What if Davy & Beddoes Had Used Nitrous Oxide for Surgical Anesthesia?

A.J. Wright, M.L.S.Department of Anesthesiology

University of Alabama School of Medicine

Questions to Answer

• What did Beddoes & Davy accomplish?

• Why didn’t they pursue surgical anesthesia?

• What if they had tried it?

Thomas Beddoes [1760-1808]

Thomas Beddoes [1760-1808]

• Studied at Oxford, Edinburgh

• Both chemistry and medicine

• M.B. and M.D. from Oxford, 1786

• Visited France, met Lavoisier, Summer 1787

Thomas Beddoes [1760-1808]

• Oxford reader in chemistry, 1788-93

• Moved to Hotwells, Clifton, near Bristol, 1793

• Began raising money for P.I.

• P.I. opened Fall 1798

Thomas Beddoes [1760-1808]

• Hired H. Davy

• Beddoes a prolific author of political and medical titles

• Linked social change and medical reform

• By 1802, P.I. Had become Preventive Medical Institution for the Sick and Drooping Poor

Humphrey Davy [1778-1829]

Humphry Davy [1778-1829]

• As a youth, often boarded with godfather John Tonkin, an apothecary-surgeon

• Apprenticed to John Borlase, apothecary-surgeon, in February 1795

• Self-educated in chemistry, botany, anatomy, physics and mechanics

Humphry Davy [1778-1829]

• Hired by Beddoes, October 1798

• Moved to London, March 1801

• Began chemistry lectures, November 1801

• Great success as lecturer, researcher and author

Pneumatic Institution Participants

• Samuel Taylor Coleridge

• Robert Southey

• Peter Mark Roget

• Joseph Priestley, Jr.

• James Watt and wife

• Anna Laetitia Barbauld and husband

• Robert Kinglake

• Josiah Wedgewood, Jr.

• Tom Wedgewood

• Anna Beddoes

• William Clayfield

• Numerous others

Why Didn’t They?

• American and French revolutions, enlightenment began age of “common man”

• Attitude toward pain had to change

• Help from Romantic movement in the arts

• Especially poets Coleridge and Shelley

Papper, Romantic Poetry and Surgical Sleep [1995]

Why Didn’t They?

• Beddoes felt future of medicine lay in chemistry

• Beddoes felt pain of surgery no different from pain of consumption, etc.

• Blood conveyed gases, so blood loss would negate gas effects

• Silk, wood, leather apparatus inadequate

Jacob & Sauter, J Hist Med 57:161, 2002

Why Didn’t They?

• Nitrous oxide experiments closely associated with enlightenment chemistry

• Chemistry was a “French” science

Golinski, Science as Public Culture [1992, pp 176-87]

Why Didn’t They?

• Callousness toward individual pain

Cartwright, English Pioneers of Anaesthesia [1952]

Why Didn’t They?

“The abolishment of pain in surgery is a chimera. It is absurd to go on seeking it today. Knife and pain are two words in surgery that must forever be associated in the consciousness of the patient. To this compulsory combination we shall have to adjust ourselves.”

Dr. Alfred Velpeau [1795-1867] in 1839

Quoted in Warren, Trans Am Surg Assoc 15:1-25, 1897]

Alfred Velpeau [1795-1867]

Why Didn’t They?

• Preoccupation with exhilarating qualities of nitrous oxide

• Ignored capacity to ease pain

Smith, History of the British Royal Infirmary [1917, p 319]

Why Didn’t They?

• Brunonian theory of stimuli

• Although apprenticed to surgeon-apothecary Borlase, Davy had no interest in surgical pain relief

• Consistent surgical pain relief was not viewed as possible

Bergman, Genesis of Surgical Anesthesia [1998]

Why Didn’t They? My Theories!

• All of the above!

• Beddoes was a physician, not a surgeon (who were tradesmen)

• Davy’s later career shows his genius was chemistry, not medicine or surgery

• Satiric attacks by the Anti-Jacobins made P.I. Experiments seem silly*

*Wright, Bulletin of Anesthesia History 14(1): 15, January 1996

What Did They Accomplish?

• First human respiration of nitrous oxide*

• Respiratory therapy

• P.I. Combined research, education and patient care

• Research: laboratory, animal, human

*Davy, April 1799

What Did They Accomplish?

• Beddoes gathered numerous case studies from other physicians

• Manufacture, storage and inhalation of several gases: Oxygen, nitrogen, CO2, hydrogen, N2O, “hydrocarbonate”

• Davy noticed N2O inhalation relieved headache and toothache

• Recreational use of gas inhalation

Watt’s Apparatus

Watt’s Apparatus

Watt’s Apparatus

Watt’s Apparatus

Why Didn’t They?

“The Institution should be conducted with a view to the attainment of two objects—1. To ascertain the effects of these powerful agents in various diseases; and 2. To discover the best method of procuring and applying them.”

Beddoes, Outline of a Plan…[November 1795, p 7]

Why Didn’t They?

“As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.”

Davy, Researches…[1800, p 556]

Why Didn’t They?

“An easily manageable apparatus for producing, containing and accurately measuring Factitious Airs, has been invented by that ingenious mechanical philosopher, Mr. Watt.”

Beddoes, Outline of a Plan…[November 1795, p 13]

Surgical Pain Relief by Inhalation

• Johannes Quistorp – 1718- associated inhalation and word “anaesthesia”

• Davies Giddy - 1795- letter to Beddoes [see Bergman]

• Davy - 1800

• Beddoes - 1803- comments to Dr. Joseph Frank [see Bergman]

What If They Had?

• Davy knew nitrous inhalation could relieve pain

• Davy knew animals lived longer breathing a nitrous/oxygen mixture than nitrous alone

• Could manufacture nitrous

• Breathing apparatus designed by Watt and Clayfield

What If They Had?

• Would have needed willing surgeon(s)

• Infection risk and blood loss same as those faced for years by surgeons after discovery of anesthesia

• Short duration of nitrous sedation matched by speed of surgeons

What If They Had?

• Beddoes association with radical politics/ridiculed gas experiments might have created much criticism of the surgeries

• Was Beddoes willing to be ostracized by other physicians teaming with a surgeon?

What varied wonders tempt us as they pass!The Cowpox, Tractors, Galvanism, GasIn turns appear to make the vulgar stare, In the swoll’n bubble bursts—and all is air.

Lord Byron, English Bards and Scotch Reviewers: A Satire [1809]