Francis Sibson (1814–1876): The Unsung Hero of Modern Surgeryand Anesthesia

Stephen Osiro • Erin Downs • Joanna Grater •

Marios Loukas

Published online: 30 March 2012

� Societe Internationale de Chirurgie 2012

Abstract Francis Sibson (1814–1876) was a British

physician and anatomist widely regarded as a true pioneer

of the medical profession. He overcame a tragic and dif-

ficult childhood to become an avid educator at several

medical schools and dedicated his life to research. For

modern scientists, he is most remembered for describing

Sibson’s fascia, his experimental use of curare in the

treatment of hydrophobia and tetanus, and his detailed

description of the positions and movements of internal

organs. He died on September 7, 1876 at the age of 62 from

complications of an aortic aneurysm.

Early life

Francis Sibson (Fig. 1) was born on May 21, 1814 to

Francis and Jane Sibson in Cross Canonby Township in

Cumberland, England [1]. He was the third child in a

family of five sons. After encountering economic hardships

in 1819, Sibson’s father moved the entire family to

Edinburgh, where Sibson spent the remainder of his

childhood [1]. At the age of five, along with his four

brothers, Sibson was baptized at the St. Peter’s Episcopal

Church in Edinburgh [2]. Sibson’s promising childhood

took a sudden turn for the worse when his family was torn

apart by the tragic death of his mother and three brothers

[3]. He was therefore forced to work at a young age to

support his father and the remaining younger brother,

Thomas Sibson. The latter grew up to become a well-

known artist and illustrator for Charles Dickens [3]. Some

authors have pointed out that the overwhelming responsi-

bility Sibson had at such a young age may have contributed

to his drive and later successes in life.

Education

Sibson’s interest in medicine started at an early age. He

was educated at a school in Edinburgh, and at the age of 14

became a student of a well-known surgeon–anatomist,

Professor John Lizars, with whom he became friends for

life [1]. Lizars was especially distinguished because he was

the Chair of Surgery in Edinburgh and was the first British

surgeon to perform an ovariectomy [1]. Three years later,

at the age of 17, Sibson received his diploma from the

Royal College of Surgeons of Edinburgh on December 21,

1831 [2]. Around the same time, Great Britain was in the

middle of a cholera outbreak, and Sibson was eager to give

his assistance. Immediately after receiving his license, he

volunteered his time to this cause in Leith, Newhaven, and

Edinburgh hospitals during 1831–1832 [1].

In 1833, Sibson returned to his hometown of Cumber-

land, where he briefly worked with another doctor in

general practice in Cockermouth. He then moved to

London, where he studied at Guy’s Hospital in the

Department of Pathology [1]. While there, he worked

alongside and was mentored by a physician named Thomas

Hodgkin [4, 5]. Hodgkin was a leader in the field of

pathology and is well-known for his description of

Hodgkin’s lymphoma, a cancer of the lymphatic system

[5]. In 1835, Sibson took on a life-changing role at the

Nottingham General Hospital where he was offered the

S. Osiro � E. Downs � J. Grater � M. Loukas (&)

Department of Anatomical Sciences, School of Medicine,

St. George’s University, Grenada, West Indies

e-mail: mloukas@sgu.edu

M. Loukas

Department of Anatomy, Medical School,

University of Varmia and Mazuria, Olsztyn, Poland

123

World J Surg (2012) 36:1993–1997

DOI 10.1007/s00268-012-1573-5

position of resident surgeon and apothecarist [1]. There, he

expanded his knowledge clinically while also participating

in many research studies on pathologic, anatomic, and

medical issues [1]. His experience in Nottingham launched

his interest in medical research and writing, and it provided

a solid basis for his other, future work [2].

Postgraduate research and publications

Sibson reportedly was passionate about his papers and con-

veying the message to his readers [1]. His first publication

appeared in the medical gazette in 1840 and was entitled,

‘‘a flexible stethoscope’’ (Fig. 2). He gained his status in the

medical community through a paper he later wrote in 1844:

‘‘on changes induced in the situation and structure of internal

organs under varying circumstances of health and disease’’

[2]. That same year, he also wrote an incredibly detailed

description of the anatomy, physiology, and pathology of the

heart and lungs, including Sibson’s fascia, named in his

honor (Figs. 3, 4, and 5). In addition, he generated several

papers on anesthesia between 1847 and 1848 [6].

