Parturition without Pain or Loss of Consciousness.
by James Townley.
PREFACE
A second edition of my little work being required at the expiration of only a few months is gratifying to me, as evidence that my views regarding the use of an Anodyne in Parturition have attracted considerable attention. I may take this opportunity of stating, that I have never had any intention of undervaluing the merits of others who have laboured in the field of anaesthetics, my only claim to attention consisting in the novelty of my mode of applying the agent, by which its effects are so remarkably modified.
When chloroform is administered in the usual way it is given slowly, and "goes the round of the circulation" before it relieves the pain or produces anaesthesia. Whereas, in my plan of using the "anodyne," the rapidly repeated but interrupted impressions made on the nervous system produce the anodyne without the anaesthetic effect--before, indeed, the ma.s.s of the blood has become affected. In this consists all the originality to which I lay claim. I have used the word "anodyne,"
instead of "modified chloroform," in consequence of this peculiarity of its effects. I cannot but regard this as an improvement on the old plan of using chloroform--which relieved pain, it is true, but it produced loss of consciousness also, and was not unattended with danger.
_2, Harleyford Place, Kennington, S., October, 1862._
PARTURITION WITHOUT PAIN.
For some time past, my attention has been directed to the use of anaesthetics in parturition. I had often been requested by patients to administer chloroform to them during labour, but I had seen the ill effects of this drug in one instance so strongly and almost fatally developed, that I shrank from its use. After considerable reflection on the subject, I thought that if a plan could be devised by which the anaesthetic agent should act only in deadening sensation, and not interfere with consciousness, it would be a boon to the accoucheur as well as to the patient. How was this to be effected? Two conditions appeared necessary for its accomplishment,--namely, a modification of the Inhaler at present in use; and certain additions to the chloroform--additions which would reduce its strength, and give it a certain flavour. These two conditions I had not much difficulty in fulfilling. But there arose an obstacle of more serious moment: How, when, and for what time, was the inhalation to be made? I will now give an account, _seriatim_, of my inhaler, the anodyne fluid which I employ, and the mode in which I direct the inhalation to be made.
_The Inhaler_[A] is similar to one very commonly used in administering chloroform. It has, however, in addition, two tubes, an inch and a quarter long and a quarter of an inch in diameter, running parallel to the floor of the inhaler. These tubes, being placed above and to the sides of the inspiring valve, admit two small streams of fresh air, which to a great extent are inspired unmixed with the vapour of the anodyne. In the place of the grating there is a curved p.r.o.ng for retaining the sponge under the right tube and opposite the hole in the right side connected with the cup which receives the mixture to be inhaled. The object of this cup is--first, to receive the mixture, and direct it to the centre of the sponge. It has, in the second place, the advantage of helping to keep the Inhaler cool by the patient making use of it to rest her thumb upon when she is inhaling. It will therefore be gathered from this that the patient herself always holds the inhaler.
[Footnote A: Manufactured by Messrs. Weiss and Son.]
[Ill.u.s.tration: A, cup; B, external opening of tubes; C, internal opening of tubes; D, sponge.]
_The anodyne mixture_ which I have found to be the most manageable is composed as follows: Alcohol, two ounces; one drachm of aromatic tincture; with sufficient chloroform added, short of the production of a turbid state of the fluid. The object of adding the tincture is to make it pleasanter to inhale; the spice also appears to prevent the sickness which would otherwise sometimes arise from long-continued inhalation. By giving a little colour to the mixture, also, it prevents any accident that might arise by putting in by mistake pure for the modified chloroform. I prepare the aromatic tincture as follows: One drachm of nutmegs; two drachms of cloves; pterocarp chips, a drachm and a half; water, four ounces; alcohol, five ounces: mix.
_Mode of administering the anodyne vapour._--The great object to be attained is to so far influence the nerves of sensation as to prevent pain, and yet not carry the anaesthetic agent to the extent of producing unconsciousness. This can be effected in the following manner:--The woman, in the upright or rec.u.mbent position, as the case may be, holds the Inhaler in her right hand. She is directed to take a full inspiration, and then to apply the Inhaler to the mouth and nose. She is then to breathe rapidly for six, eight, or more inspirations (the inspirations and expirations being equal) only with the diaphragm and abdominal muscles, the chest being kept a fixture all the time. The Inhaler should then be removed immediately, and one or two full, deep, quick chest-inspirations taken. This will be found sufficient to relieve all pain, and there will be no loss of consciousness. During the entire process it is desirable to have a full light upon the face, to watch the countenance and feel the pulse occasionally, and observe the pupils. These, in some cases, are very quickly affected, and then the inhalation requires to be suspended for a time. During the time the process is going on, I am in the habit of giving a teaspoonful of brandy in a cup of weak tea with plenty of milk, and something to eat; or, instead, a gla.s.s of wine and a little cake or bread-and-b.u.t.ter, from time to time, to keep up the strength and prevent that sudden pallor of the face which sometimes occurs. I may add, as only a portion of the alcohol is taken up in vapour, it acc.u.mulates in the sponge, so that it is necessary occasionally to squeeze it out before adding a fresh quant.i.ty.
