In addition to ether, another agent, chloroform, was introduced into clinical practice by James Simpson in 1847. Although chloroform was more potent and easier to use, it had significant side effects. However, it was John. Y. Snow who popularized the use of chloroform for obstetric anesthesia. He was one of the first physicians to study and calculate dosages for the use of ether and chloroform, and personally administered chloroform to Queen Victoria when she gave birth to the last two of her nine children.

By the end of the nineteenth century, many other advances in the field of anesthesia followed, as shown in Table 2.1. With the discovery of the local anesthetic properties of cocaine, infiltration anesthesia, nerve blocks, spinal, and epidural techniques were introduced. By the turn of the century, there were many advances in the area of airway management, such as orotracheal tubes used for intubation, laryngoscopes, and bag-mask ventilation devices. Soon, various intravenous induction agents were introduced, allowing patients to go off to sleep quickly, resulting in a more pleasant experience. Newer and better muscle relaxants became widely available, followed by safer and more clinically useful inhalational agents. Today, anesthesia is very safe, with mortality as low as 4–5 deaths per million of anesthetic administrations. This improvement in safety is in large part due to better patient monitoring, modern anesthetic drugs and equipment, and constant vigilance by the anesthesia provider.