WOA
5613r
1848
m  C^C TICKET  w  CTC

•M.  V  LC« Cc£jtt.£< C  *CA <
     c   c cc c cjs c *■ c v c .





        : k(. i' t< «c « cc  <.
        C C«lC C  « «£ <J C<C
,-^i <.'  c     * ' ■••«  *  'JO  «•< «<
i* ,*■ C    C  <««  «  '' Cf r< *«
cc c    c  occ c-€ crcc cc
[CC C   C  C(f(C C«C(( cc cc
& c  c c« c c c « cc CC    c«C
icccc  c
CCC^c

cccc
 CCC C c r CC  CC
 C cCAC  c < < cc  C c
C<«LC C<'< CC  C«L
  -k <  CktuCCC i
  'k 'k-^C  <_ c< i

 '  <  re  c5" t*cr'
 CC <c  Cc Cc «LCCC
 vCk-C << CCki ^c CC
c v-/c  cc.o c< cc «C CCt
 "T - i. - ■ «.  '■<_«. '^bl. < <
 :  ■ - * . C  ' " ' «T I c «c <L
 • .. t cC c<-  c•<  <~^ ' -
: cc < < c < •'  <"' < <  c _
rccc c  (  cccc/r
^C CC  C k (  C rOLC
C 'CXC  C-C-c cc
c cecc  c-k<(c
c ccecc  c C< cc
cc   c c
' '   c c
CC<  c c C
 C«J<  C C
*c C
•  c ccccr
c  c CCXf'

   C CCC
cc- CCc
c<r<ccc
cccc

 jC«C C^
  C <■ <cc<t
C   C C (M cc
  c c cc ccc:
:  cccc ccc
C <; C C CCCX"


r,CkC( CCC'
■vCCCC CCC
<- C <-;<• c c C <-:
*£'«<;  c «. < ^ k  <
    <  <; CC<(( C< C
   C  C CC CC c c <
   0  C  CCCC CCC '
   c ' c u.'cci :
      k.c UkU c C^ kC_
  k.CC.'" '<- .kCf ' C c< ^
 -;(CC!lCk" ■ <  C kC.

&>."'  "^ '   " """
   c cCCr  c: tf

c«; c«<c  >
C«C  (
cc-kCc: c t c
 <«'C« c  C<
Cc  cC
 C c <
crca
 Vcc  c^ctt

t  ^ cv ^«cc^
ccccc^«   cc ^r

                dc <
^c  ccc  cc  <&ir
«r«: c « c
   C« C
     : c «. c
     : « c f
     r  « <

cc c « C
• <c c c<
ccc c
  Cc  c  k
 rcc C  kic
   :c c  <c-
   - c«.  *  <c
    cc c  «t
     «... C  cc
«tcCJ"VVi
' cc< <r  <c
 CCC c  cc
 Ccc c  «t'
-- c^t  r.l
 CccC «f
 Ckk c < <
CCC r C
• o< c <^c
c C tr
C• c C- '
C  C Ct 
  Surgeon General's Office
umtmm 
 
 
REMARKS
SUPERINDUCTION  OF ANESTHESIA
NATURAL  AND MORBID PARTURITION:
CASES ILLUSTRATIVE OF THE USE AND EFFECTS OF
      CHLOROFORM IN OBSTETRIC PRACTICE.
       J. Y. SIMPSON, M.D., F.R.S.E.,   ^
PROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF EDINBURGH, AND
    P1IY3ICIAN-ACCOUCHEUR TO HER MAJESTY IN SCOTLAND.
Serve me—as Mandragora—that I may sleep.
           Webster's Duchess of Malbt.
       But there is
No danger in what show of sleep it makes,
More than the locking up the spirits a time,
To be more fresh, reviving.
           Shakespeare's Ctmbelike.
,0'

WITH AN APPENDIX.  ''^LII™
1
           BOSTON:
PUBLISHED BY WILLIAM B. LITTLE & CO.,
        CHEMISTS AXH DRUGGISTS,
       104 Hanover, Corner of Salem Street.
               1848. 
S6l3r-
  I'M 8
White & Potter, Printers,
  Spring Lane, Boston. 
PREFACE TO THE BOSTON EDITION.
  The discovery of an anaesthetic agent, possessing the power of annulling all
sense of pain under the severest surgical operation, and employed in all cases
without the slightest bad results of any kind whatever, is certainly one of the
most important achievments of modern times, and forms an epoch in  the anniili
of the nineteenth century.
  Doct. Charles T. Jackson, of this city, discovered that temporary insensibility
to pain may be safely induced by the inhalation of Sulphuric Ether, with a proper
admixture of atmospheric  air; he inferred from his experiments, that, by this
means, surgical operations might be rendered absolutely painless.  It may be
proper to add, that Dr. Jackson's experiments were made with Sulphuric Ether,
only ;—he presumed, however, that other substances of a similar character would
produce similar effects upon the system.
  With the view of improving on the discovery of Sulphuric Ether, Prof. Simp-
son, of Edinburgh, first demonstiated,  by actual trial, the anaesthetic effects of
Chloroform.  The experiments which he performed are of great value, and entitle
him to the gratitude of mankind.
  Chloroform, as an  inhaled agent, possesses many advantages over Sulphuric
Ether.  Professor Simpson speaks most confidently of its superior anaesthetic
properties, and affirms, that in no single instance has he known the slightest bad
results to occur from its employment.
                                            \VM. B. LITTLE  & CO.
Boston, February 1, 1848. 
 
   JOHN C.WARREN, M. D.
THIS REPRINT,  IS DEDICATED,
      WITH THE RESPECTS
           or the
       PUBLISHERS. 
 
ON THE
SUPERINDUCTION OF ANESTHESIA, &c."
   Among the many improvements by which the operative part
of medicine has, from time to time, been enriched, few or none
have exerted a more potent, or a more beneficial influence over
its advancement and progress, than the introduction,  in the
16th century, of  the application of ligatures  to  arteries,  with
the object of arresting the hemorrhage attendant upon surgical
wounds and operations.  Previously to that time, surgeons had
no other means of stemming the flow of blood—after amputa-
tion of the limbs, for instance—than by scorching over the raw
and bleeding wound with a red hot iron, or by plunging it into
boiling pitch,  or by applying strong  potential cauteries  to its
surface.  With laudable efforts to diminish the fearful severities
of their practice, they exerted their ingenuity  in devising, as it
were, refinements upon these necessitous cruelties.  Thus, Hil-
danus, the patriarch of German Surgery, amputated the  limbs
of his patients with red hot knives, in order that he might di-
vide the flesh  and sear up the vessels at one and the same time.
Upon all these  practices,  the great and  happy  suggestion of
Ambrose Pare, viz. to shut up the bleeding vessels, by constrict-
ing or tying them with slender ligatures, was a vast and mighty
improvement.   It at once made the arrestment of hemorrhage
in operations far more simple, more  certain, and  more secure.
It saved immeasurably the  sufferings of the patients, while it

  * Read to the Medico-Chirurgical Society, of Edinburgh, at their meeting
on the 1st December, 1847. 
8
added  immeasurably to  their  safety.   But the  practice waa
new, and an innovation ;  and consequently, like all other inno-
vations in medical practice, it was, at first and  for long, bitterly
decried and denounced.   The  College  of Physicians  of Paris
attacked Pare for his proposed  new practice:  they  attempted,
by the authority of the French Parliament, to suppress the pub-
lication and dissemination of his  observations :  and, for nearly
a long  century afterwards, some  of the  Hospital  Surgeons of
Paris continued,  with the characteristic  obstinacy of  the pro-
fession,  to prefer cauterizing bleeding arteries " with all  the
ancients," rather than simply tie  them  " after the manner of a
few   ignorant  and  presumptuous  moderns."*   " Without,"
(writes the late Mr. John Bell,)—" without reading  the  books
of these old surgeons, it is not possible to imagine the horrors
of the cautery, nor  how much reason Par'  had for upbraiding
the surgeons of his own time with their cruelties. . .  . The hor-
rors  of the patient,  and his ungovernable  cries,  the hurry of the
operators and assistants, the sparkling of the (heated) irons, and
the hissing of the blood  against them, must  have made terrible
scenes; and surgery must, in those  days, have been  a horrid
trade."f
  * All writers on surgical history give more or less full details upon this oppo-
sition to  the practice of Pari.  Thus, for example, Professor Cooper observes,
"By many surgeons, however, the tying of arteries continued to  be deemed too
troublesome, and hence they persisted in  the barbarous use of the actual cau-
tery ; of this number were Pigrai, F. Plazzoni, and P. M. Rossi. Nay, so difficult
was it to eradicate the blind attachment shown to the  ancients, that Theodorus
Baronius, a professor at Cremona, publicly  declared, in 1609, that he would
rather err with Galen than follow the advice of any other person.....
I shall not here expatiate upon the ill-treatment which Par6  experienced from
the base and ignorant Gourmelin, president of the Parisian College of physicians;
nor upon the slowness and  reluctance with  which the generality of surgeons
renounced the cautery for  the ligature.  .  . .  Almost one  hundred years
after Pare, a button of vitriol was ordinarily employed in the Hotel  Dieu, at
Paris, for the stoppage of hemorrhage after amputations;  Dionis was  the first
French surgeon who taught and recommended Pare's  method.  This happened
towards the close of the 17th century, while Pare lived towards the end  of the
16th."— Cooper's Dictionary of Practical Surgery, 7th edit. pp. 46, 47.   See
also Sprengel's Histoire de Medecine, Vol. III. p. 315 :  Bell's Sureery, Vol. I. p.
226, &c.                                                  *        V
  t Principles of Surgery, Vol. I. p. 212. 
9
   The sentiments  which Mr.  Bell  here expresses, are those
 with which the human mind often looks back upon our opinions
 and practices, when these opinions and practices are past and
 gone, and have become mere matters of history.   In the above,
 as in many other instances, we never become fully awakened
 to the cruelty and enormity of some of our established doctrines
 and  doings, until, from  time to time, an advance is made  in
 civilization or  science, and  we find  that this  or that doctrine
 and practice, with all its attendant sufferings and inhumanities,
 was  in reality utterly unnecessary, and  utterly uncalled for.*
 In general, however, long years elapse before  this new aspect
 of matters is duly seen, or at least, duly acknowledged.  While
 the practices  themselves  are in  full  operation,  the  mind
 enthralled  by education  and  habit, cannot  be easily made  to
 view them in their true  character;  and  when, in  the progress
 of the march  of knowledge and  science,  their propriety and
 perpetuation come  at last to be  challenged  and contested,
 human passions and prejudices ever (as in  the above instance
 of cauterization) rise up to argue for, and insist upon, the con-
 tinuance and safety of the past, and  the total impolicy and high
 peril of any attempted  alteration.   But time passes on,  and
 brings with  it, sometimes abruptly—generally  almost  imper-
 ceptibly—a perfect change of doctrine and  practice.  Any sur-
 geon who,  in the days of Pare, dared to arrest the hemorrhages
 from his  amputation wounds, by applying  ligatures instead  of
 red-hot  irons, would  have  been  denounced by  his compeers.
 Any  surgeon, on the contrary, who now, at this  present day,
 dared to arrest the  hemorrhages from  his amputation wounds,

