wine or other drink with any substance injurious to health, one year's imprisonment, or a fine of three hundred dollars. In addition to these general recommendations, the Commissioners advise that institutions be formed to educate nurses for the sick; that a class of medical practitioners be educated to practise as preventive advisers as well as curative; that physicians keep records of all their cases (for which a form is supplied); that clergymen of all denominations make public health the subject of one or more discourses annually; that each family keep records of its physical and sanitary condition, for which suitable schedules are prepared; and that parents and others apply a knowledge of the laws of health to the management of infancy and childhood. Of all these more or less valuable suggestions, the most noteworthy are those which recommend that the people be made practically acquainted with physiology and hygiène. In relation to these important subjects, it is emphatically true that "the people perish for lack of knowledge," and it is (we think) equally true, that unless the lack be supplied, the best directed efforts of the public authorities will be comparatively useless. The intelligent Americans fully recognise the great principle, that a free people can only be governed by guiding their judgments, and establishing a sound. public opinion. With them this recognition is the inevitable necessity of their form of government and their political institutions. Hence the strenuous efforts to educate every citizen, and hence their numerous and well-established schools. The more restricted institutions of this country do not render this great necessity so apparent; but, in reality, education is with us also become absolutely necessary to the safety of our institutions, and to the maintenance of our position amongst nations. Although we cannot but regret that our American brethren have anticipated us in making hygiene a part of their established system of education, we feel that it is not too late to profit by their example, and to be encouraged by their success. In 1843, of 150,000 scholars in the public schools of Massachusetts, only 416 were pursuing the study of human physiology, while 2333 were studying the less important branch of algebra. The Hon. Horace Mann, Secretary of the Board of Education, made some very valuable remarks on this incongruity, in his able Report for that year. As a proof how much may be done by an earnest and intelligent functionary, we quote the following extract from a letter sent by Mr. Mann to Dr. S. Curtis, the reporter on the Public Hygiène of Massachusetts to the American Medical Association. It is dated April 12th, 1849. "A vast change has taken place in the public mind since that time; perhaps on no other subject a greater. All the teachers just out of our normal schools are well-grounded in the elements of human physiology. They introduce it wherever they go. It has been prominent at all our teachers' institutes. I have lectured upon it hundreds of times to teachers and school associations. My estimate is, that not less than 15,000 of the 170,000 children in our public schools attend to this subject." These are encouraging facts for the consideration of British statesmen and philanthropists. Whatever may be the fate of the parent country, we have no fears that the transatlantic stock will degenerate, with so able and earnest and wise a corps of labourers, and such a vast scheme of physical and moral advancement of a free people, as is comprised in the application of medical science to every branch of its social economy. With these remarks we must close this article; not, however, without recommending the Report of the Massachusetts Commissioners (for which that State is mainly indebted, we understand, to Mr. Shattuck) to our readers, and especially to those officially engaged in sanitary operations. ART. VIII. 1. Anaesthesia, or the Employment of Chloroform and Ether in Surgery, Midwifery, &c. By J. Y. SIMPSON, M.D., F.R.S.E., Professor of Midwifery in the University of Edinburgh, Physician-Accoucheur to the Queen in Scotland, &c. &c.—Philadelphia, 1849. pp. 248. 2. A Treatise on Etherization in Childbirth, illustrated by Five Hundred and Eighty-one Cases. By WALTER CHANNING, M.D., Professor of Midwifery and Medical Jurisprudence in the University at Cambridge, U.S.-Boston, 1848. pp. 400. 3. On Anæsthesia and Anaesthetic Substances generally. By THOMAS NUNNELEY, Esq., F.R.C.S.E., Transactions of the Provincial Medical and Surgical Association.-London, 1849. pp. 381. 4. Traité de la Méthode Anaesthétique appliquée à la Chirurgie et aux differentes Branches de l'Art de Guérir. Par le Docteur E. F. BOUISSON, Professeur de Clinique Chirurgicale à la Faculté de Médicine de Montpellier, Chirurgien en Chef de l'Hôpital Saint Eloi, &c.-Paris, 1850. Treatise on the Anaesthetic Method applied to Surgery and to the different Branches of the Healing Art. By Dr. E. F. BOUISSON, Professor of Clinical Surgery to the Medical Faculty of Montpellier, Chief-Surgeon of the St. Eloi Hospital, &c.-Paris, 1850. pp. 560. 5. Ether and Chloroform their Employment in Surgery, Dentistry, Midwifery, Therapeutics, &c. By J. B. FLAGG, M.D., Surgeon-Dentist, Member of the Rhode Island Medical Society.-Philadelphia, 1851. Pp. 189. 6. On the Inhalation of the Vapour of Ether in Surgical Operations; containing a Description of the various stages of Etherization. By JOHN SNOW, M.D.-London, 1847. 