- Email: [email protected]
Another look at religious objections to obstetric anaesthesia
Accepted Manuscript SPECIAL ARTICLE Another look at religious objections to obstetric anaesthesia A.G. McKenzie PII: DOI: Reference:
S0959-289X(16)30028-0 http://dx.doi.org/10.1016/j.ijoa.2016.05.003 YIJOA 2465
To appear in:
International Journal of Obstetric Anesthesia
Accepted Date:
13 May 2016
Please cite this article as: McKenzie, A.G., Another look at religious objections to obstetric anaesthesia, International Journal of Obstetric Anesthesia (2016), doi: http://dx.doi.org/10.1016/j.ijoa.2016.05.003
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
IJOA 16-00072 SPECIAL ARTICLE Another look at religious objections to obstetric anaesthesia A. G. McKenzie Department of Anaesthesia, Critical Care & Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
Short title: Religious objections to obstetric anaesthesia
Correspondence to: Dr A. G. McKenzie, Consultant Anaesthetist, Department of Anaesthesia, Critical Care & Pain Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA E-mail: [email protected]
ABSTRACT Starting with the earliest biographies of James Young Simpson, the topic of religious opposition to obstetric anaesthesia in 1847 was gradually embellished in historical articles. Objective data are lacking and it has been suggested that this is a myth of recent medical history. A search for more information led to a contemporaneous casebook of the maternity hospital in Edinburgh, which was examined. The provision of anaesthesia in the 11 months before publication of Simpson’s pamphlet Answer to the Religious Objections was compared with that in the 11 months after. This revealed a marked increase (P<0.01) in the provision of anaesthesia for childbirth after the publication of Simpson’s pamphlet in December 1847. This analysis supports the existence of opposition to obstetric anaesthesia and the success of Simpson’s pamphlet in overcoming it, but the introduction of chloroform about six weeks earlier, may also have contributed.
Keywords: Anaesthesia; Obstetrics; Childbirth; Pain; Religious objections; Simpson
Introduction In December 1847, shortly after introducing chloroform in Edinburgh, James Young Simpson published a pamphlet Answer to the Religious Objections advanced against the Employment of Anaesthetic Agents in Midwifery and Surgery.1 Thousands of copies were printed. After his death in 1870, some authors2, 3 progressively exaggerated the misgivings of religious women, extending this to primary objections by the Church.4 This trend continued into the 20th century, for example in Grantly Dick Read’s Childbirth Without Fear published in 1953.5 In 1977, Farr researched the alleged opposition to obstetric anaesthesia for a PhD thesis6 and followed this up with two papers7, 8 in which, having found virtually no written evidence, he dismissed the religious opposition as a myth of historiography. The topic was revisited in 2000 by Russell, who opined that the said religious opposition had become an established myth of recent medical history, acceptance of which continued.9 This stimulated further debate in 2001 by Adams10 and Maltby.11 While concurring with Farr, they pointed out that it was Murphy12 who had first incriminated the Church as a body in 1855, and that others besides Simpson (Protheroe Smith13, Bainbrigge14) had also written answers to religious opposition in
1848. Adams and Maltby suggested that opposition was heard rather than read and that primary material may have been lost or destroyed.
Case-book of the Edinburgh Royal Maternity Hospital A source of further information, not previously utilised in detail, is the case-book of the Edinburgh Royal Maternity Hospital (ERMH), 1844–72.15 This is in the Manuscripts Collection within the library of the Royal College of Physicians of Edinburgh. Details of deliveries for 1847–48 were methodically recorded in the casebook, although the record may not be totally comprehensive. It is important to note that most of Simpson’s obstetric practice was peripatetic. He would deliver ‘well to do’ ladies in their own homes. The ERMH had been set up as a charity, opening in 1844. Many of the patients were unmarried. Simpson did not attend regularly; he was called only for cases of extreme difficulty. Perhaps he also went there to try out new methods: thus he presided at the first use in the hospital of ether (2 February 1847), chloroform (21 November 1847), bisulphuret of carbon (carbon bisulphide, 14 March 1848) and a new extracting instrument, the Air Tractor (15 December 1848). From 1846 to 1852 the hospital was situated at Milton House, which no longer exists; its site on the Canongate is now occupied by the Royal Mile School. The first obstetric delivery under ether had been conducted by Simpson on 19 January 1847, but this was not at the ERMH.16 The first use of ether at that hospital was on 2 February 1847, although the patient had been admitted at the end of January. Therefore, 1 February 1847 seems a suitable starting date for a comparison of the use of anaesthesia at the hospital before and after Simpson’s pamphlet Answer to the Religious Objections. It is unclear exactly when in December 1847 the pamphlet was distributed, although letters to Simpson thanking him for it suggest this was probably mid to late December; so it seems safest to consider the period before his pamphlet as extending to 31 December 1847, and the period after the pamphlet as commencing on 1 January 1848.
