suggested to Valentine Mott who referred to it in a paper published in the Boston Medical and Surgical Journal in 1845. It also appears that Dr. Crawford Long, a practicing physician of Jefferson, Jackson County, Georgia, had used ether in surgical practice even as early as 1842, but made no formal report of his experience until so late that he just prevented Morton receiving an appropriation from the Congress of the United States. In a Commemorative Address delivered at the Medical Department of the University of Buffalo, October 16, 1896, Roswell Park said: "There probably is every reason to think that, either by accident or design, a condition of greater or less insensibility to pain had been produced between 1820 and 1846, by a number of different people, educated and ignorant, but that no one had the originality or the hardihood to push these investigations to the point of determining the real usefulness of ether. This was partly from ignorance, partly from fear, and partly because of the generally accepted impossibility of producing safe insensibility to pain. So, while independent claims sprang up from various sources, made by aspirants for honors in this direction, it is undoubtedly as properly due to Morton to credit him with the introduction of this agent as an anesthetic as to credit Columbus with the discovery of the New World, in spite of certain evidences that some portions of the American continent had been touched upon by adventurous voyagers before Columbus ever saw it." Sir James Paget has summed up the relative claims of these four contestants very tersely in an article entitled "Escape from Pain," published in the Nineteenth Century for December 1879. He says: "While Long waited, and Wells turned back, and Jackson was thinking, and those to whom they had talked were neither acting nor thinking, Morton, the practical man, went to work and worked resolutely. He gave ether successfully in severe surgical operations; he loudly proclaimed his deeds and he compelled mankind to hear him." Thus, an impartial verdict, rendered long after the heat of the discussion, extends the honor of introducing the inhalation anesthetics for the relief of suffering humanity, to Dr. Wm. T. G. Morton. That is his reward and in a way it is quite in keeping with the immeasurable debt humanity owes for such a blessing. It should not be overlooked that the words anesthetic and anesthesia were after-thoughts and were suggested by Dr. Oliver Wendell Holmes. A number of similar substances were promptly put in the field but ether, nitrous-oxide, chloroform, and ethyl chloride still hold the popular confidence. The effect on the dental profession was staggering. Literally thousands decided to make dentistry their life work. The places for instruction were swamped. Although there had been for a number of years a few dental colleges in the country they were separate schools and it was not until 1868 that "Harvard did what she ought to have done at the outset. She opened a dental department and began the teaching of dentistry as a branch of medicine, establishing therefore a separate degree; D. M. D., (Dentariae Medicinae Doctor). In 1874 the University of Michigan established a dental department, and a little later the University of Pennsylvania did the same. Other schools followed rapidly. The Dental Department of the University of Buffalo was established in 1892, at which time there were between forty and fifty dental colleges in the United States, most of which owed their origin quite directly to the increased demand for instruction above noted. This enormously increased field of usefulness imposed certain obligations, such as better preparation for the study of dentistry and an improved and extended curriculum, all of which, I am proud to say have been met in a very satisfactory way. Although the present high place in medicine that dentistry occupies can be credited to the inhalation anesthetics, their use in dentistry has been largely reserved for the more formidable procedures since the introduction of cocaine by Koller at the Congress of German Oculists in Heidelberg in 1884. Under these circumstances, when the decision rests on an inhalation anesthetic, the respnosibility should be divided with a trained anesthetist and he should decide on the particular anesthetic to be used and the method of its administration. In any instance the method of administration should be the simplest possible to meet the indications. To my mind simplicity of administration has a salutary psychic effect that cannot be ignored and the psychic side of anesthesia is a most important one. BIBLIOGRAPHY: Gwathmey-Anesthesia. Park-Surgical and Scientific Papers. Mumford-History of Medicine in America. Typhoid Due to Laboratory Inoculation. Dr. ANDY HALL, Mt. Vernon, Ill., Capt. M. R. C. A colleague of the writer, accustomed to preparing autogenous vaccines and maintaining typhoid cultures, shook a culture tube to distribute the sediment and wet the cotton stopper. He washed his hands with soap and water immediately but used no antiseptic and soon after, rolled and smoked a cigarette. Exactly three weeks later, he noticed the first malaise and found that his temperature was 101. The next day, he felt worse but kept about as usual till later in the day fhen the temperature was 102. He then sought advice and was sent to a hospital. The course of the disease was typic though rather mild. The maximum temperature was 103.5; rose spots appeared, in all about 50 confined to the abdomen; there was no delirium, diarrhoea nor haemorrhage; the subjective symptoms were rather marked, consisting especially of pain in the nape of the neck. Defervescence occurred in three weeks, full recovery in five. Expectant treatment was employed. An interesting postscript is that, 8 years later, the patient reacted rather severely to triple typhoid inoculation, though this is said to be the rule and the general opinion seems to be that the reaction is due