WEBVTT - The Chloroform Baronet (Part 2) 0:00:00.280 --> 0:00:04.640 Welcome to Noble Blood, a production of iHeartRadio and Grimm 0:00:04.640 --> 0:00:10.160 and Mild from Aaron Manky. Listener discretion advised. This is 0:00:10.320 --> 0:00:14.800 part two of our episode on James Young Simpson. If 0:00:14.800 --> 0:00:17.880 you haven't listened to part one yet, you should probably 0:00:17.960 --> 0:00:26.880 start there. On November eighth, eighteen forty seven, James Young 0:00:26.960 --> 0:00:32.159 Simpson successfully used chloroform for the first time for a 0:00:32.200 --> 0:00:36.920 pain free delivery of a baby. Just two days later, 0:00:37.320 --> 0:00:40.560 he was ready to share his successes with the rest 0:00:40.680 --> 0:00:45.000 of the medical community. He invited colleagues into his own 0:00:45.080 --> 0:00:49.360 home for a demonstration where a dentist used chloroform for 0:00:49.440 --> 0:00:54.120 a tooth extraction in front of an audience of scientific observers. 0:00:54.840 --> 0:00:57.840 One of the observers was a surgeon in the Edinburgh 0:00:57.920 --> 0:01:01.200 Royal Infirmary, and he was so so impressed by the 0:01:01.400 --> 0:01:06.280 painless tooth extraction that Simpson managed to convince him to 0:01:06.400 --> 0:01:12.280 try using chloroform in surgery. Two days later, with Simpson overseeing, 0:01:12.800 --> 0:01:18.039 that surgeon used chloroform to amputate a diseased forearm on 0:01:18.160 --> 0:01:22.800 a five year old boy. After the operation, the surgeon 0:01:22.880 --> 0:01:27.120 recalled that the patient quote was found in bed like 0:01:27.160 --> 0:01:31.640 a child newly awakened from a refreshing sleep, with a clear, 0:01:31.840 --> 0:01:36.720 merry eye and placid expression of countenance, wholly unlike what 0:01:36.840 --> 0:01:43.840 is found to obtain after ordinary etherization end quote. Within 0:01:43.920 --> 0:01:49.320 a week, Simpson had successfully tested chloroform on thirty patients, and, 0:01:49.480 --> 0:01:53.480 in a frenzy, wrote a paper for publication in The Lancet. 0:01:54.160 --> 0:01:58.320 He wrote about the chemical with flowery enthusiasm, saying that 0:01:58.400 --> 0:02:03.000 it had quote an agreeable, fragrant, fruit like odor and 0:02:03.120 --> 0:02:07.880 a second pleasant taste. This might seem over the top 0:02:08.360 --> 0:02:13.359 and more pertinently premature, given that the chemical had only 0:02:13.400 --> 0:02:16.320 been in use for about a week, and a good 0:02:16.400 --> 0:02:19.040 number of those that had tried it had taken it 0:02:19.160 --> 0:02:23.839 recreationally in Simpson's dining room, but it was clear even 0:02:23.960 --> 0:02:29.720 by that point that chloroform had distinct advantages, especially when 0:02:29.760 --> 0:02:35.360 compared with ether. Chloroform was cheaper and more portable than ether, 0:02:36.000 --> 0:02:40.600 and easier to use. Physicians could hold up a handkerchief 0:02:40.639 --> 0:02:46.160 to their patient's faces rather than using a cumbersome, imposing inhaler. 0:02:46.880 --> 0:02:51.360 Chloroform didn't have a noxious smell that irritated the throat, 0:02:52.080 --> 0:02:55.840 Physicians needed far less of it to sedate their patients, 0:02:56.280 --> 0:02:59.720 and it worked much more quickly and reliably than ether. 0:03:00.919 --> 0:03:05.560 Simpson was so confident about the efficacy of chloroform that 0:03:05.639 --> 0:03:10.880 he wrote a pamphlet promoting the chemical intended for general audiences, 0:03:11.040 --> 0:03:16.200 titled on a New Anesthetic Agent More Efficient than Sulfuric Ether. 0:03:17.200 --> 0:03:19.840 By the end of the month, that pamphlet had sold 0:03:20.120 --> 0:03:26.280 fifteen hundred copies. On December fifteenth, Edinburgh Hospital convened a 0:03:26.360 --> 0:03:31.840 meeting that unanimously concluded that they should use chloroform instead 0:03:31.840 --> 0:03:36.240 of ether in all operations at the hospital moving forward. 