WLM HISTORY REVIEW:

Spirits of Anesthesia

February, 1997

Volume 4, Number 1

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SUBJECT: The Beginning of Obstretric Anesthesia

January 19, 1997 marks the sesquicentennial of the first modern obstetric anesthetic. It was administered by James Young Simpson (1811-1870), a colorful, charismatic and influential Scottish obstetrician who later that year described the anesthetic properties of chloroform. Simpson is also remembererd for designing a special set of obstetric forceps, influencing hospital design and many paper on archeology.

Simpson's use of anesthesia for obstetrics precipitated a storm of protest from physicians. One of the most outspoken opponents was American obstetrician Charles Delucina Meigs. Author of several textbooks and professor of Midwifery at Jefferson Medical College in Philadelphia, Meigs believed that anesthesia was inherently dangerous and that the pain of childbirth was not so severe enough to warrent the risks of using ether or chloroform. Although most obstetricians agreed with Meigs, Simpson's views eventually prevailed in large part because he took his case directly to the public.

Several books and many papers deal with this important era in the history of our specialty:

Books

Gordon HL. Sir James Young Simpson and Chloroform.London: T. Fisher Unwin; 1897: 56, 1-36, 53. Shepard JA. Simpson and Syme of Edinburgh.Edinburgh: Livingstone; 1969: 85, 77-102 (Both books offer good material about the life and times of Simpson. Inevitably there is some overlap. Gordon's book, if you are willing to make allowances for Victorian prose, gives more insight into the personal life of simpson, his family and education.

Shepard's book deals more with Simpson's career, particularly his long-standing feud with Philip Syme, a colleague on the faculity of Edinburgh Medical school. They became enemies when Syme, a surgeon, opposed Simpson's appointment and, in the fashion of the times, remained stalwart enemies for the rest of their lives. The contrast between the careers of the two men porvide an unusual perspective of medical practice and education in Edinburg, just after the reputatuon and influence of the school had peaked.)

Other Resources

Morrell JH. The university of Edinburgh in the late eighteenth century: its scientific eminence and academic structure. Isis. 1971; 62:158-171. Risse GB. "Doctor William Cullen, physician Edinburgh": A consultation practice in the eighteenth century. Bull Hist Med.1974; 48:338-351. (Overlooked in most histories of early anesthesia, is the character of medicine and the medical community just prior to the introduction of ether and chloroform. Shortly before James Young Simpson began his training, Edinburgh Medical School was known as the world's preeminent institution. In large part this was the result of the work of William Cullen. These two papers describe the influence of Edinburgh and the work of its foremost professor. Cullen taught a variation of Galenic medicine, a system derived from the ancient Greeks. Within two decades this system of medicine had virtually disappeared, to be replaced by the style of medicine that we practice today. Simpson was involved in the transition: He studied a variation of Galenic medicine but evolved to modern methods.) *Canton D. Obstetric anesthesia; the first ten years. Anesthesiology.1969; 33:102-109. *Farr AD. Early opposition to obstetric anesthesia. Anesthesia.1980; 35:896-907.

Farr AD. Religious opposition aid obstetric anesthesia: a myth? Annals of Science.1983; 40:159-177. These first two papers describe the medical opposition to obstetric anesthesia. Simpson's use of ether viloated many of the theories of safe obstetric practice and contradicted prevailing ideas about pain. Farr's paper debunks the idea that the physicians objected to anesthesia for religious reasons - a myth started by Simpson himself and perpetuated by generations of writers.) Levinson A. The three Meigs and the contribution to pediatrics. Annals of Medical History.1928; 10:138-148. Scheffey LC. The earlier history and the transition period of obstetrics and gynecology in Philadelphia. Annals of Medical History.year; 2:215-224. (There is less biographical material about Charles Delucina Meigs, Simpson's outspoken American opponent. Meigs, also a colorful and influential man, came from an important and interesting American family. Both papers have good material. More about Meigs may be found in Caton's paper, listed above. In the United States as in Edinburg medicine was in transition. Scheffey's paper discusses some of the changes occuring in obstetrics at the time that anesthesia appeared.)

*loan or photocopy available from the WLM.

E-mail your request to wlm@asahq.org.

Compiled and edited by Donald Caton, M.D.