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things for himself, to accept no statements on trust, and, as far as possible, to bring the conclusions of science under the test of personal observation. Many of his papers on these subjects have been published under the title of "Literature and Travels," a book abounding in sprightly descriptions characterized alike by grace, wit, and erudition.

It was while reading De Tocqueville's "Democracy in America," during a trip up the Rhine, that Ampère conceived the desire and purpose to visit the United States, which he carried into effect in 1852-'53. His Promenade en Amérique, recording his tour, says a recent critic, "is singularly unpretending. It resembles in tone and method the best conversation. The style is pure and animated, and the thoughts naturally suggested. He describes what he sees with candor and geniality, criticizes without the slightest acrimony, and commends with graceful zeal. And yet, simple and unambitious as is the narrative, it affords a most agreeable, authentic, and suggestive illustration of De Tocqueville's theories." His remaining works comprise "Greece, Rome, and Dante." "Literary Studies after Nature (1848), "Roman History at Rome" (1856), a a novel and remarkably liberal application of archæology to literature and politics, "Cæsar; Historic Scenes" (1859), etc., beside eulogies on Ballanche and Chateaubriand read before the Academy. His own eulogy was pronounced by Guizot, who bore testimony to his scholarly attainments, critical abilities, and a rare amenity of manners.

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ANESTHETICS, if the term be taken in its original and broadest sense, are those agents of whatever sort which, upon administration or application to the living body, suspend or greatly diminish for a time the common sensibility, i. e., the power of feeling. Since the development, however, of the modern and most successful methods to this end-and hence, mainly within the past twenty years-this term has acquired a new importance and in a manner a new signification, being now employed to designate specifically those agents which are in greater or less degree available for the relief or prevention of pain, as incident to surgical or dental operations, or as met with in general medical or in obstetrical practice. The condition of insensibility which such agents induce, and which, when perfect, precludes the feeling of pain, is termed anasthesia. Illustrations of it are witnessed in the insensibility of fainting, of stupor from narcotics or other cause, and of one form of paralysis, and in the numbness caused by a blow or by severe cold. But since the common sensibility depends on the activity of a certain set of nerves and of nervous centres hence called the "sensory," or those of sensation-we may say, more precisely, that anesthesia is that state of a living body or of some part of it, in which the action of its sensory nervous apparatus is for the time suspended; and whatever can produce such condition,

without destroying the nervous apparatus itself, is so far an anaesthetic.

Under the title, ANESTHETICS, in the NEW AMERICAN CYCLOPÆDIA, will be found a concise history of the practice (to about the year 1858), together with an account of the mode of action of anaesthetic agents, and their effects, a summary of their applications in medicine, surgery, and obstetrics, &c.

Among the earliest recorded instances of anaesthetic practice collected by MM. Perrin and Lallemand (“Treatise upon Surgical Anæsthesia," Paris, 1863), and in which the end aimed at was precisely that sought in the practice of the present day, are those of the resort, among the Assyrians, to the stupor caused by compressing the arteries (it would appear) of the neck, preparatory to performing circumcision in childhood; of the local application in certain minor surgical operations, among the early Greeks and Romans, of the powdered "Memphis stone "-probably a species of marble-mixed with vinegar, to parts to be benumbed, and which the authors conjecture to have acted by means of the carbonic acid set free by the mixture; and of the anæsthetic employment in China of the Indian hemp (Cannabis Indica)—the plant, closely allied to our common hemp, from which the celebrated "hashish," well known as possessing inebriating and stupefying properties, is still extracted; as also of both the hemp and the mandrake (Atropa mandragora) in India and some other oriental countries. The medical school of Bologna, in the 13th century, brought into vogue in surgery a set of stupefying preparations some of them believed to have been imitated from the ancients, and some, at least, of a highly complex character; of the latter class, one is known to have been a mixture of extracts with which a sponge was saturated; and when to be used, the sponge was wet in warm water, and the emanations were inhaled until stupor followed. But, in western and southern Europe, all the modes of producing anæsthesia thus far considered-imperfect as they were-would appear by the beginning of the 18th century to have passed wholly out of use. The stupor of intoxication, and that produced by opium, were still resorted to, at times, in severe operations; and in minor ones, the practice of diverting the patient's attention by a blow or by some agitation of the feelings was much in vogue. The 18th century was strongly marked, however, by a tendency to seek for anaesthetic effects through agencies of a physical or biological character.

