AM S THE TICS. 
BY 
EDWARD R. SQUIBB, M. D., 
OF BROOKLYN. N. Y. 
Read before the Medical Society of the State of New York, February 8, 1871 ; 
and by authority of the Society published in advance of the volume of 
Transactions, in the New York Medical Journal, April, 1871. 
NEW YORK: 
1871. AESTHETICS. 
BY 
EDWARD R. SQUIBB, M. D., 
OP BROOKLYN, N. Y. 
Read before the Medical Society of the State of New York, February 8, 1871; 
and by authority of the Society published in advance of the volume of 
Transactions, in the New York Medical Journal, April, 1871. 
NEW YORK: 
1871. ANAESTHETICS. 
Time, that tries all things, has disposed of many of the 
issues which arose in the early application of anaesthesia, hut 
has entirely failed in producing that universally applicable 
anaesthetic—that philosopher’s stone for which the alchemists 
of the profession still vainly search—namely, an agent which 
shall be potent, but potent only for good. This physical im- 
possibility seems to be to the medical profession what per- 
petual motion is to mechanics, and time wears away such 
heresies very slowly. It would, doubtless, be better for the 
profession and for mankind if the anaesthetics already known 
w'ere better studied in relation to their special adaptations, 
and were applied with a more wise discrimination. 
The condition of perfect anaesthesia is one of the most 
grave and frightful conditions of life, and by suspending more 
than half of vitality it comes so near to death that it is won- 
derful to reflect how near that boundary-line can be ap- 
proached and yet be so rarely passed. Familiarity with 
anaesthesia, and a mere distant view of its accidents, lead the 
profession to plunge their patients into it with too much reck- 
lessness. This condition, now so familiar to all, when seen 
but a few' years ago, never failed to excite the gravest appre- 4 
ANAESTHETICS. 
hension; and even now, when seen as the effect of other nar- 
cotic poisons, causes much anxiety and secures the most active 
measures for relief. 
So much does it become a matter of personal or local habit 
or practice to use one or other anaesthetic exclusively, regard- 
less of risks or warnings, and to defend this exclusive practice 
against all who doubt its wisdom, that each little circle in the 
profession, or each man, requires, as in the instance of this 
writer, some grave accident to awaken a sense of proper re- 
sponsibility, and teach the wisdom of discrimination. 
The roughly-expressed though perhaps practical condition 
essential to anaesthesia, is diminished oxidation in the senso- 
rium; and the primary object is, to confine this within the 
limits of safety. It is a kind of partial suffocation or asphyxia 
occurring not in the organs of respiration and circulation pri- 
marily, but far back of these in the tissues where the vital act 
of oxidation occurs. The air-passages normally admit oxygen, 
and the blood takes it up and carries it, but carries with it an 
agent which prevents its assimilation in the tissues which pre- 
side over vitality. To diminish this assimilation seems to con- 
stitute anaesthesia. To prevent it is death by narcosis. Hence 
the only line of safety in practice, in the present state of 
knowledge, is to regard the difference between anaesthesia and 
death as a difference in degree or quantity only. The con- 
dition may be partial, full, profound, or fatal, but with no dis- 
tinct boundary-lines between the degrees. The two interme- 
diate degrees constitute anaesthesia proper, and the first of 
these is desired in medicine and surgery. In the production 
of this anaesthesia the more powerful, prompt, and efficient the 
agent, and the more impressible the individual organization 
upon which it acts, the greater the liability to overleap the in- 
termediate stages or degrees, and unexpectedly extinguish life. 
This seems but common-sense, and physicians are familiar 
with the principle in the toxic influence of all acute diseases, 
though they often fail to apply it in this most acute of all 
diseased conditions wherein the issues of life and death are 
narrowed down, not to a few hours, but within a few minutes. 
Add to this the fact that this condition rests with the physi- ANAESTHETICS, 
5 
cian whether to produce it or not, and it is difficult to under- 
stand how its importance can be over-estimated. 
The agents commonly used to produce anaesthesia, and 
now called anaesthetics, were formerly all classed as diffusible 
stimulants, because, in studying them, writers had not gone 
beyond their prominent primary effect. Now, however, this 
stimulation is regarded as the first of four degrees or stages 
into which their total effects may be usefully divided; and it 
is remarkable that the first and last of these stages are in such 
absolute antagonism that, studied separately and independent 
of a known cause, the agent producing the one would natu- 
rally suggest itself* as an antidote to the other. The most im- 
portant relations between these agents and the different de- 
grees or stages of their effects, are quantity and potency or in- 
herent strength; and these are again but relative to the sus- 
ceptibility upon which they act. A fluidounce of alcohol 
■would stimulate an adult, and four fluidounces wrould narco- 
tize him, but with distinct intermediate stages. The same 
quantities of the same agent would destroy an infantry nar- 
cotism, without any distinct intermediate stages from either 
dose. One-eighth of these quantities of chloroform would pro- 
duce similar results from its inherent potency, in one-eighth of 
the time, and the rapidity of its action wrould amount to sud- 
denness, and hence to the obliteration of intermediate stages. 
