der; but, having done so, some little delay occurred in grasping the stone, which was small, very flat, and lying in the posterior part of the bladder; the delay was also increased by the extremely relaxed state of the bladder itself which seemed to fall in folds on the forceps, and to cover the stone. The time occupied from the commencement of the operation to the period when the man was unbound, was ten minutes, during which the ether was administered at intervals. The patient was placed fully under its influence, and the breathing first became heavy, and ultimately stertorous. He recovered, however, from its effects after a short time, and continued in a quiet passive state, but without decided reaction, for 24 hours. At this period he had a chill, which lasted for nearly twenty minutes. Mr. Taylor (the house-surgeon,) immediately gave him two ounces of brandy, with an equal quantity of water, after which the patient remained in a dozing state till 8 o'clock, P. M., when the house-surgeon considered it necessary to send for me, as a state of complete prostration or collapse had ensued. I ordered small quantities of brandy and water (equal parts,) with arrow-root, at intervals, wrapped him in hot blankets, placed hot bottles in the bed, &c. This treatment was kept up till 9 o'clock the following morning, when ammonia was given alternately with the before-mentioned stimulus. The patient seemed incoherent from 8 o'clock, P. M., of Saturday till 9 A. M., of the following day, when symptoms of slight reaction appeared. At a consultation of the medical staff, which was held at the time, it was determined that the same treatment should be continued, (modified according to circumstances,) and that, in addition, a stimulating injection should be administered. (The effects of the injection were to increase slightly the frequency of the heart's pulsation, but without exciting his nervous energies.) From this time he gradually sank, and died at 5 o'clock, P. M., being sensible to the last.

I should here mention that the small vessels which are necessarily divided in making the first incision showed much inclination to bleed, owing, I imagine, to their want of contractile power. I therefore, to prevent any unnecessary hæmorrhage, secured them immediately after the patient was put to bed, so that he did not lose much blood.

Postmortem (67 hours after death.)-Membranous congestion of the brain, but no effusion; brain firm'; lungs permeable throughout, anteriorly ex-sanguineous, posteriorly engorged; heart flaccid, of a natural size, and nearly empty; the left kidney pale; the right, slightly congested. The bladder and the adjoining parts presented the usual aspect after an operation.

I would mention that the blood throughout the whole vascular system was in a perfectly fluid state.

It is not my intention or inclination to attribute the loss of my patient wholly to the influence of the ether which was administered in this case, nor hastily to decry its use under all circumstances connected with surgical operations; but still I feel called upon to bring before the notice of my medical brethren the effects which resulted from its exhibition in this instance, that the profession may judge,

from the recital of an unsuccessful case, how far it may be considered safe to employ ether generally as a means of preventing the pain otherwise inseparable from the physical lesion. The suffused eye, livid lips, and stertorous breathing, accompanied, first, by convulsive struggles, and next by a sudden cessation of all motion, are often indicative of the effects of the vapour; and these were not altogether absent in the present instance: still, I felt myself justified in employing it, from the published accounts of many successful cases, and the sanction of my colleagues and numerous friends around me. In prosecuting the operation, there was nothing peculiar to attract my attention, or to lead me to consider the patient's physical condition different from that of those on whom I had before operated, until I had reached the bladder, when I can but attribute the difficulty in seizing the stone to the apparently collapsed state of that viscus which had fallen in folds over the calculus, and so prevented its being grasped by the forceps. I must not, however, omit to mention the fact that the patient expressed no signs of suffering during the operation. Thus far, therefore, it may be said the ether fulfilled its intended office; but I think another question is involved, viz. whether the artificial means thus employed may not produce very serious depressing effects on the nervous system, depriving a patient of that reactive power so necessary to the reparative process. Has not a patient, after the administration of ether, a double shock to overcome that produced by the vapour superadded to that of the operation itself? Does not the history of the postmortem examination bear out the suspicion of the depressing influence of this inhalation ?-positively, from the still fluid state of the blood (although the body was not opened for 67 hours after death,) and from the flaccid state of the heart; negatively, from the fact that the inspection detected no indications of violence done to the parts that could explain the rapid dissolution which ensued, and that there was no evidence of nature having made the slightest effort towards local reparation. Pain is doubtless our great safeguard under ordinary circumstances; but for it we should be hourly falling into danger; and I am inclined to believe that pain should be considered as a healthy indication, and an essential concomitant with surgical operations, and that it is amply compensated by the effects it produces on the system as the natural incentive to reparative action.

*

I trust that the publication of this unsuccessful case may lead to the publication of many others which have occurred, so that the profession may not be led away by the erroneous supposition that the prevention of pain is so vital a desideratum in operative surgery. Operators have hitherto fallen into the error of looking only to one side of the question. The profession is indebted to Mr. Nunn for placing in so strong a light the danger which may occasionally arise from the use of ether vapour. We have hitherto had a run of successful cases: it is now time that our correspondents should pause in their records of successful cases, and look to the possible danger. London Med. Gaz.

