ANESTHETICS IN7 LABOR. 
\I 
■f 
BY S. S. TODD, M. D. 
Professor of Obstetrics and Diseases of Women in the Kansas City College of Physicians 
and Surgeons; Late President and Honorary Member of the Medical 
Association of the State of Missouri, etc. 
REPRINTED FROM THE TRANSACTIONS OF THE MEDICAL ASSOCI- 
ATION OF THE STATE OF MISSOURI FOR 1875. ON THE 
USE OF ANESTHETICS IN LABOR. 
BY S. S. TODD, M. D. 
[.Reprinted from the Transactions of the Medical Asso- 
ciation of the State of Missouri for 1875.] 
In the prosecution of the duty imposed on me by your commit- 
tee I have sought to avail myself of nearly everything that has been 
written upon the subject during the past twenty-eight years. My suc- 
cess in this, however, has hardly equalled my expectations, for the 
field is so very broad, and covers such a lengthened period of pa- 
tient trial and acrimonious debate, and further, is so void of sta- 
tistics that I find myself in possession of a vast array of con- 
flicting opinions and but few facts. That these opinions have 
much value and will not fail to make their impress on those who 
have given the subject but little attention, cannot be denied, how- 
ever completely they may fail to satisfy the demands of scientific 
accuracy. 
In order to make our information as complete as may be I 
have not restricted this paper to my own observations, or the ob- 
servations of my immediate acquaintances, nor to the literature of 
the subject as we find it in our libraries; but have endeavored to 
avail myself also of the experience of a large number of silent, 
though generally competent observers distributed over a wide field 
of observation, as well as the most recent and matured views of 
those who have betimes contributed to the literature of the sub- 
ject. To effect this the following list of queries was prepared : 
i. Estimate the per - ntage of all cases of Normal Labor in 
which you administer Anesthetics. 2. Estimate the frequency 2 
with which you employ anesthetics in turning, forceps delivery, 
and other painful obstetric operations. 3. At what period in nor 
mal labors do you begin with the use of anesthetics ? 4. To what 
extent is the induction of anesthesia carried in normal labors? 5. 
What anesthetic is used and by what kind of appliance? 6. What 
bad results to the woman have you known to follow anesthesia ? 
7. What bad results to the child? 8. Have you ever known flood- 
ing, retention of the placenta, or rupture of the perineum to re- 
sult from the use of anesthetics? 9. Can you cite any case of death 
to the woman directly traceable to the use of anesthetics during 
labor? 10. From your own experience would you counsel a more 
extended use of anesthetics in Normal Labor ? 
Over six hundred circular letters embodying these questions 
were prepared, four hundred of which were addressed to obstetri 
cal writers and teachers, prominent obstetricians, leading surgeons 
and practitioners of medicine, both in this country and in Europe, 
embracing, among others less known, the greater part of those 
whose names have been in any way associated with the subject and 
whose present views were not otherwise known. About two hun- 
dred were addressed to country and village practitioners, resident 
of our own State and of Kansas. The result in replies, though 
not so great in point of numbers as might have been expected, ha 
been exceedingly gratifying in many respects. Two hundred and 
sixty-two replies have been received, though in some cases the 
writers have failed to answer all the questions asked. Many have 
not only answered the questions asked but have written long let- 
ters detailing their experience, giving history of cases, quotations 
from authors, citations of books, papers, etc. I may be permitted 
here to say, as a just tribute to the parties themselves and to the 
judgment of the masses of our profession whose award of distinc- 
tion is seldom misplaced, that the most courteous and elaborate 
replies, in the main, have come from those who are esteemed the 
best, the bravest, and the busiest men in the profession ! 
ANESTHESIA IN PAINFUL, PROTRACTED AND DIFFICULT DELIVERIES. 
The first announcements of painless surgery with ether, and 
subsequently by the use of chloroform, created the utmost amaze- 
ment all over .the civilized world. I well remember, being a 
student at the time, how the medical world was astonished with 
the startling news, and with what incredulity some received it. 
Nothing probably was more natural, and surely nothing was more 
certain, than that some made up their minds instantaneously— 
prejudice (prejudgment) you may call it,—saying to themselves, if 
not to others, “this will never do ; assuredly God will not permit 
man to do these things and live !” Is this not true ? It was even 
worse yet when that grand old man, Sir James Simpson—he whose 
sovereign made him a baronet, and whom God made a prince—it 
was, I say, even worse yet when Simpson proposed to introduce 
this diablerie into midwifery ! Not into surgical obstetrics only 3 
did he propose to carry it, but into the home of every lying-in 
woman, despite ancestral curses and contemporaneous execrations! 
That I may not appear to exaggerate the consternation thus awak- 
ened, I recall one instance in the language of Dr. Robert Lee. 
“Very soon after the discovery of its physiological effects,” said 
Dr. Lee, speaking of chloroform,” I was confounded by the an- 
nouncement of its application to midwifery.” [Med. Times and 
Gazette, Sep. 1854.] 
Before studying this matter closely I was of opinion that the 
profession were so nearly of one mind with respect to the use 
of anesthetics in almost every form of departure from easy 
labor, that I had proposed dealing very briefly with this branch of 
the subject. I have learned, however, that there is much less un- 
animity than I had thought. 
In Painful and Protracted Labors.—With few excep- 
tions, still, it may be said, the most strenuous opposers of anesthe- 
sia in normal labor concede that in labor attended with excessive 
pain and mental disquietude, or which promises to be of long 
duration, moderate anesthesia is not only allowable but of positive 
benefit. Particularly is there great unanimity in this, if it shall 
seem that the excessive suffering and delay are caused by spasmod- 
ic or reflex rigidity of the os uteri, or perineum. Anesthetics can- 
not be too highly commended also in those cases rendered tedi- 
ous by reason of inefficiency of the pains; the inefficiency being 
due to the want of co-ordination and concert of action on the part 
of the expulsive forces. This want of reciprocal action (misdirec- 
ted nerve force), happens ordinarily in, labors at term, but which 
are precipitated a few days, or a few hours, by a general hyper- 
sensibility of the patient, or some local irritation more or less well 
defined. With reference to arrest of labor under these circum- 
stances, Dr. Robert Barnes, of London, uses the following lan- 
guage: “It is not a figure .of speech to say that here chloroform 
acts like a charm. It may even save the necessity of resorting to 
instruments.”—[Obstet. Operations, p. 70.] 
Closely allied to this class are those cases of permature labor 
made tedious from want of development of uterine muscular fibre 
and the absence of other physiological and anatomical changes 
that pave the way to easy labor at term. Though in both of these 
classes chloroform would render excellent service, yet here it is, 
and particularly in the character of cases last mentioned, that sub 
cutaneous use of morphia and the chloral hydrate are especially 
beneficial. In these cases it is not expected that labor will ter- 
minate speedily; rest, and it may be sleep, is required, and the 
persistent effects both of morphia and the chloral hydrate render 
them exceedingly valuable agents, and preferable in many instan- 
ces to all other anesthetics. Opposition to anesthesia in these 
cases springs from a variety of causes, some of which we shall con- 
sider hereafter, inasmuch as the objections to anesthesia in cases of 
extreme suffering, or unusual delay, apply with equal, even greater 
force to common labor. 4 
In Difficult Delivery.—The question of anesthetic obstet- 
ricy acquires unusual importance, in some respects, where the la- 
bor involves manual or instrumental aid ; such cases, necessitating 
more profound narcosis, approach more nearly the conditions 
present in ordinary surgery and demand the same precautions 
against danger. Now what does the profession throughout the civ- 
ilized world to-day hold with respect to anesthesia in this class of 
labors ? That sudden death from the anesthetic might take place 
sometimes in these cases of deeper anesthesia, as in ordinary surg- 
ery, is just what we might expect, but, curiously enough—a prob- 
lem we shall again have occasion to advert to, there is not yet such 
a case of death on record, unless we except the one reported by 
Dr. Routh in a discussion before the London Obstetrical Society, 
May, 1863, and quoted by Sansom. [Chloroform: Its Action 
and Administration, p. 2 2 7]'in which death took place during de- 
livery by the forceps, chloroform being administered by the nurse. 
Two other cases are cited by Sansom in which death took place a 
short time after forceps delivery, one reported by Dr. Pomeroy, of 
New York, and the other by Dr. Faye in “Schmidt’s Jarbuecher.” 
But, as Sansom says, “such accidents have occurred aforetime in- 
dependently of chloroform,” and “the positive evidence of the 
preservation of life by anesthesia greatly outweighs these doubtful 
signs of its danger.” 