especially to the para-typhoid element. In this connection may be mentioned the case of another physician who had never had typhoid but who, several years ago received a (non-military) triple typhoid inoculation. A short but rather severe febrile period followed which was pretty definitely explained by a failure to kill all of one of the para-typhoid cultures though the evidence was circumstantial and, naturally, more or less contradicted by statements of the source of the vaccine. This man had an exacerbation of a neuritis immediately following the triple typhoid inoculation. It is obvious that typhoid or para-typhoid from cultures, even if no attempt to kill had been made, would naturally be expected to be somewhat milder than cases derived from ordinary sources of infection, with the virulence of the organism heightened by recent passage through the animal body. A careful collection of laboratory workers' infections might, however, show the a priori view to be incorrect and, even in such a case as the first mentioned, the severity, though not marked, was as great as in many spontaneously infected cases. BUFFALO MEDICAL JOURNAL A Monthly Review of Medicine and Surgery EDITOR AND PUBLISHER, DR. A. L. BENEDICT, 228 Summer St., corner of Elmwood Ave., Buffalo, (Address for all communications. Please make personal and telephone calls before 1 P. M.) Third, in age, on the western continent. Independent, but supports professional organizations. News limited mainly to Western N. Y. and Penn. Subscription $2.00 a year; $3.00 for two years in advance. Changes and errors in address or failure or duplication of delivery, should be reported immediately. Yearly Volume 74 AUGUST, 1918 The Heart After the War. Number 1 Reports are unanimous as to the general health and increase in physical development and resistance of men suddenly transferred from civil to military life. Even if the former habits have not included much exercise, the great majority of men even of middle age, as in the Medical Reserve Corps, have readily adapted themselves to the average increase in physical demands. It should be considered, however, that the pendulum has swung back from a period with industrial and social tendencies to sedentary occupations with little exercise to a very general interest in extra-vocational physical training of one kind or another. Thus, the outbreak of the present war, probably found our country with at least as great an average muscular development as at the time of the Civil War when a relatively larger proportion of the population was engaged in agriculture and other occupations necessitating physical strength, and with a much higher average of physical health and general resistance, which are by no means synonymous with muscular strength. Barring actual discoverable lesions, as of the heart, vessels, lungs, kidneys, thyroid, liver, etc., and deformities, mutilations, defects of special senses, etc., which more or less definitely exclude from military service though not sarily involving the general health, the vast majority of failures to stand the strain of military life may be placed under the old term of irritable heart or under the newer English term of Effort Syndrome, meaning that the heart and vascular system and, to a certain extent, also, the respiratory functions, do not easily meet the sudden increased strain so that, without demonstrable. disease and without necessarily preventing the performance of ordinary civil duties of the individual, even if he has broken down under military training or has passed the period of training and has broken down in actual service at the front, he is useless as a soldier. While no statistics have been published either for the British or our own troops, it may be said that the Effort Syndrome involves an appreciable though small proportion of soldiers and that the last sentence requires qualification as about 60% of those involved are returned to duty after rest and a course in graduated exercises of the general nature of calisthenics and setting up exercises, drugs and rest treatment in the limited sense having been found to be useless. Medical men scarcely need to be told that the heart nor mally hypertrophies very readily to meet increased demands but it has been a surprise to many, that this response occurs, either in athletics or military training very rapidly, even in a month, in the vast majority of all cases, even when the previous habits have been strictly sedentary and when only the most rudimentary precautions have been taken to prevent undue and sudden strain; also that even the failures have seldom resulted in either temporary incapacity or permanent damage of any degree. Pierre Nadal, in a series of articles in the Jour. de Med. de Bordeaux, has considered especially the physical training of "intellectuals." While, in the main, he says nothing that is not obvious as to general principles and that is not included in descriptions of calisthenic, and especially setting up exercises, including the special adaptations to the Effort Syndrome, some of his points might be overlooked. The necessity of developing articular suppleness as well as muscular strength; of securing instant obedience to mands, of properly coordinating movements and of excluding certain habits of improper coordination and inhibition, of psychic and psycho-neural as well as gross muscular response, etc., might be missed especially by one attacking the subject without actual experience. One detail of his seems especially important catching the breath, on attempting a difficult and especially a straining task, is not really a normal reflex but one which should be overcome by training as it obviouslywhen we stop to reflect-diminishes the supply of oxygen and immediate elimination of waste and imposes additional cardio-vascular strain, at the very time when the most favorable conditions are demanded. Another point which might be neglected and which, we believe, has been in some military . |