I can hardly attempt to explain clearly the _modus operandi_ of the agent. Practically, however, it answers the purpose intended. The great point is, of course, to arrest its action before it produces unconsciousness. This is effected by using it as I have described. It is requisite that the patient be carefully watched, so that the moment for administering the agent may be seized. From the experience I have now had of its use, I can estimate pretty accurately the exact time the inhalation should be resumed or discontinued. After a little practice this knowledge can be obtained by any competent observer. I have now given my anodyne mixture in 216 cases, and without in any one instance seeing a bad result _quoad_ the administration of the mixture. Of these cases many have come to me in consequence of the severity of their former labours, their extreme nervousness, and other causes.
I select a few instances from my notebook in which the anodyne was employed with complete and satisfactory effects:
1. The patient was in her twenty-ninth year, by no means robust, of a nervous temperament, and looking forward to her first labour with great apprehension.
2. Was in her thirty-third year, and looked forward to her first labour with great dread.
3. Her sixth labour; all her previous labours had been very severe.
4. Her tenth labour; her previous labours very severe, and each time followed by a great deal of after-pain.
5. Her eighth labour; had suffered intensely in every previous labour, in some of which she had been delivered with instruments; had had a protracted recovery after each labour.
6. Her seventh labour; inflammation had followed each of her former labours.
7. Her fifth and sixth labours; her former labours had been very severe.
8. Her third and fourth labours; her former labours having been very severe.
9. Her first labour; very strong expulsive pains; soft parts at first being very rigid, then gradually giving way after six hours" use of the inhaler.
10. Her third labour; child"s head very large and firm; much exhaustion; delivered with the short forceps, very great force requiring to be used before the head could be extracted.
11. Her first labour; very nervous and timid; with difficulty could I get her to use the Inhaler rightly, but she became much more composed towards the end, and inhaled very well. I have rarely seen stronger expulsive pains than she had towards the last; the arch of the p.u.b.es being rather contracted, and the child full-sized.
12. Her fourth labour; breech presentation; used the Inhaler for three hours.
13. Her first labour; in her thirty-ninth year; very severe expulsive pains for nine hours; the last hour, owing to the size of the head and the contracted outlet, no progress was made; and beginning to get exhausted, it was decided to apply the forceps, which were accordingly sent for, but a few minutes before they arrived, nature had overcome the difficulty; the child was born alive, but with a large caput succedaneum, showing how firmly it had been retained the last hour.
14. Had always had great suffering in her former labours; used the Inhaler about three hours; breech presentation; placenta was adherent, and required great force to peel it off.
I have thus given the results of my experience with an agent calculated, under proper management, I venture to think, to be of great service in the practice of midwifery. I believe my experience with it has proved that--
1st. It is possible for a woman to be delivered with less pain from the beginning to the end of her labour than a rhubarb draught would occasion.
2nd. It is possible to afford that relief without interfering with the regular and natural action of the heart or brain.
3rd. It is possible for the child to be born without the mother experiencing any pain whatever, while at the same time she retains her consciousness and power to bear down when told to do so; and her first knowledge of the birth of her child shall be from hearing it cry.
4th. That when a woman is delivered without suffering pain, although she shall have had inflammation after each of six previous labours, the prevention of the suffering will have the effect of preventing the usual inflammation.
5th. That by preventing the suffering of labour, the woman does not lose her strength, and always has a speedy recovery.
CASES.
_Of the following Letters from Patients which I have selected for publication, six relate to cases of first labour._
It is generally admitted that the suffering of first labours equals, if not surpa.s.ses, that of subsequent ones. In three of these six labours there was the additional drawback of age, the youngest being more than twenty-eight years old. In one of these cases also there was a contracted outlet, which retained the head for one hour. It follows, therefore, that if in the severer cases of labour, with obstacles to impede delivery, women can be so fully relieved as not to suffer pain, the more ordinary and milder cases will also have the same relief. I, therefore, think it unnecessary to give any larger number of cases.
I will only add, that in all these cases the patient deserved as much credit as the accoucheur, as it was by her quickly altering and exactly following his directions in the manner of inhaling that enabled her to go through the labour without pain. Some patients, with the best intentions of doing what you wish, find it difficult, and then they have a little pain at times, but so little that I am within bounds when I say it is not one-twentieth of what they would otherwise have suffered.
Providence Place.
My dear Sir,
Having always had a great dread of the pains of labour, I was exceedingly pleased when you told me that you had it in your power almost entirely to prevent their being felt, though I must confess I was at the time rather sceptical as to the amount of alleviation you could effect without producing unconsciousness; but having been so happy as to be under your care during my confinement, I can truly say that the result fully realized all you had said. I suffered very much before you arrived, part of the time lying on the floor in great agony, perfectly unable to rise; but from the time I took the Inhaler in my hand, and used it under your directions, I had no more pain, lying quite still on the bed, and giving orders to the attendants to get all that was required (as you are aware, I was confined quite unexpectedly). I was perfectly conscious all the time, and remembered where everything was that was wanted. I was quite free from pain, excepting when you took the Inhaler from me to replenish it, when the pains came on rapidly, and I was delighted to get it back again. When the child was born, there was a feeling of great forcing, but scarcely any pain; indeed, I did not think it was born until you said "There, Mamma, you have a nice little girl."
Again thanking you, dear Sir, for your kindness, and the immense relief I experienced under your most beautiful method,