Analysis of case records at the ERMH before and after distribution of Simpson’s pamphlet A comparison of the figures for the 11 months of February–December 1847 with those for the 11 months of January–November 1848 is shown in Table 1. From 1
February to 20 May 1847 there were only three administrations of ether. From 21 May 1847 no further anaesthetics were given until 21 November 1847, the date of introduction of chloroform, which was given to 17 women by the end of that year (5 in November, 12 in December). In the 11 months preceding 1 January 1848, 202 women delivered, of whom 20 received anaesthesia (9.9 %). In the 11 months commencing 1 January 1848 there were 186 deliveries with 72 anaesthetics (38.7 %) (Table 1). The difference is statistically significant (P<0.001, chi-squared test).
Evaluation of the analysis It is remarkable that despite Simpson’s glowing report on ether in midwifery (March 1847),16 it was given to only three patients at the ERMH in 1847. This suggests there was opposition to it. On 1 December 1847, Simpson read to the Medico-Chirurgical Society of Edinburgh his paper Superinduction of anaesthesia in natural and morbid parturition: with cases illustrative of the use and effects of chloroform in obstetric practice.17 Therein, he urged the employment of anaesthesia “by every principle of true humanity, as well as by every principle of true religion”. News of this probably spread by word of mouth even before his pamphlet Answer to the Religious Objections. Notably there were 12 cases of chloroform administration at the ERMH in December 1847. The analysis of deliveries in the case-book of the ERMH reveals that following distribution of Simpson’s pamphlet Answer to the Religious Objections, there was a significant increase in the provision of anaesthesia. While this does not prove cause and effect post hoc ergo propter hoc, equally the possibility that the rise in anaesthesia rate was related to the pamphlet cannot be discounted.
Discussion More recent reviewers have overlooked the fact that the first mention of religious objections to ether in obstetric practice was NOT by Simpson, but by Dr Protheroe Smith at St Bartholomew’s Hospital, London. Commenting on abolishing some usual concomitants of labour including pain, in The Lancet of 1 May 1847, he wrote: “Can this be accomplished by ether – and if so, is it justifiable on Christian principles? as I have frequently been asked.” He then argued that it certainly was justifiable.18 In a recent biography of Simpson,19 the author, McCrae, avoided perpetuating the alleged myth of religious objections to obstetric anaesthesia. He wrote that
Simpson was surprised that the anticipated torrent of (religious) opposition to chloroform in obstetrics did not arrive. This seems a sensible summary, albeit without evidence that Simpson was surprised, but is there a risk that future biographers will “run with this” to the other extreme? At that time there was a widespread belief that pain provided a means of atonement for sin.20 The fact that Farr found no written primary evidence of religious opposition to relief of pain in childbirth does not guarantee that it did not exist. The great philosopher of history R.G. Collingwood pointed out the use of “unwritten sources".21 There are ideas and moral values that have been passed by word of mouth from generation to generation, and largely escaped being written down. Sometimes these can be inferred from other written material. An apposite example is the following excerpt from the (Edinburgh) Free Church Magazine of 1847:22
SURGICAL OPERATION RENDERED PAINLESS Any opinion which we could express respecting the marvellous power of the inhalation of sulphuric ether, in rendering the patient insensible to pain during the most formidable surgical operations, could be of little value, as the subject lies in a province which we are little conversant; but the fact seems to have been most amply proved. If so, it must be regarded as the most valuable medical discovery of modern times, even although it may be possible that injury might be done by the careless use of so powerful an agent. On another ground, we have hailed it with great delight, regarding it as a death-blow to what we have already shrunk from with dread and abhorrence, namely the dreamy and dangerous delusion and quackery of mesmerism. He deserves well of mankind who mitigates human suffering; but not so, if in the proves he subject the mind to delusions of an infidel tendency, which mesmerism seems to do. But we leave the subject to the care of those who are more able to prosecute it to its legitimate results.
