Tuesday, September 24, 2013

Neither shall there by any more pain

By Alice Askins, Site Manager at Rose Hill

New York February 24, 1851  
My Dear Margaret
. . . Caroline is now doing very well & has one of the prettiest little girls I ever saw. . . [she] had a better time than usual[,] she took the Ether & did not know when the child was born.”  
Mary Saidler Swan to her daughter-in-law, Margaret Swan

The quest to eliminate pain goes back at least to 3,000 years BCE.  Early cultures used various preparations, including alcohol, opium, and cannabis to relieve pain.  The first documented use of general anesthesia during surgery was performed by the Japanese doctor Hanaoka Seishu.  Trained in both Chinese herbal medicine and Western surgical techniques, Dr. Hanaoka worked for years to develop a compound of plant extracts that would numb pain and cause temporary unconsciousness.  His first recorded operation using his formula took place in October 1804, when he performed a partial mastectomy for breast cancer on a woman named Kan Aiya.  Because the government of Japan kept the country isolated from the rest of the world, Dr. Hanaoka’s achievements were not known in the larger world during his lifetime.   By the time the isolation ended in 1854, different techniques for general anesthesia had already been independently developed in America and Europe.

Dr. Hanaoka Seishu

By the late 1830s, Western doctors and scientists had experimented with such compounds as nitrous oxide, ether, and chloroform.  The interest at that time was in the altered consciousness the compounds caused.  Traveling lecturers would hold public gatherings called “ether frolics,” where members of the audience inhaled ether or nitrous oxide to demonstrate their mind-altering qualities and entertain the onlookers.  Several men who participated in these events later used these substances as medical anesthesia.

Dr. Crawford Long practiced in Jefferson, Georgia.  As a student the University of Pennsylvania, he attended ether frolics.  Long noted that some participants experienced bumps and bruises, but afterward had no memory of the injuries.  In March 1842, he gave ether to James Venable, in order to remove a tumor from the man's neck.  In December 1845, Long first used ether as an anesthetic during childbirth.  The patient’s name seems not to have been recorded.  Because Dr. Long wanted to test ether in many patients over time, before publishing his findings, he did not at first receive credit for his pioneering work.  There was, in fact, considerable controversy about who first used ether for anesthesia, but now Dr. Long’s work is being recognized.

Dr. Crawford Long
We do know the names of two women who became well-known for using anesthesia in childbirth.  Frances “Fanny” Appleton Longfellow, wife of the poet Henry Wadsworth Longfellow, bore six children.  When her third child was born on April 7, 1847, Dr. Nathan Cooley Keep administered ether to her.  She later wrote,

I did it for the good of women everywhere as no woman should have to suffer that much pain. 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 in abroad where the surgeons extend this great blessing more boldly and universally than our timid doctors.... This is certainly the greatest blessing of this age.

Fanny Longfellow with her sons
Emma Darwin, the wife of naturalist Charles Darwin, also tried anesthesia.  Darwin gave chloroform to his wife for the last two of her eight births. The first time she used chloroform was also in 1847, and for the next (and final) birth she is said to have screamed, “Get me the chloroform.”

Historians debate whether conservative clergymen objected to obstetric anesthesia on Biblical grounds.  In Scotland,  Sir James Young Simpson, who advocated chloroform and painless delivery, faced objections from certain Calvinists, who cited Genesis 3:16:   "Unto the woman he said, 'I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children.'”  Opponents interpreted this passage to mean that God wanted women to suffer in childbirth.  It seems, though, that religious opposition to anesthesia was from a vocal minority.  There were also many doctors who were understandably cautious about anesthesia, because it could present dangers to mother and child.

There was a third woman who used anesthesia for childbirth, and she was famous before the issue arose.   Queen Victoria’s eighth child was born in 1853, with his mother under an accurate and controlled dose of chloroform.  She reported, "Dr. Snow gave that blessed chloroform and the effect was soothing, quieting and delightful beyond measure.”  Her example broke down barriers against the practice.  In fact, though, as Dr.  Simpson said,

Medical men may oppose for a time the superinduction of anaesthesia in parturition, but they will oppose it in vain; for certainly our patients themselves will force use of it upon the profession. The whole question is, even now, one merely of time.

Queen Victoria, Prince Albert and their children, 1857

Caroline Post Swan (Margaret Swan’s sister-in-law) tried “the ether” in 1851, before even Queen Victoria.  We might consider her a pioneer as well.

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