Risk Assessment Fail

11 04 james young simpsonToday I want to tell you a bit about Dr James Young Simpson who on this day in 1847, along with a couple of friends, discovered the anaesthetic properties of chloroform. He was searching for an alternative to ether, which had some unpleasant side-effects. Although ultimately chloroform proved to be more dangerous than ether, for a while it was quite revolutionary and he was the first doctor to be knighted for services to medicine. The way he went about seeking a new chemical anaesthetic seems utterly reckless and involved a great deal of personal risk. The history of science is peppered with people who have experimented on themselves in ways that seem insane now.

Dr. Simpson’s practice was in Edinburgh and he had a particular interest in obstetrics. He was also quite fond of archaeology and studying hermaphroditism, but let’s not get sidetracked. Surgery was a terrible thing in the early nineteenth century. Simpson had been greatly upset when he witnessed a woman having a breast removed without the aid of anaesthesia and he dedicated himself to trying to find a solution. Early experiments with mesmerism produced some success but he eventually abandoned the idea. Then he heard about ether.

The anaesthetic properties of ether had first been demonstrated in October 1846 and Simpson was the first to use it to aid childbirth in January 1847. However he found it wanting in some respects. It caused nausea, headaches and was also quite flammable. Not great if you rely on gas lighting. He began to devote his evenings to trying to find something better. He did this by testing every chemical he could get hold of on himself. Either alone or with his assistants, Dr Keith and Dr Duncan, Simpson inhaled substance after substance, much to the alarm of his household, noting their effects. He asked chemists to let him try anything odd that they might have lying around. He had a lucky escape when he visited his friend Lyon Playfair. Playfair had something new and Simpson begged to try it immediately, but Playfair insisted they tested it on two rabbits first. It seemed to work fine, but when Simpson returned the following day to try it for himself, they discovered that both the rabbits had died.

On the evening of November 4th, Drs Simpson, Keith and Duncan had already tried several substances with no result. Then they unearthed from under a heap of waste paper, a small bottle that they had previously dismissed as unlikely. It was chloroform. What happened next is beautifully described by Simpson’s friend and neighbour Professor Miller, so we’ll let him do it:

 Credit: Wellcome Library, London. Wellcome Images

photo credit: Wellcome Library

“…with each tumbler newly charged, the inhalers resumed their vocation. Immediately an unwonted hilarity seized the party – they became brighteyed, very happy, and very loquacious – expatiating on the delicious aroma of the new fluid. The conversation was of unusual intelligence, and quite charmed the listeners… But suddenly, there was talk of sounds being heard like those of a cotton mill louder and louder; a moment more and then all was quiet – and then crash!”

All three of them collapsed. When Simpson came to, his first thought was that this was something far better than ether. His second thought was: I seem to be lying on the floor. He looked about for his friends. Dr Duncan was underneath a chair, eyes wide open but snoring loudly. Dr Keith seemed to be trying to kick over the supper table. They were so excited about their discovery that they tried it all over again, and many times until the chloroform was quite used up. Simpson’s niece, who was dining with them that night, was persuaded to try it too. She fell asleep crying “I’m an angel! Oh I’m an angel!”

Almost immediately he began to try it on his patients. He was very happy with the results and proud to think of the amount of pain that he had alleviated. By November 15th , he had used chloroform on about fifty of his patients. Not everyone thought it was a good idea though. He faced a good deal of opposition because many thought that it was wrong and against nature to provide pain relief in childbirth. They thought that the pain was a punishment for original sin. They quoted the bible at him: “…in sorrow thou shalt bring forth children.” He reminded them of another biblical quote about how God created Eve: “…and the Lord God caused a deep sleep to fall upon Adam, and he slept: and he took one of his ribs, and closed up the flesh instead thereof.” He also said that if people were so against what was unnatural, they probably shouldn’t wear shoes or ride about on horses. When an Irish lady voiced her feelings: “How unnatural for you doctors in Edinburgh to take away the pain of your patients.” He replied “How unnatural it is for you to have swam over from Ireland to Scotland against wind and tide in a steamboat.”

As you see, Simpson stood his ground and eventually won people over. Especially after Queen Victoria used it during childbirth. If he hadn’t been blessed with a pioneering spirit and a certain amount of reckless abandon, he would not have achieved as much as he did. There was one occasion when the bottle of precious chloroform was spilled part way through an operation. As it was often necessary to give more than one dose during the procedure, no one was quite sure how they could continue. Simpson got down on his hands and knees, cut a square out of the carpet where the anaesthetic was spilled and clapped it over the patients face to keep him unconscious. Now that’s thinking on your feet.

Having said all this, if anyone offers you chloroform, just say no. It’s really dangerous. But if you’re offered pain relief during childbirth, take it. It really hurts.

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