ANESTHETICS IN SURGERY.'

FROM A PATIENT'S POINT OF VIEW.

MY DEAR DR. SIMPSON-I have recently read, with mingled sadness and surprise, the declarations of some surgeons that anæsthetics are needless luxuries, and that unendurable agony is the best of tonics. Those surgeons, I think, can scarcely have been patients of their brother surgeons, and jest at scars only because they never felt a wound; but if they remain enemies of anaesthetics after what you have written, I despair of convincing them of their utility. My present object in writing is not to supplement your arguments in favor of the administration of anesthetics to those who are about to undergo surgical operations; but, as one who knows from personal experience what operations were to the patient before ether or chloroform was employed anæsthetically, I am anxious to state certain reasons in justification of their use, which only those who suffered without their help are in a condition to urge.

Several years ago, I was required to prepare, on very short warning, for the loss of a limb by amputation. A painful disease, which for a time had seemed likely to yield to the remedies employed, suddenly became greatly aggravated, and I was informed by two surgeons of the highest skill, who were consulted on my case, that I must choose between death and the sacrifice of a limb, and that my choice must be promptly made, for my strength was fast sinking under pain, sleeplessness, and exhaustion.

I at once agreed to submit to the operation, but asked a week to prepare for it, not with the slightest expectation that the disease would take a favorable turn in the interval, or that the anticipated horrors of the operation would become less appalling by reflection upon them, but simply because it was so probable that the operation would be followed by a fatal issue, that I wished to prepare for death and what lies beyond it, whilst my faculties were clear and my emotions were comparatively undisturbed, for I knew well that if the operation were speedily followed by death, I should be in a condition, during the interval, in the last degree unfavorable to making preparation for the great change.

The week, so slow, and yet so swift in its passage, at length came to an end, and the morning of the operation arrived. There were 'I have much pleasure in publishing the following interesting and beautiful letter written by an esteemed professorial colleague, who holds a distinguished place in British science and literature, and who, before the days of anaesthetics, was himself the subject of a severe surgical operation.-J. Y. S.

no anesthetics in those days, and I took no preparative stimulant or anodyne of any kind, unless two cups of tea, which with a fragment of toast formed my breakfast, be considered such.

The operation was a more tedious one than some which involve much greater mutilation. It necessitated cruel cutting through inflamed and morbidly sensitive parts, and could not be despatched by a few swift strokes of the knife. I do not suppose that it was more painful than the majority of severe surgical operations are, but I am not, I believe, mistaken in thinking that it was not less painful, and this is all that I wish to contend for.

Of the agony it occasioned, I will say nothing. Suffering as great as I underwent cannot be expressed in words, and thus fortunately cannot be recalled. The particular pangs are now forgotten; but the black whirlwind of emotion, the horror of great darkness, and the sense of desertion by God and man, bordering close upon despair, which swept through my mind and overwhelmed my heart, I can never forget, however gladly I would do so. Only the wish to save others some of my sufferings, makes me deliberately recall and confess the anguish and humiliation of such a personal experience; nor can I find language more sober or familiar than that I have used, to express feelings which, happily for us all, are too rare as matters of general experience to have been shaped into household words.

From all this anguish I should of course have been saved had I been rendered insensible by ether or chloroform, or otherwise, before submitting to the operation. On that point, however, I do not dwell, because it needs no proof, and the testimony of the thousands who have been spared such experiences by the employment of chloroform, is at hand to satisfy all who are not determined not to be satisfied.

But there are other modes in which anesthetics may serve a patient than by rendering him insensible at the period of his undergoing a surgical operation, and it is to these modes of service, which may not strike even the most humane and thoughtful surgeon, and cannot be matters of experience, except to patients who have not taken anesthetics, that I seek mainly to refer in this letter.

I am not gifted with physical courage. Physical courage I understand to signify that consciousness of a power to endure bodily agony, which accompanies a certain temperament. Its possessors know from the first instinctively, and by and bye learn from experience, that a blow, a cut, a burn, an attack of toothache, or the like infliction of injury, or onset of pain, can be endured by them, though unwelcome, up to an extent of considerable severity, with

out excessively incommoding them, or exhausting their patience. From severe injuries and dangerous diseases such persons recover, fortified by the assurance that they can bear without flinching what would make others complain loudly, and they are not afraid to anticipate suffering, believing that they will be able to bear it. This estimable virtue is possessed more largely by men than by women, and by savage than by civilized men, and may or may not be accompanied by moral courage.

I belong, on the other hand, to that large class, including most women, to whom cutting, bruising, burning, or any similar physical injury, even to a small extent, is a source of suffering never willingly endured, and always anticipated with more or less of apprehension. Pain in itself has nothing tonic or bracing in its effects upon such. In its relation to the body, it is a sheer and unmitigated evil, and every fresh attack of suffering only furnishes a fresh proof of the sensitiveness possessed to pain, and increases the apprehension with which its attacks are awaited.

