By Dr. T. Jock Murray
and Janet Murray
For The Advocate
Two of the major advances in medicine and surgery were anesthesia and antisepsis. Both had interesting Pictou connections.
J.D.B. Fraser and the early use of chloroform
James Daniel Bain Fraser was an energetic, creative and entrepreneurial man with many interests and activities. Early life was difficult as the family moved a lot, from Pictou to Halifax, back to Pictou, then to Saint John and back to Pictou. His father was often in debtor prison, the family home burned down and the children were farmed out to family friends. Archivist Allan Dunlop thought he may have been educated at Pictou Academy and apprenticed to a physician or pharmacist later. In 1828, when he was just 21, he took over a drug store on Water Street providing “drugs, medicines, patent medicines, perfumery, spices, dye stuffs, etc.” Two of his brothers also became druggists. He later expanded his pharmacy business to serve eastern Nova Scotia and Prince Edward Island. He was involved in other ventures, as agent for the Eastern Stage Coach Company, a diving operation to salvage a sunken naval ship, owner of a coal mining company, a quarry, and owner of three other shops in Pictou. He was a prominent citizen of Pictou, as justice of the peace, commissioner of streets, member of the Board of Health, fire warden, and briefly a Liberal political candidate, joining Joseph Howe in opposing Confederation. He was also prominent in the Temperance Society, a founding member of the Agricultural Society, and a board member of many companies.
He regularly presented experiments and presentations to the Pictou Literary and Scientific Society on the latest advances in science, often within months of the discoveries. He demonstrated the early anesthetic nitrous oxide or “laughing gas”, construction of a electro-magnet, a fireworks display, tests of hydrogen and oxygen, a demonstration of guncotton, and an early electric light.
On November 1, 1847, James Young Simpson, a surgeon in Edinburgh, noted the anesthetic qualities of chloroform when he and some friends experimented with the chemical. On November 9, 1847, he published the first use of chloroform as an anesthetic in a woman in childbirth. Across the sea in Pictou, J.D.B. Fraser, in his pharmacy on Water Street, read the publication of J.Y. Simpson and prepared some chloroform and exactly three months after Young’s publication, delivered chloroform to surgeon William Almon of Halifax, the medical officer for the Poor Asylum. Almon with surgeon Daniel McNeill Parker amputated a thumb from a patient, and a month later used Fraser’s chloroform to do an above-knee amputation on a woman who felt no pain through the operation.
In March, Fraser gave chloroform to his wife, Christianna, while she was in labour with their seventh child, the first use of this anesthetic in childbirth in British North America. A month later he demonstrated chloroform to the Pictou Literary and Scientific Society.
Fraser’s use of an anesthetic in childbirth caused consternation within the First Presbyterian Church on Prince Street. After all, did not the Bible say, “in pain you will bring forth children”. It has been suggested that the Court of Session of the Prince Street Church censured him, and soon after Fraser left the congregation. Neither his son’s birth nor Fraser’s obituary can be found in the records of that church. Debates over anesthesia in childbirth continued until 1853, when Queen Victoria received chloroform from Dr. John Snow while in labour with her eighth child.
Fraser was ill in his last years from a chronic liver disease, and died at age 62 in 1869, a pioneer in the advance of surgery. He is buried in Laurel Hill Cemetery.
Dr. John Stewart and the advent of antiseptic surgery
By the mid-19th century surgery could be done without pain using chloroform or ether, but the likelihood of dying from infection following surgery remained high. A compound fracture would have a mortality of 50 per cent or more, and the risk of infection on surgically entering the abdomen, chest or skull were so high these were regarded as completely out of bounds. Hospitals were unclean, malodorous cesspools of infection which spread from one patient to another.
At this time Louis Pasteur in Paris carried out experiments that demonstrated putrefaction and infection occurred from something in the air. He postulated the germ theory, that germs in the air were the culprit, not oxygen or some other gas entering. Joseph Lister, a Quaker and London-trained surgeon, became a surgeon in Edinburgh and then Glasgow. He was concerned about the high rate of infections in compound fractures, where the skin is broken, compared to a fracture with the skin intact. A colleague suggested he read the papers of Pasteur. If the germ theory explained the infection, what would prevent or treat the infection? A number of chemicals could work, but he experimented with solutions and salves of carbolic acid. Eventually he developed a machine that would spray the operative site with a mist of carbolic acid. He also sterilized the surgical instruments with a solution of carbolic. He then achieved remarkable results with his surgical cases. Not all were impressed, especially the surgeons in London, as they had trouble accepting the germ theory — that something in the air that they couldn’t see was causing serious and sometimes fatal infections. While he was the Professor of Surgery in Edinburgh, one of his favoured surgical assistants was a young surgeon from Nova Scotia, Dr. John Stewart. When Lister later moved to London, Stewart accompanied him as one of his “bearded Scots” assistants. Lister, a Quaker, had no children and seemed to regard Stewart as the son he never had. Their relationship lasted as long as Lister lived, and Stewart wrote the Lister obituary for the medical journals.
Stewart wrote a lot about the time of Lister’s discovery and noted students and physicians wanted him to talk about the miraculous carbolic, but Lister always maintained it was not about carbolic, which he was not wedded to as an antiseptic, but about the importance of the germ theory. There is an emotional scene at an international meeting when Lister and Pasteur crossed the stage to greet each other.
Encouraged by Lister, Stewart was expected to rise as a prominent surgical consultant in London. Instead, he moved to Pictou where his family was residing. He established the first general hospital on High Street and was much sought after as a surgeon and teacher. He lectured to the physicians of the province about the proper use of chloroform and the approach to antiseptic surgery. Stewart later became the leader of the Dalhousie #7 Stationary Hospital during World War One and then Dean of Dalhousie Medical School. The Lister carbolic spray machine he brought back from London is at Dalhousie.
The two greatest advances in health care in the 19th century were anesthesia and antisepsis, and two Pictonians were part of that remarkable transformation in surgery.