Concerning anesthesia in Embryotomy, and the Caesarean 
Operation there is no difference of opinion. One would as soon 
think of discarding it in amputations of the leg, as to think of 
discarding it here. Objection, however, is sometimes made to its 
use in cases of Adherent Placenta, and by those who concede its 
value in obstetric surgery; an objection based upon a supposed 
liability to hemorrhage from paralysis of uterine muscular fibre in- 
duced by the anesthetic. That no such paralysis occurs unless 
under the most profound, and needless narcosis, will presently be 
shown. Its use in Turning is objected to by others, because, as 
they say, the act is easily and quickly accomplished, often with- 
out introducing the hand, and in a large proportion of cases causes 
little pain ; that insensibility to pain and relaxation of the cervix 
sufficient to allow the easy introduction of the hand, cannot be 
had, without narcosis to the extent of endangering life, directly, 
or subsequently through post partum hemorrhage, and that there- 
fore no adequate compensation is yielded for the risk incurred. 
Prof. Fordyce Barker, of New York, [Trans. New York Acad, of 
Med. 1861,] is undoubtedly correct when he says, “Its value in 
these cases is beyond controversy.” 
Agam, objections are urged against anesthesia in Forceps cases. 
It is said that the operation is not necessarily painful; that if the 
instrument be carefully introduced, properly applied, and dexter- 
ously used, the entire operation may be completed with little pain 
and but trifling constitutional disturbance. I can but admit that 
this is true of many cases, especially in the hands of those who 
constantly use the forceps where there is even inconsiderable de- 5 
lay of the head at the outlet, but I am sure it is far from being 
true of all, even of a majority. Whoever has labored for an hour 
to seize the head at the superior strait, or a disproportionate head 
in the pelvic cavity, or drag a like head and the shoulders of an 
overgrown fetus through the inferior strait of an irritable, not to 
say irascible primiparous woman, without an anesthetic, must have 
seen the need of some such agent, else he has studied his own 
comfort and the patient’s welfare to little profit. The terror, too, 
inspired by the sight or thought of instruments probably con- 
tributes not a little to the untoward result that sometimes follows 
instrumental deliveries. It must not be forgotten also that a large 
number of forceps deliveries are hastened deliveries, as in asphyx- 
ia, eclampsia, concealed, and unavoidable hemorrhages, and that 
such rapid birth greatly endangers the perineum ; but if a suffi- 
cient degree of narcotism be induced this risk is much lessened, by 
reason of relaxation of the soft parts, save in those exceptional 
cases where distension is hindered by the presence in the vagina 
or at the vulvar outlet of cicatrices or a superabundance of 
adipose tissue. The objection that anesthesia removes a valuable 
index to the extent of any injury likely to be inflicted by the in- 
strument was well met, at the moment of its birth, by Prof. Simp- 
son when he asked Prof. Meigs, “would it be right and moral in a 
surgeon to deny to his patients the advantages of anesthesia, in order 
that their sensations and sufferings should make up for his want of 
anatomical and operative knowledge?” ; and further when he says 
in that same memorable “answer,” speaking of the introduction 
of the forceps, “it enables you without any pain to the patient, to 
Introduce your fingers for this purpose far more deeply between 
the head and maternal structures than you could do if the patient 
were awake, and in her usual sensitive state.”—[Works of Sir 
James Y. Simpson, Bart. Vol. 2, p. 1x8.] 
In considering the validity of objections to anesthesia in re- 
moval of adherent placenta, turning and extraction with the for- 
ceps, which objections reach me by letter from many excellent 
and unimpeachable sources, and which I find elsewhere, I cannot 
help half suspecting that in some instances, at least, the opposition 
should be imputed to an unsuspected and pre-conceived aversion 
to anesthesia in toto, save perhaps in the rarer cases of obstetric 
surgery, rather than to the results of experience. The remark will 
apply with equal propriety to some objections to anesthesia in nor- 
mal labor. 
No one, we presume, is rash enough to counsel the indiscrim- 
inate use of anesthetics in the cases we have been considering. 
The warmest advocates of anesthesia recognize and teach, to the 
contrary, the necessity of an adjudication in every individual case. 
While each must decide in a particular case for himself, what cases 
are in a general way suitable for its use, and what advantages are 
claimed for its employment in any case, the authority therefor, 
may now engage our notice. 
“Pain,” says Prof. Simpson, [loc. cit. p. 112.] “whenever it 6 
is great in degree or great in duration, is in itself deleterious; and 
by shielding our patients by anesthetic measures against the more 
severe portions of the pains of parturition, we not only preserve 
them from the agony of their more immediate sufferings, but we 
preserve their constitutions also from the effects and consequences 
of these sufferings.” Again, [p. 25.] “When the state of anesthe- 
sia is adequately deep, it renders the patient quiet and unresisting 
during the required operative procedures; it prevents, on her part, 
those sudden shrinkings and changes of position which the boldest 
and firmest woman cannot sometimes abstain from when her mind 
and body have been worn out, as happens in most operative cases, 
by a previous long and protracted endurance of exhausting but 
still ineffectual labor pains;—the introduction of the hand into the 
maternal passages, or of the hand to guide our instruments, is 
greatly facilitated both by the passiveness and apathetic state of 
the mother, and by that relaxation of the passages which deep an- 
esthesia almost always induces ; and, lastly, this state of relaxation 
and dilatability renders the process of the artificial extraction of 
the infant through these passages alike more easy for the practi- 
tioner, less dangerous for the child, and more safe for the struc- 
tures of the mother.” 
With regard to the value of anesthesia in forceps delivery, 
Prof. Fordyce Barker, of New York, says: “If all due precau- 
tions are taken in introducing and locking the blades, the danger 
of injury to the mother and child is greatly decreased, because the 
perfect quietude and tranquillity of the patient is secured, and the 
operation can be performed with the greatest deliberation and 
carefulness, which is often impossible when the patient is under 
great excitement. Especially is this the case with regard to the 
safety of the perineum.” The same eminent authority, also, in a 
very brief and comprehensive way sums up its advantages thus, in 
turning : “There is much less resistance to the introduction of 
the hand ; as it is introduced without pain to the patient, it rarely 
requires to be withdrawn and re-introduced on account of the 
paralyzing effect of the uterine contraction ; the external and in- 
ternal manipulations are much more safely and expeditiously ac- 
complished, and there is less danger of injury to the internal sur- 
face of the uterus."—[Trans. N. Y. A.cad. of Med. 1861.] 
“In instrumental labor there can be no doubt that chloroform 
has tended to the presevation of life. Labors have thus been com- 
pleted, the patient being in a state of insensibility, when other 
wise delivery would have been impossible, and death would have 
occurred. * * * * The value of chloroform in operative 
midwifery is that it renders the patient passive in the hands of the 
practitioner, favors relaxation of the rigid tissues, lessens the suf- 
fering of the patient, and promotes convalescence by reducing the 
effects of shock and exhaustion.”—[Sansom, loc. cit. p. p. 226, 
236.] 
Prof. Byford, of Chicago, uses the following language : “In 
tedious, difficult, and operative cases of labor, I feel as much 7 
under obligation to use the anesthetic, and make as profound an 
impression with it, as in the performance of any of the more pain- 
ful surgical operations, and for all the same reasons.”—[Theory 
and Prac. of Obstetrics, 1873, P* 227-] 
“In all difficult, and especially in painful operations,” says 
Dr. Karl Schroeder, of Erlangen,” it is of immeasurable benefit 
to the patient; it also materially facilitates operations, and there- 
fore deserves to be always used in such cases.”—[Manual of Mid- 
wifery, 1873, P- 96-] 
Prof. Leishman, of Glasgow, thus indorses anesthesia: “The 
question of anesthetics seems to stand thus. In eclampsia, in 
some cases of mania, and in all cases of operative midwifery, it is 
without exaggeration, invaluable.”—[System of Midwifery, 1873, 
p. 693.] 
From the letters of one hundred and thirty-three correspon- 
dents, resident of the United States, the kingdom of Great Britain 
and Ireland, and continental Europe, who give precise data from 
their own practice, I find that : 
86, or 64 per cent, use anesthesia in all operative cases of 
midwifery except when forbidden by some peculiarity of the case. 
12, or 9 per cent, use it in all operative procedures except 
forceps cases. 
5, or 3-7 Per cent, use it in all operative cases except in turn- 
ing. 
7, or 5 per cent, use it in all operative cases except in turning 
and forceps cases. 
11, or 8 percent, use it in 50 per cent, or less, of all opera- 
tive cases. 
121, or 90.9 per cent, use it in a greater or lesser number of 
operative \:ases. 
12, or 9.01 per cent do not use it in any of these cases. 
