St John's Hospital (Morton House), Launceston, Australia: A history of the hospital and Dr William Russ Pugh's first operations under ether.

On 7 June 1847, William Russ Pugh, MD, performed two operations at the St John's Hospital and Self-Supporting Dispensary, Launceston, Tasmania, while his patients were rendered insensible by the inhalation of sulphuric ether. These operations are the earliest documented surgical operations under ether in Australia. St John's Hospital officially opened on 1 September 1845. The hospital may have closed in late 1853 because of financial difficulties. The two-storey Georgian-style building which served as the hospital was completed c1831-1832. It has served as a residence, school, boarding school, hospital, medical consulting rooms and commercial offices. The building is now known as Morton House. We could not identify the date when the name Morton House was adopted, or explain the origin of the name. The earliest identified use of this name is in May 1873 in a newspaper advertisement for boarders. No person with the surname Morton is known to have been associated with the building as an owner or as a tenant. The name Morton House may honour William T.G. Morton, MD, the Boston dentist who performed the first public demonstration of surgical etherisation on 16 October 1846.

Dr Pugh and the myth of the illicit still.

In her valuable history of the arrival of the news of etherisation in Australia and its implementation by many doctors and dentists, titled One Grand Chain, the late Dr Gwen Wilson asserted that the dentist and the doctor who pioneered etherisation in Australia, "Belisario and Pugh, …were charged by the authorities with possession of an illicit still." This paper examines the evidence for the truth or otherwise of this assertion, in relation to Dr Pugh.

The role of Dr Isaac Aaron and the Australian Medical Journal in the dissemination of information about etherisation in the 1840s.

Isaac Aaron (1804 to 1877), an ambitious young medical practitioner, arrived in Sydney from Britain in 1838 and was registered by the New South Wales Medical Board the following year. After contributing to the Australian Medical Journal, established in August 1846 by William Baker, he became the editor in December and acquired it in May the following year. Dr Pugh became the most prolific local contributor to the journal but he and the editor had a somewhat 'prickly' relationship. Aaron was very critical of etherisation when the first news arrived in Australia, but Pugh chose Aaron's journal in which to report his initial and subsequent experience with the technique. Aaron repeatedly appealed for experimental evidence and rational decision-making to determine the place of etherisation in medical practice. Unfortunately for Australian medicine, Aaron had to suspend the publication of the journal in October 1847, lacking both time and the support of the profession necessary to maintain it. This created an unanticipated adverse outcome for Dr Pugh.

Dr Pugh: a poisoner?

On 16 February 1845 the Reverend W. H. Browne, rector of St John's Church in Launceston, Van Diemen's Land, wrote in his journal, "My dear Wife died very suddenly almost immediately after and in consequence of taking a preparation of Hyd. Cyan. Acid prepared & supplied by Dr Pugh". This journal entry raises a number of questions. Was Dr Pugh treating a condition which he thought merited that treatment or was it a ghastly mistake? Was Caroline Browne suffering from pulmonary tuberculosis? Was hydrocyanic acid an accepted treatment at that time? Did Mrs Browne take the wrong dose? Was an incorrect concentration of the drug prepared by Dr Pugh? Did he use the wrong pharmacopoeia in preparing the hydrocyanic acid? Why was there no inquest? Only some of these questions can be answered.

William Russ Pugh's remarkable life: natural scientist, innovative anaesthetist and founding member of the Royal Society of Tasmania.

While well known in anaesthetic circles for being the first to provide ether anaesthesia for a surgical procedure in June 1847 in Launceston, Tasmania, William Russ Pugh's achievements in the field of natural history are less well known. He personally assisted Count Peter de Strzelecki in the chemical analysis of Australian coal and mineral samples and provided the laboratory space and equipment. His analytic skills were utilised by coroners in cases of poisoning. He was consulted about a ship's cargo which threatened to spontaneously combust in Launceston's port. He was a founding member of the Tasmanian Society and subsequently of the Royal Society of Tasmania. He made many presentations on geology, zoology, botany, mineralogy and meteorology to meetings of both Societies. These scientific interests may have provided the knowledge and motivation which encouraged Pugh to proceed so confidently with the introduction of ether anaesthesia.

Gilles vs Pugh and the lost letter.

