Pod Insights Noble Blood The Chloroform Baronet (Part 1) About this episode James Young Simpson, as a young surgeon, was distraught at the seemingly inescapable pain and fear that patients were suffering. He decided to try to find a better solution.
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1:35 Dana Schwartz? Welcome to Noble Blood, a production of iHeartRadio and Grim and Mild from Aaron Mankey. Listener discretion advised.
1:44 Dana Schwartz? Around 1829, 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.
2:03 Dana Schwartz? 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, "Time 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
2:45 Dana Schwartz? 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, Liston could do it in just 30 seconds. Mastectomies were particularly gruesome and painful. After taking the woman from the highlands 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, trigger warning, lift the soft tissue of her breast
3:28 Dana Schwartz? 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 19-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, but the idea of actually performing surgery made him a little uneasy. His own pain tolerance was low.
4:13 Dana Schwartz? 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 patients 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
4:53 Dana Schwartz? 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?" Little could he possibly know that this question would go on to define his medical career.
5:33 Dana Schwartz? 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 14, 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, saucy, callant, with a wide face with dimples on his cheeks and a particularly large head," end quote. His early years at school were miserable. Later, Simpson recalled that he felt,
6:17 Dana Schwartz? quote, "very, very young and very solitary, very poor and almost friendless."
6:24 Dana Schwartz? 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 1828, where he studied with Robert Liston, the lightning-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 1830, and then prepared his doctoral thesis so he could pursue his M.D.
7:04 Dana Schwartz? 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. His 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
7:49 Dana Schwartz? 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. The 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.
8:28 Dana Schwartz? 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 balked 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, "His winning manners, his power of entering fully and at once into the mind and heart of the patient,
9:09 Dana Schwartz? wonderfully reinforced his professional sagacity and skill." And so in 1836, Simpson began to practice midwifery at the maternity hospital in Edinburgh on the side. He started lecturing about midwifery at the medical school in 1838, and even opened up a popular private practice operating out of his townhouse. The Lancet gushed, "His 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.
9:53 Dana Schwartz? He had to be elected into the position by his colleagues, and he had two serious disadvantages. He was young, only 28 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.
10:35 Dana Schwartz? 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: the pain of his patients. Seeing his patients suffer through childbirth disturbed him. He wrote to a fellow doctor in 1836, "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
11:20 Dana Schwartz? 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 1846 that he heard promising news about a potential anesthetic: a colorless, sweet-smelling gas called ether.
12:02 Dana Schwartz? Ether had been around for hundreds of years, but mostly as a, to put it frankly, "party drug." During a dinner party or salon in the early 19th century, guests might participate in "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 partygoers, a dentist in Boston decided to see if it could be used medicinally.
12:42 Dana Schwartz? On October 16th, 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.
13:24 Dana Schwartz? The surgery took all of 28 seconds, the patient felt nothing, and Liston is said to have exclaimed, "This Yankee Dodge, gentlemen, 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 ether. One proclaimed that he had the most "pleasurable sensations" while on ether, while another said he was transported to "a beautiful heaven" and cried with joy when her operation was over without any pain at all.
14:05 Dana Schwartz? 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 Queen the next day to appoint him the Queen's physician in Scotland, he was comparatively unmoved.
14:46 Dana Schwartz? 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 ether that he even used it for so-called "natural births", because he thought that it had the potential to increase survival rates. While ether was better than the alternatives, a few months later Simpson's enthusiasm about ether began to fade.
15:24 Dana Schwartz? March 1847, a 21-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. Even in less fatal cases, ether had a number of drawbacks. The gas had an overpoweringly acidic, stinging smell that irritated the throat, even causing choking for some patients. It caught fire if it was too close to a candle or gas light. It was also cumbersome to use.
16:09 Dana Schwartz? 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 10 minutes was a difficult and unpleasant task. Simpson wanted to find a better solution. Over the summer and fall of 1847, he did a series of experiments with different chemicals to see if they could be used for surgery.
16:52 Dana Schwartz? 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.
17:32 Dana Schwartz? The group tried out ethyl nitrate, benzene, 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.
