Blood and Guts (7 page)

Liston took to holding parties at which ether was passed around
the assembled guests. These social events usually included a cross-section
of the capital's best-known artists and sportsmen, as well
as surgeons, doctors and other gentlemen and their wives. Much
hilarity ensued when the gas was tried out by some of Liston's
assistants and they were seen to lapse into insensibility.

The relatively small doses of ether applied before operations
meant that patients were 'under' for only a few minutes at most,
yet the possibilities the successful relief of pain offered were endless.
Operations no longer had to be so fast. Surgeons could take their
time; they could attempt more complicated procedures. Robert
Liston would not live to see the full potential of anaesthetics
realized. He died in a sailing accident less than a year later. But
by then his era of lightning-quick surgery was over.

While surgeons were saving lives with new techniques, medical
science was struggling to catch up. The work of doctors had barely
advanced since the Middle Ages, and if surgery was an inexact
science, then Western medicine was more akin to a faith, a bit like
astrology – scientific method built on foundations of sand.
Treatments had changed little over the proceeding centuries and
were limited in their scope. There were few cures available to
doctors, and fewer genuinely effective drugs. Apothecaries boiled
up all sorts of weird mixtures with varying results. A typical example
from Guy's Hospital includes 'bath of herbs and sheep heads'
prescribed to a woman suffering from an 'unknown illness'. How
marinating the poor lady in offal was going to cure her was anyone's
guess. Still, she probably paid handsomely for the privilege.

At best, all doctors could hope to do was to assist the natural
process of healing. This might work for influenza, but would be
completely ineffective against tuberculosis, syphilis or a heart condition.
Even in the 1840s, the work of the physician was still firmly
rooted in superstition. When you called on a doctor to attend you –
and they did not come cheap – you might reasonably expect some
sort of treatment. But the physician's options were limited. Medical
practice was still based on the theory of the four humours developed
by Galen. It was the job of the doctor to balance the bodily
fluids of yellow bile, black bile, phlegm and blood.

As the understanding of anatomy had advanced over the
centuries, most Victorian doctors knew this view of physiology no
longer made sense. Yet the treatments available remained largely
unchanged. Doctors could prescribe drugs. Some were effective for
pain relief but others, such as mercury, were downright dangerous.
Physicians would induce vomiting or diarrhoea in the patient to
purge the body. They could also drain away excess blood. All these
treatments made sense if you accepted the idea of the humours.
They made no sense at all if you looked at the growing scientific
evidence against them.

Bloodletting was as important to early Victorian medicine as it
had been for almost two thousand years. Draining blood allowed
doctors to remove 'morbid' matter from the bloodstream. This, the
logic went, would be replaced by new healthy blood. Doctors carried
scalpels or lancets (hence the name of the medical journal) to cut
the skin and allow the blood to drain into shallow bowls. Others
employed 'cupping' techniques, where small glass bowls were
heated and placed over the lanced area of skin. The bowls cooled,
forming a vacuum which helped to suck blood from the body.
^*

^*
Cupping also proved effective for pain relief, and was in common use in hospitals until
the 1950s.

Some doctors preferred using leeches rather than cups. When
leeches are attached to the skin they secrete a chemical that
prevents the blood from clotting. This anticoagulant is so effective
that even when the leech is removed, the wound will continue to
bleed for another three to four hours. Leeches were particularly
useful for bleeding sensitive areas of the body, such as the gums or
around the eyes. American leeches were said to have a less irritating
bite than British ones. The received wisdom was that leeches should
be kept in a tub of river water with some peat or turf. It was best to
rinse them before application.

For the modern physician who wanted to keep up with cutting-edge
medical advances, scarifiers were the answer. These vicious
contraptions resembled the mechanism of a clock and were
marketed as the 'mechanical leech'. This 'new and modern' device
contained a row of blades. When it was placed against the skin and
a button was depressed, the blades sprang out to puncture the
surface and induce bleeding.