The modern anæsthetic practice may be in a manner traced to the founding of Dr. Beddoes' "Medical Pneumatic Institution," in 1798, near Bristol, England, and which was designed for the treatment of pulmonary diseases by inhalation of ether, and of carbonic acid and other gases. It was here that Humphry Davy, then young, acquired his interest in the subjects of gases and their inhalation; and his discovery,

soon after, of nitrous oxide (protoxide of nitrogen), or "laughing gas," and of its effects on the human system-first published in the year 1800-created for some time a sort of furore in regard to its inhalation, for amusement, and as a restorative and curative agent. Davy himself predicted the use of this gas for anæsthetic purposes, when he wrote: "As nitrous oxide in its extreme operation [deeper stages of its effect] seems capable of destroying physical pain, it will probably be used with advantage during surgical operations in which no great effusion of blood takes place." Still, this remained a mere prediction until, many years after, the use of agents capable of anaesthetic effects was taken up and successfully reduced to practice in this country, by three physicians of the cities of Hartford and Boston. For, although nitrous oxide was in the outset experimented with by European chemists and surgeons, it was by them pronounced unsafe and laid aside; and ether, to which attention was thereupon turned as a substitute, was not at the time brought into practice. As early as 1828, Dr. Hickman, of London, in particular, addressed the French Academy on the subject of anesthesia by inhalation, and especially of carbonic acid; but that body did not favorably entertain the subject, and it was dropped.

Without here entering into a discussion of the vexed question of priority in the discovery of the modern anæsthetic methods, it will be proper, at least, to name what appear to be the facts in the case. Recent evidence goes to show that the first painless operations (and also quite numerous) in the development of the new method, were performed by Dr. Horace Wells, a dentist of Hartford, Conn., during the close of the year 1844 and the early part of 1845; and that the agent which he employed in these cases was nitrous oxide, the operations being the extraction of teeth. This conclusion has been confirmed by the report and action of at least two important medical bodies in this country within the past two years. While, however, it is by some asserted that Dr. Wells was led to try the nitrous oxide by his reading of the views of Davy and other early authorities on the subject, Dr. G. Q. Colton states that Dr. Wells' attention was called to the agent by an observation made by the latter of the painlessness, for the time, of a wound which a person inhaling the gas at one of Dr. Colton's exhibitions of it had inflicted upon himself. Dr. Wells laid aside the use of the nitrous oxide, after its failure on the occasion of an attempted public demonstration with it, in Boston. It would further appear, that it was the application of Dr. Wells' process that Dr. W. T. G. Morton, of Boston, was proposing to imitate, with a person for whom he was about to extract a tooth, when Dr. C. T. Jackson, a chemist, also of Boston, and who had previously had experience in his own person of the insensibility produced by ether, suggested to Dr. Morton the real and superior value of the latter agent.

This was in September, 1846. Dr. Morton's first private administration of ether occurred on the 30th of that month, and his first public demonstration of the method, in the Massachusetts General Hospital, on the 16th of October following; while the first capital operation upon an etherized patient was performed on the 7th of the succeeding November, by Prof. George Hayward, also of Boston: the result in all these cases was, as desired, a complete freedom, on the part of the subjects operated on, from pain. The news of the remarkable success obtained with ether having reached Europe, certain physicians and chemists there made trial of several other volatile liquids, in the hope of obtaining one still more suited to the end in view than ether. In the following year, 1847, Dr. Simpson, of Edinburgh, announced his discovery of the applicability of chloroform-a material which has since closely contested the ground with the prior agent, and has even in some degree supplanted it.

The fact, soon rendered evident in practice, that neither ether nor chloroform was wholly free from danger or from other inconveniences of application, led to the trial of still other agents, with a view, if possible, to find some one that should be entirely safe and devoid of disagreeable effects-conditions which, however, no substance has yet been found fully to satisfy.

