Part 4 (2/2)
The great surgeon thought that the chief application of the process would be in the practice of rapidly operating surgeons; it was at first generally believed that the inhalation could be borne for only a brief period. Simpson speedily showed that no evil resulted if the patient remained under the influence of the vapour for hours. In the month of January, 1847, he gained for the Edinburgh Medical School the proud honour of being the scene of the first use of anaesthetics in obstetric practice. In March of the same year he published a record of cases of parturition in which he had used ether with success; and had a large number of copies of his paper printed and distributed far and wide at home and abroad, so eager was he to popularise amongst the members of his profession the revolutionary practice which he introduced. From the day on which he first used ether in midwifery until the end of his career he constantly used anaesthetics in his practice. He quickly perceived, however, the short-comings of ether, and having satisfied himself that they were unavoidable, he set about his next great step, namely, to discover some substance possessing the advantages without the disadvantages of ether. In the midst of his now immense daily work he gave all his spare time, often only the midnight hours, to testing upon himself the effect of numerous drugs. With the same courage that had filled Morton he sat down alone, or with Dr.
George Keith and Dr. Matthews Duncan, his a.s.sistants, to inhale substance after substance, often to the real alarm of the household at 52, Queen Street. Appeal was made to scientific chemists to provide drugs. .h.i.therto known only as curiosities of the laboratory, and for others that their special knowledge might be able to suggest. The experiments usually took place in the dining-room in the quiet of the evening or the dead of night. The enthusiasts sat at the table and inhaled the particular substance under trial from tumblers or saucers; but the summer of 1847 pa.s.sed away, and the autumn was commenced before he succeeded in finding any substance which at all fulfilled his requirements. All this time he was battling for anaesthesia, which, particularly in its application to midwifery, was meeting with what appears now as an astonis.h.i.+ng amount of opposition, on varying grounds from all sorts and conditions of persons; but the vigour and power of his advocacy and defence of the practice in the days when laughing-gas and ether were the only known agents, were as nothing to that which he exerted after his own discovery at the end of 1847.
The suggestion to try chloroform first came from a Mr. Waldie, a native of Linlithgows.h.i.+re, settled in Liverpool as a chemist. It was a ”curious liquid,” discovered and described in 1831 by two chemists, Soubeiran and Liebig, simultaneously but independently. In 1835 its chemical composition was first accurately ascertained by Dumas, the famous French chemist. Simpson was apparently not aware that early in 1847 another French chemist, Flourens, had drawn attention to the effect of chloroform upon animals, or he would probably have hastened to use it upon himself experimentally, instead of putting away the first specimen obtained as unlikely; it was heavy and not volatile looking, and less attractive to him than other substances. How it finally came to be tried is best described in the words of Simpson's colleague and neighbour, Professor Miller, who used to look in every morning at nine o'clock to see how the enthusiasts had fared in the experiments of the previous evening.
”Late one evening, it was the 4th of November, 1847, on returning home after a weary day's labour, Dr. Simpson with his two friends and a.s.sistants, Drs. Keith and Duncan, sat down to their somewhat hazardous work in Dr. Simpson's dining-room. Having inhaled several substances, but without much effect, it occurred to Dr. Simpson to try a ponderous material which he had formerly set aside on a lumber-table, and which on account of its great weight he had hitherto regarded as of no likelihood whatever; that happened to be a small bottle of chloroform. It was searched for and recovered from beneath a heap of waste paper. And 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--some ladies of the family and a naval officer, brother-in-law of Dr. Simpson. But suddenly there was a talk of sounds being heard like those of a cotton mill louder and louder; a moment more and then all was quiet--and then cras.h.!.+ On awakening Dr. Simpson's first perception was mental--'This is far stronger and better than ether,' said he to himself. His second was to note that he was prostrate on the floor, and that among the friends about him there was both confusion and alarm. Hearing a noise he turned round and saw Dr. Duncan beneath a chair--his jaw dropped, his eyes staring, his head bent half under him; quite unconscious, and snoring in a most determined and alarming manner. More noise still and much motion. And then his eyes overtook Dr. Keith's feet and legs making valorous attempts to overturn the supper table, or more probably to annihilate everything that was on it. By and by Dr.
