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Painless Operations in Surgery.

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ART. VII.-1. A Treatise on the Inhalation of the Vapour of Ether, &c. By J. ROBINSON, Surgeon-Dentist, &c. London, 1847. 2. Notes on the Inhalation of Sulphuric Ether, in the Practice of Midwifery. By J. Y. SIMPSON, Professor of Midwifery in the University of Edinburgh. Edinburgh, 1847. 3. The Medical Periodicals, passim.

Ar first sight, this subject may seem to lie beyond the strict range of our Journal, and to belong rather to those periodicals which treat exclusively of physic and surgery. But a moment's reflection makes it very plain how this is a matter which touches all members of the human family alike; or, if there be any difference, patients are more interested than practitioners-the laity more than the profession-the mass more than the medical section of mankind. No doubt, it is a boon to the surgeon to know that he can achieve what he knows to be essential for his patient's welfare, without, at the same time, inflicting on him an instant's pain. He will be very thankful to find a fellow-being placid, and calm, and motionless, under an operation which used to cause much torture, as evinced too plainly by writhings, and shoutings, and groans. His hand is all the steadier; his head all the more cool and collected; his feelings are comparatively untouched; and his heart, all thankful, is incomparably at ease. But surely the boon is greater far to the victim-to the suffering portion of humanity. Injury and disease often require operations of dread severity; fearful in themselves, and still more fearful in anticipation. In war, the bravest hearts, who cared not for the foeman's steel, and scarce felt the wound it made, have yet shrunk back from the friendly knife which in kindness had to follow. In disease, the sternest minds, and the most possessed, have looked death steadily in the face, day by day, week by week, and month by month; they have reasoned calmly of that which they believed to be surely carrying them onward to their grave; and yet they have turned, trembling and appalled, from the thought of an operation which a turn of their malady may have rendered expedient or imperative. Many a wise, as well as many a bold man has refused to submit to what his own conviction told him was essential to his safety; and many a valuable life has thus, in one sense, been thrown away, which otherwise might have been saved, or at least prolonged. And why? Simply because, in the operations of surgery of a graver kind, there has hitherto been such cruel pain as frail humanity, even of the highest class, is fain to shrink from. We remember the case of a gallant admiral--one of the bravest hearts that ever beat, in a service whose

men of every grade are, to a proverb, dauntless-who, in the opening of his distinguished career, had been engaged in cutting out an enemy's frigate. From the gunboat, he climbed up the ship's steep side, and, foremost of his crew, had reached the bulwarks, when, receiving a stunning blow, he fell backwards into his boat again, striking his back violently on the tholpin. Many years afterwards, a tumour had grown on the injured part; and at length, the admiral-grey, and bent in years-found it advisable that this growth should be removed. The man that never feared death in its most appalling form, while in the discharge of duty, now shrank from the surgeon's knife; the removal, contemplated with a feeling almost akin to fear, was long deferred; and at length, half-stupified by opium though he was, a most unsteady patient did he prove during the operation. Women-mothers -who, for their kindred, have been at any time ready to sacrifice their lives, by watching and privation, in loathsome and tainted chambers of infectious disease-have, when themselves become victims of that which they know requires a surgical operation, and which, without this, they are well assured, must miserably consume them away; -even these noble minds, resolute in the fear of death, have yet quailed under the fear of suffering; they have studiously concealed their malady from their nearest friends, and deliberately preferred the misery of a fatal, and unchecked, and ever-gnawing cancer, to the apprehended torture of an operation, temporary though it be. We repeat it; even the best portions of humanity have an instinctive dread and shrinking from the pain of deliberate cutting of the living flesh. And does it not concern us all, that, in God's good providence, a remedy has sprung up for this?-that now a fair prospect is afforded of even the most dreaded of these dire proceedings being performed during a happy unconsciousness of the patient? Not merely with little suffering, but absolutely with none.

Than the subject at the beginning of our page, we can conceive nothing more catholic ;-it affects the whole human race. Even editors and critics must stoop to arrange themselves among the benefited; and in this question may well say-confessing their humanity, and throwing aside for once the almost suprahuman obscurity in which they love to dwell-“ Homo sum; humani nihil a me alienum puto."

We do not propose to enter fully into the subject of Etherization, but shall content ourselves with little more than a narrative of the principal events connected with it; making also some observations regarding the application of the discovery, which it may be at once useful and interesting for the general public to

know.

It has always been a leading object in practical surgery, to di

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minish as far as possible the amount of suffering during the manipulations of that art. Accordingly, in some operations, tight pressure has been made above the part to be cut, applied by a tourniquet, by bandaging, or by the powerful grasp of an assistant. Sometimes, but more frequently in obedience to the urgent request of the patient than of the operator's own free will, opium, or some other narcotic, has been given previously to the hour of operation, in the hope of producing thereby a comparative deadness to pain; always, however, with an imperfect and unsatisfactory result as to the object sought to be attained, and almost always with the effect of subsequent disadvantage accruing, in the form of headach, feverishness, or other general disorder. Each individual operation has had its details oftentimes considered and changed in the hope of accelerating the speed of operating, while safety might be retained; and many ingenious instruments have been invented with the like object in view; surgeons seeking in every way to arrive at a due combination of the tuto et celeriter" always giving to the former the first place in importance, and yet, perhaps, pursuing the latter with a greater earnestness and perseverance. In this, it is gratifying to know that surgery has, of late years, made no inconsiderable advance. The operation for stone, for example, used to average many minutes in duration, now it seldom occupies above three or four; often it is completed in two; and, withal, the average mortality is found rather abated than otherwise; the search for the "celeriter" has been successful, and the "tuto" has been retained. In like manner, the old method of amputating by "circular incision" has been, in a great measure, superseded by the modern operation by "flaps," and the cutting procedure, in consequence, has been abridged of fully one-half its period of duration; while better stumps are formed, and the casualties affecting life are at least as few. Still, the results of such attempts, however successful, have been but imperfect; pain has still been inflicted, with all its intensity unbroken; the saving has merely been as to the tortures actually endured whilst under the knife, and that not with reference to acuteness or amount, but only as to the term of duration. And furthermore, no slight evil may well be supposed to have occurred, in the temptation to hurry in operating, held out, more especially, to those surgeons whose duty led them to public exhibition of their professional skill. A false criterion of operative power was apt to be raised-not merely in the vulgar mind; the dexterity of the hand was apt to be estimated according to the rapidity of its movement; the judgment and tact of the head, which planned an operation, were apt to be gauged by the time occupied in performance; and, in consequence, the surgeon may not unfrequently have been urged, almost uncon

