THE date was November 4, 1847, and the place was 52 Queen Street in the New Town of Edinburgh, one of the grand but discreet houses lining that thoroughfare with an outlook over the distant hills to the north.
It was the home of James Young Simpson, surgical superstar at the capital’s university. Born in 1811, this son of the baker of Bathgate in West Lothian was by professorial standards still a young and humble fellow, candidly God-fearing, too. At least he kept a cheerful peasant’s look about him and believed in the health-giving virtues of red wine.
Yet he showed no qualms about joining in the fierce quarrels with his senior colleagues for which they were notorious. By contrast, he often went down into the slums of Edinburgh to treat the poorest and least regarded patients – and never sought to charge his normal fees.
On that day in 1847, Simpson had arranged for a private experiment that would call on the help of two of his favourite students, George Keith and James Matthews Duncan, both with distinguished medical careers before them.
They came round to his house in Queen Street to take part in inhaling samples of ether. They already knew this chemical substance had an anaesthetic effect that would be invaluable to the medical profession, so long as its properties were fully understood. The experiment did not take long. The three men inhaled – and a minute or two later slumped over and lost consciousness in Simpson’s drawing room. They demonstrated the anaesthetic effect, but it only later became clear they might have killed themselves. Instead they went down in history as intrepid scientists and benefactors of humanity.
Simpson had already spent much of his career pushing back the frontiers of knowledge, and would continue to do so till his death in 1870. He had shown brilliance even as a schoolboy. He inspired his wider family, all common folk from the Scottish Lowlands, to make the collective material sacrifice necessary for him to go to university.
He enrolled as an arts student at Edinburgh in 1825, and began his medical studies two years later. He graduated MD in 1832. The quality of his thesis attracted the attention of John Thomson, professor of pathology, who appointed Simpson as his assistant.
Simpson specialised in obstetrics, or childbirth. By the standards of the time it was hardly a prestigious branch of knowledge. Not so long before it had been merely a matter for midwives, who might be clumsy old crones. Only recently had it attracted qualified doctors who wanted to turn it into a profession – and to start by making it less agonising for patients. Yet there were surgeons who wanted to stop others developing skills they lacked themselves.
Some said the best skill for surgeons to cultivate was the speed of the operation. Speed made a visible difference in terms of pain and survival. Simpson worried more about preventing the pain before he started the operation.
In 1836 he won appointment to Edinburgh’s Lying-in Hospital, and began to practise midwifery. By 1839 he was giving extramural lectures on obstetrics. Finally, he transferred to the university’s chair of midwifery. From then on his business boomed.
Childbirth is universal but in the mid-19th century it still posed complex problems. One of them was which substance to choose as the painkiller. The earliest experiments using ether had taken place in the US, but were noted by Robert Liston, a son of East Lothian who held a post at University College Hospital in London.
Simpson followed suit and soon was regularly employing ether too. But it still did not solve all the problems. David Waldie, a Scottish chemist working in Liverpool, suggested the properties of chloroform might be worth investigating. Simpson, never a snob, was always ready to try suggestions from any knowledgeable source.
Support from Simpson made chloroform a standard obstetric. It had its own dangers, however, though it was in several ways more convenient than ether. Before safer agents were found, there could be deaths from overdoses or from adverse reactions. Still, credit must go to Simpson for establishing that the relief of pain should be central to an obstetrician’s practice.
But there should also be other aims. He was, for example, a champion of breastfeeding and understood the importance of bonding between mother and baby.
Despite his success, Simpson still faced opposition and prejudice. While anaesthesia for routine operations was no longer controversial, surgeons worried about applying it to the pains of labour. Many medical, clerical and lay critics took the view that such pains were either good for the mother or else ordained by God.
It was lucky for Simpson that the religious royal couple Queen Victoria and Prince Albert kept having children. In 1847 Simpson was appointed one of her physicians, and she gave birth to her eighth child, Prince Leopold, under anaesthesia. Loyal subjects would hardly object after that. In 1866, Simpson received a baronetcy.
Despite his interest in technological aids, Simpson was more patient and less interventionist than other colleagues. He thought closer attention should be paid to infection and sepsis in hospital.
In 1850 he argued puerperal fever and surgical fever were identical and that both were contagious. They might be transmitted to stricken patients through the fingers of the surgeon or the carbolic acid used to dress the wounds. New safeguards were needed.
What was more, Simpson believed this kind of infection was closely related to defects in the design, ventilation and management of large hospitals. He collected a mass of statistical data to show that death after amputation was most common in these large hospitals and lowest at home or in a cottage hospital. He devoted himself to the design of hospitals, where alterations in layout and management could limit sepsis.
Simpson grew formidable in public medical debates, seizing straight on controversial subjects that different types of professional surgeon had long considered to be their own. Not the least of his skills was his inspiring and vigorous personality, which made him a successful lecturer and practitioner. Liberal in his social attitudes, he advanced the cause of foreign students in Edinburgh and supported the medical education of women.
He gave a new character to surgery, as something almost always healing rather than capable of killing. Anybody who could help was welcome through the front door of 52 Queen Street.
