Europe and in parts of the United States. Some of our surgeons in this metropolis have applied the ether inhalation in their surgical cases-and some persons in labor have likewise been rendered insensible to their pain by breathing the vapor of chloroform or ether. I am not able to say in how many instances this recourse has been had here; but I should suppose that not fewer than some thousands of women have been subjected to it on account of labor; and I believe the practice does not become much more common and general in our community; and that not a great many more women in labor will have been etherized in 1856 than in 1850-51.

I do not feel inclined at all to deny that there may be instances of severe suffering for women in labor, that ought to be mitigated or even wholly obviated by casting the woman into the profound anæsthesia of etherization. But what I do desire to say is this, viz: that, having carefully studied the reports upon etherization and chloroformization, whether those of this country or those produced in Europe, I remain as yet unconvinced—either of the necessity for the method, or of its propriety as an ordinary practice.

1st. As to its necessity in ordinary cases of parturition. The average duration of labor is four hours, and I have shown at page 293 that the number of labor pains is about fifty; and that they last, each about thirty seconds, so that the parturient woman really suffers from labor pains about twenty-five minutes and no more-and these twentyfive minutes are distributed among the four hours of a labor of mean duration.

It has never been pretended that the motive for the anaesthetic practice has any connection with the other pains of women in labor, but only with the suffering from contraction or labor pains; for, though we may well suppose that women suffer from painful sensations independent of those arising from the actually contracting womb, yet we find them in general, easy, complacent, and but too happy when the pain is off. Hence the ether is exhibited for the pain, and for no other motive.

I contend, that it is to an exaggerated notion of the nature of laborpains we owe the too frequent use of ether in our art; for if the mean of labor-pain be only twenty-five minutes in all, there can be no necessity in the average of cases for its exhibition. I should find the objection to it less and the inducement greater, were the twenty-five minutes of pain to be always twenty-five consecutive minutes. When they are distributed through two hundred and forty minutes, or four hours, I look upon the exhibition as unnecessary and uncalled for.

2d. The representations that have been made by the friends of

anæsthesia, of the harrowing distress endured by women in childbirth, do not consist with the general state of facts in the case; and it is quite true that a lying-in room is, for the most of the labor, a scene of cheerfulness and gayety, instead of the shrieks and anguish and despair that have been so forcibly portrayed.

Few women lose their health or their lives in labor, and the dread of future sufferings is insufficient to prevent the increase of the family. As to the necessity of the Letheon practice, the birth of the past myriads of the race shows that it is not necessary.

The propriety of resorting to the use of chloroform and ether as means of obviating the pain and hazards of labor is a question to be settled by an estimate of the safeness as well as necessity of it. It were well, before making up his mind upon this point, were the Student to make himself aware that the encephalon is a compound organ, or a compound bulbous nervous mass, part of which (the hemispheres) are devoted to the offices of intellection; part, the cerebellum, to the duty of co-ordinating or regulating the movement, or the force which is generated perhaps by the whole nervous mass; a part, the tubercula quadrigemina, to the faculty of seeing or vision; and a part, the medulla oblongata, to the important office of governing or giving origin to the act of respiration. Thus we have the brain of intellection, and those of co-ordination of force, of vision, and of respiration. They might be denominated the thinking, co-ordinating, seeing, and breathing bulbs of the nervous mass.

Now, it appears from very numerous reports contained in the Comptes Rendus of the French Institute, and from papers in various journals containing accounts of experiments made both in men and in animals, that to breathe for a few minutes the vapor of ether or of chloroform and various volatile liquids, is to cast the subject into an insensibility called anesthesia, so profound that the cautery, whether actual or potential, the bistoury, the ligation, or the forceps are equally incapable of exciting any sense of pain. Nay, more, that the patient, in some instances, looks upon the incision of his flesh without feeling the knife.

Very soon after ceasing to inhale the vapor, the insensibility disappears, and the individual, upon recovering the use of his faculties, is with difficulty persuaded to admit that he has been subjected to a severe operation; while the mother is incredulous as to her having borne a child during her sleep. Such are the facts. The Student ought to know them. Half an ounce to an ounce of ether poured upon a sponge, and held to the mouth and nose, or a drachm to two or three drachms of chloroform administered in the same way, bring on the

insensibility in from three to ten minutes, less or more. The insensibility, once produced, may be maintained according to the pleasure of the physician, by repeating the application of the moistened sponge from time to time upon any manifest signs of returning consciousness. The statements show that the power of these anæsthetics is capable of abolishing the sensibility, without greatly interfering with the motor power of the subject-or it may abolish the motor power, and allow the sensitive power to be acute, as in health. The inhalation may produce anæsthesia of the thinking brain, yet leave the co-ordinating, breathing, and seeing brains intact or it may put a temporary end to the power of the cerebellum and tubercula quadrigemina, without influencing the other parts of the encephalon. In short, there is no ascertained law of progression in the activity or power of the ancesthetic agent, chloroform; and no man knows, when he begins to administer the article, upon what part of the brain it will proceed to exert its benumbing power. M. Flourens has shown that all the other parts of the brain may be safely suspended of their forces, provided the medulla oblongata remain unattacked by the agent; and that, as long as the medulla oblongata retains its energy, it is capable of recalling the other bulbs to life and activity through its own force, provided the further inhalation of the letheon be arrested. Hence he calls the medulla oblongata the vital tie (le nœud vital), since it binds the rest of the encephalon and nervous system with its "silver cord."