Simpson having regained his seat, Dr. Duncan having finished his uncomfortable and unrefres.h.i.+ng slumber, and Dr. Keith having come to an arrangement with the table and its contents, the _sederunt_ was resumed. Each expressed himself delighted with this new agent, and its inhalation was repeated many times that night--one of the ladies gallantly taking her place and turn at the table--until the supply of chloroform was fairly exhausted.”
The lady was Miss Petrie, a niece of Mrs. Simpson's; she folded her arms across her breast as she inhaled the vapour, and fell asleep crying, ”I'm an angel! Oh, I'm an angel”! The party sat discussing their sensations, and the merits of the substance long after it was finished; they were unanimous in considering that at last something had been found to surpa.s.s ether.
The following morning a manufacturing chemist was pressed into service, and had to burn the midnight oil to meet Simpson's demand for the new substance. So great was Simpson's midwifery practice that he was able to make immediate trial of chloroform, and on November 10th he read a paper to the Medico-Chirurgical Society, describing the nature of his agent, and narrating cases in which he had already successfully used it. ”I have never had the pleasure,” he said, ”of watching over a series of better and more rapid recoveries; nor once witnessed any disagreeable results follow to either mother or child; whilst I have now seen an immense amount of maternal pain and agony saved by its employment. And I most conscientiously believe that the proud mission of the physician is distinctly twofold--namely to alleviate human suffering as well as preserve human life.” In a postscript to the same paper he states on November 15th that he had already administered chloroform to about fifty individuals without the slightest bad result, and gives an account of the first surgical cases in which he gave the agent to patients of his friends, Professor Miller and Dr. Duncan, in the Edinburgh Royal Infirmary. ”A great collection,” he says, ”of professional gentlemen and students witnessed the results, and amongst them Professor Dumas, of Paris, the chemist who first ascertained and established the chemical composition of chloroform. He happened to be pa.s.sing through Edinburgh, and was in no small degree rejoiced to witness the wonderful physiological effects of a substance with whose chemical history his own name was so intimately connected.” Four thousand copies of this paper were sold in a few days, and many thousands afterwards.
It is worthy of mention that, according to a promise, Professor Miller had sent for Simpson a few days after the discovery to give chloroform to a patient on whom he was about to perform a major operation; Simpson, however, was unavoidably prevented from attending, and Miller began the operation without him--at the first cut of the knife the patient fainted and died. It is easy to imagine what a blow to Simpson, and to the cause of anaesthesia this would have been had it happened while the patient was under chloroform.
Thus in little more than a year from the date of Morton's discovery of the powers of ether, Simpson had crowned the achievement by the discovery of the equally wonderful and beneficial powers of chloroform. Already he had made two satisfactory answers to the question he had early set himself--first, the application of anaesthesia to midwifery practice; and, second, the discovery of the properties of the more portable and manageable chloroform; the third, and perhaps the greatest, the defence of the practice, and the beating down of the powerful opposition to anaesthesia was yet required to render his reply complete.
CHAPTER VII
THE FIGHT FOR ANaeSTHESIA. 1847 ONWARDS
His faith in chloroform--Confused public opinion on the subject--Personal attacks--Opposition on professional grounds--His reply--Opposition on moral grounds--His reply--Opposition on religious grounds--His reply--Her Majesty the Queen anaesthetised--Indiscrete supporters--The Edinburgh teaching of anaesthesia administration--The far-reaching effects of the successful introduction of anaesthesia.
Professor Simpson firmly believed that he possessed now in chloroform an anaesthetic agent ”more portable, more manageable and powerful, more agreeable to inhale, and less exciting” than ether, and one giving him ”greater control and command over the superinduction of the anaesthetic state.” Fortified by this belief, full of facts relating to the subject, and fired with zeal and enthusiasm, he was prepared to meet the opposition which from his knowledge of human nature he must have antic.i.p.ated. So bravely and so emphatically did he champion the cause that he became identified with it in the public mind. The revelation of anaesthesia, the discovery of chloroform, and the application of anaesthetics to surgery as well as to midwifery were attributed to him by all cla.s.ses of the community, not even excepting many of his own profession. Chloroform was spoken of as if ether had never existed; and chloroform and chloroforming displaced the terms anaesthetic and anaesthetising in ordinary talk--such unwieldy terms were naturally abandoned when there was the excuse that chloroform was universally considered the best substance of its cla.s.s. Simpson made no attempt as Morton had done to patent his discovery under a fanciful name for his own pecuniary profit; but widely spread abroad every particle of knowledge concerning it that he possessed, so that every pract.i.tioner was forthwith enabled to avail himself thereof for the benefit of his patients.
