been saved, had the treatment been commenced at an earlier period in the disease

Reflections. The first important inquiry which presents itself, in relation to this disease, is, as to its novelty. Were it a common and well known disease, we should not search authors, both ancient and modern, for, and search in vain. After close research, I have failed entirely in finding any treatise on this particular disease, except an able article by Dr. Channing, of Boston, published in the New England Medical Journal, in 1842; and that, so far as the treatment was concerned, is entirely unsatisfactory. Some twelve or fifteen cases were reported, some of which came under his own observation, others were reported to him by other physicians, nearly every one of which proved fatal. They were not all connected with the puerperal state, a part of them being males, and in a part of the females, the disease had its origin in other causes than gestation or lactation. If a disease of so grave a nature, and so important and momentous in its consequences, always involving the lives of individuals, had been preying upon the hu man family for any considerable length of time, it must long since have attracted the attention of medical men. But so far is this from being true, that the most recent works on Theory and Prac tice of Medicine, as also on Midwifery and Diseases of Women, do not give it even a passing notice.

Neither do the professors in the medical schools introduce it into their catalogue of diseases upon which instruction is needed. We are therefore induced to believe that it is one of those diseases dependent upon, and induced by, more recent atmospherical, meteorological and physiological causes, not yet well known to the profession. But again, why is this disease connected with the puerperal state? True, a portion of the nutriment of the parent goes to sustain the foetus, and is therefore abstracted from the mother. But this is a process perfectly natural, and does not of necessity affect the health or strength of the mother. This, therefore, cannot be a producing cause of the disease; if it were so, why should a part suffer while others are exempt? Besides, it is evident that the child suffers in the direct ratio with the mother, being always weak, (where the disease appears before parturition,) and in bad cases dead at birth. The cases above given were all good livers, and could not have been affected by bad diet. They also contain all varieties of temperament, health, strength and vigor of constitution. Another remarkable fact is, that most of them were young women, vigorous and athletic, and at the very age of life when there is a redundancy of the sanguineous fluid, of vivacity and the vital powers; most of them being pregnant with their first children.-Bos. Med. Surg. Jour.

ON ANESTHESIA BY THE INHALATION OF ETHER OR CHLOROFORM.

M. VELPEAU read, at the annual meeting of the Academy of Sciences, a paper on the inhalation of ether or chloroform, in which he embodies the history of anaesthetic agents, their introduction into practice, the results obtained, and his own opinions on the subject. In the historical sketch we find the following passages. The so-called Memphis-stone, dissolved in vinegar, after having been reduced to powder, was used as an anaesthetic agent amongst the Greeks and Romans, and mandragora was extensively known as possessing an esthetic properties. Dodonaus says, in his history of plants, that the vinous decoction of mandragora causes sleep, and allays pain; and that it was therefore administered to those who were to have part of their body burnt or sawn off. The surgeons of the middle ages were well acquainted with the employment of certain anesthetic agents. Hugh, of Lucca, a celebrated practitioner of the thirteenth century, speaks very distinctly on the subject. A sponge dipped in the juice of morel, or nightshade, hyoscyamus, cicuta, lactuca, mandragora, or opium, was put under the nose of patients, and made them sleep during operations; they were then roused by being presented another sponge soaked with vinegar, or by putting the juice of rue into their ears. From M. Julien's communication to the Academy of Sciences, it may be seen that the Chinese, some centuries ago, were aware of means for rendering patients insensible during operations. Boccaccio mentions, in the Decamerone, 39th tale, that Mazet de la Montagne used to operate on his patients after having put them to sleep with a water of his composition. Formula have been transmitted from father to son among malefactors, by which their intended victims might be plunged into sleep. Prisoners, towards the revival of letters, knew how to procure certain drugs with which they could bear torture without feeling the pain. Is it not likewise said that the Turks possess the means of plunging into anesthesia those upon whom circumcision is to be performed? In our times we find Sir Humphrey Davy stating, after having used the nitrous oxide gas upon himself to allay toothache, that this gas might probably be of use in surgical operations. Mr. Wells, of Hartford, used this gas in 1842, for extracting teeth without pain. Mr. Hickman announced in Paris, in 1821, that he was able to render patients insensible to pain by making them breathe a gaseous substance, the naine of which he did not make public. Messrs. Orfila and Christison had found that animals might be rendered insensible by being given ether internally. M. Merat used ether inhalations for allaying pain, and Mr. Faraday observes (Quarterly Journal of Sciences, 1818) that ether acts

upon man like the nitrous oxide gas, and that the action of the former, at first exhilerating, soon becomes stupefying.

M. VELPEAU, after refuting the objections of those who represent the inhalations of ether or chloroform as dangerous, says: The use of these agents does not seem prudent in operations to be performed on the mouth or throat, in the nasal fossæ, the larynx, or trachea, on account of the necessity for patients to expel, by coughing, the blood which tends to invade the bronchi. Without proscribing chloroform, I however, do not advise it when operations are to be performed on the eyes, lids, or lips, when in aneurism an artery is sought for, or in operation upon individuals much enfeebled, either by disease or old age. It is a mistake to believe that chloroform facilitates the surgeon's task, for it would be often advantageous to make the patient change his position, answer questions, &c.; and the operator is likely to get nervous and flushed when the chloroform is kept on for a long time, as fears of ultimate unpleasant results will disturb his mind. Yet painless operations by means of chloroform must be reckoned among the most brilliant discoveries of the nineteenth century; and so great is the desire to take advantage of it among the public, that the surgeon is more frequently obliged to refuse giving the chloroform than to induce the patients to inhale it. Many people who would have gone to their grave without even disclosing the nature of their affection, for their horror of operations, will now have a chance of a prolonged life. Finally, M. Velpeau thinks that the administration of anasthetic agents ought to be regulated more by the nervousness and fear of the patient than by the importance of the operation. Terror and dread are very detrimental, and though the cases be slight, anesthetics should be had recourse to when the patient's mind is disturbed by lively apprehensions of pain.-Lon.