0:03:37.280 --> 0:03:42.240 One committee participant recalled there was no instance on record 0:03:42.520 --> 0:03:46.320 where the discovery of a remedy had been so rapidly 0:03:46.520 --> 0:03:51.760 made known and its employment so universally adopted as that 0:03:52.080 --> 0:03:57.480 of the inhalation of chloroform. Before the end of eighteen 0:03:57.680 --> 0:04:02.760 forty seven, established man manufacturers were unable to keep up 0:04:02.800 --> 0:04:06.720 with demand, and new firms were springing up to cash 0:04:06.760 --> 0:04:11.320 in on the rush. But not every doctor was as 0:04:11.520 --> 0:04:16.520 enthusiastic about chloroform as Simpson. There was a dark fear 0:04:16.720 --> 0:04:22.839 around chloroform for both philosophical and medical reasons, and Simpson 0:04:22.920 --> 0:04:26.680 would need to navigate those fears when faced with his 0:04:26.880 --> 0:04:31.600 most important patient yet, a woman who certainly knew her 0:04:31.640 --> 0:04:38.599 way around childbirth. Queen Victoria, I'm Danish forts and this 0:04:38.800 --> 0:04:46.520 is noble blood. One strain of criticism against chloroform arose 0:04:46.640 --> 0:04:51.560 from broader concerns about whether pain had any biological purpose. 0:04:52.480 --> 0:04:56.120 At the time, it was common medical practice that the 0:04:56.160 --> 0:05:00.920 physician should not interfere with the body's natural process and 0:05:01.040 --> 0:05:05.560 should instead leave the body alone to heal itself. Because 0:05:05.720 --> 0:05:10.200 pain was considered a natural function, many doctors thought that 0:05:10.279 --> 0:05:14.719 suppressing it with anesthesia might cause more harm to the patient. 0:05:15.920 --> 0:05:20.480 Simpson had no patience for that argument. He rebutted that 0:05:20.600 --> 0:05:25.200 pain was unnecessary and destructive. In an early paper, he 0:05:25.320 --> 0:05:30.560 quoted the second century Greek physician Galen quote pain is 0:05:30.800 --> 0:05:34.719 useless to the pained. He also had statistics to back 0:05:34.760 --> 0:05:39.000 it up. He found that the mortality rate associated with 0:05:39.160 --> 0:05:44.440 amputation of the thigh decreased from fifty percent to twenty 0:05:44.560 --> 0:05:49.240 five percent when the patients were anesthetized, suggesting that taking 0:05:49.279 --> 0:05:54.960 away patient's pain improved their healing rather than inhibiting it. 0:05:56.320 --> 0:06:01.480 This line of reasoning, buttressed by data, convinced some doctors 0:06:01.520 --> 0:06:05.919 that chloroform was safe to use in surgery. After all, 0:06:06.320 --> 0:06:12.799 surgery is an inherently invasive, unnatural process. The body cannot 0:06:12.920 --> 0:06:18.080 naturally amputate a limb or biopsy by itself, and even 0:06:18.120 --> 0:06:23.080 though early anesthetics were unreliable, opiates and other forms of 0:06:23.160 --> 0:06:27.640 pain reduction have been used in surgery for centuries without 0:06:27.760 --> 0:06:33.880 much controversy, But many physicians balked at Simpson's use of 0:06:34.000 --> 0:06:41.279 chloroform during routine childbirth. Unlike surgery, childbirth is a process 0:06:41.320 --> 0:06:45.640 that the body can undergo without medical intervention. Doctors and 0:06:45.880 --> 0:06:50.680 midwives alike thought that they should facilitate so called natural 0:06:50.920 --> 0:06:56.279 labor without getting in the way. A common adage was quote, 0:06:56.440 --> 0:07:01.599 A meddlesome midwifery is bad because to meddle in any 0:07:01.680 --> 0:07:05.919 of the natural functions of labor, including or relieving pain, 0:07:06.680 --> 0:07:10.960 might cause things to go wrong. But disbelief in the 0:07:11.040 --> 0:07:15.200 importance of labor pain was just as moral as it 0:07:15.320 --> 0:07:20.960 was medical. Victorian women were expected to show their femininity 0:07:21.040 --> 0:07:25.800 by suffering for the greater good. Popular women's conduct manuals 0:07:25.840 --> 0:07:29.240 from the eighteen forties, like the Women of England and 0:07:29.520 --> 0:07:33.840 the Wives of England by Sarah Stickney Ellis, argued that 0:07:33.960 --> 0:07:40.520 women's moral authority came from being patient self sacrificing and disciplined. 0:07:41.680 --> 0:07:46.920 Childbirth was considered the ultimate display of virtue, as being 0:07:46.960 --> 0:07:49.880 able to suffer through pain for the good of a 0:07:50.000 --> 0:07:55.440 child was the ultimate symbol of sacrifice. It also had 0:07:55.600 --> 0:08:00.840 biblical precedence, with the quote in sorrow, thou shalt bring 0:08:00.960 --> 0:08:06.840 forth children from Genesis three sixteen, quote, proving that pain 0:08:07.000 --> 0:08:12.160 during childbirth was a part of God's higher purpose. Even 0:08:12.200 --> 0:08:16.920 though doctors rarely brought out their Bibles to justify labor pain, 0:08:17.560 --> 0:08:22.960 many physicians critical of chloroform used religious language to talk 0:08:23.000 --> 0:08:28.679 about the medical utility of women's physical suffering. As one 0:08:28.840 --> 0:08:32.400 physician put it at the time, quote, the agonies of 0:08:32.520 --> 0:08:36.440 delivery were an indicator of safety and a well nigh 0:08:36.640 --> 0:08:41.440 holy accompaniment of childbirth. Another doctor wrote that it was 0:08:41.600 --> 0:08:46.680 ultimately more ethical to convince their patients to endure labor 0:08:46.760 --> 0:08:51.760 pain because relieving it would deny their biological destiny, as 0:08:51.880 --> 0:08:58.120 quote Daughters of Eve. An obstetrician from Liverpool suggested that 0:08:58.200 --> 0:09:03.120 women who wanted chloroform or childbirth were shirking their natural 0:09:03.200 --> 0:09:07.720 duty and thus were so ethically dubious that they were 0:09:07.880 --> 0:09:12.120 quote in no fit state to make decisions and thus 0:09:12.160 --> 0:09:15.640 should be ignored. Quote, are we going to allow the 0:09:15.720 --> 0:09:20.880 patient to tell us what to do? He wrote. Most 0:09:20.920 --> 0:09:25.080 of these early and influential critics of chloroform did not 0:09:25.480 --> 0:09:31.200 only have ethical concerns. They also worried about chloroform's safety, 0:09:31.640 --> 0:09:35.839 since this was an experimental drug that had gone from 0:09:35.920 --> 0:09:40.960 a niche chemical solvent to a pretty popular anesthetic in 0:09:41.040 --> 0:09:45.360 a little over a month. These critics were also suspicious 0:09:45.440 --> 0:09:50.880 of how Simpson advertised chloroform directly to the public before 0:09:50.920 --> 0:09:55.680 it had been properly tested. One physician wrote quote, I 0:09:55.800 --> 0:10:00.200 did not expect that doctor Simpson would have appealed so 0:10:00.400 --> 0:10:04.880 generally and through so many channels to the feelings and 0:10:05.080 --> 0:10:09.920 imperfect knowledge of society in general. For it is, i 0:10:09.960 --> 0:10:14.720 am happy to say, still very uncommon in our profession 0:10:15.280 --> 0:10:18.560 to find those of its members who would give tone 0:10:18.760 --> 0:10:22.800 to its bearing and conduct. Professors, for instance, of our 0:10:22.840 --> 0:10:27.400 ancient universities going about from one city to another to 0:10:27.520 --> 0:10:31.920 announce and exhibit the wonder effects of new gas, and, 0:10:32.160 --> 0:10:36.400 as I am informed, somewhat after the fashion of a showman, 0:10:36.920 --> 0:10:42.600 to demonstrate them personally at dinner parties and in drawing rooms. 0:10:43.679 --> 0:10:49.840 Simpson replied personally, writing quote, my blood feels chilled by 0:10:49.880 --> 0:10:55.240 the cruel inhumanity and deliberate cruelty which you and some 0:10:55.400 --> 0:10:59.920 members of the profession openly avow you have not yet 0:11:00.160 --> 0:11:04.239 had time to get rid of some old professional caprices 0:11:04.679 --> 0:11:10.920 and nonsensical thought. Simpson invited that physician to stay with him, 0:11:11.360 --> 0:11:15.880 perhaps to try out chloroform himself, but the physician declined. 0:11:17.160 --> 0:11:22.400 That doctor did have a point, though throughout eighteen forty seven, 0:11:22.880 --> 0:11:27.440 Simpson was still riding the high of his discovery, both 0:11:27.600 --> 0:11:33.480 metaphorically and literally. He hawked chloroform to anyone who would listen, 0:11:33.840 --> 0:11:38.360 and pushed the drug on unwitting dinner guests. While his 0:11:38.640 --> 0:11:41.600 sister in law was a bit cautious after her first 0:11:41.679 --> 0:11:46.360 experiment with it on November fourth, Simpson used to joke 0:11:46.760 --> 0:11:50.000 that he would chloroform her, and he chased her around 0:11:50.000 --> 0:11:54.880 the house with a bottle, laughing. Once, Simpson made a 0:11:54.920 --> 0:11:59.240 cocktail with chloric ether and aer rated water, which he 0:11:59.320 --> 0:12:03.760 called chlor reform champagne, and served it to a dinner party. 0:12:04.679 --> 0:12:09.200 They found it nice but quote hetty. The butler offered 0:12:09.200 --> 0:12:12.920 some to the cook, who downed it and immediately collapsed. 0:12:13.400 --> 0:12:17.560 The butler ran upstairs announced that he had poisoned the cook, 0:12:18.120 --> 0:12:21.520 and the guests rushed to the kitchen to find the 0:12:21.600 --> 0:12:27.840 cook on the floor snoring loudly. The incident was not fatal, 0:12:28.320 --> 0:12:34.800 but it did disturb Simpson's guests. Simpson, however, was completely undeterred, 0:12:35.440 --> 0:12:40.400 as one widow of an Edinburgh physician later recalled the 0:12:40.480 --> 0:12:45.120 professor used to try his experiments with chloroform on us girls. 