User:KendallChristian/sandbox

The administration of general anesthesia in operative procedures was publicly demonstrated by William Norton (1819-1868) in Boston, October 1846 as the first successful practice of it's kind. This practice revealed the pain-annulling properties of ether inhalation during surgery. Pioneers of obstetric anesthesia extended these findings to cases of parturition or childbirth, notably including James Young Simpson of Scotland (1811-1870), John Snow of London (1813-1858) and Walter Channing of the United States of America (1786-1876).

Prior to the anesthetizing of Queen Victoria in 1853, the use of diethyl ether and chloroform as obstetric anesthetics faced social, religious, and medical opposition alike. With the shift in social attitudes, women began coercing physicians to administer these powerful anesthetics during labor and became less reserved towards this novel practice. Medical objections were similarly disintegrated with casebook publications regarding the safety of obstetric anesthesia for both the mother and child. Further, the advent of obstetric anesthesia facilitated the use of instruments during delivery as obstetricians were afforded greater scope in terms of these materials.

Following Morton's use of ether as an anesthetic, James Simpson conducted his own obstetric anesthetic trial on January 19th, 1847 using an open-drop approach to administer ether. Though unsatisfied by this application of ether, Simpson's later personal discovery of chloroform's anesthetic properties inspired subsequent trials with chloroform that he went on to make public in November, 1847. The Medico Chirurgical Society publication of Simpson's findings was not well received and required significant defense which Simpson was willing to provide. Simpson claimed that London physicians objections were primarily based in jealousy as they commonly distinguished themselves by their opposition to any and all innovations that they did not think up. John Snow however found great issue with Simpson's lack of safety consideration and assumptions that obstetric anesthesia by means of chloroform inhalation was safer than natural parturition.

Having the role of anesthetizing the Queen of England, John Snow is attributed for influencing public and medical opinions on obstetric anesthesia through his authority and confidence. Though the birth of the Queen's 8th child Prince Leopold on April 7, 1853 was not generally publicized, the London social elite were aware of the use of chloroform in this delivery and thereafter found it appealing. This societal aspect of childbirth was recognized by Dr. Churchill of Dublin who concurrently published on the statistics of obstetric anesthesia, suggesting that wealthier individuals were recorded to have easier births from the use of such drugs. Though Snow greatly differed from Simpson in that he emphasized proper quantity measurements and the delay of administration until the second stage of labor commenced. Snow additionally disagreed with Simpson's argument that the laboring patient should be anesthetized to the level of unconsciousness. These differences among others is why the title "Father of Obstetric Anesthesia" has become so controversial.

Religious Opposition Labor analgesia was debated further on the grounds of religion and morality, which John Simpson used as his own weapons against opposition. Biblical literalism led many to interpret labor pains as punishment for sin and deemed obstetric anesthesia impious with respect to the primeval curse. Though Simpson advocates that “whosoever shall keep the whole law and yet offend in one point, is guilty of all”, referring to many of the medical practitioners who mitigate minor pains but avoid obstetric anesthetics for fear of opposition or religious persecution. Critic Charles Meigs exemplified this belief of the physiological value in parturition pain, which the the greater public supported in the mid 19th century.

Medical Objections Medical historian Richard Shyrock suggested that humanitarians sentiments motivated 19th century physicians, while science shaped their practice. Victorian practitioners believed that if suffering was preventable it was their duty to abolish it in any way possible. The pathological process of childbirth was seen to be of necessity for successful delivery and dulling the pain of contractions would hinder this process, until Simpson was able to overturn this theory in 1854. The inhalation of anesthetic agents do not affect the act of labor or the mechanism by which uterine contractions occur, but rather renders the woman insensible to the high degree of pain. With this finding, along with the statistical records of safely executed anesthetic administrations, the medical opposition to obstetric analgesia for pain annulment was suppressed.