   * Witness, for example,—(as compared with the past opinions of those who
 practiced them)—our present opinions regarding the burning, by our Druidical
 forefathers, of whole wickerfulls of living human beings,  and in the name of
 religion ; or, in times nearer our own—in Christian times—the application of
 the fire and fagot by man to man, still under the plea of religion; or the use of
 the rack and torture; the incremation in the sixteenth and seventeenth centuries
 of many poor wretches for the alleged crime of witchcraft;  the altered existing
ideas regarding the required frequency of capital punishments, and the  whole
question regarding their policy; the recent rapid and complete change of doctrine
regarding the horrors and inhumanity of slavery; the changes in practice regard-
ing insanity from what it was in the last century, when chains and a dungeon
were the portion of every poor lunatic ; &c. &c. 
10
by applying to the bleeding vessels, not ligatures but  red-hot
irons, would  as certainly be denounced  by his  compeers, and
his talents, as well as his humanity, would be strongly chal-
lenged.   We look back with sorrow upon the pitiless practices,
in that respect, of the contemporaries and opponents of Pare,
In the course of  years our successors in the profession will, I
most sincerely believe, look back with similar feelings upon the
alleged " insignificance," and " propriety," and " desirability,"
of pain in surgical operations, as maintained by many members
of the profession  at  the  present day ; and  they will equally
marvel at the idea of men—of humane men—complacently con-
fessing and  upholding, that  they prefer operating  upon their
patients in a  waking instead of an anaesthetic state;  and  that
the fearful agonies which they thus inflict—the agonies  of the
surgeon's  knife—should  be endured rather  than  avoided—
quietly and decorously submitted to, and not  attempted  to be
eschewed.  I have elsewhere  discussed,* at some  length, the
strange opinions and practices of some modern surgeons, upon
this alleged propriety and necessity of pain in surgical practice
and surgical  operations.   On the present occasion my object is
to offer some remarks regarding the pains  attendant  upon par-
turition, and  the  propriety of alleviating and annulling  the suf-
ferings of our  patients in obstetrical operations.  But  let me
first adduce some evidence of thnir intensity and amount.
   " The distress and  pain (observes  Dr.  Denmanf)   which
women often endure while they are struggling through  a difficult
labor, are beyond all  description,  and  seem to be more than
human nature  would-be able to  bear under any other  circum-
stances."   But even the amount of agony endured in most cases
of natural parturition, is  abundantly severe.J   Viewed apart,
and in an isolated light, the total sum of actual pain  attendant

  * See Monthly Journal of Medical Science, of September, 1847, pp. 156, 166,
" On the Allegation of the Prevention of Pain in Surgical Cases being Unneces-
sary and Improper."
  t Introduction to Midwifery.  5th edition, p. 377.
  ; Cases undoubtedly ever and anon occur, in which the mother  Buffers com-
paratively little or no pain; but these are exceptions, rare exceptions, to a gene-
ral rule. 
11
upon common labor is as great, if not greater, than that attend-
ant upon most surgical operations.   It  is, I  believe, education
and custom, and  perhaps  the idea of its inevitable necessity,
which have made the  profession in general look upon the degree
of maternal pain  and physical suffering accompanying  natural
parturition, as less deserving of consideration than in reality it
is.  These circumstances have, in a great measure,  blinded us
as to its actual amount, and intensity, and importance.  For it
was, no doubt with perfect truth, remarked by an author* who
wrote three hundred years ago,  " Mulier, in partu, maximos et
fere intolerabiles  sustinet dolores."
   Some living authors—without any view to such a question as
the possibility of avoiding it—in fact, with a view only to the
accurate painting of nature, have described to us  in  forcible
language the degree of suffering attendant upon the last stages
of the process  of common parturition.  "The pulse (says Dr.
Merriman) "gradually increases in quickness and force; the
skin grows hot;  the face becomes intensely red; drops of sweat
stand upon the forehead ;  and a perspiration,  sometimes profuse,
breaks out all over the body; frequently violent tremblings ac-
company the last pain, and at the moment that the head passes
into the world, the extremity of suffering seems  to  be beyond
endurance."!  Or, let us take the picture of the sufferings of the
mother in the last part of natural labor, as  portrayed  by one
who is universally reputed  by  the  obstetric profession as the
most faithful of living observers—Professor Naegele of Heidel-
berg—" The pains (he observes) of  this stage are still more se-
vere,  painful, and enduring; return after a short interval, and
take a  far greater effect upon the patient than those of the pre-
vious stage.  Their severity increases so much the more from
the additional suffering arising from the continually increasing
distension of the external parts.    They convulse  the whole
frame, and have hence been called  the  dolores conquassantes.
The bearing down becomes more continued, and there is not un-
frequently vomiting.   The patient quivers and trembles all over.
Her face is flushed, and, with the rest of the body, is bathed in

  * Hieronymus Mercurialis, in Spachius Gynaecia, p. 233.
  t Synopsis of Parturition, p. 15. 
12
perspiration.  Her looks are staring and wild ;  the features alter
so much that they can scarcely be recognised.  Her impatience
rises to its maximum with  loud  crying and wailing, and fre-
quently expressions which,  even with  sensible, high-principled
women, border close upon insanity,   livery thing  denotes the
violent manner in which both  body and mind  are affected.'*
" This (observes Dr. Rigby) is the moment of greatest pain, and
the patient is frequently quite wild and frantic with suffering;
it approaches to a species of insanity,  and shows itself in the
most quiet and gentle dispositions.   The laws in Germany have
made great allowances for any act of violence committed during
these moments of frenzy, and wisely and  mercifully  consider
that the patient at the time was laboring under a species of
temporary insanity.  Even the act of child murder, when satis-
factorily proved to have taken place at this moment, is treated
with considerable leniency.  This  state of mind is sometimes
manifested in a  slighter degree by actions and words so con-
trary to the  general habit and nature of the patient,  as  to prove
that she could not have been under the proper control of her
reason at the moment.   It is a question how far this  state of
mind may arise from intense suffering, or how far  the circula-
tion of the brain may be affected by the pressure which is ex-
erted upon the abdominal viscera."f
  Such is  the description of  the amount of pain and agony en-
dured  in  natural parturition,  given by some of our best and
most esteemed authorities in obstetric  literature.
  Is it right for the physician to interfere with these fearful suf-
ferings and agonies in order  to save and shield his patients from
the endurance of  them?  Is it proper  for  him to exercise  the
skill of his art so  as to  moderate and remove these  " almost in-
tolerable pains  {fere intolerabiles dolores'f)  Would  it  be fit
and meet in him to use human means to assuage the pangs and
anguish attendant upon the process of parturition in the human
mother?
  These questions, and questions like  these,  I have often dur-

 * Lehrbuch der Geburtshulfe, p. 104.  See British and Foreign Medical Re-
view, vol. xix. p. 64.
 t System of Midwifery, p.  103. 
13
ing the currency of the present year,  heard complacently put
by medical men,—men, too, whose opinions and actions in oth-
er matters, and in other respects, were fully and truly actuated
by that great principle of emotion which both impels us to feel
sympathy at the sight of suffering in any fellow creature/ and
at the same time imparts to us delight and gratification in the
exercise of any power by which we can mitigate  and alleviate
that suffering.   Such  questions, I repeat, are seriously asked
by physicians and surgeons, the professed object of whose whole
science and art is  the relief of human disease and human suf-
fering.  They  are questions  propounded with  all imaginable
gravity and seriousness by individuals who (in a mere abstract
point of view)  would, no doubt,  strongly object to being consid-
ered as anxious to patronize and abet  human misery, or traffic
in the perpetuation of human pain.  Nay, probably, at the date
at which I write,  there is  not one in  twenty—perhaps not one
in a hundred—of  the physicians and surgeons of Great Britain
who have, as yet, thought seriously upon the propriety of alle-
viating and annulling the tortures attendant on human parturi-
tion ; or who have acknowledged to their own minds the pro-
priety of their  bestirring themselves so as to be able, in the ex-
ercise of their profession, to secure for their patients an immu-
nity from the throes and agonies of childbirth.
  Perhaps, as an  apology for their indolence and apathy, some
may be ready to argue, that the pain and suffering attendant on
parturition is not dangerous and  destructive in its results, how-
ever agonizing  and distressing it may  be to the patient during
its continuance.   But the argument is fundamentally unsound.
All pain is per se, and especially when  in excess, destructive
and even ultimately fatal in its action and effects.   It " exhausts
(says Mr. Travers) the principle of life."f  "It exhausts (says
Mr. Burns of Glasgow) both the system and the part."J  " Mere
pain (observed  the late Dr. Gooch) can destroy life."§  And the

  * " Inditus est, ab ipsa Natura, homini, miserieordUe affectus nobilis et excel-
lena."  Bacon—" De Augmentis Scient," Lib. viii. cap. ii.
  t Inquiry concerning Constitutional Irritation, vol. i. p. 76.
  I Principles of Surgery, vol. i. p. 502.
  § Dr. Merriman's Synopsis of Parturition, p. 239.
             2 
14
 great pain accompanying human parturition is no exception to
ihis general pathological law.   For,  in fact, the maternal mor-
 tality attendant upon parturition, regularly increases in a ratio
 progressive  with the increased duration of the woman's suffer-
 ings.   The  statistical data published by Dr. Collins, in his Re-
 port of the  Dublin Lying-in Hospital, affords ample proof of
 this general principle.   According to calculations which I some
 time ago made from Dr. Collins' data, I found that while in the
 women delivered in the Dublin Hospital, and  whose sufferings
 were  terminated  within 2 hours, only 1 in 320 of  the mothers
 died;   where the labor varied  in duration from 2 to 6 hours, 1
 in 145 of  the mothers died;  in those  in whom it continued from
 7 to 12 hours, 1 in 80 died; where it endured from 12 to 21 hours,
 1 in 26 died; where it lasted from 21 to 30 hours, 1 in 17 died;
 and out of all those whose parturient sufferings were prolonged
 beyond 36 hours, 1 in every 6  perished.
  Again, some may possibly be inclined  to  reason, that any
 means by which we could produce a state of anaesthesia  or in-
 sensibility to the  physical pains of  labor,  must, of necessity,
 be of such a character as to add to  the perils and dangers of the
 patient.   I believe this argument to be as futile and untenable
 as the one that I have just noticed.  Indeed, judging from analo-
 gy, and from what is  the fact in  surgery, I believe that, as a
 counteraction to the morbific influence of pain, the state of arti-
 ficial  anaesthesia does not only imply a saving of human suffer-
 ing, but a saving also of human life.  Out of above 300 cases
 of the larger amputations performed during the current year,
 upon  patients in an etherized or ancesthetic state, and which I
 have  collated from different  hospitals in Great Britain,  Ireland,
 and France, a smaller proportion died than  formerly used to
 perish in the same hospitals under the same operations without
 etherization.  I shall take one of these amputations as an illus-
 tration of the whole—and that one the most severe of all—viz.
 amputation of  the thigh.  Malgaigne (1842)  showed, that un-
 der amputations of the thigh,  in  the hospitals of Paris, 62 in
 every 100 died ; in Edinburgh, the mortality from this operation,
 in the only  years during which  the  hospital  reports were pub-
 lished (1839-42.) was 50 in every 100; Mr. Phillips of London 
15
(IS 14,) found the average  mortality 40 in 100;  Dr. Lawrie at
Glasgow (1839.) found it also in the hospitals of that city to be
40 in 100.*  1 have notes of 135 cases in which this same opera-
tion  has been performed in hospital practice upon patients in an
etherized state.   Out of these 135 cases 33 died,  or only 24 in
100.   Hence I repeat, that the condition of anaesthesia not only
preserves the patient in  surgical  practice from agony and  tor-
ture, but actually preserves him too from the chances of danger
and death.   And I  firmly believe,  that the superinduction of
anaesthesia in obstetric practice  will  yet be  found to diminish
and remove also, in some degree, the perils as well as the pains
of labor.
  In an essay which I wrote in  February  last, " On the Em-
ployment of the Inhalation  of Sulphuric Ether in  the Practice
of Midwifery," {Monthly Journal of Medical Science for March
1847, p. 728,) I offered  some remarks on its application  to cases
of common as well as of morbid parturition, and took occasion
to observe,  " The question which  I have been repeatedly asked
is this—Will we ever be 'justified' in using the vapour  of ether
to assuage  the pains of natural  labor?  Now, if experience
betimes goes fully to prove  to us  the safety with which ether
may, under proper precautions and management,  be employed
in the course of parturition,  then,  looking to  the  facts of  the
case, and considering the actual amount of pain usually endur-
ed, I believe that the question will require to be quite changed
  * The following table exhibits the actual number of the cases of amputation
of the thigh referred to in the text, with their respective results:—
       Mortality accompanying Amputation of the Thigh.
N'arue of Reporter.	Number of Cases.	Xuinber of Deaths.	Per Centage of Deaths.
	201 43 660 1S4	126 21 263 73	62 in 100 50 in 100 40 in 100 40 in 100
Phillips' Collection of Cases, . . .			
			
