February 1997
Volume 61 |
Number 2
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| James
Young Simpson, M.D.: First Obstetrical Anesthetist |
Donald Caton, M.D.
Committee on Obstetrical Anesthesia
On January 19, 1997, we observed the 150th anniversary of the
administration of the first modern obstetrical anesthetic. Just
three months after William T.G. Morton's famous demonstration
of the anesthetic properties of ether in Boston, Scottish obstetrician
James Young Simpson, M.D. (1811-1870), administered ether to a
woman with a contracted pelvis to facilitate delivery of her child.
Never one to hide his accomplishments, Simpson published a description
of this case and several other cases in Edinburgh's Monthly
Journal of Medical Science on March 1, 1847.
Using anesthesia for obstetrics was only one of Simpson's many
accomplishments. Later that same year, he discovered the anesthetic
properties of chloroform. He also designed obstetric forceps,
made many innovations in the management of obstetric problems
and influenced hospital design and the management of tubercular
patients.
According to contemporary accounts, Simpson was a man of great
energy and charm and was one of singular appearance. One friend
described him as having the head of Jove and the body of Bacchus.
By the time of his death, Simpson was one of the best known and
most influential physicians in Europe. More than 30,000 mourners
lined the streets of Edinburgh for his funeral. Friends commissioned
a greater-than-life-sized statue - which still stands on Princess
Street in Edinburgh - and installed a plaque dedicated to him
in Westminster Abbey, which reads:
"To whose genius and benevolence
The world owes the blessings derived
From the use of chloroform for
The relief of suffering
Laus Deo"
Simpson's fame and popularity obscures the fact that anesthesia
for childbirth was an innovation challenged by virtually every
other authoritative obstetrician of that time. Opponents recognized
the potency and dangers of ether and chloroform, and they believed
that the danger of labor pain was not great enough to risk interfering
with uterine contractions, depressing the child or increasing
postpartum hemorrhage. Anesthesia, they said, was untested and
represented an unnecessary and dangerous intrusion into a natural
biological process. This controversy over anesthesia was part
of a larger ongoing debate within obstetrics about other "meddlesome"
procedures such as forceps and ergot. Advocates of more aggressive
obstetric management, Simpson included, were in the minority.
Even John Snow, a staunch advocate of anesthesia, criticized
Simpson. Although he was in favor of obstetric applications (Snow
anesthetized Queen Victoria with chloroform for the deliveries
of her last two children), Snow criticized Simpson's method: Simpson
started anesthesia early in labor, gave a lot of anesthesia and
made no attempt to tailor his technique to the needs of individual
patients. He simply poured chloroform on a cloth placed over the
patient's nose until she was unconscious and unresponsive, virtually
the same technique that others used for surgery. Although appropriate
for amputations or extractions of bladder stones - procedures
that lasted only a few minutes - this method was not appropriate
for labor, which might last hours. Snow said so and criticized
Simpson's influence on others:
"The high position of Dr. Simpson and his previous services
in this department, more particularly in being the first to administer
ether in labour, gave his recommendations very great influence;
the consequence of which is, that the practice of anesthesia is
presently probably in a much less satisfactory state than it would
have been if chloroform had never been introduced."
Snow's comment is telling, considering that it came not from
a critic of obstetrical anesthesia, but from one of its most articulate
and effective proponents.
Simpson never dealt with these medical issues. Instead, he took
his case directly to the public. He told patients that the pain
of childbirth was unnecessary, if not dangerous. He criticized
the stodginess of physicians who refused to use it, comparing
them to earlier physicians who had resisted vaccination for smallpox.
Simpson also diverted attention from medical issues when he published
a pamphlet, "Answer to the Religious Objections Advanced
Against the Employment of Anaesthetic Agents in Midwifery and
Surgery." Seven months later, he readdressed the subject
in a long letter to Protheroe Smith, M.D., a London obstetrician
who had written a similar pamphlet. Simpson described his dismay
when he learned that:
"Patients and others strongly object to the superinduction
of anaesthesia in labour, by the inhalation of ether or chloroform,
on the assumed ground that an immunity from pain during parturition
was contrary to religion and the express command of the Scripture."
The scriptural command in question was the passage from the Old
Testament Book of Genesis in which God condemned Eve's descendants
to suffer during labor because of her disobedience in Eden. Despite
Simpson's preoccupation with the subject, recent scholars have
failed to find evidence of any organized opposition from church
officials. In fact, one Scottish theologian, a contemporary of
Simpson, called it a "trivial problem." Simpson's paper,
therefore, represents his own interest in the subject and not
necessarily the position of the Church.
Simpson overcame opposition of physicians to obstetrical anesthesia
because he understood the mood of the public. Victorian women
did not want pain, and they had an overwhelming, if not unreasonable,
faith in the ability of physicians to overcome technical problems.
Social pressure from patients slowly brought physicians to adopt
its use.
For his contribution to obstetric anesthesia, James Young Simpson
deserves great credit. His influence and charisma were important
factors in his success. On the other hand, equal credit is due
to subsequent generations of physicians who quietly worked out
the medical issues that continue to make the obstetrical applications
of anesthesia safer and better.
The Wood Library-Museum of Anesthesiology has a collection of
Simpson's complete works. It also has several biographies, including
Simpson and Syme of Edinburgh, by J.A. Shepherd, who gives
an excellent description of the man and his times. Those who would
like to learn more should contact the Wood Library-Museum of Anesthesiology,
520 N. Northwest Highway, Park Ridge, IL 60068-2573; telephone:
(847) 825-5586; e-mail: <wlm@ASAhq.org>.
Donald Caton, M.D., is Professor of Anesthesiology
and Obstetrics/Gynecology at the University of Florida College
of Medicine, Gainesville, Florida.
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