THE BROMIDE OF ETHYL 
AS AN 
ANESTHETIC IN LABOR. 
BY 
E. E. MONTGOMERY, M.D., 
Philadelphia, Pa., 
Late Obstetrician to the Philadelphia Hospital. 
Reprinted from The American Journal of Obstetrics and Diseases 
of Women and Children, Yol. XVIII., No. 6, 1885. 
NEAV YORK: 
WM. WOOD & CO., PUBLISHERS, 56 & 58 LAFAYETTE PLACE. 
1885. Compliments of the Author. 
THU BROMIDE OF ETHYL 
AS AN 
ANESTHETIC IN LABOR. 
BY / 
E. E. MONTGOMERY, M.D., 
Philadelphia, Pa., 
Late Obstetrician to the Philadelphia HosyfiSh 
Reprinted from The American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XVIII., No. 6, 1885. 
NEW YORK: 
WM. WOOD & CO., PUBLISHERS, 56 & 58 LAFAYETTE PLACE. 
1885. THE BROMIDE OE ETHYL 
AS AN 
ANESTHETIC IN LABOR 
The expression of Galen, “ Dolor dolentibus inutilis est,” 
has ever been an actuating principle in the practice of medi- 
cine and surgery, and would undoubtedly have been equally 
effective in midwifery, had not obstetricians labored for ages 
under that incubus to progress, “ Meddlesome midwifery is 
bad.” 
It is true there is now no question as to the value of anes- 
thetics in irregularities of labor pains, in eclampsia, and in the 
various operative obstetric procedures ; but their habitual em- 
ployment for assuaging the pains of natural labor is still a 
much mooted subject. We are not confronted, as were the 
earlier advocates of anesthesia, with the charge that the ar- 
rest of labor-pain is a violation of divine and physiological 
laws, retribution for which entails upon the unfortunate patient 
paralysis, mania, and other bodily ills ; but it is apparent that 
anesthesia in natural labor is not only not practised, but op- 
posed by the teaching and practice of the majority of the 
profession of this country. In the discussion of a paper read 
before the Philadelphia Obstetrical Society in 1879, the general 
sentiment was expressed as adverse to the practice. 
It may be asserted that this opposition to anesthesia in nat- M ontgomery : The Bromide of Ethyl 
4 
ural labor is sufficient evidence that such practice is undesirable, 
but we only need to quote the following graphic descriptions of 
the last stage of labor to controvert this: 
Dr. Merriman (“ Synopsis of Parturition,” p. 15) says : 
“ The pulse gradually increases in quickness and force ; the 
skin grows hot; the face becomes intensely red; drops of 
sweat stand upon the forehead, and a perspiration, sometimes 
profuse, breaks out all over the body; frequently violent 
trembling accompanies the last, and at the moment the head 
passes into the world, the extremity of suffering seems beyond 
endurance.” Denman (“ System of Midwifery,” p. 103) : 
“ The distress and pain which women often endure while they 
are struggling through a difficult labor are beyond all descrip- 
tion, and seem to be more than human nature would be able to 
bear under other circumstances.” “ Mere pain can destroy life ” 
(Gooch, in Merriman’s “ Synop. of Parturition,” p. 239), as is 
shown by the report of women delivered in the Dublin Lying-in 
Hospital under Dr. Collins: “Of women whose sufferings 
were terminated in 2 hours oidy, 1 in 320 died ; where labor 
varied in duration from 2 to 6 hours, 1 in 145 died; in those 
in whom it continued from 7 to 12 hours, 1 in 80 died ; where 
it endured from 12 to 24 hours, 1 in 26 died ; where it lasted 
from 24 to 36 hours,1 in 17 died : and out of all those whose 
parturient sufferings were prolonged beyond 36 hours, 1 in every 
6 perished.” (“ Anesthesia in Surg. and Midwifery,” Simp- 
son, p. 98.) ‘ 
Meigs (“ Prac. of Midwif.,” p. 153) says : “ What do you 
call the pain of parturition?” There is no name for it but 
agony.” 
