Classic pages in obstetrics and gynecology

Abstract

The year following the introduction of anesthesia, Simpson presented six case reports in which he used ether. The first (see above) was a patient with a grossly distorted pelvis. Following a 20 minute induction of labor, Simpson performed a breech extraction on an 8 pound infant who died with a compressed skull. Simpson noted, “Under some circumstances or degrees of intensity, the process of etherization may possibly interfere with the uterine contractility, particularly in the early stages of the labour. . . . A careful collection of cautions and accurate observations will no doubt be required before the inhalation of sulphuric ether is adopted to any great extent in the practice of midwifery. It will be necessary to ascertain its precise effects, both upon the action of the uterus, and of the assistant abdominal muscles; its influence, if any, upon the child; whether it gives a tendency to hemorrhage or other complications; the contraindications peculiar to its use; the most certain modes of exhibiting it; the length of time it may be employed, etc. In no case have I observed any harm whatever to either mother or infant, follow upon its employment. And, on the other hand, I have the strongest assurance and conviction that I have already seen no small amount of maternal suffering and agony saved by its application.” He concluded, “I have stated that the question which I have been repeatedly asked is this-will we ever be ‘iustified’ in using the vapor of ethei to assuage the pains of natural labour? . 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 ‘iustified’ in withholding, and not using any such safe means he had the power by it of assuaging the agonies of the last stage of natural labour, and thus counteracting what Velpeau describes as ‘those piercing cries, that agitation so lively, those excessive efforts, those inexpressible agonies, and those pains apparently intolerable,’ which accompany the termination of natural parturition in the human mother.” (Photograph courtesy of the College of Physicians, Philadelphia, Pennsylvania.)