0:12:45.679 --> 0:12:49.240 He was then just introducing it, and with some of 0:12:49.280 --> 0:12:53.400 the liquid simply poured onto a handkerchief, would have half 0:12:53.440 --> 0:12:57.240 a dozen of us lying about in various stages of sleep. 0:12:57.840 --> 0:13:02.360 Our mother feared nothing and was only too delighted to sacrifice, 0:13:02.720 --> 0:13:09.679 if unavoidably, a daughter or two to science. Chloroform's critics 0:13:09.880 --> 0:13:16.240 listed their reasonable practical objections alongside more philosophical ones about 0:13:16.240 --> 0:13:20.520 the nature of pain and the feminine virtue of suffering. 0:13:21.200 --> 0:13:28.480 This rhetorical strategy majorly backfired. Simpson couldn't effectively undermine his 0:13:28.559 --> 0:13:32.280 critics concerns about the safety of chloroform because it was 0:13:32.320 --> 0:13:35.640 still so early, so no one had the data to 0:13:35.720 --> 0:13:40.120 prove anything substantial either way, and so he went after 0:13:40.200 --> 0:13:45.600 his critics' moral arguments instead, which were on more shaky ground. 0:13:46.800 --> 0:13:52.800 Simpson was willing to fight directly with his critics in pamphlets, articles, 0:13:52.800 --> 0:13:58.559 and published letters directly responding to their points. In December 0:13:58.640 --> 0:14:03.960 eighteen forty seven, and Simpson published a pamphlet entitled Answers 0:14:04.040 --> 0:14:09.160 to the Religious Objections Advanced against the Employment of anesthetic 0:14:09.200 --> 0:14:13.800 agents in midwafery and surgery and Obstetrics. In the pamphlet, 0:14:14.160 --> 0:14:19.160 Simpson wrote that the traditional interpretations of the Biblical quote 0:14:19.680 --> 0:14:23.880 in sorrow, thou shalt bring forth children did not mean 0:14:24.080 --> 0:14:27.720 that women were to experience pain, but that they were 0:14:28.040 --> 0:14:33.960 to work during childbirth. He dismissed the moral arguments about 0:14:34.000 --> 0:14:39.680 a woman's inherent predisposition towards suffering as quote aught else 0:14:39.880 --> 0:14:44.320 than indications of a strange degree of eccentricity of thought. 0:14:45.160 --> 0:14:50.600 He dismissed any objection to the use of chloroform as prejudice, 0:14:50.720 --> 0:14:59.400 but soon chloroform's dangers would be impossible to ignore. In 0:14:59.600 --> 0:15:03.080 New ca Casle, on January twenty eighth, eighteen forty eight, 0:15:03.600 --> 0:15:06.680 a surgeon showed up at the home of a fifteen 0:15:06.760 --> 0:15:11.440 year old girl named Hannah Greener for a routine procedure. 0:15:12.200 --> 0:15:16.680 She had an infected ingrown toenail, and the surgeon had 0:15:16.840 --> 0:15:20.480 arrived to remove it. While it was a minor surgery, 0:15:20.880 --> 0:15:25.160 the nail bed can be surprisingly painful, so the surgeon 0:15:25.320 --> 0:15:29.200 put a teaspoon of chloroform onto a cloth and held 0:15:29.240 --> 0:15:33.720 it toward her nose. She took two breaths before pulling 0:15:33.800 --> 0:15:36.840 the cloth away, but the doctor told her to keep going. 0:15:37.440 --> 0:15:41.600 After the first incision, Hannah flailed until the doctor gave 0:15:41.720 --> 0:15:46.160 her more chloroform. When the doctor pulled up an eyelid 0:15:46.360 --> 0:15:50.480 to check if she was anesthetized, her eye stayed open. 0:15:51.200 --> 0:15:55.640 She turned pale and didn't respond when the surgeon splashed 0:15:55.680 --> 0:16:00.920 water on her face. Two minutes after the surgeon administered chloroform, 0:16:01.400 --> 0:16:06.760 she was dead. An autopsy revealed that quote, congestion of 0:16:06.840 --> 0:16:11.800 the lungs after inhaling chloroform had caused Hannah's death, but 0:16:11.960 --> 0:16:16.400 did not blame the surgeon. The coroner wrote, quote, no 0:16:16.680 --> 0:16:21.520 human foresight, no human knowledge, no degree of science could 0:16:21.560 --> 0:16:25.280 have forewarned any man against the use of chloroform in 0:16:25.400 --> 0:16:30.240 this case. After a report about Hannah's death appeared in 0:16:30.280 --> 0:16:35.280 The Lancet, news spread quickly about the case. It was 0:16:35.440 --> 0:16:40.280 tragic but commonplace for patients to die after surgery from 0:16:40.440 --> 0:16:44.400 infection or blood