Finding so universal assent as to the severity of labor pains, 
we are induced to seek farther, for the cause of the non-admin- 
istration of anesthetics. It is undoubtedly based upon a want 
of confidence in the safety of the various alleviating agents. 
Of these, chloroform has probably been the most frequently 
used, in this country. 
Anesthesia in obstetrics was first introduced and actively 
championed by Simpson. The frequent fatality from the use 
of chloroform in surgical practice, and the influence of public 
opinion, have led to its more infrequent use in obstetrics. as an Anesthetic in Labor. 
5 
Theoretical reasons have been given, why chloroform should 
be perfectly safe in labor; but are all dispelled, when cases 
are reported, as they have been by Fagge (Schmidt's Jahr., 
No. 5, 1860) and Curtin (Discuss. Phi lad. Obs. Soc., Dec. 4th, 
1879), in which death occurred as a result of its administra- 
tion. 
As to the influence of chloroform upon the uterine contractions 
and the progress of labor, there has been great diversity of 
opinion. It has, however, been certainly demonstrated that 
profound chloroform narcosis does suspend involuntary as well 
as voluntary muscular contractions. But complete narcosis is 
unnecessary except in operative procedures. In natural labor, 
it is only given during a pain, allowing the patient to recover 
consciousness in the interval; but, even so administered, there 
is a general feeling that the frequency of uterine inertia, post- 
partum hemorrhage, is thereby greatly enhanced. But this 
tendency to weakening and after-hemorrhage is not so signifi- 
cant as to outweigh the advantage of relief from pain, were 
we not under the ban of the relatively so rare evil influences 
and fatal results of the drug in surgical cases. 
Although ether has been generally preferred to chloroform 
in surgical practice, from its greater safety, it is less desirable 
in obstetrics, for the reason that the patient must be profoundly 
etherized to afford relief. A small quantity of ether removes 
the woman’s moral control without alleviating pain. Tait 
(Brit. M. J., vol. ii., 1880, p. 845) directed attention to the fact 
that ether passes quickly into the fetal circulation and increases 
the peril of the fetus. He cites a case of extranterine preg- 
nancy operated upon under ether, in which the fetus was pro- 
foundly hypnotized, and says this peril to the child from ether 
was indicated by Simpson. 
Klikowitsch (St. Petersb. M. W ochenschr., 1880,117 and 249) 
praises a mixture of nitrous oxide four parts, air one part, as 
being the ideal obstetric anesthetic agent. But the difficulty 
in transporting so large a bulk, and the necessity for a special 
apparatus, render its general use in private practice improb- 
able. 
The ideal obstetric anesthetic is one which will act rapidly, 
surely, and safely, one whose effects are of short duration, and 6 
Montgomery : The Bromide oj Ethyl 
that can be carried in small compass. The bromide of ethyl an- 
swers these demands. It is a colorless, not unpleasant smell- 
ing fluid, which when breathed removes the sensation of pain 
without destroying intelligence. It was quite recently intro- 
duced into surgical practice in this country by Dr. Levis, 
though its anesthetic properties had long been known. 
Rabuteau, studying to fix its physiological action, arrived at 
the following conclusion: the bromide of ethyl, in comparison 
with chloroform, is better borne, is more rapid, but displaced, 
its action is less continuous, and is eliminated through the 
lungs much more rapidly. 
Lebert {Arch, de Tocologie, June, 1882) first employed it in 
obstetrics. He published four cases, a forceps operation, a 
version, and two normal labors, in which he produced complete 
absence of pain with but little disturbance of the sensorium. 
He mentioned that he had tried the agent for a long time and 
spoke with such enthusiasm that others were induced to follow 
his example. 
