urged against the practice; and, in conclusion, I will very briefly allude to, and attempt to answer, the more prominent among these that happen to have been brought forward.

CHAPTER IX.

ALLEGED DIFFICULTIES IN THE SUPERINDUCTION OF
ANESTHESIA.1

In a previous page, I have stated the principal circumstances which require to be attended to in the exhibition of chloroform in labour. I have been occasionally told of cases, in which it was supposed that it was impossible to produce the anaesthetic effect of this agent. In my own practice (and I have now used chloroform in many hundred persons), I never yet met with a single instance in which a person was proof against its full influence.

It has been sometimes averred, in the English journals, that on attempting to use chloroform, jactitation, incoherent talking and delirium, spasms, &c., &c., have supervened, instead of a state of quiet anæsthesia. These are symptoms which do occasionally come on in the first or exciting stage of its action, more especially if strict quietude is not enjoined; and, though they are apt to terrify the beginner, they are in reality no more serious in their effects and character, than some of the equally frightful symptoms sometimes seen in hysteria. They are an evidence, however, of one of two things-either that the vapour is being given too slowly, or that it is given in two small quantity-in an exciting, in fact, instead of a soporific dose; and the simple remedy, as every one properly experienced in its action knows, is at once to increase the dose in order to pass the patient as speedily as possible into the second or full narcotic stage.

Chloroform, it is alleged, sometimes gives rise to much coughing, and pulmonary irritation. Certainly not so, if the chloroform is of good quality, and its vapour is not at first approached in too strong and concentrated a form to the face of the patient. After some experience, it will be found that it can be given so as seldom or never to induce even coughing. Some time ago, a well-known physician, in a large city of the 1 From Edinburgh Monthly Journal of Medical Science, Oct. 1848, p. 244.

south of England, wrote me, that he and his townsmen had found it too dangerously irritant a substance to breathe, and that he had seen it produce cough, bronchitis, phthisis, &c. The answer was simple; it never produced any such effects in Edinburgh practice. And I believe that the explanation was equally simple; he and his townsmen had experimented with an imperfect and impure article. A few days ago one of the principal druggists in Edinburgh showed Dr. Christison, Dr. Douglas Maclagan, and myself, a bottle of chloroform of high specific gravity, viz., 1.490, which he had just received from a very large manufacturing chemical house in London. It was impossible to breathe it without feeling great irritation in the throat and chest. It emitted fumes that at once reddened litmus paper; and which, on examination, proved to be muriatic acid. Is it wonderful that bronchitis, coughs, and more serious disasters, should have followed the inhalation of such an improper and dangerous article?

Dr. Letheby has shown, that some kinds of chloroform in the market, besides containing muriatic acid, are also mixed with aldehyde, hydrochloric ether, hypochlorous acid, &c.1

1 See Medical Gazette for June 16, 1848, p. 1038. The presence of some of these deleterious agents has been supposed to be an inevitable and speedy effect of the spontaneous decomposition of very pure chloroform. But I find that some of the article, manufactured several months ago, in its purest form, by Duncan, Flockhart, and Company, of this city, has undergone no kind of change, even though long exposed to the sun. Messrs. Smith have also shown me the same, in regard to their chloroform. I have reason to know, that the dangerous article alluded to in the text as containing a quantity of muriatic acid, has been extensively sold to the profession, throughout Scotland and England, at a price two or three shillings per pound cheaper than is charged for the pure chloroform manufactured by other houses; and, probably, its very cheapness has led to its extensive use. The following is the formula by which chloroform is prepared by Messrs. Duncan, Flockhart, and Company, of Edinburgh, whose article I have always found of the most superior quality:-4 pounds of chloride of lime, and 12 pounds of water, are first well mixed together, and then 12 ounces of spirit added. Heat is then applied to the still (which ought not to be more than a third full), but as soon as the upper part of the still becomes warm, the heat is withdrawn, and the action allowed to go on of itself. In a short time the distillation commences, and whenever it begins to go on slowly, the heat is again applied. The fluid which passes over separates into two layers, the lower of which is chloroform. This, after having been separated from the weak spirit forming the upper layer, is mixed with half its measure of strong sulphuric acid, added gradually. The mixture, when cool, is poured into a leaden retort, and distilled from as much carbonate of baryta by weight, as there is of sulphuric acid by measure. The product should be allowed to stand over quicklime for a day or two, and repeatedly shaken, and then redistilled from the lime. The specific gravity of the resulting chloroform is generally 1.496 or 1.497.

685

CHAPTER X.

OBJECTIONS TO ANESTHESIA IN MIDWIFERY.'

Objections of various kinds, religious, moral, and medical, have been zealously brought against the practice of anesthesia in midwifery.