Now I have to suggest to the Student the propriety of asking what would be his feelings, provided, in any such case, this silver cord should be loosened; and I ask him whether, if the anaesthesia should proceed, at first, or secondarily, to attack and overthrow the power of the medulla oblongata, his patient would not be instantly deprived of life! For if to breathe is to live, to be deprived of the uses of the medulla oblongata is to die-since on that nœud vital depends the whole business of the oxygenation of the body.

Many, and but too many examples of the power of these tremendous agents to overthrow, almost instantly, the force resident in the medulla oblongata, are spread upon the records of medicine in the last few years. I do not well understand how those persons can recover their composure or their complacency, who, by an unnecessary and inappropriate resort to so dangerous a process, have seen the victims of this extraordinary power struck lifeless before their eyes.

It behooves not me to enter into the lists with the surgeons who cast their patients into the deep insensibility of etherization before performing their operations-suum cuique tribuito is a proper law for me in this place. But I cannot avoid the feeling of astonishment

which seizes upon me when I read the details of cases of midwifery that have been treated during the long profound Drunkenness of etherization. To be insensible from whiskey, and gin, and brandy, and wine, and beer, and ether, and chloroform, is to be what in the world is called Dead-drunk. No reasoning-no argumentation is strong enough to point out the ninth part of a hair's difference between them-except that the volatility of one of the agents or its diffusibility as a stimulant narcotic, enables it sooner to produce its intoxicating effect, which is sooner recovered from in one case than in any other of the use of an intoxicating drug.

I showed, in the first part of this section, why I deemed the use of etherization in Midwifery unnecessary; in the second part, I have endeavored to show why it is improper. I have by no means said what I am inclined to say as to the doubtful nature of any processes, that the physician sets up, to contravene the operation of those natural and physiological forces that the Divinity has ordained us to enjoy or to suffer. The question is often propounded as to the Beneficence that ordained woman to the sorrow and pain of them that travail in childbirth. It ought to be taken for granted, without any, the least, dispo sition to what is called canting, that some economical connection exists betwixt the power and the pain of labors. While, therefore, we may assume the privilege to control, check, and diminish the pains of labor whenever they become so great as to be properly deemed pathological, I deny that we have the professional right, in order wholly to prevent or obviate these physiological states, to place the lives of women on the hazard of that progress of anesthesia, whose laws are not, and probably can never be ascertained, so as to be truly foreknown. Not. withstanding I have expressed the above opinions in regard to ether ization in Midwifery, which might suffice to expose my sentiments upon that topic, still, my respect for eminent brethren who think dif ferently, calls upon me to acknowledge their equal rights, and probably superior claims to the confidence of the Student. Professor Simpson, of the University of Edinburgh, it is well known, is among the most distinguished and able advocates of anesthesia in our art. I will not, therefore, refrain from laying before the reader the following letter from that eminent gentleman, with my answer to his communication.

Letter from Professor Simpson.

EDINBURGH, January 23, 1848.

DEAR SIR: By private letters from America, brought by the last steamer, I hear that in most of the cities of the Union, your chemists

had failed in preparing proper chloroform; and that, consequently, most experiments tried with it had been unsuccessful. In Great Britain, and on the continent of Europe, chloroform has everywhere entirely, or nearly entirely, superseded the use of sulphuric ether, as an anesthetic agent. The want of success which has attended its employment in America is, perhaps, owing in a great measure to an error of my own, viz: to my not stating, in my original account of it, the proper method of purifying it. This and other omissions were owing to the haste with which my first paper was drawn up.

I will feel, therefore, deeply obliged by your taking any measures that you may deem fit, to circulate amongst American medical men. the formula which I inclose for the preparation of chloroform. It is the formula used by Messrs. Duncan and Flockhart, our Edinburgh druggists, who have already manufactured enormous quantities of it. They always now are able to produce it as heavy as 1500 in specific gravity. Their first distillation of it is made in two large wooden barrels, with a third similar barrel as a receiver. They throw hot steam into the first two barrels, which serves to afford both sufficient heat and water for the process. They employ sixty pounds of chloride of lime at each distillation, and have been able to manufacture three hundred ounces of chloroform a day. Each ounce of the chlo ride yields, in the long run, about half an ounce of chloroform: consequently, to obtain three hundred ounces (as above), about six hundred ounces of bleaching powder are required. At first, they could only make ten or twenty ounces per diem, then they rose to sixty, and latterly, enlarging their barrels, they can make, as I have said, three hundred ounces in the twenty-four hours.

Various other chemical houses in Edinburgh, Liverpool, Glasgow, York, London, &c., are busy manufacturing it in great quantities. They keep their formulas as secrets. But none of them make so good an article as Duncan and Flockhart, whose formula I append.

The statements which I have already made may show you to what an extent the chloroform is used in this country; and our chemists tell me that the demand for it steadily increases with them.

In Surgery, its use is quite general, for operations, painful diagnosis, &c. My friend, Mr. Andrew Wood, has just been telling me of a beautiful application of it. A boy fell from a height, and severely injured his thigh. It was so painful that he shrieked when Dr. Wood tried to handle the limb, and would not allow of a proper examination. Dr. W. immediately chloroformed him-at once ascertained that the femur was fractured-kept him anæsthetic till he sent for his splints

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