sciously, if not to precipitancy in the use of his knife, at least to an unwarrantable sacrifice of the "tuto" to the "celeriter"—-in plain language, to a sacrifice of his patient's best interests in favour of his own precarious and ephemeral reputation. 66 If it were well done, when 'tis done, then 'twere well it were done quickly." But it were a poor economy, on the part of the patient, to obtain a moment's absolvence from pain, at the cost of misadventure which may bring life into hazard, or which may entail weeks or months of protracted suffering. In a recent publication, Professor Syme has stated, in reference to a particular operation, "I have completed the operation in less than a minute, and on other occasions have found nearly half an hour requisite for the purpose. If all operators had paid as little regard to the time occupied, I believe that the unfavourable results on record would not have been so numerous as they are." And this, we doubt not, is just an indication of the right feeling which pervades all truly good surgeons, who, as operators, are usually rapid-but rapid because skilful, and rapid only when safe; and who well know that, in some procedures, attempted rapidity will not fail to prove injurious, and must ever be abstained from. Still, there is no doubt, the operative surgery of modern days is decidedly more rapid than that of the olden times, and, on the whole, fully as safe in its immediate results. In consequence, a a real saving of pain has thus been achieved in favour of humanity. And in another way has good progress been made in this direction. It has been the pride of modern surgery, as it has been its aim, not to multiply instruments and the means of using them; not to enlarge the operative field, but to circumscribe it; not to expend blood and pain, but by gentler means to arrest disease, and remedy disaster. Joints are saved, and made supple again, which used to be amputated; growths are made to disappear by their own act, which used to be dug out or cut away; and accidental wounds are brought to heal more rapidly and more kindly, with less use of the probe, sewing needle, and knife. The modern surgeon finds his mission to be "not to cut but to cure."

By the skill and diligence of surgeons, then, and by the advance of improvement in their art, operations have been reduced in frequency, and shortened in performance. Still, however, they are almost everyday occurrences in each extensive practice; and, until within these few months, they were still inseparable from such suffering as even the bravest minds would fain recoil from.

"Pneumatic medicine," as it was called, was in vogue at the end of last century; that is, the treatment of disease, by the inhalation of gases or vapours. The names of Drs. Beddoes,

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Thornton, and Pearson, are prominently associated with this; and it is well known that Sir Humphry Davy, in his early years, repeatedly risked his life in recklessly inhaling gases which are now ascertained to be poisonous. His experiments were not without their fruit. Advances in the general science of chemistry were attained; and, as will afterwards be shown, a very near approach to the present discovery was also made. Indeed, a very fair question may be raised, as to whether Sir Humphry be not actually entitled to rank as the discoverer of what has been termed "the Letheon”—or, at least, of the system of “Letheonizing."

Dr. Pearson, in 1795, recommends the inhaled vapour of sulphuric ether as " remarkably serviceable in phthisical cases. It abates the hectic fever, checks the sweats, removes the dyspnoea, and greatly improves the smell, colour, and other qualities of the expectorated matter.. Patients who have inhaled it two or three times, find it so grateful to their feelings that they are disposed to have recourse to it too often, and cannot readily be prevailed upon to lay it aside when it is no longer necessary." His mode of applying it was to pour "one or two teaspoonfuls of ether into a tea saucer, holding it to the mouth, and drawing in the vapour with the breath;" continuing the inhalation till the saucer became dry; and repeating it "two or three times a-day, or oftener if necessary." His ether, too, was duly rectified. The best having been got, "lest it should contain any loose acid, it is advisable to put a little alkaline salt into the bottle in which it is kept, and to shake them together now and then.” And he was not content with using ether alone. He impregnated it with musk, camphor, opium, assafoetida, and the like;" and squill seemed a favourite addition with him-for, says he, "the finer particles of the squill applied to the lungs in this manner, along with the vapour of ether, gently stimulate the secreting surfaces of the bronchia, and promote the mucous discharge; and if applied in sufficient quantity, produce sickness, which takes off the spasm, and is otherwise serviceable in such (asthmatic) cases."

Nysten, in 1815, published a strong recommendation of etherial inhalation as an anodyne, especially in pulmonary complaints; and described suitable inhaling apparatus.

In Brande's Journal of Science and the Arts, 1818, an author writes "on the effects of inhaling the vapour of sulphuric ether," showing how it may be conveniently managed, what risks may be expected, and how these may be avoided.

The medical use of gaseous inhalation, however, fell into desuetude. The profession let it slip; empiricism took it up; and between the neglect of science, and the favour of quackery, it lapsed not only into disuse, but also into disrepute.

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