loss. But it was nearly unheard of 0:16:44.840 --> 0:16:48.080 for a patient to die while surgery had barely begun, 0:16:48.720 --> 0:16:52.200 let alone a young and healthy patient dying during a 0:16:52.320 --> 0:16:58.479 minor operation. Headlines like death by chloroform appeared in newspapers 0:16:58.520 --> 0:17:04.920 across England, but the medical establishment could not reach consensus 0:17:04.960 --> 0:17:09.240 on what exactly had killed her. It was still unclear 0:17:09.400 --> 0:17:13.639 how exactly chloroform worked, so no one knew how it 0:17:13.720 --> 0:17:19.440 had suffocated her. To chloroform skeptics, the episode proved that 0:17:19.480 --> 0:17:23.160 the drug was dangerous and had been adopted too quickly, 0:17:23.960 --> 0:17:29.199 but chloroform supporters thought that these results were inconclusive, and 0:17:29.240 --> 0:17:34.320 that perhaps she died not because chloroform was inherently dangerous, 0:17:34.800 --> 0:17:37.679 but instead because she had been given too much of 0:17:37.720 --> 0:17:42.600 it or it was administered improperly. Some even thought that 0:17:42.720 --> 0:17:46.160 Hannah's death had nothing to do with chloroform at all, 0:17:46.640 --> 0:17:49.600 and that she instead died because of the shock of 0:17:49.640 --> 0:17:55.359 the surgical operation. One physician was unconvinced by all of 0:17:55.400 --> 0:18:01.680 these hypotheses. John Snow, a surgeon from London. Like Simpson, 0:18:02.160 --> 0:18:07.159 Snow was interested in the burgeoning field of anesthesiology, but 0:18:07.480 --> 0:18:11.560 temperamentally these two men could not have been more different. 0:18:12.520 --> 0:18:18.399 Snow was known for being methodical and reserved. He didn't drink, 0:18:18.840 --> 0:18:24.240 eat meat, read novels, or consume any water that hadn't 0:18:24.280 --> 0:18:31.000 been distilled. Unlike Simpson, Snow was a research scientist. He 0:18:31.119 --> 0:18:35.080 had published a paper about how to properly administer ether 0:18:35.520 --> 0:18:39.720 in eighteen forty seven and had been conducting animal studies 0:18:39.760 --> 0:18:43.520 on chloroform throughout the rest of the year to compare 0:18:43.680 --> 0:18:50.280 fatal and non fatal doses. According to historian Linda Stratman, quote, 0:18:50.600 --> 0:18:54.720 he was the personification of order, keeping a diary of 0:18:54.800 --> 0:18:58.960 every case in which he administered an anesthetic and detailed 0:18:59.040 --> 0:19:05.119 notes of his excs. Spearman's end, his familiarity with anesthesia 0:19:05.560 --> 0:19:09.919 meant that he found the most common explanation that the 0:19:10.040 --> 0:19:17.400 chloroform had suffocated Hannah improbable. Usually deaths from asphyxiation were 0:19:17.520 --> 0:19:22.160 slow and involved a lot of visible struggle, but Hannah 0:19:22.440 --> 0:19:27.000 had rapidly collapsed, indicating to him that something else was 0:19:27.080 --> 0:19:34.160 going on. Snow studied the inquest, testimony, and medical reports 0:19:34.560 --> 0:19:39.119 and found that Hannah had not been suffocated. Instead, she 0:19:39.240 --> 0:19:43.800 had overdosed from having been given too much chloroform too quickly. 0:19:44.640 --> 0:19:48.920 Even though Hannah had only been given one teaspoonful of chloroform, 0:19:49.320 --> 0:19:53.959 it was undiluted, so it was in its strongest form. 0:19:54.520 --> 0:19:58.399 Snow emphasized that this made it dangerously easy for a 0:19:58.400 --> 0:20:03.240 patient to overdose. He also found that the surgeon's method, 0:20:03.680 --> 0:20:07.480 holding a handkerchief dipped in chloroform up to Hannah's nose 0:20:07.560 --> 0:20:11.639 and mouth was too imprecise. There was no way to 0:20:11.800 --> 0:20:16.800 control exactly how much chloroform Hannah was getting. Even small 0:20:16.880 --> 0:20:20.720 factors like the temperature and air circulation in the room, 0:20:21.240 --> 0:20:24.359 or how close the handkerchief was to the patient's face, 0:20:24.880 --> 0:20:30.200 could change how the drug worked. Worse, from his animal studies, 0:20:30.640 --> 0:20:35.879 Snow had found that chloroform vapor continued to accumulate in 0:20:35.960 --> 0:20:40.320 the lungs even after it had already been administered, making 0:20:40.359 --> 0:20:46.360 it even more difficult to control. Luckily, Snow had a solution, 0:20:47.080 --> 0:20:52.439 an inhaler. Snow even had developed a prototype a large 0:20:52.560 --> 0:20:56.160 