This paragraph begs the question “why did the Free Church put this article in its magazine?” The Church per se could have no interest in an anaesthetic agent or surgical technique; the thrust of the article is surely that mitigation of human suffering
is laudable. Reading between the lines, the Church must have known of opposition to pain relief, and this prompted the publication. Arguably, Farr’s quest for written evidence of religious objections to obstetric anaesthesia before Simpson’s pamphlet (of December 1847), was almost bound to draw a blank. This is because of the extraordinary prudishness of the Victorian era. The topics of procreation, pregnancy and childbirth were not voiced in polite society, less so written about! This is exemplified in the novel Martin Chuzzlewit by Charles Dickens, which appeared in serial form in 1843 and was published in one volume in 1844. In chapter XIX the reader is introduced to Mrs Gamp, a midwife, upon whom Mr Pecksniff calls to secure her other professional service: laying out of the dead (for the deceased Anthony Chuzzlewit). Exercising masterful circumlocution Dickens avoids the words ‘childbirth’ and ‘pregnancy’. “…Mrs Gamp had been up all the previous night, in a ceremony to which the usage of gossips has given that name which expresses, in two syllables, the curse pronounced on Adam”. Again “…whole troops of married ladies (some about to trouble Mrs Gamp themselves, very shortly) came flocking round the steps…”. And again “A third lady (with her arms folded) said she wished he had chosen any other time for fetching Mrs Gamp, but it always happened so with her.” The hint that this lady might be pregnant is confirmed by the illustration by Hablot K Browne (“Phiz”) which shows the lady with her folded arms resting on her heavily pregnant abdomen.23 It is interesting that on 8 July 1848 Simpson wrote a letter to Protheroe Smith in London stating “Here, in Edinburgh, I never now meet with any objections on this point, for the religious, like the other forms of opposition to chloroform, have ceased among us”.24 Perhaps Simpson was over-confident in this assertion; the case-book of the ERMH reveals that less than six weeks earlier a patient had objected strongly to taking chloroform, which therefore was withheld;15 or perhaps Simpson was simply seizing the opportunity to claim success as was his wont.16 It seems doubtful that religious and moral objections to the use of anaesthesia in labour abruptly ceased, because these were listed in the lecture notes taken by a student attending Simpson’s course during 1848-9.25 Caton in 2000 opined that opposition to obstetric anaesthesia persisted for about 10 years from 1847. He argued that, rather than Simpson, it was John Snow who boosted acceptance of obstetric anaesthesia in 1853.26 However, Caton did not have figures from Edinburgh to compare with those from Snow’s casebooks based in
London. In 2003, Caton drew attention to the second conflict between medical science and social values; in the 1950s when Dick Read “nearly undid all that Simpson achieved to establish anesthesia as part of obstetric practice”.27 The idea of suffering as discipline from God persists in some Christian sects to this day.28 In conclusion, examination of the case records of the only maternity hospital in Edinburgh through 22 months of 1847–48 shows a statistically significant increase in obstetric anaesthesia after the distribution of Simpson’s pamphlet Answer to the Religious Objections. Although this may simply reflect a greater enthusiasm for chloroform compared with ether, with the background of beliefs prevailing in the 1840s, it seems probable that Simpson’s pamphlet also contributed to this change.
Acknowledgements I am grateful to Daisy Cunynghame, Archivist of the Royal College of Physicians of Edinburgh, for permission to peruse the Case-book of the ERMH, 1844-71. I also thank Colin Morrison, Free Church of Scotland, for the paragraph in The Free Church Magazine 1847.
Disclosure The author received no external funding and has no competing interests to declare.
References 1.
Simpson JY. Answer to the Religious Objections advanced against the Employment of Anaesthetic Agents in Midwifery and Surgery. Edinburgh: Sutherland & Knox, 1847.
2.
Duns J. Memoir of Sir James Y. Simpson. Edinburgh: Edmonston & Douglas, 1873.
3.