The cases where bloodletting appeared to be effective were
probably attributable to the placebo effect – the patient's belief in
the treatment.
^*
At least with bloodletting, patients were getting
something for their money. However, by the 1860s evidence was
mounting that the procedure was not only useless, but was probably
doing more harm than good, particularly when advances in human
physiology showed that bloodletting reduced the concentration of
red blood cells. These contain haemoglobin, the protein complex
that carries oxygen.

^*
There have been several studies over the years that show the placebo effect is actually quite
an effective treatment. If patients believe a drug is doing them good, they tend to recover
more quickly.

Nevertheless, and despite the scientific evidence, doctors were
reluctant to abandon bloodletting altogether. At the turn of the
twentieth century it remained a recommended treatment for high
blood pressure (based on the 'common sense' argument that less
blood meant less pressure). Even as late as the First World War,
the technique of bloodletting was applied to the victims of gas
attacks in the trenches.

Aside from blood, there were plenty of other bodily secretions
to worry about. Urine in particular was seen as a valuable diagnostic
tool. Not its chemical composition – its protein or sugar concentration
– but its colour. Much, it was said, could be read into the colour
of urine. Some specialists made their diagnosis on urine alone.
Flasks of urine would be sent to them by other doctors for a specialist
opinion. Often, somewhat inevitably, the prescribed treatment
for the patient's ailment would be bloodletting. And so it went on.
Doctors seemed to be struggling to keep up with scientific developments.
Surgeons, on the other hand, were as eager as ever to try
something new.

Edinburgh, 1847

Ether was gaining in popularity, but the anaesthetic did have its
drawbacks. It was a noxious gas to breathe, irritating the mouth and
lungs. It had a tendency to induce vomiting in patients. The flask
and tubes involved in administering it were awkward, and its effectiveness
proved inconsistent. But the biggest problem was ether's
high flammability.

Ether was being used only inches from the naked flames of the
gas lights hanging over the operating table. The slightest upset and
the gas was likely to explode in a ball of flame. There was also no way
of telling how the prolonged use of ether would affect the patient.
Would it leave them permanently unconscious or even brain
damaged? Surgeons were used to their patients dying, but this
seemed an especially unnatural way to go. There was also the question
of its pedigree: it had been invented by a maverick 'Yankee' dentist.
This was deeply unsettling to British, scientifically trained surgeons.

The only way the medical questions were going to be answered
was to experiment on patients. Surgeons, of course, usually had no
problem with this. Some, however, felt the drawbacks of ether were
too great and started to look for an alternative.

James Simpson was a young professor of midwifery at
Edinburgh University. As a student under Robert Liston, Simpson
had attended his first operation aged just sixteen (he qualified in
medicine at eighteen). The horror of the experience had lived with
him ever since. Now head of obstetrics, he realized that every day he
was witnessing more pain than ever.

Simpson was the son of a village baker, so to have risen to such
a high position within the Scottish medical establishment was a
remarkable achievement. He appears to have won the post through
a combination of political persuasion (money may or may not have
changed hands), public campaigning and, above all, an overwhelming
sense of confidence and self-belief. It helped that he was also an
excellent surgeon.

During a visit to London, shortly after the first ether operation,
he had the opportunity to talk to Liston and confirm what was
involved in the procedure. Perhaps he could apply pain relief
during childbirth to relieve the terrible suffering some women had
to endure? But questions about ether's safety become even more
important when childbirth is involved. The gas would not only have
to be used over a long period – hours possibly – but there was no
knowing what effect it could have on the foetus. Might the child be
killed or born an idiot? Simpson would also have to contend with
religious and moral objections to the use of pain relief. Surely the
pain of childbirth was a natural process? Didn't Genesis state that
woman should bring forth her children in sorrow?

