SUPPLEMENT TO THE MAY NUMBER OP THE JOURNAL OF THE GYNECOLOGICAL SOCIETY OF BOSTON. A REPLY TO DR. JACOB BIGELOW’S SECOND LETTER. Sik James Y. Simpson, Edinburgh. [Communicated to the Society, and received April 28,1870.] Note. The appended letter was received after the May number of the Journal had gone to press. It is published at once, in accordance with Prof. Simpson’s desire that it should appear in this country before its publication in Europe, and through the medium of the Gynaecological Society. Dr, S. lies very ill, possibly never to recover, and the letter was written by dicta- tion. Under these circumstances, it will be read with the more interest, and will be found a bitter pill to swallow, though an effective one, by the gentle- man to whom it is addressed. Editors. My dear Sir : A few months ago I saw in an American general newspaper the gratuitous attack upon me which you had published in the “ Boston Medical and Surgical Journal,” but of which you had for- gotten to send me either an intimation or a copy, doubtless from accident, and not from intentional discourtesy. Towards the begin- ning of the present year, I sent, in reply to your groundless accusa- tion, an answer in the form of a letter to yourself; and subsequently I received from you a written note, in which you stated you were “ not disposed to pursue the subject further.” In consequence, I dismissed the matter entirely from my mind; and I deeply regret, both for your own sake and for the peace and character of our hon- orable profession, that you have not adhered to your resolution. For I have just received a slip of printed statement, unaccompanied by one word of writing, but drawn up in the form of another letter from you to me, in which you continue the subject in terms perhaps 2 still more bitter and personal than before. On first perusing it, my impression was that it was too querulous in tone and temper to de- serve an answer. I then thought of sending back a reply to you, stating, simply and briefly, that the new imputations in it were, one and all of them, without a shadow of foundation in fact, and even more worthless than those in your first. But, on reperusing it, it struck me that you were considering yourself a representative and champion of the Boston School of Medicine, and that it might be well, once for all, to answer you as such even more fully and per- fectly than I had done; and thus state, in my opinion, the great things which the Boston School had done and had not done —in the cause of anaesthesia; and how mistakes and errors might pos- sibly have originated on the subject, between your city and other places, which I trusted could be fully removed. Hence pardon my addressing to you the following observations : I.—-TENDENCY TO CONFUSION, FROM THE DISCOVERY OF CHLOROFORM RAPIDLY FOLLOWING THAT OF SULPHURIC ETHER. From some communications which I have lately received from America, I find that your observations have stirred up there, in some minds, the idea that I have held up the introduction of chloroform as an anaesthetic in Edinburgh to be antecedent, in point of time, to the introduction of sulphuric ether in Boston. I feel sure that and I will mutually agree that never anything so wild or extravagant was hinted or suggested by either of us. The first case of an anaesthetic operation under sulphuric ether occurred at Boston on the 30th Sep- tember, 1846. The first case of an anaesthetic operation under chlo- roform occurred at Edinburgh on the 15th November, 18.47. During the intervening thirteen months I had worked much with sulphuric ether in midwifery, etc.; and some of our surgeons, here and else- where, had used it more or less extensively ; but it was not by any means adopted by all. At the same time, you must allow me to remark that the ideas on the subject in your own mind, which have excited you to write, have, it appears to me, become chiefly bewildered and confused in conse- quence of one thing, namely, of the rapidity with which chloroform thus followed as an anaesthetic after the discovery of sulphuric ether; and in consequence also of the relative practical adaptability and superiority of the former in many respects, leading speedily to its general substitution in Europe, Asia, Australia, etc., for the latter. 3 In the “Dispensatory of the United States of America,” Drs. Wood and Bache, when speaking of the use of sulphuric ether for inhalation in medicine, observe: “ Many years ago [1796, etc.] its use in this way was proposed by Drs. Beddoes, Pearson, and Thornton, in England, as a remedy in certain diseases of the lungs. As early as 1805, Dr. Warren, of Boston, employed ethereal inhalation to relieve the distress attending the last stage of pulmonary inflammation. About the year 1812, in Philadelphia, at a time when nitrous oxide was the subject of popular lectures, the vapor of ether was fre- quently bx*eathed from a bladder for experiment or diversion, and its effects in producing a transient intoxication analogous to that caused by the nitrous oxide were observed.” Now, if in Boston in 1805, or in Philadelphia in 1812, the inhalation of sulphuric ether had been tried to a sufficient depth for its anaesthetic effects to be discovered in dentistry and surgery,—while the superior anaesthetic powers and higher practical properties of chloroform in midwifery as well as in surgery remained undetected till 1848, then all this storm of mist and obscurity, which has been attempted within the last few months to be stirred up on the matter, would have been an entire failure, or indeed an entire impossibility. For while the glory of first discovering the induction of surgical anaesthesia by the vapor of sulphuric ether would have been, as it undoubtedly is, American in its birthplace and origin, a Lord Provost of Edinburgh in 1869,— or forty or fifty years afterwards, knowing and looking to the fact that chlbroform in Scotland and in other parts of Europe, etc., had for the previous twenty years, if not entirely, yet nearly entirely, superseded the use of sulphuric ether, and by its general adoption diffused greatly and everywhere the practice of anaesthesia— might surely, without vindictive challenges and reexamination on your part, have ventured to speak; of “ the discovery and application of chloroform to the assuagement of human suffering ” as “ the greatest of all discoveries in modern times in connection with medicine.” * An illustration, however, may show my meaning better than an ab- stract statement. We have now at present in practice various means of abolishing the pain attendant upon surgical operations, as nitrous oxide gas, sulphuric ether, chloroform, etc.; and the olden surgeons had others. We have various means also of arresting the hemor- rhage attendant upon these operations, as cauterization, torsion, deli- gation, acupressure, etc. These hemostatic means all arrest hem- • Seo the report of the Lord Provost’s speech as given in the “ Scotsman” of 27th Oc- tober, 1869, copied into the “Journal of the Gynaecological Society” of Boston for December. 