The following list presents-not altogether in the order of time-the more important of the substances, possessing anæsthetic powers in some degree, which have been experimented with for the purposes now indicated:

1.

2.

Nitrous oxide. (Davy, 1800; Dr. Horace Wells,
1844; Dr. G. Q. Colton, 1863.)
Carbonic acid. (Dr. Hickman, 1828; Dr. Ozanam,
about 1862; and others.)

3. Sulphuric ether. (Drs. Jackson and Morton, 1846.) 4. Chloroform. (Dr. Simpson, 1847.)

5. Hydrochloric ether. (M. Flourens, 1847; M. Sédillot.)

6. Acetic ether. (M. Figuier, 1848; M. Flourens.) 7. Nitrous ether. (M. Flourens.)

8. Nitric ether. (Dr. Simpson-tried on animals.) 9. Aldehyde. (M. Poggiale.)

10.

11.

Olefiant gas. (M. Tourdes.)

Chloride of hydrocarbon; or, Dutch liquid. (Dr.
Nunneley; M. Aran.)'

12. Benzine. (Drs. Simpson and Snow.)
13. Formomethylal. (M. Bouisson.)
14. Bisulphide of Carbon. (1848.)
15. Carbonic oxide. (MM. Ozanam and Tourdes.)
16. Kerosolene. (Drs. Jackson and Bigelow.)
17. Amylene. (Drs. Snow and Fergusson, about 1856.)
18. Oil of turpentine. (Successfully, on shipboard,
by John Wilmhurst, naval surgeon.)
Iodoform, the teriodide of formyle, and thus
the analogue of chloroform, as well as, of
course, many other substances which do not
appear to have been especially subjected to trial,
possesses in degree anæsthetic powers. The an-
ticipations awakened by the earlier success of
amylene, in the hands of Dr. Snow and others,
were soon disappointed, through the detection
of disagreeable consequences, and finally by the
occurrence in two cases of death, under its use;

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and the agent was thereupon abandoned. Dr. Ozanam, in his recent revival of inhalation of carbonic acid to produce insensibility, administered it along with common air, 3 parts to 1. He found this mixture safe; and it produced complete anæsthesia, from which the patient recovered without difficulty; but it does not appear that the use of this agent has yet become in any manner general. The condition of trance, som nambulism, or artificial sleep, as induced in connection with the agencies or methods of influence passing under the names of "Mesmerism," "animal magnetism," "Braidism" or "hypnotism," "psychometric impression," "spiritualism," &c., has been of late years often resorted to, and in some of these forms for a time much vaunted; but though in exceptional cases, or in the hands of particular persons, painless surgical operations have been doubtless secured under some or all of the influences named, yet their effect is far from uniform, or even certain; and at the present day, none of them are relied on as suitable to take the place of the material anaesthetics.

Dr. Valentine Mott, in his monograph upon "Pain and Anæsthetics," prepared at the request of the U. S. Sanitary Commission (Washington, 1863), in considering the philosophy of of anaesthetics, and their value to the surgeon, justly remarks, not only that pain is useless, but also that it is positively injurious to the pained; and he cites from difierent authorities the expression of a truth which is stated by Gooch, in the words, "Mere pain can destroy the powers of life." But when complete insensibility exists, both pain and nervous shock are, so far as the operation is concerned, avoided. "The most severe operation during anæsthesia," says Dr. Mott, "produces little or no effect upon the pulse, because the nervous centres receive little or no impression." But again, except where the conscious cooperation of the patient with the surgeon is required, and in all cases in which the locality or peculiar nature of the operation may not forbid the administration of anaesthetics, the unconsciousness, helplessness, and complete relaxation which those agents can produce, is often a matter of the highest convenience and advantage. The use of anaesthetics thus allows the surgeon to undertake cases in which, without them, he could not safely think of operating; and it also allows him to take more time. Considerations such as these show that their employment practically extends the domain of surgery; and moreover that, prima facie, it should lessen the danger and the mortality of operations.

