Letters

Pioneers of surgery and anaesthesia

Context and history

Tue May 16 2023 - 00:11

Sir, – It’s apparently unclear if Bismarck ever said that laws, much like sausages, are more palatable if we don’t know how they are made. I often think that medical advances could be added to that list. Chris Fitzpatrick’s overview of the work of James Marion Sims is a good example (“The ‘Father of Gynaecology’ Dr James Marion Sims and his brutal experiments on slaves”, Opinion & Analysis, May 14th). Some of the criticisms made though are arguably harsh in their historical context.

Discussing a series of experimental operations done for vesico-vaginal fistula (VVF) between 1845 and 1849, Prof Fitzpatrick is strongly and, in many ways, appropriately, critical of Sims under a heading “Operating without anaesthesia”. It’s fair to point out though that the advent of anaesthesia only occurred in October of 1846, using ether as the agent. It was then reported in the New England Journal of Medicine in December of that year.

Ether is a dangerous drug associated with vomiting and consequent lung damage. The nauseating effects were not limited to the patient, but often affected the operating doctors and nearby staff too. It is furthermore highly flammable, and in the era in question electric light was not practically available. The light bulb was patented around 1880. Candlelit procedures with the use of ether were thus often extremely dangerous undertakings.

In ways that are hard to rationalise in hindsight however, anaesthesia remained controversial for some years thereafter, and most particularly so in the areas of obstetrics and gynaecology. An illustration of this can be seen from historical details of Queen Victoria’s medical care. She had expressed interest in the use of chloroform for analgesia during childbirth as early as 1848, while expecting her sixth child. However it was only at the birth of her eighth child, in 1853, that it was actually provided (Connor et al, Anaesthesia, 1996).

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The use of chloroform was safer than ether. It was actually discovered by a British obstetrician, James Young Simpson, including for use in labour, in 1847. He first tested it on himself. This was reported in November of that year, in Scotland.

The new drugs uptake in obstetric care was slow while in surgery it was quite readily adopted. Part of the reluctance around its use, somewhat bizarrely, was religiously motivated. A verse from Genesis, 3:16, “I will greatly increase your pangs in childbirth. In pain shall you bear children” was the main basis for this. Simpson during the relevant time was sufficiently concerned about this to write an article entitled “An Answer to Religious Objections Advanced against the employment of Anaesthetic Agents in Midwifery and Surgery”. The widely reported fact that Victoria used it in 1853 seemed to serve to eliminate much of the controversy about the practice, in Europe at least.

While there is much to condemn about the practice of Sims in developing his surgical approach, we living in developed countries today need to acknowledge our good fortune in taking for granted many such medical innovations. Had he used anaesthesia on these patients in the late 1840s that too should be labelled as experimentation without consent. Despite seeking it as early as 1848, it was only in 1853 that the British monarch could even get such care. I would doubt if it was provided to people in conditions of slavery in the US at any point prior to abolition.

Furthermore, and most alarmingly, to the millions of enslaved people around the world today, safe anaesthesia care remains one of the many things they acutely lack. In poorer parts of the globe, VVF remains a devastating long-term consequence of childbirth, with victims often becoming outcast. If they are to have any hope of treatment, it will be thanks to the pioneers of surgery and anaesthesia, whose early endeavours now often seem shocking and barbaric in their conduct. – Yours, etc,

BRIAN O’BRIEN,

Kinsale,

Co Cork.