Famous Doctors in History : Sir James Young Simpson
Famous Doctors in History : Sir James Young Simpson
"He could heal where others abandoned hope"
The next time you experience the relief of a pain-killing treatment or injection you may want to give praise to the people who made that possible. And think of a great Scotsman who lived back in the 19th century who helped pave the way for modern anaesthesia. His name was Sir James Young Simpson.
A precocious child
Simpson was born in 1811 in the town of Bathgate near Edinburgh and was one of eight children. His father David Simpson was a local baker and his mother was a French woman called Mary Jervay. As a child James was said to be of a bright, pleasant disposition with a nimbleness of thought and an enquiring mind. This was encouraged by his mother in particular and in the words of George Herbert "A good mother is worth a thousand schoolmasters" in matters of education. Tragically however she died when James was only nine years old but she had sown the seeds in his young mind.
He attended the University of Edinburgh at the age of 14 to study Medicine. He was rather lonely at first in the city and felt out of place. One of his fellow students described "a painstaking but not a specially brilliant scholar". However with much diligence and an original approach Simpson eventually rose to first place in the class. He finally passed his degree with honours.
A rapid rise
In 1835 he started his Doctor's practice in the Stockbridge area of the city but after only a year he obtained a hospital appointment. With a newly settled existence he married Jessie Grindlay on Boxing Day of 1839 and started a family.
By January 1940 he was Professor of Medicine and Midwifery at the age of only 28 years old. He introduced several innovations such as improved forceps for the delivery of babies, prevention of hospital-borne infections, better hospital design and statistical record-keeping. In 1844 he also opened a Dispensary for Women and Children in St John Street in Edinburgh and after 3 years 7,617 patients were registered. Then in 1847 he attained the distinction of being appointed as one of Queen Victoria's Royal Physicians for Scotland.
An early experience of observing an operation on a woman's breast removal without anaesthetic had greatly upset Simpson. So badly had it affected him that he almost abandoned the medical profession. However this unpleasant experience only made him determined to help ease the suffering of patients undergoing surgery.
The beginnings of anaesthesia
He was inspired by the pioneering Scottish surgeon Robert Liston of University College in London. Liston had performed the first operation anywhere in Europe using modern anaesthesia. He had used ether which had recently been imported from the USA after work by dentist William Morton in Boston. Simpson adopted its use for his patients.
In fact Sir Humphry Davy had first used nitrous oxide or 'laughing gas' as it was known back in 1799 as an analgesic at the Pneumatic Institution in Bristol, England. But it was not introduced into wide medical circulation for another 44 years. In fact it became merely a novelty at upper-class dinner parties employed as a recreational drug.
Furthermore known agents like ether, nitrous oxide, opiates and alcohol all produced unpleasant side-effects especially nausea and headaches. In fact the highly flammable nature of ether made it dangerous in those gas-lit times. Simpson had even tried 'mesmerism' the precursor to modern hypnosis but without success.
A willing subject
Therefore Simpson sought out an alternative and tested many different concoctions devised by researchers sometimes at risk to himself. He visited the famous chemist Lyon Playfair and on one particular day was willing to be a human guinea pig on a new liquid. Playfair refused and insisted that it first be administered to rabbits in his laboratory. They duly did this and later the rabbits roused from their unconscious state.
Simpson returned to Playfair's laboratory the next day to try out the new anaesthetic for himself. But his assistant cautioned to first check the condition of the two rabbits they had used. They then discovered that both the animals were dead. Simpson's dedication it seemed could border on a reckless disregard for his own personal well-being.
The famous dinner party
In his home in Edinburgh one evening on 4th November 1847 he and two of his friends Dr Keith and Dr Duncan tried inhaling chloroform. The idea of using it came from David Waldie, an industrial chemist, who had once been a student with Simpson. It was a normal occurrence after a dinner party in the Simpson household as the medical men would test a new compounds for its efficacy. Dr Keith inhaled half a glassful of the latest liquid and within two minutes he was under the dining table. Simpson and Duncan soon followed into unconsciousness
They awoke next morning and discovered that as well as possessing anaesthetic qualities this chloroform possessed no unpleasant side-effects. "This will turn the world upside down" declared Simpson.
The discovery was quickly used when a local Edinburgh dentist Francis Brodie Imlach performed the first tooth extraction using the chemical only four days later.
Simpson did not actually invent chloroform as this was achieved in 1831 by Samuel Guthrie who was a physician and chemist of New York State in the USA. At the same time a Frenchman, Eugène Soubeiran and a German, Justus Liebig also independently discovered the anaesthetic qualities of this new solution of distilled chloride of lime with alcohol. However it was Guthrie that obtained the credit after being the first to publish his findings.
Nevertheless over the Atlantic it was Simpson who vigorously promoted its wider use in patient care beginning with his paper 'Account of a New Anaesthetic Agent' on 10th November 1847. He presented his findings that day to the Medico-Chirurgical Society of Edinburgh and soon after they were published in the British Medical Journal. Simpson proved to be an effective communicator who wrote prodigiously and took advantage of the increased use of journals in which to publish medical research and knowledge.
Initially however, he met with strong opposition from religious circles. Church leaders regarded the 'tribulations' of labour pains as a natural phenomena that should not be interfered with.
Of course Church leaders were exclusively male and we may speculate about their personal knowledge and expertise in the pains of childbirth.
To accusations that chloroform was 'unnatural' Simpson riposted that "So are railway trains, carriages and steamboats" in a stout defence of his work.