Dr. Detmold, in 1847, M. Ozanam later, and some other medical authorities, have argued that in the inhalation of ether, chloroform, or other anaesthetics, the insensibility obtained is de to action of carbonic acid resulting from the decomposition of such substance within the ystem. M. Ozanam went so far as to say that carbon is in all cases the true anaesthetic; and that so-called anesthetic agents possess their

power just in the proportion that they are more largely composed of carbon. But if this were true, amylene should be a more potent anæsthetic than ether, and ether itself than chloroform; whereas the reverse is true in both cases. Again, the experiments and observations of Flourens and Longet go to show that the specific anaesthetic agents, not less than morphine, strychnine, alcohol, &c., produce their effects by a direct and positive depressing action upon the nervous centres. Thus, they are all (save, perhaps, nitrous oxide-and even on this point there is room for question) positive poisons; and in undue quantity they produce death in that mode (naturally, and usually in fact) in which we say it begins in the nervous system.

Nitrous oxide, by freely yielding oxygen, is, like common air, only in still higher degree, a supporter of combustion. Of course, in the outset of its inhalation, it is in proportionate degree a supporter and quickener of the functions of life. By hurrying on decomposition in the system, it rapidly generates carbonic acid, and loads the blood with this product. Ether is not a supporter of combustion, but is combustible; and its decomposition may to some extent increase the proportion of carbonic acid naturally contained in the blood. But chloroform is neither a supporter of combustion nor combustible; and it is doubtful whether it undergoes decomposition in the system at all. All anaesthetics, however, after a preliminary stage of excitement, longer or shorter, then forthwith begin, by inducing a torpor or inactivity in the nervous centres, to depress and to lower the respiration, if not also the heart's action; and as a consequence, they occasion the retaining for the time in the blood of much of the carbonic acid, naturally forming in the system, which would under a normal respiration be continually expelled. Still further, wherever gaseous anæsthetics are administered by means of a containing reservoir or bag, so that the patient breathes the same material over and over, even the carbonic acid which is expelled, for the time, mingles with the anaesthetic, increasing in quantity, and being reinhaled. These facts would show, that with chloroform, there is a single source of increase of carbonic acid in the blood-this being, however, not the cause, but the consequence, of the anæsthetic action; that with ether, there are twoo such sources; while with nitrous oxide, there are three sources of increase of carbonic acid. And unquestionably the retained carbonic acid will contribute its share to the depth of the stupor that results; if, indeed, in the case of nitrous oxide alone, it may not be in a large degree the really effective agent. At all events, it is probable that the action of carbonic acid, generated or retained in the blood during anæsthetic inhalation, may in some cases modify materially the symptoms attending or following upon their use.

The stages of anesthesia are strictly comparable to those of intoxication (carried to

stupor), only that they are passed through much more rapidly. They may be conveniently considered as four in number: the first, that of action on the cerebral hemispheres, marked first by mental excitement, and then by loss of intelligence and of power of will; the second, that in which the anaesthetic acts on the cerebellum, destroying the power-if the common theory of the use of this organ be correct-of combining the muscular actions, when the body becomes fully relaxed and helpless; the third, that in which the effect extends to the ganglia of the base of the brain and probably to the exterior parts of the medulla oblongata, as well as in some degree to the spinal cord; so that the senses are obliterated, the capacity of feeling pain lost, and the reflex actions to some extent arrested; the fourth, that in which it attacks the "vital centre" within the medulla oblongata, from which arise the nerves that maintain the function of respiration, and so, indirectly, that of the circulation. When this last degree of action is fully established, the breathing and the heart's action cease, and death is already taking place.