One of Sibson’s more notable experiments was per-

formed with a physician named Charles Waterton [7]. They

studied narcotics, curare—or wourali poison, as it was

known then—in the treatment of hydrophobia and tetanus

[2]. The curare apparently was to be used in 1839 in

Nottingham when a rabid dog bit a police inspector, but he

died before the treatment could be started [6].

Sibson did not limit his research to one focus. He was

involved in a wide variety of projects throughout his life.

For example, he conducted trials with inhalation of ether

for treating facial neuralgias [6]. He treated his first patient

on January 30, 1847, just a short time after the famous

operation by Robert Liston at University College Hospital,

who had used ether as an anesthetic during amputation. In

addition, Sibson is reported to have designed his own

chloroform inhaler for artificial respiration during this

treatment [6].

In 1849, Sibson wrote a detailed paper describing the

position and movements of the heart in both healthy and

disease states [6] (Fig. 5). His mission in the study was to

determine the position of each part of the heart during

systole and diastole and to understand and describe the

friction sounds heard with auscultation. He accomplished

this by directly observing the thoracotomy of an uncon-

scious donkey anesthetized using curare. With the respi-

ration maintained, he removed the ribs and inserted pins

into the donkey’s heart in various directions to observe

their movements [6]. Sibson’s other notable publications

and work included the mechanisms of respiration, the

treatment of gout and rheumatism, the use of ether and

chloroform in the treatment of neuralgia, and the 1847

typhoid epidemic in Nottingham [2].

Clinical practice

In 1848, after spending 13 years in Nottingham, Sibson

decided to relocate to London to establish his own medical

practice [1]. This was a challenging undertaking in London

at the time, and as a result he received mixed reactions from

his family and friends in Nottingham [1]. Before the end of

1848, despite a 17-year gap from his previous qualifying

examination, Sibson passed the examinations for both MB

and MD degrees with honors within 1 week [1, 8].

Fig. 2 Flexible stethoscope introduced by Francis Sibson. With

permission from Sibson F (1840–1841), the London medical gazette,

London

Fig. 1 Francis Sibson (courtesy of wellcome library, London)

1994 World J Surg (2012) 36:1993–1997

123

London proved to be no challenge to Sibson’s booming

personality and revolutionary ideas. He quickly made

friends; and by the winter of 1849 he was hosting private

demonstrations on visceral anatomy to a select group of

colleagues at his home [1]. He turned a house on Brook

street in Grosvenor Square into his own private practice

office [1]. That same year, he was also elected as a fellow

in both the Royal College of Physicians and the Royal

Society. He later served in the latter as the Joint Treasurer

and a member of its Council from 1872 to 1874 [1]. His

election into the Royal Society was recognition of his

meticulous work studying the anatomy of healthy and

diseased viscera [2].

Sibson was instrumental in the founding of St. Mary’s

Hospital in Paddington in 1851, becoming one of the first

physicians to work there [2]. At the hospital, he majored in

renal, pulmonary, and cardiac diseases, including aortic

aneurysms [2]. When St. Mary’s later became a teaching

hospital, Sibson enthusiastically took on the role of Chair

of Medicine [1]. Upon its upgrade to a medical school in

1854, he served as its lecturer of medicine [2]. He soon

realized his passion for teaching and became an educator

at Samuel Armstrong Lane’s School of Anatomy in

Grosvenor Place.

Works and honors

One of Sibson’s most significant works, ‘‘medical anatomy,

or, illustrations of the relative position and movements of

the internal organs’’ (Figs. 3, 4, and 5) was based on his

work at St. Mary’s Hospital [2]. He began this paper in

1855, and it was published in seven parts, the last being in

1869. Ord described this publication as ‘‘the crown of

Sibson’s labours’’ [1].

Sibson also made many contributions to the field of

anesthesia, especially concerning the use of nitrous oxide

for inhalation induction. As a member of the Royal

Fig. 3 Sibson’s illustrations of the body of a man lying down, with

the trunk dissected. The lungs are shown after expiration (top) and

after inspiration (bottom). With permission from Sibson F (1869)

medical anatomy: or, illustrations of the relative position and

movements of the internal organs. John Churchill & Sons, London

World J Surg (2012) 36:1993–1997 1995

123

Medical and Chirurgical Society of London, he served on

the Chloroform Committee, where he studied the use,

therapeutic and toxic effects, and administration of

chloroform. This committee published its report in 1864,

which is considered a classic in anesthetic literature [6].

