CHILDBIRTH, Painless. That women in travail have always suffered more or less pain seems probable, since the writer of Genesis quotes God as saying in the primaeval curse: "In sorrow thou shalt bring forth children.° Yet there are many reasons for believing that labor for the primitive woman was more purely a physiological process and therefore less pain ful than it is to-day. Normal physiological processes are painless. The sensation of pain is caused by the abnormal and is usually sug gestive of pathology. Childbirth being a natural function of woman should be physiological and therefore relatively painless.
Very easy and practically painless labors are still observed but they are now the exception since most women suffer more or less intense pain during the second or expulsive stage of labor. The more difficult labors of to-day re sult from several factors, the more important being the intermarriage of races, the develop ment of the brain, the survival of the physically unfit, and the abnormal methods of dressing and living. Civilization, at the same time, has de veloped in woman a more sensitive nervous system which is less able to endure the shock of pain.
The belief that pain is an inevitable accom paniment of labor has reconciled most mothers to endure it, while the joys of successful motherhood have caused them to forget it. There is, however, no logical reason why women should suffer during labor. Suffering, physical or mental, produces surgical shock; it increases the dangers of puerperal complications, and delays the convalescence. When labor be comes pathological and therefore painful, the physician should endeavor to minimize and re lieve this pain with the same skill he shows in the care of other painful conditions.
The conduct of labor among all primitive peoples was purely intuitive and very little or no assistance was given. In difficult cases the older women of the tribe would assist with pressure, massage and nauseating drinks. In the earlier stages of civilization some of the older women assisted during labor and the priests gave spiritual assistance (mental sug gestion) or mechanical assistance in difficult cases.
The ancient Greeks appreciated the increased susceptibility of the nervous system of women during pregnancy. "The law in Carthage and Athens forbade the pursuit and punishment of a criminal or murderer who sought refuge in the house of a woman who was pregnant or had recently given birth to a child.° (Englemann). There is also considerable evidence in the Greek literature that an attempt was made to relieve the suffering of labor by anaesthetizing agents and other means.
To mention the various drugs which have been used in the attempt to relieve the pain of labor would necessitate the listing of every drug thought to have hypnotic, sedative, anal gesic or anaesthetic properties. Hypnotism and mesmerism have been used successfully and the value of mental suggestion has long been ap preciated.
The drugs most used by the ancients were probably cannabis indica (Indian hemp; hash ish), mandragora and opium. Of these opium is still employed, although its limitations have been recognized for at least a century. W. P.
Dewees wrote in 1819, "I have in a number of instances seen opium exhibited with a view to mitigate the severity of the pain, when labor advanced slowly, and have never failed to ob serve that the force of the contraction was diminished at the time it was required to be the strongest.° James Y. Simpson in January 1847 used ether to produce analgesia in midwifery and inaugu rated the first consistent effort to relieve the severe pain of labor. Flourens in March of the same year announced the anaesthetic prop erties of chloroform, and Simpson in November read his paper entitled, °Notice of a New Anesthetizing Agent as a Substitute for Sul phuric Ether in Surgery and Midwifery.° Be cause of superstition and religious prejudice these anaesthetizing agents at first were opposed by both the profession and the laity. However, following its use by Queen Victoria in 1854, chloroform a la refine became the fashion and analgesia was maintained for many hours in large numbers of cases. Protheroe Smith in a letter to Simpson stated that he had used chloro form analgesia for 28% hours. Simpson him self used it for over 13 hours.