It is, accordingly, the third stage of anæsthesia, as here divided, that the surgical or dental operator seeks to produce, and to maintain. The quantity of chloroform used to such end may vary from one to four drachms, or an ounce. A sponge or napkin wet with the liquid is brought near to the mouth and nostrils, so that the patient inhales the vapor mingled with air. The time required for the full effect is thirty or sixty seconds, or even more. Of the many forms of apparatus that have been devised for inhalation of anaesthetics, none have been received with general favor. The greater power, and consequently (unless under judicious management) danger, of chloroform over sulphuric ether, is shown in that the quantity of the latter required is much greater, as from two to four ounces, and in some instances even a quart or more; and the time required to produce insensibility is usually from three to five minutes. Generally, it is preferred that the patient shall be in the recumbent position. When the anæsthesia is complete, as indicated by sonorous or stertorous breathing, and other signs, the inhalation is discontinued, to be renewed from time to time if the patient show signs of passing back into the preceding or semi-conscious stages.

The fact that several cases of death under chloroform, and one or more under ether, have been directly traceable to the circumstances that the stomach was at the time loaded with food, is one that, where practicable, should never be lost sight of in fixing the period for operating. The most suitable time is some three or four hours after a meal, when, although the system is not yet weakened for want of food, the organs of digestion are in the main relieved and in a quiescent state. It is always desirable, if possible, to guard against vomiting under the influence of an anesthetic, and almost always

unfortunate in some way where it occurs. According to Dr. Mott's observations, if vomiting occurs, one result that is quite certain is that the anaesthetic effect will immediately pass off. Of seventy-seven immediately fatal cases under chloroform, collected by Perrin and Lallemand, and of which they present a very full analysis in tabular form, in sixty-seven the posture of the patient is noted; and of the latter, in forty-eight cases the posture was recumbent, in nineteen that of sitting. Those authors, however, agree with the usage of practitioners generally, in favoring the horizontal posture, unless the nature of the operation requires some other; and it is certain that an upright position of the body increases the likelihood of fainting. The horizontal posture favors the entrance of the vapor of chloroform especially-its density being about four times that of air-into the lungs. This extreme density of the vapor of so powerful an agent is, however, in itself, and in several ways, a source of danger. The too sudden and rapid introduction of the vapor into the lungs may at once occasion asphyxia (suffocation), or it may cause a sudden arrest of the heart's action, besides that it is apt to induce coughing, and perhaps may tend in some cases to cause vomiting. Dr. Mott regards it as a further recommendation of the recumbent posture, in case of chloroform, that if for any reason it should become desirable to free the lungs suddenly of the vapor they may at the moment contain, the result is readily aided by turning the body upon the side (or, we may suppose, inclining the face partly downward), while the proper measures for recuscitation are employed. And this consideration is the more important, since, as implied by another authority, when alarming symptoms do arise, the deadly power of the vapor already in the lungs may suffice to complete the fatal effect of the drug. Both with ether and chloroform, while the administration of the vapor should not be so slow in the outset as to prolong inconveniently the preliminary stages of the effect, it is yet, on the other hand, very important that it be not commenced too abruptly and too strongly in the outset, lest the dangers already indicated be incurred. Dr. Mott adduces the reckless and heedless manner in which he has seen ether and chloroform administered, and without evil results, in Paris and New York, as a proof of the comparative safety of the practice; but he insists none the less upon the necessity of such cautions as have here been indicated. It is always important, especially so with chloroform, that the sponge or handkerchief wet with the liquid should be approached cautiously toward the mouth at the first; and that it shall at no time be brought so near but that the percentage of air inhaled shall largely exceed that of the vapor at the same time entering the lungs.

Dr. Mott states that, although preferring chloroform for use alone, he is in the habit of employing often the two usual anaesthetics in

the same case, beginning with ether, and resorting to chloroform if insensibility is not thus readily induced. He mentions Dr. Simpson's recent method of administering these agents, with a view to securing the due admixture of air-that of spreading a handkerchief single-fold over the face of the patient, and allowing the liquid to drop at intervals upon this, near to the mouth and nose. fears, however, that this method might give rise to irritation of the skin, a result he usually guards against in his own practice, by previously applying a little olive oil about the mouth and nostrils.

