Progress in the Mid-19th Century: Nightingale, Chadwick, Snow and Simpson » Dangers in Surgery and Simpson's Chloroform
What you'll learn this session
Study time: 30 minutes
Edexcel spec: Paper 2 Section B, Breadth study B2, Key topic 1
- The three great dangers of surgery in 1848: pain, infection and bleeding
- How ether and then Simpson's chloroform (1847) stopped the pain
- Why some people opposed anaesthetics, and how Queen Victoria's use of chloroform in 1853 helped
- Why surgery then entered a 'black period' of deadly infection
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Unlock This CourseThe three dangers of surgery
In 1848 an operation was a terrifying thing. Surgeons cut off damaged arms and legs (amputations), removed stones from the bladder and took away lumps on the outside of the body. They rarely dared to open the chest, stomach or head, because patients almost never survived. Three dangers stood in their way.
😰 Pain
Patients were awake and in agony. Helpers held them down. Surgeons had to work very fast, and some, such as Robert Liston in London, were famous for amputating a leg in a few minutes at most. Speed meant mistakes.
🩸 Bleeding
Surgeons could tie blood vessels with thread, but patients still lost a great deal of blood. Fast work was the best defence. There was no safe way to replace lost blood.
🦠 Infection
Wounds often went septic. Surgeons did not wash their hands, and instruments and operating rooms were not cleaned. Many patients survived the operation but died days later.
Key terms:
- Anaesthetic: a drug that stops a person feeling pain, usually by making them unconscious during an operation.
- Infection: harm caused when germs get into the body. In wounds it often led to sepsis, which is blood poisoning.
- Ether: a liquid whose fumes, when breathed in, made a patient unconscious.
- Chloroform: another liquid whose fumes, when breathed in, made a patient unconscious.
- Obstetrician: a doctor who looks after women during pregnancy and childbirth.
- Black period: the name historians give to the years after the first anaesthetics, when more operations led to more deaths from infection.
Ether and the search for something better
People had long tried alcohol and opium to dull pain, but they were not strong enough for surgery. In October 1846 a dentist, William Morton, showed doctors in Boston, USA, that breathing in ether could send a patient into a deep sleep. In December 1846 Liston used ether in London to amputate a patient's leg. Word spread fast.
Ether worked, but it had problems. It irritated the lungs, so patients coughed and vomited. It was bulky to carry, and it could catch fire. Doctors wanted something simpler.
Simpson and chloroform
James Simpson was an obstetrician in Edinburgh. He wanted to ease the pain of childbirth, so he and his assistants tested different vapours on themselves. In November 1847 they breathed in chloroform and fell unconscious. Simpson soon used it on patients and quickly published his findings.
Chloroform had real advantages over ether:
- It acted quickly, and only a small amount was needed.
- It did not irritate the lungs.
- It was easy to use: a few drops on a cloth held over the nose and mouth.
- It was not bulky and it did not catch fire.
Chloroform soon became the most widely used anaesthetic in Britain.
Opposition to anaesthetics
Not everyone welcomed the new drugs. There were two main objections.
⛪ Religion
Some churchmen argued that pain in childbirth was God's will, pointing to the Bible (Genesis, where women are told they will bring forth children in sorrow). Simpson replied with another Bible passage, where God puts Adam into a deep sleep before taking his rib.
🩺 Medicine
Some doctors thought pain was a useful sign that the body was fighting, or that shock was good for recovery. Others pointed to the risk of death from an overdose. In January 1848 a 15-year-old girl, Hannah Greener, died after being given chloroform for a minor operation.
Some surgeons also worried that their skill would be lost. They were proud of working fast and did not like having to change.
Queen Victoria
The turning point in public opinion came in April 1853, when Queen Victoria took chloroform during the birth of her eighth child, Prince Leopold. Her doctor was John Snow, who specialised in giving anaesthetics. The Queen was head of the Church of England and was greatly respected, so her example made chloroform fashionable and respectable. Much of the religious and public opposition faded.
The 'black period' of surgery
Anaesthetics removed pain, so surgeons no longer had to rush. They could take more care and try longer, more difficult operations. The number of operations rose. But the other two dangers remained, and infection became far worse.
- Surgeons still did not know that germs cause infection, so nothing was cleaned. Some wore old coats stiff with blood.
- More and deeper operations gave germs more chances to get into the body.
- Hospitals were crowded and dirty, so infection spread from patient to patient.
Many patients now survived the operation only to die of sepsis afterwards. This period, from the late 1840s until the late 1860s, is often called the black period of surgery. It ended only when antiseptics came in (see the lesson on Lister and Antiseptic Surgery).
Change and continuity
What changed: pain was finally controlled, so surgery became less terrifying and more operations were possible.
What stayed the same: infection and heavy bleeding were still unsolved. Anaesthetics made surgery possible, but not safe.
Common mistakes
- Saying anaesthetics made surgery safe. They removed pain, but deaths from infection rose at first.
- Mixing up ether (first used in 1846) and chloroform (Simpson, 1847).
- Saying Queen Victoria discovered chloroform. She used it, and her example reduced opposition.
- Saying Simpson invented anaesthetics. He introduced chloroform as a better alternative to ether.
- Giving only one cause in an 'Explain TWO causes' question. That scores half marks at most.
Exam-style question
Explain TWO causes of the 'black period' of surgery in the years c1847-c1867. [8 marks]
Model answer
One cause was the arrival of anaesthetics. After ether in 1846 and Simpson's chloroform in 1847, pain no longer forced surgeons to work in minutes. They could carry out longer, deeper operations and the number of operations rose. Every cut let germs into the body, so more patients developed sepsis. This meant more people died of infection after surgery, even though they had felt no pain.
A second cause was that nobody understood what caused infection. Surgeons did not wash their hands, and instruments, coats and operating rooms were left dirty, because germs were not yet known to be dangerous. In crowded hospitals infection passed from patient to patient. As a result, infection after an operation was common, and it stayed deadly until antiseptics were introduced.
What lifts this to the top level: each cause is developed with precise knowledge (dates, names, actions), and each paragraph explains how the cause led to more deaths from infection.
Exam tip
Show the link in each paragraph. Do not just say 'chloroform was invented'. Explain how it led to more operations, and so more infection.