ANESTHESIA AND ANESTHETICS, 
BY J. W. TRADER, SEDALIA, MO, 
REPRINTED FROM THE TRANSACTIONS OF THE MEDICAL ASSOCI- 
ATION OF THE STATE OF MISSOURI FOR 1875. ANESTHESIA AND ANESTHETICS. 
BY J. W. TRADER, M. D., SEDALIA, MO. 
\_Reprinted from the Transactions of the Medical Asso- 
ciation of the State of Missouri for 187 5. 
The power of producing insensibility by general or local an- 
aesthesia is of comparatively recent origin. Although the ancients 
were possessed of a knowledge of certain medicines that would re- 
lieve, to some extent, the pains of surgery or surgical wounds, 
they evidently were not acquainted with anaesthetic agents as ap- 
plied at the present day. In the times of Achilles, and during the 
Trojan war, much praise was bestowed upon a reputed son of 
Aesculapius for the manner in which he so successfully relieved, 
by his applications, the wounds of the enemy's darts. When Ma- 
chaon fell in the conflict with Paris, the stern Achilles expressed a 
deep solicitude in the welfare of the wounded hero, and exhorts 
the valiant Nestor, to whose care he is entrusted, to use his best 
exertions in his behalf; "for a leech like him, who knows how to 
cut out darts and relieve the smarting of wounds by soothing un- 
guents, is to armies more in value than many other heroes." (In- 
troduction to Miller's Principles of Surgery.) After the days of 
Machaon, the profession seemed to abandon everything like sooth- 
ing applications in the practice of Surgery, and so painful were 
some of their operations, that the Surgeon was looked upon as an 
enemy, instead of a benefactor to mankind. Hippocrates recom- 
mended that "when medicine fails, recourse should be had to the 
knife, and when the knife was unsuccessful, to fire." Sometimes 
he applied red-hot iron to the part affected. Sometimes he raised 
a conflagration on it, and of it, by a piece of wood dipped in boil- 2 
ing oil." (Ibid.). Praxagoras of Cos, the last of the school of 
Asclepiades who succeeded in leaving a name behind him, is said 
to have been bold in the extreme, making incisions into the bow- 
els to remove obstructions, when milder means would fail. Erasis- 
tratus who flourished in the Alexandrian period, and practiced his 
profession under the auspices of Ptolemy Soter, is reputed to have 
been more heroic still. In scirrhosities and tumors of the liver, 
he did not scruple to make an ample division of the integuments, 
and try applications to that viscus itself. He followed the same 
practice in diseases of the spleen, which he regarded as of little 
consequence in the animal economy. (Ibid.) 
When the political flood swept over Europe, and transferred 
the seat of empire to Rome, under Julius Caesar, the abhorrence 
in which practitioners of surgery were held, caused an edict to be 
issued forbidding them to practice in the Republic, and calling on 
the people to depend upon "traditionary prescriptions and relig- 
ious rites," and to trust for restoration to health in the less pain- 
ful operation of incantations and spells. For six hundred years 
the Roman Empire had no regular practitioner of surgery. After 
the expiration of this period Archagathus, a Greek, from the Al- 
exandrian school, established himself in Rome. So deep, how- 
ever, was the prejudice of the people excited against the tortures 
of the profession, that Archagathus, after changing his original 
title from "healer of wounds" to that of executioner, was banished 
from the Roman capital. The antipathy against the regular pro- 
fession became so great, that any system which would offer a re- 
lief from the pain and torture of the doctors, would be recom- 
mended and received with pleasure. Charlatanism and ignorance, 
supported by some of the best minds of Rome, now made rapid 
strides, and the followers of the mythical Circe, hurried on by such 
an impetus, not only made dangerous inroads but absolutely reign- 
ed without a rival. Philosophy and the sciences began to wane. 
Egypt, Greece and Rome who in their turn had done so much to 
advance the arts and learning, and had given to the world Ma- 
chaon, Hippocrates, Praxagoras, Celsus and Galen, now refused 
to allow their profession practiced or taught. The deep Cimmer- 
ian gloom that overspread the world of letters, threatened forever 
to obscure the science of surgery and envelop it in a cloud of ig- 
norance and superstition. For nearly one thousand years were the 
voices silent that should bring it to light. The classic shores of 
Italy and Greece had now withdrawn the protecting shadows of 3 
the cross, and when the warlike followers of Mahomet, and the 
fiery descendants of Ishmael, promised protection in the Empire 
of the Crescent, the barbarous practices still clinging to our pro- 
fession, they too strangled it by royal edicts. It was not until the 
middle of the 18th century that the maxim "Dolor Medicina dol- 
oris" was taken away, and the lifeless form of Surgery resurrected 
from the remains of barbarism by the immortal Pott. A more 
humane and rational plan was now adopted. The practices of 
barbarism were set aside. Notwithstanding the great improve- 
ments of Pott, and afterwards of Hunter, it remained for the 19th 
century, and our own country to give to the world a perfect free- 
dom from pain, during surgical procedures, by the administration 
of an ansesthetic. 
