Anaesthesia, or the employment of chloroform and ether in surgery, midwifery, etc.

Front matter

I i

'1 i .

^1

Part II

CHAP. L From Monthly .Journal of Medical Science for March, 1847. II. Read to the Edinburgh Medico-Chirurgical Society, 1st December, 1848.

III. Published as a Separate Pamphlet in December, 1847.

IV. Published in an Appendix, to a Pamphlet by Dr. Protheroe

Smith, on the "Scriptural Authority for the Mitigation of the Pains of Labour.

V. From Monthly Journal of Medical Science for Oct. 1848. . VI. Ibid. Ibid.

VII. Ibid. Ibid.

VIII. Ibid. Ibid.

IX. Ibid. Ibid.

X. Ibid. Ibid.

Part III

CHAP. I. From IMonthly Journal of Medical Science, Dec. 1847.

II. Communicated to Edinburgh Medico-Chirurgical Society, 11th November, 1848.

III. From Monthly .Journal of Medical Science for Dec. 1847.

IV. Ibid, for April, 1848.

Part IV

CHAP. I. From Provincial Med. and Surg. Journal for July 12, 1848. II. Ibid. Ibid.

III. Ibid. Ibid.

IV. Read before the Dublin Obstetric Society in February, 1849. Pao-es 29 and 30 are Extracted from the Monthly Journal for .January,

JSf. B. — The Table, p. 64, and the Contents of pp. 65, 66, and 67, have been added by the Printer by mistake from a paper of Dr. Fenwick's, following that of Dr. S. in the same number of the Monthly Journal.

Chapter I

On tlie Inhalation of Sulphuric Ether in the practice of Midwifery, - 83

CHAPTER H.

On the Superinduction of Anaesthesia in Natural and Morbid Parturition, and cases illustrative of the use and effects of Chloroform in Obstetric Practice, ....-- 93

CHAPTER nr.

Answer to the Religious Objections advanced against the employment of Anaesthetic Agents in Midwifery and Surgery, - - 1 10

CHAPTER IV.

Same subject continued in a letter to Dr. Protheroe Smith, of London, 124

CHAPTER V.

Report on the early history and progress of Anaesthetic Midwifery, - 133

CHAPTER VI.

Results of the practice of Anaesthesia in Midwifery, - - 138

CHAPTER VII.

Mode of exhibiting Chloroform— Dose, &c., - - - - 145

CHAPTER VIII.

Report of the results of Anaesthesia from different Obstetric Hospitals and Practitioners, - - 151

CHAPTER IX.

Alleged dilEculties in the superinduction of Anaesthesia, - - . iso

CHAPTER X.

Objections to Anaesthesia in Midwifery. Discussion on the employ-

CONTENTS. 3JV

ment of Chloroform in Midwifery and Surgery, before the Medico- Chirurgical Society of Edinburgh, 182

PART IIL

ON THE NATURE AND POWERS OF VARIOUS ANiESTHETIC AGENTS.

CHAPTER I.

Historical researches regarding the superinduction of insensibility to Pain in Surgical Operations, - - -■ - -191

Chapter II

Account of a new Anaesthetic Agent as a substitute for Sulphuric Ether in Surgery and Midwifery, ----- - 193

CHAPTER m.

Ansesthetic and other therapeutic properties of Chloroform, - 203

Chapter IV

Notes on the Anaesthetic effects of Chloride of Hydrocarbon, Nitrate of Ethyle, Aldehyde, and Bisulphuret of Carbon, - - 209

Part IV. Local Anesthesia- Chapter I

Historical notice on the production of Artificial Local Anaesthesia, • 214

CHAPTER II.

On the production of Local Anaesthesia in the lower animals, - 217

CHAPTER III.

On the production of Local Anaesthesia in the human subject, - - 220

CHAPTER IV.

