily die.
William said the patient was likely to die anyway if his leg was not amputated. The man suffered from erysipelas in his left leg, which had developed into gangrene. Also, he had an indolent ulcer in the flexion contracture at the knee. He was in constant pain. The only drug William could give him to relieve the pain was laudanum, a tincture of opium. The patient hated it because it gave him nightmares. He had asked for his leg to be taken off.
“Who is the patient?” his father asked. “Frederick Carlisle.” “What! The Deputy Sheriff ?” “The very one.” Realising that William was determined to operate, John insisted on being present, with two of his Army medical colleagues, Dr Hadaway and Dr Irwin, to assist. William welcomed the help of these three surgeons.
Carlisle was a big man, and William realised he would need to take that into consideration when judging how much anaesthetic to administer. He had a big voice, too. He boomed: “Doctor, are you going to take off this leg of mine?”
William said: “It’s what you want me to do, isn’t it?”
“You know very well I want you to do it. I’m sick and tired of taking your laudanum for the pain of this left leg. The trouble is I’m also frightened of the pain of an amputation!”
“Mr Carlisle,” said William, “I can take your leg off, and I believe you will feel no pain while I do it.”
“What? I’ve read something about that, but…”
“… But you must realise that this is going to be in the nature of an experiment. Ether has never been used before in an operation in this country: it was first used in America last year. As you see, there are three surgeons assisting me – Doctors Atherton, Hadaway, and Irwin. Do you, in front of these witnesses, consent to my doing the operation using this new method?”
“Yes, yes, I consent!” boomed Carlisle. “It’s not every day that I have four doctors attending me all at the same time! Let’s get on with it.”
William prepared his equipment – a 2 quarts-capacity glass bottle which he filled with half an ounce of ether. The bottle had, threaded through its stopper, two glass tubes, one of which ended just above the surface of the ether. This tube was attached to a flexible pipe ending in an ivory mouthpiece. He sealed the top ends of both tubes to allow the bottle to fill with the ether vapour.
William told Carlisle that he wanted him to put the mouthpiece to his lips and breathe in, or suck in, the vapour through his mouth, and out through his nose. He must hold his nose while breathing in. William unsealed the tubes.
“Now, try it.” The doctors watched tensely as the patient did as he was told. He inhaled two, three, four times, looking up at them while he did it. He closed his nose each time as if he had been doing it all his life.
After 12 inhalations, William pinched Carlisle’s leg. A few moments later the patient pinched his own leg while he inhaled a few more times. He pinched his own leg once more and to the doctors’ surprise said: “I think I am drunk enough now! You may begin.”
William said: “Mr Carlisle, please continue breathing in the vapour.”
Then he nodded to his father, who at once tightened the tourniquet round the upper part of the patient’s thigh. Irwin took up his position at the patient’s head, checking his pulse and clamping his arms in the time-honoured way, while Hadaway held the patient’s legs tightly.
William held his scalpel over the leg, and hesitated, his eyes meeting those of his colleagues. His father nodded to him, and William plunged the knife deep into Carlisle’s leg. The patient didn’t move a muscle or utter a sound. The eyes of the experienced assistant surgeons widened in disbelief.
Carlisle seemed to be concentrating on his breathing. With a gesture of incredulity Irwin let go of the patient’s arms, but went on checking his pulse. Hadaway likewise released the right leg but still held the left leg, which was being operated on. Now William made the second incision, to cut the large nerves and blood vessels. At that moment Carlisle let out a muffled shriek. The doctors flinched and someone let out his breath with a hiss.
William’s heart sank. Was the experiment going to fail at this point? They looked blankly at each other. Then John Atherstone said quietly: “Gentlemen, the patient is still manifestly insensible. Continue, William!”
William nodded and carried on. After four long minutes the amputation was complete. The doctors busied themselves cleaning and securing the arteries, applying dressings and removing the tourniquet, while William gently took the mouthpiece out of Carlisle’s mouth and removed and resealed the glass bottle.
At this point, Carlisle seemed to wake up. He said: “It’s very odd. Do you know, I fancy I am still holding my nose.”
Irwin said: “Well, so you are.”
Carlisle said: “Then why have you removed the vapour?”
Irwin said: “Because the operation is over – your leg has been taken off.”
“Now, don’t talk nonsense to me,” said Carlisle. “I’m a reasonable man, you know. Explain to me why the bottle is gone.”
“You don’t want it any longer,” said Irwin. “Your leg is off, Mr Carlisle.”
The patient boomed: “What? My leg off ? Impossible – I can’t believe it. Let me see for myself.”
The doctors helped him to sit. He looked down, saw the bandaged stump, and said: “God be praised! It’s the greatest discovery ever made.”
He looked round at the surgeons. “We must erect a monument to this fellow’s memory,” he said, gesturing at William. “It’s the greatest boon ever conferred on Man.”
John Atherstone said: “One moment, sir: did you feel any pain?” “None at all!” “But, were you conscious of what was happening?”
“Conscious?” said Carlisle. “No… Oh, it was as if I was in a dream. I may have heard the noise of his damned saw. But as for pain, I did not feel the slightest.”
That is how William described the operation to a scribe from the Grahamstown Journal, and the report appeared in that newspaper’s issue next day.
William made his name with that ground-breaking operation. He also became a famous geologist, and in 1867, 150 years ago today, he won further fame by finding and identifying the first of the country’s diamonds at Colesberg Kop, which later became Kimberley.