The first attempt to introduce an anaesthetic to the attention 
of the medical profession was made by Mr. Horace Wells, of 
Connecticut, in bringing forward the nitrous oxide gas ; but his 
first attempts were unsuccessful, and were finally superceded by 
the discovery of etherization. 
In the latter part of the last century, Drs. Beddoes, Pearson 
and Thornton, of England, following, perhaps, the example of 
Hippocrates and some Arab physicians, who used certain remedies 
by inhalation, in lung diseases, tried the vapor of ether for a like 
purpose, but without producing anaesthesia. As early as 1805, 
Dr. Warren, of Boston, used the inhalation to relieve the dis- 
tress attending the last stages of pulmonary inflammation. In 
October, 1846, attention was first drawn to ether inhalations as 
an anaesthetic, and it was used in a dental operation by Dr. Mor- 
ton, of Boston, upon the suggestion, as is alleged, of Dr. Jackson. 
"From this beginning the employment of ether by inhalation, for 
the prevention and removal of pain, has spread throughout the 
civilized world." 
In the year 1831, Mr. Guthrie, of Sackett's Harbor, N. Y., ob- 
tained by distillation an article which he called chloric ether (but 
to which Mr. Dumas, of France, in a later communication, gave 
the name of chloroform,) that has, so far, outstripped all its pro- 
totypes. About the same time, Mr. Soubeiran, of France, and 
Liebig, of Germany, made a like discovery. Later still, Dr. 
Simpson, of Edinburg, by personal experiments, tested its practi- 
cal utility. 
The following table gives all the leading aneesthetics that have 
been experimented with, viz.: 
Nitrous Oxide, 
Ethylic Ether, 
Tetra Chloride of Carbon 
Chlorethylidine, 
Methylic Ether, 
Bichloride of Methylene, 
Bichloride of Ethylene, 
Bromide of Ethyl, 
Methyl-ethyl-ether, 
Chloroform, 
Methylal, 
Amylene, 
And we might add Chloral Hydrate. 
That these agents will all produce anaesthesia more or less 
perfect, cannot be doubted, but their behavior has not been sat- 4 
isfactory with the exception of a few, which we will now proceed 
to notice. 
Since the attention of the profession has been so earnestly 
directed to the investigation of anaesthesia, and the probability of 
finding out some more safe and reliable agent than chloroform, 
much has been said about sulphuric ether. It is claimed that it 
is free, or nearly sb, from danger, and quite as reliable and effi- 
cient as chloroform. In support of these assertions the names and 
experience of many leading men in the profession are brought 
forward. J. E. Petrequin, of the Hotel Dieu, Lyons, remarks 
that " complete anaesthesia can be produced by it with certainty 
and safety/'-[Boston Medical Journal, Oct. 1867, page 190.] 
Dr. Jackson, of Boston, who, as before stated, is supposed to 
have been the originator of the idea of anaesthesia by ether vapor, 
recognized that insensibility could be obtained in a very short 
time, but that it disappeared rapidly. The assertion of M. 
Perrin, in his Traite d'Ancesthesie Chirurgicale, that Dr. Jack- 
son considered anaesthesia from ether inhalation as being free from 
danger, is doubted by leading medical men in this country.- 
[Hay's Journal, Jan. 1867.] 
The Boston Medical Society, as well as Xhe Medical Society 
of Lyons, decided that the inhalation of ether vapor is absolutely 
free from danger. In referring to said decision, M. Giraldes, in 
the Dictionnaire de Medicine, decides that the Boston and Lyons 
Societies advanced a proposition much exaggerated, and that if the 
critical examination given to chloroform had been accorded to 
ether, "we should have arrived at a diminution of the number of 
mortal accidents which cast a shadow over its history. To say 
that ether is unaccompanied with danger, after all due care has been 
taken, is to assume partisan grounds. Upon investigation it will 
appear that this claim cannot be allowed." 
In Dr. Sansom's work on chloroform, nineteen cases of death 
from ether are referred to, as reported in the of Trous- 
seau. Dr. Saborth, in his Das Chloroform, says " thirty-six cases of 
death from ether are known to have been collected, so that in 
proportion to the frequency of the administration of chloroform, 
and the much less frequent use of ether, the number is a very large 
one."-[Hay's Journal, Jan., 1867, page 183.] 
The tabular statements given by the various authors upon this 
subject will only be approximately correct from the lack of suffici- 
ent reliable data It is not at all likely that every death is re- 
ported from any one of the agents used. Occasionally you will 
see a case of death from the use of some anaesthetic, wandering 
through the medical journals of the day, which, never enters into 
the general summary or finds a permanent place in medical litera- 
ture. 
Dr. E. Andrews, of Chicago, who has taken a great deal of 
pains in tabulating cases, both in this country and Europe, has 
very kindly furnished me the result of his labor. These tables in- 
clude surgical cases only, and give the following rate of mortality 5 
appended to each article; as follows : Sul. Ether, i death to 
23,204 administrations. Chloroform, 1 death to 2,723 adminis- 
trations. Mixed Chloroform and Ether, 1 death to 5,588 admin- 
istrations. Bichloride of Methylene, 1 death to 700 administra- 
tions. Nitrous oxide, no death in 75,000 administrations. Since 
the publication of Dr. Andrew's tables, one case of death from 
Nitrous oxide inhalation has certainly been reported, and no 
doubt others have occurred. 