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Prof. Samuel D. Gross, in the recent edition of his "System of Surgery" (Phila., 1864), treats at some length of the choice and application of anaesthetics. He prefers chloroform to ether, as having a less objectionable odor, and as being less liable to occasion vomiting and other unpleasant symptoms. Instead of the mixture of ether and chloroform, 3 parts of the former to 1 of the latter, employed by some practitioners, he favors-if any mixture be used that proposed by Dr. Snow, of equal parts of chloroform and alcohol. He has administered chloroform in several thousands of cases: no death from its use has occurred in his hands, and only two threatening cases that could be traced to an injudicious mode of use. He regards age as being no bar to the employment of anesthetics; as he has given chloroform with success to children-even to infants under two months, and also to very old persons-in one case, to a lady of 92. As to danger from disease of the heart or brain, he says: "For my own part, I have never allowed any affection whatever to stand in my way;" and considering the tranquillizing effects of the anaesthetics, he finds no physiological reason for doing so. Some difference of practice appears to exist among surgeons in respect to operations about the mouth, jaws, and nose. Dr. Mott recommends in these, that, generally, anæsthetics should not be used, but reliance placed on narcotics. Prof. Gross advises that in such cases usually the patient should be under anæsthetic influence only at the beginning of the operation; but he states that he has repeatedly performed excision of the tonsils, exsection of the jaw, etc., while the patient was perfectly unconscious and incapable of resisting.

It has been seen that in anesthesia the use of the special senses is commonly lost, along with or before the disappearance (in most parts of the system) of the general sensibility and susceptibility to pain. A remarkable exception to this rule is named by Dr. H. B. Montgomery: a boy undergoing amputation of the leg under the influence of chloroform, in the Stevens Hospital, Dublin, opened his eyes as if from sleep, when a finger was placed upon the neck over the carotid artery, remarked that there was nothing the matter with his neck, but that the surgeons were setting his leg, and VOL. IV.-2 A

remained thereafter with his eyes open, and noticing such objects as came before them throughout the operation; but after recovering from the anaesthetic, he declared that he had felt no pain, and did not know that amputation was being performed. In this case, consciousness was retained, and sight, and to some extent touch, were active, though the common sensibility-at least in the lower limbs-must have been in abeyance.

M. Simonin (" Revue des Sociétés Savantes," June 26, 1863) states that the two most important points for the surgeon to observe, in the deeper stages of anesthesia, in order to be forewarned in time of the near approach of collapse of the respiration and circulation, are, the condition (as to its sensibility, or the opposite) of the region of the temples, and the continued contraction of the muscles holding up the lower jaw, or their narcotism, allowing it to fall. The disappearance of sensibility of the temples marks a definite and deep degree of anesthesia, but, alone, does not show immediate danger. The sensory nervous filaments to the temples, and the motor filaments to the masseter muscles, are alike furnished by the fifth pair, some roots of which arise from portions of the medulla oblongata not far from the "vital centre." The masseters, the contraction of which holds out last in the entire voluntary muscular system, may even relax, and life still not be immediately threatened; but the symptom is usually one of danger, showing as it does that the torpor induced by the anaesthetic has spread well-nigh to the nervous centre of respiration, on the action of which life itself depends. Dr. B. W. Richardson ("Brit. & For. Med.-Chirurg. Review," April, 1864), confirming the importance of Simonin's observations, explains by the principle he has brought forward the fact, remarked by himself, of more dangerous symptoms arising during the profound anesthesia induced for operations within the mouth, than under any other circumstances. Dr. Wm. Marcet is led to believe that chloroform absorbed into the blood sometimes produces death, not by its anaesthetic or directly depressing action, but by exciting a spasmodic closure of the glottisthis, at the time, being likely to pass unobserved; and in case of complete suspension of the respiration under chloroform, as the chances of recovery are then small, he advises immediate tracheotomy, and artificial respiration. Dr. G. W. Balfour has called attention to the danger of the filling of the trachea with vomited matters-at least one death having been known by him to occur from that cause, and even though the patient appeared to recover properly from the anaesthetic.

Prof. Gross states the phenomena which indicate danger, in anesthesia, as being stertorous respiration (very marked, of course), small and feeble pulse, lividity of the features, dilatation of the pupils, relaxation of the sphincters and rapid diminution of the temperature of the

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