Anesthesia

In 1853 the Queen’s personal physician, Dr. John Snow dripped an ounce of chloroform on a handkerchief which was then held next to the royal mouth as Prince Leopold was delivered.  Her Majesty was very happy with the experience and endorsed the use of chloroform.  Many women followed suit, sometimes even naming their newborn children “Anesthesia.”

Dr Oz and phthalates

phthalateThe title of the segment on the Dr. Oz Show was “The Secret Ingredient Companies are Hiding in Your Food.” What could that be? Some opiate to keep you coming back for more? Tetrahydrocannabinol to increase appetite? No. The segment was all about chemicals called phthalates. And companies are not hiding their presence any more than they are “hiding” the presence of numerous substances that are not added to our food supply on purpose but can be detected through sophisticated analytical methods. These include pesticide residues, corrosion inhibitors, PCBs, detergents, chloroform, cadmium, radium, mercury, aflatoxins, bacteria and a host of others. Some of these are man-made, some occur naturally, but all are potentially toxic if present in a high enough dose. They end up in our food supply for the simple reason that if substances come into contact with each other, there will be a transfer of material from one to the other. If chloroform forms in water as a result of chlorination, which it does, some will be transferred to food that comes into contact with the water. Flourinated compounds used to produce grease-proof packaging can leave residues in food, aspergillus fungi can contaminate apple juice with their toxic metabolite patulin, wine may harbour residues of isinglass, a fish protein used to remove fine particles, and the potential carcinogen acrylamide forms when bread is baked.

None of these substances appears on food labels, not because there is some conspiracy to hide them, but because they are unavoidable. So it is with the phthalates. They do end up in our food supply because these chemicals have widespread applications. They lend flexibility conveyor belts, tubes used in milking machines and to plastic water pipes. They help the dispersal of pesticides, they’re found in caulking and in printing inks used on food packaging.

It’s no surprise to anyone familiar with chemical analysis that phthalates can be detected in our urine. Their presence, though, did come as a big surprise to the ten women Dr. Oz selected to have their urine analyzed for phthalates. None of the women had ever heard of phthalates before, which is quite surprising given the amount of publicity they have received. Their faces filled with panic when Oz revealed that they all tested positive for phthalates, chemicals that had been associated with endometriosis, weight gain, respiratory problems as well as brain and behaviour changes in children.

But here is the crux of the problem. Associations do not prove cause and effect. Just because women are more likely to suffer from endometriosis if they have higher levels of phthalates in their urine doesn’t mean that phthalates are the cause. Perhaps they have greater phthalate exposure because they eat more fatty foods like dairy and meat which are known to have higher amounts of phthalates. Perhaps they used more scented products most of which contain phthalates to inhibit the evaporation of the scent and they were somehow reacting to some of the numerous chemicals that make up scented products.

None of this is meant absolve phthalates from all blame because there are sufficient laboratory studies, animal experiments and human epidemiological data that suggest the need for further investigation. But there is no need for panic. There are numerous other substances that could be detected in our urine that could also be vilified in the same fashion as the phthalates. How many? At least 3,079 compounds can be detected, of which 2,282 come from diet, drugs, cosmetics or environmental exposure. Enough chemicals there for Dr. Oz to discuss and panic audiences for many years.

 

Joe Schwarcz

Joe Schwarcz: James Simpson, chloroform pioneer, took the pain away

SimpsonThe experiment, James Simpson decided, would go ahead even though the rabbits had died. And that decision was destined to have such a huge impact on medicine that more than 100,000 grateful Scots lined the streets of Edinburgh in 1870 to pay their respects as Simpson’s funeral cortège passed by. Many had undergone surgery or had given birth to children painlessly thanks to Simpson’s great discovery: chloroform.

Not many students graduate with a medical degree at age 20, but James Simpson did. In the early years of the 19th century, doctors didn’t have many tools at their disposal, and young Simpson was particularly disturbed by the suffering he witnessed in the surgical theatre. He once remarked that “the man laid on an operating table in one of our surgical hospitals is exposed to more chances of death than the English soldier on the field of Waterloo.” No surprise, then, that when word came from America of the discovery of ether as an anesthetic, Simpson was quick to jump on the bandwagon.