4 orrhage by closing up, in one way or other, the open mouths of the cut vessels. They get at one and the same end by three or four dif- ferent means ; but because these means have been suggested at three or four different and distant times, any one displacing the former does not of necessity require to be apologized for and denounced, as you seem rather to think ought to be the fact in the case of anaesthet- ics. Or take another illustration : The greatest thought ever per- haps broached in practical medicine, was the suggestion in relation to small-pox, and to probably other fatal diseases, destined to occur only once in life, that their severity and fatalit}7 might be averted, if, instead of the contagious poison producing them being allowed to enter in limitless quantities into the body by respiration, it could be inserted in very small and definite quantities, by inoculation through the skin. Hence small-pox inoculation, and the wonderful protection obtained by it against the fatality of small-pox , an idea brought from Asia and Turkey, and acted on in England in the be- ginning of the last century. Ere, however, the century was closed, a new variety of matter was proposed to be inoculated by Dr. Jenner, and proved infinitely a greater success. The material used by the old Asiatic and Turkish inoculators was small-pox matter taken di- rectly from pustules on the bodies of human beings who were infected with small-pox. The material used by Jenner was small-pox matter taken from the pustules produced on the udders and nipples of cows who were infected with small-pox poison. That vaccination was thus a modification of small-pox inoculation has never, however, been al- lowed to detract one iota, I believe, from the merit of the great patho- logical and practical revolution produced by Dr. Jenner. And the two discoveries, —or two prophylactics against small-pox, the Asiatic and English, have never clashed and been entangled together ; for they were in our own country upwards of half a century or more separate from each other in the date of their introduction and discov- ery. Neither, I think, would the relative merits of the two anaesthet- ics, the American and the English, sulphuric ether and chloroform, have been commixed in the manner in which they have been confused by you and others, had their discoveries been separated by upwards of half a century also. 2. EARLIEST ANAESTHETIC OPERATIONS IN AMERICA, AND THEIR CONNECTION WITH HARTFORD AND BOSTON. At the present time three kinds of anaesthetics are principally and specially used in practice, namely : 5 1. Nitrous oxide gas, now, I believe, employed extensively in den- tal surgery, etc.,* since it was reintroduced a few years ago by Dr. Evans, of Paris; but originally suggested by Sir Humphrey Davy, in 1800, and and successfully employed by Dr. Horace Wells, in Hartford, in 1844. 2. Sulphuric ether, first used by Dr. Morton, at Boston, in 1846. 3. Chloroform, first employed in Edinburgh, in 1847. There have been latterly used, also, from time to time, various minor anaesthetic agents, but none of them, I believe, to any great practical extent; though in all likelihood some will yet be discovered with qualities superior to any we as yet know. In my former letter to you, and on different other occasions, I have, with other writers, shown that the ancient surgeons Mediaeval, Roman, and Greek were long employed in the search after surgical anaesthetics, and so far succeeded, by making their patients inhale the fumes of narcotic vegetable extracts, drink solutions of them, etc., etc. Apparently afraid that the history and uses of these olden surgical anaesthetics would detract from the merit of the Medical School of Boston, in the discovery of the anaesthetic properties of sulphuric ether, you bitterly denounce in your letter to me the study and consideration of them. Rest assured that no wishes or declamations, either on your part ox- mine, will wash out or obliterate that or any other point of the past histox-y of surgery. “ I did not desire,” you exclaim, “to provoke this mediaeval history.” But was not your sole cause of complaint against me, this, that in speaking to the Town Council of Edin- burgh one or two sentences regarding chloroform, I omitted most erroneously in your opinion to refer to, or speak of, the past his- tory of anaesthetics, say for a quarter or half a century backward? “ Your prolix mediaeval history,” you again querulously complain, “is simply irrelevant, and its application illogical.” It is in no de- gree illogical; but I believe that it would have been quite irrelevant if brought before the Town Council of my native city. My letter to you, as you further again bitterly observe, is “ occupied with a cloud of antiquarian dust, of which the only apparent result is to obscure the truth and ci-eate a confusion in the mind of the readers, in the midst of which chloroform may be advantageously introduced.” Surely, my dear sir, this undignified and calumnious sentence is un- worthy alike of the heart and of the pen of Dr. Jacob Bigelow, and requires no answer from me. * See, for example, papers in the last numbers of the London “ Lancet ” by Mr. Fox, on the use of Nitrous Oxide as an Anaesthetic in Surgery. 