	1088	483	44 in 100
Upon Patients in an Anirsthetic >	135	33	24 in 100
			
 
16
 in its character.   For,  instead  of determining in relation to it
 whether we shall  be'justified'  in  using  this  agent  under the
 circumstances named, it will become, on the other hand, neces-
 sary to determine whether on any grounds, moral or  medical, a
 professional man could deem himself 'justified' in withholding,
 and not using any such safe means (as we at present presuppose
 this to be,) provided he had the power  by it of assuaging the
 pangs and anguish of the  last stage of natural labor, and thus
 counteracting what Velpeau describes as ' as those piercing cries,
 that agitation so lively, those excessive efforts,  those inexpressi-
 ble agonies, and those pains apparently intolerable,'*  which ac-
 company the termination of natural parturition  in the human
 mother."
  Since the latter  part of January, I have  employed etheriza-
 tion,  with few  and rare  exceptions, in every  case of  labor
 which has been under my care.   And the results, as  I have al-
 ready elsewhere stated, have been, indeed, most happy and grati-
 fying.  I never had the pleasure of watching over a series  of
 more  perfect or more rapid recoveries; nor have I once witness-
 ed any disagreeable result to either mother  or child.  I  have
 kept up the  anaesthetic state during periods varying from a few
 minutes to three, four, five,  and  six hours.   I do not remember
 a single patient to have taken it who has not afterwards de-
clared her sincere gratitude  for its employment, and  her indu-
 bitable determination to have recourse again to similar means
 under similar circumstances.  All who  happened to  have for-
 merly entertained any dread respecting the inhalation, or its ef-
 fects,  have afterwards looked back, both amazed at, and amus-
 ed with, their  previous absurd  fears and  groundless terrors.
 Most, indeed, have subsequently set out, like zealous missiona-
 ries, to persuade other friends  to avail themselves of the  same
 measure of relief in their hour of trial and travail; and a num-
 ber of my most  esteemed  professional  brethren  in Edinburgh
 have adopted it with success,  and  results equal to  my  own.
 All of us, I most sincerely believe, are called upon to employ it

  * Traite des Accouchemens, Vol. 1. p. 449.  " Ces cris percans, cette agita-
 tion si vive, ces efforts  excessifs, ces angoisses inexprimables, ces  douleura qui
 parassaient intolerables," &c. 
17
by every principle of  true humanity, as well as by every princi-
ple of true religion.*   Medical men may oppose for a time the
superinduction of anaesthesia in parturition,  but they will  op-
pose it in vain ; for certainly our patients themselves will force
the use of it upon the profession.   The whole question is, even
now, one merely of time.   It is not—Shall the practice come to
be generally adopted? but, When shall it come to be generally
adopted ?  Of course, it will meet from various  quarters with
all due  and determinate opposition.  Medical men will, no doubt,
earnestly argue that their established medical opinions and med-
ical practices should not be harshly interfered  with by any vio-
lent innovations of doctrine regarding the non-necessity and non-
propriety of maternal suffering.  They will  insist on  mothers
continuing to endure, in all their primitive intensity, all the ago-
nies of  childbirth,  as a proper sacrifice  to the conservatism of
the doctrine of the desirability of pain.  They will  perhaps at-
tempt to frighten their patients into the medical propriety of this
sacrifice of their feelings  ;f and some may be found who will

   * See "Answer to the Religious Objections urged against the employment of
Anesthetic Agents in Midwifery and Surgery."
   t We can all recollect the many absurd stories of apocryphal disasters and
deaths that the opponents of etherization busily and anxiously reported towards
the commencement of the  present  year, as  having occurred from the employ-
ment of ether-inhalation in surgery.   Dr. Forbes,  in his excellent article on
etherization, in treating  of these unscrupulous and disreputable pieces of pro-
fessional gossip, observes—" One day we had death from asphyxia; another from
coma; another from hemoptysis; some from convulsions; a few from pneumonia;
and  one or two from actual incremation, or explosion*- through the accident?-!
firing of the ethereal vapour within the air passages.  We have not had time to
investigate all these terrible cases ; but we may state that we traced the one which
seemed the best authenticated—that from hemoptysis—from its full-blown ma-
jesty in after-dinner gossip, to its humble source in the hospital.  And this was
the case, as the man himself detailed it to us :—A day or two after a successful
operation for hernia, under etherization, the man pricked his gums while picking
his teeth with a pin ; and it was the product  of this operation, not of the ether,
seen in the spitting-pot by the patient's bedside, that was bruited about town, as
of itself sufficient to  settle the question in all future time !—(British  and For-
eign Medical Review, No. XLVI.  April 1847, p. 564.)—When first employing
etherization in midwifery, I met with no small number of  similar strange tales
and accusations.  For example,  in February last, a patient who happened to be
severely frightened had,  in  consequence, a  premature  labor.  The child  pre-
sented preternaturally; and died a day or two after birth.  The mother was at-
              2* 
18
unscrupulously ascribe to the new agency any misadventures,
from any causes whatever, that may happen to occur in practice.
But husbands will scarcely permit the sufferings of  their wives
to be perpetuated merely in order that the  tranquillity  of this
or that medical dogma be not rudely disturbed.   Women them-
selves will betimes  rebel against enduring  the usual  tortures
and miseries of childbirth,  merely  to subserve the caprice of
their medical attendants.  And I more than  doubt if any phy-
sician  is really justified, on any grounds,  medical  or moral, in
deliberately desiring and asking his patients to shriek and writhe
on in their agonies for a few months—or a few years  longer—
in order that, by doing so,  they  may  defer  to  his  professional
apathy,  or pander to his professional prejudices.
  Two agents  have the power of producing  anaesthesia during
labor,  viz. the inhalation of sulphuric ether, and the inhalation
of  chloroform.    With  most, if  not all, of  my   professional
brethren, I believe that  the  latter  agent  possesses various im-
portant advantages over the former, particularly  in  obstetric
practice; and that,  in  particular, it is far more portable;  more
manageable and powerful; more agreeable to inhale; is less ex-

