What a Blessing She Had Chloroform.By Donald Caton. New Haven, Yale University Press, 1999. Pages: 288. Price $30.00.

Adolph H. Giesecke, M.D.

“Oh,” I thought, “Don Caton has written a book about the history of obstetrical anesthesia; how nice.” Dr. Caton is certainly well-qualified to write a history about the subject of his career interest since he became a medical doctor. If the book were only that, it would be of value to obstetricians and anesthesiologists. By his own admission, that would have been easy because the medical literature has been well-preserved and is available from several sources.

But Dr. Caton has given us much, much more. Through the magic of his story telling, he has put the innovators into the society of their time and shown us how their innovations answered social and medical needs. He emphasizes the impact of each development on the relationship between doctors and their patients, and how social pressures modified the development of the innovations. There are several examples in the well-written text, but the most powerful is his description of the impact of the feminist movement of 1900–1930 on the development of obstetrical anesthesia and how it forced the medical profession in the wrong direction.

The champions of the feminist movement wanted improvements in all aspects of the lives of women. They wanted improved job opportunities, improved representation in politics, and more participation in the important affairs of life. They wanted improved health care for women and children, including improved access to prenatal care and obstetric anesthesia. They believed the glowing reports of “Dammerschlaf” or “twilight sleep” from Freiberg, Germany. Dr. Carl Gauss, a well-known obstetrician, was administering small doses of morphine and scopolamine during labor and delivery for analgesia and memory ablation. Articles written by leaders of the feminist movement who had delivered babies in Freiberg were published in popular women’s magazines of the time. The implication was that the parturient experienced a deep, restful sleep during which she labored without awareness. When she awoke, a healthy baby lay in a crib beside her bed.

Women throughout the country demanded that twilight sleep become available in the US. Never mind that the laboring mother was not really asleep but rather was confused and delirious, requiring heavy restraints and constant attention of a trained nurse. Never mind that the neonate was depressed and hypoxic. Never mind that reluctant doctors wanted scientific studies before the technique was offered broadly to the public. They would not prevail. Every labor bed and every delivery table in the US was equipped with heavy leather straps to restrain the scopolamine-intoxicated women. Only a series of well-publicized disasters quieted the clamor for twilight sleep and forced the feminist movement to concentrate on other items of their agenda. Dr. Caton’s descriptions of the events are colorful and well-documented.

Similar discussions are presented for the introduction of obstetric anesthesia by Simpson, the opposition in the US by Meigs, and the assistance offered by Channing, all of whom were influential clinicians and powerful spokesmen for their respective points of view. Dr. Caton describes at length the similar educational heritage of the three who nevertheless came to different conclusions about obstetric anesthesia. His description of the subsequent career of John Snow stands in sharp contrast. Snow was from a poor family and had an apprenticeship in medicine rather than a university education. He became the founder of epidemiology when he observed that the early cases of the cholera epidemic in London came from the same neighborhood and limited the spread of the disease by removing the handle from the pump of the contaminated neighborhood well. He became famous as an anesthesiologist when he anesthetized Queen Victoria for the delivery of one of her children. The title of the book is a quotation from Queen Victoria, when she was told that her daughter had delivered a grandchild with the influence of chloroform.

More medical–social discussions are presented for childbirth without fear, spinal anesthesia, neonatal effects of anesthesia, neonatal resuscitation, and the Lamaze technique. As published, the book is of value to doctors, nurses, and laypersons—in fact, anyone who is interested in the medical or social background of health care for women. The book should be given as a gift to medical students, residents, nurses, wives, and mothers.