In June 1842 the wife of Lewis W Gilles, a banker in Launceston, wrote to Mrs Pugh, inviting her and her husband, Mr William Russ Pugh, to an entertainment and ball. The Pughs neither responded to the invitation, nor attended the ball. Mrs Gilles mentioned the discourtesy of their non-attendance to a friend, who the following morning brought the complaint to the attention of Dr Pugh. Pugh immediately wrote a brief note explaining that neither he nor his wife had received the invitation. Further correspondence between Gilles and Pugh ensued, becoming more and more bitter until Pugh publicly insulted Gilles. The Launceston Club, of which both men were members, ultimately became a casualty of the dispute and was dissolved. A Supreme Court defamation and libel case followed with Gilles as plaintiff and Pugh as defendant. Gilles won the case but received only token damages. And the missing letter? Too late, Mrs Pugh's maid found it tucked between the pages of a periodical on the dresser

The perils of pointing the finger: a lesson for Dr. Haygarth.

Mr. William Russ Pugh, well known for his anaesthetic activities, and probably the first in Australia to administer ether anaesthesia for a surgical operation in May 1847, was involved in several court cases in Launceston, Tasmania in 1842 and 1843. At that time Tasmania was known as Van Diemen's Land. Two of the most dramatic cases ensued after a young doctor, Dr. Burton George Haygarth, a recent arrival in the colony of Van Diemen's Land, was persuaded to accuse Pugh of manslaughter. Because of Pugh's standing in Launceston the cases attracted enormous public attention and support for Pugh. The outcome for Dr. Haygarth was very unpleasant and not something which he had anticipated.

Supersensitivity to the stimulant action of noradrenaline on human myometrium near term.

Noradrenaline (10-50 nM) and tyramine (0.05-1 mM) enhanced contractile force elicited by field stimulation of strips of myometrium from non-pregnant and pregnant women. In higher concentrations, noradrenaline produced sustained contractions. The EC50 values for noradrenaline were 0.4 microM in tissues from pregnant women and 3.1 microM in tissues from non-pregnant women; maximum responses were greater in the former tissues. In addition, the effects of noradrenaline on myometrium from pregnant women were more marked on the inner layer than on the outer layer, antagonized by the alpha 1-adrenoceptor antagonist prazosin (0.1 and 1.0 microM), and unaffected by the inhibitor of neuronal uptake, nisoxetine (0.1 microM). Taken together, these observations confirm that supersensitivity to noradrenaline develops during pregnancy and is present near term. The supersensitivity to noradrenaline at term can be attributed only in part to a decrease in its removal by the sympathetic innervation, which declines towards term, because responses to tyramine were also enhanced in tissues from pregnant women. It is possible that gap junction formation may also contribute to this supersensitivity.

Intraoperative patient-controlled analgesia: an alternative to physician administration during outpatient monitored anesthesia care.

Outpatients undergoing minor diagnostic and therapeutic procedures associated with intermittent discomfort are frequently given bolus injections of intravenous opioid analgesics. In a group of 80 healthy women undergoing vaginal ovum pickup procedures, we evaluated patient-controlled administration of alfentanil using a patient-controlled analgesia device (with a lockout interval of 3 min) as an alternative to conventional physician-controlled administration. The two alfentanil administration techniques were equally effective in providing intraoperative analgesia. The average alfentanil dosage requirements were 1.49 +/- 0.50 and 1.46 +/- 0.55 micrograms.kg-1.min-1 (mean +/- SD) in the physician- and patient-controlled groups, respectively. The incidence of postoperative nausea was the same in both treatment groups (8%). Even with the mandatory lockout interval, intraoperative patient-controlled administration of alfentanil was comparable to physician-controlled administration with respect to patient comfort and satisfaction during vaginal ovum pickup procedures.

The actions of tulobuterol on isolated preparations of gravid human myometrium.

1. The effects of tulobuterol (Abbott 54173) on the contractile force developed by electrically stimulated strips of gravid (gestation 36-40 weeks) human uterine muscle were compared with those of isoprenaline and adrenalin. 2. Isoprenaline produced inhibition of electrically evoked contractions of myometrium from 12 of 17 women at concentrations at or below 1 mumol/L (range 0.001-1 mumol/L). It enhanced contractions at concentrations of 10-50 mumol/L. In tissues from the remaining five women isoprenaline produced neither inhibitory nor excitatory effects. Adrenalin (0.1-50 mumol/L) was found to enhance contractile force in a concentration-dependent manner (EC50 = 0.30 mumol/L). 3. In the presence of metoprolol (0.3 mumol/L), a selective antagonist at beta 1-adrenoceptors, the isoprenaline concentration-response relationship was shifted to the left, indicating that beta 1-adrenoceptors are present and that they mediate excitation in the human uterus. 4. In contrast tulobuterol (in neither the presence nor absence of metoprolol), in the same concentration range as isoprenaline and adrenalin, (0.001-50 mumol/L) was found to have no effect on the electrically evoked contraction of gravid human uterine muscle strips.

The place of caudal anaesthesia in obstetrics.