tacked with phlegmasia dolens, and made a very long and protracted recovery
Various kind  friends,  anxious about the results of etherization in midwifery,
warned me of the professional odium which this case was bringing upon the new
practice, and of the strong argument which it was affording to others against the
safety of ether-inhalation in obstetrics.   I was repeatedly and credibly told that
ladies had informed their physicians, that the quantity used was so great that
they had felt the odour of it perfectly oppressive when calling, even days after-
wards, at the house of my patient.  The answer to all this was sufficiently sim-
ple.  The danger of death to the child from its prematurity and preternatural
presentation appeared to be from the first so imminent, that I did not choose to
peril the character of the new practice by following it in this case.  The ether
had not only not been used : but not a drop of it had ever been in the house.
One of  my patients was zealously attempted, some months ago, to be persuaded
against the " horrors of ether," on the strong and round assertion, that some
dozen ladies or more in Dublin, upon whom the practice had been tried, had in-
dubitably  perished from the effects of it.  Unfortunately for the veracity of this
statement, ether-inhalation had never once been used, or attempted to be used
in obstetric practice in Dublin, up to that date, or for a long time afterwards.
Indeed, the first case in which ether was employed in midwifery in Dublin only
occurred this week (28th Nov.;) as I am informed in a letter of that date, which
I have just received regarding it, from Dr. Tyler. 
19
citing than ether; and gives us far greater control and command
over the superinduction of the  anaesthetic state.  In  the re-
maining part of these observations I shall detail briefly some
instances illustrative of  its effects and utility in the production
of anaesthesia in cases of natural and morbid parturition.
  Case I.—The patient to whom it was first exhibited had been
previously delivered in the country by craniotomy after a very
long labor.   Her second confinement took place a fortnight be-
fore the full time.   Chloroform was begun to be inhaled when
the os uteri was becoming wefl expanded, and  the pains veTy
severe.   In twenty-five minutes the child was born.   The cry-
ing of the infant did not rouse the mother, nor  did she awake
till after the placenta was removed.   She was then perfectly
unaware that her child  was born.  She stated her sensations to
be those of awaking from " a very comfortable sleep."   It was,
for a  time, a  matter of no small difficulty to persuade  her that
the labor was over, and that the living  child presented to her
was her own.
   Case II.—I exhibited it, with Mr. Carmichael, to  a patient
who had, at  her  preceding confinement,  been in severe  labor
for twenty hours—followed  by  flooding.  She began the inha-
lation when the dilatation of the os  uteri was half completed.
The child was born in fifty minutes afterwards.  She was kept
under its influence  for a quarter of an hour longer, till the pla-
centa was removed, and the  binder, body, and bed-clothes, all
adjusted.  On awaking, she declared she had been sleeping re-
freshingly; and was quite unconscious that the child was born,
till she  suddenly heard  it squalling at its  first toilet in the next
room.  No flooding.  An hour afterwards, she declared she felt
perfectly unfatigued, and not as if she had borne a child at all.
   Case III.—Patient unmarried. A first labor.  Twins.  The
first child presented by the pelvis,  the second  with  the hand
and head.  The chloroform was exhibited when the os uteri
was nearly fully dilated.  The passages speedily became great-
ly relaxed (as has happened in other cases placed under its full
influence;) andin a few pains the first child was born,  assisted
by some traction.   I broke the membranes of the second, push-
ed up the hand, and secured  the more complete presentation of 
20
the head.   Three pains expelled the child.  The mother was
then bound up; her clothes were changed ; and she was lifted
into another bed.   During all this time she  slept on soundly,
and for a full hour afterwards: the chloroform acting in this, as
in other cases of its prolonged employment, as a soporific.  The
patient recollected nothing from the time of the first inhalations;
and was in no small  degree distressed when not one—but two
—living children were brought by the nurse to her.   Dr. Chris-
tison accompanied me to this case.
  Case IV.—Primipara of full habit.  When the first examina-
tion was made, the passages were rigid, and the os uteri difficult
to reach.  Between six and seven hours after labor began, the
patient, who was  complaining much,  was apathized with the
chloroform.  In about two hours afterwards, the os uteri was
fully dilated, and in four hours and  a  half after the inhalation
was begun, a large child was expelled.  The placenta was re-
moved, and the patient bound up and dressed before she was
allowed to awake.   This patient required an unusual quantity
of chloroform;  and Dr. Williamson,  who  remained beside her,
states to me in his notes of the case,  " the handkerchief was
moistened often in order to keep up the soporific effect.  On one
occasion, 1 allowed her to emerge from this  state for a short
time;  but on the accession of  the first pain she called out so for
the chloroform,  that it was necessary  to  pacify her by giving
her some immediately.   In all, four ounces of chloroform were
used/'  Like the others, she  was quite unconscious of what
had gone on during her anesthetic state;  and awoke altogether
unaware that her child was born.
  Case V.—Second labor.  This patient, after being several
hours in labor, was brought to the Maternity  Hospital.  I  saw
her some time afterwards, and found the first stage protracted
by the right side of the cervix uteri being thick, cedematous,
and undilatable.  The inhalation of chloroform was begun, and
the first stage was terminated in about a couple of hours. Two
or three pains drove  the  child through the pelvic canal, and
completed the second stage.  Fifteen  minutes in all elapsed from
the termination of the first to the termination of the third stage,
or the expulsion of the placenta.  The patient was dressed and 
21
removed into a dry bed, where she slept on for a short time be-
fore awaking, and being conscious of her delivery.
   Case VI.—Second labor.  The patient, a person of small
form and delicate constitution; bore her first child prematurely
at the seventh month.  After being six hours in labor, the os
uteri was fully expanded, and the head well down in the pelvic
cavity.  For two hours subsequently, it remained fixed in near-
ly the same position, and scarcely if at all  advanced, although
the pains were very distressing, and the patient becoming faint
and exhausted.  She entertained  some mistaken religious feel-
ings against ether or chloroform, which had made her object to
the earlier use of the latter; but I now placed her under its in-
fluence.   She lay as usual like a  person soundly asleep under
it, and I was now able, without any suffering on her part, to in-
crease the intensity and force of each recurring pain, by excit-
ing the uterus and abdominal muscles through  pressure on the
lower  part of the vagina  and perineum.  The child was ex-
pelled in  about  fifteen minutes  after the inhalation was com-
menced.   In a few minutes she  awoke  to ask if it was really
possible that her child  had been born ; and was overjoyed to be
told that it was  so.  I had the conviction  that  in this case the
forceps would in all probability have been  ultimately required,
perhaps hours subsequently, provided I  had not  been able to
have interfered in  the way mentioned.  I might, it is true, have
followed the same proceeding though the patient was not in an
anaesthetic state, but I could not have done so  without inflict-
ing great misery and agony upon  her, and meeting with great
resistance.
   Case VII.—A third  labor.   The patient had been twice be-
fore confined of  dead premature children  ; once of twins, under
the care of Mr. Stone of London ; the second time  of a single
child, under my own charge.   The liquor amnii began to escape
about one o'clock, a. m., but no pains followed  for  some time.
I saw her between three and four, with the pains commencing,
and  the os uteri  beginning to dilate.  In two hours  afterwards
the first stage was well advanced, and, the pains becoming se-
vere, she had the chloroform exhibited to her, and slept soundly
under its influence.   In twenty minutes the child was born, and 
'>9
cried very loudly without rousing the mother.  In about twelve
or fifteen minutes more she awoke, as the application of the
binder was going  on,  and immediately demanded if her child
was really born and alive, as she thought she had some recollec-
tion of hearing the nurse say so.  She  was rejoiced beyond
measure on her son being brought in and  presented to her:
  Case VIII.—Fourth labor.  The patient had born three dead
children prematurely, about  the  sixth and seventh months of
utero-gestation.  During her present pregnancy I placed her un-
der strict rules and discipline ; and she used, from  an early pe-
riod, small doses of chlorate of potass several times a day.  She
carried her child to the full time.  Labor came on  about one
o'clock, a. m.   The membranes broke at  eight, a. m., when the
os uteri was  still very slightly open.  It had made very little
progress till ten o'clock, when Dr. Keith exhibited the chloro-
form to her.  The pains continued very strong and regular, the
passages relaxed,  and at half-past eleven  she  was delivered of
a large living child.  The placenta came away immediately;
and she was bound up, and her  soiled clothes removed, before
she awoke.  She  remembered nothing whatever  that had oc-
curred after she began to  inhale the chloroform till  the period of
her awaking.
  The preceding instances afford, perhaps, a sufficient number
of examples of the use  of  chloroform  in natural labor.  In
these  and in all others which 1 have seen, or that have been re-
ported to me, the immediate effects of the  chloroform have been
delightful.  The mothers, instead of crying and  suffering un-
der the strong agonies and throes of  labor, have lain in a state
of quiet,  placid slumber,  made more  or less deep at the will of
the medical attendant, and,  if disturbed  at all,  disturbed only
unconsciously from time to time by the recurring  uterine con-
tractions producing some reflex or automatic movements on the
part of the patient—like those of a person moving under any
irritation of the surface, or from  the  touch of another, though
still in a state of sleep.  Nor  have the ultimate consequences
and results been less happy.   No difficulties have been met with
in the third stage; and the uterus has contracted perfectly after
delivery.   I never saw mothers  recover  more satisfactorily or 
23
rapidly,—or children that looked more viable.  And the prac-
tice is not a great blessing to  the patient merely; it is a great
boon also to the practitioner.   For whilst it relieves the former
from the dread and endurance of agony and  pain, it both re-
lieves the latter from the disagreeable necessity of witnessing
such agony and pain in a fellow-creature, and imparts to him
the proud power of being able to cancel and remove pangs and
torture  that would otherwise be inevitable.  It transforms a
work of physical anguish into one of painless  muscular effort;
and changes into a scene of sleep and comparative repose, that
anxious hour of female existence, which has ever been prover-
bially cited as the hour of the greatest of mortal suffering.
  The effects of the superiuduction of anaesthesia in parturition
are, if  possible, still more marked and beneficial in cases of
morbid  labor and operative delivery.   In proof of  its influence
in this respect, I shall cite some examples of its employment in
cases of turning, of the application of the forceps,  and of em-
bryulsio.
  Case  IX.—Fourth  labor.   The mother deformed, and the
conjugate diameter of the brim of the pelvis  contracted  from
the projection inwards and forwards of the  promontory of the
sacrum.  Her  first child  was delivered  by  embryulsio;  the
second  by the  long forceps;  the third was  small, and passed
without artificial assistance.   On the present occasion, after suf-
fering  slight  pains during the whole  night, labor set in with
greater severity towards morning.  After being in  strong labor
for some hours, she was seen first by Mr. Figg, and afterwards
by  Dr. Peddie, her ordinary medical attendant.  I was called to
her about  four o'clock, f. m.  The pains were then enormous-
ly powerful and straining, imparting to the mind  the dread of
the uterus rupturing under their influence ; but the head of the
child was  still altogether above the brim,  and  only an cedema-
tous ridge of the scalp pressed  through the superior and con-
tracted  pelvic opening.  The passages had become heated, the
mothers pulse raised,  &c, and Dr. Peddie had tried  two differ-
ent pairs of long forceps.   After I arrived he applied, with  great
skill, another  pair of long forceps which  I  had with me; but
it was found impossible to move the head  in the least degree 
24
 forwards.  The urgency and power of the uterine contractions,
 the immobility of the head upon the brim of a deformed pelvis,
 and the state of the patient and of the parts, all showed the ne-
 cessity of relief being obtained by artificial delivery.  In her
 first  labor I had assisted Dr. Peddie  in  delivering her under
 similar circumstances by perforation of the head.   But here the
 child's heart was heard distinctly with the stethescope, and he
 at once agreed to my proposition,  that I  should  try to deliver
 her by turning the infant,—compressing and indenting the flexi-
 ble skull of the foetus, instead of perforating it, and thus afford-
 ing (as I have for some time  past taught and  believed) some
 chance of life to  the child, and more  chance of safety to the
 mother.  The patient was placed under the influence of chloro-
 form still more deeply than when the forceps were used, in or-
 der,  if possible,  entirely to arrest  the  uterine contractions.   I
 passed up my hand into the uterus, seized a knee, and easily
 turned the infant; but very great exertion anjl  pulling was re-
 quired to extract the child's head  through the distorted brim.
 At last it passed, much compressed and elongated.  The child
 was still-born, but, by applying the usual restorative means, it
 speedily began to breathe and cry.  The child  continues well,
 and the mother has made a rapid recovery.
  Case X.—In  the .Maternity Hospital; first child.   Labor
 began at ten, p. m. (21st Nov.) I was desired to see her at six
 a. m. (22d.)  The os uteri was well dilated, but it was evident
 that  the pelvic canal was contracted throughout, and  the head
 was  passing with unusual difficulty through  the brim.   The
 patient was complaining much of her sufferings.   It was clear
 that it would be a very tedious and probably,  at last, an instru-
 mental case, and one therefore calculated to test the length of
 time during which chloroform might be used.  She began to in-
 hale  it at a quarter past six, a. m., and was kept under its influ-
 ence till a quarter past seven, p. m., the date of her delivery; thir-
 teen hours in all.  From the time it was begun to the time de-
livery was completed, her cries and complaints ceased,  and she
slept soundly on throughout the day.  The bladder required to
be emptied several times  with the catheter.   The head passed
the os uteri at ten, a. m. and, during the day, gradually descended 
25
 through the pelvis.  At seven, a. m. I at last deemed it proper to
 deliver her by the forceps ; the head, which was now elongated
 and (edematous,  having by that, time rested  for some hours
 against the contracted pelvic  outlet with little or  no evidence
 of  advancement,  the bones of the foetal  cranium overlapping
 each other, and the fastal heart becoming less  strong and dis-
 tinct in its pulsations.  A  warm bath, irritation of  the chest.
 &c, were necessary to excite full and  perfect respiration in the
 infant.  Whilst we were all busied with the infant, the mother
 lost some blood;  but  the placenta was immediately removed,
 and the uterus contracted perfectly.  On afterwards measuring
 the quantity  of blood lost, it was calculated to amount to 15
 or  18  ounces.  The mother's clothes were changed  ; she was
 bound up and removed  to a dry bed  before  she awoke.  She
 had at first no idea that  the child  was born,  and was in no re-
 spect  conscious  of being delivered.   In fact  she  had been
 " sleeping," according to her own account, from the time she had
 begun the inhalation, and  only thought she  once or twice re-
 membered or dreamed  that  she  heard  Dr.  Williamson,  the
 house  surgeon, speak near her.  Dr.  Beilby,  Dr. Zeialer, <Scc,
 saw the case  with me.   The mother and child have  continued
 perfectly well.
   In this, as in  other cases, I have  watched  and  noted  the
 effects of the chloroform  upon the  duration of the  pains and of
 the intervals,  the rate of the foetal and  maternal pulse, &c.
  Case XI. — Patient with a deformed  spine  and contracted
 pelvic  outlet.  At her first confinement  two different medical
 gentlemen had failed in effecting  delivery by the forceps.  At
 this, her second confinement, she placed herself under the care
 of  Dr. Paterson of Leith.  After being very long in labor, and
 the symptoms of the case becoming urgent, I saw her with Dr.
 Paterson.  The head was low down in  the pelvis : but it was
 placed  in  the right  occipito-posterior position (the third  of
 Naegele,) and the forehead instead of the vertex was present-
ing, one orbit  being easily felt behind the symphysis pubis.   It
had been lodged in nearly the same  position  for many hours.
The foetal heart was  still  distinct, but  weak.   I applied the
forceps — turned  the  head round  with them a quarter of a
                 3 
26
circle, into an occipito-anterior position (the second of Naegele,)
and, after being so adjusted, it still required considerable force
to extract it.  Before applying the forceps the patient  was sent
into a state of deep anaesthesia by the inhalation of chloroform;
and subsequently, when she awakened out of it,  she was in no
small degree surprised to find that she had  really been de-
livered while she was sleeping and resting so soundly.   The
placenta separated, and the uterus contracted  firmly.   The
child, which  was large, lived for  eight hours after delivery;
but, despite of all the measures tried, full and perfect respiration
was never established in it. apparently in  consequence of some
effusion or injury about the base of the brain.  Unfortunately
a post-mortem examination was not obtained.  The mother has
made an excellent recovery.
   I quote the following instance, of craniotomy under chloro-
form from a letter (dated  2(Jth November,) which I have re-
ceived from  my friend, Professor  Murphy of London.  I give
the case in Dr.  Murphy's own words: —
   Case  XII. — "I have tried the  chloroform  with great  suc-
cess in a case of distorled pelvis.   It was  the ovate deformity,
the conjugate measurement being  only 2j  inches;  the head of
the child could  not enter the brim, and I  was obliged to per-
forate.   I got Dr. Snow to assist me in bringing her under the
influence of chloroform.  She made some resistance, and strug-
gled a good deal at first, chiefly I think from apprehension that
we were going  to do  something very dreadful;  however, she
soon began to inhale  quietly, and  gradually fell into a kind of
dreamy sleep.  I perforated  the  head, and  labored with the
crochet  (sometimes with  the craniotomy forceps) for  three
quarters  of an  hour before  I could get the  head through the
brim.  She was at length delivered;  the  placenta was  sepa-
rated in about ten minutes; the bandage applied, soiled clothes
removed, and she was made ' clean and  comfortable,' as the
midwives say.  My patient was perfectly  unconscious all this
time, and did not awake for about a quarter of an hour after
the operation ; she did so  then quite quietly, and  was greatly
surprised to  find that all her miseries were  over.  There was
no hemorrhage,  but  the  uterus felt rather  spongy and large. 
27
She is now recovering most favorably.  I never had a case re-
cover so far, so well."
  Other cases, both of natural and morbid labor, in which the
patients were delivered in an anaesthetic  state from the in-
halation  of chloroform, have been reported  to  me by  Dr.
Protheroe Smith,  Dr. Imlach, Dr. Robertson  of Birkenhead,
Dr. Malcolm, Dr.  Buchanan,  &c.;  but as these,  and some
other instances  which I have myself seen, presented nothing
new or different in their phenomena from the  cases which I
have already detailed, I have thought it  unnecessary to over-
load the present communication by the details of them. 
 