According to the above showing, we will have a mortality 
from chloroform eight and a half times greater than ether. In re- 
gard to mixture of chloroform and ether, Dr. Andrews gives the 
following table of anaesthesias by mixture of chloroform and ether 
with accompanying deaths, viz. : Chicago statistics, 1 death to 
350 administrations. U. S. A. circular No. 6, no deaths to 2,326 
administrations. Guy's Hospital, London, 1 death to 8,500 ad- 
ministrations; making the mixture twice as safe as chloroform and 
four times more dangerous than ether. 
Dr. Sansom estimates that "'one case in seventeen thousand 
only have proved fatal from its use." His work, together with 
the Report of the Committee of the Royal Medical and Chirurgical 
Society of London, in 1864, may be said to contain the best re- 
sults of English investigation up to this date. This appears to be 
a small rate of mortality, although nearer the truth, in all proba- 
bility, than the strictures upon said work by Dr. Andrews, also of 
London, who, from the statistics he had been able to obtain, 
states that of eighty-three thousand and fifty-nine (83,059) cases 
in which chloroform was administered, twenty four proved fatal, 
or one in three thousand, four hundred and sixty-one. (St. Louis 
Medical and Surgical Journal, Dec. 1867.) 
In taking into account the number of fatal cases from the in- 
halation of chloroform, it must be allowed that many accidents 
occur from the careless and reckless manner in which it is adminis- 
tered ; other cases there are, where a constitutional incompatibility 
exists, in which it would not be just to attribute the death to chlo- 
roform. As may be shown by tabular statements, out of one hun- 
dred and thirty three cases of death from chloroform, only forty- 
nine could be said to have resulted exclusively from this agent; of 
these forty-nine cases, sixteen were attributed to shock, while 
thirty-three were "cases in which every precaution seems to have 
been observed, and no explanation of death can be given in the 
present state of our knowledge." Of the remaining eighty-four 
cases, thirty-three were "cases in which the report is so imperfect 
that a judgment cannot be formed as to the manner of death, or 
the share chloroform had in producing itthree were cases in 
which severe operations were performed, and in which, therefore, 
chloroform had but a share in producing the result; eleven were 
cases of death during administration to patients laboring under 
delirium tremens, or who were hard drinkers ; nine were from the 
shock produced by the surgical procedure. By the above state- 
ment it is shown that the great majority, or near two thirds of the 6 
deaths attributed to chloroform, were complicated with certain 
conditions of the system that would seem to contraindicate its use. 
These statistics, purporting to give the relative deaths from chlo- 
roform, are often prepared by strong partisan advocates, and 
while some few cases, that have proved fatal, may have been over- 
looked, the majority of those collected may properly be said to 
have had their origin, in whole or in part, to some anterior or 
ulterior agent. Some go so far as to rest their statement upon 
very uncertain foundations, including among the list of fatal cases 
those who had died several days after the administration of chlo- 
roform. "One of those," says Dr. Reeves, whom I shall have oc- 
casion to quote in several instances throughout this article, "writ- 
ing in favor of ether, in an American Journal, makes the state- 
ment that a French author had ascertained that there had been 
about two hundred deaths from chloroform as long ago as 1859, 
a number which increases to several hundred before his brief ar- 
ticle closes." 
The best statistical record we have, in all probability, is that 
of Dr. Snow, who up to 1858, had collected only fifty fatal cases. 
The report of Lallemand, Perrin and Duroy, in the Traite d' An- 
aesthesie Chirurgicale, dated 1862, contains seventy-seven cases. 
The Royal Medico-Chirurgical Society in 1864, report one hun- 
dred and nine; Saborth's Work, "Das Chloroform," dated Wurz- 
burg, July 1865, has a list of one hundred and nineteen. Mr. 
Sansom in his hand-book on chloroform, has recorded one hun- 
dred and seven, and it is a remarkable fact that the preponderance 
of fatal cases are those for trivial operations. The following is a 
list of the deaths : For minor operations, extraction of teeth, 
&c., 62. For operations of moderate severity, as removal of 
breast, 26. For capital operations, 7. For reductions of disloca- 
tions, 6. For delirium tremens and mania, 4. For natural la- 
bor, 2. 
Mental shock, if the term is admissible, no doubt operated as 
an important factor in many of those fatal cases. We know that 
this condition does some times exist. The case of Desault, is 
certainly a very remarkable one, in which he traced with his fin • 
ger nail the line of incision in the perineum of a patient bound 
up for the operation of lithotomy, and the man shrieked and died. 