metal can connected to a gas mask with a hose. 0:20:56.880 --> 0:21:00.119 With this kind of a device, Snow could mix the 0:21:00.200 --> 0:21:05.080 chloroform with air and introduced the drug gradually to make 0:21:05.119 --> 0:21:10.719 sure patients weren't getting too much too quickly. These findings 0:21:10.840 --> 0:21:16.080 should have comforted Simpson, since they suggested that chloroform wasn't 0:21:16.119 --> 0:21:19.800 inherently dangerous, but it was so powerful that it just 0:21:19.880 --> 0:21:24.160 had to be administered carefully. This wasn't so different from 0:21:24.200 --> 0:21:28.199 the arguments Simpson was making himself at the time. He 0:21:28.320 --> 0:21:33.639 had maintained that, just like familiar anesthetics like opiates or ether, 0:21:34.200 --> 0:21:40.280 chloroform wasn't risk free but safe in moderation. And yet 0:21:40.440 --> 0:21:46.000 Simpson was up in arms about Snow's result. Simpson thought 0:21:46.040 --> 0:21:50.879 that Hannah's death had nothing at all to do with chloroform. Instead, 0:21:51.080 --> 0:21:56.320 he fixated on another detail. The surgeon had given Hannah 0:21:56.400 --> 0:22:01.480 some brandy in addition to the chloroform. This was relatively 0:22:01.680 --> 0:22:06.359 common practice at the time to calm nervous patients, but 0:22:06.680 --> 0:22:11.600 Simpson thought that Hannah Greener had drowned from having brandy 0:22:11.920 --> 0:22:16.320 poured into her mouth while she was unconscious. But this 0:22:16.480 --> 0:22:21.000 hypothesis did not make any sense. The surgeon gave her 0:22:21.040 --> 0:22:26.160 brandy before she was given the chloroform, and the autopsy 0:22:26.400 --> 0:22:31.280 showed no signs of drowning. Still, Simpson wasn't the only 0:22:31.320 --> 0:22:37.600 one who disagreed with Snow's findings. Physicians published scathing letters 0:22:37.640 --> 0:22:41.600 in The Lancet and the London Medical Gazette. Arguing that 0:22:41.720 --> 0:22:47.119 Snow was overcomplicating this whole anesthesia business. They thought that 0:22:47.320 --> 0:22:51.080 all a surgeon had to do to safely use chloroform 0:22:51.520 --> 0:22:55.400 was watch the patient and stop when they fell unconscious. 0:22:56.840 --> 0:23:00.480 It was still unclear whether the chloroform had killed Hannah 0:23:00.520 --> 0:23:04.400 through the heart or the lungs, or whether the chloroform 0:23:04.520 --> 0:23:10.359 affected some undiagnosed pre existing condition that reared its head 0:23:10.520 --> 0:23:15.120 for the first time during the surgery. Ever, the methodical 0:23:15.320 --> 0:23:22.720 researcher Snow reluctantly agreed with those conclusions. These findings could 0:23:22.760 --> 0:23:26.360 not be the final word on the safety of chloroform. 0:23:26.960 --> 0:23:31.879 His sample size was too small. Hannah was just one case. 0:23:32.600 --> 0:23:36.080 Snow would have to wait for more deaths before he 0:23:36.119 --> 0:23:41.719 could make a definite conclusion. Unfortunately, he did not have 0:23:41.840 --> 0:23:46.640 to wait long. Within months, reports appeared from across Europe 0:23:46.680 --> 0:23:52.280 and North America of patients dying in surgery after taking chloroform. 0:23:53.160 --> 0:23:57.600 By the early eighteen fifties, Hannah Greener's death no longer 0:23:57.640 --> 0:24:01.720 seemed like a freak accident. Snow put out a paper 0:24:01.720 --> 0:24:07.600 in eighteen fifty two comparing twenty one documented chloroform deaths. 0:24:08.280 --> 0:24:12.440 He advanced essentially the same argument as the greener case 0:24:12.960 --> 0:24:16.520 that these deaths were a result of the surgeons using 0:24:16.640 --> 0:24:21.160 handkerchiefs to administer the drug and ending up giving patients 0:24:21.440 --> 0:24:26.320 too much chloroform too quickly. Still, Snow's paper did not 0:24:26.480 --> 0:24:30.280 make that big of a splash. The medical establishment was 0:24:30.440 --> 0:24:34.960 still fighting tooth and nail about every aspect of chloroform, 0:24:35.520 --> 0:24:38.879 whether you needed to measure how much of the drug 0:24:38.920 --> 0:24:42.879 you used, whether it was safer than ether, whether pain 0:24:42.960 --> 0:24:47.280 relief should be used in surgery at all. But one 0:24:47.840 --> 0:24:52.960 very important person did take note of Snow's new paper, 0:24:53.560 --> 0:25:00.600 Queen Victoria. Even though Queen Victoria had nine children, hated 0:25:00.800 --> 0:25:06.520 pregnancy and