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Sir James Young Simpson
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 anticipated. 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 classes 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 class. 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 practitioner 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 112 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 instituted 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 fetal 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

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 asserted 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 entitled, w Does Anaesthesia increase or decrease the mortality attendant upon surgical operations ? " According to his wont, he headed it with a quotation from Shakspeare :

"Why doest thou whet thy knife so earnestly? . . . Shylock must be merciful. On what compulsion must I? Tell me that! "

Victorious in this encounter, he turned to those who urged that anaesthetics were responsible for various kinds of ills such as a tendency to haemorrhage, convulsions, paralysis, pneumonia, and various kinds of inflammatory mischief as well as mental derangement. He combated these contentions until the end of his career; and not only proved that the objections were visionary, but showed that for one of the alleged evils formerly often seen after operations, viz., convulsions, chloroform, far from being a cause, was one of our most powerful remedies.

But the professional opponents of anaesthesia were most emphatic in the denunciation of its use in midwifery. Pain in the process of parturition was, they said, "a desirable, salutary, and conservative manifestation of life-force": neither its violence nor its continuance was productive of injury to the constitution. Strong opposition on these grounds came from the Dublin School,and with characteristic boldness Simpson turned to the statistics of their own lying-in hospital to prove his contention that to abolish parturient pain was to diminish the peril of the process. Again the statistics stood him in good stead; he flourished them triumphantly before his opponents, and proceeded to deal with those who asserted that the use of anaesthetics was accompanied by danger to life. He pointed out that, although unquestionably there were some dangers connected therewith, they were insignificant compared with the dangers in both surgery and midwifery which their use averted. Pain itself was a danger; shock in surgery was responsible for many untimely deaths upon the operating table; by preventing these chloroform saved countless lives. His arguments were characterised by painstaking thoroughness and evidenced wide reading. In addressing Professor Meigs, of Philadelphia, he said :—

"First, I do believe that if improperly and incautiously given, and in some rare idiosyncrasies, ether and chloroform may prove injurious or even fatal— just as opium, calomel, and every other powerful remedy and strong drug will occasionally do. Drinking cold water itself will sometimes produce death. 'It is well known,' says Dr. Taylor, in his excellent work on Medical Jurisprudence, 'that there are many cases on record in which cold water, swallowed in large quantity and in an excited state of the system, has led to the destruction of life/ Should we therefore never allay our thirst with cold water? What would the disciples of Father Mathew say to this? But, secondly, you and others have very unnecessary and aggravated fears about the dangers of ether and chloroform, and in the course of experience you will find these fears to be, in a great measure, perfectly ideal and imaginary. But the same fears have, in the first instance, been conjured up against almost all other innovations in medicine and in the common luxuries of life. Cavendish, the secretary to Cardinal Wolsey, tells us in his life of that prelate, that when the cardinal was banished from London to York by his master—that regal Robespierre, Henry the Eighth—many of the cardinal's servants refused to go such an enormous journey—'for they were loath to abandon their native country, their parents, wives, and children.' The journey which can new be accomplished in six hours was considered then a perfect banishment. ... In his Life of Lord Loughborough, John Lord Campbell tells us that when he (the biographer) first travelled from Edinburgh to London in the mail-coach the time had been reduced (from the former twelve or fourteen days) to three nights and two days; 'but,' he adds, 'this new and swift travelling from the Scots to the English capital was wonderful, and I was gravely advised to stop a day at York as several passengers who had gone through without stopping had died of apoplexy from the rapidity of the motion' ('Lives of the Lord Chancellors'). Be assured that many of the cases of apoplexy, &c., &c., alleged to arise from ether and chloroform, have as veritable an etiology as this apoplexy from rapid locomotion, and that a few years hence they will stand in the same light in which we now look back upon the apoplexy from travelling ten miles an hour. And as to the supposed great moral and physical evils and injuries arising from the use of ether and chloroform, they will by and by, I believe, sound much in the same way as the supposed great moral and physical evils and injuries arising from using hackney coaches, which were seriously described by Taylor, the water-poet, two or three centuries ago when these coaches were introduced. Taylor warned his fellow-creatures to avoid them, otherwise 'they would find their bodies tossed, tumbled, rumbled, and jumbled' without mercy. i The coach,' says he, cis a. close hypocrite, for it hath a cover for knavery ; they (the passengers) are carried back to back in it like people surprised by pirates, and moreover it maketh men imitate sea-crabs in being drawn sideways, and altogether it is a dangerous carriage for the commonwealth.' Then he proceeds to call them c hell-carts,' &c., and vents upon them a great deal of other abuse very much of the same kind and character as that lavished against anaesthetics in our own day."