When I, accordingly, made up my mind to submit to the operation proposed to me, it was with the fullest conviction that the pain. it would occasion would far exceed my power of patient tolerance, and I prepared for it, simply as for a dreadful necessity from which there was no escape. I awoke each morning from troubled sleep to reconsider the whole reasons for and against submitting to the surgeons, and by a painful effort reached again the determination not to draw back from my first resolution. From all this distracting mental struggle, which reacted very injuriously on my bodily constitution, I should have been exempted, had I been able to look forward to the administration of chloroform. A far greater amount of internal composure and serenity would then have been mine, and this mental peacefulness would have been a powerful aid towards sustaining my strength, and fitting me to bear the shock of the operation.

Again, I concealed from the relatives who were about my sick-bed what awaited me, knowing that an announcement of the impending operation would occasion them the greatest grief, and fearing that the expression of that grief would utterly shake my resolution. On the very morning of the operation, I performed my toilet with peculiar pains and care, with a view to disarm their apprehensions, on hearing that the surgeons were to pay me a visit that day; and I had at least the satisfaction of afterwards learning that the ruse was successful. But I need scarcely say that the mental tension occasioned by this reserve, and the continued effort to play a part, was a prejudicial exertion, and kept my faculties injuriously on the strain. Could I have told my friends that the operation would be

painless, we should have conferred about it, and they and I would have been saved much distress.

Further; during the operation, in spite of the pain it occasioned, my senses were preternaturally acute, as I have been told they generally are in patients in such circumstances. I watched all that the surgeons did with a fascinated intensity. I still recall with unwelcome vividness the spreading out of the instruments; the twisting of the tourniquet; the first incision; the fingering of the sawed bone; the sponge pressed on the flap; the tying of the bloodvessels; the stitching of the skin; and the bloody dismembered limb lying on the floor.

Those are not pleasant remembrances. For a long time they haunted me, and even now they are easily resuscitated; and though they cannot bring back the suffering attending the events which gave them a place in my memory, they can occasion a suffering of their own, and be the cause of a disquiet which favors neither mental nor bodily health. From memories of this kind, those subjects of operations who receive chloroform are of course free; and could I, even now, by some Lethean draught erase the remembrances I speak of, I would drink it, for they are easily brought back, and they are never welcome.

How far my experiences agree with those of others who have undergone similar operations I do not know, but except that I may have a more active and roving fancy or imagination than some of my fellow-sufferers, I cannot doubt that my experiences are not singular.

That the dread of pain keeps many a patient from submitting to operations, which would save life, is notorious; but the dread of a particular mode of inflicting pain is a more dissuasive motive with many than the dread of the pain so inflicted. Hundreds every day endure the great torture of toothache, rather than the small torture of the extraction of the tooth. Women in particular, suffer prolonged agonies for months, rather than submit to a fraction of the same amount of pain at a surgeon's hand, because, as produced by him, it takes the form of an incision with a sharp knife; and a redhot iron is held in such horror by most persons, that rather than be touched by it, though the pain it occasions is but momentary, they will endure the application of chemical caustics which occasion torture for hours.

Anæsthetics render all such persons as great a service by rendering them insensible to the accompaniments of an operation, as by rendering them insensible to its pain. It is true that if they felt no pain, they might be as calm and even curious spectators of the dismembering of themselves as in dreams all men are, of what in waking life would be the most agonizing realities. But it is not

less true, that sufferings equal to those of the severest operations are experienced by patients, in the course of acute or aggravated maladies, without being followed by the crushing effect of the operations which they rival in power to occasion agony; and surely this is not to be wondered at. Before the days of anesthetics, a patient preparing for an operation, was like a condemned criminal preparing for execution. He counted the days till the appointed day came. He counted the hours of that day till the appointed hour came. He listened for the echo on the street of the surgeon's carriage. He watched for his pull at the door-bell; for his foot on the stair; for his step in the room; for the production of his dreaded instruments; for his few grave words, and his last preparations before beginning. And then he surrendered his liberty, and revolting at the necessity, submitted to be held or bound, and helplessly gave himself up to the cruel knife. The excitement, disquiet, and exhaustion thus occasioned, could not but greatly aggravate the evil effects of the operation, which fell upon a physical frame predisposed to magnify, not to repel, its severity. To make a patient incognizant of the surgeon's proceedings, and unable to recall the details of an operation, is assuredly to save him from much present and much future self-torture, and to give to him thereby a much greater likelihood of recovery.

Further; the horror with which attached relatives regard the prospect of operations on those very dear to them; a horror far surpassing that with which they would, in many cases, hear of such operations awaiting themselves, leads them often to dissuade their friends from submitting to surgical interference. The issue in too many cases is, that the poor patient listens, though but half convinced, to their arguments; tries doctor after doctor, and remedy after remedy, only to be compelled in the end, after weeks or months of prolonged suffering, to submit to the operation. The prospects of recovery, however, in such cases, are too often immensely lessened by the physical exhaustion and enfeebled general health which have resulted from the delay. The knowledge on the other hand that a mother, a sister, a wife, or a child, will be carried unconsciously through a severe operation, cannot but rob it of half its horrors in the eyes of friends, and will make them often the allies rather than the opponents of the surgeon, and keep them from showing the false kindness to their relatives, of dissuading them from submitting to the only treatment which promises a cure.

The sum, you will perceive, of what I have been urging, is, that the unconsciousness of the patient secured by anæsthetics is scarcely less important than the painlessness with which they permit injuries to be inflicted on him. To steep his senses in forgetfulness, and