Answer to the Objections to Anaesthesia in Midwifery, adduced by Professor Meigs of Philadelphia, 230

Part I. Anaesthesia In Surgery

" The mtilt ipljpd pxperiments to prevent pain in surtrical operations, which bear so deli"ht ■ ful a testimony tu the humanity of their authors, will cert,iinly, in the course of time'i be crowned with success." — Marx' Akesios — Letter to Herman Boerliaave.

Chapter I

MERE OPINIONS AND PREJUDGMENTS NOT SUFFICIENT TO SETTLE THE QUESTION OF THE PROPRIETY OK IMPROPRIETY OF ANAESTHETIC AGENTS : ILLUSTRATION FROM THE HISTORY OF VACCINATION.

During the latter half of the last century, 30,000 individuals were computed to die annually of small-pox in England.* From the official returns of the Registrar-General, it appears, that in England and Wales the number that perish annually of this same disease at the present time is reduced to less than 10,000.f In England alone, therefore, the absolute mortality

* Dr. Greg^ory observes, "The total deaths by small-po.ic throughout England were estimated at about 45,000 annually," — Cyclopaedia of Medicine, vol. iv. p. 402. Dr. Hay^arth calculated the annual number of deaths from small. poi to amount to 38,000 in 8,000,000 of inhabitants. — Sec the data of his computation in his '^Sketch of a Plan to exterminate Small-pox" 1793, p. 144. In making the various computations regarding vaccination in the text, I have, in order to avoid the possibility of error, kept all the calculations cousiderably below the ascertained data.

t During the five years from 1838 to 1842 inclusive, there died, on an average, 8893 individualsyearly of small. po.\. In 1842, only 2715 died. — See Sixth Annual Report of the Registrar-General, p. 514. Formerly, 1 in about every 250 of the general population died annually of small pox ; now, only 1 in about every 1700. In England, the registration of every birth and every death is properly enforced by law. If the registration of the vaccination of each child were enforced as rigorously as the registration of its birth, much disease, and many thousand human lives would thus undoubtedly be saved annually in Great Britain. Surely it is a subject well worthy of the attention of a benevolent legislature. We see the good effects of such interference in other European states. For, whilst in England, (the native country of Jenner,) still 1 in every 1700 inhabitants dies annually of smallpox, — in Austria, 1 in 4800 dies of this disease ; in France, 1 in 11,000;" and in Sweden, only 1 in 27,000. On the great extent of the number of from smnll-pox is less by twenty thousand a year than it was half a century ago. If a similar rate of reduction in the number of deaths from small-pox holds good— as we have every reason to believe is the case — in tlie other kingdoms of Europe, then, out of the 220 millions of people that inhabit this quarter of the globe, 400,000 or 500,000 fewer die now of smali-pox, than, vvith a similar population, would have died from this malady fifty years ago. In other words, according to this rate of computation, there are now preserved from death by smallpox in England, during the currency of a single half century, a number of lives greater in amount than the whole existing pnpulatirm of Wales. There are preserved in Europe, during the same period, a number of lives greater in amount than the whole existing population of Great Britain.

For this mighty triumph of medicine over one of the most loathed and dreaded forms of human disease and death, science stands indebted to the inestimable discovery of Dr. Jenner ;* and every medical man is ready to allow, at the present day, that his discovery is not less remarkable in consequence of its gigantic results and amazing success, than in consequence of the singular simplicity and safety of the means with which that success is obtained. For no one now dreams of ever expecting any deleterious or dangerous consequences to ensue from vaccination ; and, indeed, the performance of it has been mainly or entirely conducted, in some districts, by non-professional individuals, — by the priest, as well as by the physician, — by the nurse, as well as by the surgeon.