Simpson EB. Sir James Y. Simpson. Edinburgh: Oliphant, Anderson & Ferrier, 1896; 64-66.
4.
White AD. A History of the Warfare of Science with Theology in Christendom. London: Macmillan, 1896; II: 55-63.
5.
Dick Read G. Childbirth Without Fear. London: William Heinemann, 1953; 2-3, 58.
6.
Farr AD. Medical Developments and Religious Beliefs, with Special Reference to Europe in the 18th and 19th Centuries. PhD Thesis, The Open University, 1977.
7.
Farr AD. Early opposition to obstetric anaesthesia. Anaesthesia 1980; 35: 896907.
8.
Farr AD. Religious opposition to obstetric anaesthesia: a myth? Ann Sci 1983; 40: 159-77.
9.
Russell CA. Objections to anaesthesia: the case of James Young Simpson. The History of Anaesthesia Society Proceedings 2000; 28: 26-36.
10. Adams CN, Maltby JR. Religious objections I: blaming the Church, labouring under a misconception. The History of Anaesthesia Society Proceedings 2001; 29: 42-49. 11. Maltby JR, Adams CN. Religious objections II: blaming Simpson, a miscarriage of justice. The History of Anaesthesia Society Proceedings 2001; 29: 50-57. 12. Murphy EW. Chloroform; its properties and safety in childbirth. London: Walton and Maberly, 1855; 1-7. 13. Smith P. Scriptural Authority for the Mitigation of the Pains of Labour by Chloroform and other Anaesthetic Agents. London: Highley, 1848. 14. Bainbrigge WH. Remarks on chloroform in alleviating human suffering addressed particularly to the female sex, showing that there is no scriptural authority to interdict its administration for the mitigation of physical pain under any circumstances. London: Highley, 1848. 15. Edinburgh Royal Maternity Hospital, Indoor Case-book, 1844-72. RCPE Archive; DEP/ROY/1. 16. Simpson JY. Notes on the inhalation of sulphuric ether in the practice of midwifery (extracted from March 1847 edition of Monthly Journal of Medical Science). Edinburgh: Sutherland & Knox, 1847. 17. Simpson JY. Remarks on the superinduction of anaesthesia in natural and morbid parturition: with cases illustrative of the use and effects of chloroform in obstetric practice. Edinburgh: Sutherland & Knox, 1847. 18. Smith P. Employment of ether by inhalation in obstetric practice, with cases and clinical observations. The Lancet 1847; II: 452-7. 19. McCrae M. Simpson – The Turbulent Life of a Medical Pioneer. Edinburgh: John Donald, 2010; 129.
20. Papper EM. Suffering and anesthesia in the romantic period. Ph.D. Thesis, University of Miami, Florida, 1990. 21. Collingwood RG. The Idea of History. London: Oxford University Press (Reprint, Paperback), 1961; 238, 277. 22. Anonymous. Surgical operations rendered painless. The Free Church Magazine 1847; 4: 67. 23. Dickens C. The life and adventures of Martin Chuzzlewit. London; Chapman & Hall, 1912; 252-3. 24. Simpson JY. Letter to Dr Protheroe Smith of London, 8th July 1848. In: Simpson JY Anaesthesia or the employment of chloroform and ether in surgery, midwifery, etc. Philadelphia: Lindsay & Blakiston, 1849; 123. 25. Zuck D. Simpson as a teacher – a student’s notebook. Br J Anaesth 1976; 48: 1103-11. 26. Caton D. John Snow’s Practice of Obstetric Anesthesia. Anesthesiology 2000; 92: 247-52. 27. Caton D. Medical science and social values. Int J Obstet Anesth 2004; 13: 16773. 28. Piper J. The Painful Discipline of Our Heavenly Father. http://desiringgod.org/messages/the-painful-discipline-of-our-heavenly-father [accessed January 2016].
