Simpson and chloroform

Some discoveries arrive at the bench, in the slow accretion of a careful programme. Others arrive at the dining table, after the soup is cleared and the candles are lit, when a physician who has spent the day delivering children of the Edinburgh poor decides that the next compound in the wooden box deserves a turn at his own lungs. The history of medicine has its martyrs and its theorists; it also has its hosts, the men who poured a measure onto a folded handkerchief and breathed in before they asked anyone else to.

THE PROFESSOR AT QUEEN STREET

James Young Simpson, seventh and youngest child of a Bathgate baker, took his MD at Edinburgh at twenty-one, the youngest medical doctorate the Scottish universities had yet recorded, and by 1839 sat in the Chair of Midwifery at the age of twenty-eight. He had built, in the eight years since, the largest obstetric practice in Scotland, run out of the tall grey terrace at 52 Queen Street. He knew the pain of childbed in a way the surgical theatres did not: not the single shock of the knife but the long hours, the exhaustion, the woman who survived the delivery and did not survive the week. The Boston demonstration of October 1846 had shown that ether could put a man under for the saw; Simpson had used it on the labour ward within months, and found it wanting. Slow to take. Harsh on the lung. It would not do for women in the eighteenth hour of labour. So he had taken to walking down to Duncan and Flockhart on the South Bridge, asking for whatever clear volatile liquid the chemists could spare in an ounce bottle, and carrying the box home.

THE FOURTH OF NOVEMBER

The evening is dark by five. The dining-room at Queen Street is panelled, lamp-lit, the cloth cleared, the decanters left on the sideboard for the gentlemen. Across the table sit George Keith, thirty-five, his junior partner; and James Matthews Duncan, twenty-one, Aberdeen-trained, his residential assistant since the summer. On the table is the wooden box: ten glass bottles, each holding about an ounce, each a candidate. Two have already been tried earlier in the fortnight and dismissed, a Dutch acetone preparation and a bromide of ethylene, mild things, dizziness and nothing more. The third bottle was brought up from the South Bridge on the Tuesday. Trichloromethane. A clear sweet-smelling liquid, named chloroform by the French chemist Soubeiran in 1831, written of in the journals, but never given to a human lung for the purpose of putting that human to sleep.

THE THIRD BOTTLE

He considers it. The room is warm, the conversation easy; outside, the November rain is on the area railings. He is a professor of midwifery, not a chemist, and the bottle in his hand has not been tested on a dog or a rabbit; it has been described in print and it has been sniffed at the bench, and that is all. He knows what he is risking. He has six children of his patients delivered this month who would not have been delivered without forceps and ether, and three who were delivered with neither, screaming, and one who died of exhaustion before the head was through. He thinks of the verse the ministers like to quote when he speaks of pain relief, in pain thou shalt bring forth children, as though pain were a sacrament and not a wound. He has read Soubeiran. He has read Liebig. He has held the bottle to the light. Keith is watching him; Duncan is watching him. He is thirty-six, he is the youngest professor in the faculty, and he has decided that the next compound in the box will be tried tonight by the only laboratory animal he is prepared to inflict it on, which is himself. He pours a measure onto a folded handkerchief and raises it to his face, and Keith and Duncan, who have been with him long enough to know the rule of the house, do the same.

THE FLOOR

Within a minute the conversation rises. The talk becomes, by Simpson's own note set down in the small hours, animated and full of laughter. The three are, he writes, most happily under the influence and shewing the effects we had been seeking. Then the floor. Keith's head slides into the fender; Duncan goes under his chair. Simpson, the heaviest of the three, slumps against the table-leg. The handkerchiefs fall from their hands and the room goes quiet.

THE LADY OF THE HOUSE

Jessie Simpson, who has been in the parlour with the older children, comes through at about ten and stops in the doorway. I found Mr Simpson on the carpet, Dr Keith with his head in the fender, Dr Duncan under the chair. I thought for a moment they were dead. She is the wife of an obstetrician; she has been called from her bed often enough to know the colour of the dying, and these three are not dying, they are breathing slow and even on the dining-room floor. She calls the housekeeper. Between them they turn the three onto their sides, loosen the collars, open the window to the cold of Queen Street. She sits down in her husband's chair and waits. The clock on the mantel goes round to eleven. Somewhere in the city, in a back room she does not know, a woman is in the eighteenth hour of a labour that will not advance, and for that woman this hour on the dining-room carpet is the hour that everything turns.

THE PAPER

Simpson comes round first, at about half past eleven, heavy-headed and clear. He wakes the others. He goes to the sideboard, opens the notebook he keeps there, and begins to write while the sensation is still on him: the speed of induction, the sweetness on the breath, the absence of the pulmonary catch that ether had given. He stays at the dining-room table until three in the morning. On the eighth of November, four days later, he administers chloroform to Jane Carstairs at her Edinburgh home for the delivery of her second child; the child is born without her knowledge of the passage. On the tenth of November he reads the paper, Account of a New Anaesthetic Agent as a Substitute for Sulphuric Ether in Surgery and Midwifery, to the Edinburgh Medico-Chirurgical Society. By the following month it is in use in London, in Paris, in Boston.

THE PULPIT AND THE PALACE

The Church of Scotland answers from the pulpit. Pain in childbirth is the ordinance of Genesis; to abolish it is to set the physician against the Almighty. Simpson, who knows his Bible as well as any man in the New Town, answers in a pamphlet: the same God who put Adam into a deep sleep before taking the rib was, by his reading, the first anaesthetist. The argument runs on for six years in the Edinburgh and London journals, and is settled not by theology but by precedent. On the eighth of April 1853, in a bedroom at Buckingham Palace, the London anaesthetist John Snow administers chloroform to Queen Victoria for the birth of Prince Leopold. The Queen, in her journal, calls it soothing, quieting and delightful beyond measure. After that the pulpits go quiet. By the 1860s the practice is standard in Edinburgh, in London, in Boston, in Vienna.

THE STONE AT WARRISTON

Simpson was knighted in 1866, the first knighthood given for medical services in Scotland, and made a baronet the same year. He died at 52 Queen Street on the sixth of May 1870, fifty-eight years old, worn through. Westminster Abbey offered him a place in the south transept; he declined, and was buried at Warriston in Edinburgh, behind the longest funeral procession the city had on its nineteenth-century record. The decisive moments of medicine are not always made in laboratories, and the men who make them are not always chemists. Sometimes they are obstetricians who have sat too long with women in pain, and who have decided, on a Thursday evening in November, that the next bottle in the box will be opened tonight, and that the first lung it enters will be their own. On the south wall of the Queen Street house there is a bronze plaque, set there in 1947 when the building passed back into private hands, and the inscription is the only one the city judged the moment required: In this house on the fourth of November 1847 Sir James Young Simpson first discovered the anaesthetic properties of chloroform.