Following out the same line of reasoning he brought to the minds of medical opponents how the introducers of such useful drugs as mercury, antimony, and cinchona bark had met with now long-forgotten but stubborn opposition ; and he reminded surgeons of the stern obstinacy with which the introduction of the ligature of arteries had been long objected to and the barbarous method of arresting bleeding with red-hot irons had been preferred. But in the history of the discovery and introduction of vaccination by Jenner he found a strong parallel; and he wrote a pregnant article to prove that mere opinion and prejudgments were not sufficient to settle the question of the propriety or impropriety of anaesthetic agents, illustrating it from the story of vaccination. The result of vaccination had been to save during the half century since its introduction a number of lives in England alone equal to the whole existing population of Wales; and in Europe during the same period it had preserved a number of lives greater than the whole existing population of Great Britain. And yet Jenner, when he first announced his discovery, had encountered the most determined opposition on the part of many of his professional brethren, who ridiculed and bitterly denounced both him and his discovery; whilst ignorant laymen announced that small-pox was ordained by heaven and vaccination was a daring and profane violation of holy religion. He pointed out that these objections had been slowly and surely crushed out of existence by accumulated facts, and predicted that the ultimate decision concerning anaesthesia would come to be based, not upon impressions, opinions, and prejudices, but upon the evidence of " a sufficient body of accurate and well-ascertained facts." To these facts, as has been indicated, he subsequently successfully appealed.

Those who objected to anaesthesia on moral grounds directed their attacks chiefly against its use in midwifery. They not only condemned that application as iniquitous, but went the length of asserting that the birth of past myriads without it proved how unnecessary it was, and that Nature conducted the whole process of birth unaided in a greatly superior manner. The pains associated with parturition were actually beneficial, they said. Simpson answered this by showing that the proper use of anaesthetics shortened parturition, and by diminishing the amount of pain led to more rapid and more perfect recoveries. The leading exponent of the Dublin School of Midwifery at that time foolishly wrote that he did not think any one in Dublin had as yet used anaesthetics in midwifery; that the feeling was very strong against its use in ordinary cases, merely to avert the ordinary amount of pain, which the Almighty had seen fit— and most wisely, no doubt—to allot to natural labour ; and in this feeling he (the writer) most heartily concurred. Simpson's private comment on this remarkable epistle at once showed his opinion of it, and ridiculed the objection out of existence. He skilfully parodied the letter thus:—"I do not believe that any one in Dublin has as yet used a carriage in locomotion; the feeling is very strong against its use in ordinary progression, merely to avert the ordinary amount of fatigue which the Almighty has seen fit—and most wisely, no doubt—to allot to natural walking; and in this feeling I heartily and entirely concur."

He twitted the surgeons who opposed him with their sudden discovery, now that anaesthetics were introduced, that there was something really beneficial in the pain and agony caused by their dreaded knife. Such a contention contraverted his cherished principle that the function of the medical man was not only to prolong life, but also to alleviate human sufferings.