Among the 47 correspondents who discard anesthetics in 
operative midwifery, in whole (12) or in part (35), are the sub- 
joined names. To the question : “Will you give the frequency 
with which you employ Anesthetics in Turning, Forceps Delivery, 
and other painful Obstetric Operations,” the following replies 
were made : 
Dr. W. H. Bryant, Savannah, Mo.—“I use chloroform in delay- 
ed labor from rigidity of the os uteri and perineum, and in version; 
during the last seven years I have used the forceps once in every 
eight cases of labor, and without anesthetics in a single case.” Dr. 
J. P. Chesney, St. Joseph, Mo.—“Have never used them but once 
in version, and am entirely opposed to their use in instrumental 
interference.” Dr. D. W. Stormont, Topeka, Kan.—“Always to 
complete anesthesia, in forceps delivery and other painful opera- 
tions. For the last six years I have turned by postural, or ‘breast 
and knee’ position ; and so easy and comparatively painless is the 
operation, in this position, that I am surprised that it has not re- 
ceived more consideration at the hands of the profession generally. 
The use ofanesthetics would interfere with the position.” Dr. F. 8 
M. Johnson, Platte City, Mo.—“I always employ anesthetics in 
turning, but sparingly in forceps delivery.” Prof. H. T. Cleaver, 
Keokuk, Iowa.—“In all cases where the hand has to be inserted 
(they are very rare)—but seldom in forceps cases.” Dr. David 
Prince, Jacksonville, 111.—“Always in turning, never in forceps 
cases.” Dr. J. S. Cleveland, Cincinnati, Ohio.—“Probably io 
per cent. I prefer operating without anesthesis.” Dr. C. D. 
Palmer, Cincinnati.—“Usually in turning ; very seldom in forceps 
delivery, unless demanding previous craniotomy.” Prof. S. 
Loving, Columbus, Ohio.—“Never in using the forceps, which 
should not give pain. In turning, if the woman is very timid, or 
if the contractions of the womb are so strong as to interfere ser- 
iously with the operation, I consider it proper to use chloroform 
or ether, and maintain anesthesia till the foot is secured, not after- 
ward.” Prof. D. N. Kinsman, Columbus, Ohio.—“I never use 
anesthetics in forceps deliveries, and have nevtr done so but once 
in turning.” Dr. J. M. Toner, Washington, D. C.— “In about 
20 per cent, of turning. Do not use them in ordinary forceps de- 
liveries.” 
Of the 86 practitioners who resort to anesthesia in all opera- 
tive cases where it is not specially forbidden, 12 are members of 
this association, though it is proper to say that reports have not 
been received from all of its members. From among these 86 
the following are selected and their reports are given in their own 
language. 
Says Dr. Bryant Grafton, Wyandotte, Kas.: “In all painful 
operations.” Dr. J. A. Coons, Spring Hill, Kas.: “I administer 
them in all cases of turning, forceps, and painful operations of 
whatever nature.” Dr. G. W. Haldeman, Paola, Kas.; “I never 
fail to use them under any of the aforementioned circum- 
stances.” Dr. W. W. Cochrane, Atchison, Kas : “I use 
them in all of these cases.” Dr. A. W. Reese, Warrensburg, 
Mo.: “I always use them.” Prof. J. Adams Allen, Chicago: 
“Almost without exception.” Prof. A. Sager, Ann Arbor, Mich.: 
“Always, except when hemorrhage from relaxation exists, or when 
the patient objects.” Prof. A. B. Palmer, Ann Arbor, Mich.— 
“I always use them in such cases.” Prof. R. N. Todd, Indian- 
apolis—“I use them in all such cases.” Prof. D. W. Yandell, 
Louisviile, Ky.—“In every case, unless the woman objects.” Res. 
Physician of Louisville Hospital—“Always.” Dr. John S. Sea- 
ton, Louisville, Ky.—“In all cases if used at all. In 1640 cases 
of labor I have never used instruments of any kind, but have 
turned often.” Dr. B. W. Avent, Memphis, Tenn.—“In all.” 
Dr. Jerome Cochrane, Mobile, Ala—“Always in turning and 
painful operations, and usually in forceps cases.” Prof. W. H. 
Daughty, Univ. Ga.—“Almost invariably.” Prof. M. Schuppert, 
New Orleans, who claims to be the discoverer of what is known as 
Nelaton's method of resuscitation in chloroform narcotism—“In 
every one of the named conditions.” Prof. T. G. Simons, 
Charleston, S. C.—“Always, unless special contra-indications 9 
exist.” Prof. T. L. Latimer, Baltimore—“In all cases.” Prof. 
T. R. Brown, Baltimore—“In all cases where considerable pain is 
to be inflicted.” Prof. John Morris, Baltimore—“I always em- 
ploy anesthetics in turning, and think it good practice to use them 
in all instrumental cases.” Dr. W. Symington Brown, Stoneham, 
Mass.—“Invariably in all such cases.” Dr. W. L. Atlee, Phila- 
delphia (retired from the practice of midwifery)—“I employed 
anesthetics nearly always in turning, forceps delivery and painful 
obstetric operations.” Dr. W. R. Gillette, New York, “I always 
use them in obstetric operations.” Prof. Montrose A. Pallen, N. 
Y.—“Always when there are no cardiac or pulmonary contra-in- 
dications.” Prof E. S Bunker, Brooklyn, N. Y—“In turning 
always, and for all painful operations ; in forceps deliveries 90 per 
cent.” Prof. Fordyce Barker, New York—“In all cases of the 
kind, except where there has been previously dangerous hemor- 
rhage, as in placenta previa. ” Dr. Lombe Atthill, Dublin—“In 
turning always; in forceps delivery, about 50 per cent.—this refers 
solely to private practice. In other painful operations I use it 
(chloroform) nearly invariably.” Dr. J. Matthews Duncan, Edin- 
burg, Scotland—“In all.” Mr. Lawson Tait, Birmingham, Eng- 
land—“Invariably.” Dr. Arthur Steele, Liverpool, England— 
“In nearly all such cases I use anesthetics. In the tedious labors 
of irritable primiparge they are invaluable. In all operations it 
wonderfully aids the accoucheur, but here, of course, anesthesia 
must be pushed to the surgical degree, and an assistant to watch 
the administration should be insisted on.” Dr. J. Braxton Hicks, 
London—“In all cases of turning and other obstetric operations, 
though in some forceps cases I avoid their use unless full anesthe- 
sia is intended.” Prof. B. S. Schultze, Univ. of Jena—“I always 
use chloroform, if not especially contra-indicated, in turning, 
forceps delivery, and other painful operations.” Prof. Carl Braun- 
Fernwald, Univ. of Vienna—“In the above named operations, an- 
esthetics have always been used (in the great Vienna Hospital) 
with the best results for the last twenty-five years, and in one hun 
dred thousand cases.” 
For the last six years, I have myself resorted to anesthesia by 
chloroform in all protracted, painful and instrumental labors, 
unless some special reason existed for not doing so. The excep- 
tional cases are now rare. I quite agree with Dr. Brown, of 
Stoneham, Mass., “that no patient has ever persistently objected 
under such circumstances.” The number of exceptional cases 
would be still further reduced could I fully agree with the late Dr. 
Anstie, who says : “It is my firm persuasion that, with proper 
care, chloroform may be safely administered to any patient who is 
fit to undergo an operation at all, whether there be any existing dis- 
ease of heart, lungs or brain or not. I have never allowed the ex- 
istence of such disease to prevent my administering it, and I have 
never found any evil result.”—[Stimulants and Narcotics, p. 330.] 
During the ten years just passed, I have given chloroform in 
34 cases requiring manual or instrumental aid ; part of them oc- 10 
curing in my own practice, and part of them seen by me in con- 
sultation. Twenty-one of these were forceps cases, of which two 
died, one from eclampsia, and one from inter-current dysentery. 
Eleven were cases requiring version, of which number one died 
from eclampsia; one was a case of adherent placenta, and the other 
was a case of placenta previa, both of whom recovered. The ag- 
gregate of recoveries is 31, with 3 deaths. There was laceration 
of the perineum to the sphincter ani in one of the forceps cases, 
but in no case did hemorrhage follow, or was there retention of 
the placenta, except the case of adherent placenta already re- 
ferred to, and in no instance did the forceps seem to have been 
required as a result of the anesthetic. The results to the children 
were three still born, two of them being delivered by the forceps 
and one by turning. In no case was the fatal result, either to 
mother or child, imputed to the chloroform. 
The degree of narcosis ordinarily induced in these cases, is, 
so far as I have been able to learn, determined by the character of 
the case and the effects witnessed. Adopting Dr. Sansom’s divis- 
ion of narcosis into three stages—that of sopor, stupor and stertory 
between which, of course, there is no definite line of demarca- 
tion—we may say that in cases of painful or protracted labor, not 
requiring operative interference, anesthesia to the first degree, in 
which pain is abolished without loss of consciousness, is 
deemed to be sufficient. In all operative measures it is enough if 
the second degree, that of stupor, be induced and maintained, in 
which stage there is entire loss of consciousness, and a state of 
perfect quietude. It is certainly not the accepted belief that nar- 
cosis to the extent of causing complete relaxation of the uterus is 
ever necessary in version, as Dr. Barnes [Obstetric Operations, p. 
