HISTORY OF ANESTHESIA: Early Obstetric Anesthesia

A.J. Wright, MLS

Department of Anesthesiology Library

School of Medicine

University of Alabama at Birmingham

NOTE: This column appeared in _Educational Synopses in

Anesthesia and Critical Care_ V3N5 May 1996

This month I offer the following complete article.

Commentary is provided by Donald Caton, MD, University of

Florida Department of Anesthesiology and an authority

on the history of obstetric anesthesia. Clark's piece appeared

in the Boston medical press almost one year to the day after Morton's

October 1846 public demonstrations of ether anesthesia in

Boston. The item was reprinted from the _Philadelphia Medical

Examiner_ of an earlier, undetermined date. A very brief

bibliography is appended for those who would like to begin

further reading on this topic. Dr. Caton also provides

additional references.

Clark, Jonathan. Inhalation of ether in labor. Boston

Medical and Surgical Journal 37(11):214-216, October 13,

1847.

Mrs. N., of Blockley, aged 26, was taken unwell on

the afternoon of Saturday, the 14th of September. She com-

plained of great weakness, vertigo, sickness of stomach, and

pains in the back and limbs. The bowels were disturbed

several times during the afternoon and evening; the

evacuations were black and very fetid. The matter ejected

from the stomach, as she vomited repeatedly, was also of a

bilious character. Her constitution had been very much im-

paired three years since, by an attack of autumnal fever,

from the effects of which she has not yet recovered.

During this her first preganancy, she has suffered

much from indigestion, a train of nervous symptoms of a

distressing character, together with general _oedema_.

At 8 o'clock in the morning, after a restless night,

of which she has no recollection, she was seized with

convulsions, which continued to recur; the interval between

the convulsions decreasing, while the violence and duration

of the paroxysms increased. At 10 o'clock, when I saw her,

she had had six convulsions.

Her perceptive faculties were altogether obliterated.

As each paroxysm subsided, she was observed to recover her

faculties less perfectly, till they were wholly lost, with

the exception, perhaps, of the ability to feel pain, which

appeared to be regained simultaneously with the power of the

uterus to contract; a slight contraction of which served

only to usher in another paroxysm. An examination showed

that but little progress had been made in the labor; the os

uteri was dilated to the extent of an inch and a half, the

membranes were entire, and the head was presenting. Her

pulse was 110 in the minute. As she had complained of head-

ache before the convulsions came on, and as the pulse

appeared of a character to bear it, I took sixteen ounces

of blood from the arm.

This had no favorable effect. On the contrary, the

spasms continued to increase in force and frequency. The

pulse rose to 135 in a minute, becoming much weaker. The

extremities became cold, notwithstanding the application

of sinapisms, and the surface was generally cold and

clammy, and of a livid hue. Under these circumstances, it

occurred to me that the vapor of ether might act as a

stimulant, and also change the disordered action then

existing. By administering the vapor, a worse state of things

could not be induced than already existed, for it was

evident to me, from the untoward progress the case had made,

that a few more convulsions would destroy her.

All hope of a favorable result was lost, inasmuch as

the labor made no perceptible progress. The lethargy suc-

ceeding a paroxysm of convulsions was accompanied by a want

of contractile power in the uterus, and as soon as this was

in a measure regained, and the uterus began to contract,

another paroxysm would occur, preventing the further progress

of the labor.

Under these circumstances, I thought that if I could

substitute the lethargy from the inhalation of ether, for the

existing one, there would be a great point gained; _the one

putting an entire stop to the labor, the other having no

such effect_.

During the interval between each paroxysm, I had examined

the state of the os uteri, hoping to find it dilated sufficiently

to enable me to introduce my hand for the purpose of turning, but

this was not the case, as there was very little dilation. In a few

minutes after the ninth paroxysm had passed off, I applied a sponge,

well moistened with ether, over the mouth and nostrils. The patient

soon began to rub her nose violently, pushing away the sponge as soon

as it was re-applied, till she was prevented by holding her hands.

Her countenance in a minute or two lost its deathly hue, and resumed a

more natural appearance. In less than ten minutes the whole surface

became warm and much more natural.

The pulse fell to 125; the interval between the paroxysms in-

creased more than one half, and their duration, when they did occur,

was much lessened. Uterine contractions now ceased to have their

former effect of bringing on the convulsions, _so that I could observe

several distinct and efficient pains or contractions between the

paroxysms_. The os uteri, as a consequence, began to dilate, but not

as yet sufficiently to admit of the introduction of the hand.

I did not venture to apply the sponge long enough to produce a

complete lethargy, but removed it when her opposition to its applica-

tion in a measure ceased. I was fearful, if a complete state of

lethargy was introduced in her then low condition, she might not re-act.

After being three hours and half under the influence of the ether,

the uterus was sufficiently dilatable to admit of the gradual intro-

duction of the hand, the membranes which were still entire, were

ruptured, and I succeeded in obtaining one foot, which was brought

down and secured with a tape. Owing to the ungovernable restlessness

of my patient, and to the powerful contractions of the uterus, I had

great difficulty in finding the other; and when I had succeeded in

getting it partly down, it offered so much resistance to my efforts,

that I was apprehensive it might not be a fellow to the one I had.

After comparing the direction of the toes, I ventured to exert a little

more force, and brought away the child.

It was still living, though much exhausted; the lungs required

inflation before it breathed, but after respiration was once established

it did very well. The placenta came away promptly, and there was no

flooding.

No vapor was given after the child was delivered. The mother still

continued in a stupor, with convulsions at intervals of forty-five

minutes, till 4 o'clock the next morning, when they ceased. She took,

during the night, as an antispasmodic, forty drops of tr.assafoetida in

milk, at intervals of two hours. In the evening her pulse was 128, and

quite feeble. I should mention that the convulsions had diminished in

force, and continued to do so till they ceased.

At 8 in the morning, the stupor still continuing, she took ten

grams of calomel, and in one hour a teaspoonful of fluid extract of

senna, which was repeated every hour for four hours, when it operated

on the bowels, producing copious black and very fetid evacuations. From

this time she recovered rapidly; the day following she noticed some

things and answered questions. Her tongue and been sadly bitten; she could

not account for its soreness; has no recollection of anything that has

occurred, and thinks it strange that her child could have been born with-

out her knowledge. In two weeks she was about her room, having convalesced

rapidly without an unpleasant symptom. The child, a fine boy, is doing

well.--_Philadelphia Medical Examiner_