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young woman who afterwards declared that she was unconcious that any thing had been done to her.
On the 12th of the same month the vapour was administered for three minutes to a female patient who had a large tumour taken from the arm, and so entirely tranquil was she that a bystander who was interested in the case did not know that the operation had commenced till it was nearly completed.
On the 21st, a large tumour, covering nearly all the anterior part of the thigh, was taken away from a strong muscular man, without the patient being aware of it, until examining the wound created by its excision. In the extraction of teeth, the vapour of ether is deservedly a popular and efficient remedy for alleviating the pain of this simple but severe operation.
In addition to the experiments which have been tried in this country, there is ample testimony from the highest authority of its marked success in Europe. A writer from London states that the use of this vapour in surgical operations is considered by the surgeons of the metropolis as the “most wonderful discovery of the present century," and that it is now used extensively in private practice, and in almost every hospital. He further states that he has seen operations in lithotomy, hernia, amputations, extirpation of schirrous breasts, &c., and that during the whole proceedings the patients have been entirely unconscious.
In Guy's Hospital, a boy operated on for stone died a few days afterwards; and an unfortunate female, upon whom was practised the Cesarian section, died in thirty-six hours after the operation. In the first case the kidneys were found to be extensively diseased, and in the latter the cause of death could not be directly traced to the effects of the ether. A case has been reported by Dr. Simpson, of difficult labour, which was conducted to a happy termination under the ethereal influence, the uterine contractions continuing regularly and powerfully, but without the least suffering to the woman.
From a late number of the Gazette des Hopitaux, we find that the learned Societies of Paris have tested the merits of this discovery by a variety of experiments. At a meeting of the Academie de Medecine, M. Malgaigne announced that he had
tried the American method of rendering surgical operations painless upon five patients. The first was afflicted with an abscess in the leg. He breathed the vapour for two minutes, the bistoury was used to open the abscess, and when the patient was aroused from his “ lethargy,” he expressed a wish that the operation might be done immediately, and was much surprised to find that his wishes had already been complied with.
The second had a tumour taken from the neck, was conscious of the operation being executed, but felt no pain.
The third had a tumour in the neck also ; the incisions were made without pain, but the sufferings of the subsequent part of the operation were considerable.
The fourth was an amputation of the leg: the vapour was inhaled for seventeen minutes; the patient was conscious of the operation, but experienced no suffering.
The last was a young man with strabismus'; the operation was performed with but little, if any diminution of pain.
A patient at the Hotel Dieu, who had a compound fracture of the leg, had it adjusted and dressed without pain, after inhaling the vapour for twenty minutes.
A case is reported by Malgaigne, of a man at St. Louis Hospital, of very strong constitution, with a phlegmonous abscess on the leg about the region of the malleolus; after inhaling the vapour for three minutes, he fell into a state resembling drunkenness. Having answered in the affirmative the question whether his sight was dim, (a symptom which the operator considered proof of the effect of the remedy,) the surgeon made an incision in the abscess through a portion of skin that was much inflamed, and abundantly supplied with nerves, and pressed out the pus; the patient was much agitated, his face red, his eye-lids closed, and the muscles of the face and superior extremities abnormally contracted; "he appeared to be under the weight of pain
; ful feelings which he was struggling to throw off; he lost the reasoning faculty, and foamed from the mouth.” This condition lasted two or three minutes; and when conciousness returned, he declared that he felt no more pain than would have been produced by a slight pricking of the skin, but complained
of the smarting of the wound made by the operation. Wine was administered in these cases to effect a speedy recovery from the stupor, and this may have had something to do with the singular conduct of the patient. M. Velpeau had failed in obtaining entirely satisfactory results from his own trials of the remedy. One patient had proved unmanageable, another had suffered pain during an operation, and a third declared that he was thrown into such a state of ecstacy that he was unable to complain, while another had a tumour removed without any pain.
It is to be regretted that we have not in our possession more positive and detailed reports of all the physiological effects of the vapour upon the human constitution. Among the cases cited above, we have, in one instance, the pupils dilated; in another, they are contracted, with injection of the conjunctiva ; in one the pulse was 88 before an operation and 92 after it, and in another it rose from 80 to 120; in several it was not affected at all, while in one case, where the remedy was administered in excess, it produced coldness of the surface and sinking of the pulse. One case is reported where hemorrhage occurred half an hour after the removal of a small tumour from over the mastoid process, which suggests a caution that surgeons should be entirely satisfied before closing a wound that all the important arteries are well secured.