184,] seems to think. Indeed, when we remember that the func- 
tions of the sympathetic system, of which the uterine force is one, 
are ordinarily the very latest to be extinguished in fatal cases of 
chloroform-narcotism, it is difficult to see how the “perfect flac- 
cidity,” which he deems essential, can be reached short of the 
very verge of dissolution. This flaccid condition of the uterus is 
therefore practically unattainable, and, we believe, wholly un- 
necessary in any case. 
ANESTHESIA IN NORMAL LABOR 
What are the advantages claimed for anesthesia in Normal 
Labor l Several of my correspondents say to me that they have 
never used anesthetics and much prefer the “old fashioned way.” 
This leads me to ask, “what benefits do the friends of anesthesia 
say are conferred on the parturient woman by its use, that any of 
us should seek to abandon the old way?” Briefly stated, they are 
these : The pains of child birth are abolished, and its dangers 
lessened. Is this true, and if so why is not the practice universal ? 
It is unsafe, say objectors, in this : (0) It may result in sudden 
death to the woman from drug poisoning. (b) It hazards the 11 
life of both mother and child by retarding labor. (V) It increases 
the liability to hemorrhage. (d) It favors retention of the pla- 
centa. (<?) It endangers laceration of the perineum. (/) It en- 
dangers the life or future welfare of the child by poisoning the 
blood of the mother. 
It is an illegitimate use of drugs, again they say, in this—Nor- 
mal labor is a physiological process; it cannot be aided, and should 
not be interfered with. 
Is there any danger to the mother of sudden death from drug 
poisoning? The first feeling aroused by the discovery of modern 
anesthesia, was, as we have already indicated, one of most pro- 
found astonishment at the rashness, the temerity of the man who 
could propose such a thing, except as an idle experiment. The 
second feeling was one of terror, lest it should become the play- 
thing of dentists and rash experimentalists—a very glove-handed 
demon of the retort, full of seductive blandishments and—death. 
It was a long time before the gravest fear, death, was realized 
in the occurrence of a fatal case, in surgery ; but chloroform, for 
the rest have never been popular, soon got into the best of society. 
Since the introduction of chloroform into obstetric practice by 
Prof. Simpson, Nov. 1847, nearly a generation of watchers have 
passed away without witnessing a single death, by narcosis, when 
the drug was administered by a physician. I am informed by 
Prof. Thomas S. Latimer, of Baltimore, that one such case is re- 
ported by Prof. Simpson in a number of the London Lancet, but 
I have not been able to find the report. The nearest approxima- 
tion to such result that I have found is recorded in the Medical 
Times and Gazette for April 14, 1855, where a lady died in the 
course of a natural labor, from the effects of coloroform admis- 
tered to her by the nurse, on a handkerchief, without the sanction 
or knowledge of the doctor, who was in the house at the time. 
The quantity used in this case, with fatal effect, could not have 
exceeded five fluidrachms.—[Dublin Quarterly Journal of Medical 
Science, Aug. 1855.] 
This exemption from fatality in childbed is something quite 
wonderful when it is known that anesthesia has thus been induced 
in, at least, three million casesf and in view of the fact that the 
number of deaths from chloroform in surgery have by this time 
* Statements from two hundred and forty sources, one-half being furnished by physi- 
cians of the cities and larger towns of the United States and the other half derived from 
country and village practitioners, together with an estimate that the latter bear to the former 
the relative proportion in number of four to one, furnish us with the following results, to- 
wit: that the mean per centage of cases in which anesthetics are now used throughout this 
country in normal labors is about nine per cent. Making due allowance however, for error, 
the present mean may be placed at five per cent., or an approximate mean of two and one- 
half per cent from the discovery of anesthesia to the present date. From June ist, 1848 to 
June ist, 1875, according to the United States census reports, about twenty-four million 
children have been born in the United States. Estimating the mean number of anesthet- 
ized patients at two and one-half per cent., and we have six hundred thousand as the total 
number of cases of anesthesia in normal labors during the past twenty-seven years in this 
country. Multiply this number by five and it will give, approximately, the entire number 
for that period in this country and in Europe, or three millions. This estimate is based on 
the supposition that anesthesia in midwifery is just as frequent throughout Europe as in 
this country. Countries not embraced in this calculation will doubtless more tha-» make 
up for any over-estimate I may have made. 12 
probably nearly reached two hundred, and in view also of another 
fact, that for the first few years anesthesia in midwifery, under the 
teaching of Simpson, was carried to the second, or surgical de- 
gree, that is, to loss of consciousness. The fact may find solution, 
possibly, in several ways. First, in this, that more males than 
females die from anesthetic poisoning. From data furnished by 
Drs. Snow, Scoutteten, Kidd and Sansom, the proportion is as 
n.8t0 5, and, according to the Chloroform Committee of the 
Royal Medical and Chirurgical Society, in the proportion of 72 to 
37. Second, anesthesia in ordinary labor is induced in the pres- 
ence of pain ; which in some way, it may be inferred, establishes 
a tolerance of the anesthetic. Experience shows that of the fatal 
cases of chloroform narcotism in surgery a large proportion have 
died before the operation was begun. From an analysis of fatal 
cases cited by Snow, Scoutteten and Kidd, aggregating 121, it 
would appear that in 44.6 per cent, death occurred before the 
commencement of the operation.—[Sansom, loc. cit. p. 101.] 
Third, immunity in obstetrical practice is favored by the recum- 
bent posture. This results in two ways—cerebral anemia is less 
likely to occur, and it is probable, also, that a smaller quantity of 
the drug is sufficient to accomplish the object. Finally, and for 
this cause mainly, the amount required in all ordinary cases of 
midwifery is far below that necessary in surgery, and for the reason 
that the pains of labor are much more readily abolished than is 
common sensation. The woman will feel the prick of a lancet on 
the hand or surface of the abdomen, long after she has become ob- 
livious to the pains of labor. Dr. Campbell, a well known obstet- 
rician of Paris, in a memoir read before the Academie de Mede- 
cine reports his employment of chloroform in 942 cases without 
having to regret the slightest accident. He believes that the 
cause of such immunity is to be found in the cerebral 
hyperemia induced by the efforts rendered necessary for the ex- 
pulsion of the child.* That death might occur from anesthesia 
in ordinary labor, through gross carelessness, is not to be ques- 
tioned, but if exhibited with the care that governs the physician 
in giving other drugs, chloroform need not ever prove fatal in or- 
dinary labor. 
What other dangers to the mother are he apprehended from 
anesthesia ? That it hinders the progress of labor is the most 
common, and I may say, most plausible objection made to 
anesthesia in ordinary labor. The objection is the legitimate 
* Prof. W. W. Dawson, of Cincinnati, in a valuable paper on “Chloroform Deaths,” 
published in the “Cincinnati Lancet and Observer” for January, 1871, gives two notable ex- 
amples having a bearing on this question of immunity in labor. The first case was that of 
Mrs. Garris, reported by Dr. J. G. Wilson, Washington, Ohio. Mrs. G. had taken chlo- 
roform in all of her labors (several), and during her confinement was kept under its positive 
influence for 12 hours. Subsequently she visited a dentist for the purpose of having teeth 
extracted, and died in the operating chair. Her physician, Dr. W., administered the 
chloroform—about one drachm, which was afterward tested and found to be pure. The 
second case was that of a patient of Prof. M. B. Wright, of Cincinnati. The lady had 
taken chloroform in all her labors, and they had been many, and it had always acted admira- 
bly, producing no unpleasant symptoms of any kind, but “on several occasions, when she 
inhaled it at a dentist’s office for the extraction of teeth, the symptoms were of the most 
alarming character." 13 
outgrowth of the general fact that in narcosis induced by ether or 
chloroform paralysis and relaxation take place, by a gradual series 
of approaches, involving first the voluntary, and finally the invol- 
untary muscles; and of the belief that a condition approximating 
complete relaxation of the involuntary muscles is rendered neces- 
sary before the pains of labor are abolished. To enumerate those 
who have opposed anesthesia in midwifery for this cause, is to 
name all who have ever opposed it for any reason. In 1854, Dr. 