The case of Sir Jas. Y. Simpson furnishes another example, and 
probably of more value, because chloroform was to have been ad- 
ministered for the first time, but owing to some delay in the prep- 
aration of the anaesthetic, the operation was undertaken without 
it, the patient dying after the first incision. Hence it is justly re- 
marked by Dr. Sansom, "It is reasonable to suppose that fright 
or apprehension may have had some share in causing the mortality 
among those who have succumbed before the symptoms of anaesthe- 
sia have been induced-that chloroform may have been but one 
(and that perhaps the least) among the influences." Dr. Richard- 
son, in his Medical history of England, has placed the number of 
deaths from inhalation of chloroform as one to seventeen thousand, 7 
as quoted by Dr. Sansom. Others claim a less per cent even than 
this ; as low as one death in twenty and twenty-three thousand 
inhalations. "Yet all these calculations differ much and assist us 
but little.'' Some persons have enjoyed complete immunity from 
accident, who have dealt with this agent for years, as in the case 
of Velpeau and Syme ; "and the instance of the French army in 
the Crimea with 30,000 administrations and no death, is remark- 
able.'' * 
In regard to the mode of action of anaesthetics upon the sys- 
tem, we cannot positively be assured. The evidence furnished 
by our best experimenters and observers is often unreliable and in 
some cases contradictory. There is no doubt but that all these 
agents are capable of acting in two ways, as we shall try to show 
as we proceed. It is not always possible for us to know whether 
the carbonization of the blood invariably takes place antecedent to 
anaesthesia or whether anaesthesia may not be produced by di- 
rect action on the brain through the nervous system, independ- 
ent of blood contamination. However, in all the experiments 
and observations reported where the condition of the brain under 
chloroform or ether could be seen, its vessels were filled with black 
blood. (A. J. Med. Sci., 1868, page 92.) Dr. Sansom, in a pa- 
per read before the British Medical Association, August, 1868, 
denies that anaesthetics have a direct action on the central ganglia 
of sensation and says,-"on the contrary, they presented in their 
action a complete similarity with the phenomena of deprivation 
of oxygen. Tracing the action of the typical anaesthetics, the 
author showed that they acted both as a cardiac and vaso motor 
stimulant ; they contracted the systemic arteries, producing a con- 
dition of insufficient supply of arterial blood, cutting off the capil- 
lary supply and expressing the great volume of blood towards the 
venous channels and distending the right side of the heart, as 
witnessed in post mortems. The author concluded that anaesthe- 
tics produce these phenomena by inducing a suppression of oxida- 
tion in the body, 1st,directly,by acting on the blood, 2d,indirect- 
ly, by modifying the forces by which the blood is circulated, and 
that they have no special action on the sensorial ganglia.'' (A. J. 
Med. Sci. 1868, page 545-6.) In the same year (1868) Dr. San- 
som read a paper before the Obstetrical society of London in which 
he insists that the action of chloroform and the other anaesthetics 
is primarily upon the nerves of sensation and not those of motion. 
(A. J. M. S. 1869, page 490.) 
Dr. Richardson, in a communication to the Physiological sec- 
tion of the British Medical Association, August 1870, says, with 
regard to the action of the various anaesthetics upon the system, 
that the chemical composition of a vapor cannot be taken to de- 
termine its narcotic property. Bodies of very different composi- 
tion, e. g. nitrous oxide and benzol, act as anaesthetics. Many 
* Also in our own army during the late civil war, where only eight deaths are reporte 
to one hundred and twenty thousand administrations. 8 
good ansesthetics are simply hydrocarbons; but so also are com- 
binations of hydrogen and carbon with chlorine (chloroform) of 
carbon with chlorine (tetra chloride of carbon), of carbon with 
oxygen (carbonic oxide), etc. 
Dr. Richardson had been unable to devise any satisfactory 
explanation of the mode in which anaesthetics act upon the sensor- 
ium. He thought it probable that there were two modes ; that 
some directly interfered with the changes in the blood while others 
interrupted function by immediate contact with the sensorial or- 
gans. The first class he called negative, the second, active sub- 
stances. (Amer. Jour. Med. Sci., 1871, page 250.) 
Dr. Sansom, in his book, lays down these modes of death : 
1st, Syncope; 2d, asphyxia; 3d, necremia. With a view, 
however, to perspicuity, we prefer the classification of Dr. Rich- 
ardson, and shall divide the methods of action of anaesthetics into 
two classes. 1st. Those cases in which they are supposed to act 
upon the blood, and which action is more or less influenced by 
the presence of some materies morbi that may exist in the vital 
fluid. 2d. Those cases in which their action is directed to the 
sensorium, producing direct shock, as when the par vagum is sud- 
denly impressed by full inspirations of undiluted vapor. 
Taking chloroform as the type, we have pretty strong evi- 
dence of its behavior in one of the two ways above indicated. 
Being devoid of oxygen, except such quantities as may be gath- 
ered from the air during inhalation, it is not unlikely that as- 
phyxia would more readily take place from long continued in- 
spirations of its unmixed vapor than some others in the table. 
That chloroform does readily enter the blood, has been abun- 
dantly proven in numerous instances, both before and after death. 
Dr. Ragsby detected it in the blood by distilling an ounce from a 
flask. Dr. Snow, proceeding in a similar manner, has proven 
that chloroform may be detected in various parts of the body 
(vide U. S. Disp. Article,Chloroform.) Mr. Playfair,* of London, 
in quoting Dr. Zweifel, of Berlin, also records that it may be de- 
tected in the umbilical cord, of new born babes whose mothers 
have taken chloroform during the labor. 