APPENDIX.
  Many distinguished members of the  Medical Profession,  have fur-
nished us with their testimonials in relation to the use of Chloroform,
from which we select the following :
                 Letter from John C. Warren, M. D.,
 Emeritus Professor of Anatomy and Surgery in  the University at Cambridge, and Surgeon at
                       Massachusetts General Hospital.
                                           Boston, Feb. 2, 1848.
   Messrs. Little & Co.,—Three or  four days since I received your
 note, informing me of your intention to republish Professor Simpson's
 pamphlet on the use of Chloroform in Midwifery, and  of your wish that
 I should give an account of my experience of this article in  Surgical
 Practice.  Although the time allotted for the purpose is too short to al-
 low me to give  a full statement, I shall  readily  comply  with  your re-
 quest, so far as  to  send you  some few  remarks.  This I do the more
 willingly as a return for your polite attention in exhibiting to me the actual
 process for making  Chloroform, and  because the first information of
 the discovery of Chloroform  appeared  here after the printing  of  the
 principal part of my remarks on Etherization ;  so that I  had little  op-
 portunity, before the actual publication was made, of  experimenting on
 its use.  Immediately  on being acquainted with the discovery of Chloro-
 form, and its application to Etherization, I  determined to  give it a  fair
 trial, and to make up, as far as I was able,  a faithful judgment  of its
 value.   The result I shall communicate of  course very briefly.
  Chloric Ether was discovered in this country  in the  year 1831, by
 Mr. Guthrie, in consequence  of some  experiments performed by him,
on the  suggestion of Professor Silliman, for the purpose of manufactur-
ing the chloric ether of the Dutch chemists.
                    3* 
30
  Chloroform is the product of the redistillation  of chloric ether  with
an additional quantity of chloride of lime, and it seems proper enough
for this, as well as other reasons, to continue the use of the term " ether-
ization," to designate the action of Chloroform  on the animal body.
Chloric Ether has been for many years employed in medical practice ;
and its use, in the way of inhalation, has been resorted to, among others,
by the celebrated Mr. Lawrence, of London, and by ourselves. Chloro-
form as distinguished  from the  latter seems to have been  first pointed
out by the French chemists, and first employed  to relieve  pain by Mr.
Bell, of London,  in February, 1847.   This gentleman, however, did
not pursue its application very decidedly, and it remained for Professor
Simpson, of Edinburgh, already well known for his successful practice
of Etherization in Midwifery, to show its full importance in preventing
and relieving pain.
  Chloroform is a beautiful substance.   Its limpidity, specific gravity,
agreeable taste, fragrant odor, and  its  wonderful  power of alleviating
and preventing pain,  combine to render it quite remarkable.  These
properties have been fully displayed  by  Professor Simpson, and 1 have
only to advert to its effects comparatively  with those of Sulphuric
Ether.
  The operation of these two substances on the  living body is essenti-
ally the same, especially in the wonderful influence, first discovered  in
this city, of preventing and  alleviating  the suffering from  painful im-
pressions.   Is there any difference in their  mode of action, which en-
titles one to  be preferred above the other ?   Chloroform, so far as my
experience enables  me to determine,  has  advantages over  the  other
ethers.  It seems to me to steal away the senses  in  a  more quiet and
insidious manner.  The distinction between the  abolition of the tactile
and intellectual functions is less marked.  They fall together, and thus
indicate a  simultaneous invasion  of the organs which  perform them.
There is less of intellectual, vascular and muscular  excitement  in the
beginning, more of depression in the course  and termination ; and we
are therefore led  to the conclusion,  that the successive disappearance
of these faculties from sulphuric etherization is owing to  a difference
in the degree of ethereal action, rather than to a difference of the parts
acted on.  There is  less pulmonary irritation.   The time  necessary
with chloroform for the  production  of  these effects is less  than  with
sulphuric ether.   The degree of insensibility is,  I  think, greater from
chloroform;  as we do not so often notice the  unconscious shrinking,
which seems to indicate pain.   The duration of this state is  also more 
31
considerable.   The restoration of nervous action  is  more sudden  and
perfect.   A gentleman from whom  I  removed  a large  tumor of the
groin required  five minutes for the accomplishment of etherization, re-
mained fifteen  wholly unconscious, and then awoke with  faculties per-
fectly unclouded, and without a dream, or the knowledge of what pass-
ed  during his  sleep.   The more  sudden action of chloroform,  and
more perfect termination of this action is to  be  attributed probably to
its greater volatility ; for although a more dense  liquid than  sulphuric
ether, its  emanations diffuse themselves more rapidly, act  of course
more speedily, and are more suddenly absorbed  into the circulation.
  A great advantage of chloroform is found in the comparatively small
quantity required for etherization :  twenty or thirty drops judiciously
applied are often sufficient. This fact has contributed much to its sud-
den and extensive use in this country.   An additional recommendation
is the absence  of inflammability.
   The  facility  with  which chloroform is  inhaled  may no doubt lead to
an  abuse  of this article for the purpose of intoxication.  The knowledge
of the probability of such  an occurrence will, it is to be hoped, lead
those who may employ  it to reflect on the dangers that must result from
the frequent application to the nervous system of a substance  exhaust-
ing to the bodily and mental powers, and which may ultimately lead to
the permanent  derangement of both.
  The effects of the new anaesthetic I  have had opportunity of observ-
ing in a considerable number of operations, and  among these anchylo-
sis, strangulated hernia,  amputation, removal of tumors, etc.   It was
a great satisfaction to me to  do an operation  for strangulated hernia—
an  operation  which I have so often seen attended with severe distress—
on a gentleman with a bad strangulation, who during  the ten minutes
required lay as perfectly tranquil as  a subject on the dissecting table of
the anatomist,  and who directly after its  completion awoke in his right
mind, and with no knowledge of the operation.   This gentleman acci-
dentally swallowed about  half a tea-spoonful of  pure chloroform with-
out any material ill  consequence.
  The phenomena  have  generally  been of an agreeable character;
but, as in  regard to  sulphuric ether, there  have  been  exceptions.  In
two cases convulsions took place before perfect insensibility ; in  one a
sense of insupportable enlargement of the heart; in another dizziness,
nausea, fainting, and great depression of strength for five or six days.
  The mode  of administration, which my experience leads me to  adopt,
is different from that of  Sulphuric  Ether.   The latter is  most con- 
32
veniently employed by a large  sponge,  while Chloroform,  applied  to
the skin, producing an inconvenient  and sometimes painful  irritation,
ought to be enclosed in a vessel.  The apparatus I prefer is very sim-
ple.   It is constructed so as to introduce the vapor through the nostrils
instead of the mouth, for reasons stated in my remarks on Etherization.
The nostrils are the natural apertures for inhalation ;  cold  air and all
irritating fluids  disturb the lungs less when introduced by them than by
the mouth.  The apparatus then should  consist  of  a straight tube, to
one end of which are affixed two small  tubes, a little curved, about an
inch and a half long, adapted to the nostrils;  to  the other end is con-
nected a little box with an aperture on its upper plate for the entrance
of air, and another communicating with the  principal tube.   The  box
opens at the upper part to receive a piece of  muslin, or a sponge.
  Chloroform may be used externally, as well as by inhalation.  Time
has not permitted me to employ it thus to any great extent, but having
used it with advantage in a number of instances,  I  should recommend
it in the way of friction in rheumatic, neuralgic and other local pains.
The friction should  be so conducted as  to prevent the ready escape of
the volatile liquid, and the possible etherization of the nurse.  Its pro-
perty of irritating the skin would in this way have a  double  advantage ;
first, in  producing counter-irritation, and second, in disposing by this
irritation to cutaneous absorption of the  anodyne liquid.   These  effects
are more certainly secured, if the friction be made with  a sponge, than
if with a cloth, on account of the rapidity of evaporation  from the latter.
  The agreeable action of Chloroform  depends  on its purity.   When
it was first brought here, on inhaling it myself, a  violent burning,  like
that from a flame, was experienced  in the  nostrils,  larynx and lungs,
which  continued to the next day.   The irritation  was produced no
doubt by a liquid impure, whether from retained alcohol, sulphuric acid,
or from some other irritating exhalation  combined  with alcohol, I am
unable to say.   A test of easy application is  said to be  found by drop-
ping the chloroform into water, mixed with an  equal quantity of sul-
phuric acid  ;—when  perfectly pure it retains as it sinks into the water
its transparency, when otherwise it becomes cloudy.  That which you
have recently exhibited to me  seems to  possess the former  quality in a
high degree.   The  reduction of its price I heard with great pleasure,
as its dearness must have proved a serious  impediment to its extensive
employment in public institutions.
  The vapor of Sulphuric Ether has the effect of producing headache
in many individuals, and I can state, that I have never  administered it, 
33
for any  length of  time, without  experiencing  this  inconvenience;
Chloroform, so far as I can judge, has not the same objection.
   Whether Chloroform will supersede the other Ethers as an anaesthe-
tic, is yet unsettled.  The present impression is in favor of this expecta-
tion,  but  however strongly our bias may be in  this direction, we must
wait a little before we conclude to banish Sulphuric Ether, and receive
exclusively its new relation.   We may venture to say, perhaps without
qualification, that  the  article so happily  introduced into  practice by Pro-
fessor Simpson, is the most valuable improvement on Etherization hith-
erto made.                                    JOHN  C. WARREX.
   Note.—Perhaps it will be an  advantage  to know the latest improTcment of
the French chemists, in the mode  of preparing chloroform.
   "Take  10 kilogr (26/6. 9oz. idr.  20gr.) of the chlorinated lime of commerce at
 about 90° ; dilute carefully in GO  kilogr (1601b. 9oz. 2dr.) of water; fill a brass
still, up to two-thirds only, with the calcareous milk which results from this
combination;  add 2 kilogr (5lb. 4oz. 2dr. 28gr.) of alcohol 85°.  Adapt the capi-
tal and  worm ; then  apply a brisk fire underneath the apparatus.  At about 80°
the action produced is such  as would raise the mass and cause it to pass in the
recipient, if the fire were not promptly abstracted.   After a few moments, dis-
tillation commences and goes on rapidly; it terminates almostentirely of itself:—
This is  known by the almost entire absence of the sweetish taste of chloroform
in the liquors  in process of distillation.
   " The produce is composed of two layers ; the inferior is dense, and of a slight
yellowish hue; it is chloroform mixed with alcohol and tainted with a little
chlorine.  The superior layer, more abundant, is a mixture, now and then milky,
of water,  alcohol, and chloroform, or chloric ether.  A certain quantity of this
produce is deposited in about twenty-four hours. The chloroform is separated
by decantation, and washed  with water; then with a weak solution of carbonate
of soda, which frees it from  the chlorine; add chloride of calcium, and rectify
by distillation per balneum maris.  M. Soubeiran thinks that for medical use it
is superfluous  to rectify anew by sulphuric acid.
  " The waters which float on the chloroform in the direct produce of distilla-
tion, and those that have been used to wash it, are united and spread with a new
quantity of water and distilled per balneum maris. The chloroform soon passes,
carrying away a little alcoholized water which floats upon it.   Purifj- as directed
above.  What renders the fabrication of  chloroform difficult, is the necessity in
which the operator  is placed, of  working with  chlorinated  lime considerably
spread,  in order to enable him to separate impurities;  hence, the necessity of
operating  with vases of great capacity, and of acting at the same time with very
limited  quantities of alcohol.  In the actual state, the quantity of the produce
is always sufficiently restricted.                       M.  SOU13EIRAX." 
34
                 Letter from  Walter Channino, M. D.,
                    Professor of Midwifery in Harvard University.
                                        Boston, January 25, 1818.
   Messrs.  Wm. B. Little cj* Co.,
     Gentlemen,—I have read this morning Prof. Simpson's tract on the
   employment of Chloroform in childbirth.   It is a very important contri-
   bution to the use of Chloroform in the cases treated of, and cannot fail to
   produce  very useful results.  With  the pamphlet came a request that  I
   would furnish for an Appendix to an edition about to be published by your-
   selves, the results of my  own observations on the use of Chloroform.   I
   should with pleasure do this,  and  feel highly honored by having my
   name  associated with that of Prof. Simpson in this behalf.   But having
   \a purpose  soon to put to press  a volume on the employment of Ether-
   ization in Childbirth, I have thought it best to reserve my contributions
   to this subject till they appear in the work referred to.
     I am very glad to  find that you have entered with  so much zeal in
 '  the making of Chloroform.   I have witnessed the happiest effects in all
   cases in  which I have employed it.   1 am glad too that it is your pur-
,   pose to republish this  second pamphlet of Prof. S. upon  Chloroform.
   We owe our American Edition of his first  work to  the  Druggists in
   New  York, and it is  grateful to me  that a Druggist in Boston is about to
   publish  the second in a Boston Edition.   I have not met with Prof.
   Simpson's answer to the  " Religious Objections" urged against Ether-
   ization, but I hope you will publish  it here as soon  as  you receive  it.
   We have discovered, and successfully employed  in our city, an agent,
   Sulphuric  Ether, which is of the deepest interest to humanity—which
   destroys pain,—diminishes the chances of death,—and makes processes
   which were once attended with almost unmitigated suffering,  and great
   danger,  comparatively safe  and even pleasurable.  We acknowledge
   our obligations to Prof. Simpson for his introduction of Chloroform  for
   the same objects.
     Let us have light from whatever source, so it be light, and then let
   us in the spirit of a noble charity diffuse it every where.
     I have constructed a very simple  inhaler which covers both mouth and
   nose.  It admits atmospheric air with  sufficient  freedom to prevent all
   difficulty of breathing, and allows of the free egress of the expired  air.
   I have used this in a case of exceedingly embarrassing dyspnoea, and
   spasmodic  cough.   I first tried  Chloroform on a  handkerchief, and
   great disturbance followed.  The  conical inhaler above referred to, was
   used  with  entire freedom from all annoyance.
            I remain your friend, &c.,             W.  CHANNING. 
3.5
               Lbtter prom How. A. R. Thomson. M. D.