8vo, pp. 88. THE time appears to have come, when, from the accumulation of facts and the lessons of experience, we may be enabled to arrive at satisfactory conclusions generally, with regard to the whole subject of Anæsthesia. Since the discovery of the anaesthetic powers of ether, a prodigious amount of labour has been devoted to the investigation of the properties of this substance and of the other anæsthetic agents which have been since discovered, to the best modes of administering them, to their physiological and toxicological action, and to the still disputed questions connected with their use in midwifery. It is not possible here to review all the works of importance which have appeared on Anæsthesia, still less the host of essays and pamphlets, many of them of a controversial character; but we have placed at the head of this article the titles of such as appeared of most importance; and many others will incidentally come under our notice. The work which stands first is an American reprint of the various publications on this subject which have issued from the pen of Professor Simpson. The second work contains a very complete account of the various questions connected with the practice of Anesthesia in midwifery. The paper of Mr. Nunneley contains the fullest investigation which has been published, of the physiological properties of the various anaesthetic agents. The work of M. Bouisson is the most complete treatise on the whole subject that has yet appeared. The little work of Dr. Flagg is valuable as showing the present state of opinion in America, with regard to the comparative merits and disadvantages of ether and chloroform; for it appears that many of our trans-atlantic brethren have returned to the use of the former substance. And the various publications of Dr. Snow, while containing a large amount of information upon the whole subject, treat most fully of the instrumental means of applying anæsthetic agents. We shall divide our present article into three parts:-We propose, 1st, to speak of the history of anesthesia; for there are several rectifications yet to be made; 2ndly, we shall treat of the physiological and toxicological action of anesthetic agents; and, in the 3rd place, of their natural history and comparative merits. We shall devote a subsequent article to the discussion of the purely practical matters connected with the subject. Meanwhile, in the present article, many practical points will necessarily be alluded to. 1. The history of great discoveries exhibits a kind of uniform outline. Minerva does not, except in fable, spring at once from the head of Jupiter. One human being has rarely in himself sufficient power both to excogitate a great principle, and to carry it out in its details and practical applications. We almost invariably find two classes of persons engaged in these cases; those who originate the ideas, and those who make them useful; and as mankind only pay in general for actual value received, the latter class are sure to receive the more substantial reward. History, therefore, should embalm the memory of the former. The practice of Anesthesia appears to have existed in very remote times. The root of the mandrake, to which so many extraordinary properties were ascribed by the ancients, is distinctly stated by Dioscorides and Pliny to have the power of throwing patients into such a deep sleep, as to render them insensible to the pain of surgical operations. In the middle ages, the vapours of somniferous plants appear to have been used for the like purpose. A secret agent was used to render a king of Poland insensible during a surgical operation, towards the close of the seventeenth century.* But the art of inducing anesthesia had so completely fallen into desuetude, that the announcement of the application of vapours for this purpose, as recently made from America, deserves the entire merit of a discovery. It is true, that it was known how compression of a limb may induce insensibility below the part compressed; and insensibility to pain during the mesmeric state had been much canvassed. It was also See Dr. Simpson's paper On the History of Anaesthetic Agents,' read before the MedicoChirurgical Society of Edinburgh, (Edinburgh Monthly Journal of Medical Science, for 1847. p. 451,) and Dr. Silvester On the Administration of Anæsthetics in Former Times,' (Medical Gazette, for 1848, vol. vi. p. 513.) The King of Poland referred to must have been Augustus the Second, the rival of Leczinski and enemy of Charles the Twelfth; and we have read that this prince had really lost part of his foot by some disease or operation. generally known that little sensibility to pain existed during intoxi cation. Sir Humphry Davy, about the beginning of the present century, has the credit of having been the first to propose the application of nitrous oxide gas to the removal of pain in surgical operations. "As nitrous oxide, in its extensive operation, appears capable of destroying physical pain, it may probably be used with advantage in surgical operations, in which no great effusion of blood takes place.' The idea of Davy was not put into practice until the year 1844. In the autumn of that year, the late Mr. Horace Wells, of Connecticut, was led to use nitrous oxide gas as an anæsthetic agent, not, according to his own account, from the expressed idea of Davy, but from analogical inference from the effects of great excitement in producing insensibility, from what has been observed in drunkenness, and so forth. He says, "I accordingly procured some nitrous oxide gas, resolving to make the first experiment on myself, by having a tooth extracted, which was done without any painful sensation. I then performed the same operation for twelve or fourteen others, with the like results. This was in the fall of 1844. Being a resident of Hartford, Connecticut, I proceeded to Boston, in December of the same year, in order to present my discovery to the medical faculty; first making it known to Drs. Warren, Hayward, Jackson, and Morton; the last two of whom expressed themselves in the disbelief that surgical operations could be performed without pain, both admitting that this modus operandi was quite new to them, and these are the individuals who now claim my discovery."