Table 1 Use of anaesthesia for deliveries at Edinburgh Royal Maternity Hospital 184748 Number of Patients given anaesthesia patients ether chloroform carbon disulphide 01/02/1847 – 202 3 17 0 31/12/1847 01/01/1848 – 186 0 71 1 30/11/1848
IJOA 16-00072 Highlights •
This study provides objective data on opposition to the introduction of obstetric anaesthesia in 1847
•
The effect of Simpson’s pamphlet Answer to the Religious Objections is examined
•
The effect of the introduction of chloroform is examined
•
Contemporary and subsequent literature is reviewed
S0959-289X(16)30028-0 http://dx.doi.org/10.1016/j.ijoa.2016.05.003 YIJOA 2465
To appear in:
International Journal of Obstetric Anesthesia
Accepted Date:
13 May 2016
Please cite this article as: McKenzie, A.G., Another look at religious objections to obstetric anaesthesia, International Journal of Obstetric Anesthesia (2016), doi: http://dx.doi.org/10.1016/j.ijoa.2016.05.003
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
IJOA 16-00072 SPECIAL ARTICLE Another look at religious objections to obstetric anaesthesia A. G. McKenzie Department of Anaesthesia, Critical Care & Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
Short title: Religious objections to obstetric anaesthesia
Correspondence to: Dr A. G. McKenzie, Consultant Anaesthetist, Department of Anaesthesia, Critical Care & Pain Medicine, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA E-mail: [email protected]
ABSTRACT Starting with the earliest biographies of James Young Simpson, the topic of religious opposition to obstetric anaesthesia in 1847 was gradually embellished in historical articles. Objective data are lacking and it has been suggested that this is a myth of recent medical history. A search for more information led to a contemporaneous casebook of the maternity hospital in Edinburgh, which was examined. The provision of anaesthesia in the 11 months before publication of Simpson’s pamphlet Answer to the Religious Objections was compared with that in the 11 months after. This revealed a marked increase (P<0.01) in the provision of anaesthesia for childbirth after the publication of Simpson’s pamphlet in December 1847. This analysis supports the existence of opposition to obstetric anaesthesia and the success of Simpson’s pamphlet in overcoming it, but the introduction of chloroform about six weeks earlier, may also have contributed.
Keywords: Anaesthesia; Obstetrics; Childbirth; Pain; Religious objections; Simpson
Introduction In December 1847, shortly after introducing chloroform in Edinburgh, James Young Simpson published a pamphlet Answer to the Religious Objections advanced against the Employment of Anaesthetic Agents in Midwifery and Surgery.1 Thousands of copies were printed. After his death in 1870, some authors2, 3 progressively exaggerated the misgivings of religious women, extending this to primary objections by the Church.4 This trend continued into the 20th century, for example in Grantly Dick Read’s Childbirth Without Fear published in 1953.5 In 1977, Farr researched the alleged opposition to obstetric anaesthesia for a PhD thesis6 and followed this up with two papers7, 8 in which, having found virtually no written evidence, he dismissed the religious opposition as a myth of historiography. The topic was revisited in 2000 by Russell, who opined that the said religious opposition had become an established myth of recent medical history, acceptance of which continued.9 This stimulated further debate in 2001 by Adams10 and Maltby.11 While concurring with Farr, they pointed out that it was Murphy12 who had first incriminated the Church as a body in 1855, and that others besides Simpson (Protheroe Smith13, Bainbrigge14) had also written answers to religious opposition in
1848. Adams and Maltby suggested that opposition was heard rather than read and that primary material may have been lost or destroyed.
Case-book of the Edinburgh Royal Maternity Hospital A source of further information, not previously utilised in detail, is the case-book of the Edinburgh Royal Maternity Hospital (ERMH), 1844–72.15 This is in the Manuscripts Collection within the library of the Royal College of Physicians of Edinburgh. Details of deliveries for 1847–48 were methodically recorded in the casebook, although the record may not be totally comprehensive. It is important to note that most of Simpson’s obstetric practice was peripatetic. He would deliver ‘well to do’ ladies in their own homes. The ERMH had been set up as a charity, opening in 1844. Many of the patients were unmarried. Simpson did not attend regularly; he was called only for cases of extreme difficulty. Perhaps he also went there to try out new methods: thus he presided at the first use in the hospital of ether (2 February 1847), chloroform (21 November 1847), bisulphuret of carbon (carbon bisulphide, 14 March 1848) and a new extracting instrument, the Air Tractor (15 December 1848). From 1846 to 1852 the hospital was situated at Milton House, which no longer exists; its site on the Canongate is now occupied by the Royal Mile School. The first obstetric delivery under ether had been conducted by Simpson on 19 January 1847, but this was not at the ERMH.16 The first use of ether at that hospital was on 2 February 1847, although the patient had been admitted at the end of January. Therefore, 1 February 1847 seems a suitable starting date for a comparison of the use of anaesthesia at the hospital before and after Simpson’s pamphlet Answer to the Religious Objections. It is unclear exactly when in December 1847 the pamphlet was distributed, although letters to Simpson thanking him for it suggest this was probably mid to late December; so it seems safest to consider the period before his pamphlet as extending to 31 December 1847, and the period after the pamphlet as commencing on 1 January 1848.
