The First Successful Chloroform Birth

This is an IiHart podcast Guaranteed human I turned off news altogether I hate to say it, but I don't trust much of anything It's the raange bit. It feels like it's trying to divise people If we got clear facts, maybe we can calm down a little NBC News brings you clear reporting. Let's meet at the facts. Let's move forward from there. NBC News, repeporting for America This is Chelsea Handler from Dear Chelsea. I'm going to be honest with you. I am online way more than I probably should be. And between me and everyone else at my house, we've got a zillion screens going on at any given moment. So when my internet slows down, it is a full crisis. That's why having fast, reliable internet that can keep up really matters and why you need optimum famously Fast fiber Internet Optimum fiber blows flaky five G out of the water and keeps it cool with the fastest and most reliable speeds that don't slow when things heat up. 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Listener Discretion addvised Around eighteen twenty nine, a woman from the Scottish Highlands arrived at the University of Edinburgh Hospital for surgery She had breast cancer and was getting a mastectomy with one of the most famous and renowned surgeons in the country James Liston Every time Liston performed surgeries, medical students crowded into the theater to learn his extraordinary techniques. Sometimes the students were so close to the operating table that they'd be splattered with blood Legend has it that before he began surgery, Liston would shout to the med students in the audience Te me, gentlemen. While this brag may seem crass, it may have comforted the patient Before anesthesia and antiseptics, patients were awake during surgery and would feel every cut The best strategy a surgeon had to ease the patient's suffering was to get the operation over with as quickly as possible Liston was one of the fastest surgeons in the country while most at the time took a couple of minutes to amputate a limb, Listen could do it in just thirty seconds Mastectomies were particularly gruesome and painful after taking the woman from the Highland into the medical theater and securing her onto the operating table with leather straps Liston held her down with one hand and wielded a hook with the other He used the hook to Tgger warning lift the soft tissue of her breast before slicing her breast with two clean cuts as she writhed and screamed The medical students watched carefully. taking careful notes except for one of them a nineteen year old named James Young Simpson Simpson was so disturbed and overwhelmed by the woman's pain. that he pushed through the crowd of fellow students and stormed out of the room Simpson was an ambitious diligent medical student who excelled in his classes The idea of actually performing surgery made him a little uneasy His own pain tolerance was low. He wrote to a friend that he couldn't so much as go to the dentist without quote The stimulus to my courage of two or three glasses of whiskey The idea of inflicting the same thing or worse on his patience was too much to bear He walked out of the hospital gate and up the hill to Parliament Square where he announced to the university administrators that he wanted to enroll as a clerk and study law instead The change of heart was short lived He soon returned to his medical studies and accepted the reality that the surgeon had to tolerate a patient's pain. just as the patient did But the mastectomy he witnessed stuck with him. He wrote to a friend at the time that, quote, All pain is, per se, and especially in excess destructive and even ultimately fatal in its action and effects end quote As he returned to his medical studies, he asked himself Can nothing be done to make operations less painful? littleittle could he possibly know question would go on to define his medical career And only a little over a decade later He would be the one to answer it I'm Dana Schwartz and this is Noble Blood. James Young Simpson started at Edinburgh University at fourteen traveling all the way to the city from its rural outskirts in his brother's ill fitting corduroy suit His colleague, John Brown, described him as quote thick set, fat, saonsy talallent, with a wide face with dimples on his cheeks in a particularly large head His early years at school were miserable. Later, Simpson recalled that he felt, quote Very, very young and very solitary, very poor and almost friendless. He initially was studying the arts, but during his first year of school, a friend took him to an anatomy lecture Simpson was fascinated He switched to medical school in eighteen twenty eight where he studied with Robert Liston The lightightning Fast surgeon Liston thought Simpson was an exemplary student writing that he was convinced that Simpson will become a well informed and excellent practitioner Simpson finished his medical coursework in eighteen thirty and then prepared his doctoral thesis so he could pursue his MD He ended up writing his thesis about inflammation which impressed his former pathology professor so much that he offered Simpson a job as his assistant And so Simpson spent the next few years rising up the medical ranks, pursuing leadership positions in various medical societies During that time, Simpson began to develop an interest in obstetrics, or the labor and delivery of babies The pathology professor suggested that he might be more successful as an obstetrician as opposed to a pathologist. Fields like surgery, internal medicine, and pathology were competitive, and in order to advance, Simpson would have to break into an elite network of established doctors This would be