A strange little book

The presence of James Mathews Duncan at the dinner party held in James Young Simpson's house on 4 November 1847 is well known. The events leading up to this important date in anaesthetic history have been outlined many times as the discovery of the anaesthetic action of chloroform is heralded as one of Simpson's major contributions to medicine. James Mathews Duncan moved to St. Bartholomew's Hospital in 1877 and his family deposited a wealth of material relating to his work in the library stores some time before 1950. A review of this material sheds some interesting new light on these early days of anaesthesia's development and even suggests that Simpson's discovery might belong to another. In the basement library store at St. Bartholomew's Hospital, a small privately bound book was discovered by the author with the words ‘Mathews Duncan–J.Y. Simpson’ on the spine. The contents page reads: ‘Notes on the inhalation of sulphuric ether, J.Y. Simpson, Newspaper account of the Simpson Centenary Daily Telegraph June 7th 1911 and Account of the election of Midwifery Chair Edinburgh 1840’. Inside the book had been pasted various items. The ‘Notes on the inhalation of sulphuric ether’ was a copy of Simpson's paper for the use of ether in midwifery printed on 28 February 1847 in Edinburgh. The Daily Telegraph account was published to commemorate Simpson's birth and ran to several columns. It gives an overview of his life and focuses heavily on his discovery of chloroform anaesthesia. The final item on the contents page is a detailed account of the appointment of Simpson to the Chair of Midwifery in Edinburgh. These latter two items are of no great relevance to anaesthesia. In the back of this small book and not mentioned on the contents page is a short letter from J.Y. Simpson to Mathews Duncan in Paris. The address is (as far as I can read it): ‘M le Docteur Duncan, Cour de Commerce 24, Fouburg St Germain, Paris’. It is ‘stamped’ 1 March 1847 and says: ‘My Dear Sir, Many thanks for your letter. I shall ever be delighted to hear from you, I have sent copies to Velpeau, Moreau, Roux, Dubois, etc. I wish you could or would translate the pith of these notes for one of the French Journals. James Keith will be in Paris in a few days. I believe we will all yet use the ether in Common Midwifery cases. Send me all particulars, yours ever truly, J Y Simpson.’(Fig. 1). The letter is dated 28 February 1847 and presumably contained the paper that Simpson had written and which had been published on the same day in Edinburgh. Letter from James Young Simpson to James Mathews Duncan in Paris January 1847. This is absolute further confirmation that Duncan was asked to translate Simpson's paper for the French and is an important link in the chain that binds Simpson and Duncan together. This small booklet is now placed in the Archives of St. Bartholomew's Hospital (‘Barts’) with several others relating to Duncan's life. The Barts Archive has a rich repository of items relating to Duncan and a clear picture of his life and upbringing can be garnered. He was born on 29 April 1826 in Aberdeen, Scotland, and was baptised by the Reverend Alexander Thompson at the family home on the corner of Bon-Accord Square, then on the outskirts of Aberdeen. His father, William Duncan, had a commission and shipping business in Aberdeen together with some lime quarries in Banffshire. His mother, Isabella, was some 13 years younger than his father and was 25 years old when James was born. He was the fifth of eleven children and, when he was 1 year old, the family moved to Broadford, a northern suburb of the city, so that his mother could be nearer to her parents. This was a large house with considerable gardens and land. There are descriptions of large flower and vegetable gardens, greenhouses, a vinery and a hay meadow. The house was well staffed with a factotum and a cook and the family obviously lived in style travelling by pony and carriage and having several large watchdogs at home. At the age of 4, James was sent to Mr Meston's Academy; he was a reputedly severe teacher and James no doubt looked forward to the holidays when the family would move to a rented farmhouse at Dyce, where all would swim and relax. James moved to Aberdeen Grammar School when 8 years old, an unusually young age to enter this school. He was noted to have a contempt of any danger that, together with an unfailing sense of humour, made him a very popular companion. Within a few years his father retired and bought a farm in Skene. James entered Marischal College in 1839 (at the age of 13) and studied at the Faculty of Arts, obtaining an MA in 1843 (as a 17-year-old). He soon became fluent in both French and German, an ability he retained throughout his life. At the age of 15 he started to study medicine and regularly attended Aberdeen Royal Infirmary, spending five months as a dresser to Dr Keith and working in the Museum of Anatomy. On 28 October 1845, he passed his second examination for the degree of Doctor of Medicine and moved to Edinburgh University to improve his studies attending classes held by Simpson, Alison, Christison and Syme. He was too young to graduate as a Doctor of Medicine from Edinburgh (he needed to be 21 years old) and so gained his MD at Marischal by special petition in 1846 when aged 20. In the winter of 1846–47, James Duncan was sent by his father to study in Paris. He studied at the College Royal de France and obtained a Certificate of Study on 21 March 1847. This, then, was the time that he received the letter from Simpson with his paper on ether. Dr James Keith visited him at this time and it is possible that the idea of working with Simpson was part of their conversation. In June 1847 he returned to Edinburgh and became a junior assistant to Simpson, seemingly with a specific remit to investigate other potential anaesthetic agents in addition to his other obstetric work. In 1851 James