Robert Lee, of London, (loc. cit.) wrote thus : “We are assured 
by many that the contractility of the womb is in no degree di- 
minished by the action of chloroform. But of this important po- 
sition, we have as yet received not a jot of proof; nay, there are 
innumerable proofs to the contrary. It is expected that we should 
be satisfied with bare assertion ; and, considering that it was made 
at a very early period, when not a score of women had yet been 
delivered under the influence of chloroform; and, moreover, that it is 
made by those who continue in the face of the most painful con- 
tradiction of facts, to affirm the perfect innocence of this poison, 
we may be permitted to set aside this evidence without further no- 
tice. But I rely not upon a priori reasoning, but on the direct 
testimony of my own senses, and maintain, with this unerring 
guide, that the action of chloroform does very materially impede 
the uterine contractions, and, in some cases, put a stop to them 
altogether.” 
The writer from whom we have just quoted, was one of the 
earliest, ablest and most bitter opponents of anesthesia. Chloro- 
form was characterized by him as a “treacherous poison ;” its ad- 
ministration in labor “rashness,” and its effects “deplorable.” 
His mind was fully imbued with the spirit that women are “doom- 
ed,” as he says, “to bring forth their offspring in pain and sor 
row,” and, under the influence of such inspiration it is not dif- 
ficult now to conceive of the facility with which disasters and per- 
nicious results sprang into life, a host of evils, invisible to all save 
him whose fancy called them into being. It must, however, be 
said, to his credit, that while he contributed more than almost 
any other to retard the progress of anesthesia, he also did much to 
restrain its illegitimate use. Dr. Lee’s arraignment of chloroform 
did not rest with the charge that it retarded labor, and we quote 
further from him for the purpose of showing the extent of hostility 
to the drug at this early period in the sweeping nature of other ac- 
cusations made against it. The London Medical Times and Ga- 
zette, Sept. 1854, contains an account by Dr. Lee—from which 
we have already quoted—of seventeen cases of parturition in which 
chloroform was inhaled with “pernicious effects.” 
The following is a summary of these cases, as taken from the 
Amer. Jour, of Med. Sciences, Jan. 1855 ; 
“In the first and second of these cases, the contractions of the 
uterus were arrested by the chloroform, and delivery was com- 
pleted by craniotomy. Insanity and great disturbance of the 
functions of the brain followed its use in cases 3, 4, 5, 10, 14, 15, 14 
and 16. It became necessary to deliver with the forceps in cases 
6, 8, n, 12, and 13. Dangerous or fatal peritonitis, or phlebitis, 
ensued after the exhibition of chloroform in 7, 8, 11, and 13. 
Epilepsy followed its use in case 14, and dangerous fits of syncope 
in case 17.” 
The above summary gives insufficient data upon which to base 
a logical analysis that shall do impartial justice to the subject, our- 
selves, or the writer, and we shall not attempt it. We may be 
permitted to say, however, that the multiplied experience of the 
profession justifies us in denying every one of the propositions 
definitely, or inferentially put forth ; as, that chloroform may 
cause epilepsy, phlebitis, peritonitis, or that it may render the for- 
ceps necessary, and still less, craniotomy. No intelligent accou- 
cheur “out west” would for a moment think of resorting to cran- 
iotomy in any case where the only reason for doing so was that 
labor had been arrested by chloroform ; at least, not so, unless he 
had become tired of turning and forceps trivialities and greatly 
wished to add another craniotomy “scalp” to his professional belt, 
or, shall I say it, desired to make out another case against chlo- 
roform. 
Most objectors hold to a more moderate view of the evils of 
anesthesia than is expressed in the quotations above given, 
Cazeaux says : “Whatever the exact truth may be, in an unpre 
judiced mind, no doubt can exist of its being proved by numerous 
facts, that when chloroform is taken so moderately as to blunt and 
almost extinguish sensibility without entirely depriving the patient 
of the powers of motion or of self consciousness, it has, ordinarily, 
no influence over the contractile powers of the uterus ; but that 
when carried to complete anesthesia, the contractions may be di- 
minished both in frequency and intensity to the point of complete 
extinction.”—[Treatise on Midwifery, p. 960.] The same au- 
thority, [p. 970.] after quoting from Drs. Duncan, Channing, 
and Montgomery, several cases in which hemorrhage took place 
after anesthesia, adds : “I am well aware that in all these instan- 
ces the hemorrhage may have been due to various circumstances, 
and there is nothing to show that chloroform was necessarily the 
cause ; still, it is well to be aware of them, were it only to excite 
prudence in the use of the agent; for, since by too large a dose 
the exercise of the organic contractility has sometimes been sus 
pended, why may not the same dose diminish the contractility of 
the tissue ?” 
At a meeting of the Obstetrical Society of Philadelphia, Oct. 
2d, 1873, Dr. Packard reported a case wherein labor being pro- 
tracted from non-dilatation a speedy termination was had on giving 
ether. Dr. Smith remarked “that many cases present a condition 
of spasmodic contraction of the neck of the uterus, in which an- 
esthetics have an admirable effect.” In other cases he thought 
that ether retards labor by enfeebling the power of the patient. 
Ether, he held, retards labor by impairing the voluntary contrac- 
tions which are so useful. Dr. F. M. Johnson, of Platte City, 15 
Mo., sends the following statistics : “During a period of four 
years (prior to i860) I attended 160 cases of natural labor, in 70 
of which I gave chloroform, begining as soon as the second stage 
of labor was well established. The average duration of the second 
stage in the 90 who were not anesthetized was not quite three 
hours, and in the 70 who took the anesthetic, about four hours 
and a half." Dr. Lombe Atthill, of Dublin, who, as already 
quoted, uses anesthesia in all cases of turning, and in most cases of 
other obstetric operations, writes me as follows : “ * * * Hav- 
ing been long since convinced that patients kept for any length of 
time under the influence of chloroform were specially liable to the 
occurrence of post-partum hemorrhage I discourage its use in 
natural labor. I am also of opinion that it has a marked influence 
in lessening the force of the uterine contractions. The only anes- 
thetic* I have ever employed in midwifery is chloroform, and I 
have never once seen, in labor cases, any injurious effects except 
those I have indicated, etc.” Prof. W. S. Playfair, of King’s 
College, London, in a recent clinical lecture, uses the following 
language : “I know not what may have been the experience of 
others, but my own certainly is that in a large number of cases it 
has a very marked effect in diminishing the strength of the pains, 
and thereby very materially lengthens the continuance of labor. 
Besides this I have no doubt that a very continuous use of chloro- 
form during labor has a marked effect in predisposing to post-par- 
tum hemorrhage, inasmuch as the tendency to undue relaxation of 
the uterine fibres continues for a time after the birth of the 
child.” 
Dr. W. Tyler Smith believes that anesthesia sometimes oc- 
casions post partum hemorrhage, and retention of the placenta, 
and that its use is contraindicated where there is deficient action 
of the womb, as in feeble and tardy labor from inertia. He is also 
of opinion that he has seen rupture of the perineum occasioned by 
chloroform. “The patients were relieved from pain, but volition 
was not suspended, and under these circumstances the violent and 
fearless straining efforts ploughed up the perineum by the fetal, 
head in the expulsive pains ” 
Prof Leishman, speaking of vomiting as an effect of chloro- 
form in midwifery—an effect seen all too frequently in deep an- 
esthesia, and but very seldom, only, where this is moderate— 
admits that it is comparatively rare, but says : “Still it does oc- 
cur ; and, more than that, it occasionally persists for a consider- 
able time, to the manifest disturbance of the patient during the 
post-partum period. Partly on this account, and partly, it may be, 
in consequence of the effect which is produced on the nervous 
centers, it has been pretty clearly established that the indiscrimi- 
nate use of chloroform, or other anesthetics, predisposes to hemor- 
rhage after delivery.”—[System of Midwifery, p. 693.] 
Dr. Chas. C. Hildreth, Zanesville, Ohio, who favors anesthe- 
sia in all operative procedures, holds the following views with re- 
spect to chloroform in normal labors. “Chloroform,” he says, 16 
“most certainly predisposes our patients to post-partum hemor- 
rhage. Theoretically, we are assured of the fact.”—[Amer. Jour. 
Med. Sciences, April, 1866 ] “After a long period of additional 
experience,” writes Dr. Charles Clay, of Manchester, England, “I 
have never had any accident that could be traced to the exhibi- 
tion of chloroform, and believe with the precautions laid down, no 
such are to be feared. I still continue to condemn its indiscrimi- 
nate application in ordinary labors, believing it to be unjustifi- 
able”—[Handbook of Obstetric Surgery, p. 15.] 
The following personal communication from Dr. J. Matthews 
Duncan, the well-known Edinburg gynecologist, possesses much 
significance when it is known that the doctor employs chloroform 
in all operative cases, and in a majority of normal labors. 
