THE LIFE AND DEATH
OF CHLOROFORM
Ether burst onto the medical stage in October of 1846 when a dentist, William Thomas Green Morton, administered the volatile compound to twenty-year-old Edward Abbott while the noted Boston surgeon, Dr. John Warren removed a neck tumor. Painless surgery had arrived.
News of the dramatic effect of ether flew across the Atlantic. That December, Dr. James Simpson, Professor of Midwifery in
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| James Simpson (Wikipedia) |
Edinburgh, traveled to London to witness its use in an operation by his old teacher, Robert Liston. Liston took 28 seconds (surgeons before anesthesia had to be quick) to amputate a leg without any complaint from the etherized patient. He announced after the procedure, “This Yankee dodge, gentlemen, beats mesmerism hollow.” Simpson eagerly took up ether anesthesia to ease the pains of labor as well as in surgeries. He ignored objections from clergy and other quarters that pain was natural in childbirth and should not be suppressed.
But difficulties administering and transporting ether led Simpson to assess many other agents. After trying somewhat indiscriminately, primarily on himself, various volatile compounds, a chemist friend suggested chloroform. On the evening of November 4, 1847, Simpson and two assistants sat at his dining room table and inhaled a small amount of the sweet-smelling substance. Simpson soon found himself on the floor along with his two semiconscious companions. The trio were so delighted with the result that they inhaled the substance several times more, finally heading home at 3 AM, determined to use it.
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| Cartoon of Simpson's home trial of chloroform (Wellcome Library) |
Chloroform, like ether, had been around for a while before its anesthetic potential was realized. Credit for the first synthesis goes to an American, Samuel Guthrie. Trained as a physician, Guthrie became more interested in business and set up a gunpowder plant and other enterprises near the shore of Lake Ontario. Interested in chemistry, he read in writings of the Yale University chemist,
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| Samuel Guthrie (Wikipedia) |
Benjamin Silliman, about a compound named “chloric ether,” whose sweet aroma might have uses in medicine. Dr. Guthrie devised a simpler method, in 1831, of making it by combining “best whisky” with chloride of lime and distilling the result. What he actually made was an alcoholic solution of chloroform. Sippers of this solution became pleasantly tipsy, sometimes drunk. Silliman chemically removed the alcohol, producing pure chloroform, but the mild alcoholic solution was used by American doctors for its pleasant and seemingly beneficial effects. Its anesthetic properties remained unknown.
Just over one year following Dr. Warren’s first use of ether and five days after Simpson’s chloroform experiment at home, a young woman in Edinburgh, Scotland, entered her second labor. She had previously endured an agonizing three-day labor resulting in a dead child. Simpson was her accoucheur, as he was called, and, anxious to avoid a second tortuous labor, he anesthetized her with chloroform – its first use in a patient. The young lady delivered a healthy child after a three-hour, painless labor. Within a few weeks Simpson helped over 50 women avoid labor pains and surgeons quickly adopted it for operations. His successful experience made him an enthusiast of the new agent and he publicized it relentlessly. It was cheap, easy to administer, acted rapidly, had a pleasant smell, lacked the irritating qualities of ether, and was not flammable.
In London, when ether was first in use, the highly educated but relatively obscure practitioner, John Snow (later of cholera fame), took an interest. He had worked on respiratory physiology and
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| John Snow (Wikipedia) |
surmised that the varying results with ether might be due to varying dosage. He measured the amount of ether in air at varying temperatures, devised a breathing apparatus that produced a predictable amount for administration, and characterized five levels of anesthesia. Later, responding to the enthusiasm for chloroform, Snow devised a similar breathing apparatus to administer an exact dose. He helped Queen Victoria through two labors with the new agent, though without the apparatus since she was lightly dosed. Most practitioners, in fact, continued to pour chloroform onto a sponge or cloth-covered cone. During the American Civil War and the Crimean War chloroform was the chief anesthetic employed. The agent also made headlines as an instrument in kidnappings, rapes, and other crimes, though much of this was exaggerated.
Before long, reports of sudden death during chloroform anesthesia appeared, often during induction, that were unrelated to dose or underlying medical problems. The Lancet criticized Snow for using it on Queen Victoria, citing reports of unexpected deaths. Not until 1911 did Goodman Levy show that ventricular fibrillation occurred in cats under chloroform, suggesting a mechanism. He later published data showing that over two decades chloroform use constituted between 72 and 90 percent of all anesthetic deaths in Britain. In these cases British doctors were obliged to testify at a coroner’s inquest, but none were charged with anesthetic
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| Henry J. Bigelow (Wikipedia) |
malpractice throughout the nineteenth century. In the northern United states, however, doctors were sued for anesthetic deaths and, additionally, Henry J. Bigelow, Professor of Surgery at Harvard, used his influence to champion the use of ether as the safer choice. Chloroform usage died quickly in the north, though in the southern states its use continued for some time.
Levy’s publications were persuasive and eventually the mortality statistics could not be ignored on either side of the Atlantic. Chloroform usage declined everywhere, replaced by ether and eventually newer agents.
Pierre Louis in Paris pioneered the use of statistical methods in the early 1800s to question the value of bloodletting as treatment for pneumonia. His methods, after over half a century, finally convinced chloroform users to choose another anesthetic.
SOURCES:
Stratmann, Linda, Chloroform: The Quest for Oblivion, Sutton Publishing, 2003
Johansen, Peter V, et al, Cholera, Chloroform, and the Science of Medicine: A Life of John Snow, Oxford University Press, 2003.
Shepherd, John A, Simpson and Syme of Edinburgh, E&S Livingston, 1969.
Snow, Stephanie J, Blessed Days of Anaesthesia: How Anaesthetics Changed the World, Oxford University Press, 2008.
Levy, A. Goodman, Chloroform Anesthesia, William Wood & Co. 1922
Bigelow, Henry J, “Death by Chloroform and Alleged Death by Ether,” Boston Med Surg Journal, 1872; 86: 277-9.
Holmes, Oliver Wendell, “Henry Jacob Bigelow,” Proc Amer Acad Arts Sci 1891;
26; 339-51.
Thomas, K B, “The Early Use of Chloroform,” Anesthesia” 26(3): 348-62, 1971.