6 But, dismissing the history of the olden forms of anaesthetics, let me direct your attention for a moment to an episode in their more modern history connected with Boston and its Medical School. You properly claim for yourselves true and vast merit from the discovery and application of sulphuric ether in dentistry and surgery. Indeed, you almost seem to me to insinuate in your let- ter that the medical world should have been ever afterwards con- tented to use sulphuric ether, and it alone, since you now argue and hold that sulphuric ether (see your last letter) formed a “ discovery of wonderful perfection at its very outset.” Yet, I think, however, Dr. Channing (pp. 322 and 337) alludes to you yourself using chlo- roform in some midwifery cases ; and early in the practice of ether- ization in midwifery, I found that no busy obstetric practitioner could extensively employ sulphuric ether without inevitably carrying about with him, and upon his clothes, an odor so disagree- able to many other patients and other houses, as to make his presence there aught but desirable. Other Boston surgeons have tried, at least, other anaesthetics besides sulphuric ether, as if they did not look upon it in the way of “ perfection,” as you do. I have read of your accomplished son, Dr. Henry Bigelow, excising the mamma after he had placed the patient under the anaes- thetic influence of nitrous oxide gas. In your two late articles you have carefully eschewed all reference to this last special anaesthetic, in despite of its being now largely and successfully employed in Paris, London, and elsewhere, in tooth-extraction. I wish, on the contrary, to recall your attention particularly to it. For let me here again put you in mind that the first anaesthetic operation under sulphuric ether at Boston occurred on the 20th September, 1846, when Dr. Morton drew a tooth from the head of Eben Frost, who had been previously placed under the influence of the anaesthetic vapor. Nearly two years previ- ously, however, or on the 11th December, 1844, the same anaesthetic operation was as successfully performed at Hartford, the anaesthetic inhaled being not sulphuric ether, but nitrous oxide gas, and the pa- tient'being Dr. Wells himself,* to whose mind the idea had suggested * The account which Dr. Biggs has given, in his official examination in 1852, of this first anaesthetic operation in America, is sufficiently graphic. Messrs. Cooley, Wells, Colton, etc., were present. Dr. Biggs says: “A few minutes after I went in, and, after conversa- tion, Dr. Wells took a seat in the operating chair. I examined the tooth to be extracted with a glass, as I usually do; Wells took a bag of gas from Mr. Colton, and sat with it in his lap, and I stood by his side; Wells then breathed the gas until he was much affected by it; his head chopped back; I put my hand to his chin; he opened his mouth and I extract- ed the tooth; his mouth still remained open some time; I held up the tooth in the instru- ment, that the others might see it; they standing, partially behind the screen, were looking on. Dr. Wells soon recovered from the influence of the gas, so as to know what he was 7 itself on the night previously, that a person under a deep dose of nitrous oxide might not feel, when in that state, the pain of tooth- drawing and other operations, because he had seen Mr., now Colonel, Cooley wound his limbs severely against the benches without feeling any sulfering from these injuries.* A short and adequate experience of a dozen or more cases soon satisfied Dr. Horace Wells and others that teeth could in this way be extracted without pain.f however much trouble there might be in pre- paring and applying the gas with the imperfect means then in exist- ence. His affidavits of its success (see foot-note) are unchallengeable. His friend, Dr. Riggs, drew six teeth from one patient, at one sitting, without any suffering whatever. During this time, also, he seems to have discovered the great point which we now know to be so essential in the successful exhibition of nitrous oxide, namely, that it should be breathed as pure as possible, and without any mixture of atmos- pheric air.J Elated with his discovery, he in a week or two proceeded to Bos- ton, in order to lay it before the medical faculty there, and show its effects ; and first made it known there according to his own ac- about, discharged the blood from bis mouth, swung his hand, and said, ‘A new eba in tooth-pulling.’ He said it did not hurt him at all. We were all much elated, and con- versed about it for an hour after.”— (See “ Appendix, Mr. Colton’s Statements,” p. 95.) * This occurrence took place at a public exhibition of, and lecture on, laughing gas, at Hartford, by Mr. Colton. The advertisement for Mr. Colton’s lecture, published in the “ Daily Times,” of December 10, 1844, has been republished in the “Daily Journal” for February of the present year. “ The entertainment,” says the advertisement, “is scientific to those who make it scientific.” For a full account of the effects produced by the gas upon some of the most distinguished men in Europe, Mr. Colton refers to “ Hooper’s Medi- cal Dictionary,” where an abstract of the experiments of Sir Humphrey Davy is given. f In his pamphlet, and elsewhere, Dr. Wells brings forward sworn affidavits, from differ- ent patients, of the anaesthetic effects of the nitrous oxide gas. Thus, for example, Mr. Bur- leigh states that, after having had an opportunity of witnessing its effects on several persons, he himself breathed it, and he adds, “ two carious teeth were extracted from my lower jaw without the least suffering on my part, though, ordinarily, owing to the firmness with which my teeth are fixed in my jaw, I suffer extreme pain from their extraction.” “ Dr. Wells,” states Mr. Goodrich, “ was most successful in extracting for me a large, firmly set, bicuspid tooth, without the slightest sensation of pain. I also witnessed, soon after, a repetition of the same process by Dr. Wells upon several individuals, accompanied in every instance with perfect success,” etc. j; See Dr. Morton’s volume of “ Official Documents,” p. 29, etc. “ The less atmospheric air is admitted into the lungs, with any gas or vapor, the better, the more satisfactory will he the result of the operation.” Dr. Morton, unaware of the rules for breathing nitrous oxide, denounces this observation of Dr. Wells as “inconsistent with fact.” “This agent” nitrous oxide— “never,” stoutly avers Dr. Morton, “was, nor can it ever be of any value.” (Official volume, p. 12.) Dr. Morton’s first chapter in this volume against nitrous oxide reads now, I fear, as only an exhibition of jealousy and ignorance; and Prof. Jack- son’s letter against Dr. Wells (see p. 472, of the same volume) is still more painful and inexcusable in its tone and character. 8 count —to Drs. Warren, Hayward, Jackson, and Morton, the last gentleman being a former pupil and partner of his own, and destined to be the future discoverer of anaesthesia by sulphuric ether.