C. Wiedemann {St. Petersb. M. Wochenschr., 1883, No. ii.) 
reports a series of seven well-controlled normal labors, and 
Haeckermann (Centralbl. f. Gynaek., 1883, No. 34) has tried 
the drug in fifty cases. Both concluded that it could be used, 
without danger to mother or child, without influence upon the 
course of labor, and without loss of consciousness, essentially 
diminishing or quite removing the pains of labor. They pro- 
nounced it the long sought-for, and yearned-after means for 
abrogation of the curse resting upon mankind, “ with pain 
shalt thou bring forth thy children.” 
Prof. Muller {Arch. f. Gynaek., Berk, 1883, xxii., 99, 102. 
Berl. Klin. Wochenschr., 83, xx., 673) employed it in twenty- 
two exactly observed obstetrical cases; sixteen were pri mi parse 
and six multiparse, all of whom were quite healthy. In nine 
cases, a trifling acceleration of the heart and lung activity was 
observed. In eight cases, dilatation of the pupil swiftly oc- 
curred and very frequently the face became red—a circum- 
stance which speaks for, rather than against the agent, as we 
ascribe the syncope of chloroform to anemia of the brain. The 
unpleasant after-influences of chloroform, as pain in the head, 
etc., were entirely wanting. Elimination appeared to occur as an Anesthetic in Labor. 
7 
almost exclusively by the lungs, and continued over the first 
two days of childbed, producing a garlicky odor upon the 
breath. This odor could be distinctly perceived upon the breath 
of the fetus, showing that it had quickly passed to its circula- 
tion, but without producing the most trifling effect upon it. 
Muller did not, like his predecessors, find the drug free from 
disadvantage. In five of his cases, weakness of labor was in- 
duced, but all were terminated naturally. No hemorrhage fol- 
lowed, nor was there any delay in the process of involution. 
More important still was disturbance of the respiratory or- 
gans during convalescence. One patient, to whom eighty 
grams (fl § ij.) were given, complained afterward of suffocation 
and headache, and was annoyed by a dry cough. Temperature 
and pulse were normal, with regular action of the abdominal 
organs. Coarse crepitant rales were heard over both lungs. 
The unpleasant symptoms had vanished by the tenth day. The 
second patient, to whom over TOO grams (fl § iiss.) were given, 
presented more serious symptoms. About the third or fourth 
day of convalescence, the pulse rose to 100, Temp. 39° C. 
(I02i° F.), and both lungs were filled with large and small crepi- 
tant rales, without phenomena of smothering. The symptoms 
vanished with profuse expectoration, and the patient was dis- 
charged at the end of two weeks well. His experience further 
showed it not always effective. Thus in thirteen cases in which 
it was administered at the time of expulsion, a complete result 
was obtained in but five cases, three times pain was diminished, 
but in five cases it produced no effect whatever. 
I have used the drug in twenty-nine cases, and have become 
so well pleased with its action as to regard it a necessity in the 
practice of obstetrics. 
In the use of a new anesthetic, and one which, from its 
recent use, must necessarily be regarded with suspicion, I have 
been extremely careful in observing and noting its effects. 
Of these cases, eight were primiparse and twenty-one multi- 
parse ; in the former, delivery was completed five times with 
forceps, in the latter eleven times. 
Analyzing these cases farther, discloses that: 
In 5, ethyl was not given until the forceps were applied ; 
“ 3, labor was completed naturally where previous labors 
were instrumental; 8 
Montgomery : The Bromide of Ethyl 
In 1, former labor was also instrumental; 
“ 3, labor pains were weak before and after administration 
of the drug ; 
“ 2, pains were weak, but strength greatly increased after 
its administration ; 
“ 2, the fetus presented with vertex in R. O. P. position ; 
“ 1, delivery followed by uterine inertia, inversion, and 
hemorrhage ; 
“ 1, fetus still-born ; 
“ 1, child died same day in convulsions ; 
“ 1, child died second day of cyanosis. 