Yet at the time of Dr. Jenner's first public announcement of vaccination in 1798, and for many years subsequently, the proposal of substituting vaccine for variolous inoculation was encountered by various members of the profession, with incredulity and ridicule, and direct and determined opposition. The measure by which he taught medical science to save annually from death, thousands of human lives in England, and hundreds of thousands throughout Europe, was, on its first introduction,

individuals in society who remain unvaccinated, see some excellent remarks by Dr. Start!, in ttie Edinhurf^h Medical and Surgical Journal, No. 161.

• In answer to tliose who have affected to doubt entirely the utility of physic and physicians, medical science may proudly point to the results of vaccination. During the long European wars connected with and following the French Revolution, it has been calculated that five or six millions of human lives were lost. In Europe, vaccination has already preserved from death a greater number of human beings than were sacrificed during the course of these wars. The lancet of Jenner has saved far more human lives than the sword of Napoleon destroyed. On these devastating European wars England lavished millions of monev, and' freely bestowed honours, peerages, and heavy annual pensions upon the soldiers who were most successful infighting her battles and destroying their fellow.men • she grudgingly rewarded Jenner with twenty thousand pounds for saving twenty thousand of her subjects annually.

bitterly denounced and decried in different quarters, — its effects doubted, — and its own safety and propriety strongly and strenuously called in question.

Dr. Squirrcll earnestly and publicly supplicated his Majesty George the Third to suppress " the destructive practice of vac cine inoculation throughout his dominions."* " It ought," observed Professor Monro of Edinburgh, " to be prohibited by Act of Parliament."f " The College of Physicians have," exclainacd Dr. Moseley, " a duty to perform, and I trust this business will not escape them. "J Others, despairing of interference on the part of the King, Parliament, or Colleges, appealed to the people themselves. " It would," said Dr. Brown, " undoubtedly be downright madness to imagine they will condescend to encourage it,"§ The Anti-Vaccinarian Society called upon the public " to second their efforts in supporting the cause of humanity against cow-pox injuries," and besought their aid to suppress " the cruel despotic tyranny of forcing cow-pox misery on the innocent babes of the poor — a gross violation of religion, morality, law, and humanity."||

Frightful, and even fatal consequences were boldly averred to be the direct and immediate results of vaccination.

Deaths from cow-pox inoculation were published in the mortality bills of London.TI " I have," alleged Dr. Moseley, physician to the Chelsea Hospital, " seen childi-en die of the cow-pox without losing the sense of torment even in the article of death."** Dr. Rowley, physician to the St. Marylebone Infirmary, professed to publish true accounts of fifty-nine deaths from " cruel vaccination ;" and added, that " when humanity reflects" on these and (to use his own words) " a great heap of victims diseased for life, and likely to transmit to posterity, for ages, beastly chronic diseases.ff it is enough to freeze the soul with horror." And " it is," he exclaims, " the duty of honourable men in the medical profession to alarm mankind of the impending danger of vaccination; to warn society of the multifarious evils that await them in the form of this mild catholicon, of a sweetened potion that carries fatal poison in

* Observations on the pernicious consequence' of Cow-pox Inoculation. 2d ed, London, 1806. P. vi.

+ Edinburgh Medical and Surgical Journal, vol. xv, p. 61.

t A Treatise on tlie Lues Bovilla. 2d edition. London, 1805, P. xiv,

§ A Letter in Reply to the Surgeons of the Vaccine Institution. Edinburgh, 1809. P. 96.

II See their Address of 1806 in Blair's Vaccine Contest, p. 56.

IT Mr. Blair's Pamphlet. P. 95.

»« Treatise, p. 95.