He quoted authorities of all times to show that pain had been always abhorred by physicians and surgeons, commencing with a reference to Galen's aphorism— 'Dolor dolentibus inutile est" (tt pain is useless to the pained "); citing Ambroise Pare, who said that pain ought to be assuaged because nothing so much dejected the powers of the patient; and, finally, reproducing the words of modern authors, who asserted that, far from being conducive to well-being, pain exhausted the principle of life, and in itself was frequently both dangerous and destructive. He brought forward a collection of cases where in former days patients had died on the operating-table, even before the surgeon had begun his work, so great was the influence of the mere fear of pain; and reminded those who attributed occasional deaths on the operating-table to the influence of the anaesthetic of the numerous cases in bygone days where death occurred whilst the surgeon was at work. He recalled also how the great surgeon of St. Thomas's Hospital, Cheselden, had-abhorred the pain which he caused in the process of his work, and longed for some means for its prevention. " No one," said Cheselden, w ever endured more anxiety and sickness before an operation " than himself.

Simpson did not forget to look at the subject from the patient's point of view, and reproduced the letter from an old patient, which has been already quoted (Chapter VI.).

The soldier and sailor, brave unto heroism in facing the enemy, never fearing the death which stared them in the face in its most horrible form whilst answering the call of duty, would quail like children at the mere thought of submitting to the deliberate knife of the surgeon. Were quibbles about the efficacy of pain to stand in the way of the merciful prevention of such suffering by the process of anaesthetisation?

Those who opposed him with this curious idea, that pain after all was beneficial, were some of them men of no mean standing in the profession. Gull, Bransby Cooper, and Nunn were amongst those whom he had to silence. After replying to their arguments seriatim with all -his polemic power, he referred them once more to the evidence of facts and of facts alone as set forth by his statistics. Had he lived but a twelvemonth longer than he did he would have been able to conjure up a picture of the incalculable amount of suffering prevented by the eighteen hundred pounds of chloroform which were forwarded to the rival armies from one firm of chemists alone during the Franco-Prussian war ; happily for the wounded within and around Paris, there was then no longer any doubt as to the propriety of employing anaesthetics.

The religious objections to the use of anaesthetics could scarcely be met with statistics. Foolish as they now appear to us after the lapse of time, and with the practice they attempted to repel universally adopted, they were nevertheless urged in good faith by clergy and laity of various denominations. The same kind of bigotry had met the introduction of vaccination, and Simpson himself remembered how many people had opposed the emancipation of the negroes on the ground that they were the lineal descendants of Ham, of whom it was said "a servant of servants shall he be unto his brethren." Sir Walter Scott reminds us, in "Old Mortality," of the spirit which met the introduction of fanners to separate the chaff from the corn, which displaced the ancient method of tossing the corn in the air upon broad shovels. Headrigg reproved Lady Bellenden for allowing the new process to be used on her farm, " thus impiously thwarting the will of Divine Providence by raising a wind for your leddyship's ain particular use by human art, instead of soliciting it by prayer or waiting patiently for whatever dispensation of wind Providence was pleased to send upon the sheeling hill."

To-day in South Africa the same spirit is seen. Honest countryfolk of European descent are earnestly counselled by their spiritual advisers to submit patiently to the plague of locusts on the ground that it comes as a punishment from Providence. These worthy men stolidly witness their cornfields and their grass lands being eaten bare before their eyes in a few hours, whilst their more enlightened neighbours, brought up in another faith, resort with success to 124 all sorts of artifices to ward off the destructive little invaders.

It is pleasant to be able to record that Dr. Chalmers, one of the heroes of Scots religious history, not only countenanced chloroform by witnessing operations performed under it in the Royal Infirmary, but when requested to deal in a magazine article with the theological aspect of anaesthesia refused on the ground that the question had no theological aspect, and advised Simpson and his friends to take no heed of the " small theologians" who advocated such views. This was futile advice to give to one of Professor Simpson's controversial propensities; he entered with keen enjoyment into the fray with these "religious" opponents. His famous pamphlet, entitled," Answer to the Religious Objections advanced against the employment of Anaesthetic Agents in Midwifery and Surgery," fought his enemies with their own weapons by appealing with consummate skill to Scripture for authority for the practice. The paper was headed with two scriptural verses:—" For every creature of God is good, and nothing to be refused if it be received with thanksgiving" (i Timothy iv. 4). "Therefore to him that knoweth to do good and doeth it not to him it is sin " (James iv. 17).