The method adopted in Paris for administering the gas may account for the failure that occurred in several cases of producing its legitimate effect,—the plan they pursued was to inhale the vapour through the nose and exhale with the mouth, or vice
The plan adopted in this country is considered more certain and effectual, as well as more simple and easy.
The instrument employed, is described as a small double necked glass globe, containing the prepared vapour, together with sponges to enlarge the evaporating surface. One aperture admits the air to the interior of the globe ; when charged with the vapour, it is drawn through the other into the lungs, the inspired air thus passes through the glass vessel, while the expired air is diverted through a valve in the mouth-piece, and
escaping into the apartment, is thus prevented from vitiating the medicated air.
Before closing this Report it will be interesting to notice a few suggestions which present themselves for consideration i the examination of this subject.
Sulphuric Ether is classed among the cerebral stimulants, medicines which act peculiarly upon the brain while they exert a stimulating effect upon the general nervous system, and upon the circulation. In sufficiently large doses, the effect of all this class of remedies is so powerful upon the brain as to render it incapable of receiving and transmitting its ordinary impressions; and it may readily be, imagined that by urging this ethereal vapour upon the system injudiciously, the cerebral influence may be so far paralyzed as to prevent respiration, and of course destroy life. Such has been proved to be its effect on animals. But so you may do with other remedies of the same class. Take opium, for example; the first effect of this drug is to accelerate the action of the heart,-confusion of the intelligence is the next result, until you at last produce its full suporific effect; and like the ether, it diminishes muscular strength, brings on stupor and stertorous respiration, with insensibility to surrounding impressions :—but the peculiar tendency of the ether to allay the pain of severe operations, renders it the supreme remedy on such occasions. Its effects upon the system are more transient, the signs of its influence pass away speedily, and so far as we are yet informed, the system feels no subsequent unpleasant results: its operation does not continue so long as to wear out the natural susceptibility, but for the moment to hold it under control.
There can be no doubt that the insensibility to pain which it produces must be the result of some present unnatural condition of the nervous system; but how this state of insensibility can be consequent upon an affection of the cerebral substance, and admit of perfect consciousness at the same time, as is stated by Malgaigne, is an intricate problem in physiology, which is yet to be solved ;—but because it is intricate and hard to explain, we should not lay aside as worthless the testimony of the best men of our profession, and refuse to acknowledge the facts which their fidelity in research and experiment has developed.”
In regard to the subject to which the report from the Western District is mainly devoted, the Committee think it right to say that, while there can exist no doubt of the availableness of this prevention of pain in many cases, as is proved by the facts so carefully collated by the reporter, there have occurred several instances-some in their own neighbourhood—where unpleasant results inculcate the indispensable necessity of great caution in the use of this powerful stimulant. In one case, convulsions were induced, which continued for several successive days with great severity and frequency, awakening in the friends and medical attendants the most serious apprehensions of the death of the patient. The opinion among medical men in Boston, where it was first introduced, and where the most approved modes of administering it are adopted, is far from being uniformly in favour of its general safe operation. Within a few days, a case has been reported, wherein it was used preparatory to the amputation of a contused and lacerated fractured limb, in which, in the opinion of the surgeon who performed the operation, and who made the post mortem examination, the life of the patient fell a sacrifice to its administration. Even had not such facts occurred, the judicious physician, who knows the effect of powerful stimulants, though they are diffusible and transient, upon persons of high cerebral organization, or of a delicate pulmonary conformation, will be slow to sanction the general use of an agent capable of producing such an exaltation of the nervous and arterial energies.
There have been reported to the Committee no cases of irregularities, neglect or contempt of the laws, rules and regulations of the Society, nor have any worthy of special notice come to the knowledge of the Committee. The popular infatuation in regard to certain novelties, which have been elaborated in the secluded closets of German transcendentalists, has induced some melancholy defections from the time-honoured and well estab. lished principles of true medical philosophy; but there is good
son to believe that these have been confined to persons whose natural perceptions have been too feeble, or whose intellectua discipline has been too imperfect, to qualify them to distinguish