* A case of amputation was about to be performed by Dr. Hayward in the Massachusetts Hospital, but was put off for some days. After Dr. Wells had addressed Dr. Warren’s class on the subject, it was proposed that the anaesthetic should be tried in a case of tooth-extrac- tion. “ Accordingly,” writes Dr. Wells, “ a large number of stu- dents, with several physicians, met to see the operation performed, one of their number to be a patient. Unfortunately,” he continues, “ for the experiment, the bag was withdrawn much too soon, and he was but partially under its influence when the tooth was extracted. He testified that he experienced some pain, but not as much as usu- ally attends the operation.” The audience pronounced it a humbug affair and an imposition, and Dr. Wells was hissed away, left Bos- ton, and gave up, for a time, his profession in disgust and vexation. “He was laughed at,” contemptuously writes Dr. Charles T. Jackson, “ for his pretensions, and left Boston. No one ever believed in his story.” (“Official Documents,” p. 472.) According to the state- ments of Dr. Morton (who accompanied him as his friend and former partner), “ the spectators laughed and hissed ; the meeting broke up, and we were looked upon as having made ourselves veiy ridiculous.” (See “ Official Documents,” p. 47.) In these experiments, Dr. Wells, as I have said, used the niti’ous oxide gas, which in 1800 Sir Hum- phrey Davy had in England found capable in his own person of re- moving intense physical pain, and which he consequently suggested as “ capable of destroying physical pain during surgical operations in which no great effusion of blood takes place.” In your late letter to me, however, you maintain that “ Sir Humphrey Davy,” to quote your own extraordinary words, “ must be exonerated from all practi- cal knowledge of anaesthetic inhalation, otherwise he is chargeable with all the tortures of amputation and lithotomy which have taken place since he made the discovery and concealed it.” You have used, I know, the same wild and irrelevant argument against Dr. Jackson which you here use against Sir Humphrey Davy, forgetting that their profession was that of chemists and not of surgeons. Have you re- ally any hope or expectation that, either in Boston or elsewhere, such a violent observation as I have just now quoted, will blot out and erase in some cabalistic way the remarkable fact that Sir Humphrey * See the appendix to Dr. Morton’s volume of “ Official Documents,” pp. 11, lb 15, etc., and Dr. Wells’ pamphlet about the history of the discovery of the application of nitrous oxide gas, p. 6, etc. 9 Davy, seventy years ago, relieved intense physical pain in his own person hy breathing nitrous oxide gas, or that he suggested that it might be used as an anaesthetic in some surgical operations, and published the suggestion? But now mark what subsequently occurs. An American dentist works out to its practical results the suggestion published in Eng- land half a century before by Sir Humphrey Davy, and which you seem to wish to efface from anaesthetic records ; and he travels a long distance to place the important result before the Medical School at Boston, and some surgeons of the Massachusetts Hospital. There is a slip in the single experiment allowed him. He is spurned and hooted away. In doing this the Medical School of Boston thus de- lays the whole subject of artificial surgical anaesthesia for a couple of years. Was not the Medical School of Boston then, in your violent language, “ chargeable with the continuance of operative tortures,” for that period, much more than Sir Humphrey Davy? Did not your school stamp out and thus prevent for two years more the “ most beneficent discovery,” to use again your own grandiloquent words, “ which has blessed humanity since the primeval days of paradise ” ? I am using here not my language and logic, but yours. It is perhaps here unnecessary to add that there is sufficient evi- dence that Drs. Wells, Marcy, and Goodrich debated the question together whether sulphuric ether would not be an agent preferable to nitrous oxide in these experiments. (See “ Official Documents,” pp. 26, 27, and 43, Appendix, pp. 87, 111, 114.) But Dr. Marcy thought nitrous oxide the safer and pleasanter of the two, and also more easy to inhale. In the Essay in which your son first describes the inhala- tion of sulphuric ether in surgery, he points out its similarity to nitrous oxide.* “ Ether inhaled in vapor,” he says, “is well known to produce symptoms similar to those produced by the nitrous oxide.” (See Paper read before Boston Society of Medical Improvement, 3d November, 1846.) But the step from using nitrous oxide to using sulphuric ether was great and momentous in its results. Dr. Morton, who, as his friend and old partner, assisted at Dr. Wells’ experi- ment at Boston, no doubt knew all the results obtained at Hartford, where he twice visited Dr. Wells after 1844; and he evidently, be- * In the volume of “ Official Documents/’ p. 372, there is one case entered, suggestive of the applicability of artificial anaesthesia from breathing sulphuric ether, quite similar to Colonel Cooley’s experience with regard to nitrous oxide. “ A young gentleman, ten years since, who is now a physician, was inhaling ether for amusement, as was the custom at Harvard College. He took enough to make him so insensible that he fell upon the floor. In falling he cut his head badly. On recovering he was unaware that he had injured himself at all.” 10 times, got the speculation into his mind that sulphuric ether might prove successful. From a different line of observation, Professor Charles Jackson was led to the entertainment of the same speculation. Assisted, apparently, by one or two hints from Dr. Jackson regard- ing the pure quality of the ether, or, possibly, its easiest mode of exhibition, Dr. Morton verified the speculation on the 30th Septem- ber, 1846, by operating on Eben Frost, and fixed that date as an era in science. 3.