A short history of Obstetric Anaesthesia

The pain of childbirth has afflicted women for generations and the quest to relieve such pain has been pursued throughout history. Dr Ann Whitfield relates the story of obstetric anaesthesia from its early beginnings in ancient times, the introduction of chloroform by Sir James Young Simpson in the 1800s, through to the present day and the controversy over natural childbirth. Copyright Royal Medical Society. All rights reserved. The copyright is retained by the author and the Royal Medical Society, except where explicitly otherwise stated. Scans have been produced by the Digital Imaging Unit at Edinburgh University Library. Res Medica is supported by the University of Edinburgh’s Journal Hosting Service url: http://journals.ed.ac.uk ISSN: 2051-7580 (Online) ISSN: ISSN 0482-3206 (Print) Res Medica is published by the Royal Medical Society, 5/5 Bristo Square, Edinburgh, EH8 9AL Res Medica, Vol. III No. 1 1992: pp.28-30 doi: 10.2218/resmedica.v3i1.972


Obstetric Anaesthesia
The pain of childbirth has afflicted women for generations and the quest to relieve such pain has been pursued throughout history.Dr Ann Whitfield relates the story of obstetric anaesthesia from its early beginnings in ancient times, the introduction o f chloroform by Sir James Young Simpson in the 1800s, through to the present day and the controversy over natural childbirth.
T he unique pain of childbirth has been recognised since time immemorial.There are numerous references in the Bible such as Genesis Chapter 3 and there are many other descriptions of attempts by previous civilisations to alleviate this tor m ent The Chinese gave their parturients opium and alcohol, while the Egyptians in Pharaonic times burnt turpentine near the labouring woman or concocted a vinegar and marble dust mixture to rub on her abdo men.Acknowledging childbirth to be pain ful and often dangerous, the Babylonians and Greeks before Christ practised goddessworship and placation with sacrifices.Hippocrates noted that primipara suffer the most pain in childbirth.Many ancient methods were non-pharmacological and seem to us barbaric.Simpson was professor of obstetrics in Edinburgh (and senior president of the R.M.S. in 1835), a man of wide interests and with a great humanitarian desire to in troduce some form of pain relief for his patients in labour (Figure 1).Hearing of Liston's success in London, using ether for an amputation, he at once obtained a small quantity and used it on January 1st 1847.On January 19th he gave the first obstetric anaesthetic.He continued to use ether during 1847 but was not satisfied with it and began searching for an alternative.
The anaesthetic properties of chloroform were possibly discovered by David Waldie of Linlithgow.He made a pure preparation and promised Simpson a sample.However, a fire destroyed his factory and Simpson ob-tained the chloroform from Duncan Flockhart of Edinburgh.At a party in his house in Queen Street the guests inhaled the agent and "were all under the mahogany in a trice", alarming Lady Simpson when she entered the room.Simpson then used chlo roform on November 4th, presenting his findings to the Medico-Chirurgical Society on November 10th.H ow ever he was subsequently much reviled by members of the medical pro fession and minis ters o f relig io n ; Genesis chapter 3 was quoted against him : " In sorrow thou sh alt bring fo rth c h ild re n " .Others accused him of turning the lyingin chamber into a scene of drunken debauchery.
Simpson refuted his critics, interpret ing sorrow as toil rath er than pain.However, not until 1853, when Queen Victoria requested chloroform for the birth of her ninth child, did its use finally become respectable.The technique became known as Chloro form a la Reine and this agent was used in obstetrics until after the second world war.
In 1880, a Russian, Klikowich, de scribed the use of nitrous oxide in labour.In 1933 Minnitt developed a self-administer ing nitrous oxide and air apparatus which was widely used until 1970.Its successor, Entonox (50% nitrous oxide in 50% oxygen premixed in one cylinder), was introduced in 1961.
A nother inhalation agent, Trichlorethylene, was also used for about forty years until its withdrawal in 1984.
Bier performed the first spinal anaes thetic in 1898 and the first epidural, de scribed by Sicard and Cathelin, followed in In 1906 'Damm e rs c h la f' or Twilight Sleep, was introduced; this was achieved by administering morphine with hyoscine.In a long labour the hyoscine was repeated but not the morphine.Thus the pain returned, but the hyoscine, providing amnesia, clouded the unpleasant memory.In 1913 Gwathmey described the use of colonic ether in oil, which was used until the 1950s.What of present day methods of obstetric analgesia?Opiates are widely used in gen erous quantities, most commonly diamor phine, morphine and pethidine.Patient controlled analgesia (PCA)  In this fascinating story, stretching back over 140 years, we have come a long way, although many women still approach labour with great trepidation.Of all the people mentioned in this review, the greatest surely is James Young Simpson, who had a vision and pursued it, making the relief of pain in childbirth an attainable goal.
A drawing o f an early inhalational general anaesthetic apparatus.

Figure 1 .
Figure 1.Sir James Young Simpson, the father o f obstetric anaesthesia.