Remarks on the superinduction of anaesthesia in natural and morbid parturition: with cases illustrative of the use and effects of chloroform in obstetric practice / [Sir James Young Simpson].

  • Simpson, James Young, 1811-1870.
Date:
1848
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    ; 7 1 1 gers of the patient. I believe this argument to be as futile and untenable as the one that I have just noticed. Indeed, judging from analogy, and from what is the fact in surgery, I believe that, as a counteraction to the morbific influence of pain, the state of artificial aneesthesia does not only imply a sav- ing of human suffering, but a saving also of human life. Out of above 300 cases of the larger amputations performed during the current year, upon patients im an etherized or anzesthetic state, and which I have collated from different hospitals in Great Britain, Ireland, and France, a smaller proportion died than formerly used to perish in the same hospitals under the same operations without etherization. I shall take one _ of these amputations as an illustration of the whole—and that one the most severe of all—viz. amputation of the thigh. Malgaigne (1842) showed, that under amputations of the thigh, in the hospitals of Paris, 62 in every 100 died; in Edin- burgh, the mortality from this operation, in the only years during which the hospital reports were published (1839-42), was 50 in every 100; Mr Phillips of London (1844), found the average mortality 40 in 100; Dr Lawrie at Glasgow (1839), found it also in the hospitals of that city to be 40 in 100.* I have notes of 135 cases in which this same operation has been performed in hospital practice upon patients in an etherized state. Out of these 135 cases 33 died, or only 24 in 100. HenceI repeat, that the condition of anesthesia not only preserves the patient im surgical practice from agony 1 The following table exhibits the actual number of the cases of amputation of the thigh referred to in the text, with their respective results :— MORTALITY ACCOMPANYING AMPUTATION OF THE THIGH. Name of Reporter. eee ef ect Lag Fer Contes? o Malgaigne—Paris,........... 201 126 62 in. 100: Peacock—Edinburgh, ...... ae 43 21 50 in 100 Phillips’ Collection of Cases, ... - 660 263 40 in 100 Lawrie—Glasgow, ......s00¢. 184 73 40 in 100 Total, 6... '.5.- 1088 483 44 in 100 Upon Patients in an Anesthetic
    and torture, but actually preserves him too from the chances of danger and death. And I firmly believe, that the super- induction of anesthesia in obstetric practice will yet be found to diminish and remove also, in some degree, the perils as well as the pains of labour. | In an essay which I wrote in February last, “On the Employment of the Inhalation of Sulphuric Ether in the Practice of Midwifery,” (Monthly Journal of Medical Science for March 1847, p. 728), I offered some remarks on its ap- plication to cases of common as well as of morbid parturi- tion, and took occasion to observe, “ The question which I have been repeatedly asked is this—Will we ever be ‘ justified’ in using the vapour of ether to assuage the pains of natural labour? Now, if experience betimes goes fully to prove to us the safety with which ether may, under proper precautions and management, be employed in the course of parturition, then, looking to the facts of the case, and considering the actual amount of pain usually en- dured, I believe that the question will require to be quite changed in its character. For, instead of determining in relation to it whether we shall be ‘ justified’ in using this agent under the circumstances named, it will become, on the other hand, necessary to determine whether on any grounds, moral or medical, a professional man could deem himself ‘ justified’ in withholding, and not using any such safe means (as we at present pre-suppose this to be), provided he had the power by it of assuaging the pangs and anguish of the last stage of natural labour, and thus counteracting what Velpeau describes as ‘ as those piercing cries, that agitation so lively, those excessive efforts, those inexpressible agonies, and those pains apparently intolerable, * which accompany the termination of natural parturition in the human mother.” Since the latter part of January, I have employed ether- ization, with few and rare exceptions, in every case of labour 1 Traité des Accouchemens, Vol. I. p. 449. ‘Ces cris percans, cette agitation si vive, ces efforts excessifs, ces angoisses inexprimables, ces douleurs qui parassaient intolerables,” &c.