Partly owing to his own enthusiasm and his strong belief in the superiority of chloroform over ether, and partly owing to the confusion prevailing in general circles as to the history of anaesthesia, no small number of attacks were directed against Simpson personally by those who either were jealous of his achievements, or who considered that the part taken by themselves or their friends in the establishment of this new era in medical science had been slighted or overlooked. Simpson took all these as part of the fight into which he had entered. His nature was not sensitive to such personal attacks; he replied to them, cast them off, and went on his way unaffected. He handled some of these opponents somewhat severely when they accused him of encouraging the public belief in him as the discoverer of anaesthesia. It is clear to us to-day after anaesthesia has been on its trial for fifty years that Simpson magnified the superiority of chloroform over ether, and was led by that feeling to look on the history of ether as but a stage in the history of the greater chloroform. He regarded chloroform as the only anaesthetic; his utterances betrayed this feeling, and offence was naturally taken by the introducers and advocates of ether. His opinion of chloroform was shared by the leading European surgeons to such an extent in his day that shortly after his death Professor Gusserow, of Berlin, stated that with a few exceptions almost all over the earth nothing else was used to produce anaesthesia but chloroform.
The real fight for anaesthesia was against those who found in the practice something which ran contrary to their beliefs or principles.
There were first those who objected on purely _medical_ grounds; secondly, those who took exception to it from a _moral_ point of view; and thirdly, those who found their _religious_ convictions seriously offended by the new practice.
The _medical_ opponents were, perhaps, the most powerful; certainly it was they who had first to be won over, for without the support of the profession the cause was in danger. It was urged first of all that the use of anaesthetics would increase the mortality, then very great, of surgical operations, and those who took their stand upon this ground were men who had at first denied the possibility of making operations painless, and had been driven to abandon that opinion only by a clear demonstration of the fact. To meet this form of opposition he inst.i.tuted a laborious and extensive statistical investigation in order to compare the results obtained in hospitals where anaesthetics were used with those where the operations were performed on patients in the waking state. He took care that the reports dealt with the same operations under, as nearly as possible, similar conditions in each case. He obtained returns from close upon fifty hospitals in London, Edinburgh, Dublin, and various provincial towns. One of the most fatal operations in those days, and one dreaded by patient and surgeon alike, was amputation of the thigh. In 1845 Professor Syme said that the stern evidence of hospital statistics showed that the average frequency of death after that operation was not less than 60 to 70 per cent., or above one in every two operated upon. Simpson fearlessly collated statistics of this operation amongst the others, and proved that when performed under anaesthetics amputation of the thigh had its mortality reduced to 25 per cent. His figures were as follows:--
TABLE OF THE MORTALITY OF AMPUTATIONS OF THE THIGH.
Reporter. Cases. Deaths. % of Deaths.
Not anaesthetised.
Parisian hospitals--Malgaigne 201 126 62 in 100 Edinburgh ” --Peac.o.c.k 43 21 49 ”
General collection--Phillips 987 435 44 ”
Glasgow hospitals --Lawrie 127 46 36 ”
British ” --Simpson 284 107 38 ”
Cases on patients in an anaesthetised state 145 37 25 ”
He pointed to the above table as a proof that far from increasing the mortality of this operation the introduction of anaesthetics had already led to a saving of from eleven to twenty lives out of every hundred cases. He acknowledged that the number of cases he had collected (145) was somewhat small from a statistical point of view; but he confidently a.s.serted that future figures would show greater triumphs. The tables of other operations showed similar results, and he entered exhaustively into the subject in a paper published in 1848.
The paper was ent.i.tled, ”Does Anaesthesia increase or decrease the mortality attendant upon surgical operations?” According to his wont, he headed it with a quotation from Shakspeare:
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