30 Charlotte Square, 1 
Edinburgh, February 17, 1874. j 
Dear Sir : 
I am of opinion that it would be good for lying-in women 
generally if the use of anesthetics in natural labours were further 
restricted than it is. Much evil was, I believe, done at first by 
the too early and too copious use of anethetics in labour, I mean 
an evil that could be proved by the mortality. Anesthesia is not 
so much used now as it was, and much less freely when it is em- 
ployed. It is fashionable to have chloroform, and often the use 
of it is a mere farce in deference to fashion. The fashion was 
fostered by exaggerated pictures being drawn of the pains of 
natural labour. Ingenuous women sometimes wait till at last the 
child is born, always expecting the agonies they have been told 
about. 
Anesthesia is an intoxication which in my opinion is never a 
trifling addition to the conditions of natural labour’ It lulls pain 
and that is a great boon ; its other influences are injurious, espec- 
ially in weakening and prolonging labour. 
I am, dear sir, yours faithfully, 
J. Matthews Duncan 
“Dr. Denham,” says Sansom, “has recorded four cases in 
which suspension of action was proved to be due to chloroform. 
The number of chloroformed cases whence these were taken was 
fifty six ; but it must be recollected that only fifteen were natural 
labors. It is most possible, therefore, that the suspension occur- 
red generally in the cases in which deep narcosis was induced.” 
Dr. Henry J. Bigelow, of Boston, recounting the physiological 
effects of anesthesia, says : “It is well known that the uterus con- 
tracts during partial and even complete unconsciousness; a di- 
minution or cessation of its contractile action being the rare ex- 
ception and not the rule.”—[Trans. Amer. Med. Assoc., 1848.] 
“In a certain class of cases lam convinced that its effect is un- 
doubtedly to prolong the labor. These cases constitute a minori- 
ty, and even in them I have not been satisfied that this apparent 
objection was not more than counterbalanced by the advantages 17 
obtained from its use. * * * * But in a large majority of 
cases my experience would lead me to the conviction that the use 
of chloroform shortens labor.” [Prof. Fordyce Barker, Trans. N. 
Y. Acad, of Med., 1861.] The same authority further says: “I 
have repeatedly seen the chloroform act quite as efficiently as an 
oxytocic under analogous circumstances as I have seen the ergot. 
* * * * On the whole then, I am obliged to state my con- 
viction that chloroform accelerates labor in a greater number of 
cases than it retards it.” Prof. Barker thinks, also, with Prof. 
Simpson and others, that anesthesia is conservative of the strength 
of the patient, and so protective against hemorrhage : “The 
great security against post-partum hemorrhage lies in the efficient 
and permanent contraction of the uterus after delivery. What is 
termed inertia is but another name for uterine exhaustion, and this 
must certainly be much less likely to occur where the nerve force 
and vital powers have been saved by the use of an anesthetic.”— 
[loc. cit.]* 
Dr. Protheroe Smith, of London, thus writes to Prof. Simp- 
son : “I have records in my own practice and that of my friends 
of upwards of 125 cases of anesthetic labor; and with one excep- 
tion, all have done well. In several thus treated no hemorrhage 
has ensued, though in previous labors there was flooding. In 
nearly all the getting up has been more speedy, requiring no aid 
of opiates and purgatives ; and it is my sincere conviction that 
chloroform lessens the chance of puerperal inflammation and fever.” 
Mr. Stallard, also author of Practical Observations on the Admin- 
istration and Effects of Chloroform in Normal Labor, writes to the 
same point as follows: “In the thirty cases I have attended I 
have not had a single case of flooding, and two individuals had 
never been free from it on former occasions.”—[Works of Sir Jas. 
Y. Simpson, p.p. 233, 234.] “It is quite possible to afford im- 
mense relief, and render the pain quite bearable, by a dose which 
does not produce sleep or impair the mental condition of the pa 
tient; it is needless to add that under these conditions a patient is 
quite free from danger. * * * * * it does not prevent the 
subsequent contraction of the uterus, so as to render the female 
more liable to post-partum hemorrhage.”—[Practical Midwifery, 
&c., by John Tanner, M. D. &c., &c.] 
Speaking of the favorable effects of small doses of chloroform 
on parturition. Dr. Anstie says: “Used in the way above describ- 
ed, (Snow’s inhaler, charged with fifteen minims.) I am satisfied, 
from very considerable experience, that it materially increases the 
force and regularity of the uterine contractions, and that its action 
by no means only or chiefly consists in the relaxation of the exter- 
nal passages. Again and again I have seen the contractions of 
the uterus, which had been weak and irregular, become strong and 
effective, at the same time their painfulness was greatly diminished 
* Dr. Barker in a recent personal communication says : “An additional experience of 
twelve years only confirms the views expressed.” He has given chloroform in fully ninety- 
five per cent, of all natural labors for the past twenty-five years, 18 
or removed, under the influence of minute doses of chloroform.”— 
[Stimulants and Narcotics, p. 334.] 
Dr. Charles Clay, (loc. cit.) writes thus : “It may be used 
in severe, short but ineffectual pains, which restrain bearing down 
efforts. In these, chloroform renders uterine contractions larger, 
stronger and more efficacious ; and thus it accelerates the accom- 
plishment of the process. Where the parts are rigid and unyield- 
ing, it assists in dilating the parts, relaxes the muscular fibre, and 
relieves the severity of pain arising from rigidity. In long, pro- 
tracted cases, worn down and suffering from nervous debility, and 
also irrritability, it restores the physical powers, relieving both 
pain and anxiety.” 
To the same point is the testimony of Prof. Leishman, whose 
opinion that the indiscriminate use of chloroform leads often to 
hemorrhage after delivery, we have already quoted. Dr. Leish- 
man says : “In ordinary cases it is always to be used with cau- 
tion, but if employed in small quantities on a handkerchief at the 
approach of each pain, towards the termination of the second 
stage, it can never do harm. It thus allays pain and assuages ner- 
vous irritability; and, in the hand of the skilful practitioner, is a 
power for good and never for evil.” Dr. Byford, referring to the 
closing act of the second stage under etherization, has the follow- 
ing language : “We not only thus save our patient from passing 
through the unspeakable agony connected with this crowning ter- 
ror, but the tissues distend and relax better under the full influence 
of the anesthetic. They are relieved of all irritability and reflex 
tendency to contraction and rigidity, and consequently there is 
less danger of extensive rupture.”—[loc. cit.] 
At a meeting of the London Obstetrical Society, held June 3d, 
1868, Dr. Sansom read a paper on Pain in Parturition and Anes- 
thesia in Obstetric Practice, in which he took occasion to say that 
“the tendency of modern investigation has been to show that the 
abrogation of the pain of labor is a direct means of diminishing 
after-dangers, and so of conserving life.” In the discussion which 
ensued on the reading of this paper, Dr. Martyn remarked, that in 
his experience of chloroform he had not found it predisposed to 
post-partum hemorrhage, but rather the contrary. 
Prof. Thomas S. Latimer, of Baltimore, in a valuable paper 
published in the Transactions of the Medical and Chirurgical 
Faculty of Maryland, 1873, has following language: “Inves- 
tigations have not shown that the involuntary muscular fibres are 
affected invariably by the same agents which affect the voluntary 
fibres. On the contrary it has been positively shown that the in- 
voluntary fibres are not affected in the same degree, and it is quite 
possible to produce complete insensibility to pain with general 
muscular relaxation, without sensibly affecting the force of uterine 
contractions.” 
A vast number of opinions of the same tenor are before me, 
received through personal correspondence. Many of these are 
from persons of great experience, and distinguished in the profes- 19 
sion. I shall content myself with two or three quotations. In a 
long and interesting communication from Prof. T. R. Brown, Bal- 
timore, occurs this paragraph: “I have been struck with the 
calm, sweet sleep it has induced; of sufficient length to enable the 
already inert uterus to regain its vigor, and to subdue that painful 
restlessness as expressed in the countenance of the sufferer.” Dr. 
E. R. Peaslee, New York, so well known in connection with the sub- 
ject of ovariotomy, writes that he uses ether in all obstetric opera- 
tions, and in ninety-nine per cent, (at least) of all natural labors. He 
has never known any bad results, either to mother or child, trace- 
able to the anesthetic, “except that the contractions have been ar- 
rested for a time in a small proportion of cases, one per cent, per- 
haps, when I have given up the ether, returning to its use after the 
perineum was distended by the head.” 
Does A nesthesia endanger the life or future welfare of the child 
by poisoning the blood of the mother ? One of the earliest objec- 
tions to obstetric anesthesia was that it might compromise the 
safety of the child. It was asked, “How can we know or ascertain 
the possible consequences of the use of such an agent on the brain 
of the child ? And how can we calculate what may be the ultimate 
consequences of the action in reference to the development of the 
mental faculties?” [Dr. Malen, in Lancet, for April, 1848, quoted 
by Simpson.] In an article, too, in the London Med. Gazette, for 
Sept. 1848, it was claimed that etherization so accelerated the 
action of the fetal heart that the pulsations could not be counted ; 
that, after birth convulsions, and even idiocy were to be feared. 