—ETHERIZATION, OR ANAESTHESIA, IN MIDWIFERY. The first operations under anaesthetic inhalations in America oc- curred, therefore, as we have seen in the last section, at Hartford, and not in Boston. In Hartford it was effected by an anaesthetic gas, long before suggested by Sir Humphrey Davy. But at Boston you at first retarded, for a time, the whole progress of anaesthesia, by rejecting the evidence of it offered you by Dr. Horace Wells. For, to quote the words of Dr. Riggs, “ there (in your school) he met with a recep- tion so cold that, after a single imperfect trial of the gas, amidst the sneers of those around him, he left Boston in disgust, and sick at heart at the unfair disposition manifested towards him.” Besides erring in this direction you must permit me to add that in my opinion some of the Boston physicians have also erred in quite an opposite direction. For, after once making the discovery of the superinduc- tion of anaesthesia by sulphuric ether, you seem inclined to hold that the subsequent merit of everything connected with etherization be- longs to Boston, and to Boston exclusive^. The object of your first article on the present subject was to show that, because when I received the burghership of Edinburgh, I omitted to allude to the previous use of anaesthetics at Hartford and Boston, I was therefore deliberately guilty of trying to appropriate what be- longed to my American brethren. In ray reply to you, whilst showing that I was entirely guiltless of any such appropriation in thought or in word, I pointed out that, strangely enough, you yourself were in the same article openly and .flagrantly guilty of the unprofessional misdemeanor of which you accused me ; for, in claiming, as you there did, for Boston the introduction of anaesthetic inhalations, in obstet- rical practice, you attempted to annex and appropriate to your coun- try what most indubitably belonged to mine. In your last letter you begrudgingly state to me, “ I do not now question that you were the first to use ether in labor;” and then you superciliously add, “ but who first introduced anaesthetics in ob- 11 stetrical practice is a matter of limited importance.” According to the testimony, however, of onr late mutual friend, Sir John Forbes, the application of anaesthetics to midwifery involved many more difficult and delicate problems than its mere application to dentistry and surgery. New rules required to be established for its use, the time during which it could be given ascertained, its effects upon the action of the uterus, upon the state of the child, and upon the parturient and puerperal state of the mother, etc., all required to be accurately studied. Would it increase or diminish the tendency to convulsions, hemorrhage, and various other complications? Moral and religious questions also came to be involved, and required to be duly answered. The Boston patent for the use of sulphuric ether, taken out by Drs. Morton and Jackson, did not, I believe in- clude its employment in midwifery; and your son, Dr. Henry Bige- low, weeks after its use was first begun, deemed it only “ adapted to operations which were brief in their duration, whatever be their severity. Of these, the two most striking, perhaps, are amputations and the extraction of teeth.” * This was published in November. When I saw Mr. Liston in London, during the following Christmas holidays, he expressed to me the opinion that the new anaesthetic would be of special use to him, who was so swift an operator, as he thought, like Dr. Bigelow, it could only be used for a brief time. I went back, however, from this London visit to Edinburgh, bent on testing its applicability to midwifery, and found that it could be safely used for hours, etc. But is its application to midwifery of “ limited importance,” as wow in the fervor of disputation you seem anxious to affirm? Your words in your first article regarding the commencement of anaesthetics in Boston are these: That anaesthetic inhalation “began in this coun- try, and was first used in the extraction of teeth, and afterwards (2) in capital operations in thefMassachusetts General Hospital; and (3) in obstetrical practice.” You adduce thus three kinds of practice in which it was used in Boston, —namely, (1) dentistry ; (2) surgery ; and (3) midwifery. You have omitted medicine, probably because you well knew the employment of the inhalation of sulphuric ether had been introduced (as we have seen in a previous part of this letter) into medical practice by Dr. Pearson half a century before. Holding, as you now affect to declare, that the use of anaesthetics in obstetrical practice is a matter of limited importance, upon what * See the paper which he read five or six weeks after the introduction of sulphuric ether before the Boston Society of Medical Improvement, as cited in Brook’s Essay on the Vapor of Sulphuric Ether, page 30. 12 ground, may I venture to ask, did you, only two or three months ago, in your first attack, adduce its application to midwifery as one of its three chief applications? Further, among these three chief applica- tions, may I ask you, in all honor and honesty, is its use not even in your opinion a matter of infinitely less importance in dentistry than in midwifery? Of the relative value of any new practice, such as artificial anaesthesia, we are bound to judge by its utility, not in any specialized practice, as that of a surgical hospital, but in the general practice of the general practitioner. Now most general practitioners have twenty or thirty cases at least of labor in which they may employ anaesthetics for every one case of surgery in which its use could be adopted by them; surgical cases being rare, and obstetrical cases common in general practice. You practise, and have, I bejieve, all along practised chiefly as a physician, and are hence, perhaps, no good judge in the matter ; but let me extract for you from the volume of “Official Documents ” published by your towns- man, Dr. Morton, the opinions of one or two general practitioners on the subject. “It is,” says Dr. Appleton, “in obstetric practice that I have most frequently used these most valuable agents, and I regard their usefulness in this relation as among the most valuable results of their discovery.” “In private practice,” writes Dr. Ellis, “ its most happy and beneficial effect is in obstetrics . . . , its benefit, if in no other, in this class of cases alone, is the greatest discovery in any age of the world for the relief of suffering humanity.” (See vol. of “ Official Statements,” pp. 180, 182.) You profess to deem it a “ matter of limited importance ” who first introduced anaesthetics into midwifery. Perhaps it is so. But you will excuse my adding that at the time of the first application of anaesthesia to obstetrical practice, - amidst the hundreds and thou- sands of practitioners who were then engaged in midwifery in the Old and the New World, I happened to be the first who took up the subject and worked out most of the problems connected with it. Any one of these hundreds and thousands might certainly have done the same, but did not do it. Let me here add that I would not have dwelt thus long upon the application of anaesthetics to midwifery, did I not feel compelled to