In the presentation of any anesthetic for general obstetric 
use, the profession have the right to demand that it shall be 
shown to be absolutely safe for mother and child ; that it 
will not cause uterine inertia, thus increasing the danger of 
post-partum hemorrhage ; nor induce acute inflammatory con- 
ditions in the organs by wliiclr it is eliminated, complicating 
the puerperal stage. 
Of my cases, three deserve especial consideration ; in one, 
a woman of delicate physique, who had been supposed to have 
phthisis in a previous pregnancy, after inhalation of about a 
drachm of the ethyl during three pains, began to complain of 
a sense of suffocation or oppression ; respirations were lefis 
frequent and sighing; pulse normal, pupils dilated. The 
anesthetic was discontinued and labor completed normally, 
but the sensation did not wholly disappear until the following 
day. The second, a nervous and hysterical primipara with 
fetus presenting the R. O. P., took § vi. between 9.30 i\m. 
and 2 a.m., when the delivery was completed by the forceps. 
The uterus contracted firmly. There was no laceration of 
vaginal mucous membrane or perineum. The patient seemed in 
good condition, and did well until in the afternoon. At 5.30 
p.m., T. 103°, P. 152, respirations frequent, looked badly, 
abdomen tympanitic, bowels had been frequently evacuated 
unconsciously. Quinine, morphine, and digitalis were promptly 
given, and vaginal injections employed. 
The following morning her temperature was normal, pulse 
120. Her subsequent improvement was undisturbed, save by 
rhe want of control of the bowel, which continued for nearly 
ten days. as an Anesthetic in Labor'. 
9 
The third patient, a primipara, having had more or less severe 
pain for twenty-four hours without the os dilating, was at 12 m. 
ordered, Ext. belladon, Morphiae sulph., aa gr. ij.; 01. theo- 
bromse, q. s. ft. supposit. no. iv. One suppository to be inserted 
at once and another in the evening. At 10 p.m., 1 found they 
had inserted three. She was then experiencing the effects of 
the belladonna, in dryness of the throat, dilated pupils, etc. 
Pains were infrequent and feeble, os dilated slowly. At 8 
a.m. it was fully dilated, the fetal head was driven down to 
the inf. strait, but the pains were insufficient to accomplish 
more. At 9.15 a.m., delivery was completed with forceps. 
The ethyl was not administered until the application of the 
forceps, and was continued until delivery. After delivery of 
the fetus, the uterus was flabby, did not contract, and bleeding 
was quite free. The removal of the placenta was hastened by 
expression and traction upon the placental mass by two fingers 
in the vagina. Shortly after its delivery, continued hemor- 
rhage, and the absence of a uterine tumor through the abdomi- 
nal walls, led to a vaginal examination which disclosed com- 
plete inversion of the uterus. She was quickly given the ethyl, 
and the uterus restored by pressing the fingers against the 
fundus and carrying the hand into the vagina, while the 
uterus was held by the external hand. 
The placenta had been attached to the posterior surface, 
low down. The uterine cavity was washed out with hot water. 
She recovered without special difficulty. 
The first case mentioned was one unsuitable for the adminis- 
tration of any anesthetic. The alarming symptoms of the 
second case I am inclined to attribute rather to the shock of a 
threatened peritonitis than to any deleterious effects of the 
anesthetic. In the third case, the inertia was too plainly pres- 
ent before its use. Although the ethyl was administered to 
restore the organ, it became at once quite firm, and there was 
no subsequent inclination to relaxation. 
There was a fetal mortality of three. The first died of 
cyanosis the second day after delivery. It was small and 
poorly developed. The mother had been under treatment 
during the last three months of pregnancy, for albuminuria, 
the labor had been quite tedious and was completed by for- 
ceps, with some difficulty. The other two were both cases in 10 
Montgomery : The Bromide of Ethyl 
which the anesthetic was only given during the use of instru- 
ments; in one it was the eleventh pregnancy. She had a 
pendulous abdomen, and the fetus presented the vertex in it. 
