The Queen's Physician
by George Wade
“A wise wean protected by the kelpies.” That, according to Scots legend, was the future of a seventh son. James Young Simpson - surgeon, hospital reformer and humanitarian - was a seventh son, and proved beyond doubt that he was a wise wean who grew up to be a clever and compassionate man.
Born in Bathgate on 7th June 1811, the seventh son of a village baker, James grew up in a close-knit and loving family. At the local school, it was acknowledged that he was its brightest pupil. He was quick to learn and practical in the application of his learning. As his brothers were involved in the running of the family business, it was decided that he should be given the chance to be something better than a village tradesman.
In 1825, when only fourteen, Simpson entered Edinburgh University and after spending two years in the Faculty of Arts decided to specialize in medicine. At the age of twenty-one, he graduated as a doctor and became a Licentiate of the College of Surgeons. The subject for his thesis was entitled “Death from Inflammation” and attracted the then Professor of Pathology, Dr John Thomson. Simpson’s unbiased reasoning, cautious analysis and penetrating judgement impressed him so much that Thompson offered the post of Assistant to the newly qualified graduate.
Simpson gladly accepted and soon became a valued member of his staff. In 1837 when Professor Thomson took ill Simpson assumed his duties. Then only twenty-six, he lectured on pathology. When Professor Thomson was fit enough to resume his normal duties, Simpson began to lecture in obstetrics.
It was during a spell of lecturing in Edinburgh that Simpson met the lady who was to become his wife. She was Jessie Grindlay, the daughter of a Liverpool merchant, at whose home Simpson became a frequent and welcome visitor during his holidays in that city.
In 1839, the Chair of Midwifery at Edinburgh University - the supreme post of its kind in Great Britain - fell vacant. The Chair was the gift of Edinburgh Town Council and, as such, the Council chose the occupant. All candidates - and there were many well-qualified medical personalities - had to be able to project an uncontroversial public image. Simpson - brilliant though he was - was only thirty, unmarried, and of relatively humble background.
In the strictly structured society of the mid-19th century, these prejudices were held against him. Simpson spent £500 (a considerable sum of money at that time) to put forward his case in the best possible light. When it was pointed out that the Chair was a position for a married man, the astute Simpson promptly married Jessie Grindlay and won by a single vote. When the result was announced the victorious Simpson proceeded on his honeymoon.
Since childbirth was classified as a natural phenomenon, the medical men of the day didn’t think it was worthy of serious study. Not so with James. To the two cardinal objects of the doctor’s ideals, “Heal the sick and save lives,” Simpson added a third: “Eliminate pain wherever possible.” Appalled by the suffering women had to endure when giving birth, he decided to alleviate pain whenever he could.
Unsystematic, unpunctual, extrovert - he had all of those characteristics. Yet he was always at the hub of activity, whatever the occasion. Away from the clinic and the University, Simpson had numerous other interests, which included archaeology, and he was a leading figure in Church of Scotland politics.
Money was not a motivating factor in Simpson’s life. On occasion he was seen folding a banknote into a wedge to stop a window rattling while he was delivering a lecture. In 1847, at the age of thirty-six, he was appointed physician to Queen Victoria during her visits to Scotland. With his massive shoulders, huge head and long fair hair, Simpson was easily recognizable. He was now the best known medical figure in Scotland.
In 1846, during a visit to London, Simpson met Robert Lister, who described an operation he had recently witnessed when ether was used to anaesthetize the patient. At this time, before anesthetics were in general use, a very high proportion of patients died on the table, owing to fear, dirt, and the after-effects of the operation - or a combination of all three. In the mid-19th century, about one-third of all amputees were dead within a month of the operation. And it was little wonder. With fires burning constantly to warm the tar with which they sealed raw stumps, the operating theatre was more like a torture chamber than a place of healing.
Simpson, always eager to explore any avenue that would help his patients in childbirth, was more than interested. When he discussed the use of ether with his contemporaries, their reaction was one of shocked incredulity. Their arguments against any form of anesthesia were twofold: medical and religious. Childbirth was a natural function, and the pain suffered was merely due to normal healthy contractions of a muscular organ. To interfere with this natural process might cause infinite harm. And might not the resultant child be born an idiot? The few doctors who had any knowledge of ether pointed out that its effects lasted only a few minutes while childbirth could last for hours.
The highly moral, Bible-dominated, upper class Victorians quoted Genesis at Simpson, pointing out that “women should bring forth their children in sorrow.” James Simpson knew and loved his Bible. “Sorrow” did not mean “pain” in his interpretation of Genesis.
To back up his argument he reminded critics that God had made Adam fall into a “deep sleep” when the rib was removed. The Bible was regarded as having the final say in many judgements of the time, and Simpson’s theories held much weight.
In today’s society, it seems ludicrous that such arguments ever took place between learned men. In the mid-19th century such was the case.
As a substitute for the short-lasting effects of ether, Simpson turned his attention elsewhere. Throughout the summer of 1847, he tried and rejected many chemical compounds. A Liverpool chemist suggested he try chloroform. A colourless, oily liquid with a sweet taste and subtle smell, chloroform passed quickly into the bloodstream when inhaled. An easy anaesthetic to use, its potential had never been realized until then. Despite the seriousness that he attached to his work, the breakthrough came in a cavalier fashion. Simpson had invited two young colleagues (Doctors Keith and Duncan) to dinner at his home in Queen Street, Edinburgh. It was the 4th November 1847, and after the meal the three men retired to another room. Filling three tumblers with chloroform, Simpson and his friends inhaled. They remembered talking loudly, laughing and joking, the furniture revolving, before they passed out. Simpson appears to have been the first to recover. His initial thought was, “This is much better than ether.” His two companions backed his opinion: chloroform was much better than ether.
When the men rejoined the ladies, fully recovered and suffering no ill effects, a niece of Simpson’s volunteered to take part in the experiment. This would allow the doctors to observe the influence of the administered chloroform. The young lady fell asleep exclaiming, “I’m an angel!” and revived soon afterwards feeling perfectly normal.
Simpson immediately started using chloroform in his practice. Within a fortnight of his first experiment, he notified a medical society of his work. Out of fifty cases not one proved unsatisfactory. In every instance the recovery time was much shorter, while pain and discomfort had been eliminated. Joseph Lister adopted chloroform as his favorite anaesthetic, and was quickly followed by most of the other surgeons. Sniping at the use of anesthetics in childbirth, mostly by moralists, was finally eliminated in 1853.
Chloroform was used when Queen Victoria gave birth to her eighth child. Simpson had triumphed and the final areas of opposition were removed. He was created a baronet in 1866, the first such honour to be given to a practicing doctor in Scotland.
This was not only for his development of anesthetics in medicine, but also for his work in gynaecology, obstetrics and hospital reform.
James Young Simpson died on 6th May 1870 at his home in Queen Street, Edinburgh. The City of Edinburgh gave him a public funeral and he is buried in Warriston Cemetery. His family declined a burial in Westminster Abbey, although a bust has been placed there with the inscription indicating, “that it is to his genius and benevolence the world owes the blessings derived from the use of chloroform for the relief of suffering.”