Lancet.

NEW METHOD OF REMEDYING THE ACCIDENTS CAUSED BY CHLOROFORM.

BY M. RICORD.

(Translated for the Lancet,by J.L. Milton, Esq., M.R.C.S.Lond.)

THE following letter, by M. Ricord, has been copied into the Journal de Chimie, Jan., 1850, from which I took it, having vainly attempted to get at the original. The subject of which it treats is important enough to merit attention; for few accidents can be more appalling to a surgeon, than the death of a patient from the use of a remedy which that surgeon has administered, perhaps much against the wishes of the other.

"M. Ricord," says this journal, "has just published a very interesting letter, on a method by which he has twice succeeded in

rescuing from death, two persons, whom he brought to the verge of it by the exhibition of chloroform. This method is insufflation by the mouth, without any intermedium;—but we will let him speak for himself.

"In my practice, I have met with two cases, in which the employment of chloroform had nearly been fatal: in both, its action was very rapid, and had not occasioned any previous excitement. It had been administered by means of a sponge, with large pores, which permitted, at least in appearance, the inhalation of a sufficient quantity of air.

"CASE 1. The patient who furnishes the subject of my first case, was a woman of about twenty-six, from whom I was about to remove some growth of no great size. She was previously chloroformed, to which she only submitted after repeated entreaties, for she appeared to be excessively timid.

"The anaesthetic effect of the chloroform was very rapid, for after a few respirations she appeared asleep; the sponge was removed, and I commenced excising the growths, but had scarcely given two or three cuts, when one of my assistant surgeons told me that the pulse appeared to be failing. I now saw, in fact, that the beating of the heart was suspended, that all respiratory movements had ceased, and that the lips were livid, and hung down. The limbs were completely relaxed, and the paleness of the face showed that the patient was in that state of syncope which is the herald of death. All the remedies indicated in such a case were forthwith employed, as cold currents of air, sprinkling cold water on the face, tickling the nostrils, &c. Artificial respiration, by pressure on the walls of the chest, was tried.

I

"The syncope continued, and death seemed close at hand. I began to be uneasy, and determined to try direct insufflation. applied my mouth to that of the patient. After some inspiration, the dying woman gave a sigh, her chest heaved, the face resumed its normal color, the heart and pulse commenced beating in an appreciable manner, and the eyes opened; respiration had again brought into play all the functions of life, and the return of sensation was evidenced by a smile. The patient was saved, and we escaped with the fright.

A

"CASE 2. The second time that I experienced the dangers of chloroform, was with a patient under my care in the Southern Hospital, (Hospital du Midi.) He was a young man whose case required circumcision. As this operation is generally painful enough, he asked me to send him to sleep with the chloroform. sponge impregnated with it was given him to respire from; the action was very rapid, without any appearance of preceding excitement, and the patient was soon plunged into total insensibility. I performed the operation, but when it was concluded, the patient did not recover his consciousness, and remained in a state of alarm

ing stillness. The pulse gradually sank; the heart ceased to beat; all the sphincters were relaxed, and his cadaverous face seemed to testify that death was near.

"All the means I have indicated in the preceding case were tried, but without avail, and it became necessary to have recourse to direct insufflation, which had already so well succeeded in one case. Success crowned my efforts, and the patient recovered.

"Now, my dear colleague,* may we not conclude from these two instances, that in cases of impending death from the use of chloroform, direct insufflation from mouth to mouth, from the surgeon to the patient, is a more sure and efficacious remedy than any thing else ever recommended in such cases; more certain and quicker than all the other methods of artificial respiration with tubes or catheters. Do you not, with me, think that the surgeon who should neglect having recourse to it, would take upon himself a very serious responsibility?

66

I know well it will be objected that such a plan is disgusting and repulsive but this is of but very little importance to men whose life is professedly one great act of devotion."t-Lon. Lan.

ALARMING RESULTS OF CHLOROFORM.

BY CHARLES BLEEK.

SIR,-After reading the case of death from chloroform, published in THE LANCET, a short time since, by Mr. Solly, I made up my mind to send you the following. On July 3d of last year, removed a large scirrhous breast from a strong stout woman, Mrs. K—, aged forty-two, the wife of a plumber, of this town. It was her wish that she should be put under the influence of chloroform, which was accordingly done. For several minutes her system resisted the influence of the remedy, and it was not till three drachms were used, and the vapor concentrated by placing a fold of lint over the back of the inhaler, that she was rendered unconscious.

The removal of the breast occupied about four minutes, during which she showed not the slightest consciousness of pain, or of what was going on; just as the last incision was completed, she slipped from the chair in which she was sitting, and from the grasp of an athletic woman who was holding her, and fell apparently dead upon the floor; her face was of a deadly pallid and livid color, and her lips, lobes of the ears, and finger-nails, of a

* This letter seems to have been addressed to M. Escalier.

†M. Escalier recommended, instead of insufflation. the introduction of one or two fingers into the mouth, as far back as the entry of larynx and œsɔphagus. This method has succeeded in his hands.