In cases of blood poisoning by ansesthetics we notice, first, a 
general livid appearance of the skin with labored and stertorous 
breathing, preceding the fatal asphyxia. Cases particularly in- 
fluenced in this way may be those who have been subject to delirium 
tremens, or excessive alcoholism, prior to the administration of the 
anaesthetic, or from other causes that would tend to deteriorate 
the blood, as .phagedenic ulceration, or septicaemia. Again, there 
may be a toxic property developed by the organism itself, when 
being brought into contact with the vapor of those agents produc- 
ing anaesthesia, under certain conditions-properties existing 
otherwise in a nascent state, either in the system or the agent em- 
ployed. On the other hand, when death is from shock, it is not 
# London Medical Record, June 24, 1874. 9 
necessary that the anaesthetic should enter the blood, but being 
suddenly and rapidly inhaled a profound impression is made 
upon the sensorium, which being reflected back on the heart, "the 
patient is destroyed as suddenly, and in the same manner, as 
sometimes happens from swallowing rapidly a draught of ice-water 
or clear spirits, or from a trifling blow upon the epigastrium." 
Dr. Reeves, in his article on "Cause of Death from Chloroform, 
etc," reported in the American Journal of the Medical Sciences, 
October, 1867, gives eleven cases of death from chloroform, where 
the subject had been of intemperate habits; others who had 
sloughing ulcers, malignant tumors, etc. The following is a 
statement of cases proving fatal: 
Case 1-In a London Hospital.-The subject of bad constitu- 
tion and presented signs of delirium tremens. 
Case 2-St Thomas Hospital.-The man was of intemperate 
habits and had had an attack of delirium tremens. 
Case 3-London Hospital. Anaesthetic administered for 
previous delirium tremens. 
. Case 4.-The patient's countenance showed the effects of hard 
drinking. The chloroform was given rapidly, until two drachms 
had been administered, then forty or fifty minims were added, and 
"while the vociferation and struggling yet continued, some stertor 
appeared, and the sponge was at once withdrawn. In another 
minute full stertor came on." 
Case 5-Northampton Infirmary.-Patient of drinking habits. 
Case 6.-University College'Hospital-" She had been in the 
habit of drinking pretty freely." 
Case 7-King's College Hospital.-Very intemperate habits. 
Case 8-University College Hospital.-"Intoxicated." These 
are all the particulars given. 
Case 9-King's College Hospital.-"Not in good health- 
intoxicated." 
The above cases showed the result of chloroform inhalation 
by inebriates, and in almost all, the language of the Hospital Re- 
ports has been adopted. We have no knowledge that any of the 
above cases died suddenly, or that it is possible to attribute any of 
them to direct shock. Other fatal cases are reported where the 
patients were of intemperate habits, but, as in some instances, the 
death was brought about from want of due regard to the condi- 
tion necessary to a safe administration, we will not include them in 
this class. Another complication is where organic derangement, 
or local lesion exist at the time of inhalation. Of these, we select 
the following: 
Case 1-Dreadnought Hospital Ship.-Two and a half drachms 
given at intervals, on lint, for the application of nitric acid to 
syphlitic sores. "Anaesthesia imperfect, resisted the application of 
the acid ; struggling ceased ; face pallid; pulse and breathing- 
stopped. 
Case 2-Vienna, Nov. 11, 1853.-Young man. Death at the 
expiration of a quarter of an hour. " Patient addicted to onanism." 10 
Case 3-Westminister Hospital.-Post mortem showed fatty 
degeneration of the heart in a high degree. 
Case 4-Guy's Hospital.-Fatty degeneration of the heart. 
Case 5-Sept. 15, 1852.-Had inhaled chloroform before, but 
exhibited bad symptoms soon after one of the previous inhala- 
tions. " Fatty degeneration of the heart." 
Case 6 * -Hopital Beaujou, Paris.-A case of humid gan- 
grene. Death before the completion of the operation, which was 
amputation of the finger. 
Case 7 * -United States Military Hospital, Jefferson City.- 
A case of humid gangrene. Death soon after the completion of 
the operation, which was amputation of the thigh-lower third. 
Case 8 *-Private practice, Sedalia, Mo.-A case of humid gan- 
grene. Death before the completion of the operation, which was 
amputation of the leg. 
Case 9-United States Hospital, Beverly, N. J.-Case of 
second amputation. Wound sloughing. " Death was not sudden, 
but came on gradually." 
Case 10-Manchester Royal Infirmary.-Operation for Malig- 
nant tumor of the thigh. 
Case 11.-Hopital la Pitie.-Painful hemorrhoidal tumor; 
also aneurism of the aorta. 
The above cases are sufficient to call attention to blood poi- 
soning as the probable cause of death. 
The fact that death may occur from shock, and before the 
blood has had sufficient time to imbibe any toxic property from 
the anaesthetic, may be shown by the following exhibit, taken also 
from the tables of Dr. Reeves. 