childbirth, which she called wretched. During her sixth 0:25:06.680 --> 0:25:11.520 pregnancy in eighteen forty seven, the Duchess of Sutherland sent 0:25:11.640 --> 0:25:17.080 Victoria a pamphlet about the obstetric potential of chloroform. In 0:25:17.160 --> 0:25:21.320 eighteen fifty, when she was pregnant with Prince Arthur, she 0:25:21.560 --> 0:25:26.600 sent her Royal accoutier to meet with John Snow about 0:25:26.680 --> 0:25:30.520 potentially using the drug in her own labor, but in 0:25:30.560 --> 0:25:33.080 the end she was too cautious to go through with it. 0:25:34.200 --> 0:25:38.000 By the time she was pregnant again in eighteen fifty three, 0:25:38.359 --> 0:25:42.240 she had Snow administer chloroform to one of her ladies 0:25:42.280 --> 0:25:47.000 in waiting during a tooth extraction. After seeing proof that 0:25:47.080 --> 0:25:52.200 he had administered the drug safely and successfully, Victoria invited 0:25:52.320 --> 0:25:56.919 Snow to court for an interview. Snow put on a 0:25:57.000 --> 0:26:01.000 court suit with a sword and flattened head, and met 0:26:01.080 --> 0:26:05.800 up with Prince Albert, victorious husband and the cause of 0:26:05.840 --> 0:26:10.040 all of these painful pregnancies. On the way there, Snow 0:26:10.200 --> 0:26:13.159 ran into a friend's wife and child on the street. 0:26:13.800 --> 0:26:18.480 He recalled that the child threw up her hands and exclaimed, Oh, 0:26:18.600 --> 0:26:23.600 isn't doctor Snow pretty, Mamma. Snow was short, balding, and 0:26:23.840 --> 0:26:28.480 self professed to be plain, so he repeated this story 0:26:28.560 --> 0:26:33.360 as a self deprecating anecdote for the rest of his life. 0:26:33.600 --> 0:26:38.440 Upon meeting Prince Albert, Snow and the consort talked through 0:26:38.480 --> 0:26:43.400 the queen's concerns. Snow was impressed by the Prince's interest 0:26:43.520 --> 0:26:49.280 in the sciences, and Albert was comforted by Snow's caution, expertise, 0:26:49.600 --> 0:26:55.440 and humility. Then and there, Albert approved Snow to administer 0:26:55.560 --> 0:26:59.480 chloroform to the queen for the birth of her eighth child. 0:27:00.400 --> 0:27:04.840 On April seventh, eighteen fifty three, at twelve forty p m. 0:27:05.000 --> 0:27:10.520 According to Snow's detailed notes, Snow arrived at the Queen's bedside. 0:27:11.000 --> 0:27:13.520 She had been in the labor for a few hours, 0:27:13.920 --> 0:27:17.440 but wanted to relieve her pain for the final stages, 0:27:18.040 --> 0:27:21.960 and really, who can blame her? Ironically, given how much 0:27:22.040 --> 0:27:26.520 he railed against the use of handkerchiefs in anesthesia, Snow 0:27:26.640 --> 0:27:31.359 gave Victoria a chloroform dipped handkerchief to relieve her pain. 0:27:32.160 --> 0:27:35.160 But Snow figured it was safe to use a handkerchief 0:27:35.440 --> 0:27:39.120 because he was only using a tiny bit of chloroform. 0:27:39.800 --> 0:27:43.560 He had noted that women in labor often required a 0:27:43.680 --> 0:27:47.879 smaller dose of anesthetic, and he aimed to anesthetize his 0:27:48.000 --> 0:27:52.439 patients so lightly that most of them remained conscious and 0:27:52.640 --> 0:27:57.960 responded to commands without remembering the labor pain. He used 0:27:58.119 --> 0:28:02.719 the same method to relieve Victoria's pain, and it worked 0:28:03.520 --> 0:28:08.600 between contractions. Snow reported that quote there was complete ease. 0:28:09.440 --> 0:28:15.120 At one thirteen in the afternoon, Leopold was born. Victoria 0:28:15.280 --> 0:28:18.040 was reported to have said that the experience of using 0:28:18.119 --> 0:28:24.800 chloroform was quote soothing, quieting, and delightful beyond measure. The 0:28:24.880 --> 0:28:28.480 next day she wrote to her uncle, I can report 0:28:28.560 --> 0:28:31.840 most favorably of it myself, for I have never been 0:28:31.920 --> 0:28:40.320 better or stronger. Since the use of chloroform was still controversial, 0:28:40.800 --> 0:28:45.320 Buckingham Palace tried to keep it under wraps, but eventually 0:28:45.600 --> 0:28:49.960 news got out. Snow's patience begged him for details about 0:28:50.000 --> 0:28:52.960 the royal birth, but all he would say was that 0:28:53.120 --> 0:28:57.480 Her Majesty is a model patient. One of his patients 0:28:57.560 --> 0:29:02.200 refused to take any more chloroform until Snow told her 0:29:02.280 --> 0:29:05.320 what the Queen had said while she was under the influence. 