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September 1997
Volume 61 |
Number 9
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| 150 Years of Obstetric
Anesthesia: A Pictorial Overview |
George S. Bause, M.D. ,Trustee
Wood Library-Museum of Anesthesiology
To his credit, James Young Simpson advocated labor analgesia
in the face of stiff opposition from many clergy and even obstetricians
who felt that women were biblically condemned to pain during childbirth.
By February 1847, he had published accounts of inhalational ether
in obstetrics. As Professor of Midwifery at the University of
Edinburgh, Simpson soon became disenchanted with etherizing his
patients. After self-experimenting with a host of volatile agents,
including acetone and iodoform, Simpson focused on chloroform,
which possessed "an agreeable, fragrant, fruit-like odor
and a saccharine pleasant taste." In contrast to ether, chloroform
was more potent, swift in onset, pleasant and economical. As pleasing
as chloroform was to surgeons, anesthesiologists and patients,
the agent had an unexpectedly high incidence of sudden death.
Having successfully defined five degrees of etherization by 1847,
John Snow popularized chloroform usage when he administered
the gas to Queen Victoria for the 1853 birth of her eighth child,
Prince Leopold. As the world's first full-time anesthesiologist,
Snow was even more remarkable in fathering epidemiology, the search
for causes of illness and death. In 1849, Snow published not only
his solution of the Broad Street pump as a point-source for one
of London's cholera outbreaks, but that same year his classic
article "On Fatal Cases of Inhalation of Chloroform"
also was published.
Having studied Snow and epidemiology, Columbia University's Virginia
Apgar, M.D., furthered the science of obstetric anesthesia
by publishing "A Proposal for a New Method of Evaluation
of the Newborn Infant." She set forth five objective signs
for a 10-point evaluation of infants at one minute and five minutes
after birth. Dr. Apgar's signs were 1) heart rate; 2) respiratory
effort; 3) reflex irritability; 4) muscle tone and 5) color. For
the first time, obstetric anesthesiologists were able to quantify
the risks and benefits of their art on neonatal outcome.
Distant as the deaths of the above Scotsman, Englishman and American
now seem, we must pay homage to some recently passed colleagues
who began or ended their careers in obstetric anesthesia: John
J. Bonica, M.D., Sol M. Shnider, M.D., Gerard W. Ostheimer, M.D.,
and Robert A. Hingson, M.D.
- Before fathering multidisciplinary pain management, Seattle's
John J. Bonica, M.D., began by exploring analgesia for
obstetrics. Having witnessed his wife suffer difficult labor
and delivery, Dr. Bonica pursued obstetric anesthesia as his
labor of love.
- Another West Coast professor we must acknowledge is Sol
M. Shnider, M.D. Enthusiastic lecturer, author and experimental
physiologist, Dr. Shnider helped pioneer fetal lamb models for
understanding the effects of medications/anesthetics on human
fetuses.
- The East Coast experienced the sudden death of Gerard W.
Ostheimer, M.D. Author, editor and master organizer, Dr.
Ostheimer's passing left a vacuum in the realms of both regional
and obstetric anesthesia.
- The most recently deceased of our giants in obstetric anesthesia,
Robert A. Hingson, M.D., transcended our specialty. He
popularized clinical use of Xylocaine. Dr. Hingson's continuous
caudal and, later, lumbar epidural helped the obstetric anesthesia
world to waken from the twilight sleep of scopolamine combined
with morphine and to abandon inhalational/rectal ether administration.
Using tiny, compressed gas cylinders of cyclopropane and of
oxygen, Dr. Hingson made possible portable administration of
these agents for analgesia/resuscitation not only for obstetrics,
but also for the Third World. Dr. Hingson's hypospray jet injector
inoculated millions against eight different diseases worldwide.
The American Society of Anesthesiologists is proud to salute
150 years of obstetric anesthesia and all those who seek safe
relief of stress for mother and newborn.
George S. Bause, M.D., is Honorary
Curator for the Wood Library-Museum of Anesthesiology, Park Ridge,
Illinois.
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