Case 1-Madam Labrune, Longres, France.-Inhaled chloro- 
form for extraction of tooth. "Complete insensibility was not 
produced at the first trial; more chloroform was placed on the 
handkerchief, and she drew a full inspiration. She died as if struck 
by lightning. 
Case 2-John Atkinson, Melbourne, Australia.-Upon the 
first application of chloroform, "the patient suddenly expired." 
Case 3-Madam W., Ulm, June 27, 1852.-Died after four 
or five full inspirations. "The patient's husband said that the 
time between the inhalations and death was so short that one 
could scarcely have said yes or no." 
Case 4-Wife of a physician.-The patient was seated on a 
sofa, and began to inhale very eagerly; " but had no sooner com- 
menced than she gave a sudden start and was gone." 
The conditions contra-indicating the use of general anaes- 
thetics may be set down as follows : 
1st. Heart disease. 
2d. Disease of Lungs. 
3d. Extensive chronic abscess. 
4th. Phagedenic ulceration, including humid gangrene. 
5th. Derangement of blood by chronic alcoholism. 
* These cases not included in Dr. Reeves' Report. 11 
As regards the agent used, care should be taken, 
ist. That the article be pure. 
2d. It should be given by a competent person. 
As regards the subject: 
ist. The patient should be in a horizontal position. 
2d. The stomach should not be distended with food or 
water. 
3d. The administration should not be too rapid, or too pro- 
longed in bringing the patient sufficiently under the influence of 
the anaesthetic for operation. Great care should be taken, even 
where no incompatibility is known to exist, to see that a sufficient 
amount of oxygen is mixed with the vapor during its inhalation. 
Few surgeons are now so bold as to recommend the inhalation of 
pure vapor of chloroform or ether. A good plan, and one which, 
scientifically speaking, is correct, is the one suggested by Mr. 
Clover, of London ; but his apparatus is too bulky and unwieldy, 
besides being too expensive to insure its adoption by the general 
practitioner. Dr. Oscar H. Allis, of Philadelphia, in his paper 
read before the Philadelphia County Medical Society, October 
14th, 1874, gives all the details necessary to insure safety to the 
patient, and satisfactory results to the operator. " Safety does 
not lie in an inhaler," as the Dr. very truthfully remarks, but in 
him who uses it Chloroformists should have no other business to 
attend to during an operation, but to attend to the anaesthetic. 
The use of mixed vapors has been proposed, and is sanctioned 
by high authority. The Chloroform Committee of the Medico- 
Chirurgical Society of London, recommend three mixtures- 
ist. Alcohol I part. 
Ether 3 parts. 
Chloroform 2 parts. 
2d. Chloroform ..ipart. 
Ether 4 parts. 
3d. Chloroform 1 part. 
Ether 2 parts. 
The introduction of alcohol is probably due to the sugges- 
tion of Dr. Sansom, and will act, no doubt, an important part in 
counteracting, by its stimulant properties, the depressing influence 
of chloroform ; ether acting the same way, in all probability, in 
combination. The great danger to be encountered is the 
unequal evaporation of the fluids, as you can not tell whether you 
are administering an equal proportion of the vapors of the mix- 
ture, or whether you may not be administering absolute chloro- 
form. The last mixture proposed in the above table has generally 
been looked upon as a perfectly reliable anaesthetic. Mr. Robert 
Ellis, of the Belgrave Dispensary, who is good authority, seems to 
think differently, and after numerous experiments has come to the 
following conclusions. 
ist. That the ingredients of fluid anaesthetic mixtures evapo- 
rate, in a great degree, independently of each other, and in ex- 12 
tremely differing quantities. 2d. That though alcohol exerts, in 
vacuo, a powerful influence in restraining and equalizing their va- 
porization, this influence is in a great measure annulled in evapo- 
ration into free air, as in an inhaler. 3d. That the only method 
of obtaining a true anaesthetic mixture is by consideration of the 
respective volatility of its ingredients, and so adjusting their pro- 
portions as to provide that all should evaporate simultaneously. 
4th. But as this can only be done by a very great reduction of 
the quantities employed, both of alcohol and chloroform, then 
the object of the mixture is entirely frustrated, and it is reduced 
in its properties to one similar to ether only-the most volatile of 
the ingredients always taking precedence of the rest. 5th. That 
if impure alcohol and ether are used, the defects of unequal vola- 
tilization become still more exaggerated, and the result vitiated by 
the water left behind. (American Journal Medical Science, July, 
1867, page 248). 
Dr Ellis speaks of a case proving fatal in Bristol, where a 
mixed anaesthetic was administered. Dr W. A. Hammond reports 
a case, while Asst. Surgeon U. S. A., of the administration of 
mixed vapor, or tincture of chloroform to a soldier of the 2d 
United States Dragoons, which proved fatal. (American Journal 
Medical Science, July 1858.) 
In order to insure an equal evaporation of the various fluids 
used, Dr. Ellis has invented an instrument, for which he claims 
that a certain per cent, of chloroform vapor may be made to pass 
over, and by keeping the different agents separated in the inhaler 
he, by this means, secures the desired proportional mixture of the 
vapors without mixing the fluids at all. (Half yearly Abst. of 
Med. Sci., Vol 44, 1866, page 167.) 