    which has been under my care. And the results, as I have already elsewhere stated, have been, indeed, most happy and gratifying. ‘I never had the pleasure of watching over a series of more perfect or more rapid recoveries; nor have I once witnessed any disagreeable result to either mother or child. Ihave kept up the anesthetic state during periods varying from a few minutes to three, four, five, and six hours. I do not remember a single patient to have taken it who has not afterwards declared her sincere gratitude for its employ- ment, and her indubitable determination to have recourse again to similar means under similar circumstances. All who happened to have formerly entertained any dread. respecting the inhalation, or its effects, have afterwards looked back, both amazed at, and amused with, their previous absurd fears and groundless terrors. Most, indeed, have subsequently set out, like zealous missionaries, to persuade other friends to avail themselves of the same measure of relief in their hour of trial and travail; and a number of my most esteem- ed professional brethren in Edinburgh have adopted it with success, and results equal to my own. All of us, I most: sincerely believe, are called upon to employ it by every principle of true humanity, as well as by every principle of true religion." Medical men may oppose for a time the superinduction of anzesthesia in parturition, but they will oppose it im vain; for certainly our patients them- selves will force the use of it upon the profession. The whole question is, even now, one merely of time. It is not—Shall the practice come to be generally adopted? but, When shall it come to be generally adopted? Ofcourse, it will meet from various quarters with all due and determi- nate opposition. Medical men will, no doubt, earnestly argue that them established medical opinions and medical practices should not be harshly interfered with by any violent innovations of doctrine regarding the non-necessity and non-propriety of maternal suffering. They will insist 1 See “ Answer to the Religious Objections urged against the em-. ployment of Anesthetic Agents in Midwifery and Surgery.”
    on mothers continuing to endure, in all their primitive in- tensity, all the agonies of childbirth, as a proper sacrifice to the conservatism of the doctrine of the desirability of pain. They will perhaps attempt to frighten their patients into the medical propriety of this sacrifice of their feelings ; * 1 We can all recollect the many absurd stories of apocryphal dis- asters and deaths that the opponents of etherization busily and anxiously reported tuwards the commencement of the present year, as having occurred from the employment of ether-inhalation in surgery. Dr Forbes, in his excellent article on etherization, in treating of these unscrupulous and disreputable pieces of professional gossip, observes—“ Qne day we had death from asphyxia; another from coma; another from hemoptysis ; some from convulsions; a few from pneumonia; and ene or two from actual incremation, or explosion, through the accidental firing of the ethereal vapour with- in the air passages. We have not had time to investigate all these terrible cases; but we may state that we traced the one which seemed the best authenticated—that from hemoptysis—from its full-blown majesty in after-dinner gossip, to its humble source in the hospital. And this was the case, as the man himself detailed it to us:—-A day or two after a successful operation for hernia, under etherization, the man pricked his gums while picking his teeth with a pin; and it was the product of this operation, not of the ether, seen in the spitting-pot by the patient’s bedside, that was bruited about town, as of itself sufficient to settle the question in all future time !—(British and Foreign Medical Review, No. XLVI. April 1847, p. 564)—When first employing etherization in midwifery, I met with no small number of similar strange tales and accusations. For example, in February last, a patient who happened to be severely frightened had, in consequence, a premature labour. The child presented preternaturally ; and died a day or two after birth. The mother was attacked with phlegmasia dolens, and made a very long and protracted recovery. Various kind friends, anxious about the results of etherization in midwifery, warned me of the professional odium which this case was bringing upon the new practice, and of the strong argument which t was affording to others against the safety of ether-inhalation in obstetrics. I was repeatedly and credibly told that ladies had informed their physicians, that the quantity used was so great that they had felt the odour of it perfectly oppressive when calling, even days afterwards, at the house of my patient. The answer to all this was sufficiently simple. The danger