O. P. position. The delivery was accomplished after con- 
siderable difficulty. The child did well for several hours when 
convulsions occurred and death followed. The other was a 
primipara seen in consultation. She had a contracted con- 
jugate, and had been in labor some hours. JJer attendant 
had made three trials with instruments before my arrival. 
The head was delivered after hard pulling, the cord encircled 
the child’s neck, but no pulsations were perceptible in it. 
The greatest difficulty was experienced in delivering the body. 
Prolonged efforts were made to resuscitate the child without 
avail. 
In this paper, then, we are able to enumerate one hundred and 
twelve cases in which the drug was used without any fatality 
for mothers, and with but three deaths in children, none of 
which could be attributed to its action. Fearing that the un- 
usually large proportion of operative cases in my series would 
be attributed to the enervating effect of the drug upon the 
progress of labor, I have looked over the notes of the same 
number of cases immediately preceding those in which the 
anesthetic was used, and find that twelve of them were 
operative. 
With but one exception, the anesthetic was not employed 
until the completion of the second stage of labor, and in five, 
only for the application of instruments. The only case of 
post-partum inertia was one of these, the third case described 
above. 
The ethyl was administered with the advent of each pain, 
by holding over the face of the patient a napkin on which a 
few drops had been poured. This was removed as the pain sub- 
sided. There was no choking or suffocation, as in chloroform, 
and entire absence of the stage of excitement. After one 
inhalation, the patient invariably begged for it with the advent 
of each recurring pain. With small quantities, the sensation 
of pain was blunted, while intelligence was uninterrupted ; the 
patient was perfectly subject to control and ready to render or 
withhold voluntary efforts as desired. Under such treatment, 
the expulsive efforts resembled those made to evacuate obsti- as an Anesthetic in Labor. 
11 
nately constipated bowels and were not attended with more 
pain. In multiparse, the usual expression was that they had 
never known such relief. 
No diminished power in the uterine contractions was ob- 
served subsequent to its use; in fact, in many of the cases 
where before the contractions had been ineffective and irregu- 
lar, they became strong and regular. In one case I attempted 
to determine the duration of pause and pain during a part of 
the labor, by palpation over the abdomen, with the following 
result: 
Before Administration. 
After Administration. 
Time of beginning. Length. 
11', 13", 30'" p.m. 30'" 
11', 15", 45'" 30'" 
11', 19" 1", 30'" 
11', 21", 20'" 1" 
11', 22", 45'" 30'" 
11', 25", 20'" 1" 
11', 27" 30'" 
11', 28", 45'" 2", 30'" 
Total T. 17", 45'" Total L. 8" 
Time of beginning. Length. 
11', 40", 45'" 30'" 
11', 42", 30'" 1" 
11', 44", 30'" 45'" 
11', 46", 80'" 1" 
11', 49", 15'" 1" 
11', 52" * 30'" 
11', 54" 1" 
11', 56" 1.15 
T. T. 16", 30'" T. L. 7" 
It was difficult to determine the exact length of the first and 
third pains after administration of the drug, as a nausea that 
had existed for some time then culminated in vomiting. The 
above kind of observation has not, however, sufficient power 
of demonstration to decide the important question whether 
this agent influences the character of the labor pains, and con- 
sequently the duration of the labor. 
I have noticed a marked want of uniformity in the action of 
different preparations of this drug. Some, procured for use in 
the Philadelphia Hospital, had an unpleasant irritating 
odor and was slow in producing the anesthetic effect. To 
this fact I am inclined to ascribe the want of action experi- 
enced by Muller in a number of his cases. 1 have been in 
the habit of specifying either Wolff & Co. or Parke, Davis 
Co. when procuring it, as I have invariably found their 
preparations of the drug with a pleasant odor and reliable 
in action. 
I feel that the experience derived from my own cases, 
together with the commendation of other experimenters, 12 
Montgomery : Bromide of Ethyl as an Anesthetic. 
justify me in urging upon the profession a more extended 
trial of this agent in alleviating the sufferings of the most 
trying period of maternal life. 
1305 N. Broad St.