The Religious Objections and Military Opposition to Anesthetics, 1846–1848☆

More than four years before the anesthetic first published in the medical literature, on March 30, 1843, Crawford Williamson Long administered sulfuric ether for the excision of a neck cyst on a patient in Jefferson, Georgia.1 On October 16, 1846, William Thomas Green Morton (1819-1868) used sulfuric ether to anesthetize a patient at the Massachusetts General Hospital. Bigelow’s first published account of anesthesia greatly influenced the spread of volatile anesthesia.2 Within months anesthesia had been used throughout Europe and had even made its way to China.3 The next year on January 19, 1847 Sir James Young Simpson (1811-1870) first used sulfuric ether during the management of labor and childbirth in Edinburgh, Scotland.4 The first wartime use of anesthesia took place later that year on March 29, 1847, in Vera Cruz, Mexico, when Edward H. Barton administered sulfuric ether during the amputation of a gangrenous lower limb performed on a civilian teamster who had suffered an accidental gunshot wound during the MexicanAmerican War (1846-1848).5 Simpson would make a further lasting contribution to medicine in the final months of 1847 by introducing a new volatile agent to clinical practice, chloroform.6 From the beginning, the introduction of inhaled anesthesia would be controversial. In two areas of perennial human suffering, childbirth and warfare, where the potential for alleviation was greatest, acceptance of this new technique was not immediate. This essay presents a description of two physicians of the Victorian period, Scottish obstetrician James Young Simpson and American Army military surgeon John Porter. Each, after seeing the effects of anesthesia on the suffering of surgical patients came to a very different conclusion. Their subsequent work and writing strove for divergent ends; one embraced the use of volatile agents; the other deplored their use. Arguments against the use of anesthesia in British obstetrics ranged from questioning the safety of the new volatile agents for mother and fetus to challenging the theological basis for altering the birthing process. Although objections on the basis of safety are arguably the most demonstrable, as attested by the number of written accounts and historical treatment, the objections on the basis of religion described by Simpson are not as easily demonstrated but became a matter of intense interest during the twentieth century. Nearing the year 2000, the early religious opposition to anesthesia became a controversy in its own right as historical researchers sought original written sources.8 Opposition to the military use of anesthetics in the United States was based on Porter’s anecdotal concepts regarding bleeding and wound healing and was promulgated by a few physicians in the hierarchy of the U.S. Army Medical Corps who controlled policy at military hospitals. As reports of the use of volatile agents entered the collective professional consciousness of physicians and surgeons throughout the world, reactions were mixed. Proponents of anesthesia emerged, none more prominent than the energetic Scottish obstetrician, James Young Simpson. Remarkably, he first entered the University of Edinburgh at age 14 in 1825.8 Elected Chair of Midwifery at the University of Edinburgh in 1840, he was a popular lecturer on medical topics predominantly, but had expertise in archaeology as well. He was said to be the busiest obstetrician in Scotland,9 and in 1847, the year of his great innovations, he was named one of Her Majesty’s Physicians in Scotland.10 Simpson lived in a society immersed in religion and yet shaped by ideas of the Enlightenment period. His daily interactions were among people whose culture was shaped by two forces, an emerging secular liberalism that was by mid-century strong enough to realize the election of a nonChristian born prime minister, Benjamin Disraeli, and the enduring influence of the established Churches of Scotland and England, headed by the British Monarch. The idea of early religious opposition to anesthesia animated Simpson’s professional efforts to popularize the ether and chloroform techniques. In December, 1847, he produced a thought-provoking treatise, Answer to the Religious Objections Advanced Against the Employment of Anaesthetic Agents in Midwifery and Surgery. He wrote the pamphlet because he had: “during the last few months, often heard patients and others strongly object to the superinduction of anaesthesia in labour, by the inhalation of Ether or Chloroform, on the assumed ground, that an immunity from the pain during parturition was contrary to religion and the express commands of Scripture. Not a few medical men have, I know, joined in this same objection; and have refused to relieve their patients from the agonies of childbirth, on the allegation that they believed that their employment of suitable