                                     Charlestown, Jan. 29, 1848.
 Messrs. Wm. B. Little  fy Co.,
   Gentlemen :—To your note  of Jan'y 28th, '48,  (which  I received
 last evening) requesting my opinion of the use of Chloroform, I reply
 that my experience in the use of both Ether  and Chloroform is quite
 limited as to the number of cases—but the very first can settle at once
 and forever in my mind, the grand fact, viz.  that under a judicious ad-
 ministration of Ether or Chloroform, Parturient action may  go on to a
 safe conclusion, while the suffering of the mother is entirely suspend-
 ed.   This is the grand fact to be established—and this fact proved and
 believed, makes the rule of practice plain, clear and absolutely binding
 on every humane Obstetrician.   The power to take oflT  the  perception
 of pain, without, at the  same time, essentially interrupting vital  or phy-
 sical action, rests on a Physiological truth—long ago  settled—viz. that
 the  sensitive nerves—those nerves by which we feel and  act,  and which
 bring in into relation to  the world  around us—are  different  from  the
 vital nerves  ; that is those nerves by which we live.   This great Physi-
 ological fact, so long known as a theory, has recently been applied with
 such brilliant success in  practice, that  it assumes all the freshness of a
 new discovery, it certainly is a  delightful advance  in the glorious sci-
 ence of humanity.  For whatever  disputations there may be in Theo-
 retic schools, the great facts of relief for human  suffering,   form  the
 true science for the people, Dr. Rush  said, that " when Physicians be-
 came better Metaphysicians, and Metaphysicians became better Physi-
 cians, it would be happier for mankind."   And now one word in regard
 to the morale of this matter.   I hear that some objections have been
 raised to the use of Ether and Chloroform, on  the  ground  that it is a
 contravention of  the original plan, or as it has been  sometimes called,
 the doom of Parturition.   " In sorrow  shalt thou bring forth  thy chil-
 dren."   At the time when our common mother brought  forth her first
 born, and while that event was expected, her  situation must  have been
 highly interesting, and she must have had a great many things to think
 of, and  doubtless much sorrow of mind to bear, whether she had a hard
 or an easy labor.  The record is not particular on  this  point, nor is  it
at all important that it should be; all that is said of the  '• sorrows of  a
travailing woman" may  be well understood  without  the necessity  of
bringing in mere bodily pain.   This I think is incidental, rather than
penal, and through all the successive generations of the race, sympathy 
36
 and science have been found intimately  united and earnestly  striving
 to ameliorate  the  pangs of woman.   We may  safely conclude  that
 neither Ether nor Chloroform  were  known in that day ;  but they cer-
 tainly are now, and I think it is our  duty to use them.   I have no dis-
 position to contend with those who cling to the old dispensation and in-
 sist on the infliction of the " primal curse."  For my part I hold to a
 " new and better covenant," believing firmly in Jesus Christ,
                 " In whom the tribes of Adam boast,
                 More blessings than their father lost."
 Those who believe that all knowledge should ever be under the control
 of religious  principle, have in their hands, in these two agents, Chloro-
 form and  Ether, a sublime power,  which  makes  them " ministers of
 (!od" for good ; co-workers with him,and in the true spirit of his blessed
 son, in the holy calling of soothing and relieving  human 'suffering and
sorrow.  It is  a divine revelation—a blessed gift—and as " every good
 gift and every perfect gift cometh down from the  Father of light," let
 us use it with  gratitude,—and to him be all the  glory.
  In regard  to the comparative  value of Chloroform  and Ether, I be-
lieve that they both operate  on the same  principle, and  produce the
same results.  But Ether is very disagreablc  to many,  and all things
considered, the Chloroform is to be preferred.   It has the most power;
is more invariably  to be  depended upon, and is not merely unobjection-
able, but is even delightful in its odor.  Let Physicians, who  know its
inestimable value and its mighty  power, be  solemnly mindful how they
use it; and be faithful to guard the community  against  the abuse of a
power alike  mighty for evil as well as good.
  Wishing you success, Gentlemen, in all your endeavors to advance
the  cause of humanity and science, I am, with great respect,
                        Very faithfully, Yours,
                                        AB'M. R. THOMPSON. 
37
          Letter from Charles T. Jackson, M. D., State Assayer.
Messrs. W. B. Little fy Co.,
  Gentlemen,—In reply to your letter requesting from me some ac-
count of my experiments with Chloroform, I send you  an  extract from
an article published by me in the Boston Atlas of 3d January last, also
some additional remarks which are at your service.
                 Respectfully, your obedient servant,
                                              C. T. JACKSON.
                        CHLOROFORM.
                                         Boston, Jan. 1st, 1848.
 To the Editor of the Atlas :
   Dear Sir :—In order to meet the inquiries of numerous friends as to
 the nature and application of Perchloride of Formyle, or Chloroform,
 an anaesthetic  agent lately employed by Prof. J. Y. Simpson, of Edin-
 burgh, as a substitute for Sulphuric Ether, I  offer you a short account
 of the method  of preparing  it, and a  statement of the experiments
 which I have made in confirmation of the results obtained by that gen-
 tleman.
   So far as I can form an opinion, from a considerable number of care-
 ful experiments, I think it probable that this new application will super-
 cede  that of Sulphuric  Ether, and when manufactured on a large scale
 in capacious stills, Chloroform may be made at a sufficiently moderate
 cost to authorize its general employment in surgical cases,  when pain-
 ful operations  are to  be performed.  It may  be made advantageously
 from  rum  or  whisky,  while  pure  Sulphuric Ether can  only be made
 from  the most highly rectified alcohol.   It may be made in any rum
 distillery where a steam or water  bath heat  is employed, and may be
 collected in tanks, and separated from all traces of alcohol  by washing
 it with water.   Chloroform is  composed of two atoms of carbon, one
 atom  of hydrogen, and three atoms of chlorine.  It  is a heavy sweet
 liquid, having a sp. gr.  of 1.489 at 60  F. (according to my  experi-
 ments,) or 1.480, as given in the books.  It boils at 141 F. and  is very
volatile, having a fragrant odor.  It is not combustible  when flame is
applied to it, nor is its mixture  with  the air explosive.  It is made as
follows, according to the  directions given in Prof. Simpson's paper:
  " R.   Bleaching powder (Hyper Chlorite of Lime) lb. iv.
         Water....................lb. xn.
         Alcohol,.................floz. xn.
               4 
38
Mix in a capacious retort or still, and distill so  long as a dense  liquid
which sinks in the water with which it comes over, is produced."
  I have found, by experience, that a much larger proportion of alcohol
may be advantageously used, and any excess of it which may  come
over may be readily  separated by the action of water,  which  dissolves
the alcohol and leaves the Chloroform in the state of a dense, oily look-
ing fluid at the  bottom.  The water, after having stood some time, is to
be drawn off from the surface of the chloroform, which  may then be
more  completely separated by means of the separating funnel or  bottle
prepared for that purpose.   The Chloroform thus  obtained  free from
alcohol  is sufficiently pure  for  inhalation, but  if  it is required to be
absolutely pure, it  must be carefully agitated with concentrated sulphu-
ric acid, and re-distilled in a glass retort placed in a water bath.
  Bcrzelius recommends the following process  for the production of
Chloroform :
  Take one part of slacked lime and mix it with 21 parts of cold  wa-
ter.    Pass chlorine gas through  the mixture,  to saturation.   A little
more  slacked lime is then added, to restore the alkaline reaction.  The
clear  liquid is then mixed with one part of alcohol or  wood spirit,  and
after standing 24 hours, it is cautiously distilled in a very spacious still.
A watery liquid, containing a little spirit and a heavy oil, collect in  the
receiver.  This is  the Chloroform.   It is to be agitated with cold water
and allowed to subside to the bottom of the containing  vessel, and then
the water may be drawn off and the Chloroform may he obtained  and
separated from any remaining water by means of Chloride of calcium
and redistillation.
  In the usual process of  making "Chloric Ether,"  proof spirit (com-
mon rum) is mixed with Hyper Chlorite  of lime  and  distilled.  Some
of the alcohol escapes decomposition, and comes over  with the Chloro-
form  produced, so  that the Chloric Ether of the shops  is the tincture of
Chloroform.  It was tried as a substitute  for Sulphuric Ether, after I
discovered the anaesthetic  effects of that liquid, but  without  any satis-
factory  results.  This I now  understand was  owing to the stimulating
effects of the alcohol present in the preparation.
  In  1833-4 I introduced very strong " Chloric ether" as a remedy for
toothache, and  gave  samples of it to several dentists in this city,  and  it
has been used  for that purpose  ever since.  Weak chloric  ether  has
been  used successfully in  medicine, as an anti-spasmodic.  Its  applica-
tion by  inhalation,  for the  prevention of pain, did not succeed, as  above
mentioned. 
39
    To Professor Simpson, of Edinburgh, I am indebted for the first ac-
 count of this new application of Chloroform,  and immediately on  re-
 ceiving his pamphlet and letter, I began a series of experiments which
 resulted in entire success.  I have  prepared Chloroform from  alcohol
 and from wood naptha, (the latter giving quite a peculiar Chloroform,)
 and I have tried several e\p< riments with it  by inhaling it  myself, and
 by causing my pupils to inhale it.   I  have  also furnished  samples  of
 the Chloroform to some of our distinguished surgeons, physicians, and
 dentists, and have administered it myself to several  distinguished lt'mi-
 tlemen, and to persons who were to have teeth extracted ; and in all the
 cases I  have witnessed, not a single failure  has taken place  nor have
 any unpleasant symptoms followed.
    It appears to me that the effects  of inhalation of Chloroform passed
 off sooner than those of inhalation of Sulphuric Ether.   In one expe-
 riment in my office, the insensibility to the  prick  of  a pin was kept up
 for five minutes, without any unpleasant consequences following.
    I administered the Chloroform to three of my pupils, in the presence
 of Dr. L. V. Bell, who ascertained  that  the frequency  of  the  arterial
 pulsations was  reduced.  If any excitement of the pulse is observed, I
 think it will be found to be  owing to other  causes, rather  than to any
 stimulus from the vapor inhaled.
    In administering it, no apparatus  is  needed beyond a simple piece of
 cloth of open texture, a small conical sponge,  or a linen cambric hand-
 kerchief.  Take the cork from the phial  of  Chloroform, and apply the
 cloth to its mouth, and shake the bottle, so as to wet a spot on the hand-
 kerchief, (just as people commonly  scent a handkerchief with cologne,)
 cover the mouth and nose with it  lightly, and let the air be drawn part-
 ly through the cloth.   Five or six full inspirations  generally  suffice to
 produce momentary insensibility,  and a  few  more bring on a sound,
 snoring sleep, in which no pain can be felt, even when the knife or
 cautery  are applied.
   It is probable, from the  experiments  made  in Europe  and  in this
   Note—Chloric Ether was manufactured  in this country by Mr. Samuel Gurth-
 rie, of Sackett's Harbor, in 1832.  (See Amer. Jour. Science, Vol. XXII, p. 105.)
   Chloroform was made about the same time, by Leibig and Dumas, in Germany
 and France.
   Mr. Gurthrie appears to have obtained nearly pure Chloroform, for he states
 that its Sp. Gr. was 1.486 at 60  F., and that it boded  at 166 deg.
   Prof. Simpson states that it was discovered  by Souberian, in 1831.  Berzelius
attributes it to Leibig, who, Prof. S.  says,  discovered it in  1832.  Dumas first
determined its true composition. 
40
country, that this new agent will take the place of Sulphuric ICther in
Surgery and Dentistry, and that  an extensive demand for it will take
place.   An  opportunity is thus afforded for working much of our New
England Rum into an uninflammable and much more useful liquid.   I
understand that Messrs. Little & Co., enterprising Druggists in this city,
have already established a suitable distillery for manufacturing Chloro-
form.               Respectfully, your ob't serv't.
                                               C. T. JACKSON.
  I have  administered  Chloroform to more than thirty persons and
generally  with success, only two or three cases presenting any remarka-
ble  peculiarities, and two of these were nervous ladies and the Chloro-
form was  administered to them with slowness and caution.  The effect
on them was singular, and it may have arisen from the very slow mode
of administration, for they sobbed and  cried out  as if  hysterical, but
when they recovered in  a few minutes they said the sensation was quite
agreeable  and would gladly have repeated the inhalation.
  The third case was certainly an  exception  to  general  experience
with regard to the influence of anaesthetic agents.
  A hardy mariner, captain of a ship, called to ask my opinion as to
the  probable effect of Ether  and Chloroform on his  constitution, de-
claring that Exhilarating gas(Prot Oxide  of Nitrogen) had no influence
over him,  though he had breathed it freely in a  lecture  room where it
was exhibited.   He was going to a dentist's to have a tooth extracted
and I accompanied him to see the trial of the Chloroform.
  It was administered to him freely for a longtime until  we were satis-
fied it would not affect him.  Then Sulphuric Ether was tried  in an
equally persevering manner, but  no other effect was noticed beyond a
slight nausea from the Chloroform and a  little  exhilaration  from  the
Ether vapor, so the tooth was extracted without insensibility having been
produced by either of these agents.
  It has been observed that those who make  excessive  use  of ardent
spirits are not so readily affected by anaesthetic agents  and are with-
drawn in a measure from the benefit of this new discovery, but the per-
son above  noticed said that he was not in  the  habit of drinking ardent
spirits, and hence his case must be set down  as  one of those curious
idiosyncracies we occasionally meet with.
  It should  be  remarked  that when  we administer  Chloroform very
slowly and cautiously we are more liable to produce excitement than if
we  administer it more rapidly.  It  appeared  to affect the  head more 
41
when inhaled through the nostrils than if taken by inhaling through the
mouth.  One gentleman to whom I  administered it  cautiously poured
forth his raptures in poetry, while  two others  to  whom  I  gave it in a
rapid manner sunk immediately into a deep sleep of utter  insensibility
and  powerlessness, but recovered in three minutes  entirely.   I have
found that if we sponge the forehead  with cold  water the patient regains
his conciousness much more rapidly and  seems as  if starting from a
deep sleep.
   I  have  administered  both  Chloroform and  Sulphuric Ether  vapors
to the  insane with very agreeable effects, the patients falling into a deep
sleep and gaining, as it were, a short respite from their distressing de-
lusions which had  haunted them continually and prevented sleep.  This
period of rest was found  to be quite salutary, and it is probable that
critical changes in those troubles may be induced by  this new  method
of treatment.  In one case, that of  a furious maniac  who had  torn his
clothes entirely from his body, and  whom  we took  from his cell and
treated with Sulphuric Ether vapor, the relief by inhalation  of the Ether
was most remarkable.    This  patient who had  not  slept for several
nights was at once subdued by this treatment and put into a deep sleep
of insensibility and laid on his bed where  he  remained  asleep  all the
afternoon and evening of that day, and became quite  tranquil when  he
awoke and has up to the latest accounts not suffered any new paroxysm.*
In the hands of skillful Physicians, for the insane these remedial agents
may prove a great blessing.
   I  have long since urged the  application of Etherization in  cases of
intermittent fever, but have not yet  seen any account of its trial.  I
would  now renew my invitation to physicians  in the south and  west to
try both  Chloroform and Ether in  that  troublesome disorder, if the
Chloroform  will break the chills and bring on, as it probably will, a co-
pious perspiration  (one of its common effects) it will prove  a great
blessing, and the remedy  will be found quite portable, since only thirty
or forty drops of this agent is required to produce its proper effects.
  It  was observed by Dr.  L. V. Bell, that the number of arterial pulsa-
tions was  diminished about 10 in the minute by the influence of Chloro-
form, and this seems to be a  general effect for  the only  case in which
the pulse was increased in number was one when the patient (an insane
person) struggled violently during the administration.
                   Respectfully, your ob't serv't,
  Boston, February 1st,  1848.                  C.  T. JACKSON.
  « My experiments were made at the McLean  Hospital in the presence of Dr.
L. V. Bell. 
42
                  Letter from Morrill Wtman, M. D.
                                 Cambridge, Mass. Jan. 31, 18 IN.
Messrs. W.  B. Little $f Co.,
  Gentlemen,—In answer to your letter of Jan. 29th, requesting any
information I may be able to communicate, illustrating the use of Chloro-
form in Midwifery, I send you the following case.
  Jan. 25th, 184S, 12 1-2, a. m.   Visited Mrs. A. B., aged 25, of slight
form and an excitable temperament,  in  labor with her second child.
She was sitting up ; said her pains had been  slight  during the evening,
within an hour had increased  but were still not severe.   The mouth of
the womb in the course  of an hour and a half was dilated to the  size of
a dollar, and the pains becoming more severe she kept the bed and was
submitted to the influence of Chloroform.  The inhalation was efl'ccted
by simple  means.  A piece of sponge about one cubic inch in bulk was
moistened with a tea-spoonful of Chloroform and held in  the hollow of
the hand, barely supported  by  the thumb and forefinger, and kept in
contact with the nostrils, while  the little finger  and edge of the hand
compressed the  lips  and compelled inhalation through the nose.   In
about one minute and  a half the patient became  partially insensible,
said she felt " queerly," and in  less than a minute after was insensible.
During the following thirty-five  minutes, the sponge being from time to
time moistened, she  was under the  influence of the Chloroform with
occasional intervals of  apparent partial consciousness.   In these  inter-
vals ihe only indications of pain were interruptions of her incoherent
talking, which was almost constant.  The pains  (if I may use the  ex-
pression where pain was not felt) were always accompanied by a strong
contraction of the womb, felt, as usual, when  the hand was placed upon
the abdomen, but not accompanied  by voluntary  exertion of  other
muscles.  During the following hour  and a half the pains increased in
frequency and in  length; the  child  advancing regularly meanwhile.
At the end of  this period the head was resting very  low down, the pains
changed in character, becoming more expulsive, and after three or four
strong throes,  the labor was terminated  by the  birth  of a strong  and
healthy female child.
   During the whole  of  the hour and  a half the patient was apparently
perfectly insensible,  lay without moving the lower limbs and with slight
motion of the  hands.   The womb contracted at  once  and firmly ;  the
after-birth being expelled without any untoward circumstances in about
five minutes.   The patient was allowed to remain quiet.  The pulse, 
43
which, during the early stage of the inhalation was above 90, had fallen
below 70 and was slow in its beat.   In about fifteen minutes  she re-
covered her consciousness and was very much surprised to learn that
her child was born, saying she knew nothing of it and thought  she had
been dreaming.  She  complained  of  great indistinctness of vision, a
feeling in the limbs approaching to numbness, and in answer to my in-
quiries said she felt confused and did not wish to talk.  She complained
also of much smarting of  the nose and upper lip.*  At noon most of
these uncomfortable feelings had disappeared,  and she assured me she
had no recollection of anything which occurred, from the time of the
first inhalation of the Chloroform, not  even during the half hour when I
supposed her partially conscious.  She had a number of  after-pains but
not sufficiently severe to require  the use of an opiate.   She remarked
that the day  after her first confinement she could move only with  diffi-
culty on account of pain and soreness of the limbs, the consequence of
her voluntary exertions, but now she felt perfectly well in that respect.
Her recovery has been, thus far, very  favorable, and she expresses her-
self highly pleased with the effects of  the inhalation.  The quantity of
Chloroform used during my attendance was about four ounces.t
   I have found since the case above described occurred, that oiling the
lips and nostrils with an animal oil will prevent, in a great measure, the
uncomfortable and sometimes distressing  irritation  of those  parts in-
duced by the corrosive action of Chloroform after long continued inha-
lation.                Very respectfully,
                              Your obedient servant,
                                                   M. WYMAN.

