A large jolly man with broad shoulders, large hands, blue eyes, and a charismatic personality, James Young Simpson was said to have been the most popular man in Edinburgh since the death of Sir Walter Scott.1 Born in 1811 at Bathgate, he was the seventh son of a village baker in a poor family housed in a four-room cottage and with a total income of eight shillings and threepence.2,3 He was the pride and hope of the family, and at age fourteen was sent to study at the University of Edinburgh, “very, very young, very solitary, and almost friendless.”3 He is said to have won a scholarship of ten pounds a year and shared a room with two other students at three shillings a week.3 He first underwent literary studies, then qualified to practice medicine by age nineteen.
After a stint as a country doctor, Simpson returned to Edinburgh to lecture at the University. His ascent was rapid, and at twenty-four he was president of the Royal Medical Society of Edinburgh (1835). In those days, professorships in midwifery at the University of Edinburgh were awarded by local election, and he campaigned under the motto that if he did not think he was the best man he would not have gone for the job. When people whispered that no professor of midwifery could possibly be a bachelor, he married, and after a “fierce contest” was elected by a single vote (1839).1,4 He proved himself to be an excellent teacher and also developed a phenomenal obstetrics practice, women from all over Britain and Europe coming to have their babies delivered by him. In 1847 he was appointed accoucheur to Queen Victoria.2
During his long career, Simpson published on a wide variety of subjects, beginning in 1835 with a paper read before the Royal Medical Society on diseases of the placenta. He invented uterine sounds and pessaries, and wrote on numerous obstetrical subjects such as closing vesico-vaginal fistulae, removing uterine fibroids, fetal malformations, Siamese twins, and intrauterine diseases. He also published on homeopathy, leprosy, syphilis, cholera, the prevention of scarlet fever and measles, and the eradication of smallpox. By the time of his death in 1870 he had also written papers on archaeology, the construction of hospitals, ancient sculptures on the walls of caves, the Great Pyramid of Egypt, Roman medical stamps, and even on whether the Roman army had been provided with medical officers.2,4
Earlier on, while on a consultation to an aristocratic lady in London, he attended on December 21, 1846 a party at the house of Robert Liston celebrating his former teacher’s first use of ether as an anesthetic. He at once began to consider its possible application in childbirth, but at the time, and for many years to come, encountered numerous and heated objections. Did not the Bible say “in sorrow shalt thou bring forth children”? What about safety for the mother and what might be the long-term effects on the baby? Yet returning to Edinburgh, Simpson took a bold step and on January 27, 1847 carried out the first delivery under ether anesthesia.2 By March of that year he was able to report that he had used ether forty or fifty times with “the most perfect safety and success.” Ether, however, was an unpleasant anesthetic, slow and uncertain in action, irritating to the air passages, and at the time seems to have required special apparatus for its administration.
Later in 1847, while trying on himself various other chemical compounds, Simpson happened to learn from a Liverpool chemist about chloroform. This substance had been produced simultaneously around 1831 in America, France, and Germany by scientists working independently of each other and studied for ten years by the French chemist JB Dumas, former teacher of Louis Pasteur. It was a liquid with a sweetish odor, rapidly absorbed when inhaled, quick in its action, and easier to use.
On the evening of November 4, 1847, at a social party after dinner, with ladies present and experiments with anesthesia then being a common social entertainment, Simpson and his friends inhaled some chloroform. They became relaxed, boisterous, expansive, laughing and joking, then passed out and found themselves on the floor. As they recovered they concluded that the experience had been most enjoyable and Simpson declared this was far stronger and better than ether.1,4 He began to use it almost immediately and by November 15, 1847 was able to read a paper at a local medical society on it use in three surgical patients, the first being a Highland boy who could only speak Gaelic and underwent an orthopedic operation on his forearm.4 His first obstetric case was that of the daughter of an Edinburgh physician whom he christened Anaesthesia. For many years her photograph at age seventeen stood on Simpson’s desk, and he called her his patron saint, St. Anaesthesia.4
As is often the case with seminal inventions, the primacy or originality of Simpson’s work has not gone unchallenged. It has been pointed out that the anesthetic qualities of chloroform had been described as early as 1842 and presented as a thesis at the University of Edinburgh in the summer of 1847. Also, its use during a dental procedure may have antedated that of Simpson by a few days. Yet Simpson undoubtedly deserves the credit for using chloroform to make childbirth painless and becoming its advocate against prevailing objections. Soon chloroform became widely used in childbirth, and in 1853 was used to deliver Queen Victoria’s son, Prince Leopold. “It acted admirably. It was not at any time given so strongly as to render the Queen insensible, and an ounce of chloroform was scarcely consumed during the whole time. Her Majesty was greatly pleased with the effect.”5
Chloroform became the favorite anesthetic of most surgeons in England, including John Lister, although ether continued to be more popular in America. It soon became clear, however, that chloroform was not free from ill-effects, and as early as 1848 a death from its use was reported from Cincinnati, and deaths also began to occur in England.2 Yet compared to its enormous use, these events at the time were considered almost trivial.2 Eventually chloroform was replaced by safer anesthetics — nitrous oxide in the delivery room and barbiturates in general surgery — but this was much later, and at the time its use was a revolutionary advance. Simpson received many honors, medals, and awards in Britain and abroad. He was knighted, given an honorary doctorate degree by the University of Oxford, and in 1869 received the freedom of the city of Edinburgh. In 1970, on the one hundredth anniversary of his death, E. Gaskell wrote as follows: “His life had been vigorous and full, in the best Victorian tradition: his achievements quite extraordinary to the point of brilliance – in an age which teemed with brilliant achievements. Like Dickens, who died a month later and one year younger, he had aroused adulation and jealousy wherever he passed; and, like Dickens, his memory [is] secure…”6 and posterity remembers him as the man who made childbirth painless for millions of women.
- Harley Williams. Masters of Medicine, Pan Books, London, 1954, page94.
- British Medical Journal, 1870;1:505 (May14)
- British Medical Journal, 1933;2:538 (September 16)
- Guthrie, D. Centenary of chloroform anaesthesia. British Medical Journal, 1947;2:701 (November 1)
- Simpson I. “A Happy Event” British Medical Journal, 1953;1:1110 (May16)
- Gaskell E. Three letters by Sir James Young Simpson, 1970;2:414 (May14)
GEORGE DUNEA, MD, Editor-in-Chief