particularly difficult for Simpson who came from a humble background eighth child of a baker Simpson was so poor that on the day of his birth, the doctor's fee was greater than the revenue of his father's bakery for that entire year Obstetrics would be an easier field for an ambitious doctor like Simpson to advance in since it was considered a less prestigious field at the time What's more, Edinburgh had a growing maternity hospital where Simpson could establish himself And there was quite a bit of money in having a private midwife practice for wealthy families Simpson was also temperamentally well suited for obstetrics While he may have bulked at the ruthlessness of a surgeon like James Liston, Simpson's empathy and concern for his patient's well being made him a comforting presence during childbirth The Lancet wrote of him at the time that, quote His winning manners, his power of entering fully and at once into the mind and heart of the patient, wonderfully reinforced his professional sagacity and skills And so in eighteen thirty six, Simpson began to practice midwifery at the maternity hospital in Edinburgh on the side He started lecturing about midwifery at the medical school in eighteen thirty eight and even opened up a popular private practice operating out of his townhouse The lanset gushed, quote, hisis house soon became crowded with patients whom he treated according to their need. rather than their ability to pay When the chair of Midwifery resigned the following year, Simpson applied to replace him. He had to be elected into the position by his colleagues, and he had two serious disadvantages He was young, only twenty eight years old. And he was a bachelor which was a problem because many thought it was unseemly for a bachelor to devote his career to childbirth So Simpson disappeared from Edinburgh for a month, solved the second problem by marrying his cousin, Jesse Grindlay and returned just in time for the election He won by one vote. And afterward, the couple departed for their honeymoon to celebrate Simpson's career had skyrocketed. Before the age of thirty, he became one of the most respected obstetricians in the country But he was still haunted by the same issue that caused him to almost quit medicine when he was still in school pain of his patience Seeing his patients suffer through childbirth disturbed him. He wrote to a fellow doctor in eighteen thirty six Cannot something be done to render the patient unconscious while under acute pain Without interfering with the free and healthy play of natural functions He didn't have a lot of options Alcohol could numb the senses, but the effect didn't last long and pain still cut through drunkenness opium was an effective sedative, but it dulled pain only partially and took a while to take effect. It was also unpredictable and dangerous, as it could slow a patient's breathing and sometimes cause their death. Simpson experimented with mesmerism and hypnosis as a potential way of lessening pain which turned out to be even less effective. It wasn't until eighteen forty six that he heard promising news about a potential anesthetic colorless, sweet smelling gas called Eether Eher had been around for hundreds of years but mostly as a putut it frankly Hearty drug During a dinner party or salon in the early nineteenth century, guests might participate in quote ether frolics, where someone would take out a glass vial filled with ether, or a handkerchief dipped in the chemical and pass it around for everyone to inhale Sometimes people would even drink it straight After seeing the numbing effects of ether on party goers, a dentist in Boston decided to see if it could be used medicinally O october sixteenth, the dentist invited scientists and journalists to Massachusetts General Hospital for a public demonstration in which he used ether to sedate a patient before removing a tumor in his neck before a crowd of onlookers This was the first successful demonstrated use of an anesthetic for surgery News spread quickly across the pond By December, James Simpson's former professor, the infamously speedy surgeon, Robert Liston, used ether to anesthetize a patient before amputating an infected leg The surgery took all of twenty eight seconds. The patient felt nothing and Liston is said to have exclaimed, This Yankee dodge gentleman beats mesmerism hollow throughout the next couple of months, surgeons across Britain and Ireland tried this new wonder drug. News reports featured patients with breathless praise for Eether One proclaimed that he had the most pleasurable sensations while on Eether. while another said he was transported to a beautiful heaven cried with joy when her operation was over without any pain at all Impressed with the results, Simpson decided to try the chemical in his own obstetric practice in January He was tasked with facilitating childbirth for a woman with a deformed pelvis where it was likely to be especially painful Maybe even fatal He gave her some ether, and not only did the woman survive the complicated surgery, she didn't feel any pain. This result was so thrilling to Simpson that when he received a letter from the een the next day to appoint him the Queen's physician in Scotland He was comparatively unmoved He wrote to his brother, Flattery from the Queen is perhaps not common flattery, but I am far less interested in it than in having delivered a woman this week without any pain while inhaling sulfuric ether I can think of naught else. He was so excited about Eether that he even used it for so called quote natural births because he thought that it had the potential to increase survival rates While Eether was better than the alternatives, a few