Upon the same principle, Dr. Andrews, of Chicago, suggests 
the propriety of mixing one part of oxygen and three of nitrous 
oxide, this being perfectly safe in the longest operations. The 
union must be mechanical and free from the admixture of atmos- 
pheric air. 
Intravenous injections for the purpose of producing gen- 
eral anaesthesia have also been proposed. Mr. Ore forward- 
ed to the Paris Academy of Science the particulars of two cases of 
anesthesia produced by the intravenous injection of chloral.- 
One case of necrosis of tibia and the other a case of ovariotomy. 
In both cases complete anesthesia was produced and no accident 
accompanied or followed their use which could be attributed to 
the chloral. Dr. Lande reports a case to Dr. Ore, the origina- 
tor of this practice, in which complete anesthesia was produced 
in thirteen minutes. Five grammes of chloral was injected. The 
operation, which was ovariotomy, on account of adhesions lasted 
about half an hour. The patient soon began to sink and died in 
a little more than an hour from the commencement of the opera- 
tion. Dr. Lande thinks the moderate hemorrhage, together with 
the anaemic condition of the patient, caused her death. "Such a 
conclusion, however, will be disputed, since it is far more prob- 13 
able that death occured from the agent used being directly intro- 
duced into the circulation, the effects of which could neither be 
modified nor arrested." 
Compression may be of service in producing a local anaesthe- 
sia. The ancients were not entirely ignorant of this fact, and 
certain forms of pressure and compression were successfully used by 
them to relieve pain. The late Dr. Waller suggests compression 
of the vagus nerve to relieve the pain of surgery. When it is not 
desirable or necessary to obscure consciousness-as in amputation 
of the fingers, the rubber band compress will sufficiently blunt the 
sensibility for all practical purposes-both for the comfort of 
the patient and the operator. 
M. LeFort relates to the Surgical Society of Paris, "a case of 
excision of the elbow which he had performed by Esmarch's 
bloodless method, without the patient's having felt any pain." 
Other experiments were not so successful, and it yet remains un- 
certain whether the anaesthesia by compression is sufficiently com- 
plete for capital operations. 
Whatever agent may be decided upon there are some minor 
details, to ensure safety, that are often overlooked. No one can 
be free from danger who dashes on his chloroform by the spoon- 
ful, and disregards the demands of nature. If your patient de- 
sires to spit, which is often the case, especially in ether inhalations, 
do not restrain him ; and if vomiting comes on, turn him com- 
pletely over, face down, that no ejected matter may be forced into 
the trachea. If the towel cone is used, leave the sponge out, and 
allow a free ingress of air from the apex. A few drops of chloro- 
form applied at a time will be sufficient, and very few operators 
will require more than from two to three drachms, if properly 
utilized. 
There is another precaution that is necessary, and which is 
urged upon new beginners, viz.: in the administration of an an- 
aesthetic it is very important that you select two competent assist- 
ants, to hand things that may be needed, and to restrain any vio- 
lent motions of the patient; and who can also serve you as wit- 
nesses if occasion requires. The hallucinations of the mind, after 
the administration of anaesthetics, often cause some strange revel- 
ations. Sensual emotions are not unfrequently excited in both 
sexes. "A man who had been married about three months, stated 
on awakening, that he had been dreaming of his wife; and an 
unmarried hysterical girl certainly gave evidence, by her move- 
ments, that she was quite aware of one of the duties of married 
life ; " and moreover delicate females coming out from under the 
effects of anaesthetics will sometimes address you in terms more en- 
dearing than elegant or proper. It is but the part of wisdom, 
then, that the profession should guard well the precincts of her 
honor. 
The great conflict between chloroform and ether has had 
strong advocates among eminent medical men, both in Europe 
and America. The Americans may justly be said to be the origi- 14 
nators and champions of ether; while the Europeans hold with 
as much pertinacity to chloroform. The effort recently made to 
re-introduce ether into England seemed for a time an assured suc- 
cess. The faith of English surgeons bowed before the eloquent 
appeals of America in favor of ether, like the massive oak before 
the gathering storm; but now that the storm is over, they stand 
erect, with an abiding confidence in the safety and power4of chlo- 
roform. "The great difficulty," says a recent writer, "inaccu- 
rately estimating the comparative advantages and disadvantages 
of ether and chloroform, has been, that the advocates of either 
agent-like those famous knights who fought because they looked 
on different sides of the same shield-have little or no personal 
experience with any but the one anaesthetic which they habitually 
employ; the chloroformists, confident of the superiority of their 
favorite, make no use of ether; while those surgeons who prefer 
the latter agent, firmly convinced of its greater safety, hesitate on 
conscientious grounds to employ what they look upon as the more 
dangerous agent-chloroform." 
