The principles and practice of obstetric medicine and surgery : in reference to the process of parturition : illustrated by one hundred and forty-eight figures / by Francis H. Ramsbotham.
- Francis Henry Ramsbotham
- Date:
- 1851
Licence: Public Domain Mark
Credit: The principles and practice of obstetric medicine and surgery : in reference to the process of parturition : illustrated by one hundred and forty-eight figures / by Francis H. Ramsbotham. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
663/682 page 547
![and the words of Dr. Meigs are so graphic, and so well describe my own sentiments, that I cannot forbear to quote them: Should I exhibit the remedy for pain to a thousand patients in labour, merely to prevent the physiological pain, and for no other motive, and if I should in consequence destroy only one of them, I should feel disposed to clothe me in sackcloth and cast ashes on my head for the remainder of my days. Again, independently of death, are there no minor casualties to be apprehended ? Two in- stances have come within my own knowledge, in which I have not the slightest doubt that puerperal mania was induced by the action of the anaesthetic; and I have heard of several others.* Moreover, there is good reason to believe that paratysisf has followed the administration of anaesthetic vapours; nor can we be surprised at such a consequence; and true puerperal convulsions is another frightful occurrence that I should dread, as likely to be induced by the means we are discussing. SnowJ says, that hysterical patients, as soon as they lose their con- sciousness from the effects of the vapour, are sometimes attacked with a paroxysm of hysteria. Simpson also acknowledges, that hysterical fits are frequent when it is given in labour, by the expressions made use of in his letter to Dr. Meigs, quoted above. Snow$ again states, that persons subject to epilepsy are liable to have a fit brought on by inhaling ether or chloroform. He gives the case of a man who was suffering from delirium cum tremore, that supervened on a diseased state of the kidneys, accompanied by albuminous urine, and who had suffered from convulsions previously. This man became the subject of a convulsive seizure immediately the vapour began to take effect. The occurrence of spas- modic twitchings, powerful, irregular, and uncontrollable movements of the person, and violent convulsion fits during the second or third degree of narcotism, are so common that they are noted by every writer on the subject of anaesthesia. Moreover, in those predisposed to con- vulsions, fits may be absolutely brought on at pleasure by the inhalation of these vapours. M. Fix, a surgeon in the French army, gives very strong testimony as to the effect of chloroform I will merely add, that the caution, skill, and experience of the gentleman who superintended this case are above question; and that I know no one in the whole circle of my medical friends, on whose judgment I myself would be inclined to place greater reliance. The facts above given have been kindly communicated to me by himself. * I have in my possession a letter from a physician in very extensive practice in London, who tells me of four midwifery cases to which he has been called in consultation in the metropolis, in which mania, with the accession of no lucid interval between the inhalation and the time of his visiting the patient, had supervened on the exhibi- tion of chloroform. I have also received some other letters, relating to similar facts. (Gream's Misapplication of Anresthesia in Childbirth, p. 66.) Mr. Banner (Med. Gaz., vol. viii. p. 505) mentions a case where chloroform had been administered during a first labour, for several hours. The patient, after recovering from its primai-y effects, became delirious, and continued in that state during the day and chief part of the night. Dr. Sutherland, at the meeting of the Roy. Med. Chirurg. Soc, held on the 22d of April, 1851 (see Lancet, May 3, p. 454), stated that he had seen three cases of puerperal mania resulting from the use of chloroform during pregnancy. [Qu. labour.] The Committee of Dentists that were appointed at Boston, state that, in one case, soon after inhalation for the extraction of a tooth, delirium came on, which lasted for three days; and another patient became delirious about an hour after, and continued so all night. She afterwards raised a pint of blood from the lungs. These were both young ladies. They say they have authentic accounts of other similar cases, more or less grave in their character. (Med. Gaz., vol. iv. 1847, p. 174.) f A lady is at this time sojourning in the South of Europe, in the hope of recovering from paralysis of all her limbs, which supervened on the inhalation of chloroform in her labour, exhibited at the fountain head of this widely-spreading stream. I am informed that her first child was stillborn, in consequence, as it was supposed, of her having had scarlet fever shortly before; that the second labour was rather more than usually severe, though she recovered rapidly and perfectly; that after her third confinement, on which occasion she was subjected to the influence of chloroform, then just come into fashion in the metropolis of which I speak, she became feeble in her limbs, having difficulty in walking across the floor; that in her fourth and last labour, more than two years ago, it was also given to her; soon after which she began to lose the use of her extremities; that she was reduced in a tew months to a state of perfect helplessness; and that she remains to this day in the same sad condition. I think it right to add, that, not having seen this lady, I only give the detail of the case as I have received it, through her friends; and that it is denied that chloroform had any share in producing the miserable result. But when we call to mind how very rarely paralysis is complicated with the puerperal state; that the nervous centres are the organs primarily affected by the drug; and when we have the evidence of Baron Dubois that, in one out of his five cases, numbness of the fingers supervened, and in another, the same condition of the legs, which seems not to have sub- sided until twenty-four hours had passed, we can scarcely withhold our apprehension that this lady is now paying a very severe penalty for indulging the desire to be saved from temporary suffering, of a kind innocuous, as far as injury to the constitution is concerned. Again, Dr. Haartman, a Russian physician, in a communication to Dr. Simpson,* states that while he was house-surgeon to the Westminster Lying-in Hospital, he exhibited chloroform in twenty-five cases. One of these patients, after complaining of headache, was attacked on the eighth day from her delivery with apoplexia nervosa, after which, she got paralytic on the right side. By the aid of strengthening medicines, she began to walk in about a month. Can anybody who is not wedded to the practice of etherization doubt that this hasmiplegic condition which deprived the patient of the use of her limbs completely for a month, as it seems from the report, and partially for how long after we are not told, was the result of the inhalation? Dr. Simpson, indeed, publishes his opinion, that the puerperal paralysis was in this, as it is in most other cases, probably connected with albuminuria; and he mentions two patients he had had under his care who were, in previous labours, attacked with haemiplegia—one, at the time of her delivery; the other, immediately after the birth of her first child. I have attended women in labour who were paralytic, having been attacked with apoplexy, resulting in that affection some time before; but of the vast number of patients with whom I have been concerned in labour, I do not recollect a single instance of haemiplegia occurring within the month after delivery; so that my experience would teach me that such a case is exceedingly rare. % Med. Gaz., vol. vii. 1848, p. 1022. § Loco prox. citato. * Anaesthetic Midwifery, p. 37.](https://iiif.wellcomecollection.org/image/b21073594_0663.jp2/full/800%2C/0/default.jpg)