The more potent the agent the shorter is its course, and the 
fewer and less distinct the intermediate steps by which the 
ultimate result is reached. Add to this the circumstance that 
this potency involves the risk of incidental or accidental com- 
plications which tend to precipitate the normal calculated 
results. 
Narcosis is progressive, and may advance symmetrically or 
asymmetrically. That is, all the vital functions maybe equally 
and uniformly depressed to obliteration; or, the narcotic influ- 
ence may, in any part of its progress, be concentrated upon 
some one vital function or organ, and thus interrupt the prog- 
ress by a short-cut to the end. 
All this is intended to exhibit anaesthesia as a stage more 
than midway in a pathological course, the natural terminus ANAESTHETICS. 
of which is extinction of life; and that to produce and main- 
tain this stage of narcosis with safety is a very delicate ques- 
tion of the application of means to an end, the grave impor- 
tance of which is too often disregarded upon insufficient 
grounds. The accomplishment of any given amount of work 
with the utmost promptitude and certainty renders an excess of 
power necessary, and the greater this excess of power the more 
difficult it is to control the power with safety to the work. 
This just relation between the work to be done and the power 
which is applied to do it, involves the whole question of choos- 
ing an anaesthetic, and equally forbids the arbitrary or habitual 
use or exclusion of either of the well-known and well-tried 
agents, while it imposes a grave responsibility, first in the 
selection, and then in the application, of the special agent 
selected. 
Dr. Augustus Waller, of Geneva (see The Practitioner for 
December, 1870), proposes compression of the pneumogastric 
nerves in the neck as a safe way of procuring temporary anaes- 
thesia in some cases. Should any such mechanical means as 
this ever be found practically successful, even in a small pro- 
portion of cases, it would be a great gain for minor surgery. 
The anaesthetics that have been wrell tried up to the present 
time are three in number ; and, with proper discrimination in 
applying each of these to its appropriate uses only, and proper 
skill in using each, all the legitimate purposes of anaesthesia 
can be well accomplished with reasonable safety. These three 
anaesthetics are nitrous oxide, ether, and chloroform; and they 
are all in extensive daily use in this country at this time. 
It happened, however, that, after the application of chlo- 
roform to anaesthesia by Sir James Y. Simpson, of Edinburgh, 
the tide of popular favor ran so strongly in favor of this anaes- 
thetic that it rapidly took the place of all others, while anaes- 
thesia was yet a novelty. Hence by far the largest proportion 
of the experience in anaesthesia has accumulated from the use 
of this agent. Within the past two years there has been a 
reaction in this country in favor of the safer anaesthetics, and 
it is the primary and almost the only object of this paper to 
favor this reaction which nowr tends to give to each anaesthetic 
its proper place in anaesthesia. At one time chloroform was ANAESTHETICS. 
almost as exclusively used in this country as in Great Britain. 
Now, however, it is probably used in more than half the cases, 
or at least as often as all other anaesthetics together. Various 
mixtures of chloroform and alcohol, and chloroform and ether, 
may be used in a twentieth part of the total cases, and nitrous 
oxide in another twentieth, while ether alone may be used in 
four-tenths of the total cases. These proportions should be, 
and probably will ultimately be, so far reversed that ether will 
be used in six-tenths of the cases, nitrous oxide in three-tenths, 
and chloroform in one-tenth of the cases to which these three 
agents are applied. 
Nitrous oxide was the first anaesthetic; and the safety and 
certainty of its effects, even in inexperienced hands, for all 
momentary operations, and the promptness with which per- 
sons recover from its use, render it perhaps the most important 
of all anaesthetics, because destined to relieve a greater aggre- 
gate amount of pain with greater safety than any other agent. 
Its practical application to dental surgery by Horace 
"Wells, of Hartford, Connecticut, in December, 1844, was the 
commencement of anaesthesia; and hence, in the opinion of 
this writer, Horace Wells is in every good practical sense the 
discoverer of anaesthesia, and deserves both the honor and the 
reward. 