In order to call out the opinion of some of the leading med- 
ical men in this country and Europe, I addressed a circular letter, 
asking their views upon the comparative safety and efficiency of 
the various agents used for anaesthesia, and also as to the patho- 
logical conditions forbidding their use. In reply to said circular 
letter, I received thirty-four answers. Six were in favor of chlo- 
form, ten for ether, eight neutral, and ten who gave no opinion 
either for or against. Nearly all were agreed in speaking of the 
pathological conditions forbidding the use of anaesthetics, such 
as fatty heart, or any serious organic lesion, some expressed the 
opinion-and I think the ground well taken-that it is not always 
possible to know the pathological condition of the patient upon 
whom you are about to operate. Mr. Rigden, of London, in a 
letter to me upon this subject says: "I know of no pathological 
condition forbidding the use of an anaesthetic. I have given 
chloroform and ether successfully in all forms of heart disease. 
I have always believed, and have acted on the belief, that if the 
patient is fit for an operation, he is fit to take an anaesthetic for 
it. " This would seem to be the safer doctrine-never give an 
anaesthetic where any doubts are entertained of their admissi- 
bility, unless 'the operative procedure, from its gravity, impera- 
tively demands it; then we should not hesitate, as the shock 
would certainly be less with than without it. 
In case of blood poisoning, when death is about to ensue 
from the use of an anaesthetic, our attention should first be direc- 
ted to exhalation. There is probably no other remedy likely to 
avail in such a painful emergency, when this central fact is ig- 
nored. Dr. Nunneley, of the Leeds Infirmary, states that, in his 
opinion, we have no antidote for an overdose of any anaesthetic, 
and no remedy except exhalation of it from the blood as this is 
brought into contact with the atmospheric air. 
The best means, then, to restore your patient, is respiration. 15 
This can often be done by artificial means to inflate the lungs- 
keeping up a kind of diaphragmatic breathing, by compressing 
the lungs in quick succession, and occasionally filling the lung 
from the mouth of the operator. The patient should be imme- 
diately placed with the head downward, that any redundant va- 
por may be made to pass away, either by its gravitating tendency 
or by the pressure of the viscera upon the diaphragm forcing the 
vapor out of the lung. Another very important object is attained 
by this position-the blood at once flows to the brain and stimu- 
lates that organ, and if death be caused by anaemia of this organ, 
as maintained by Nelaton, this position alone might insure a res- 
toration of the power of life. 
The graphic description given by Dr. J. Marion Sims, of a 
case of chloroform narcosis in a case of his while in Paris [read 
at the 42d annual meeting of the British Medical Association, 
held at Norwich, August 1874], in which Nelaton saved the life 
of his patient by inverting the body, hanging the head down and 
raising the feet high in the air, would seem to leave no doubt 
about the propriety of this procedure. In this case life was three 
times extinct, and was as often restored by the inverted position 
and artificial respiration. Some other cases have been reported 
since the publication of Dr. Sims' St. Germain case, where the 
same plan was adopted and a like favorable result ensued. 
In case of death from shock, the power to resuscitate by the 
above or any other plan, is very apt to prove abortive. The gal- 
vanic current, the dashing of cold water upon the naked surface 
of the body and face, or slapping the patient with the open hand, 
or any sudden impression, as powerful excitants, applied to the 
body, are not likely to be of much benefit. I have seen employed, 
by men who had no fear of their reputations, the actual cautery, 
creating a lively blaze over the region of the heart. This latter 
proceeding can only be condemned as utterly useless, inhuman 
and barbarous. 
The question as to whether any real good has been achieved 
by the discovery and use of anaesthetics has by some been con- 
troverted, and the rate of mortality held to be greater since than 
before their use. By others the opposite ground is taken, that a 
great benefit and saving to life has been secured by their introduc- 
tion. Sir James Y. Simpson assumed the latter to be the fact; 
while Mr. Arnott, likewise good authority, as persistently argues 
the contrary. 
That anaesthetics have been, and are likely more than ever 
to be, a great boon to suffering humanity, is beyond all contro- 
versy. That pain can be of any use to the pained, might do as a 
maxim for the ancient fathers in medicine, but this maxim will 
not do for surgeons of the nineteenth century. A Spanish In- 
quisition might resort to torturing pain to force confessions from 
their victims; but no enlightened people of our day will tolerate 
such barbarism. Pain made Csesar weep, and the stoutest heart 
will fail when the body is enduring the anguish of Neuralgia. A 16 
hero may fight an hundred battles successfully, and move as majes- 
tically as a God, but let the mere filament of a nerve become 
compressed, and he struggles and cries to escape the unendurable 
agony. In the language of the American Nestor in Surgery, no 
gentleman, not to say Christian, would needlessly inflict pain on 
any creature. It was, indeed, a certain kind of humanity which 
lead the Athenians to execute Socrates, by means of a narcotic 
draught, and which also made the Romans give their malefactors, 
during crucifixion, drugged wine. Even the guillotine had its 
conception in a kind of humane sentiment. Only savages inflict 
upon their victims the horrors of torture. And I do not believe 
that there is a surgeon of the nineteenth century who would wil- 
lingly inflict any unnecessary pain in his operations if once prac- 
tically acquainted with the means of prevention, and once confi- 
dent and facile in their use.