Case 9.—In the Maternity Hospital; first child. Labor began at 10 P.M., (Nov. 21st.) I was desired to see her at six A.M., (22nd.) The os uteri was well dilated, but it was evident that the pelvic canal was contracted throughout, and the head was passing with unusual difficulty through the brim. The patient was complaining much of her sufferings. It was evident that it would be a very tedious, and probably, at last, an instrumental case, and one therefore calculated to test the length of time during which chloroform might be used. She began to inhale it at a quarter past six, A.M., and was kept under its influence till a quarter past seven, P.M.,—the date of her delivery—thirteen hours in all. From the time it was begun till the time delivery was completed, her cries and complaints ceased, and she slept on soundly throughout the day. The bladder required to be emptied several times with the catheter. The head passed the os uteri at ten A.M., and during the day, gradually descended through the pelvis. At seven P.M., I at last deemed it proper to deliver her by the forceps; the head, which was now elongated and œdematous, having by that time rested for some hours against the contracted pelvic outlet, with little or no evidence of advancement; the bones of the fœtal cranium overlapping each other, and the fœtal heart becoming less strong and distinct in its pulsations. A warm bath, irritation of the chest, &c., were necessary to excite full and perfect respiration in the infant. Whilst we were all busied with the infant, the mother lost some blood, but the placenta was immediately removed, and the uterus contracted perfectly. On afterwards measuring the quantity of blood lost, it was calculated to amount to fifteen or eighteen ounces. The mother's clothes were changed, she was bound up, and removed to a dry bed before she awoke. She had at first no idea that the child was born, and was in no respect conscious of being delivered. In fact, she had been "sleeping," according to her own account, from the time she had begun the inhalation, and thought she remembered or dreamed that she heard Dr. Williamson, the house-surgeon, speak near her once or twice. Dr. Beilby, Dr. Ziegler, &c., saw the case with me. Three days afterwards I found the mother and child perfectly well. She continued to recover so rapidly, that she insisted on leaving the hospital on the tenth day after delivery.
A sufficient number of such accounts as these could be collected to fill a large volume; but these are quite sufficient for our purpose.
In regard to the objections to using chloroform or ether, in midwifery, it will be thought by most persons, and with good reason, too, that the safety and success which has attended their use, is itself a sufficient answer to all objections.
It was at first thought, by some physicians, that the expulsive force of the womb was lessened when the pain was prevented; but this is not the case; on the contrary, it has been, in many cases, much increased. It was also thought by others that there was more danger from flooding, and convulsions, than in ordinary cases; but this is also equally at variance with truth, for it appears, beyond doubt, after a careful examination of all the cases recorded, that there is much less danger, particularly from convulsions, than when the patient is allowed to be tortured and terrified by feeling pain. Dr. Simpson remarks in another part of the article above quoted:—
The question which I have been repeatedly asked is this—Will we ever be "justified" in using the vapor of ether to assuage the pains of natural labor? Now, if experience betimes goes fully to prove to us the safety with which ether may, under proper precautions and management, be employed in the course of parturition, then, looking to the facts of the case, and considering the actual amount of pain usually endured, I believe that the question will require to be quite changed in its character. For, instead of determining, in relation to it, whether we shall be "justified" in using this agent under the circumstances named, it will become, on the other hand, necessary to determine whether, on any grounds, moral or medical, a professional man could deem himself "justified" in withholding and not using any such safe means, (as we at present presuppose this to be,) provided he had the power, by it, of assuaging the pains and anguish of the last stage of natural labor, and thus counteracting what Velpeau describes as "those piercing cries, that agitation so lively, those excessive efforts, those inexpressible agonies, and those pains apparently intolerable," which accompany the termination of natural parturition in the human mother.
Since the latter end of January I have employed etherization with few and rare exceptions, in every case of labor which has been under my care. And the results, as I already stated in The Lancet, have been, indeed, most happy and gratifying. I never had the pleasure of watching over a series of more perfect or more rapid recoveries; nor have I once witnessed any disagreeable result to either mother or child. I do not remember a single patient to have taken it who has not afterwards declared her sincere gratitude for its employment, and her indubitable determination to have recourse again to similar means under similar circumstances. Most have subsequently set out, like zealous missionaries, to persuade other friends to avail themselves of the same measure in the hour of suffering. And a number of my most esteemed professional brethren in Edinburgh have adopted it with success and results equal to my own. At the same time, I most sincerely believe that we are, all of us, called upon to employ it, by every principle of true humanity, as well as by every principle of true religion. Medical men may oppose, for a time, the superinduction of anæsthesia in parturition, but they will oppose it in vain; for certainly our patients themselves and their friends will force the use of it upon the profession. The whole question is, I believe, even now, one merely of time. It is not—Shall the practice come to be generally adopted? but—When shall it be generally adopted? And, for my part, I more than doubt if any man (rejecting willingly its benefits) is really justified, on any grounds, moral or medical, in deliberately desiring and asking his patients to shriek and writhe in their agonies for a few months, or a few years longer, in order that, by doing so, they may defer, forsooth, to his professional apathy, or pander to his professional caprices and prejudices.
Another objection has also been advanced against the employment of ether or chloroform, the force of which must be estimated by every one for themselves. It is well known that many, if not most of the lower animals during labor, or immediately afterward, experience certain feelings and desires stronger than at any other time; and it is supposed that such would be the case, as a general rule, with human beings, if it were not for the pain which overpowers everything else. This supposition has, in fact, been partly verified in a few cases; several females having confessed, after recovering from a painless labor under the influence of ether, that their dreams during the sleep were of a peculiar warm character! How far this may be generally the case, of course, we have no means of ascertaining, nor do I consider it to be practically of any consequence to know, because it can in no way interfere with the safe progress and termination of the labor, which alone is what we are properly concerned in. I have merely thought it proper to state the fact as being a singular one, and to make my readers acquainted with it. Physicians are well aware that the peculiar feelings referred to are frequently produced by various causes which act on the nervous system, such as mesmerism, and even by strong devotional excitement. I have known females with strong moral impressions who always carefully avoided both the above causes, from having discovered their liability to produce such effects; in fact, this has been one objection raised to allowing mesmerists to operate upon young persons, and several cases of moral failing having been attributed to this cause. It is not at all improbable, therefore, that such results may occasionally occur during labor, though we are not at all justified in assuming that they will in any particular case. How far this may be considered an objection to the employment of such means, must be however, as I before remarked, decided by all persons for themselves, and for themselves only! It is not a medical question at all.
Notices of Dr. Hollick's Lectures.