On the removal of Stains in Linen made by Nitrate of Silver. By W. B. HERAPATH, M. B. Lond., Bristol.-Medical practitioners in the habit of using the nitrate of silver extensively, as a remedial agent, must have frequently heard loud complaints of their patients' linen having been indelibly stained and spoilt, by some accident having occurred during its use; and in many cases, patients have refused to employ these preparations, in consequence of the extensive destruction of linen which they occasion. I have therefore very little doubt that the following observations will prove most acceptable to my brother practitioners:

These dark stains consist of very finely divided metallic silver in intimate union with the fibres of the cloth. Had they been oxide of silver, any diluted acid would have dissolved them; but nitric acid alone produces any effect upon them, which of course cannot be employed on account of its powerfully destructive effects upon the linen fabric. Iodine immediately converts them into iodide of silver, which is instantly dissolved by a solution of hypo-sulphate of soda, and the cloth remains as white as when issued from the bleaching house, and as firm and durable as ever.

The best mode of employing the substance is to strain the spotted linen over a basin of hot water, and then to let fall upon each spot, previously moistened with water, a few drops of tincture of iodine, and instantly to pour a sufficient solution of the hypo-sulphate of soda to dissolve the iodide produced, and then immerse the spot in the water beneath, to wash out and cleanse the tissue, at once, from the stain and chemical reagents employed. The tincture of iodine of London Pharmacopoeia strength is the one I employ; and one drachm of crystallized hypo-sulphate of soda, dissolved in two ounces of water, will make an excellent bleaching liquid.

A patient may thus be very readily taught the manner of removing an unpleasantness frequently attending the use of a most valuable remedy.-London Lancet.

The Philosopher's Stone the subject of a Patent in the Fourteenth Century. In a work lately published on the law of patents, it is stated that in the time of Edward III. some alchymists persuaded the King that a philosopher's stone might be made, that the King granted a commission to two friars and two aldermen to inquire if it was feasible, who certified that it was, and that the King granted to the two aldermen a patent of privilege that they and their assigns should have the sole making of the philosopher's stone." This grant is believed to be the first, or at least the first patent privilege granted for any invention of which mention is made either in law books or chronicles, and is curious as showing the state of science in the fourteenth century.-London Med. Gaz.

THE

MEDICAL EXAMINER.

AND

RECORD OF MEDICAL SCIENCE.

NEW SERIES.-No. XXX. -JUNE, 1847.

ORIGINAL COMMUNICATIONS.

Sulphuric Ether in Surgical Operations. By JAMES BRYAN, M. D., Lecturer on Surgery; formerly Professor of Surgery and Medical Jurisprudence, in Castleton Academy of Medicine, Ver

mont.

To the Editor of the Medical Examiner.

Mrs. A, a married lady, of delicate health and constitution, who had suffered for a long time from neuralgia and facial inflammations, caused by decayed teeth, consented to try the ether as administered by Mr. H. S. Porter, dentist, and one of my pupils. The inhalation was made from the instrument called the "Inhalus" of the patentees. About half an ounce of the ether was poured into the sponge, and the lady, seated in an arm chair, inhaled the vapour about five minutes, when she became languid and sleepy, and desired to be let alone.' The instruments were applied, and three teeth (two incisors and one cuspid) were dexterously extracted: the patient only raising her hand slowly, and drawing a deep sigh on the extraction of each tooth. The immediate effects of the ether continued about three or four minutes, when she expressed herself surprised that the teeth had been taken out.

Miss B, on the 2d of April, inhaled the vapour from the same apparatus in my parlour, and after continuing the process about eight minutes, appeared partially insensible, and had a dens sapientiæ of the upper jaw extracted by the same operation, and said that she experienced no pain.

A few days after this, Mrs. A., the first patient, took the ether

again, inhaling it about five minutes before the soporific effects were produced, when Mr. P. extracted two of the largest molars of the upper jaw, and the remaining cuspid of the same jaw. The lethean effect had passed off before the last tooth was extracted, and she said that she experienced considerable pain during the extraction, but much less than if no ether had been administered. A slight head ache, which may in part be attributed to previous illness, continued for four or five hours.

On the 7th of April, Miss C—, from Massachusetts, in the presence of Dr. Winslow, myself, and members of the family in which she resided, submitted to the operation for extirpation of the left mamma, while under the influence of the ether. The inhalation, under the direction of Mr. Porter, continued about eight minutes, when I made two elliptical incisions, including the nipple, and took out the tumour in the usual manner. The disease being cancerous, a portion of the healthy part was included. I proceeded, with the assistance of Dr. Winslow, to take up the arteries, when the patient inquired if there was any more cutting to be performed, seemingly unconscious that the tumour was removed. She declared, however, that she was conscious of each incision that was made, but felt no power to resist. The larger vessels were taken up, and the wound left partly dressed, that time might be allowed for reaction fairly to take place. Rather more than half an hour afterwards reaction did take place, and the vessels not taken up bled profusely, making it necessary to remove the dressings and carefully take up the most minute arteries. After this, the wound was properly dressed, and did very well, healing up almost entirely by the first intention.

Miss C. says, since she has reflected upon it, that she is sure the greatest part of the pain was avoided-very little, in fact, having been suffered. She was desirous of taking the ether while the arteries were being taken up, but I would not consent, being convinced that one effect of the ether was to diminish the action of the arterial system.

I send you these cases, sir, without comment. These with one other case in which the patient insisted that the tooth had not been taken out, although the operation was slow and difficult are all I have seen, and from these I am rather disposed to try it again in certain cases.

Case of Poisening, from swallowing Percussion Caps.—By T. W. FOSTER, M. D., of Keene, Jessamin County, Ky. Not long since. I was called in great haste to attend an infant, æt. 14 months. Upon entering the room, I was informed by the parents that they had observed their child, about two hours pre