Analysis of case records at the ERMH before and after distribution of Simpson’s pamphlet A comparison of the figures for the 11 months of February–December 1847 with those for the 11 months of January–November 1848 is shown in Table 1. From 1
February to 20 May 1847 there were only three administrations of ether. From 21 May 1847 no further anaesthetics were given until 21 November 1847, the date of introduction of chloroform, which was given to 17 women by the end of that year (5 in November, 12 in December). In the 11 months preceding 1 January 1848, 202 women delivered, of whom 20 received anaesthesia (9.9 %). In the 11 months commencing 1 January 1848 there were 186 deliveries with 72 anaesthetics (38.7 %) (Table 1). The difference is statistically significant (P<0.001, chi-squared test).
Evaluation of the analysis It is remarkable that despite Simpson’s glowing report on ether in midwifery (March 1847),16 it was given to only three patients at the ERMH in 1847. This suggests there was opposition to it. On 1 December 1847, Simpson read to the Medico-Chirurgical Society of Edinburgh his paper Superinduction of anaesthesia in natural and morbid parturition: with cases illustrative of the use and effects of chloroform in obstetric practice.17 Therein, he urged the employment of anaesthesia “by every principle of true humanity, as well as by every principle of true religion”. News of this probably spread by word of mouth even before his pamphlet Answer to the Religious Objections. Notably there were 12 cases of chloroform administration at the ERMH in December 1847. The analysis of deliveries in the case-book of the ERMH reveals that following distribution of Simpson’s pamphlet Answer to the Religious Objections, there was a significant increase in the provision of anaesthesia. While this does not prove cause and effect post hoc ergo propter hoc, equally the possibility that the rise in anaesthesia rate was related to the pamphlet cannot be discounted.
Discussion More recent reviewers have overlooked the fact that the first mention of religious objections to ether in obstetric practice was NOT by Simpson, but by Dr Protheroe Smith at St Bartholomew’s Hospital, London. Commenting on abolishing some usual concomitants of labour including pain, in The Lancet of 1 May 1847, he wrote: “Can this be accomplished by ether – and if so, is it justifiable on Christian principles? as I have frequently been asked.” He then argued that it certainly was justifiable.18 In a recent biography of Simpson,19 the author, McCrae, avoided perpetuating the alleged myth of religious objections to obstetric anaesthesia. He wrote that
Simpson was surprised that the anticipated torrent of (religious) opposition to chloroform in obstetrics did not arrive. This seems a sensible summary, albeit without evidence that Simpson was surprised, but is there a risk that future biographers will “run with this” to the other extreme? At that time there was a widespread belief that pain provided a means of atonement for sin.20 The fact that Farr found no written primary evidence of religious opposition to relief of pain in childbirth does not guarantee that it did not exist. The great philosopher of history R.G. Collingwood pointed out the use of “unwritten sources".21 There are ideas and moral values that have been passed by word of mouth from generation to generation, and largely escaped being written down. Sometimes these can be inferred from other written material. An apposite example is the following excerpt from the (Edinburgh) Free Church Magazine of 1847:22
SURGICAL OPERATION RENDERED PAINLESS Any opinion which we could express respecting the marvellous power of the inhalation of sulphuric ether, in rendering the patient insensible to pain during the most formidable surgical operations, could be of little value, as the subject lies in a province which we are little conversant; but the fact seems to have been most amply proved. If so, it must be regarded as the most valuable medical discovery of modern times, even although it may be possible that injury might be done by the careless use of so powerful an agent. On another ground, we have hailed it with great delight, regarding it as a death-blow to what we have already shrunk from with dread and abhorrence, namely the dreamy and dangerous delusion and quackery of mesmerism. He deserves well of mankind who mitigates human suffering; but not so, if in the proves he subject the mind to delusions of an infidel tendency, which mesmerism seems to do. But we leave the subject to the care of those who are more able to prosecute it to its legitimate results.
