and did not allow his patient to awake till his limb was all properly set, bandaged, and adjusted. In Medicine, its effects are being extensively tried as an anodyne, an anaesthetic, a diffusible stimulant, &c. Its antispasmodic powers in colic, asthma, &c., are everywhere recognized. In Midwifery, most or all of my brethren in Edinburgh employ it constantly. The ladies themselves insist on not being doomed to suffer, when suffering is so totally unnecessary. In London, Dublin, &c., it every day gains converts to its obstetric employment, and I have no doubt that those who most bitterly oppose it now, will be yet, in ten or twenty years hence, amazed at their own professional cruelty. They allow their medical prejudices to smother and overrule the common dictates of their profession, and of humanity. No accidents have as yet happened under its use, though several hundred thousand must have already been under the influence of chloroform. Its use here has been a common amusement in drawingroom parties, for the last two or three months. I never now apply it with anything but a silk handkerchief. In surgical cases and operations, the quantity given is not in general measured. We all judge more by the effects than the quantity. Generally, I believe, we pour two or three drachms on the handkerchief at once, and more in a minute, if no sufficient effect is produced, and we stop when sonorous respiration begins. Not unfrequently spasms, rigidity, &c., come on, but they disappear as the effect increases, and none of us care for them any more than for hysteric symptoms; nor do they leave any bad effect. But the mere appearance of them is enough to terrify a beginner. I shall be glad to hear how the cause of anaesthesia gets on among you, and I remain, with great respect, Very faithfully yours, TO PROFESSOR MEIGS. The following is the Formula for Chloroform, communicated by Professor Simpson:— "Take of Chloride of Lime, in powder Water Rectified Spirits 4 pounds. 12 12 fluidounces. "The chloride of lime and water being first well mixed together, the spirit is added. Heat is then applied to the still (which ought not to be more than a third full), but as soon as the upper part of the still becomes warm, the heat is withdrawn, and the action allowed to go on of itself. In a short time the distillation commences, and whenever it begins to go on slowly, the heat is again applied. The fluid which passes over, separates into two layers, the lower of which is Chloroform. This, after having been separated from the weak spirit forming the upper layer, is purified by being mixed with half its measure of strong sulphuric acid, added gradually. The mixture, when cool, is poured into a leaden retort, and distilled from as much carbonate of baryta by weight, as there is of sulphuric acid by measure. The product should be allowed to stand over quicklime for a day or two, and repeatedly shaken, and then re-distilled from the lime." Reply to Prof. Simpson's Letter. PHILADELPHIA, Feb. 18th, 1848. DEAR SIR: I have to acknowledge the favor of your letter of Jan. 23d, which I received yesterday. The chemists in this country have produced very perfect chloroform, of the specific gravity of 1450, as I am informed, and which is much employed in dentistry operations, and to a considerable extent also in surgery. I presume you will, ere this date, have received copies of Prof. Warren's pamphlet on "Etherization," which may inform you, very fully, as to the use of the anaesthetic agent in the Massachusetts General Hospital, and in Boston. That eminent gentleman is more reserved as to the obstetric employment of the agent; much more so, I understand, than either Dr. Channing or Dr. Homans, and other practitioners, who make use of it very commonly. In New York, as I learn, the surgical application of chloroform is common, while its obstetrical use has not as yet acquired a general Vogue. In Philadelphia, we have the Pennsylvania Hospital, with more than two hundred beds. A very considerable amount of surgical practice, which renders that house a favorite clinical study for medical students of the United States, has not, as yet, furnished a single example of the exhibition of chloroform or ether as anæsthetic agents. The Surgical Staff of the institution have not become convinced of the propriety of such a recourse in the operations performed there. In the Jefferson College, to which I am attached, as Professor of Midwifery, etc., there is a Medical and Surgical Clinic held on the Wednesday and Saturday of each week. The resort of surgical cases there is very great, and a Clinical day rarely passes without some sur gical operations before the classes. The clinical professors (in surgery), Drs. Mütter and Pancoast, almost invariably employ the chloroform, and the successful exhibition of the article has entirely confirmed them in their opinion of its great value. Some of the operations have been of the gravest character, and no serious event has occurred to check the career of the remedy. As to its employment in Midwifery here, notwithstanding a few cases have been mentioned and reported, I think it has not yet begun to find favor with accoucheurs. I have not exhibited it in any case; nor do I, at present, know of any intention in that way, entertained by the leading practitioners of obstetrical medicine and surgery, in this city. I have not yielded to several solicitations as to its exhibition, addressed to me by my patients in labor. As to the extension of the anesthesia in the Southern and Western States, I am not at present enabled to give you information. I believe the practice is slowly gaining converts, and that it will become more and more common ere long. You may perhaps feel surprised at this admission on my part, seeing that I am still a recusant; and I ought, therefore, to be allowed to explain myself, lest I should continue to appear unreasonable in your eyes. Having carefully read the Comptes Rendus of the Royal Academy of Medicine of Paris, which contained full reports of the copious discussions on the question of the Letheon, a few months since, and having also seen the English and American Reports in the Journals, and particularly having read your own pamphlet of "Remarks," &c, I may not properly be accused of ignorance of the power, effects, or motives, in