But there were problems with ether. It was flammable and difficult to administer, and often made patients sick. But Simpson reasoned that if ether could put people to sleep, there had to be other chemicals that could do the job as well. And who better to ask for suggestions than Scottish chemist Lyle Playfair, who had trained under the famed German professor Justus von Liebig?

Playfair was no expert in putting people to sleep, but he told Simpson about a sweet-smelling volatile liquid he had seen Liebig prepare back in 1832. It just so happened, Playfair went on, that one of his assistants had recently made some, and Simpson was welcome to give it a try — with one proviso: the experiment would first have to be tried on two rabbits. It seems Playfair didn’t want to be responsible for any harm that could befall the eager Simpson, who was already establishing a name as a caring, skilled physician.

The rabbits were exposed to the vapours of chloroform and promptly fell asleep. When they awakened with no apparent side effects, an exuberant Simpson grabbed a bottle of chloroform and made plans with his physician friends George Keith and Matthew Duncan for a little chloroform party the next day. The three had already been into sniffing a variety of chemicals in hopes of finding an improved anesthetic, but Keith and Duncan suggested it would be a good idea to check on the rabbits in the morning for any lingering effects. Well, there were lingering effects all right. The rabbits were dead!

Why this did not deter the trio from experimenting with chloroform isn’t clear. Perhaps it was their drive to become medical pioneers, or maybe they had enjoyed the effects produced by some of the chemicals they had previously inhaled. In any case, on the evening of Nov. 4, 1847, Keith became the first guinea pig, inhaling a good dose of chloroform. Within a couple of minutes he was under the table. Without waiting to see their colleague’s fate, Duncan and Simpson followed suit. After some initial hilarity, they also passed out. On awakening, Simpson declared that “this is far stronger and better than ether,” and predicted chloroform would “turn the world upside down.”

The young doctor was so impressed that he immediately hired a chemist to prepare a fresh supply of chloroform, which in those days was made by reacting acetone with chlorine. Four days after his sniffing binge, Simpson chloroformed a woman, who 25 minutes later gave birth. Within a month, Simpson had used chloroform successfully on more than 50 patients.

Still, as with any drug, there were risks, including death. In 1848, young Hannah Green died, probably due to improper administration of the anesthetic for the removal of an infected toenail. Soon after this tragedy Dr. John Snow developed an inhaler that regulated the dosage of chloroform and reduced the risk of such deaths. Simpson was then able to quiet those who still deemed chloroform to be too dangerous by keeping careful statistics on successes and side effects. When detractors claimed that chloroform was unnatural, Simpson replied that “so are railway trains, carriages and steamboats.”

Religious opposition, however, was harder to overcome. The faithful argued that pain relief during childbirth was unholy because according to the scriptures women were destined to be punished for Eve’s original sin. Tempting Adam with the fruit of the tree of knowledge, it seems, was not a good idea. Critics pointed to a passage in Genesis where God tells Eve that “I will increase your pains in child-bearing; with pain you will give birth to children.” Simpson cleverly retorted that anesthesia was actually inspired by God, who can be regarded as the world’s first anesthetist. He had his own biblical reference: “So the Lord God caused the man to fall into a deep sleep; and while he was sleeping, he took one of man’s ribs and closed up the place with flesh.”

Still the battle between the pro- and anti-chloroform forces raged for several years, finally abating in 1853 when Simpson recommended chloroform to his most famous patient, Queen Victoria. After giving birth to Prince Leopold, the Queen expressed herself “much gratified with the effect of the chloroform.” If chloroform was good enough for Her Majesty, it was good enough for her subjects!

As the 20th century rolled in, chloroform began to show a notorious side as well. Criminals had taken to incapacitating victims by clamping a rag soaked with the liquid over their mouth. Then, in a highly publicized case in 1901, American businessman William Marsh Rice, whose fortune founded Rice University, was killed by his valet, who aimed to get his hands on Rice’s assets. The murder weapon was chloroform.

More problems cropped up by the 1930s, with chloroform being linked to liver problems and irregular heartbeats that sometimes proved fatal. Finally, as new sleep-inducing agents like isoflurane and desflurane were introduced, the use of chloroform as an anesthetic was relegated to the junk heap of history. But in its time, that “junk” was responsible for alleviating a great deal of suffering. In commemoration, an impressive bronze sculpture of Simpson now dominates Princes Street Gardens in Edinburgh, with the inscription, “Pioneer of Anaesthesia.” Indeed he was.

Joe Schwarcz

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