This paragraph begs the question “why did the Free Church put this article in its magazine?” The Church per se could have no interest in an anaesthetic agent or surgical technique; the thrust of the article is surely that mitigation of human suffering
is laudable. Reading between the lines, the Church must have known of opposition to pain relief, and this prompted the publication. Arguably, Farr’s quest for written evidence of religious objections to obstetric anaesthesia before Simpson’s pamphlet (of December 1847), was almost bound to draw a blank. This is because of the extraordinary prudishness of the Victorian era. The topics of procreation, pregnancy and childbirth were not voiced in polite society, less so written about! This is exemplified in the novel Martin Chuzzlewit by Charles Dickens, which appeared in serial form in 1843 and was published in one volume in 1844. In chapter XIX the reader is introduced to Mrs Gamp, a midwife, upon whom Mr Pecksniff calls to secure her other professional service: laying out of the dead (for the deceased Anthony Chuzzlewit). Exercising masterful circumlocution Dickens avoids the words ‘childbirth’ and ‘pregnancy’. “…Mrs Gamp had been up all the previous night, in a ceremony to which the usage of gossips has given that name which expresses, in two syllables, the curse pronounced on Adam”. Again “…whole troops of married ladies (some about to trouble Mrs Gamp themselves, very shortly) came flocking round the steps…”. And again “A third lady (with her arms folded) said she wished he had chosen any other time for fetching Mrs Gamp, but it always happened so with her.” The hint that this lady might be pregnant is confirmed by the illustration by Hablot K Browne (“Phiz”) which shows the lady with her folded arms resting on her heavily pregnant abdomen.23 It is interesting that on 8 July 1848 Simpson wrote a letter to Protheroe Smith in London stating “Here, in Edinburgh, I never now meet with any objections on this point, for the religious, like the other forms of opposition to chloroform, have ceased among us”.24 Perhaps Simpson was over-confident in this assertion; the case-book of the ERMH reveals that less than six weeks earlier a patient had objected strongly to taking chloroform, which therefore was withheld;15 or perhaps Simpson was simply seizing the opportunity to claim success as was his wont.16 It seems doubtful that religious and moral objections to the use of anaesthesia in labour abruptly ceased, because these were listed in the lecture notes taken by a student attending Simpson’s course during 1848-9.25 Caton in 2000 opined that opposition to obstetric anaesthesia persisted for about 10 years from 1847. He argued that, rather than Simpson, it was John Snow who boosted acceptance of obstetric anaesthesia in 1853.26 However, Caton did not have figures from Edinburgh to compare with those from Snow’s casebooks based in
London. In 2003, Caton drew attention to the second conflict between medical science and social values; in the 1950s when Dick Read “nearly undid all that Simpson achieved to establish anesthesia as part of obstetric practice”.27 The idea of suffering as discipline from God persists in some Christian sects to this day.28 In conclusion, examination of the case records of the only maternity hospital in Edinburgh through 22 months of 1847–48 shows a statistically significant increase in obstetric anaesthesia after the distribution of Simpson’s pamphlet Answer to the Religious Objections. Although this may simply reflect a greater enthusiasm for chloroform compared with ether, with the background of beliefs prevailing in the 1840s, it seems probable that Simpson’s pamphlet also contributed to this change.
Acknowledgements I am grateful to Daisy Cunynghame, Archivist of the Royal College of Physicians of Edinburgh, for permission to peruse the Case-book of the ERMH, 1844-71. I also thank Colin Morrison, Free Church of Scotland, for the paragraph in The Free Church Magazine 1847.
Disclosure The author received no external funding and has no competing interests to declare.
References 1.
Simpson JY. Answer to the Religious Objections advanced against the Employment of Anaesthetic Agents in Midwifery and Surgery. Edinburgh: Sutherland & Knox, 1847.
2.
Duns J. Memoir of Sir James Y. Simpson. Edinburgh: Edmonston & Douglas, 1873.
3.
Simpson EB. Sir James Y. Simpson. Edinburgh: Oliphant, Anderson & Ferrier, 1896; 64-66.
4.
