Chloroform has been more recently introduced than ether, but has nevertheless been used quite as much, or probably more, and, in general, with still more success. It was first described, I believe, by Professor Simpson of Edinburgh, at a sitting of the medical society of that city, in November, 1847, and several cases were narrated, two of which I quote.
I have employed it in obstetric practice with entire success. The lady to whom it was first exhibited during parturition, had been previously delivered in the country by perforation of the head of the infant, after a labor of three days' duration. In this, her second confinement, pains supervened a fortnight before the full time. Three hours and a half after they commenced, ere the dilatation of the os uteri was completed, I placed her under the influence of the chloroform, by moistening with half a teaspoonful of the liquid, a pocket-handkerchief, rolled up in a funnel shape, and with the broad or open end of the funnel placed over her mouth and nostrils. In consequence of the operation of the fluid it was once more renewed in about ten or twelve minutes. The child was expelled in twenty-five minutes after the inhalation was begun. The mother subsequently remained longer soporose than commonly happens after ether. The crying of the child did not, as usual, rouse her; and some minutes elapsed after the placenta was expelled, and after the child was removed by the nurse into another room, before the patient awoke. She then turned round and observed to me that she had "enjoyed a very comfortable sleep, and, indeed, required it as she was so tired, but would now be more able for the work before her." I evaded entering into conversation with her, believing, as I have already stated, that the most complete possible quietude forms one of the principal secrets for the successful employment of either ether or chloroform. In a little time, she again remarked, that she was afraid her "sleep had stopped the pains." Shortly afterwards her infant was brought in by the nurse from the adjoining room, and it was a matter of no small difficulty to convince the astonished mother that the labor was entirely over, and that the child presented to her was really her "own living baby."
Perhaps I may be excused for adding, that since publishing on the subject of ether inhalation in midwifery, seven or eight months ago, and then for the first time directing the attention of the profession to its great use and importance in natural and morbid parturition, I have employed it, with few and rare exceptions, in every case of labor that I have attended, and with the most delightful results. And I have no doubt whatever, that some years hence the practice will be general. Obstetricians may oppose it, but I believe our patients themselves will force the use of it upon the profession. I have never had the pleasure of watching over a series of better and more rapid recoveries, nor once witnessed any disagreeable result follow to either mother or child, whilst I have often seen an immense amount of maternal pain and agony saved by its employment. And I most conscientiously believe that the proud mission of the physician is distinctly twofold—namely, to alleviate human suffering, as well as preserve human life.
In another part of the same publication Professor Simpson has another list of cases, all equally favorable. In some of these the labors were protracted many hours, and in others, operations with instruments were performed, of the most terrible character, such as would, under ordinary circumstances, have been attended with the most horrible suffering. As this article gives an instance of nearly every kind of delivery under the influence of chloroform, and contains also some admirable reflections upon its employment, I quote it in order to make the present account complete.
Case 2.—Seen with Mr. Carmichael; a second labor; she began the chloroform inhalation before the dilatation of the os uteri was entirely completed; the child was expelled in fifty minutes afterwards. I kept her under the chloroform for a quarter of an hour, till the placenta was removed, the binder applied, and the body and bed-clothes were arranged and adjusted. On awaking she declared that she had been sleeping refreshingly; she was quite unaware that the child was born, till she suddenly heard it crying at its first toilet in the next room. An hour afterwards she declared she felt perfectly unfatigued, and not as if she had borne a child at all. In her first or preceding confinement she had been in severe labor for twenty hours, followed by flooding. No hæmorrhage on the present occasion.
Case 3.—Patient unmarried; a first labor; twins; the first child presented by the pelvis, the second with the hand and head. The chloroform was exhibited when the os uteri was nearly fully dilated; the passages speedily became greatly relaxed, (as has happened in other cases placed under its full influence,) and in a few pains the first child was born, assisted by traction. I broke the membranes of the second, pushed up the hand, and secured the more complete presentation of the head; three pains expelled the child. The mother was then bound up, her clothes were changed, and she was lifted into another bed; during all this time she slept soundly on, and for a full hour afterwards, the chloroform acting in this as in other cases of its prolonged employment, as a soporific. The patient recollected nothing from the time of the first inhalations, and was greatly distressed when not one but two living children were brought in by the nurse to her. Dr. Christison, who was anxious to observe the effect of the chloroform upon the uterus, went along with me to this patient.
Case 4.—Primipara; of full habit; when the first examination was made, the passages were rigid, and the os uteri difficult to reach. Between six and seven hours after labor began, the patient, who was complaining much, was apathized with the chloroform. In about two hours afterwards, the os uteri was fully dilated, and in four hours and a half after the inhalation was begun, a large child was expelled. The placenta was removed, and the patient bound up and dressed before she was allowed to awake. This patient required an unusual quantity of chloroform, and Dr. Williamson, who remained beside her, states to me, in his notes of the case, "the handkerchief was moistened often, in order to keep up the soporific effect. On one occasion I allowed her to emerge from this state for a short time, but on the accession of the first pain, she called out so loudly for the chloroform that it was necessary to pacify her by giving her some immediately. In all, four ounces of chloroform were used." Like the others, she was quite unconscious of what had gone on during her soporised state, and awoke altogether unaware that her child was born.
Case 6.—Second labor. The patient—a person of a small form and delicate constitution—bore her first child prematurely at the seventh month. After being six hours in labor, the os uteri was fully expanded, and the head well down in the pelvic cavity. For two hours subsequently it remained fixed in nearly the same position, and scarcely, if at all, advanced, although the pains were very distressing, and the patient becoming faint and exhausted. She entertained some mistaken religious feelings against ether or chloroform, which had made her object to the earlier use of the latter; but I now placed her under its influence. She lay, as usual, like a person soundly asleep under it, and I was now able, without any suffering on her part, to increase the intensity and force of each recurring pain, by exciting the uterus and abdominal muscles through pressure on the lower part of the vagina and perinæum. The child was expelled in about fifteen minutes after the inhalation was commenced. In a few minutes she awoke to ask if it was really possible that her child had been born, and was overjoyed to be told that it was so. I have the conviction, that in this case the forceps would in all probability have been ultimately required, provided I had not been able to have interfered in the way mentioned. I might, it is true, have followed the same proceeding, though the patient was not in an anæsthetic state; but I could not have done so without inflicting great agony upon her.
Case 7.—A third labor; the patient had been twice before confined of dead premature children; once of twins, under the care of Mr. Stone, of London; the second time of a single child under my charge. The liquor amnii began to escape about one o'clock, A.M., but without pains for some time. I saw her between three and four o'clock, with the pains commencing and the os uteri beginning to dilate. In two hours afterwards, the third stage was well advanced, and the pains becoming very severe, she had the chloroform exhibited to her, and slept soundly under its influence. In twenty minutes the child was born and cried very loudly without rousing the mother. In about twelve or fifteen minutes more she awoke as the application of the binder was going on, and immediately demanded if her child was really born alive, as she thought she had some recollection of hearing the nurse say so. She was rejoiced beyond measure on her son being brought in and presented to her.