Primary and Secondary References 1 Swayne, J. G. “Obstetrical Statistics.” The British Medical Journal, vol. 2, no. 777, 1875, pp. 635–638., www.jstor.org/stable/25242218. 2 S. Shapin, The Scientific Revolution (1996), 89-117. 3 Caton, Donald, MD. "John Snow’s Practice of Obstetric Anesthesia." Anesthesiology92 (2000): 247-52. Lippincott Williams & Wilkins, Inc. Web. 4 "Anaesthesia, Hospitalism, Hermaphroditism and a Proposal to Stamp Out Small-pox and Other Contagious Diseases." Google Books. Edinburough, 1871. Web. 2017. 5 Simpson, J. Y. “Letter in Reply to Dr. Collins, on the Duration of Labour as a Cause of Danger and Mortality to the Mother and Infant.” Provincial Medical and Surgical Journal (1844-1852), vol. 12, no. 22, 1848, pp. 601–606., www.jstor.org/stable/25500540. 6 Simpson, J. Y. “The Propriety and Morality of Using Anæsthetics in Instrumental and Natural Parturition.” Association Medical Journal, vol. 1, no. 27, 1853, pp. 582–589., www.jstor.org/stable/25494769. 7 Gordon, Henry L. Sir James Young Simpson and Chloroform (1811-1870). Ed. Ernest Hart. Pasternoster Square, London: Urwin, 1897. Masters of Medicine. Web. 2017. 8 Simpson, J. Y. “The Propriety and Morality of Using Anæsthetics in Instrumental and Natural Parturition.” Association Medical Journal, vol. 1, no. 27, 1853, pp. 582–589., www.jstor.org/stable/25494769. 9 Farr, A.D. "Early Opposition to Obstetric Anesthesia." Wiley Online Library. N.p., 1980. Web. 896-907. 2017. <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1980.tb03951.x/epdf>.

10 Simpson, James Young. "ANSWER TO THE RELIGIOUS OBJECTIONS ADVANCED AGAINST THE EMPLOYMENT OF ANAESTHETIC AGENTS IN MIDWIFERY AND SURGERY." ANSWER TO THE RELIGIOUS OBJECTIONS ADVANCED AGAINST THE EMPLOYMENT OF ANAESTHETIC AGENTS IN MIDWIFERY AND SURGERY. N.p., n.d. Web. Mar. 2016. <http://bja.oxfordjournals.org/content/31/1/35.full.pdf+html>.

11 Snow, John. “On the Administration of Chloroform during Parturition.” Association Medical Journal, vol. 1, no. 23, 1853, pp. 500–502., www.jstor.org/stable/25494691. 12 Murray, R. Milne. “On Anæsthesia.” The British Medical Journal, vol. 2, no. 1290, 1885, pp. 534–539., www.jstor.org/stable/25273574.

Additions Religious Opposition

The natural benefits of such labor pains which initially inhibited the practice of obstetrical analgesia, originated from another religious consideration of perfection. Religious opponents argued that individuals of God’s creation and His standard of perfection should not be in need of such obstetrical interference. Natural processes employed by the Almighty Himself should be left untouched. In support of this claim, M. Roussel advocated that the refinement of society through technical operations (i.e. anesthesia) causes more harm then good to the natural process of childbirth.

Medical Opposition

• Though physicians responsible for administering anesthesia were known to evade interfering in delivery if the mother was an uncivilized member of society. These individuals were left to their own resources, perhaps benefitting from midwife assistance.

The conflicting clinical interpretation of obstetric labor as natural pain, as opposed to discomfort induced by an abnormal or diseased condition, led obstetric practitioners and midwives alike to endorse laissez-faire treatment. Natural, animalistic functions of child rearing were determined thereafter not to require the assistance of obstetricians or subsequent labor analgesia. Following an era of natural philosophy, physicians evoked the ability of of wild animals and ‘savaged individuals’ to deliver offspring in regions where the practice of child rearing had never been reduced to an art form. The likening of any obstetrical practice to mere pretend science, including the delivery of anesthetic agents, further prolonged the advancement of this field considerably throughout the 19th century.

Social Implications

The social distinction of labor analgesia practice strengthened the divide between savaged and civilized society, while highlighting gender roles in medical practice. The results of unassisted labor in uncivilized communities, specifically the vitality of both mom and fetus, were not documented well. The news of this ‘anti-obstetric’ practice failed to spread to the civilized community, allowing the means of obstetric interference through general and anesthetic intervention to persist. Documentation and statistical evidence was favored throughout the development of obstetric anesthesia to determine the viability of physician strategies. The obstetric diary of midwife Martha Ballard (1735-1812) is historically valued for she documented the details of all midwife calls, as well as physician assistances, instrument usage, and symptoms. Being one of the first women to provide a history of obstetrical practice, Martha Ballard’s notes regarding the marginalization of women in medical practice and the arrogance of male physicians were taken into careful consideration.