Ether in Childbirth

During this her first preganancy, she has suffered much from indigestion, a train of nervous symptoms of a distressing character, together with general oedema.

At 8 o'clock in the morning, after a restless night, of which she has no recollection, she was seized with convulsions, which continued to recur; the interval between the convulsions decreasing, while the violence and duration of the paroxysms increased. At 10 o'clock, when I saw her, she had had six convulsions.

Her perceptive faculties were altogether obliterated. As each paroxysm subsided, she was observed to recover her faculties less perfectly, till they were wholly lost, with the exception, perhaps, of the ability to feel pain, which appeared to be regained simultaneously with the power of the uterus to contract; a slight contraction of which served only to usher in another paroxysm. An examination showed that but little progress had been made in the labor; the os uteri was dilated to the extent of an inch and a half, the membranes were entire, and the head was presenting. Her pulse was 110 in the minute. As she had complained of head-ache before the convulsions came on, and as the pulse appeared of a character to bear it, I took sixteen ounces of blood from the arm.

This had no favorable effect. On the contrary, the spasms continued to increase in force and frequency. The pulse rose to 135 in a minute, becoming much weaker. The extremities became cold, notwithstanding the application of sinapisms, and the surface was generally cold and clammy, and of a livid hue. Under these circumstances, it occurred to me that the vapor of ether might act as a stimulant, and also change the disordered action then existing. By administering the vapor, a worse state of things could not be induced than already existed, for it was evident to me, from the untoward progress the case had made, that a few more convulsions would destroy her.

All hope of a favorable result was lost, inasmuch as the labor made no perceptible progress. The lethargy succeeding a paroxysm of convulsions was accompanied by a want of contractile power in the uterus, and as soon as this was in a measure regained, and the uterus began to contract, another paroxysm would occur, preventing the further progress of the labor.

Under these circumstances, I thought that if I could substitute the lethargy from the inhalation of ether, for the existing one, there would be a great point gained; the one putting an entire stop to the labor, the other having no such effect.

During the interval between each paroxysm, I had examined the state of the os uteri, hoping to find it dilated sufficiently to enable me to introduce my hand for the purpose of turning, but this was not the case, as there was very little dilation. In a few minutes after the ninth paroxysm had passed off, I applied a sponge, well moistened with ether, over the mouth and nostrils. The patient soon began to rub her nose violently, pushing away the sponge as soon as it was re-applied, till she was prevented by holding her hands. Her countenance in a minute or two lost its deathly hue, and resumed a more natural appearance. In less than ten minutes the whole surface became warm and much more natural.

The pulse fell to 125; the interval between the paroxysms in- creased more than one half, and their duration, when they did occur, was much lessened. Uterine contractions now ceased to have their former effect of bringing on the convulsions, so that I could observe several distinct and efficient pains or contractions between the paroxysms. The os uteri, as a consequence, began to dilate, but not as yet sufficiently to admit of the introduction of the hand.

I did not venture to apply the sponge long enough to produce a complete lethargy, but removed it when her opposition to its application in a measure ceased. I was fearful, if a complete state of lethargy was introduced in her then low condition, she might not re-act. After being three hours and half under the influence of the ether, the uterus was sufficiently dilatable to admit of the gradual introduction of the hand, the membranes which were still entire, were ruptured, and I succeeded in obtaining one foot, which was brought down and secured with a tape. Owing to the ungovernable restlessness of my patient, and to the powerful contractions of the uterus, I had great difficulty in finding the other; and when I had succeeded in getting it partly down, it offered so much resistance to my efforts, that I was apprehensive it might not be a fellow to the one I had. After comparing the direction of the toes, I ventured to exert a little more force, and brought away the child.

It was still living, though much exhausted; the lungs required inflation before it breathed, but after respiration was once established it did very well. The placenta came away promptly, and there was no flooding.

No vapor was given after the child was delivered. The mother still continued in a stupor, with convulsions at intervals of forty-five minutes, till 4 o'clock the next morning, when they ceased. She took, during the night, as an antispasmodic, forty drops of tr.assafoetida in milk, at intervals of two hours. In the evening her pulse was 128, and quite feeble. I should mention that the convulsions had diminished in force, and continued to do so till they ceased.

At 8 in the morning, the stupor still continuing, she took ten grams of calomel, and in one hour a teaspoonful of fluid extract of senna, which was repeated every hour for four hours, when it operated on the bowels, producing copious black and very fetid evacuations. From this time she recovered rapidly; the day following she noticed some things and answered questions. Her tongue and been sadly bitten; she could not account for its soreness; has no recollection of anything that has occurred, and thinks it strange that her child could have been born with- out her knowledge. In two weeks she was about her room, having convalesced rapidly without an unpleasant symptom. The child, a fine boy, is doing well.