■ft Cow-pock Inoculation ; with the Modes of treating the Beastly new Diseases produced by Cow-pock. 2d edition, 1805. P. 128.

all its destructive particles."* He elsewhere eloquently declaims against " afTectionate parents being robbed of their serenity, and the minds of tender mothers being wrung with eternal suspense," "whilst a few projectors or visionists are pursuing their deleterious projects on human viciims," and perpetrating, a "dangerous innovation which so many fatal facts illustrate."t

Mr. Lipscomb urgently maintained, in an essay on small-pox inoculation published in 1805, that cow-pox, the "new scourge industriously dispersed to afflict the children of men," is " sometimes fatal of itseh", and that the diseases introduced or brought into action by it may be also sometimes fatal, and can never be completely guarded against. "J One author had seen " numerous instances" of vaccination producing eruptions, remaining, " for months and even years afterwards, undermining the constitution, and very frequently terminating in phagedenic or corroding ulcers." And he had likewise witnessed coughs, dyspnoea, hectic marasmus, tedious and difficult to eradicate, &c., result from cow-pox. " Shocking reflection (he adds) to a humane mind, that a poison should thus be introduced into the human constitution without the plea of necessity, or the support of reason and experience."^ " Several children," observes Dr. Moseley, " have died from diseases brought on by the cow-pox where no ulcerations had appeared, and others have lost their nails and ends of their fingers, several months after the inoculation. "|| " My accounts from the country are (he continues) full of dismal histories of ulcerated arms and mortifications."!! " Blindness (it was averred), lameness and deformity had been the result of employing the vaccine in innumerable instances, and its fatal venom had removed many an infant untimely from the world."**

Nay, it was strenuously maintained and believed, that not only were various old maladies, peculiar to man, thus excited into action by the " cow-pox poison," but that difl'erent new diseases peculiar to the cow were sometimes communicated to the human constitution by vaccination. " Various beastly diseases," writes Dr. Rowley, "common to cattle, have appeared among the human species since the introduction of cow-pox, cow-pox mange, cow-pox abscess, cow-pox ulcer,

• Cow. pock Inoculation; with the Modes of treating the Beastly new Diseases produced by the Cow. pock. 2d edition, 1805. P. 14. '

t Ibid. p. 128.

t Inoculation for the Small-pox vindicated, &c., 1805. P. 40.

§ Observations addressed to the Public on the Cow-pox, pointinj out the dreadful consequences of this new Disease, so recently and rashly introduced into the Human Constitution. By R. Squirrell, M.D., 1805. Pp. 16, 17.

II Treatise on the Lues Bovilla, p. 118.

** Moore's History of Vaccination, p 39.

cow-pox gangrene, cow-pox mortification, and enormous hideous swellings of the face, resembling the countenance of an ox, with the eyes distorted, and eyelids forced out of their true situation; diseased joints, &c."*

This was published in 1806, eight years after Dr. Jenner's first essay on vaccination appeared. During the year subsequent to the first public announcement of his discovery. Dr. Moseley suggested the possibility of the " bestial humour" of cow-pox producing " a brutal fever exciting incongruous impressions on the brain;" and "who knows (says he) but that the human character may undergo strange mutations from quad^ rupedan sympathy, and that some modern Pasiphae may rival the fables of old?" Some, after vaccination, were actually supposed to "cough like cows," and "bellow like bulls. "f And one anti-vaccinist ingeniously suggested that if cow-pox were known to have existed in a family, this fact might debar the members of it from the chances of matrimony. ForJ " it would (he remarks) be no letter of recommendation, and it would be cruel for the world to know, who had laboured under the cow-pox mange, evil, ulcer, or any other beastly disease ; it might infallibly injure their fortune in life, particularly in matrimonial alliances. Who would marry into any family, at the risk of their offspring having filthy beastly diseases'!"