relation to chloroformization in surgery, or obstetricy. The copy of your own pamphlet, for which I now beg leave to thank you, would necessarily have put me au niveau on the subject. Not being myself engaged in the practice of surgery, proper, I prefer to avoid any expression of opinion as to the propriety of the practice; and I do this upon the principle, suum cuique tribuito. It would be an impertinence in me, were I to interfere with the conduct of the surgeons. But, in Midwifery, to which a long and extensive practice has enured me, and rendered me a familiar dispassionate witness of its various forms and phenomena, I am less liable to misconceptions. And here, allow me to say, I have been accustomed to look upon the sensation of pain in labor as a physiological relation of the power, or force; and notwithstanding I have seen so many women in the throes of labor, I have always regarded a labor-pain as a most desirable, salutary, and conservative manifestation of life-force. I have found that women, provided they were sustained by cheering counsel and promises, and carefully freed from the distressing element of terror, could in general be made to endure, without great complaint, those labor pains which the friends of the anesthesia desire so earnestly to abolish and nullify for all the fair daughters of Eve. Perhaps, dear sir, I am cruel in taking so dispassionate a view of the case; and it is even possible that I may make one of the number of those "amazed" converts of whom you speak in your worthy letter to me. But, for the present, regarding the pain of a Natural labor as a state not, by all possible means, and always, to be eschewed and obviated, I cannot bring myself to the conviction that of the two, whether labor-pain or insensibility, insensibility is to be preferred. If I could believe that chloroformal insensibility is sleep indeed, the most considerable of my objections would vanish. Chloroform is not a soporific; and I see in the anaesthesia it superinduces a state of the nervous system in no wise differing from the anaesthetic results of alcoholic potations, save in the suddenness and transitiveness of its influence. I freely admit, for I know it, that many thousands of persons are daily subjected to its power. Yet I feel that no law of succession of its action on the several distinct parts of the brain has been, or can be hereafter ascertained, seeing that the succession is contingent. Many grave objections would perhaps vanish, could the law of the succession of influences on the parts of the brain be clearly made out, and its provisions insured. There are, indubitably, certain cases in which the intellectual hemispheres are totally hebetized, and deprived of power by it, while the co-ordinating lobes remain perfectly unaffected. In others, the motor cords of the cerebro-spinal nerves are deprived of power, whilst the sensitive cords enjoy a full activity, and vice versa. In some instances, the seeing brain enables the patient to look upon the application of a cautery that he does not feel, while it sears him, or of a bistoury whose edge gives him no pain. In others, the influence of the agent upon the sources of the pneumogastric and phrenic nerves is dangerously, or at least alarmingly, made manifest by modifications of the respiratory force. It appears to me, therefore, quite certain, that there is no known law of succession of the ether-influences on the several parts of the brain. It is known that the continued aspiration of the vapor brings at last the medulla oblongata fully under its anæsthetic power, and the consequent cessation of respiration which determines the cessation of the oxygenation of the blood, and thereby of the brain, is death. M. Flourens' experiments, and others, especially those by the younger Mr. Wakley, of the Lancet, prove very conclusively that the aspiration of ether or chloroform, continued but a little longer than the period required for hebetizing the hemispheres, the cerebellum, the tubercula quadrigemina, and the cord, overthrows the medulla oblongata, and produces thereby sudden death. I fully believe with M. Flourens, that the medulla oblongata is the nœud vital, and that, though later brought under the power of chloroformization, it is always reducible under it. Hence, I fear that, in all cases of chloroformal anesthesia, there remains but one irrevocable step more to the grave. I readily hear, before your voice can reach me across the Atlantic, the triumphant reply that an hundred thousand have taken it without accident! I am a witness that it is attended with alarming accidents, however rarely. But should I exhibit the remedy for pain to a thousand patients in labor, merely to prevent the physiological pain, and for no other motive-and if I should in consequence destroy only one of them, I should feel disposed to clothe me in sackcloth, and cast ashes on my head for the remainder of my days. What sufficient motive have I to risk the life or the death of one in a thousand, in a questionable attempt to abrogate one of the general health conditions of man? As to the uses of chloroform in the medical or therapeutical treatment of pain, the question changes. There is no reasonable therapeia of health. Hygienical processes are good and valid. The sick need a physician, not that they are well. To be in natural labor, is the culminating point of the female somatic forces. There is, in natural labor, no element of disease-and, therefore, the good old writers have said nothing truer nor wiser than their old saying, that "a meddlesome midwifery is bad." Is chloroformization meddlesome? Your countryman, old Thomas Rainald, in the "Woman's Booke, or The Byrthe of Mankynde," at fol. liii., says, "Very many be the perilles, daungers, and thronges, which chaunce to women in theyr labour." These are the cases requiring our therapeutical and chirurgical intervention. You will, my dear sir, think me a hopeless recusant, if I decline the anesthesia here also. I pray you, therefore, allow me to state my reasons for such recusancy. If I were amputating a limb, or extirpating a tumor, I should see all the steps of my incisions, ligations, &c. But if I apply my forceps in a right occipito-posterior position (fourth of Baudelocque), I know that I thrust the blade of the male branch far upwards betwixt the |