† Mr. Wells states, that he remained in Boston several days, in order to administer the gas in a case where an arm was to be removed; but the operation was postponed. The only public exhibition of the agent which he seems to have made, was in a case of tooth-drawing, where he was not successful, owing, as he says, to the boy being removed too soon. So far, the statement of Mr. Wells is supported by undeniable evidence. Drs. Jackson and Morton, of Boston, had been both cognizant of the researches of Wells. Morton had received the information direct from Wells, whose account is, that the former having gone to Jackson to get some gas prepared, received the ether instead, as less troublesome to prepare, or rather at hand. As far as we can judge, from the report on the respective claims of Morton and Jackson, laid before the American House of Representatives, Feb. 23, 1849, and from that of the Massachusetts General Hospital at the annual meeting, Jan. 1848, Morton had several conversations on the subject with Jackson, after the idea was suggested by Wells. Whether Jackson or Morton first proposed to employ the ether is uncertain. Jackson, however, seems to have considered it hazardous, and of doubtful utility Morton, after trying the ether on himself, first used it in the extraction of a tooth with success on the 30th September, 1846. After this, and other successful applications of the kind, the first surgical operation of a general character-viz., removal of a tumour under the influence of ether was performed at Mr. Morton's * Remarks on Nitrous Oxide. + A History of the Application of Nitrous Oxide Gas, Ether, and other Vapours, to Surgical Operations, by Horace Wells, Hartford, U.S., 1847. ✰ An Address delivered before the Students at the Castleton Medical College, on the History of the Original Application of Anæsthetic Agents, May 17th, 1848, by E. Smilie, M.D., Boston, 1848. suggestion at the Massachusetts General Hospital. As to Dr. Jackson's merits, the following is decisive: "But to settle the whole matter, and it might have been done in the outset, to the satisfaction of every candid mind, after Dr. Morton began to use the ether in his practice, and for some weeks, it is well known to a large number of our most respectable citizens, that Dr. Jackson clearly and distinctly washed his hands of the whole thing. He, on many occasions, as is well known to his friends, disclaimed all connexion with the discovery or use of ether in surgery."* The following extract from the Report of the trustees of the Massachusetts General Hospital, quoted also by the Committee of Congress, is very decisive :: "1st. Dr. Jackson does not seem at any time to have made any discovery with regard to ether, which was not in print in Great Britain some years before." [That is to say, he was aware of the soothing effect of ether-vapour when inhaled in some chest affections.] "2ud. Dr. Morton, in 1846, discovered the fact, before unknown, that ether would prevent the pain of surgical operations, and that it might be given in sufficient quantity to effect this purpose without danger to life. He first established these facts by numerous operations on teeth, and afterwards induced the surgeons of the hospital to demonstrate its general applicability and importance in surgical operations. "3rd. Dr. Jackson appears to have had the belief that a power in ether to prevent pain in surgical operations would be discovered. He advised various parties to attempt the discovery; but neither he nor they took any measures to that end, and the world remained in entire ignorance of both the power and the safety of ether, until Dr. Morton ma ie his experiments. "4th. The whole agency of Dr. Jackson appears to consist only in his having made certain suggestions which led or aided Dr. Morton to make the discovery; a discovery which had for some time been the object of his labour and researches." It is clear that no vague idea of the soothing properties of ether, when inhaled in asthma or bronchitis, should be put in the scale. In the works on toxicology, as in those of Orfila and Christison, indications of the insensibility of animals when submitted to ether may be found. The inhalation of ether, too, as a remedial measure, was distinctly stated in treatises on Materia Medica, as for instance in the Dictionnaire de Matière Médicale et de Thérapeutique of Merat and Delens in 1831. Richard Pearson, of Birmingham, had prescribed ether as a remedy in phthisis, either alone or with extract of conium, in the way of inhalation, about the year 1795; and Beddoes, in his work on Factitious Airs, published some observations of Thornton, in which ether-vapour was found beneficial, not merely in phthisis, but was stated to be efficacious in preventing the pain of an inflamed mamma. According to Mr. Robinson, the late Dr. Woolcombe, of Plymouth, had been in the habit of causing his patients to inhale. ether as a sedative and anaesthetic in pulmonary complaints.+ A work by Chambert "Sur les Effets Physiologiques et Thérapeutiques des Ethers," quoted in an American journal before us, describes the experiments of a M. Dauriol, in 1832. This experimentalist had tried inhalations with ether containing extracts of conium, henbane, or stramonium, on animals, and states distinctly that they were thus made insen * Some Account of the Letheon, by Edward Warren, Boston, 1848. + A Treatise on the Inhalation of the Vapour of Ether, by J. Robinson. London, 1847. + Littell's Living Age, March 18, 1848. 17-IX. 11 |