Nor were theological reasons, of course, wanting for calling in question the orthodoxy of vaccination, as of other new discoveries and practices.^ " Small-pox (argues Dr. Rowley) is

• Cow-pox inoculation, p. 105. See prefixed to the work the coloured portrait "of a cow-poxed, ox-faced boy," with two scrofulous abscesses, which were at one time alleged to indicate sprouting^ horns ! — "This boy (observed Dr. Rowley, in a clinical lecture on the case) is gradually losing the human lineaments, and his countenance is transmuting into the visage of a cow." (Jl/oore's History, p. 46.) He further wrote — " A great number of new complaints, the diseases of beasts, filthy in their very nature and appearance, in the face, eyes, ears, with blindness and deafness, spreading their baneful influence over the whole body, have beea not unfrequcntly the consequence evidently of cow-pox inoculation ; either originating from the grease in horses, or the natural diseases of cows." P. 12.

t Mr. Ring, in his treatise on cow-pox, mentions "a lady who complained that, since her daughter was inoculated, she coughs like a cow, and has grown hairy all over her body ; and Mr. Blair was told, on a late excursion into the country, that the inoculation of the cow-pox was discontinued there, because those who had been inoculated in that manner bellowed like bulls I" — Blair's Vaccine Con. test, p. 69.

t Introduction to Rowley's pamphlet, p. vii.

§ As for example, small pox inoculation : see a " Sermon against the dangerous and sinful practice of Inoculation, preached at St. Andrew's, Holborn, in 1722, by Edmund Massey, M.A. He urges various theological arguments against the * diabolical operation' of inoculation, and at last maintains that, even if it were medically successful, it was not to be courted, for he believes if mankind should thus * happen to become more healthy, it is a great chance but they would be less righteous.' " P. 26. In his admirable "Account of the Inoculation of Small.Pox in Scotland (1765)," Dr. Monro [primus) states, "the first and most general prejudice against inoculation is its being deemed a tempting of God's providence, and therefore a heinous crime." P. 5. "Clergymen (observes Dr. Baron, in bis a visitation from God, and originates in man ; but the cow-pox is produced bv presumptuous, impious man. The former, heaven ordained ; the latter is perhaps a daring and profane violation of our holy religion." And he subsequently proposed, " whether vaccination be agreeable to the will and ordinances of God, as a question worthy of the consideration of the contemplative and learned ministers of the Gospel of Jesus Christ; and whether it be impious and profane, thus to wrest out of the hands of the Almighty the divine dispensation of Providence!"* "The projects of these vaccinators seem (it was affirmed) to bid bold defiance to heaven itself, even to the will of God."f " Providence (reasoned another author) never intended that the vaccine disease should aflect the human race, else why had it not, before this time, visited the inhabitants of the globe. The law of God (he continues) prohibits the practice ; the law of man and the law of nature loudly exclaim against it."J

In short, vaccination was opposed and denounced on a variety of grounds. It was alleged to be occasionally fatal in its consequences ; to be liable to excite various diseased actions and predispositions; to produce diseases new to the human constitution : to " be impious, unthinking, profane and irrational ;" to be an innovation, neiiher " established on the basis of reason, nor supported by the foundation of trutli."§ " The vaccine," exclaimed one enemy to cow-pox inoculation, " was the damnedest thing ever proposed ; he wished the inventors were all hanged, and he would give his vote for its being done."|| And strong pictures were hung up to the public eye of the miseries it would infallibly lead to, in case of the recurrence of epidemic small-pox. "In many families,"^ writes an author whom I have already quoted, " there will be none to attend the sick ; nurses will quit their patients for their own safety; and servants fly from their masters' houses to shun the pestilence. Then we shall experience an horrid scene of public and private calamity — brought on by a medical experiment ; embraced without due consideration; extended by a rash transgression over the bounds of reason ; and, after the

Life of Jenner, vol. i. p. 231) preached from their pulpits in this style of argument, if so it mia^ht be called. Some went so far as to pronounce inoculation an invention of Satan himself, and its abettors were charfjcd with sorcery and atheism. These things (he adds) would scarcely obtain credence were it not that similar arguments and assertions have been employed against vaccination itself."

* Rowley's pamphlet, p. 9.

t Vaccine Contest, p. 84.

t Preface to the second edition of Dr. Squirrell's Observations, p. iv.

§ Blair's Essay, p. 83 ; and Lipscomb's Pamphlet, p. 28.

