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Pain Relief Fit For The Queen: Anesthesia Comes Of Age

laughing gas party

Illustration: Doctor and Mrs Syntax with a party of friends, experimenting with laughing gas. 1820. T Rowlandson after W. Combe, Wellcome Trust Library

Labor pain is a great equalizer. Queen Victoria suffered during childbirth, just like her subjects. Prince Albert had heard about chloroform easing the pain of childbirth and he asked about using it during the birth of their seventh child, Arthur, in 1850. The Queen’s three doctors advised against it, as did many doctors at that time. They considered using anesthetic during labor dangerous and an act against nature and God.

Dr. John Snow The prince raised the chloroform issue again when the queen was expecting their eighth child. Her doctors called in a consulting physician, Dr. John Snow, who had used chloroform successfully in a number of deliveries. He administered chloroform to Queen Victoria during the birth of Leopold in 1853. Dr. Snow was “more measured and scientific” than some physicians in using chloroform for childbirth, according to Jodi Koste, archivist at the Virginia Commonwealth University (VCU) Tompkins-McCaw Library. “He waited until later in labor to administer chloroform and stopped short of the women becoming unconscious,” she said.

Jodi Koste, archivist The library on the Medical College of Virginia (MCV) campus has a reprint of Dr. Snow’s casebook, in which he wrote, “Administered chloroform to the queen in her confinement. Her majesty expressed great relief from the application, the pains being very trifling.The effect of the chloroform was not at any time carried to the extent of quite removing consciousness.” Snow wrote about the final minutes of the birth and concluded, “The queen appeared very cheerful and well, expressing herself much gratified with the effects of the chloroform.”

The highly respected British medical journal, The Lancet, was not amused. In a May 14, 1853 editorial, the journal expressed “intense astonishment.” The editorial said, “In no case could it be justifiable to administer chloroform in perfectly ordinary labor.”

Queen Victoria paid little attention to the journal’s “astonishment” and agreed to chloroform at the birth of her ninth and last child, Beatrice.

WCVE PBS and WHTJ PBS will air a seven-part PBS series on the early life of Queen Victoria, through the birth of her first child, beginning Sunday, January 15, 2017.

Long history of pain relief:

Humans have used chemicals, botanicals and various techniques for centuries to ease pain. Opium poppy seeds were being used about 4000 B.C. to dull pain. In 1600 B.C. acupuncture was in use in China, and in 600 B.C. cannabis vapors were easing pains in India. A German physician synthesized dimethyl ether, later simply called ether, in 1540 A.D. In 1779, hypnotism was said to “cure many ailments” and ease pain.

Several developments in the 19th century paved the way for modern-day anesthesia, VCU’s Koste said. In 1800 Sir Humphry Davey said that nitrous oxide, also called laughing gas, "appears to be capable of destroying physical pain." In 1842 a dental student used ether for a tooth extraction, and in 1847 a Scottish obstetrician began using chloroform on patients who were in labor.

With use came abuse. In the early 19th century, public demonstrations of nitrous oxide’s effects on humans were common. P.T. Barnum put on nitrous oxide shows early in his career. Traveling lecturers gave talks called "ether frolics" during which ether or nitrous oxide was inhaled by attendees. Newspapers ran illustrations of so-called laughing gas parties.

War and Medicine:

Dr. Charles Bell Gibson
, an MCV surgery professor, in 1848 performed the first surgery in Virginia using ether, Koste said. With the outbreak of the Civil War, Dr. Gibson became surgeon-in-charge at The General Hospital #1 in Richmond, treating Confederate and Union soldiers. Both ether and chloroform were used during the Civil War, and new techniques were developed for administering the gases. “Unfortunately war is a great training ground for surgeons,” Koste noted.

The PBS series “Mercy Street”, which was filmed partially in Petersburg, depicts a Civil War military hospital where anesthesia was used. “Mercy Street” returns for a second season January 22 on WCVE PBS and WHTJ PBS.

Modern Pain Relief:

Intravenous anesthetic became popular around 1929, paving the way for modern drugs such as propofol. Lidocaine was developed as a local anesthetic in 1944.

Nitrous oxide is still used today in surgical and dental procedures, but ether and chloroform have been phased out, according to Koste. “Anesthesia today is much more sophisticated,” she explained. The patient’s age, health, medical history and the type of surgery to be performed are considered in deciding which anesthesia or a combination of drugs is used. Doctors today want their patients to feel no pain during surgery or childbirth,” Koste said.