The principal standpoint of the religious opponents was the primeval curse upon womanhood to be found in Genesis. Simpson swept the ground from under his opponents' feet by reference to and study of the original Hebrew text. The word translated—"sorrow" ("I will greatly multiply thy sorrow ... in sorrow shalt thou bring forth")—was the same as that rendered as "sorrow" in the curse applied to man ("in sorrow shalt thou eat of it all the days of thy life "). Not only did the Hebrew word thus translated sorrow really mean labour, toil, or physical exertion ; but in other parts of the Bible an entirely different Hebrew word was used to express the actual pain incident to parturition. The contention, then, that sorrow in the curse meant pain was valueless. Chloroform relieved the real pain not referred to in the curse, whereas it had no effect upon the sorrow or physical exertion.

If, however, the curse was to be taken literally in its application to woman as these persons averred, and granting for the moment that sorrow did mean pain, their position was entirely illogical. If one part of the curse was to be interpreted literally, so must be the other parts, and this would have a serious effect of a revolutionary nature upon man and the human race all over the face of the earth. Literally speaking, the curse condemned the former who pulled up his thorns and thistles, as well as the man who used horses or oxen, water-power, or steam-traction to perform the work by which he earned his bread j for was he not thereby saving the sweat of his face?

Pushed further, the same argument rendered these contentions more absurd and untenable. Man was condemned to die—" dust thou art and unto dust thou shalt return." What right had the physician or surgeon to use his skill to prolong life, at the same time that he conscientiously abstained from the use of anaesthetics on the ground that they obviated pain sent by the Deity? Nay, more; sin itself was the result of the Fall; was not the Church herself erroneously labouring to turn mankind from sin?

In a truer and more serious religious spirit he reminded his foolish opponents of the Christian dispensation, and pointed out how the employment of anaesthesia was in strict consonance with the glorious spirit thereof.

Some persons broadly stated that the new process was unnatural; even these he condescended to answer. "How unnatural," exclaimed an Irish lady, "for you doctors in Edinburgh to take away the pains of your patients." "How unnatural," said he, "it is for you to have swam over from Ireland to Scotland against wind and tide in a steam-boat."

A son of De Quincey in his graduation thesis humorously supported Professor Simpson. He argued that the unmarried woman who opposed anaesthetics on the ground that her sex was condemned by the curse to suffer pains, broke the command herself " in four several ways, according to the following tabular statement":—

"1. She has no conception.
2. She brings forth no children.
3. Her desire is not to her husband.
4. The husband does not rule over her."

De Quincey himself supported his son in a letter appended to the thesis thus :—"If pain when carried to the stage which we call agony or intense struggle amongst vital functions brings with it some danger to life, then it will follow that knowingly to reject a means of mitigating or wholly cancelling the danger now that such means has been discovered and tested, travels on the road towards suicide. It is even worse than an ordinary movement in that direction, because it makes God an accomplice, through the Scriptures, in this suicidal movement, nay, the primal instigator to it, by means of a supposed curse interdicting the use of any means whatever (though revealed by Himself) for annulling that curse."

But the Bible furnished Simpson with the most powerful argument of all in Genesis ii. 21, where it is written : " And the Lord God caused a deep sleep to fall upon Adam; and he slept5 and He took one of his ribs and closed up the flesh instead thereof." He strengthened his position by explaining that the word rendered "deep sleep" might more correctly be translated "coma" or "lethargy." He had taken the full measure of his opponents when he answered them with this quotation ; it was a reply characteristic of the man, and completely defeated these self-constituted theologians with their own weapons. They had attacked him as a man of science, and found 128 that his knowledge of the Scriptures excelled their own. He did not fail to read these people a lesson, and point out the harm done to true religion by such conduct and arguments as theirs, reminding them that if God had willed pain to be irremovable no possible device of man could ever have removed it.

