Book: What a Blessing She Had Chloroform
Authors: Felicity Reynolds
Journal: BMJ (2000)

Donald Caton


Yale University Press, £20, pp 300 




ISBN 0 300 07597 9

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Rating: ★★★★

When her eldest daughter gave birth in 1859, Queen Victoria remarked, “What a blessing she had chloroform. Without it I think her strength would have suffered very much.” The Queen, an experienced mother, saw no controversy in the use of pain relief in labour. Yet the subject has continually been dogged by controversy (witches were burnt for it). Donald Caton, an eminent chronicler of the history of obstetric analgesia, has written a fascinating account of the social background to its evolution since the introduction of ether, then chloroform, to obstetrics by James Young Simpson in Edinburgh in 1847. The subject is viewed in the wider context of the whole metamorphosis of medicine in the 19th century.

The story began when medicine, religion, and philosophy were intermixed and the balance of earth, air, fire, and water still controlled our bodies, with science a late partner to medicine. Pain had an important role in society: to maintain order and collect information—a purpose still prevalent in some societies today. Its role in childbirth—education, punishment (“She's got to learn”), atonement, redemption, and bonding (“You'll love your baby all the more”)—also survives. Writing in the middle of the 19th century, John Stuart Mill pointed out that it was not God but nature that inflicted pain. It was surely permissible to improve on nature. Anaesthesia formed part of a new humanitarian movement that aimed “to eliminate suffering from human experience, a tendency that was not particularly apparent before then.”

Writing with grace and humour, Caton traces the progress of obstetric anaesthesia and analgesia through the bombastic overexuberance of Simpson, the opposition from a cautious medical profession, the diligent and innovative perspicacity that enabled Snow to put the technique on its feet and quell the opposition, the ill advised enthusiasm for twilight sleep, the reaction to the overuse of drugs embodied in Grantly Dick Read's natural childbirth campaign, to the more measured and abiding work of the UK National Birthday Trust.

The need for analgesia in labour was thought to result from the decadent lifestyle (or heightened sensibilities) of modern civilised woman. Read resurrected this 19th century belief in asserting, apparently from a personal series of two, that “primitive” people had painless, trouble-free labours but that educated women need feel no pain if fear were eliminated. Would that either of these assertions were true.

Both medical and non-medical readers will enjoy this book but may find the blanket term “anesthesia” confusing. It is used to refer to inhalational analgesia as developed by Snow, true anaesthesia (throughout labour) as advocated by Simpson, deep sedation as in twilight sleep, regional (epidural) anaesthesia as once used for labour and now reserved for surgery, and the milder regional analgesia. Caton does not mention, perhaps because it still eludes most of humanity, that effective analgesia with mobility and an alertmother and baby can now be provided for labour. Historically, women have demanded analgesia in labour when the medical profession approached it with caution, yet now that it has become vastly safer many women reject it as dangerous.