From pain to delirium to sexual dreams: the great chloroform debates

 

At the end of last year we commenced a project to catalogue and preserve the substantial James Young Simpson archive. This collection of over 2000 items has belonged to the College since 1958 and is one of the largest in the archive. It is currently undergoing a retro-conversion process that will produce a multi-level catalogue to item level.

jys-album-and-letters

Correspondence section in James Young Simpson archive, RCSEd

James Young Simpson is perhaps most famous for his role in the use of chloroform as an agent of pain relief. Developed in the mid-19th century, this pioneering work led to the reduction of suffering for countless women undergoing labour and helped change social perceptions of pain during childbirth.

Determined to develop an effective anaesthesia, and having already dabbled in ether, Simpson began researching chloroform in 1847. Some evidence of its potential had by then emerged from Dutch and American laboratories, where various chemists concocted potions and watched enthralled as the intoxicating properties took hold. Simpson himself consumed the substance, inhaling vapours from a sample he had purchased, acting as his own test subject in the name of science. When he regained consciousness, he knew he was on to a winner.

Sir J. Y. Simpson and two friends, having tested chloroform

Sir J. Y. Simpson and two friends, having tested chloroform, Wellcome Images

 

The first clinical uses of chloroform followed soon after. Simpson was also quick to announce his breakthrough to the medical community, arguing for its superiority over ether and eager to lay down guidelines for its administration. His knack for publicity ensured that the news spread fast. Soon other doctors were scrutinising vials of chloroform, tentative but curious about its effects on their patients.

Chloroform Bottle. Surgeons' Hall Museums

Chloroform Bottle, Surgeons’ Hall Museums

 

Novelty brings uncertainty, and in extreme cases danger. Though Simpson offered directions in using chloroform and was the progenitor of a growing number of case studies, some of the details remained ambiguous. More experimentation was needed. As was typical of the time, Simpson was in correspondence with numerous practitioners, many of which were keen to put his research to use.

History remembers the debates of the time – calm concerns over anaesthesia escalating into vitriol. The most famous opposing voices were from the clergy and conservative establishment, invariably men, who were set on depicting pain as a moral virtue. The childbearing they would never experience was a gift, they held, and it was wrong to diminish any element of it, no matter how excruciating that element may be.

But there were other debates. These were concerned with clinical matters. Did chloroform have scientific validity as an anaesthesia? Which data supported Simpson’s claims? Was it safe to use? In this novel situation clarity was needed: how should it be mixed, how should it be administered. Only cold hard data would give the answers.

The RCSEd Library & Archive is privileged to have a wealth of letters that illustrate these debates. They offer first-hand accounts of medical professionals tackling the key questions to which innovation so often gives rise. The retro-conversion project begun last year has enabled us to re-examine these fascinating documents.

JYS 1-2-2_1

Letter to JYS from Dr Clay, RCSEd 1/2/2

 

Missives of support were fairly common. JYS 1/2/2 is a letter to Simpson from Dr Clay in Manchester. The doctor states that he had used chloroform “in eight midwifery cases and extensively in operations” and declares himself satisfied with its results. In the letter’s opening salvo, he pronounces his “conversion to chloroform”.

JYS 1/2/41 is a letter from A Cockburn dated 30 January 1849. Lamenting prejudices against chloroform, Cockburn reels at the ignorance undergirding the opposition. He asserts “that all those medical men who are most opposed to its use have not the slightest practical, or personal, experience of it”. He targets the apothecaries most strongly in his critique but ends optimistically with the words, “Chloroform will make its own way”.

JYS 1/2/55 goes beyond soaring rhetoric to dwell on important numbers. John Baill of Arbroath writes of having administered chloroform in 415 cases – a significant data set – overwhelmingly showing effective pain relief in each case.

Not all of Simpson’s correspondents had embraced chloroform. In JYS 1/2/35, R Ingram cites post-mortem evidence of a death apparently from chloroform poisoning. He exhorts Simpson to accept the role chloroform may have played in this fatal outcome.

Dr Alex Tyler, writing from Dublin in JYS 1/2/49, discusses a reluctance to use chloroform in the city’s obstetrical and surgical cases. “Dread of bad consequences” was the factor preventing its adoption. Aberdeen was another city displaying hesitation. In JYS 1/2/26, W Williamson writes that chloroform was not widely employed in Aberdeen. Again, the fear of dangerous results was preventing a development that would have benefitted many.

By way of his voluminous correspondence, Simpson was gathering testimony as part of what could be considered one large-scale study. And he was not the only one. In JYS 1/2/39, G T Gream requested information from Simpson about the latter’s own experiences, as well as those of other practitioners in the Edinburgh area. Curious about the side effects, Gream specifically wanted to know about “any cases of prolonged indisposition, of death, or of dreams indicating sexual excitement”.

jys-letters

James Young Simpson archive, RCSEd

 

These letters act as a bountiful constellation of the concerns and passions of the individuals involved in the early use of chloroform. While many of Simpson’s interlocutors enthusiastically accepted his claims, others expressed their reservations and hinted at institutions unwilling to evolve. Opinions were plentiful as everyone grappled with this new and exciting method of pain relief.

In the end Simpson’s heralding of chloroform was vindicated when in 1853 Queen Victoria used it at the birth of Prince Leopold.

 

Simpson, JY JYS album

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