Sexual dreaming during anesthesia: early case histories (1849-1888) of the phenomenon.

THE authors have encountered the problem of sexual ideations or dreams in sedated or anesthetized patients in their own anesthesia practices, in reports from colleagues, through expert witness testimony, and in the review of contemporary civil and criminal proceedings. A recent review article examined the roles of the benzodiazepines (especially midazolam), propofol, and nitrous oxide in producing sexually related dreams during dental analgesia and surgical analgesia and anesthesia. Soon after the introduction of midazolam into clinical practice, The Lancet published two medicolegal editorials reviewing its association with sexual ideations. Even allegations of sexual abuse can occur from patients who have been sedated in intensive care units. These allegations are truly believed by the patient to be real; however, in many of these allegations, it would be impossible for a sexual assault to have occurred because of the proximity of other healthcare personnel and family members. As part of our studies, we were led to the historical aspects of this phenomenon, first reported in The Lancet in 1849. We found these historical case histories to be of note because they illustrate that within 3 yr of the public demonstration of ether anesthesia in Boston, practitioners recognized the potential for general anesthetics to produce dreaming and identified the need for a chaperone during anesthesia. In this historical review, we focus on dreams and hallucinations with the earliest anesthetics, ether and chloroform. However, it is well recognized that drugassisted sexual abuse is still today a true entity and a gross violation of ethical principles. The first reported case of alleged sexual abuse during anesthesia occurred in Paris, France, in 1847. This was less than 1 yr after the first public demonstration of ether anesthesia in Boston, Massachusetts, on October 16, 1846. A Parisian dentist was accused of using ether to assist in sexually assaulting two girls on successive days. A physical examination performed by a physician and supporting evidence presented in court indicated that the first girl truly may have been assaulted. Also, she stated that she recalled specific aspects of the alleged assault. The second girl was able to recall details of her assault, but at the time she felt that she was unable to resist because of the effects of the ether, stating that she “felt paralyzed, her limbs were heavy, and she was unable to fight off” the dentist. Quoting records of the proceedings found in the French medical journals Abeille Médicale and Gazette Médicale from 1847, Dr. Edward Hartshorne (Surgeon, Philadelphia, Pennsylvania, and Editor, The Medical Examiner; 1818–1886) stated that the court entertained the possibility that these accusations were an ether-induced dream. So, it is apparent that dreams or hallucinations were already known to occur with ether. Despite the dentist’s claims of innocence, the court determined that sexual assault had occurred, and he was convicted and sentenced to prison on October 30, 1847. Less than 2 yr later, physicians were debating whether sexual dreaming could be a side effect of anesthesia. In January, 1849, a discussion of “Chloroform in Midwifery” occurred during a meeting of the Westminster Medical Society in England. One of the physicians, Dr. G. T. Gream (Obstetrician, Queen Charlotte’s Lying-In Hospital, London, England) enumerated several reasons why he did not think that chloroform was appropriate for obstetric use, and in so doing, he “alluded to several cases in which women had, under the influence of chloroform, made use of obscene and disgusting language. This latter fact alone he considered sufficient to prevent the use of chloroform in English women.” Later in this discussion, “Dr. Tanner mentioned a case of an operation in King’s College Hospital on the vagina of a prostitute in which ether produced lascivious dreams. Dr. Henry Hancock [Surgeon, London, England; 1809–1880] had noticed this effect in some cases he had operated upon.” In a subsequent issue of The Lancet, notes from the Medico-Chirurgical Society of Edinburgh of February 7, 1849, were published. Sir James Young Simpson (Obstetrician, Edinburgh, Scotland, developer of chloroform anesthesia, and President of the Royal College of Physicians in 1849; 1811–1870) stated that after 15 months of use in thousands of cases, “he had never seen, nor had he ever heard of any other person having seen, any manifestation of sexual excitement result from the exhibition of chloroform. . . . The excitement, he was * Associate Professor of Anesthesiology, Department of Anesthesiology, Wake Forest University School of Medicine. † Professor of Anesthesiology, Department of Anesthesia, Indiana University School of Medicine.