Many medical historians believe that it was obstetrician James Simpson’s championing of obstetric anesthesia and Queen Victoria’s later demand for it that influenced its acceptance in clinical practice. However, Caton argues that another historical figure deserves credit for inclusion of anesthesia in the obstetric armamentarium.

In this issue, he traces the demise of Simpson’s arguments for obstetric anesthesia, due mostly to poor anesthetic technique and his own self-promotion, seen as unseemly by the London medical establishment. John Snow, however, conducted extensive experiments with anesthetics, publishing several treatises and books on the subject. Surviving casebooks reveal Snow’s techniques for obstetric anesthesia (delaying administration of anesthetic until the second stage of labor and limiting the dose for best results) were more refined than Simpson’s.

Furthermore, Snow worked with at least 32 obstetricians, three of whom attended Queen Victoria when Snow anesthetized her. Particularly between 1850 and 1853, the Queen’s physicians “had ample opportunity to learn about anesthesia from someone who had mastered the technique.” Therefore, Caton contends that the turning point for acceptance of obstetric anesthesia came from the conversion of Snow’s colleagues and not from the public announcement of the Queen’s anesthetic. Caton analyzed the 28 obstetric anesthetics mentioned in Snow’s casebooks to show that there were more of these cases following Queen Victoria’s anesthetic than before — 16 compared to two prior, a statistically significant difference. In addition, the social standing of Snow’s patients post-Queen Victoria had also changed to include more of London’s social elite. The role of Snow has been overlooked, Caton believes, in physicians’ acceptance of obstetric anesthesia.