II Moore's Reply to the Anti-Vaccinists, 1806. P. 14.

U Preface to "Treatise on Lues Bovilla," p. 23.

fullest conviction of its inutility, obstinately continued, by the most degrading relapse of philosophy that ever disgraced a civilized world."

Such were the chief forms of opposition and argument that were stoutly and vigorously urged against vaccination during the earlier years of its progress. They are the same by which many of the happiest and greatest improvements in our profession have each in turn been assailed at their first promulgation. From time to time in the march of medicine and other allied sciences, some earnest and expanded mind conceives and elaborates a great and novel thought, destined in its practical application to ameliorate the condition and promote the happiness of mankind. But hitherto almost as often as the human intellect has been thus permitted to obtain a new light, or strike out a new discovery, human prejudices and passions have instantly sprung up to deny its truth, or doubt its utility, and thus its first advances are never welcomed as the approach of a friend to humanity and science, but contested and battled as if it were the attack of an enemy.* Practical medicine, in its past career, is full of instances illustrative of this remark. Witness the history of the immense and now almost forgotten difficulties accompanying the first introduction of mercury, antimony, and cinchona-bark, into medical practice ; or the stern obstinacy with which the ligature of arteries after amputation was long, long rejected, and cauteries and caustics pre-

* This remjirli holds true, for instance, with regard to small-pox inoculation, Sic. &c. Lord Wharncliffe, in liis edition of the letters and worlis of Lady Mary AVortley Montagu, after giving the history of her Ladyship's introducing the practice of srnall-pox inoculation into England from the East, observes: — "What an ardnous, what a fearful, and, we may add, what a thankless enterprise it was, nobody is now in tlie least aware. Tliose who have heard her applauded for it ever since they were born, may naturally conclude, that when once the experiment had been made and had proved successful, she could have nothine to do but to sit down triumphant, and receive the thanlcs and blessings of her countrymen. But it was far otherwise. Lady IMary protested that in the four or five years imme. diately succeeding her arrival at liome, she seldom passed a day without repenting of her patriotic undertaking; and she vowed that she never would have attempted it if she had foreseen the vexation, the persecution, and even the obloquy it brought upon her. The clamours raised against the practice, and of course against her, were beyond belief. The faculty all rose in arms to a man, foretelling failure and the most disastrous consequences; the clergy descanted from their pulpits on the impiety of thus seeking to take events out of the hand of Providence; the common people were taught to hoot at her as an unnatural mother who had risked the lives of her own children.

" We now read in grave medical biography, that the discovery was instantly hailed, and the method adopted, by the principal members of that profession. Very likely they left this recorded ; for whenever an invention or a project — and the same may be said of persons — has made its way so well by itself as to esta. blish a certain reputation, most people are sure to find out that they always patronised it from the beginning; and a happy gift of forgetfulness enables many to believe their own assertion." Letters and ^^'orks of Lady Mary Wortley Montagu. Edited hy her great grandson Lord Wharnclij'e. Vol. i. p. 55.

ferred ; or the professional and religious prejudices which the propriety of saving human life by inducing premature labour has encountered up to within the last few years. Further, every proposed improvement seems to be met with the same invariable array of objections and arguments. The discovery may be new, but the grounds of opposition to it are not new, — tiiey are merely the old forms of doubt, and difficulty, and prejudice, used on former occasions, recalled and reproduced anew. Thus not only in their leading principles and spirit, but in most even of their minute details, identically the same arguments that forty or fifty years ago were urged against the propriety and safety of vaccination, or a hundred years ago against small-pox inoculation,* have, within the last few months, been again invoked and used against the employment of etherization. Time has amply proved how futile and inapplicable these arguments were as directed against vaccination. In truth, those forms of reasoning and opposition against the employment of cow-pox that, some forty or fifty years ago, appeared to many members of the profession to be perfectly conclusive and insuperable, now read and appear to us at the present day as in the highest degree illogical and absurd. History has been compared to a mirror in which we may study the faults of our predecessors, with the view of avoiding the same errors ourselves. The history of cow-pox is certainly calculated to teach us this one lesson, that in relation to the truth of any novel doctrine or practice, such as vaccination or etherization, adverse opinions and prejudgments arc — however strongly entertained, or however strongly expressed — not in themselves adequate, as some, at the present time, would seem to believe, to decide the whole matter in dispute, either in one direction or another.f And the moral is obvious, — that while