months later, Simpson's enthusiasm about Eether began to fade March eighteen forty seven. A twenty one year old woman in Grantham had a tumor on her thigh and begged the doctor to use ether in surgery to remove it The doctor did but she was left in a weakened state after the surgery, and she died two days later. E in less fatal cases Eether had a number of drawbacks The gas had an overpoweringly acidic, stinging smell that irritated the throat, even causing choking for some patients. caught fire if it was too close to a candle or gas light. It was also cumbersome to use. It was stored in heavy glass bottles, which were a nuisance to carry up and down and acted very slowly requiring a few minutes of inhaling before patients were knocked out. For a woman giving birth who was already under a lot of physical stress Taking deep breaths of an awful smelling, acidic stinging gas for ten minutes was a difficult and unpleasant task Simpson wanted to find a better solution Over the summer and fall of eighteen forty seven He did a series of experiments with different chemicals to see if they could be used for surgery. Because Simpson had no training in chemical research These experiments were Let's say a little informal He didn't take notes on his experiments But letters from the time and memoirs written by Simpson and his colleagues much later give us a general sense of what went on. He got samples of any substance that someone might be able to inhale and invited his friends over to his house to test them out His friends and assistants would sit around the dinner table and pass around whatever chemical Simpson brought that day The group tried out ethyl nitrate, benzen, carbon disulfide, acetone and Dutch liquid But all of them had significant side effects They smelled like rotting cabbage or produced intolerable ringing sensations or sometimes did nothing at all Sometimes Simpson would try them out himself and his wife would find him passed out on the basement floor Simpson's neighbor recalled that, quote, these experiments were performed at late night or early morn, when the greater part of mankind were soundly anesthetized in common sleep In October, one of Simpson's friends recommended he try chloroform Simpson was already familiar with some experiments other physicians had tried with chloric ether. Chloroform diluted with alcohol produced light, dizziness and intoxication But he didn't realize that undiluted chloric ether or chloroform hadn't been tried yet as an anesthetic When Simpson obtained some chloroform later that month He was skeptical. It was heavier than water which suggested that it might be hard to vaporize But on november fourth, eighteen forty seven, He decided to give chloroform a try Sitting around the dinner table where his typical surgery buddies but also his wife, her sister, her niece and her brother in law. He poured a little bit of chloroform in a glass for his three colleagues, and they all inhaled as his family looked on The drug took effect immediately Everyone started drunkenly laughing and talking finding each other unusually intelligent and charming As Simpson witnessed the intoxication of his guests, he thought This is far stronger and better than ether The next thing he knew, he was lying on the floor looking up at the ceiling He saw one of his colleagues sprawled out under a chair, mouth a gate unconscious and snoring Simpson heard a thump and turned to see the other man under the table. flailing his legs before tyring himself and raising his head in a stupor As they came to, the three were so thrilled at the results that they decided to try again This time around, his sister in law even decided to join the party She inhaled deeply, folded her arms across her breast, and, according to Simpson's recollection, she fell asleep while yelling, I'm an angel. Oh, I'm an angel. partarty lasted until three AM I want to take a brief moment here for any slightly younger listeners of Noble Blood Just to remind you that under no conditions, you absolutely should not throw any parties where you inhale noxious substances This was a terrible idea. and though the end result was historically significant Do not attempt to do this at home. I repeat, absolutely never attempt to do anything like this at home. okay The next day, Simpson contacted a manufacturer to get him more of this seeming miracle drug But this time it wasn't for himself or his friends. He was ready to try it on patience On november eighth, eighteen forty seven, only four days after Simpson's three AM chloroform party. A woman named Jane Carstairs entered the Edinburgh Maternity Hospital ready to give birth. She was understandably nervous. It was her second pregnancy and her first ended after three days of labor. and resulted in the death of the child Jane hadn't slept in days When she arrived at the hospital, James Simpson had rolled a handkerchief into a cone St it in chloroform and put it over the patient's nose and mouth twentyenty five minutes later Jane Carstairs woke up She told Simpson that she was grateful to finally get some sleep before giving birth But she was a bit worried that something had gone wrong because she no longer felt any of the pain from contractions Moments later, the nurse brought in her child Baby girl had already been safely born Jane was so dumbfounded that she didn't believe that the child in front of her was hers On that day James Young Simpson was elated He had done it. He had found a substance that was easy to administer and he believed could ensure a quick, painless childbirth. Now he just needed the rest of the world to catch up. That's the end of part one of our two part episode on James Young Simpson