Duncan set up in private practice in Edinburgh, although he still remained on good terms with Simpson. He had added the name Mathews (his mother's maiden name) to his in 1848 to avoid further confusion as had already arisen over another Dr James Duncan who also practised in Edinburgh. He obviously enjoyed travelling and came to London on several occasions, where he was particularly impressed by the Great Exhibition at that time. Having been proposed by Simpson, Mathews Duncan obtained a resident Fellowship of the Royal College of Physicians, Edinburgh in May 1851, and he started to lecture there on midwifery in 1853. He married Miss Jane Hoskiss (Fig. 2) on 21 August 1860, and they were to have 13 children of whom 9 were to survive him. In 1861, he was appointed to the ward for the diseases of women at Edinburgh Royal Infirmary and he also helped to found the Royal Hospital for Sick Children in Edinburgh. In 1862 he was made an Honorary Member of the London Society of Obstetricians as his fame and skills became more widely known. Chalk drawing of Miss Jane Hoskiss at the time of her engagement to James Mathews Duncan by William Crawford RSA and an oil painting of James Mathews Duncan by William Fettes Douglas. Upon the death of his mentor, Simpson, in 1870 it was expected by many that Mathews Duncan should succeed him but, despite letters of support from across Great Britain, France, Germany, Holland, Austria, Russia and America, Duncan was not appointed. In 1875 he was awarded an Honorary LLD by Edinburgh University and then, in 1877, he was invited to become Physician Accoucher to St. Bartholomew's Hospital. Duncan was said to have visited the hospital; he immediately decided to take the appointment and said afterwards that ‘there was to be found everything he most desired in the world’. His career continued to flourish as he improved the Barts Department and his lectures and teaching were very popular. When lecturing he was said to begin ‘slowly with a pleasant Scottish accent. Every word could be taken down and our attention was kept constantly alive by a humorous or caustic commentary on the mistaken ideas of those who disagreed with his own conclusions.’ He was made an honorary member of a wide variety of institutions round the world including the Medical Society of Edinburgh, the Indiana, Illinois and Kentucky Tri-State Medical Society, the Royal Medical College in Ireland, Dublin, the Gesellschaft für Geburtshulfe, Leipsig, the Russian Society of Doctors, the Physikalisch-Medicinische Societat, Erlangen, the Medical Society of Norway and the Obstetrical Society of Philadelphia and that of Louisville. In 1884, he attended the birth of a grandson of Queen Victoria, the Duke of Albany, and was thanked by the Queen with a gift of diamond and sapphire shirt studs (Fig. 3). James Mathews Duncan. He published widely on a variety of obstetric topics and had the peritoneal folds of the uterus named after him. By the end of June 1890, Mathews Duncan had to retire from work due to ill health. He and his family went to Blankenberghe in Belgium and then on to Baden-Baden to try the spa waters. On 15 August he had a severe attack of angina and, while plans were being made to travel back to London, he died suddenly on 1 September 1890. He was brought back to London and buried in Islington Cemetery. Queen Victoria noted in her diary on 31 September 1890 that ‘greatly shocked to hear of the death of Dr Duncan – a very great loss. He was a kind good man and wonderfully clever in his branch, quite an authority'. Also within the Barts Archive amongst the Duncan papers is a folder entitled ‘Mathews Duncan Copy 1’, inside which is a typescript of a 135-page document written by his eldest sister Isabella. Presumably never published, it is called ‘James Mathews Duncan: A sketch for his family’. Duncan died in 1890 and his eldest sister in 1901 so it is assumed that this was written between these years. The ‘sketch’ is a wonderfully detailed description of his life from childhood to death and is easy to read. Within it are some further details that shed light on the circumstances around the discovery of chloroform and Mathews Duncan's contributions to that discovery. Isabella writes: ‘In the evening and at all odd times came the experiments with anaesthetics which were often interrupted by urgent messages. As a sequel to the hazardous inhalation of strange vapours his health was temporarily affected – he became the victim of headache and indigestion. In November of 1847, as the story came to me, sometime after however, one morning in a quiet back room in Dr Simpson's house, James, after sniffing at various bottles and inhaling sundry new vapours, some of them deleterious to sickening point, found himself awakening slowly and pleasantly from an unconscious sleep, which the timepiece showed must have lasted about a quarter of an hour. Eureka I have found it I can imagine him exclaiming mentally with natural excitement. The substance which had put him into this peaceful swoon was called, if I remember rightly, chloride of formyle. It had been given with some other bottles to Dr Simpson by a chemist in Liverpool, where the doctor went occasionally to visit his wife's friends. I may be wrong as to this however, for I had it only from hearsay. James seized the first opportunity to tell Dr Simpson his opinion of this compound, and it was arranged that it should be tested in the presence of the latter one evening after supper. The successful issue of this trial fully satisfied Dr Simpson and he at once considered the discovery of an admirable anaesthetic accomplished.’ This, then, was the famous dinner party at which the attendees inhaled chloroform in turn and awoke in their chairs or under the table some time later on. Isabella Duncan continues: ‘It must be acknowledged that James felt rather hurt, when a little later Dr Simpson published a monograph giving an account of how he discovered chloroform, the label he gave the substance – to find that his name was merely classed with Dr Keith's as one to whom the discoverer was indebted for help. No doubt it was somewhat hard on Dr Simpson to see the crowning point reached by another after the thought and trouble he had given the subject of anaesthetics, yet one cannot help feeling that he would have gained rather than lost had he, in justice to his young coworker, generously detailed the circumstances more minutely and accurately. It would have done him no harm to have told that the evening meeting was the sequence to a previous successful experiment by an assistant. However assailable Dr Simpson might be, James never claimed, nor wished to claim, the discovery. He was Dr Simpson's subordinate and had been working in his interests, with his materials, so loyalty to his chief kept him silent.’ Here we have an extraordinary claim by the elder sister of James Mathews Duncan that it was he and not Simpson who discovered the properties of chloroform. Is there any corroborating material for this claim? Also within the Barts archive is a letter to Sir Robert Christison dated 6 March 1875. This was written by James Mathews Duncan in response to an enquiry from Christison and gives Duncan's account of the events around this time. He writes: ‘Dear Sir Robert, Attending to your suggestion I contribute to the history of the discovery of the anaesthetic properties of chloroform in which you are at present interested – this little note. A few days before the evening when the discovery was completed, I acting as Dr Simpson's assistant, accompanied him to the Laboratory of Dr Gregory, professor of chemistry. From him Dr Simpson got a variety of substances which had respirable vapours and we looked at many chemical preparations which were stored with them in the room below the seats of his classroom. When the former came to Dr Simpson's house they were placed beside others of a like sort in an oaken cupboard that stood in a …behind the morning room. It was part of my work to experiment with these and all other substances I could find that had any smell or respirable vapour. On the day of the discovery I selected from the collected…chloroform and other two or three as deserving more careful trial than I could make at the time. I am only nearly certain that the chloroform bottle was one of those brought from Gregory's laboratory. At any rate having had considerable experience in all kinds of breathings I took particular notice of chloroform as the best and likely to be most useful judging from the effects on myself.’ Here, then, Duncan, with our new hindsight, is perhaps suggesting he inhaled the chloroform and experienced its effects prior to bringing it to Simpson's attention. He continues in his letter: ‘Amongst the others selected was what was called nitric ether which gave me a bad headache of a peculiar kind. In the evening I brought these bottles to Dr Simpson and supper being finished I drew his attention to the chloroform. The result was the discovery. I do not remember what he called the substance then but certainly it was not called chloroform. The incidents of this after supper sitting in which Dr Keith participated are related with a near approach to accuracy by Professor Miller in his “Surgical experiences of chloroform” pamphlet shortly afterwards. Miller made his picturesque statements after getting particulars from the parties interested with …of the evening. I have written this from memory and have intentionally avoided referring to any kind of document. Yours Mathews Duncan’(4, 5). Part of the letter from James Mathews Duncan to Sir Robert Christison concerning the discovery of chloroform written on 8 March 1875. Part of the letter from James Mathews Duncan to Sir Robert Christison concerning the discovery of chloroform written on 8 March 1875. James Mathews Duncan became interested in anaesthesia having translated, at his request, Simpson's original paper into French while working in Paris. Simpson offered him a job that entailed research into new anaesthetic agents as a prime portion of that work. The question that remains is whether today's reader can believe the writings of Duncan's elder sister who suggests that James discovered the effects of chloroform and then brought these to Simpson who then confirmed his findings in the famous dinner party discovery. Is this family jealousy or a desire to raise the profile of her recently departed brother higher? I think not. James Mathews Duncan could not have been more highly regarded in his chosen field, and was the doyen of London obstetricians of that era, his work and his subsequent passing noticed even by the Queen! He received almost every conceivable recognition from his peers in the UK and across the world during his lifetime. I believe the story recounted in this document. It rings true from an age when deference to the senior man was the normal event and would and could not be challenged. Once the ‘discovery’ was public, any later claim by Duncan would have looked distasteful and publicity seeking, and besides Duncan was content with his position, status and work. It is likely that Simpson's trainee, James Mathews Duncan discovered the anaesthetic properties of chloroform and then left the popularisation and recognition of that discovery to his Professor, James Young Simpson. I am most grateful to Marion Rea, Trust Archivist to St. Bartholomew's Hospital and Ms Samantha Searle, Assistant Trust Archivist for their help with the research involved in this work. In addition an article in the Trust Newsletter, The Link, by Ms Sally Gilbert, previous Assistant Archivist, provided several useful additions. All the material quoted in this paper can be found within the Archives of St Bartholomew's Hospital, London filed under X303 under items relating to James Mathews Duncan (1826-1890) 1843-1952.

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