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.
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![occasioning a fit of epileptic convulsions in those who are disposed to that terrible disease, when he says: In a true epileptic, a fit maybe brought on at any time by means of chloroform. In simulated epilepsy, this agent produces only its antesthetic and relaxing effects. Ether and chloroform administered during a fit, singularly augment its duration and intensity. From a series of experiments made at the Bicetre, it has been demonstrated, that by ether inhalations a fit of epilepsy may be induced at will, in those liable to them; and that chloroform brings it on still more rapidly.* Such being the case, we cannot but eminently fear that puerperal convulsions might be induced by the action of the drug; for from the great excitability of the nervous system in the pregnant, parturient, and puerperal female, she may be considered as peculiarly predis- posed to convulsive attacks. And this, indeed, has been forcibly pointed out by Baron Dubois in the following sentence: Now if, through life, we look for a physiological condition, in which there may exist a predisposition to phenomena of that kind [convulsive seizures], we shall find that pregnancy itself but too commonly predisposes women to that sort of nervous excitement which is sometimes carried so far as to be fatal to them. I allude to the fact of puerperal convulsions, j- Of eighty-eight patients in the Maternity Hospital at Edinburgh, delivered under chloro- form, without instrumental or manual assistance, one died of convulsions, which came on five hours after delivery, and proved fatal-in six days. An attempt is made to account for this attack, by the explanation that the kidneys were found to have undergone, in some parts, the true stearoid degeneration. J I think it may be attributed, with much more truth and justice, to the deleterious agency of the drug. Much has been written respecting the propriety of obviating the shock of ordinary labour. § This is a mode of argument which I cannot subscribe to, because I do not acknow- ledge the position to be just. There should be no shock, properly so called, communicated to the patient in a well-conducted case of common labour. [| It appears to me, indeed, that a much greater shock is likely to be induced by the antesthetic agents themselves. In labour they can be had recourse to with no other intent than to assuage suffering; and it is our bounden duty to take care that the means used for that purpose are not calculated to produce greater distress and injury than the sufferings which they are intended to abolish. For it is a maxim that cannot sink too deeply into the mind of the young practitioner, that to employ dangerous remedies for non-dangerous cases is at variance with the established principles of our art.^[ We are without any very distinct explanation of the modus operandi of anaesthetic vapours.** They seem to act in the same manner that the deleterious gases do, by poisoning the blood, and thus destroying for a time the vitality of the nervous system. Sometimes the blood has been rendered almost black ;f f at others it has retained its natural hue; generally its powers of coagulation have been considerably impaired, if not altogether lost. % J * Gream's Remarks on the Employment of Anaesthetic Agents in Midwifery, p. 15, to which pamphlet I would refer for authorities to prove the frequent accession of convulsions under the action of the ethers. Montgomery tells us, that in several instances the exhibition of chloroform has been followed by symptoms of a convulsive character, and in some, by actual convulsions. (Objections to the Indiscriminate Use of Anaesthetic Agents in Midwifery.) Mr. Banner (Med. Gaz., vol. viii. 1849) gives two cases in which violent convulsions came on whilst chloroform was being administered previously to surgical operations. And Dr. Hayward says, that a woman was thrown into violent convulsions after inhaling chloroform, which continued three or four days. (American Jour- nal of Med. Sciences, July, 1850.) Instances of a like nature are reported by almost every observer of the effects of this potent medicine. f Nevins (Med. Gaz., vol. vi. 1848, p. 3S1) says, from the reports made to him, it appeared that convulsions were very frequent after etherization, and that he used the term very advisedly. He adds, that it was sometimes sup- posed they only occurred before the full effect of the chloroform had been produced; but in many of the reports it was distinctly specified, 'the patient was fully under its influence;' and this had been the case in his own instance. t Simpson's Anaesthetic Mid., p. 21, Note. § Simpson, Anaesthetic Midwifery, pp. 12, 45, &c.; see also P. Smith on the Employment of Ether in Obstetric Practice, pp. 7 and 23. || I do not, however, nryself believe that any fatal shock happens to the system from the simple effect of natural labour. (Gream on the Employment of Anaesthetic Agents in Labour, p. 27.) % In following up the history of the application of Etherization to obstetric medicine, nothing has surprised me more than the length of time which some practitioners have ventured to keep their patients under the uninter- rupted influence of the vapour. Dr. Simpson tells us he has kept up the anaesthetic state during periods varying from a few minutes to three, four, five, and six hours. (Superinduction of Anaesthesia, p. IS.) And he relates a case in which the woman was kept under its influence for thirteen hours. (Eod. loc. p. 22.) Dr. P. Smith says he has kept patients under its influence from half an hour to twenty-eight and a half hours. (Simpson's Anaes- thetic Mid., p. 33.) Mr. Lansdowne, of Bristol, can see no possible reason why it may not be used for a whole day, or even more; indeed, I cannot see why a limit should be set to the length of time in which it may be used. (Eodem loco, p. 35.) And at p. 34, the same gentleman, after describing his mode of administering it, says: It may (as has been the case with me) be used by any friends, or the nurse, should the practitioners require to be absent for a short time. Surely such language as this is calculated to lead to the reckless employment of a poison both most dangerous and uncertain in its action. ** Nunnelly (Med. Gaz., vol. vi. 1848, p. 1093) says, from his observations, he has reason to think the ultimate effects are, in some respects, not dissimilar to those produced by prussic acid. ff Glover's Experiments on Animals, Med. Gaz., vol. vi. 184S, p. 40. In M. Gorre's fatal case at Boulogne, the blood was literally as black as ink. (Med. Gaz., vol. vii. 1848, p. 213.) ft M. Lassaigne found that in venous blood, before inhalation of ether, the clot was to the serum as 65 to 34; while after inhalation, it was as 59 to 40; hence there was a great increase of serum. (Med. Gaz., vol. iv. 1847, p. 526.) Piekford has shown by his experiments, that the vapour of ether destroys to a very great degree the coagu-](https://iiif.wellcomecollection.org/image/b21073594_0664.jp2/full/800%2C/0/default.jpg)
