3 Nitrous oxide (N 2O) was introduced in the 1880s and chloroform had by then been in use for decades.
Fortunately, for women in 1920, spinal anaesthesia had already been demonstrated in 1898. Up till the end of the 19th century, caesareans meant unbearable pain and usually maternal death from haemorrhage or sepsis. 2 Similar reports of dismal results after operations had followed. In 1892, Green had noted that six of 10 pre-eclamptic patients had died in whom labour had been induced. Philip reminds Dr Clarkson of the dangers of aggressive interventions. He may have hoped that a quick delivery will resolve the problem. It is possible that toxaemia is also on Sir Philip’s mind but he does not want to alarm everyone, and burden the parturient with a journey to the hospital. 1 Before Stroganov, treatment for toxaemia was immediate delivery, if necessary by caesarean. Subsequent experience showed that Stroganov’s method was associated with maternal mortality of ≤4%, with infant mortality at 20%. 1 In spite of the neonatal depression caused, his method was quickly adopted worldwide. He called for avoidance of stimulation of the parturient (still practiced today) and heavy sedation with morphine and chloral hydrate. 1 Then, in 1900, Stroganov presented his experience with 92 eclamptic patients with five deaths. In the late 19th century, mortality from toxaemia was 20–30%.
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