Such was the great fight—the fight for anaesthesia— which Simpson fought and won. He was the one man who by his own individual effort established the practice of anaesthesia, while Morton has the honour of being the one man without whom anaesthesia might have remained unknown. Such was the opposition encountered, and such was the timidity of his professional brethren, that but for Simpson's courageous efforts it would have been the work of years to bring about what it was granted to him to accomplish in a brief period ; if fear, ridicule, contempt, and bigotry had not perhaps sunk the new practice into oblivion. Of the hundreds who are daily mercifully brought under the influence of chloroform and ether, few are aware what they owe to Simpson, even if they know how great is the suffering which they are spared.

Simpson felt that the victory was indeed complete when in April, 1853, he received a letter from Sir James Clark, physician in ordinary to Her Majesty, informing him that the Queen had been brought under the influence of chloroform, and had expressed herself as greatly pleased with the result. It was at the birth of the late Prince Leopold that Her Majesty set her subjects this judicious example.

Much trouble to the cause was occasioned by enthusiasts who administered chloroform with more zeal than discretion, and without any study of the principles laid down by Simpson. As a result of imperfect trials, some persons went the length of saying that there were people whom it was impossible to anaesthetise at all, and others who could be only partially anaesthetised. Wrong methods of administration were used. Simpson patiently corrected these, and carefully instructed his students, so that the young graduates of Edinburgh University carried his teaching and practice into all parts of the world. Syme also took up the cause, and valuable work was done in London by Snow, and later by Clover. The teaching of Simpson and Syme led to such successful results that their methods are followed by the Edinburgh School to this day practically unaltered. So satisfactory an agent is chloroform in Edinburgh hands, that other anaesthetics are in that city but rarely called into requisition. All the world over it is the anaesthetic in which the general practitioner places his trust.

Having seen what Simpson did for anaesthesia, we may briefly review what anaesthesia has done for humanity. That it has entirely abolished the pain attendant upon surgery is easily recognised by the profession and patients alike. The patient never begs for mercy nowadays; he dreads the anaesthetic more than the knife; he has no anxiety as to whether he 130 will feel pain or not, but rather as to whether he will come round when the operation is over; happily after one experience he realises that his fears were unfounded, and, if need be, will submit cheerfully to a second administration.

The horrors of the operating-room referred to in the preceding chapter were vanquished with the pain ; the surgeon has no longer to steel himself for the task as formerly, to wear a stern aspect and adopt a harsh manner. The patient has no longer to be held down by assistants ; instead of having to be dragged unwillingly to the operating-table—a daily occurrence sickening to the hearts of fellow-patients and students, while it served only to harden the surgeon and the experienced old nurse of those days—he will walk quietly to the room, or submit patiently to be carried there, and at a word from the surgeon prepare

".... to storm The thick, sweet mystery of chloroform, The drunken dark, the little death-in-life."

The operation is no longer a race against time; order, method, cleanliness, and silence prevail, where there was formerly disorder, bustle, confusion, dirt, and long-drawn shrieks. Nothing illustrates better the progress of surgery than a picture of the operating ' room in the first decade placed beside that of an operating theatre in one of our leading hospitals in this the last decade of the nineteenth century. In the quiet of the patient, in the painlessness of the operation, in the calm deliberation of the operator, and the methodical order of all around him, in the respectful silence that prevails in the room so soon as the patient is laid on the table, we see the direct results of the introduction of anaesthetics. But there are other great, if less direct, results, each making its presence known to the professional spectator. By anaesthesia successful operations previously unheard of and unthought of were made possible after the principle of antiseptic surgery had been established ; by anaesthesia experimental research, which has led to numerous beneficent results in practical surgery and medicine, was made possible. Its introduction is an achievement of which the Anglo-Saxon race may well be proud. Wells, Morton, and Simpson are its heroes. The United States has by far the greater share of the honour of its discovery; but to Scotland is due the glory which comes from the victorious fight. No event in surgery up to 1847 had had such far-reaching effects. Simpson himself looked forward to the discovery of some agent, better than both chloroform and ether ; and it is still possible that there may be an even greater future in store for anaesthesia than was ever dreamt of in his philosophy.

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