Elsewhere? I have attempted to answer the supposed religious objections that were at first so very strongly urged in various quarters against the practice, on the supposed ground of the permanence of the primeval curse; and I have shown that the disputed word "sorrow," 'etzebh ("in sorrow thou shalt bring forth children"), does not in the original Hebrew really signify the sensations of pain, but the muscular efforts and contractions connected with childbirth. Besides, if this were not the fact, and that it was the duty of man to give effect to the curse, instead of struggling to ameliorate and resist its penalties and influences, then the whole art of physic should require to be abandoned entirely, for, in the primeval curse, man was doomed to die; and yet is not the great leading aim and object of the physician a continuous attempt to preserve him in life? All forms of obstetric assistance would require also to be rejected, for the whole art and science of midwifery is one undivided effort to abate and ameliorate the effects of the curse; and to attain that object imperfectly, as heretofore, by venesection, baths, by counter-pressure to the back, and other minor practices, is as sinful as to attain it more perfectly now by anæsthetics, inasmuch as the principle of interference is not altered by the degree of relief given; "for whosoever shall keep the whole law, and yet offend in one point, he is guilty of all." In short, if there is any evidence of feelings of impiety and irreligion in the whole question, it is surely on the side of those persons who suppose that pain is permanently ordained in the primal curse as an accompaniment of human parturition; and yet that by anæsthetics, man, the creature, has discovered a power by which he can alter and subvert an immutable decree. of God, the Creator.

1 From Edinburgh Monthly Journal of Medical Science, October 1848, p. 246.

2 See p. 609 of this vol.; see also a pamphlet by Dr. Protheroe Smith, entitled, Scriptural Authority for the Mitigation of the Pains of Labour.”

The principal moral "objection," as it has been termed, against the employment of anesthesia in midwifery, amounts to the often-repeated allegation, that it is "unnatural.” "Parturition," it is avowed, is a "natural function," the pain attendant upon it is a "physiological pain"-(Dr. Meigs);1 and it is argued that it is impossible" to intermeddle with a natural function;" and to use anaesthetics is a piece of "unnecessary interference with the providentially arranged process of healthy labour" (Dr. Ashwell2). The above is, perhaps, the most genelabour"-(Dr. ral and approved of all the objections entertained and urged at this moment against the practice of anesthesia in midwifery. But it certainly is a very untenable objection; for, if it were urged against any of our similar interferences with the other physiological functions of the body, every one of which is as "providentially arranged" as the function of parturition, then the present state of society would require to be altogether changed and revolutionized. For the fact is, that almost all the habits and practices of civilized life are as "unnatural," and as direct interferences with our various "providentially arranged" functions, as the exhibition of anaesthetics during labour. Progression upon our own two lower extremities is a "providentially arranged" function, a "natural process;" and yet we "unnaturally" supplement and assist it by constantly riding on horseback and in carriages, &c. The "physiological process" of walking is apt to produce pain and injury of the uncovered foot of man, and we "unnaturally" use boots and shoes to bind the foot, and add to the protecting power of the cutaneous and other structures of the sole. Mastication and digestion are "natural processes;" but we daily intermeddle with and attempt to aid them by the arts of cookery and dietetics; and so on with regard to other functions.

To annul the pain of labour by anaesthetics, is, argues Dr. Meigs, "a questionable attempt to abrogate one of the general conditions of man." Riding and railway travelling abrogate one of the general conditions of man (progression), and are constantly leading to accidents and deaths. Should we never travel therefore except on foot? Disease and death itself form one of the most "general conditions of man,"-and medicine 1 Philadelphia Medical Examiner, March 1848, p. 152. 2 Lancet for March 11, 1848, p. 291.

is a "questionable attempt to abrogate them." Should medicine therefore be abandoned?

In a note now lying before me, an eminent London divine urges the following objections against anæsthesia, either in midwifery or surgery; and I notice it here, because it is an objection which I have often heard repeated. He writes:-" The question with me is not the alleviation of pain, but the destruction of consciousness. I should hesitate greatly to take a step which destroys consciousness." Now, certainly, our consciousness is destroyed in natural sleep as much as in the anaesthetic sleep. I have little doubt that the distinguished writer whom I have quoted, has, many a day, perhaps during almost every day for a long lifetime, voluntarily given up and destroyed his own consciousness in sleep, for an hour or two longer each morning than the necessities of his system required. Putting these many hours together, he has, perhaps now, from first to last, unnecessarily, but voluntarily, surrendered up his mental consciousness for periods, that, if added together, would count up weeks, and months, and perhaps years. He has done so too,

merely for the reprehensible indulgence of indolence; and yet he insists upon his fellow-creatures not surrendering up their consciousness for a short time, on rare and extraordinary occasions, when the object is the far more legitimate one of the avoidance of unnecessary physical pains, and the securing life and health by saving the system from the endurance of these pains. If we may sleep, and thus indulge in the destruction of consciousness to avoid and cure corporeal fatigue, surely we may do the same to avoid and cure corporeal agony.

Dr. Merriman1 opposes the employment of anesthesia in natural labour, on the ground of "the great superiority of allowing nature to conduct the whole process of the birth." But the practice of anæsthesia does, in reality, allow "nature to conduct the whole process of the birth;" it merely abstracts that intensity of pain and suffering which accompanies the act of labour in the civilized woman-a "disadvantage inseparable" from civilization, to employ Dr. Merriman's own expression, and which is not an essential part of the process of parturition, according to his own doctrine; for, as he himself states, " in the

1 Arguments against the Indiscriminate Employment of Anesthetic Agents in Midwifery. London, 1848.