add that other of your medical townsmen have seemed quietly on this head to have tried like you also to appropriate to Boston what belongs to Edinburgh, Thus Dr. A. A. Gould, in his official deposition in 1852, speaks of “the first administration of sulphuric ether in obstetrics by Dr. N. C. Keep,” * of Boston, as “ a similar step in the * Dr. Keep’s case happens to bo described by Dr. Channing in such words as to leave it 13 discovery ”as anaesthesia in dentistry and surgery. In my former letter, however, to yon, I showed you that Dr. Keep’s case, here alluded to by Dr. Gould, did not occur in Boston till weeks and months after the practice of anaesthesia in obstetrics had been fully studied and established in Edinburgh. Besides, I find now, on look- ing over the large volume published on Etherization in Midwifery, by my friend, and your townsman, Dr. Channing, that avoiding all allusion to the midwifery cases reported, and the papers published upon etherization in midwifery, in Edinburgh, weeks previously to the occurrence of Dr. Keep’s case in Boston he speaks also of Dr. Keep’s as if it were the first instance in which ether had been em- ployed in obstetrics. But this, perhaps, is merely an omission, as in a holograph inscription of his volume to me, Dr. Channing duly acknowledges that I was the first to introduce anaesthetics into ob- stetrical practice ; and, in the dedication of his work, he speaks, let me add, of midwifery as being a department which has derived “ special and vast benefit ” from the application of anaesthetics. According to your reasoning ( ?) in the case of Sir Humphrey Davy, the great philosopher “ must be exonerated from all practical knowl- edge of anaesthetic inhalation ; otherwise he is chargeable with all the tortures of amputation and lithotomy ” which have taken place from his time till the end of 1846. According to the same ratiocination, were not you and the other accoucheurs of Boston chargeable with all the tortures of childbirth and parturition borne by the female population of that city for months onwards after October, 1846 ; or, till the knowledge of the mode of relieving them from these tortures was sent out from Edinburgh, seeing the use of ether in labor was a matter of “ limited importance,” and could or should have been dis- covered months previously in your city, and not in Europe ? 4. ALLEGED NEGLECT OF AMERICAN CLAIMS IN WRITING A SKETCH OF THE HISTORY OF ANES- THETICS. The chief or only subject of your attack upon me in your first article was the frivolous allegation that, when last year I received the honorary burgess-ship of Edinburgh, and when I had to speak on various and different topics, I omitted to do justice to your city and equivocal whether or not it was the first obstetric instance in which sulphuric ether was given in Boston or America only, or in the world. Dr. Channing’s account of it is as follows: “ The anaesthetic power of sulphuric ether, when inhaled, was first used in childbirth in this city, in a case of natural labor, on the 7th of April, 1847, by Dr. N. 0. Keep, and was successful.” (“Etherization in Childbirth,” by Channing, p. 26.) 14 to America, by omitting to talk of the discovery of sulphuric ether as an anaesthetic, when I was called upon to answer an observation or two of the Lord Provost’s on chloroform.* In your last letter, following out the same jealous strain of com- plaint, you argue that, besides the alleged omission in an impromptu speech, I was guilty, in an article which I had calmly written upon chloroform in the “ Encyclopaedia Britannica,” of not doing “justice to the great American discovery.” The article in question was printed in a volume of the “ Encyclopaedia ” for 1854, and has been republished in the second volume of my works, collected and edited by Drs. Priestley and H. R. Storer. In that article, after defining chloroform and stating its composition, modes of preparation, physical, chemical, and physiological pi’operties, I have described at length the various therapeutic uses to which it, and consequently any other similar anaes- thetic, could be applied in surgery, in midwifery, in medicine, and in medical jurisprudence; and ultimately I occupied the last three columns of the article by a brief historical sketch of the various anaes- thetic agents which had been used previously to the introduction of chloroform. And this historical sketch is the special object of your new attack. In giving, in my lectures and otherwise, a history of anaesthetics, I have sometimes traced them from the earliest known periods down- * Lest there be any mistake regarding the grounds or supposed grounds of all the war which you have tried to stir up against me, let me here cite in full the Lord Provost’s remarks on chloroform, and my reply to them. The Lord Provost, let me state, was one of the most intelligent and intellectual men of the age, William Chambers, Esq., the well- known author and publisher. His address to me in presenting the burgess ticket was spoken extempore, and I find that his words on chloroform are somewhat differently re- ported in our three morning journals. The version most favorable for you is the one you select,—the “Daily Review,” and is as follows: “ I will not dwell on what you have accomplished in medical science. I will only allude to your discovery, the greatest of all discoveries in modern times, —of the application of chloroform in the assuagement of human suffering. That was a great gift to mankind at large, and it well befits us, the Corporation of Edinburgh, to mark our sense of the great act of beneficence on your part by this small compliment.” His Lordship subsequently alluded to my writings on Acupres- sure, Hospitalism, etc., etc. With regard to the observations on chloroform, I replied in the two following sentences: “You adverted to the discovery of the anesthetic effects of chloroform. Perhaps you will allow me to state that there are various manufactories of it in Great Britain, and that a single one of these, located in Edinburgh, makes as many as eight thousand doses a day, or between two million and three million of doses every year, evidence to what a great extent the practice is now carried, of wrapping men, women, and children in a painless sleep during some of the most trying moments and hours of human existence; and especially when our frail brother-man is laid upon the operating table, and subjected to the tortures of the surgeon’s knives and scalpels, his saws and his cauteries.” (See Journal of the Gynaecological Society of Boston, December, 1869, p. 377.) 