But Simpson also refuted theological criticism on scriptural grounds by displaying an erudite knowledge of the bible. Apparently he knew the book far better than his detractors and put up an able defence of his work. However Dr Thomas Chalmers, Moderator of the Free Church of Scotland had already declared that the issue had no theological basis for argument and had publicly endorsed anaesthesia before his death early in 1847.
However even the medical profession was resistant and not only for professional reasons. Cetainly there was a school of thought that the cries of a woman in labour were helpful to the efficient delivery of a child. It was believed that the exhalation of air eased anatomical pressures and concentrated the process on the uterus.
Even a surgeon called John Parkes from Liverpool, England wrote in 1848 expressing shock that;
"a woman was delivered of her child in a state of utter insensibility so evading bringing forth in sorrow"
Although sceptical about the medical benefits to the pregnant woman Dr Tyler Smith wrote in the Lancet medical journal in 1847 that;
"No human suffering, perhaps, exceeds in intensity the piercing agonies of child-bearing"
Nevertheless there was a political dimension to the opposition against Simpson's advocacy for chloroform. Simpson was a Whig supporter with radical sympathies and this came up against a professional body largely sympathetic to the Tory Party. Therefore he was located outside the establishment and seen as a maverick. It did not help that he had studied under Dr Robert Knox the latter of whom became notorious in the 1820's for his involvement with Burke and Hare. They had sold Dr Knox dead bodies for dissection who turned out to have been murder victims of the notorious criminals
But Simpson had a combative spirit and was an intellectual free-thinker with an open mind to new ideas. He was also described as a 'controversialist', brash and deeply ambitious despite his compassionate nature and generally convivial disposition. However he was criticised for being too loyal and unwavering in his support of chloroform in response to its detractors.
The improvements of Dr John Snow
Controversy also dogged his advocacy of chloroform as a safe chemical agent in which to induce unconsciousness. Some people began to die after being administered the drug. At first dozens perished and then the figure ran into hundreds. But it was unknown why many suffered no effects while others died. All that could be observed was that most of the victims were young, fit and 'fearful' in the parlance of the time.
Another Physician Dr John Snow determined to find out why this was occurring and set about patiently conducting research and experiments on chloroform. In his own time and at his own expense he spent endless hours investigating the anaesthetic by analysing data and testing the substance on animals.
Eventually he discovered why the young were affected more than others. Chloroform had what we now call a 'high therapeutic index' meaning that it had a fine line between safety and danger. In other words one-third of a teaspoonful of the drug would bring unconsciousness but only one-half a teaspoonful could be deadly. The reason the young were dying was that they required a higher amount than older weaker people and this led to their unexpected deaths.
Also the drug was simply administered by being soaked in a handkerchief and applied to the nose. If patients were in a highly anxious and 'fearful' state they tended to breathe in huge gasps especially if they had initially held their breath in fear. Chloroform worked by lowering the metabolism of all the body organs. Therefore the brain was anaesthetised but this also affected the heart causing it to fail by ventricular fibrillation resulting in death.
Therefore the public image of chloroform was still open to question and criticism on the grounds of safety as well as any moral, medical or religious objections.
However Queen Victoria became a keen supporter and demanded to use chloroform during the labour of the birth of her eighth child Leopold in 1853.
She directed Dr Snow to allow her to use the anaesthetic and she was also administered the drug in 1857 for her next child who was the Princess Beatrice.
This seal of royal approval helped establish Simpson's reputation as chloroform gained wide acceptance in medical and social circles. However Dr Snow deserved massive credit for his important research into the safe use of the anaesthetic.
A man of honour
In 1866 Simpson became the first person knighted for services to Medicine when he was bestowed with a Barnonetcy. Such was the modesty of the man that he had already turned down the honour on two previous occasions before graciously accepting at the third time of asking. Then in 1689 he received the Freedom of the city of Edinburgh.
However Simpson never forgot his roots. He always had time for people from his old town of Bathgate even though he was feted by the higher classes of society and the Royal family. This was never better exemplified than the story of a famous authoress who rang the bell of his home only to be told by the servant that no more patients would be seen that day.
"Take my name, he knows me" asked the lady writer
"Dr Simpson knows the Queen ma'am" came the caustic reply
Simpson retained a country house in Bathgate where his wife and children normally resided away from the hustle and bustle of Victorian Edinburgh and his busy consulting rooms. Nevertheless his reputation was known throughout Europe and even beyond and he received international visitors as well as locals. One of these included the famous Hans Christian Anderson who apparently took exception to the chemical inhalation sessions at gatherings in Simpson's house.
Farewell to the great magician
On his death in 1870 Simpson was buried in Warriston Cemetery in the northside of Edinburgh. He was considered for the honour of a tomb at Westminster Cathedral in London but his wish was to be laid to rest in his adopted city.
However there is a plaque dedicated to him in the cathedral in London which recognises him as the one of the most famous doctors in the history of British medicine.
Such was the high esteem in which he was held that around 1,700 family, friends, colleagues and other notables took part in the funeral procession. In fact an incredible 30,000 ordinary people lined the route of the cortege indicating the popular acclaim of the great medical man.
As described by Henry Gordon in 2002:
"In the public mind he was undoubtedly endowed with more than human powers, and regarded as a magician, at the wave of whose wand pain and disease would vanish"
He is still remembered today with a fine statue in the gardens next to Princes Street in Edinburgh. Not only that but his old house at 52 Queen Street in the Georgian 'New Town' of the city is now a children's nursery. I am sure he would have heartily approved.
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