                  Letter from J. Mason  Warren, M. D.
                                       Boston, February 1,  1848.
   Messrs. Little  & Co.,—In answer to your note, requesting my
opinion as to the use of Chloroform in Surgery, I should be disposed,
from the experience I have  been able to obtain in the short time since
this substance has been introduced here, to  come to the  following con-
clusions in regard to it, as compared with sulphuric ether:
   1st. That  the inhalation of  it  causes less irritation than the  latter
substance.                                             ___________
   <*\\'c are informed that the vapor of Chloroform produces no disagreeable ef-
fects.  It is only when applied in a liquid state, that the above unpleasant con-
sequences follow its use.
   t Had a proper inhaler been used a much less  quantity would have been re-
quired.                                                       PvB- 
44
   2d.  That it  more  rapidly  produces unconsciousness, and  is both
 preceded  and  followed, in most cases, by less excitement.   This, I
 have verified by administering it to one or two persons who had pre-
 viously taken sulphuric ether.
   It has a more agreeable odor, and requires a much smaller quantity
 than ether,—which are qualities much in its favor.   One disadvantage
 is, its caustic  property, when placed in contact with the  lips.  This
 may be obviated by the use of an apparatus, which, it appears to me,
 should be constructed so as to allow the vapor to be received  through
 both the mouth and nostrils.
   If sufficient care be taken, the most convenient and efficient method
 for its exhibition is on a bit of sponge or rag, held  in the palm of the
 hand and applied as nearly as possible to the mouth and nostrils, with-
 out allowing actual contact.
   Thus far I have seen no bad effects from its use, having used it my-
 self, or witnessed its administration in a  considerable number of cases.
                      I am, your obedient  servant,
                                         J. MASON WARREN.