» " The very same objections (writes Mr. Moore in 1805), accompanied witti the same species of proof, were adduced ajjainst it (small.pox inoculation), as are now bronght ag-ainst vaccination."— Sec his reply to the Anti-Vaccinists, p. 70.

t I have been told, that any comparison between the progress of vaccination and etherization cannot be true in one respect, that vaccination n-as at once and generally received. The quotations in the text show the contrary ; and many of the strongest adverse opinions which I have quoted were published in 1805-6, seven or eight years after Dr. Jenner published his first admirable essay on the subject in 1798. After Dr. Jenner published this essay, he went to London, and resided there for nearly three months; but during this time, "with all his efforts and those of his friends, he was unable in the metropolis to procure one person on whom he could exhibit the vaccine disease. Not one individual would submit to it. After Jenner left London, Mr. Cline made the first experiment tried in London with cow.pox, by inoculating it as a counter-irritant on the hip of a patient aflTected with morbus coxarius." — (Baron's Life of Jenner, vol. i. p. 150 ) Jenner first tried artificial vaccination in May 1796. In March 1800 Mr (afterwards Sir Matthew) Tierney wrote him from Edinburgh, where he was then a. student, stating that " Dr. Gregory, the professor of physic, knew very little about it, and, of course, did not encourage it. Mr. Anderson, a surgeon at Leith is the minds anxious lo promote new and probable inquiries should not be intimidated and deterred from their pursuit by such prejudgments on the part of others, those who are, on the contrary, anxious to suppress them, should not venture to base their opposition upon mere impressions and mere opinions only. The ultimate decision upon such investigations ever comes to be founded, not upon preconceived beliefs or hasty deductions, but upon the careful examination and evidence of a sufficient body of accurate and well-ascertained facts. During the last six months, etherization has been used to a considerable extent ia British surgery; and at the present time, we are perhaps in a condition to turn and look back upon this past experience with it, in order to endeavour to form, from the existing facts and cases, a proper judgment upon its merits or demerits, and especially in order, if possible, to obtain some satisfactory hght upon that all-important question in relation to its employment, viz., whether its adoption increases or diminishes the usual mortality consequent upon surgical operations. It was with this view that the present communication was undertaken.

But, in the first place, and before engaging with this more difficult part of the inquiry, let me briefly adduce the positive evidence which we possess of the effect of etherization in cancelling and abolishing the sufferings attendant upon surgical operations, and the best means of effecting this desirable object, the a -priori objections to it, &c.

only person here who has tried it." — (lb. p. .376.) As late as 1805, the popular opinion in London was much shaken with regard to the propriety and safety of vaccination. "The influence," says Mr. Blair, "of false rumours and distorted facts operated so strongly in the district of Bloomsbury and St. Giles, as to preclude even a single person from applying for vaccination at that dispensary." — (Pamphlet, p. vi.) Dr. Moseley boasts (p. 13 of his Treatise, second edition), that at that date, 1805, the middle and inferior classes in London had " renounced the delusion," and would not "expose their children to cow. pox." Instances of more marked popular hostility against it were not wanting in the early history of cow. pox. Mr. Gooch states, that the first people he vaccinated in Hadleigh, Suffolk, " were absolutely pelted and drove into their houses if they appeared out." —

(Baron's Life, vol. i. p. 382.) In the town of St n, Kincardineshire, a surgeon