ANASTIIETICS IN NORMAL LABOR.
Since both the usefulness and safety of both ether and chloroform in the lying-in chamber are now universally admitted, we omit this resume, and reproduce simply the general conclusions.—Ed.] Chloroform in labor is administered either in surgical or in so-called obstetrical dose.
Surgical dose.—It is thus uniformly used: 1st. Whenever an opera tion is to be performed—forceps, versions, etc.—and anaesthesia should be as complete as the operation is difficult or dangerous. 2d. Whenever the pains are unbearable, and the parturient is, in consequence, greatly excited and uncontrollable. 3d. In case of spasm of the uterus. We refer here simply to rigidity of the cervix, not to tetanus of the uterus. 4th. In case of eclampsia.
Obstetrical dose.—lst. Chloroform given in small dose unquestionably takes the edge off the pains, and thus gives the parturient both moral and physical strength. At the same time the intervals between the uterine contractions are lengthened. 2d. Complete analgesia we have never observed except under deep anaesthesia, and then the drug is ad ministered in surgical dose. 3d. At times chloroform, instead of quieting, excites the patient to such a degree that we are obliged to cease its ad ministration. 4th. Occasionally, it has seemed to us, that chloroform diminished the contractile power of the uterus, and therefore caused hem orrhage, more or less grave. 5th. Its action on the fcetus is nil. 6th. Administered during the period of expulsion, chloroform certainly dimin ishes pain; but its effect on the contractions of the abdominal muscles, and the resistance of the perineum, has seemed to us less marked than is generally supposed. Pain is not completely abolished, contractions are frequent.
Never would we administer chloroform in normal labor except in the instances noted above. There is another anaesthetic to which we often have recourse, and which has frequently rendered us yeoman service. We refer to chloral.
[It willnoticed that no reference is made to ether by Charpentier. This, of course, is because the safety of ether over chloroform is not as yet recognized in France. True enough, chloroform administered in labor, is safer than when it is given apart from this physiological act, for the reason that the uterine contractions tend to _prevent. the cerebral anemia, which is such a constant accompaniment of fatal cases. In this country, however, particularly in New-England, the birth-place of ether, it is considered much the safer plan not to administer chloroform, but always ether. Owing, however, to the longer time requisite for the ad ministration of ether, and the inability to give it intermittently as easily as chloroform, the former is best reserved for operations requiring consid erable time, and in cases of eelampsia. Of all the stages of labor, chloro
form is most useful when the second stage is about ended, and, if it be then pushed to the surgical degree, the chances of securing an intact per ineum are greatly enhanced—the accoucheur being able to shell out the presenting fetal part as slowly and as carefully as seems requisite.—Ed.] C7doral. —This drug, of which we will speak further on under the head of eclampsia, is worthy of the attention of obstetricians. We have seen that the partisans of moderate anaesthesia resort, in particular, to chloroform during the stage of expulsion, and, for us, this period, although perhaps the most painful, is not the most insupportable. It is then that the parturients take account of the progress of their labor, regain courage, listen readily to the counsel of their physician, and are, in reality, less irritable and excitable, exdbpt perhaps, dur ing the last contractions, than during the first stage of labor. It is impossible to keep the woman under chloroform from the beginning of labor until the expulsion of the foetus without danger; now it is during the first stage of labor, that is to say the period of dilatation, that chloral has appeared to us incontestably of utility. When the pains in the back are very pronounced, or dilatation is slow, either because of feeble or irregu lar pains, or because of rigidity of the cervix, in primipanr for example, then it is that we have used chloral. We give it by enema, about one drachm at the outset, and repeating this in some four or five hours. We thus procure for our patients more or less rest, sometimes deep sleep. The drug has never seemed to us to have a bad effect on the pains, but rather to make them regular, without diminishing the intensity. In three cases which we recall, there existed spasmodic rigidity of the cervix, lasting for some five to six hours, which yielded in one half an hour to the chloral enema. In the second stage of labor, the expulsory stage, the action of chloral has seemed to us less marked. We then have recourse to chloro form, even as when manual or instrumental assistance is called for, which must be administered in surgical dose.
[As a further anaesthetic of utility in labor we would refer to cocaine. A number of observers have reported excellent results from the appli cation of this drug to the cervix during the first stage of labor. It is not likely, however, that cocaine will supplant chloral in this stage, whilst, during the expulsory stage, we question very much if it would have any effect whatever.—Ed.]