Present day trainee anaesthetists could be forgiven if they finished their anaesthetic training believing that caudal anaesthesia in obstetrics is not only unnecessary, but dangerous and a relic of the past. Many anaesthetic texts teach applications and techniques which are little or no advance on the teachings of Hingson and Edwards in 1942 and reflect nothing of the true value and application of this valuable block. This paper presents a critical review of these texts and of the results of the use of the block in a busy obstetric unit.

A controlled oximetric evaluation of inhalational, opioid and epidural analgesia in labour.

The effects on patient oxygenation of nitrous oxide, narcotic and epidural analgesia in labour were evaluated using pulse oximetry. Five groups of ten patients received either no analgesia (Control, Group 1), an epidural block alone (Group 2), nitrous oxide in oxygen alone (Group 3), intramuscular pethidine (Group 4), or nitrous oxide in oxygen combined with intramuscular pethidine (Group 5). Derived parameters included the maximum (MAX), minimum (MIN), average maximum (AV MAX), and average minimum (AV MIN) arterial haemoglobin oxygen saturation (SaO2), and differences between maxima and minima (MAX-MIN). There was a statistically significant difference between Group 1 and Group 5 for MIN, AV MIN and MAX-MIN SaO2 (P less than 0.05). All other groups showed no significant difference in any parameter when compared with the control group. The results are discussed with reference to normal and disordered maternal physiological changes in pregnancy. It is suggested that nitrous oxide should not be used for analgesia in labour where there is concern about maternal, placental or foetal reserve.

Mechanism of triamterene transfer across the human placenta.

The diuretic, triamterene, had been regarded to be a drug which was actively transported by the placenta from fetus to mother. In the present study, the transfer of triamterene across the isolated perfused human placenta was examined. Placentas obtained at cesarean section were perfused for up to 2 hr from both maternal and fetal sides in either single-pass or recycling constant flow systems. In single-pass experiments, the placental clearance of triamterene (400 ng/ml) from mother to fetus or from fetus to mother was examined (n = 8). Antipyrine (20 micrograms/ml) and l-leucine (0.25 mM) were used as reference compounds. The transplacental clearance index (i.e., clearance relative to antipyrine clearance) of triamterene from mother to fetus (0.85 +/- 0.10) was similar to the clearance index from fetus to mother (0.74 +/- 0.08, P greater than .10), indicating rapid transfer across the placenta, but no active fetal to maternal transport. In contrast, the l-leucine clearance index from mother to fetus (0.62 +/- 0.05) was substantially greater than that from fetus to mother (0.27 +/- 0.03, P less than .01), consistent with active maternal to fetal transport. In recycling experiments (n = 5), with test compounds added in equal concentration to both maternal and fetal circuits, the equilibrium fetal/maternal perfusate concentration ratios were 1.41 +/- 0.02 for l-leucine and 0.98 +/- 0.01 for antipyrine. The slightly lower value for triamterene (0.92 +/- 0.02) probably reflected minor differences in protein binding between maternal and fetal circuits.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of adrenaline, isoprenaline and forskolin on pregnant human myometrial preparations.

1. The effects of adrenaline, isoprenaline and forskolin upon the evoked contractions of field-stimulated preparations of human, pregnant, isolated myometrium have been examined. Specimens were obtained at lower segment Caesarean section from patients at 31 (n = 1) and 36-40 (n = 10) weeks of gestation. 2. Adrenaline enhanced the electrically evoked contractions of all preparations studied, indicating that its predominant action on these pregnant myometrial tissues was at alpha- and not beta-adrenoceptors. 3. Isoprenaline in concentrations at and below 10 mumol/l produced inhibitory effects in eight of 11 experiments. In the remaining three experiments, tissues were not responsive to the inhibitory effects of isoprenaline. 4. In all preparations exposed to higher concentrations of isoprenaline (30 or 100 mumol/l), its effects were excitatory. 5. Forskolin produced inhibitory effects on preparations from all uteri, including those from which tissues unresponsive to isoprenaline had been obtained. 6. It is suggested that forskolin in the concentrations which were effective in this study produced its inhibitory effects largely through activation of adenylate cyclase. This implies that the lack of an inhibitory response of some preparations to isoprenaline was not due to reduced activity of the adenylate cyclase system, but that the failure of isoprenaline to produce an inhibitory effect could be due to diminished numbers of beta-adrenoceptors and/or increased numbers of alpha-adrenoceptors, or to a defect in the coupling of the receptors to the adenylate cyclase system. Alternatively, the presence of an endogenous antagonist of the effects of isoprenaline (for example, an eicosanoid), could mask its inhibitory effects. 7. The absence of an inhibitory effect of isoprenaline on some specimens of human gravid myometrium could have clinical implications, in view of the widespread use of beta 2-adrenoceptor agonists as uterine relaxants.