0:29:05.960 --> 0:29:10.480 Snow said quote, her Majesty asked no questions until she 0:29:10.560 --> 0:29:13.800 had breathed very much longer than you have, and if 0:29:13.840 --> 0:29:17.480 you will only go in loyal imitation, I will tell 0:29:17.560 --> 0:29:22.520 you everything. The patient complied, and then when she woke up, 0:29:22.680 --> 0:29:27.680 doctor Snow was already gone. Simpson too was elated about 0:29:27.720 --> 0:29:33.680 the successful royal birth. It illustrated chloroform's safety and efficacy 0:29:34.120 --> 0:29:37.600 more than any of his letters or pamphlets ever could have. 0:29:38.240 --> 0:29:41.440 If chloroform was good enough for the Queen, it was 0:29:41.520 --> 0:29:46.480 good enough for the public. Simpson still took every opportunity 0:29:46.560 --> 0:29:50.040 he could to promote the drug, and he would eventually 0:29:50.080 --> 0:29:54.120 become one of the most renowned physicians in Britain. He 0:29:54.320 --> 0:29:59.440 was awarded a baronetcy in eighteen sixty six. When Sir 0:29:59.720 --> 0:30:04.360 J James Young Simpson died in eighteen seventy, more than 0:30:04.600 --> 0:30:09.120 thirty thousand people filled the streets of Edinburgh for his funeral. 0:30:09.400 --> 0:30:14.840 According to newspaper reports, Queen Victoria sent a personal message 0:30:14.840 --> 0:30:19.880 of sympathy to the family. Simpson's lectures to medical students 0:30:19.880 --> 0:30:24.640 at the University of Edinburgh compared chloroform to innovations like 0:30:24.720 --> 0:30:29.160 eyeglasses or coffee, which were initially dismissed by the church 0:30:29.240 --> 0:30:33.800 as offsprings of man's wicked mind, but eventually were accepted 0:30:33.840 --> 0:30:38.360 into daily life. But Simpson ended up getting that wrong. 0:30:39.080 --> 0:30:45.120 Concerns about chloroform's safety never went away. After physicians collected 0:30:45.320 --> 0:30:49.920 decades of statistics about how many patients died under the 0:30:49.960 --> 0:30:55.120 influence of chloroform, it developed a bad reputation. By the 0:30:55.240 --> 0:31:00.000 late nineteenth century. Chloroform also became a popular plot device 0:31:00.640 --> 0:31:06.800 in crime fiction, appearing in lurid tales of criminals incapacitating 0:31:06.800 --> 0:31:11.880 their victims with nothing but a handkerchief. As early twentieth century, 0:31:11.920 --> 0:31:17.840 doctors turned to alternative anesthetics like nitrous oxide and eventually 0:31:17.920 --> 0:31:23.400 intravenous options, chloroform fell out of medical use almost entirely. 0:31:24.880 --> 0:31:30.920 James Simpson's most important contribution to medical science wasn't actually 0:31:31.080 --> 0:31:37.080 chloroform itself. Instead, as one contemporary wrote after his death, 0:31:37.520 --> 0:31:42.440 quote Simpson adopted obstetrics when it was the lowest and 0:31:42.640 --> 0:31:46.720 most ignoble of our medical arts. He has left it 0:31:46.880 --> 0:31:51.240 a science, numbering among its professors many of the most 0:31:51.480 --> 0:31:58.400 distinguished of our modern physicians. He made childbirth something to 0:31:58.480 --> 0:32:03.080 be taken seriously. There is no doubt that Simpson way 0:32:03.240 --> 0:32:07.840 over soled the benefits of chloroform and downplayed its dangers. 0:32:08.400 --> 0:32:13.680 His science was dubious. Throughout his life, Simpson often repeated 0:32:13.720 --> 0:32:18.280 the frankly ludicrous claim that no one had ever died 0:32:18.400 --> 0:32:25.320 from chloroform. But his dogged insistence that patience, particularly women 0:32:25.520 --> 0:32:30.560 giving birth, didn't need to undergo so much pain, has 0:32:30.760 --> 0:32:36.560 stood the test of time. As historian Donald Cayton put it, 0:32:36.560 --> 0:32:39.800 It's hard to say how much longer women would have 0:32:39.880 --> 0:32:43.440 had to wait for anesthesia had it not been for 0:32:43.520 --> 0:32:53.160 Simpson's advocacy. That's the story of James Simpson. But stick 0:32:53.200 --> 0:32:57.560 around to hear about how John snow not only administered 0:32:57.640 --> 0:33:01.240 chloroform to the Queen, but also so helped solve one 0:33:01.280 --> 0:33:15.880 of the deadliest collar outbreaks in London's history. A year 0:33:16.000 --> 0:33:20.320 after John Snow gave chloroform to Queen Victoria, in eighteen 0:33:20.480 --> 0:33:25.920 fifty three, an outbreak of cholera tore through London. Tens 0:33:25.960 --> 0:33:30.120