Prof. Meigs declared his belief that he had lost two children dur- 
ing labor from the anesthetic (ether) used. 
Dr. Zweifel, of the Obstetric Clinics in Strasburgh, has re- 
cently been making some investigations relating to the effects 
upon the fetus in utero of anesthetics administered to the woman 
in labor. His attention, he says, was first seriously directed to the 
matter by discovering in the breath of a new-born child the odor 
of chloroform, the mother having been delivered under the influ- 
ence of that anesthetic. He also declares that he detected its 
presence in the urine of another newly born child, under like 
circumstances. It was found, too, in a recently delivered pla- 
centa, the woman having been under the influence of chloroform 
for fifteen minutes, only, during labor. By these means he claims 
to have established the fact of the influence of the anesthetic upon 
the fetus, and observes that, since the use of narcotics in general 
are contra-indicated in infants, it is an important question for ob- 
stetricians to decide to just what degree anesthesia may be carried 
in women in labor, with impunity to the fetus.—[Berliner Klini- 
sche Wochenschrift, May, 1874.] 
Dr. Smith, in a discussion, already alluded to, before the Ob- 
stetrical Society of Philadelphia, averred that the prolonged use 
of ether will impair the vitality of the fetus ; that he had rarely 
seen a case where the use of ether was prolonged in which the child did not require some effort to revive it.—[Obstetrical Tour., 
Oct. 1874-] 
Five out of my two hundred and sixty-two correspondents be- 
lieve that anesthesia is liable to result in death to the child from 
asphyxia, and two of them declare that they have witnessed this 
result, once each, in their own practice. 
On the other hand the testimony is overwhelming that the 
moderate anesthesia required in ordinary labors, and even anes- 
thesia to the second degree, as required in obstetric operations, is 
without danger to the child, immediate or remote. It has not 
been shown that the infantile mortality has increased since the 
introduction of anesthesia, but, to the contrary, the few, meager 
statistics we have on the subject, as those of Prof. Simpson, and 
of Prof. Channing, of Boston, go to show that the death rate is re- 
duced under the use of anesthetics. Prof. Simpson declares that 
the pulsations of the fetal heart are little, if at all, increased in 
rapidity when the mother is anesthetized. He quotes Prof. Sie- 
bold also as saying, that “The action of the child’s heart was 
found to continue quite unaltered, not the slightest change in its 
frequency and regularity being detected.” 
M. Cazeaux, in his treatise on midwifery, uses the following 
strong language : “Whatever difference of opinion may still re- 
main respecting the influence of chloroform upon the health of the 
mother, no one doubts its entire innocence as regards the fetus. 
In the immense majority of cases, the new-born child presents its 
usual appearance; its cries are neither weaker, nor heard less 
promptly, nor does its viability appear to be in any way injured.” 
Dr. Tanner, (loc. cit.) says, speaking of chloroform: “In ordi- 
nary cases, its good effects can be produced by the smallest doses, 
without scarcely passing the first or second degree of narcotism, 
and without the slightest danger at the time, or ill effects to moth- 
er or child afterwards.” Prof. Karl Schroeder, in his recent 
work, thus writes on this subject: “A few whiffs of chloroform at 
the commencement of a pain easily suffice to suppress the loud ex- 
pressions of pain ; the woman is still conscious, she replies in a 
drowsy way to loud questions, the abdominal muscles act power 
fully, and yet the pain is suppressed. Anesthesia not continued 
any farther than this is never dangerous to the mother or the 
child. Although there is no doubt that profound anesthesia con- 
tinued for many hours (as is sometimes necessary, for instance, in 
eclampsia), may be transferred to the child also and prove fatal to 
it, yet past experience has shown that complete anesthesia lasting 
for a short time has no influence whatever upon the child.” Dr. 
F. M. Robertson, of Charleston, S. C., thus gives his experi- 
ence : “In the professional experience of the writer, who was the 
first practitioner in the city of Charleston who used chloroform 
in obstetrical practice, not a case has occured in which he has 
witnessed the slightest injurious effects whatever upon the mother 
or child, from the inhalation of chloroform during labor ; and the 
results of its use have been carefully watched and noted in a large 21 
number of cases. On the contrary, he is convinced that still- 
births have been prevented, in many instances, by its salutary 
effects in regulating and accelerating the parturient action, when 
delay and continued pressure would have placed the life of the 
fetus in imminent peril.” 
The dictum of Dr. Zweifel, that infants bear narcotics badly, 
probably needs qualification with respect to ether and chloroform. 
“Children,” says Dr. Sansom, “are the best of all subjects for the 
administration of chloroform.” “The inherent irritability of the 
heart of infants,” he again says, “is a resistance to the paralyzing 
power of chloroform.” In seventy-nine cases of death from chlo- 
roform, the records of which were in the hands of Dr. Sansom, 
the youngest was five years old. Dr. Anstie’s experiments on fifty 
children resulted in “demonstrating the comparatively small 
amount of danger to children from weakening of the heart’s 
action under chloroform.”—[loc. cit. p. 309.] 
The writer has many times kept infants, from three weeks to 
six months old, under the influence of chloroform for half an hour, 
or more, while undergoing operation for hare-lip, strabismus, club 
foot, &c., and for the relief of convulsions; and in no instance 
ever saw any ill effect whatever from the practice. 
It is fitting, perhaps, that I should give something of my own 
experience with anesthesia in normal labor. This experience 
embraces a period of twenty-five years, though my records cover 
only the last ten. During the latter period I have given anes- 
thetics in one hundred and thirty-one cases of normal labor, at 
term, chloroform being the only agent used in all except three 
cases. In these three the chloral-hydrate was used—once by 
enema and twice by the mouth. It is my rule to begin anesthe- 
sia with the opening of the second stage of labor, and this rule was 
but seldom deviated from in these cases. My reasons for not be- 
ginning sooner are, that the administration of an anesthetic 
requires the immediate supervision of the accoucheur, who is thus 
compelled to remain with his patient from the beginning, it may 
be, to the close of labor—often a matter of great inconvenience 
and loss of time; again, the woman being led to associate the 
commencement of anesthesia with the beginning of labor, now 
thinks her labor shorter than it really is; whereas, if anesthesia 
be induced at an early period she is soon harrassed with the idea 
of delay, and her patience is in danger of being exhausted long 
before the close of labor. Another reason is, that the pains of 
the first stage are short, and not difficult to be borne if the patient 
is encouraged, as she should be in most cases, to walk about the 
floor. 
11 is my rule also, to apply the anesthetic on a crumpled 
handkerchief, which the nurse makes ready for the beginning of 
each pain, by inverting against it twice, with a rapid movement, 
the four-ounce, open-mouthed bottle containing the chloroform. 
It is then handed to the patient, who soon learns to hold it her- 
self, and to demand it eagerly with each returning pain. It is 22 
kept to the mouth and nose while the contraction lasts, and re 
moved so soon as it is ended, the patient being conscious of par- 
turient effort, but feeling little or no pain. When the head and 
shoulders are passing the vulva, anesthesia is deepened to uncon- 
sciousness. About one ounce to the hour is consumed. Thus ad- 
ministered, I have succeeded in giving the most marked relief from 
suffering in one hundred and twenty-eight cases, and without the 
least bad result that I could discover in any. In a few cases I have 
noticed at the outset a slight lengthening of interval, and abate- 
ment in force of contraction, occurring in those, who, so far as I 
can now say, were unaccustomed to anesthesia, and due probably 
to the emotion of fear which a first experience with anesthesia 
sometimes causes. In no case was anesthesia attended or fol- 
lowed by vomiting, other than that which frequently happens 
without anesthesia, towards the close of the first stage ; in none 
was there any alarming hemorrhage, retention of the placenta, 
rupture of the perineum, phlebitis, or other inflammatory affection, 
save mammary inflammation in three or four cases, and phlegma 
sia dolens in two. Twenty-two of the cases were primiparous wo- 
men. All of the mothers recovered except two, one of whom 
died on the third day after the birth of her child from an acute 
diarrhea, antedating labor ; and the other within twenty-four 
hours after delivery, from small pox. In all the others convales- 
cence took place with the usual rapidity. Five of the children 
were still-born ; one was asphyxiated from an unknown cause; 
one from the delay of the head, being a breech presentation ; one 
was asphyxiated from delay of the shoulders (bis-acromial diam- 
eter 7yCt inches) ; one of them was anencephalic, and in the fifth 
the mother was dying of small-pox. In none of these cases of 
still-birth could death be attributed to the chloroform. 
The benefit derived from anesthesia in these cases is seen only 
with certainty in the relief from suffering. How often enclamp- 
sia, other diseases, and death, have been averted, it is impossible 
to say. No case of eclampsia has ever come under my observa- 
tion where chloroform was being used at the time of attack. 