15 wards to the present day; but more frequently I have followed the in- verse order, because I have found it more instructive and interesting, namely, that of tracing them gradually backwards from their most recent to their most ancient form. I have followed this last method in the said article in the “ Encyclopaedia Britannica,” and have hence first mentioned chloroform as then the most recent anaesthetic in the two following lines: “ The vapor of chloroform was first proposed by Dr. Simpson as an anaesthetic agent in 1847.” I then, after these two lines, give above twenty lines ether, beginning thus: “ For a year previous the vapor of sul- phuric ether had been used to a considerable extent both in America and Europe, for the purpose of inducing insensibility to pain in sur- gical operations. It was first practically adopted for this purpose in 1846 by Dr. Morton, a dentist at Boston, in America. Subsequently Dr. Charles T. Jackson, of that city, claimed the right of having sug- gested to Dr. Morton sulphuric ether as an agent capable of produc- ing insensibility to pain. But the power of producing by the vapor of sulphuric ether an insensibility exactly like that produced by the in- halation of nitrous oxide gas, had been long previously known,” and so on through its history.* Thirdly, I allude to carbonic acid, as suggested by Dr. Hickman in 1828 ; fourthly, to nitrous oxide gas, as hinted at by Davy in 1800; fifthly, to compression of the nerves, as used by Dr. Moore in 1784 ; sixthly, to compression of the carotids, as suggested by Yalverdi and others in the sixteenth century ; seventhly, to the fumes and extracts of mandragora, Indian hemp, and other soporific drugs, as practised by mediaeval and ancient Roman and Greek surgeons. Now comes your strong and strange accusation or accusations. For first you hold, as far as I understand you, that the article was written for my “ self-exaltation,” or, to quote your own words, “in favor of the self-exaltation of the writer.” Of any such object I know and feel myself to have been utterly guiltless, either in this or any other of my writings. In the whole course of this long encyclopaedic article upon chloroform, if my object had been “ self-exaltation,” I might, * You underscore the expression used “ to a considerable extent,” probably with a view of indicating that that is doubtful; but such, I believe, was the fact here and elsewhere in the first year of etherization. In the “ Edinburgh Medical Journal” for September, 1847,1 find it stated by me (p. 153) that “during the last six months etherization has been used to a considerable extent in British surgery.” The editor of the same journal, in his December number, —• chloroform having been introduced in the interval, observes, “In Edinburgh it (chloroform) has been used publicly by all the surgeons of the Royal Infirmary [they had not all used ether], and its employment in midwifery practice is almost universal. Ether,” he adds, “has almost been abandoned,” (p. 456.) 16 not unjustly, have connected my name with several of the original suggestions and practices stated in the article ; but I have mentioned my name only once, and that in the brief historical sentence already quoted, and (I appeal to yourself or any honorable man) such mention was utterly unavoidable for the sake of simple historical accuracy, all such history inevitably involving an enumeration of names. But then comes your other accusation, that, in enumerating the dif- ferent methods of producing anaesthesia, I have adduced chloroform first, sulphuric ether second, carbonic acid third, nitrous oxide fourth, etc., to “ cover” —to use your own reprehensible words “ this in- version of historical order in favor of the self-exaltation of the writer, . . . who availed himself of this opportunity principally to place himself conspicuously in the foreground.” Believe me, I feel difficulty in commenting upon these criticisms of yours ; they are essentially so groundless and absurd; and I know them in my own heart to be so utterly untrue. If an American or English school-boy were asked to give a retrograde chronological list of the Presidents of the United States, or the Sovereigns of England, from the present time to the commencement of this century, would he not begin with Gen. Grant and Queen Victoria? According to your logic, however, that would imply “ self-exaltation” on the part of the pupil; and to avoid this, he ought to commence with King William the Fourth, and the Presidents Johnson and Lincoln. But would not such a strange historical obliquity and misstatement, if unhappily in- dulged in, bring down condign punishment and contempt on the dis- ciple? And is there not occasionally truth in the saying that “ sages sometimes do as foolish things as school-boys ” ? If I had the same history to re-write to-day, I do not know that I would or could write it in any different terms, except by pointing out more distinctly Dr. Wells’ claims, and also Dr. Jackson’s. And pray in what terms would or could you advise me that it should have been written, or should be written now? Ought Ito have broken out into some highflown sentence or sentences regarding the history of the anaesthetic effects of sulphuric ether, when I spoke secondly of that anaesthetic? Would it not, let me ask you, have been more natural—for me at least —to have done so in speaking of the history of the anaesthetic effects of chloroform, instead of dis- missing it in the two brief lines I have already quoted; seeing, especially, that I knew that it was employed in hundreds or even thousands of instances for every five or ten in which sulphuric ether was used? 17 I have, I find, printed another short epitome of the history of anaesthetics ; but lam not sure that it will please you better. In a paper on “ Etherization in Surgery,” published in September, 1847, the first of a series on this subject,— I take occasion to speak of Dr. Morton, of Boston, as “ the gentleman to whom I believe the profes- sion and mankind are really and truly indebted for first reducing into practice the production of insensibility by ether-inhalation, with the object of annihilating pain in surgical operations,” language stronger, I think, than I have seen in most American essays on the subject. And at the meeting of the Edinburgh Medico-Chirurgical Society, on November 10th of the same year, I laid before them a paper termed “ Historical Researches regarding the