18:17 Dana Schwartz? Simpson was already familiar with some experiments other physicians had tried with chloric ether, chloroform diluted with alcohol, which 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 4th, 1847, he decided to give chloroform a try. Sitting around the dinner table were his typical surgery buddies, but also his wife,
19:02 Dana Schwartz? 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 agape, unconscious and snoring.
19:46 Dana Schwartz? Simpson heard a thump and turned to see the other man under the table, flailing his legs before tiring 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." The party lasted until 3 a.m. I want to take a brief moment here for any slightly younger listeners of Noble Blood,
20:29 Dana Schwartz? 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 patients. On November 8, 1847,
21:13 Dana Schwartz? only four days after Simpson's 3 a.m. 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, dipped it in chloroform, and put it over the patient's nose and mouth. Twenty-five minutes later, Jane Carstairs woke up.
21:54 Dana Schwartz? 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, a baby girl who 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.
22:37 Dana Schwartz? 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. But keep listening after a brief sponsor break to hear a little bit more about that miraculous first chloroform baby. You know all those pieces in your closet that you find yourself reaching for over and over again? You know, the sweater that works with every outfit you try on and the jeans that you know will always fit you just right? Or the bag you carry everywhere? Those are the exact pieces that earn a place in your wardrobe. And that's exactly what Quince does so well.
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25:25 Speaker 06 Hey, it's Niall Rogers, host of Before the Moment, a Lincoln original series. I'm driving across the country, meeting some of today's most fascinating artists. We're exploring the stories before the moment that changed everything. This week, I'm joined by my friend, John Ledger. What still makes you just sit down at the piano?
25:48 Speaker 07 If you sat down at 9:00 AM and then at noon, you had a full song that you recorded and put in your voice recorder or you recorded at your studio, you just created something brand new that didn't exist when you woke up. What a beautiful feeling it is. I'm always excited to write something new. I've been writing for Broadway, which has been a new challenge with new collaborators and these amazing performers who are triple threads, who can sing and dance and act and do all these amazing things. And I want to keep feeling that. And so that means not resting on my laurels, going out there and continuing to create something new.
26:23 Speaker 06 Experience Before the Moment, a Lincoln original series on the iHeart Radio app, YouTube, or wherever you get your podcasts.
26:34 Dana Schwartz? If you go to any modern obstetrician, it's a common sight to see a bulletin board with letters and Christmas cards featuring the cherubic babies that the doctor helped deliver. It's a sweet thing for a doctor to keep in touch with the baby he or she brought into the world. James Young Simpson agreed. He kept in touch with the baby he delivered painlessly to Jane Carstairs, exchanging letters as the baby girl grew up. He also kept a photo of her on his desk, referring to her as Saint Anesthesia because of the pious expression on her face. It's a common misconception that the baby's name actually
27:18 Dana Schwartz? was Anesthesia. And while I will say, that would be a beautiful name for a baby girl, it was only a nickname. Her real name was Wilhelmina, but for anyone looking for a unique baby name, Anesthesia is right there waiting for you.
27:43 Dana Schwartz? Noble Blood is a production of iHeart Radio and Grim and Mild from Aaron Manke. Noble Blood is hosted by me, Dana Schwartz. Writers for Noble Blood are Hannah Johnston, Hannah Zwick, Paul Jaffe, Natasha Lasky, and me, Dana Schwartz. The show is edited and produced by Jesse Funk and Gomes Griffin, with supervising producer, Reema Ilkayali, and executive producers Aaron Manke, Trevor Young, and Matt Frederick. For more podcasts from iHeart Radio, visit the iHeart Radio app, Apple Podcasts, or wherever you listen to your favorite shows.
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28:59 Speaker 06 Hey, I'm Niall Rogers. This fall, I'll be driving across the country, meeting some of today's coolest and most fascinating artists. We'll explore the stories before the moments that changed everything. Because every musician remembers the moment where it all began. Experience Before the Moment, a Lincoln original series on the iHeart Radio app, YouTube, or wherever you get your podcasts.
29:31 Dana Schwartz? This is an iHeart Podcast. Guaranteed Human.
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