His descriptions of the thickened supraclavicular pleura,

Fig. 4 Sibson’s illustration of

the relative positions and

movements of internal organs

during respiration. With

permission from Sibson F

(1869) iconographic, the body

of a man lying down. John

Churchill and Hullmandel &

Walton, London

Fig. 5 Sibson’s chromolithograph showing the relative movements of the heart with inspiration and expiration. Courtesy of the National library

of medicine, dream anatomy, online edition. http://www.nlm.nih.gov/dreamanatomy/index.html

1996 World J Surg (2012) 36:1993–1997

123

now known as Sibson’s fascia, proved useful in the field of

anesthesia because it was important in the anesthetic

blockade of the supraclavicular brachial plexus. Sibson

described this fascia in his first major paper written in 1844

[6].

Sibson had many distinguished roles in the Royal

College of Physicians [9]. He was given the honor of

presenting the Gulstonian, Croonian, and Lumleian lec-

tures, which were endowed lectures of the Royal College of

Physicians [1, 9]. The giving of these lectures was a tra-

dition started in the College in 1582 by Dr. Richard

Caldwell and Lord Lumley [1]. Sibson also served as an

examiner at the College, Curator of the Museum, and a

Censor in 1874. In addition, he was an examiner and was

elected to the Convocation and Senate at the University of

London. Among his many contributions to the University,

he retains criticism for his strong opposition to the

admission of women into medical degree colleges [9].

Personal life

Although he was evidently a busy man, Sibson married

Sarah Mary Ouvry, daughter of Peter Aime Ouvry of East

Acton, in July 1858 at Mentmore Church [10]. They were

said to have hosted regular breakfast parties in their home

for his medical firms, where conversations ranged from

anatomy to prayer [2].

The admiration of Sibson by his peers and others in his

field goes beyond his work and successes and far into his

character. He was always well received and had the distinct

ability to gain peoples’ trust and respect [1, 9]. Along with

his passion for medicine, he enjoyed the outdoors, espe-

cially mountaineering, and was one of the first people to

climb the Lyskamm in the Swiss Alps [1]. He also took an

interest in collecting Wedgewood china and architectural

drawings [2].

Death

Sibson died suddenly on September 7, 1876 at the age of 62

at the Hotel des Bergues in Geneva, Switzerland while on

vacation [11]. Ironically, he was described to have died

from an aortic aneurysm, which was one of his main

interests at St. Mary’s Hospital. His body was brought back

to London and buried in St. Mary’s Churchyard in Acton,

Middlesex [2]. His collected works (1881) was published

posthumously by Ord [3, 11].

References

1. Hughes JE (1977) Francis Sibson. Med J Aust 1:545–546

2. Brown K (2008) Sibson Francis (1814–1876). In: Matthew HCG,

Harrison B (eds) Oxford dictionary of national biography. Oxford

University Press, Oxford. http://www.oxforddnb.com/view/article/

25505

3. Ord WM (1881) Sibson F (1814–1876). In: Collected works of

Francis Sibson. MacMillan, London

4. Abbondanzo S (2003) Thomas Hodgkin. Department of Hema-

topathology, Armed Forces Institute of Pathology, Washington

D.C

5. Stone MJ (2005) Thomas Hodgkin: medical immortal and

uncompromising idealist. Proc Baylor Univ Med Center 18:

368–375

6. Maltby JR (1977) Francis Sibson (1814–1876): pioneer and

prophet in anaesthesia. Anaesthesia 32:53–62

7. Irwin RA (1955) Letters of Charles Waterton. Rockliff, Salisbury

Square, p 24

8. Williams K (2003) Sibson Francis (1814–1876). In: Royal col-

lege of physicians archives. http://www.aim25.ac.uk/cats/8/71

57.htm

9. Toghill P (2002) In: Davenport G, McDonald I, Moss-Gibbons C

(eds) The royal college of physicians and its collections: an

illustrated history. James & James, London, p 40

10. Rivington JG, Rivington F (1859) The annual register, or a view

of the history and politics of the year 1858. Woodfall and Kinder,

London, p 367

11. Anonymous (1897) Dictionary of national biography, vol LII.

Sidney Lee, London, pp 186–187

World J Surg (2012) 36:1993–1997 1997

123