Superinduction of Insensibility to Pain in Surgical Operations ; and Announcement of a new Anaesthetic Agent.” This communication on the history of anaesthetics, like that in the “ Encylopaedia Britannica,” took up the subject in retrograde chronological order, beginning with sulphuric ether first, as chloroform was not known when it was drawn up a week or two previously. In the abstract of this historical paper, which appeared in the “ Edinburgh Journal ” (it was never published entire), I find that I traced out, at much length, the chemical and therapeutic history of sulphuric ether, and added as follows: “ Its power of producing, by inhalation, effects like intoxication, or like the influence of nitrous oxide gas, he (Dr. Simpson) showed to have been stated by various American authors, as by Professor Samuel Jackson (1833), Wood and Bache (1834), Miller (1846), before it was so fortunately adopted by Dr. Morton as an anaesthetic agent. His belief was, that Professor Charles .Jackson improperly claimed the merit pertaining to its recent happy application to surgery, etc. Perhaps the idea of relieving patients from the pains of surgery by some such means, or rather, the restoration of that idea in recent times (for it was an old one), belonged justly to Horace Wells.” (See “Edinburgh Monthly Journal of Medical Science ” for Decem- ber, 1847, p. 453.)* From the abstract of this paper it appears that I went chronologically backwards, through various old anaesthetic vapors and measures, to the use of the fumes of Indian hemp in the time of Herodotus. I then took up the last or second part of the paper, and showed the Society the newly discovered anaesthetic, chlo- roform, and its effects. * The epitome has been republished in a volume of mine on “ Anesthesia ” (p. 190), printed at Philadelphia in 1849; but it is not republished in the collection of my writings edited by Drs. Priestley and Storer. I have seen it repeatedly cited, at pretty full length, in American essays on anesthetics—. sometimes with, sometimes without, acknowledgment. 18 At the time at which this paper was read, we had, with almost every mail from America, statements and counter-statements sent as to who was the rightful claimant for the discovery of artificial anaesthesia; and what was conceived to be true the one month, was apt to be upset the next. In none of these statements have I, I think, done sufficient justice to the claims of Professor Charles T. Jackson, for I now believe he had more merit in the discovery than formerly I felt inclined to attribute to him, since I have latterly looked over the large volume of “ Official Documents ” on the matter, presented to “ the Select Committee appointed by the Senate of the United States.” If we try to put into a summarized form the data * which we have been discussing regarding the introduction of anaesthesia in America and this country, it appears to me that we might correctly state the whole matter as follows : 1. That on the 10th December, 1844, Dr. Wells had, at Hartford, by his own desire and suggestion, one of his upper molar teeth extracted without any pain, in consequence of his having deeply breathed nitrous oxide gas for the purpose, as suggested nearly half a century before by Sir Humphrey Davy. 2. That after having with others proved, in a limited series of cases, the anaesthetic powers of nitrous oxide gas, Dr. Wells pro- ceeded to Boston to lay his discovery before the Medical School and Hospital there, but was unsuccessful in the single attempt which he made, in consequence of the gas-bag being removed too soon, and that he was hooted away by his audience, as if the whole matter were an imposition, and totally discouraged. 3. That Dr. Wells’ former pupil and partner, Dr. Morton, of Bos- ton, was present with Dr. Wells when he made his experiments there. 4. That on the 30th September, 1846, Dr. Morton extracted a tooth without any pain, whilst the patient was breathing sulphuric * You must kindly excuse me if some of the data are not strictly accurate in every point, as you know how difficult it is to make medical aphorisms quite correct; for example, in the inscription which you represent as cut upon the monument, lately erected at Boston, to anaesthetics, namely, “To commemorate the discovery that the inhaling [the inhalation] of ether causes insensibility to pain, first proved to the world at the Massachusetts Gen- eral Hospital, in Boston, October, A.D. 1846;" there are, it appears to me, two errors. First, ether and sulphuric ether are two terms not at all synonymous, and still you have inserted the former for the latter. Secondly, it is not strictly true that the effects of sul- phuric ether were “ first proved to the world in operations at the Massachusetts General Hospital.” For to cite the more correct statement of Dr. Channing; “These operations were first performed in private practice, and immediately afterwards upon patients in the Massachusetts General Hospital.” (Channing “On Etherization,” 1848, p, 26.) 19 ether, this fact and discovery of itself marking a new era in anaesthe- tics and in surgery. 5. That within a few weeks the vapor of sulphuric ether was tried in a number of instances of surgical operations in Boston, Dr. Morton being generally the administrator; and ether vapor was established as a successful anaesthetic in dentistry and surgery. 6. That in January, and the subsequent spring months of 1847, the application of sulphuric ether as an anaesthetic in midwifery was introduced, described in our medical journals, and fully established in Edinburgh, before any case with it was tried in Boston or America. 7. That on the 15th November, 1847, the anaesthetic effects of chloroform were discovered in Edinburgh, and that it swiftly super- seded in Scotland and elsewhere the use of sulphuric ether, and extended rapidly and greatly the practice of anaesthesia in surgery, midwifery, etc. I am very sorry to have taken up so much of your time and my time with such a petty discussion as the present. It has extended to too great a length; but I am a sad invalid just now, and quite unable to write with the force and brevity required. With many of our profession in America I have the honor of being personally acquainted, and regard their friendship so very highly that I shall not regret this attempt —my last perhaps at professional writing as altogether useless on my part, if it tend to fix my name and mem- ory duly in their love and esteem. Yours, J. y. SIMPSON. Dr. Jacob Bigelow, Boston.