          Letter from Dr. D vvid K. Hitchcock, Surgeon Dentist.
                                          Boston, Feb. 1, 1848.
   Gentlemen —I received your favor of the 28th inst., wherein you take
 occasion to say that in the course of my practice I probably have  used
 the Chloroform to a greater extent than  any other dentist in the  city.
 " I should be pleased," you add,  " if you would  furnish  me for publi-
 cation a notice of the various cases where you have administered the
 Chloroform, and with what success," &c.
  In reply to your inquiries, I would  briefly remark, that I have ad-
 ministered the Chloroform to a great number of persons of both  sexes,
 and of all ages, and that my first important case occurred on the 28th of
 Dec. last.
  As it would unquestionably occupy too much space in the proposed
 publication, you cannot, of  course, wish a  full report of the different
number of persons who have  inhaled the Chloroform.  I keep an ac-
curate record of the names of persons to whom I have given the Chloro-
 form, and of the day also when it was inhaled.   A few cases selected
 from these, will, I think, be all that you  now require.
  Case I.—A day or two since, a little boy about six years of age was
 brought to my office.   I was requested to remove his tooth.  " I  want,"
says the child, " some Chloroform ;" he inhaled it about thirty seconds.
 I extracted the tooth.   The boy continued talking to me  while  the in- 
45
haler was over his mouth, and a smile lighted up  his face when the
tooth was extracted.
   Case II.—Mrs. K. of Tewksbury, desired me to remove a tooth for
her, with the request also that I would administer the Chloroform ; ad-
ding, at the same time, that she believed it  would have  no effect upon
her.  She  inhaled it about two  minutes, and  the tooth  was drawn.  I
asked her how she  was pleased with the Chloroform.  " I am of a pe-
culiar temperament," she replied, " and I knew that it would  produce
no impression upon me."  The lady was not conscious  of having felt
the slightest pain, and  was as much delighted as surprised, when she
was shown the tooth that had caused her so  much suffering.
   Case III.  The  Rev. Mr. O. and lady  called with  three  of their
children, and the eldest a little  girl about eight years of age,  requiring
the removal of two teeth.   " She is a very timid child," observed her
father, adding, that a short time since, while under the hands of a den-
tist, it required the aid of two  persons to  hold her.  The child was
quite unwilling that I  should examine her teeth.  After great persua-
sion she  inhaled the  Chloroform,  and soon  fell into a  gentle  sleep.
While in this state I removed the two teeth.  She awoke, and with a
smile of joy exclaimed, " I have had a pleasant dream,—why you have
taken out my teeth."
   Case IV.—Mr. S. desired me to  extract two  of his  teeth ;—one in
the superior and one  in the inferior jaw.   I administered the Chloro-
form, and during etherization  removed the teeth.  When he awoke
from his very  pleasant sleep,  he  remarked, " You have removed the
tooth in the lower jaw, have you not, doctor ?"   I have, sir.  " I wish
he added, " the other was out."   He  soon discovered that the other
was missing.   " Why," he exclaimed  with an agreeable surprise, " you
have taken out the upper one also.  I am sure I did not know  it."
   Case V.—The Rev. Mr. S.,  of Concord, N. H., visited me for the
object of having a number of teeth and roots removed,  under the in-
fluence of  the Chloroform.   As that  distinguished chemist, Dr. C. T.
Jackson, was present, to witness the operation, I  desired him to admin-
ister the Chloroform.   The patient's comments are  thus given :
   " Wishing to have a number of teeth and roots, seven in all, extract-
ed, I called on Dr. Hitchcock, who  administered the vapor of fifteen
or twenty drops of  the Chloroform and extracted the teeth without pro-
ducing the least pain.  The time employed  in the whole operation did
not exceed thirty seconds.   While  inhaling  it,  I  experienced scarcely
any uneasiness.  No unpleasant effects followed its influence—not even 
4G
any effects which reminded mc that I had been breathing any other air
than that which is the common boon of all."
  Knowing from  experience  the  difficulties arising in administering
Chloroform with a sponge, napkin, or otherwise, I have, to facilitate
my operations, constructed an Inhaler, which  completely answers  the
purposes for which it was intended.   I have submitted this  instrument
to the inspection of several of my professional  friends,  who, without
hesitation, recommend it in all cases requiring  the inhalation of Chloro-
form. For their accommodation, I have directed an ingenious mechanic
of this place to manufacture  a limited  number of Inhalers after  my
pattern.   An engraving and description of the instrument are herewith
enclosed.
  It affords me great pleasure to add, that I have used  the Chloroform
manufactured at your establishment, and that its purity is unquestionable.
                          Respectfully, Yours,
                                      DAVID K. HITCHCOCK.
     Court Street, 127.
To  Messrs. W. B. Little <$• Co.
DR. HITCHCOCK'S  CHLOROFORM INHALER.
                                       a
  Explanation of the Engraving. — a  is the mouth-piece  at  the
end of the breathing-tube, and is a large, oval, bell-shaped cup, which
covers the mouth of the patient and fits on the outside of the lips  so
completely as to exclude the atmospheric air. — b is a light valve, on
the outside of the tude, and through which the breath passes  outward.
This valve is hung by a hinge on its right or upper side—somewhat re-
sembling the key of a flute.—At c there is  a valve (represented by the
dotted line) on the inside  of the tube.   This valve is vertical and hangs
by a hinge on the inner upper side of the tube, and  is  arranged, like
the valve in a common pump box, so that it can operate only in one di-
  * These Inhalers are for sale by Wm. B. Little & Co. 
47
rection—and that direction is toward the mouth-piece.—d is the cover
of the reservoir on the top of which it shuts, with a  broad rim on the
inside, like the lid of a tea-kettle, but fitting air tight.—e is the reservoir,
containing a sponge moistened with Chloroform.—/ is a short tube open-
ing into the reservoir.—# represents a joint in the breathing tube.
  Now when  the mouth-piece is placed over the lips, and the patient
commences breathing, it is plain to  see  that at every inspiration the
valve c will open, while the valve at b will be the more closely closed ;
and also that, at every expiration, or when the breath passes  out  from
the lungs, the valve b  will open, and, at  the  same instant, valve c will
be closed.   This operation is, of course, repeated at every respiration.
All the air which passes through  the valve  r, enters the reservoir  by
the tube/, and consequently becomes impregnated  with the Chloro-
form  contained in the  sponge in the reservoir.  Some ten or twelve in-
spirations are generally sufficient to produce that insensibility to pain
necessary for ordinary operations.
  When the apparatus is not in use the breathing tube may be separa-
ted from the reservoir  at the joint g, and  an air-tight cap, or common
cork, is placed in the piece  of the tube which  communicates with the
reservoir at this joint.   A similar cap, or cork,  is placed  in the mouth
of the tube/.   If these caps, or corks, are air-tight, and the top, or cover,
d is also tight, it follows that the Chloroform  remains in the reservoir
perfectly secured  from evaporation  and at all times ready for use.  The
object of the joint at g in the breathing tube, is the  more effectually  to
secure the Chloroform from  evaporating, when not in actual  use, than
it would be if left to  the protection  of the valve at c,  alone.  At the
same time, however, it renders  the apparatus more portable and conve-
nient.
  The reservoir is about two inches in height by one in  diameter—and
the  other parts proportioned  like the engraving.
             From the Bo-Unn Medical and Surgical Journal, Feb. 2d, 1848.
  " Manufacture of Chloroform.— Messrs. Wm. B Little  & Co.,
104 Hanover  st.,  are  manufacturing this new agent in large quantities.
Dr. C. T. Jackson, the Chemist whose reputation is as extensive as the
boundaries of science, speaks with  entire confidence of the purity and
excellence of Messrs. Little &  Co.'s Chloroform for all  purposes for
which it may  be required ;  and  it is by  no means  necessary  to urge
upon  practitioners the  propriety of being particular  in their purchases,
from men of established reputation, since a poor article from irrespon-
sible sources may be in the market." 
48
   Wtm. B. Little & Co., being extensively engaged in the manufacture
of Chloroform, take  this opportunity  of calling the  attention of the
medical profession to the purity of the article they prepare.   It is highly
important that Chloroform for inhalation should be absolutely pure, oth-
erwise its anaesthetic properties are not only  much  impaired, but it is
liable to produce  injurious effects.
   We give below a few testimonials we  have  received from some of
our most eminent Chemists.
                  From Charlo8 T. Jackson, M. D., State Assayer.
Messrs. W. B. Little fy Co.,                         Boston, Jan. 31, 1848.
  Gentlemen,—I have examined numerous samples of Chloroform prepared at
your establishment, and can confidently recommend it to the profession as suita-
ble for inhalation.          llespectfully, your ob't serv't,
                                           CHARLES T.  JACKSON
    From John W. Wcb^tor, M. D., Erving Professor of Chemistry in Harvard University.
Messrs. Km. B. Little fy Co.,
  Gentlemen.—I am just now wholly occupied preparing my lecture.   The ar-
ticle looks and smells well.  I have no time to examine it further.  Dr. Jackson'i
certificate is quite sufficient to satisfy any one, and I should place entire confi-
dence on what he says respecting it.      Yours, Respectfully,
  Jan. 31, 1848.                                     J. W. WEBSTER.
                           From Martin Gay, M. P.
Messrs. Wm. B. Little fy Co.,
  Gentlemen,—I have examined the specimen of Chloroform with which you
had the kindness to furnish me.  I find it to be pure, and of course all that can
be desired for inhalation.           Respectfully, Yours, &c,
  Jan. 31st, 1848.                                      MARTIN  GAY.
                        From W. P. Channing, M. D.
Messrs. Wm. B. Little fy Co.,
  Gentlemen,—I have examined the specimen of Chloroform which I received
from you and find it free from both water and alcohol.  I should therefore con-
sider it absolute.                    Yours,
  Boston, Jan. 31, 1848.                             W. F. CHANNING.
  Wm. B. Little & Co's. Chloroform is neatly put up in different sized
bottles, securely packed so that it can be sent to any distance with per-
fect safety.  All orders addressed to the subscribers will  be promptly
attended to and supplied at the lowest market prices.
           WM. B. LITTLE & CO., Chemists and Druggists,
                104 Hanover street, (Corner of Salem s*.,) Boston. 
A.
4^r-
R E M  A It K 8
SUPERINDUCTION OF ANESTHESIA
NATURAL  AND MORBID PARTURITION:
CASES ILLUSTRATIVE OF THE USE AND EFFECTS OF
     CHLOROFORM IN OBSTETRIC PRACTICE.

                W      BY
          J. Y. SIMPSON, M.D., F.R.S.K.,  *"
   PROFESSOR OF MIDWIFERY IN THt UNIVERSITY OF K11INI1UUQH, 1XD
       ['HYHICIAN-ACCOlCHMilt TO HER MAJESTY IS SCOTLAND.
Serve mo—as Mandrngora—that I may sleep.
           Wrmrtn'i Dic-hiss •>►- M,irv
       But there in
No danger in what show of sloop it nuke-,
More than the locking up the spirit* n time,
To lie more fresh, reviving.
           Shake<pe i«t's CYJmEMT.
WITH  AN APPENDIX.
           BOS TO N:
PUBLISHED HY WILLIAM  B  LITTLE & CO.
        CHEMISTS AND l)lt!'(JOISTS,
      104 Hanover, Corner of Salem Street.
              1S48. 
 
 

> 3> > >
' > y > > •>
> v^v	
./>*>"»' a	»
• "» *c^	■A
	%
vr



 \ '> >•
^^ ^ > j
'^^5>VY^

> > > >^

» »> . i *. \
,» >> >
,, » > »


*JS