The first obstetric anesthetic administered in the United States was given on April 7, 1847, in Cambridge, Massachusetts.¹ The patient was Fanny Appleton Longfellow], wife of the famous poet and scholar, Henry Wadsworth Longfellow. Fanny was attended by Nathan Cooley Keep, M.D.

Dr. Keep, a prominent physician and first Dean of Dentistry at Harvard (he considered dentistry a medical specialty) was experienced in the administration of "letheon" in dental surgery cases, but until then, it had not been used in obstetric deliveries in the United States.^{1, 2} Keep had published a letter, dated April 3, 1847, in which he described this apparatus.³ All of the participants were undoubtedly aware of the demonstration in the Ether Dome at Massachusetts General Hospital the previous October. Henry had written in his journal (April 1):

"Went to town the first time for several weeks and had a conversation with Dr. Keep about the sulphuric ether and its use."⁴

Dr. Keep probably advised the Longfellows of the experimental nature of the procedure, and they agreed to its use. During her labor, Fanny inhaled from the apparatus designed by Keep and "the sufferings of the last moments were greatly mitigated," her husband wrote. Fanny delivered a healthy girl; "no unpleasant symptoms occurred, all the results were highly satisfactory."⁵The experiment was a success, and mother and child did well. Fanny was enthusiastic and vocal. She wrote:

"I am very sorry you all thought me so rash and naughty in trying the ether. Henry's faith gave me courage and I had heard such a thing had succeeded abroad, where the surgeons extend this great blessing much more boldly and universally than our timid doctors. Two other ladies, I know, have since followed my example successfully and I feel proud to be the pioneer to less suffering for poor, weak womankind. This is certainly the greatest blessing of this age and I am glad to have lived at the time of its coming and in the country which gives it to the world, but it is sad that one's gratitude cannot be bestowed on worthier men than the joint discoverers, that is, men above quarreling over such a gift of God. As one of my brother's lady friends abroad, a pious, noble woman, says, one would like to have the bringer of such a blessing represented by some grand, lofty figure like Christ, the divine suppresser of spiritual suffering as this of physical."⁶

Henry, in his journal (April 7) stated, "This morning was born in the Craigie House a girl, to the great joy of all."⁴

This was Fanny's third confinement. She and Henry had six children, two boys and four girls. Fanny and Henry are pictured in Figure 3 with their boys, Charles and Ernest. The four girls were Fanny (born 1847), Alice (1850), Edith (1853) and Allegra (1855).⁷ The episode described here involved the birth of Fanny. Unfortunately, their long-awaited girl, Fanny, lived only a year, her demise causing her parents much grief. Equally tragic, her mother Fanny (who was Longfellow's second wife) suffered severe burns after she accidentally set her dress on fire while sealing packages, and she died in 1861.⁸ Henry had tried to save her by wrapping a rug around her, but was unsuccessful.⁹ Her passing was long mourned by Longfellow and poignantly described in the "Cross of Snow" in 1879.⁸ Longfellow never remarried. The Longfellow home, then called Craigie House, is now the Longfellow National Historic Site in Cambridge, Massachusetts.

Longfellow's first wife, Mary Storer Potter, of Portland, Maine, died of a miscarriage in Rotterdam in 1835 while Longfellow was on his study tour.¹⁰

Nathan Cooley Keep was not present at the ether demonstration in Boston on October 16, 1846,¹¹ but he must have been inspired by this event. In his communication of April 3, 1847, he stated he had administered ether in 200 dental cases.³ He insisted that the ether must be "perfectly pure." He stated, "The apparatus should have a reservoir, a mouth-piece of convenient shape and a valve near it, admitting the vapor freely from the receiver to the mouth and lungs, but perfectly preventing the expired gasses from again entering it." He also administered ether on the night of April 18 to a patient who was suffering from intense pain in the abdomen.³

Henry himself tried the ether (administered by Keep, perhaps?) on April 8, 1847. He wrote:

