Advantages of Ether. 199 tends rather the other way; and we do not well understand how it should be otherwise. For, when the ether's charm works well, the placid condition of the part and patient is surely favourable to a gentle circulation, and to a moderate flow of blood from cut vessels. Should the patient and part become excited and unruly as sometimes happens-then, no doubt, some trouble by many bleeding points may be expected. But such an event ought to be the exception to the general rule. As to the secondary bleeding; this may be explained in another way, without placing blame on the ether. In many operators, using ether without much experience of its effects, there is a natural desire to hurry over the work as rapidly as possible, lest the patient wake up and complain of pain; and, in consequence, there is a temptation to close the wound, and dress it finally, after having secured the main vessels only, without looking narrowly for minor points, or waiting to see if fresh bleeding orifices show themselves-as is ordinarily, and ought always to be done. And when this is not done, bleeding, by and bye, can scarcely fail to occur, to a greater or less extent; obviously the fault, not of the ether, but of the ether's employer, the surgeon. With skilful etherization, and the ordinary precautions of deliberate operating, we are inclined to believe that a saving of blood will be the result. 6. Instead of hurry being imparted to the-surgeon's hands, by the ether's use, they ought, on the contrary, to move with greater steadiness and deliberation. There is one operation in surgery which is always done slowly-because thus, and thus only, it can be done well-and that is trephining; there is, indeed, no excuse for haste; the sawing of the skull-the patient ordinarily insensible-being a painless operation. And, in like manner, during the painless operations of these days, the same deliberate movements should be practised; the more especially as we know that the manageability of the ether is such, as to enable us to maintain the desired state of unconsciousness almost for an indefinite period. It is very plain, however, that such increased steadiness, deliberation, and consequent perfection of operating, is not to be expected until the surgeon has become familiar with the ether's use, and confident of the power with which he can thereby command the sensibilities of his patient. In fact, so manageable is the agency, that we have often been forced mentally to liken it to the power of steam, which may be turned off or turned on as we list. Working a vessel up a difficult channel, how often is the power of progression increased, slackened, turned off, or reversed! In ether, we have no reverse in the power itself; but, during an operation, it would be no great misapplication of terms to find the superintending surgeon regulating his anodyne powers by "Set on !"-or, as it is an American discovery, "Go a-head!"-" Ease her!" "Stop her!" Unfortunately, there is no "Back her!" or "A stern!" But, if a bright look-out is kept, and no rash way made upon the vessel, the necessity for such a cry, we fondly think, will not often arise. How many operations with ether must have now taken place-many, too, it is no want of charity to suppose, with bad ether, bad apparatus, and want of caution; and yet, so far as we know, there is not one instance of fatal casualty which can be ascribed directly to the ether's use. One decided inconvenience certainly attends on etherization. More time is altogether occupied in the surgeon's labour. Dentists are already grumbling, doubtless, at the time now consumed in tooth extraction; and may be thinking, not unreasonably, of doubling the fee, when ether is used; just as a book with plates is higher in value than the ordinary unillustrated copy; or as a dinner with wine and fruit is more expensive than the plain joint, a glass of water, and a tooth-pick.* A greater demand is made on the surgeon's time, no doubt; and sometimes, too, his patience is tasked. But if, by yielding time and patience, he contribute so powerfully to his patients' comfort and wellbeing, as he has good reason to expect, surely he will not grudge the sacrifice, on his part, even were it double what it is. But it is not in cutting only that ether is of use. As an opponent of muscular resistance, it promises to be of great service in surgery. In dislocations of old standing, more especially of the larger joints, as the hip and shoulder, it is well known that great difficulty is experienced in effecting reduction; and this mainly on account of the resistance which is afforded by the muscles, whose spasmodic action is partly involuntary and partly in obedience to the will. However resolute and calm the patient may be, and anxious to assist the surgeon in every way, yet, so soon as violent extending force is applied to the limb, he cannot help straining himself greatly, fixing his chest during deep inspirations, and rendering the muscles connected with the displaced joint as rigid as if they were of wood or plaster. Now, all this straining, the effect of the will, etherial inhalation is calculated to avert entirely; and we have seen it so averted. Consequently, one great obstacle to reduction may, by the ether, be overcome. We are not so sanguine of its proving a successful opponent of involuntary spasm; having repeatedly witnessed much and violent spasmodic movement during amputations, of the pain of which the patient felt nothing. In hernia, too, the remedy promises well, in preventing the straining of the patient, which every ex * We think it not at all unlikely that etherization will be abandoned in toothdrawing, and other minor operations, and that its use will be in a great measure limited to the more serious matters of surgery. perienced surgeon knows is so greatly obstructive of reduction. In a recent case of rupture operated on, the bowels were constantly protruding from the wound, and could not be replaced, on account of the great and incontrollable action of the abdominal muscles; ether was administered, the patient became unconscious, the abdomen lay quiet, and the protruded parts were then, without the slightest difficulty, replaced and retained. Even supposing, therefore, that etherial inhalation be found ineffectual in allaying involuntary spasm, it promises much aid, by the averting of voluntary muscular action, in the reduction of dislocated joints, and in hernia-which may not inaptly be regarded as a dislocation of bowel. But, further, the ether's use is not to be limited to the province of surgery alone. It is applicable to every department of the healing art. In the practice of medicine, and in midwifery, we may expect its cautious employment to be followed by signal benefits, in certain circumstances. In the latter department, Professor Simpson has already reaped no slight success. His first application of ether was to a difficult case of turning, in a deformed mother. A painful operation had to be performed within the womb; and then the child had to be pulled forcibly away. Much force was necessary; in ordinary circumstances, much pain must have been endured, and the after recovery would in all probability have proved tedious. As it was, no pain. whatever was felt; there was no shock, or lowering of the system; and "on the fourth day she had walked out of her room to visit her mother." In several cases of extraction by forceps, the results of etherization have been equally satisfactory. In every case, "the uterine contractions continued as regular in their recurrence and duration after the state of etherization had been induced, as before the inhalation was begun. . . . . Indeed, in some cases the pains have appeared to me to have become increased as the consciousness of the patient became diminished. This has more particularly occurred with one or two patients, who breathed ether combined with tincture of ergot, or containing a solution of its oil."