But Simpson was a driven man. He spent that summer trying
out every chemical he could lay his hands on. He mixed a whole
variety of substances together, drank and sniffed a cocktail of
compounds. Every chemical that might prove a suitable candidate
was inhaled or ingested. Then one day Simpson tried a new
chemical that had been suggested by a Liverpool chemist. He woke
up on the floor.

The last substance Simpson had tried before he passed out was
known as chloroform. A colourless liquid composed of alcohol and
chlorinated lime, chloroform had been invented some fifteen years
earlier and marketed both as a treatment for asthma and a stimulant.
That it had quite the opposite effect was an early cautionary
lesson to not always believe what the pharmaceutical industry puts
on the bottle. After trying the chemical a few more times, Simpson
decided that chloroform needed rigorous testing before he used it
on patients. So a few days later he took the opportunity to experiment
on friends and family.

After dinner one night he served up tumblers of chloroform to
some of the assembled guests. On breathing in its sweet, fruity
aroma, they slipped into a magical state of relaxation. They laughed,
they joked, the room started to spin, the conversation became
distant and faint. The guests tumbled off their chairs or lay themselves
down on the floor. Then everything went blank. 'This is better
than ether!' exclaimed Simpson as he picked himself up off the rug
some minutes later. 'A most pleasurable experience.' So pleasurable,
in fact, that all the other guests were keen to try the thrill of
chloroform for themselves. Simpson's niece had a sniff and
presently declared herself an angel before passing out on the settee.

His scientific trial now complete, Simpson concluded that
chloroform was a great success, and was in no doubt that it would
bring untold benefits to his patients.

Four days later, Jane Carstairs is in the final stages of labour. Her
screams following each contraction can be heard far beyond the
delivery room. Bathed in a blanket of sweat, she is starting to
become exhausted. Simpson knows he will have to intervene. He
will probably have to use forceps, slipping the instrument – like a
pair of long, wooden-handled serving spoons – either side of the
infant's head. Then he will pull and it will hurt even more.

Simpson sprinkles a few drops of chloroform on to a handkerchief
and lays it across Mrs Carstairs' mouth and nose. 'Keep breathing
deeply,' he tells her. Within a minute she is asleep. When she
awakes she is handed a little baby girl. The first success for this
marvellous chemical.

This was the final proof Simpson needed that chloroform would
transform nineteenth-century medicine. The charismatic surgeon
saw it as his mission to spread the word. 'It was my duty,' he said, 'to
teach all these people that they were wrong and I was right.' While
taking every opportunity to try the drug out in his own practice
(within a week he had used the new anaesthetic in an astonishing
fifty cases), Simpson planned a marketing campaign to make sure as
many people as possible knew about chloroform. Rather than
publish his findings in a journal, couched in cautious scientific
terms and possibly written in Latin, he took his results directly to the
public. He drew up pamphlets that he sent out to other doctors. He
gave talks and held demonstrations. He even took out an advert in
the
Scotsman
newspaper, proclaiming this new miracle pain relief.

Not only was chloroform a more effective anaesthetic than
ether, it was also a Scottish invention, and soon became a source of
national pride. Simpson's confidence was infectious, and surgeons
across Europe began to adopt his technique. Others sought to
refine it, looking at new ways of administering the drug. One of
Simpson's friends, a certain Dr Smith, tried to administer the drug
rectally. Filling a syringe with chloroform, he injected it into his
back passage. He woke up some hours later in a pool of diarrhoea
with the syringe still in place, and suffered severe anal burns.

Apart from Dr Smith's misfortune, chloroform seemed to have
few disadvantages. Patients were comfortable taking chloroform; it
was easy to use and, unlike ether, involved no cumbersome equipment.
As Simpson put it, 'No special kind of inhaler or instrument
is necessary for its exhibition. A little of the liquid, diffused upon
the interior of a hollow-shaped sponge, or a piece of linen or
paper, and held over the mouth and nostrils, so as to be fully
inhaled, generally suffices, in about a minute or two, to produce
the desired effect.'