"Fast-day. Went to town to see Dr. Elliott about my eyes. Stepped into Dr. Keep's and had a double tooth extracted under the ethereal vapor. On inhaling it, I burst into fits of laughter. Then my brain whirled round and I seemed to soar like a lark spirally into the air. I was conscious when he took the tooth out and cried out, as if from infinitely deep caverns, "Stop," but I could not control my muscles or make any resistance and out came the tooth without pain."⁴

There are anecdotes and undocumented reports that Crawford W. Long, M.D., of Jefferson, Georgia, administered ether for obstetrics in the early 1840s. Of course, Sir James Young Simpson gave the world's first obstetric anesthetic (ether) in Edinburgh, Scotland, on January 19, 1847.¹²

Very little more is heard of Dr. Keep. Unlike Walter Channing,¹² he is not known for obstetric anesthesia, perhaps because of his dental orientation. But on April 7, 1947, he, Fanny and Henry made history!

References:

1. Pittinger CB. The anesthetization of Fanny Longfellow for childbirth on April 7, 1847 (Letter). Anesth Analg. 1987; 66:368-369.
2. Pitcock CD, Clark RB. From Fanny to Fernand: The development of consumerism in pain control during the birth process. Am J Obstet Gynecol. 1992; 167:581-587.
3. Keep NC. Inhalation of ethereal vapor for mitigating human suffering in surgical operations and acute diseases. Boston Med Surg J. 1847; 36:199-201.
4. Longfellow S. ed. Life of Henry Wadsworth Longfellow, with extracts from his journals and correspondence. Vol II. Boston, New York: Houghton, Mifflin & Co.; 1891:85.
5. Keep NC. The letheon administered in a case of labor. Boston Med Surg J. 1847; 36:226.
6. Wagenknecht EC. Mrs. Longfellow: Selected Letters and Journals of Fanny Appleton Longfellow (1817-1861). New York: Longmire Green & Co.; 1956:129-130.
7. Clark M. Telephone conversation. Longfellow National Historic Site. March 26, 1997.
8. Encyclopedia Britannica: Longfellow, Henry Wadsworth. Vol. 14, 1965:298.
9. Wagenknecht EC. Henry Wadsworth Longfellow, Portrait of an American Humanist. New York; 1966:237.
10. Naylor J. The Photographic Discovery of a Lifetime, New England Journal of Photographic History. Numbers 148/149, A double issue, issue 1, issue 2; 1996:28.
11. Vandam LD. Robert Hinckley's "The first operation with ether." Anesthesiology. 1980; 52(1):62-70.
12. Caton D. Obstetric anesthesia: The first ten years. Anesthesiology. 1970; 33:102-109.

Richard B. Clark, M.D., is Professor Emeritus in the Departments of Anesthesiology and Obstetrics/Gynecology at the University of Arkansas College of Medicine, Little Rock, Arkansas.

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FEATURES

Celebrating 150 Years of Modern OB Anesthesia

• Management of Childbirth Pain Before Anesthesia
  
  
• Fanny Longfellow and Nathan Keep
  
  
• Analgesia in Labor Becomes Respectable: The Role of John Snow
  
  
• 'To Give Birth Without Pain!' The First Cases of Mesmeric Pain Relief for Obstetrics
  
  
• 150 Years of Obstetric Anesthesia: A Pictorial Overview
  
  
• And What About the Baby? Virginia Apgar and the Apgar Score
  
  
• Obstetric Anesthesia: The Last Five Decades
  
  
• John J. Bonica Makes Obstetric Anesthesia an Academic Concern
  
  

ARTICLES

• Breaking Down the Barriers to Pain Management
  
  
• Practice Options: Considerations in Setting Up an Office-Based Anesthesia Practice

DEPARTMENTS

• To the Membership
  
• Washington Report
  
• Practice Management
  
• Residents' Review
  
• ASA News
  
• Letters to the Editor
  
• FAER Report
  

The views expressed herein are those of the authors and do not necessarily represent or reflect the views, policies or actions of the American Society of Anesthesiologists.

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