* And thus, though in some cases of surgery, ether may seem to labour under a disadvantage in not proving a successful opponent of involuntary muscular action, here, in the obstetric art, the greatest possible advantage is derived from that circumstance. Parturition is shorn of pain, and yet not retarded. The effects of ether, Professor Simpson has found very various in his patients. * Monthly Journal, March 1847, p. 724. "In some, a state of total apathy and insensibility seems to be produced; others move about and complain more or less loudly during the uterine contractions, though afterwards, when restored to their state of common consciousness, they have no recollection of any suffering whatever, or, indeed, of anything that had occurred during the inhalation and action of the ether; others again, remain quite aware and conscious of what is going on around them, and watch the recurrence of the uterine contractions, but feel indifferent to their effects, and not in any degree distressed by their presence; and in another class again, the attendant suffering is merely more or less diminished and obtunded, without being perfectly cancelled and annulled." "A careful collection," continues the Professor, "of cautious and accurate observations will no doubt be required, before the inhalation of sulphuric ether is adopted to any great extent in the practice of midwifery. It will be necessary to ascertain its precise effects, both upon the action of the uterus, and of the assistant abdominal muscles; its influence, if any, upon the child; whether it gives a tendency to hemmorrhage or other complications; the contra-indications peculiar to its use; the most certain modes of exhibiting it; the length of time it may be employed, &c. In no case have I observed any harm whatever, to either mother or infant, follow upon its employment. And, on the other hand, I have the strongest assurance and conviction, that I have already seen no small amount of maternal suffering and agony saved by its application." As to the question of whether or not etherization is to be extended to cases of natural parturition, with the object of simply assuaging pain, Professor Simpson thus ably expresses himself: "Custom and prejudice, and, perhaps, the idea of its inevitable necessity, make both the profession and our patients look upon the amount and intensity of pain encountered in common cases of natural labour, as far less worthy of consideration than in reality it is. Viewed apart, and in an isolated light, the degree of actual pain usually endured during common labour is as great, if not greater, than that attendant upon most surgical operations. I allude particularly to the excessive pain and anguish, which, in nine out of ten cases, accompany the passage of the child's head through the outlet of the pelvis and external parts. Speaking of common or natural labour in its last stages, Dr. Merriman observes, the pulse gradually increases in quickness and force; the skin grows hot; the face becomes intensely red; drops of sweat stand upon the forehead; and a perspiration, sometimes profuse, breaks out all over the body: frequent violent tremblings accompany the last pain, and at the moment that the head passes into the world, the extremity of suffering seems to be beyond endurance.' Or, take the picture of the sufferings of the mother in the last stage of natural labour, as portrayed by the most faithful of living observers-Profossor Naegele of Heidelberg-The pains (he observes) of this stage are still more severe, painful, and enduring; return after a short in terval, and take a far greater effect upon the patient than those of the previous stage. Their severity increases so much the more from the additional suffering arising from the continually increasing distension of the external parts. They convulse the whole frame, and have hence been called the dolores conquassantes. The bearing down becomes more continued, and there is not unfrequently vomiting. The patient quivers and trembles all over. Her face, is flushed, and, with the rest of the body, is bathed in perspiration. Her looks are staring and wild; the features alter so much that they can scarcely be recognised. Her impatience rises to its maximum with loud crying and wailing, and frequently expressions which, even with sensible, high principled women, border close upon insanity. Everything denotes the violent manner in which both body and mind are affected.' "I have stated that the question which I have been repeatedly asked is this-will we ever be justified' in using the vapour of ether to assuage the pains of natural labour? Now, if experience betimes goes fully to prove the safety with which ether may, under proper precautions and management, be employed in the course of parturition, then, looking to the facts of the case, and considering the actual amount of pain usually endured (as shown in the above descriptions of Merriman, Naegele, and others) I believe that the question will require to be changed in its character. For, instead of determining in relation to it whether we shall be 'justified' in using this agent under the circumstances named, it will become, on the other hand, necessary to determine whether, on any grounds, moral or medical, a professional man could deem himself 'justified' in withholding, and not using any such safe means (as we at present pre-suppose this to be,) provided he had the power by it of assuaging the agonies of the last stage of natural labour, and thus counteracting what Velpeau describes as 'those piercing cries, that agitation so lively, those excessive efforts, those inexpressible agonies, and those pains apparently intolerable,' which accompany the termination of natural parturition in the human mother." On the 23d of February, Baron Paul Dubois, Clinical Professor of Midwifery at the Faculty of Paris, read a paper to the Academy of Medicine in that city, detailing his experience of etherization in the practice of Midwifery. His conclusions are the following. 1. It has the power of preventing pain during obstetric operations; such as turning, application of forceps, &c. 2. It may momentarily suspend the pains of natural labour. 3. It does not suspend uterine contraction, nor impede the synergetic action of the abdominal muscles. 4. It appears to lessen the natural resistance which the perineal muscles oppose to the expulsion of the head. 5. It has not appeared to exert any bad influence over the life or health of the child. Notwithstanding, he is not sanguine of its general applicability to obstetrics; and concludes with an opinion that its use should be "restrained to a very limited number of cases, the nature of which ulterior expe |