White AD. A History of the Warfare of Science with Theology in Christendom. London: Macmillan, 1896; II: 55-63.
5.
Dick Read G. Childbirth Without Fear. London: William Heinemann, 1953; 2-3, 58.
6.
Farr AD. Medical Developments and Religious Beliefs, with Special Reference to Europe in the 18th and 19th Centuries. PhD Thesis, The Open University, 1977.
7.
Farr AD. Early opposition to obstetric anaesthesia. Anaesthesia 1980; 35: 896907.
8.
Farr AD. Religious opposition to obstetric anaesthesia: a myth? Ann Sci 1983; 40: 159-77.
9.
Russell CA. Objections to anaesthesia: the case of James Young Simpson. The History of Anaesthesia Society Proceedings 2000; 28: 26-36.
10. Adams CN, Maltby JR. Religious objections I: blaming the Church, labouring under a misconception. The History of Anaesthesia Society Proceedings 2001; 29: 42-49. 11. Maltby JR, Adams CN. Religious objections II: blaming Simpson, a miscarriage of justice. The History of Anaesthesia Society Proceedings 2001; 29: 50-57. 12. Murphy EW. Chloroform; its properties and safety in childbirth. London: Walton and Maberly, 1855; 1-7. 13. Smith P. Scriptural Authority for the Mitigation of the Pains of Labour by Chloroform and other Anaesthetic Agents. London: Highley, 1848. 14. Bainbrigge WH. Remarks on chloroform in alleviating human suffering addressed particularly to the female sex, showing that there is no scriptural authority to interdict its administration for the mitigation of physical pain under any circumstances. London: Highley, 1848. 15. Edinburgh Royal Maternity Hospital, Indoor Case-book, 1844-72. RCPE Archive; DEP/ROY/1. 16. Simpson JY. Notes on the inhalation of sulphuric ether in the practice of midwifery (extracted from March 1847 edition of Monthly Journal of Medical Science). Edinburgh: Sutherland & Knox, 1847. 17. Simpson JY. Remarks on the superinduction of anaesthesia in natural and morbid parturition: with cases illustrative of the use and effects of chloroform in obstetric practice. Edinburgh: Sutherland & Knox, 1847. 18. Smith P. Employment of ether by inhalation in obstetric practice, with cases and clinical observations. The Lancet 1847; II: 452-7. 19. McCrae M. Simpson – The Turbulent Life of a Medical Pioneer. Edinburgh: John Donald, 2010; 129.
20. Papper EM. Suffering and anesthesia in the romantic period. Ph.D. Thesis, University of Miami, Florida, 1990. 21. Collingwood RG. The Idea of History. London: Oxford University Press (Reprint, Paperback), 1961; 238, 277. 22. Anonymous. Surgical operations rendered painless. The Free Church Magazine 1847; 4: 67. 23. Dickens C. The life and adventures of Martin Chuzzlewit. London; Chapman & Hall, 1912; 252-3. 24. Simpson JY. Letter to Dr Protheroe Smith of London, 8th July 1848. In: Simpson JY Anaesthesia or the employment of chloroform and ether in surgery, midwifery, etc. Philadelphia: Lindsay & Blakiston, 1849; 123. 25. Zuck D. Simpson as a teacher – a student’s notebook. Br J Anaesth 1976; 48: 1103-11. 26. Caton D. John Snow’s Practice of Obstetric Anesthesia. Anesthesiology 2000; 92: 247-52. 27. Caton D. Medical science and social values. Int J Obstet Anesth 2004; 13: 16773. 28. Piper J. The Painful Discipline of Our Heavenly Father. http://desiringgod.org/messages/the-painful-discipline-of-our-heavenly-father [accessed January 2016].
Table 1 Use of anaesthesia for deliveries at Edinburgh Royal Maternity Hospital 184748 Number of Patients given anaesthesia patients ether chloroform carbon disulphide 01/02/1847 – 202 3 17 0 31/12/1847 01/01/1848 – 186 0 71 1 30/11/1848
IJOA 16-00072 Highlights •
This study provides objective data on opposition to the introduction of obstetric anaesthesia in 1847
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The effect of Simpson’s pamphlet Answer to the Religious Objections is examined
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The effect of the introduction of chloroform is examined
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Contemporary and subsequent literature is reviewed