The only cases of dangerous post partum hemorrhage, at term, 
that have come under my observation within this period were two 
which I saw in consultation, and in which no anesthetic had been 
used. Only one case of extensive laceration of the perineum has 
happened to me within the period named. The case was a pri- 
mipara, in which there was disproportion, and I had predicted the 
result before applying the forceps. Rupture took place while de- 
livering with the forceps, under the influence of chloroform. 
I feel constrained to say here, with reference to some of the 
arguments adverse to anesthesia, that the objection that it retards 
labor by suppressing uterine contraction, though pointless, as ap- 
plied to ordinary labor, is not without force in some forms of 
difficult labor, as in cases of disproportion, in which instruments 
are not to be used, and in which labor is prolonged and the pain 
is so great as to demand deeper anesthesia than is ordinarily re- 23 
quired. Even in such cases it is not necessary that the anesthetic 
be withheld, but the effect should be so graduated that the force 
and frequency of the uterine contractions shall not be lessened. 
If the forceps be used (and its use is demanded in these cases), of 
course the anesthesia must be carried to the degree usual in op- 
erative labor, that is to say, to the stage of stupor, or loss of con- 
sciousness The question whether in any given case anesthesia retards 
labor, favors the occurrence of hemorrhage after delivery, or re- 
tention of the placenta, must depend upon another point, to-wit: 
Has the anesthetic so paralyzed the womb as greatly to impair, 
or utterly to destroy its contractility ? As this will depend upon the 
degree of narcotism, and is a matter of discretion only in most 
cases, censure for any such result should fall upon the administra- 
tor, and not upon the drug. We should remember, too, that the 
proneness of medical men in the early days of anesthesia to as- 
cribe every accident to the chloroform—a practice that drew from 
Dr. Simpson some pretty lively criticisms—has not wholly passed 
away, and so difficult is it for us to separate in our minds the 
thing precedent from that which follows, even though there 
be not the slightest relationship in fact, that we are not sure that 
we shall ever be able to judge of these points correctly in all cases. 
The ignorant, in the profession and out of it, continually make.this 
mistake, and in the name of humanity, common sense and relig- 
ion, but really in the interest of falsehood, continually throw ob- 
stacles in the way of progress. 
Of my correspondents, twenty five believe that anesthesia re- 
tards labor; twenty two believe that it promotes flooding ; nine- 
teen believe that it both retards labor and favors flooding; three 
are of opinion that it favors retention of the placenta, while two 
hundred and thirty-four are either silent on this point, or in posi- 
tive terms disclaim any participation of anesthesia in the produc- 
tion of the casualties named. 
Is it right to use drugs for the relief of the pains of ordinary la- 
bor ? The answer to this question involves the validity of the last 
objection we have noted, which objection is founded upon the as 
sumption that the process, from the beginning to the close, in- 
cluding the pain, is physiological; that a normal labor cannot be 
aided, and should not be interfered with. I believe I have not 
misstated the nature of the objection in thus formulating it. We 
need not dwell upon this objection; its fallacy should be apparent 
to all. It is more than doubtful if it can be said of any act asso- 
ciated with pain, that it is purely physiological. Nay, it is cer- 
tain, abstractly viewed, that such a proposition is false. The term 
physiological, itself, in the sense here used is relative, and must 
ever be so while we retain our imperfect natures. If man were 
mentally, morally and physically perfect, there would be no need 
of schools and churches for the mind and morals, nor drugs for 
the body; but since he is not, and the power has been given him, 
and the privilege, to better his mind and his morals, it has not 
been denied to him, we infer, the power and the privilege to 24 
ameliorate his physical condition, as well, in any and in all re- 
spects. Our right to relieve pain, from whatever cause, is not cir- 
cumscribed by such narrow limits, and the wheels of public opin- 
ion, sure as inevitable fate, will grind to powder the logic of 
such as, wrapping themselves in this kind of sophistry, would ob- 
struct the march of thought. The-ultimate result of the trial now 
pending will rest alone upon the merits of the practice. It must 
not be forgotten, too, that the friends of anesthesia claim some-i 
thing more for it than the relief of pain ; that by it not only are 
the pains of childbirth abolished, but, that which is of equal value, 
its dangers also are lessened. 
Agents used, and mode of their Employment. Chloroform is 
the agent almost universally employed in ordinary labors wher- 
ever anesthesia is known, but in obstetric surgery, ether is some- 
times substituted in a comparatively small number of cases, both 
in this country and in Europe. Of my two hundred and sixty-two 
correspondents, two hundred and eighteen, or eighty-three per 
cent, employ anesthesia more or less frequently in ordinary labors. 
Two hundred and seven of this number, or nearly ninety-five per 
cent, of those who employ anesthetics in ordinary labor, use chlo- 
roform ; five use sulphuric ether, and six prefer a mixture of ether 
and chloroform, or alcohol, ether and chloroform. Three-, though 
preferring chloroform, speak favorably of the chloral hydrate. For- 
ty-four, or nearly seventeen per cent, do not employ anesthetics 
in any case, or confine their use to operative labors. Contrary to 
general belief, I think, in European countries, chloroform in 
preference to other anesthetics, is employed quite as frequently in 
obstetric practice here as there ; and with regard to different sec- 
tions of the United States, my inquiries lead me to think that, 
while anesthesia in operative midwifery is nearly universal in all 
sections, its employment in ordinary labors is most common in the 
eastern, next in the southern, and is least frequent in the western 
states. In all these sections its use in ordinary labors is mainly 
confined to the cities and larger towns. Especially does this ap- 
pear to be true in the south and west. As already stated, three of 
my correspondents speak favorably of the chloral hydrate in ordi- 
nary labors, and the journals make frequent mention of its use in 
such cases. Dr. W. S. Playfair, Professor of Obstetric Medicine 
in King’s college, London, in a recent clinical lecture before re- 
ferred to, recommends its use in strong terms. He begins when 
the first stage is approaching completion, giving it in doses of fif- 
teen grains, at intervals of twenty minutes, till two or three doses 
are taken, and afterwards keeps up the effect with smaller doses at 
longer intervals, if necessary. Thus used “the patient falls into a 
drowsy state,” says Dr. Playfair, “not quite asleep but nearly so. 
She is roused when a pain begins, but suffers comparatively little ; 
and experienced women, who have the recollection of former labors 
to guide them, bear strong witn£ss to the immense relief thus ob- 
tained.” My own experience has been too limited to enable me 
to express a reliable opinion on the subject, but I am inclined to 25 
the belief that it would be of great value in certain painful and 
protracted labors, as already alluded to. 
Chloroform and ether, in this country, are almost invariably 
given upon a handkerchief or napkin. Of eighty-five United 
States correspondents, who speak definitely as to this point, eigh- 
ty-three thus give it, two only, using “inhalers” of English origin. 
I am led to believe that a very large majority of European practi- 
tioners also use the handkerchief, but many, as Dr. J. Braxton 
Hicks, of London, Dr. Lombe Atthill, of Dublin, and Professor 
Carl Braun-Fernwald, of Vienna, use apparatus devised for the pur- 
pose. The latter uses “Tricot’s basket.” Nothing, however, can 
be safer than the handkerchief, in the way we have advised, and 
its simplicity strongly recommends it to the timid woman. There 
is great unanimity of opinion that the proper time for commen- 
cing anesthesia in ordinary labois, is when the first stage of labor 
approaches completion ; sooner, if the suffering be very great, or 
dilatation be delayed. 
Let me add a word or two of caution, partly for the benefit of 
the patient, and partly for the advantage of the physician : Never 
give an anesthetic in ordinary labor where the woman is greatly 
opposed to it, nor urge it strongly where there is great aversion to 
it on the part of interested friends, or relations. 
In conclusion, gentlemen, I will say, that careful observations 
conducted through twenty-five years of professional experience, 
and a close analysis of the facts before me, lead me to regard mod- 
ern anesthesia as one of nature’s choicest gifts ; that in the hands 
of those who are competent to practice our art it is an agent of in- 
conceivable value, both in operative and in ordinary labors , and 
that, whether for good or ill, and despite the persistent, nay bitter 
warfare sometimes waged against it, anesthesia in midwifery is 
slowly and steadily growing into favor. In the words of our dis- 
tinguished brother, Oliver Wendell Holmes, Parkman Professor 
of Anatomy in Harvard : “The pains of surgical operation and 
disease have been divested of much, if not all, of their terror. The 
agony which seemed inseparable from maternity has been divorced 
from it, in the face of the ancestral curse resting upon woman- 
hood. With the first painless birth, induced by an anesthetic 
agent, the reign of tradition was over, and humanity was ready to 
assert all its rights.”