Upon tlie general principles above mentioned it is very cer- 
tain tliat any agent capable of producing anaesthesia is capable 
of causing death, and is therefore dangerous ; and nitrous oxide 
has doubtless caused death by its primary influence. But this 
is so very rare in the many thousands of cases in which it has 
been used that its record of comparative safety is practically 
complete. The dental profession deserve the credit of all that 
has been done in the way of utilizing the advantages of nitrous 
oxide. After the reverses of Horace "Wells, it was not until 
the notoriety and fashion of using ether and chloroform had 
worn off the novelty through many years that the use of ni- 
trous oxide began to revive; and yet, in the short time during 
which it has now been popularly used in this country, the 
number of administrations have so rapidly increased that they 
can now hardly be less than twenty thousand per annum, but 
may be much greater, and this almost exclusively in dental 8 
ANAESTHETICS. 
surgery. It is quite time that the medical profession should 
awake to the practical advantages and applicability of nitrous 
oxide to the momentary operations of minor surgery. These 
operations so far outnumber the greater ones that they out- 
weigh them in the aggregate amount of pain involved; and, 
if the surgeon considers the safety and saving of pain to his 
patient first, and his own convenience in operating second, he 
will hesitate before passing over such an agent as nitrous 
oxide. 
It does not appear to be well adapted to any other than 
momentary operations, chiefly because, to obtain complete 
anaesthesia from its use, it must be breathed nearly or quite 
pure, and therefore entirely cuts off the air-supply, and arrests 
the vital process of oxidation or aeration of blood in the lungs. 
Under these circumstances, when the store of oxygen which 
the blood contained at the commencement of the inhalation is 
exhausted, death must supervene. This being rather a neg- 
ative than a toxic influence, however, the readmission of air 
to the lungs very speedily corrects it, provided the narcosis 
has not progressed so far as to arrest the mechanical move- 
ments of respiration or circulation. A patient may doubtless 
be as effectually drowned by nitrous oxide as by water, and 
the resuscitation from partial drowning by it involves the 
same principles of treatment. 
The great obstacles to the more general application of ni- 
trous oxide as an anaesthetic are the inconveniences, rather 
than difficulties, of obtaining, keeping, and administering it; 
but now under its rapidly-increasing use these obstacles are as 
rapidly being overcome. If but half the intelligent pains and 
labor had been expended upon it that have been given to car- 
bonic acid or soda-water, its advantages to mankind would 
have been better appreciated. 
In England the gas is liquefied by cold and compression, 
and i3 offered for sale in small iron bottles arranged with stop- 
cock, etc., so that the gas is liberated simply by relieving the 
pressure in the bottle of liquid. The gas is received in bags 
of india-rubber as wanted, and is administered from these. 
The enormous pressure of fifty or sixty atmospheres, or about 
eight or nine hundred pounds to the square inch, is required ANAESTHETICS. 
9 
to keep it in the liquid state, and this renders it doubtful 
whether any such plan of using it can ever become generally 
applicable. Some plan by which it may be held in solution, 
or be compressed and held under a pressure of say one or two 
atmospheres, would be much more practical, and will sooner 
or later be accomplished. 
The original apparatus for making and keeping the gas 
has now, however, been so simplified and so cheapened by the 
dental profession as to be managed by the most ordinary in- 
telligence. The entire apparatus for making and keeping the 
gas in quantities of forty and fifty gallons is now sold at the 
depots for dental supplies at a cost of from forty-five to seventy- 
five dollars in proportion to the degree of ornamentation, and 
one pound of nitrate of ammonia, costing about fifty cents, 
yields from twenty-five to thirty gallons of the gas. An aver- 
age of about seven gallons of gas is required for complete 
anaesthesia, and from one to two minutes is commonly neces- 
sary to effect this. The anaesthesia is of about one to one and 
a half minute in duration, and passes off almost entirely in 
three or four minutes. 
It is hardly too much to say that every hospital and dis- 
pensary throughout the country should be supplied with this 
apparatus until a better be devised, and should use this anaes- 
thetic in the large class of cases to which it is appropriate. 
For a full description of apparatus and mode of managing 
both the apparatus and the administration, see Thomas’s 
“ Manual of the Discovery, Manufacture, and Administration 
of Nitrous Oxide,” published and sold by S. S. White, Phila- 
delphia and New York, price $1.25. 
The next anaesthetic in chronological order, but by far the 
most important of all, is ether, still sometimes improperly 
called “sulphuric ether” even by those who should know 
better. The great importance of ether as an anaesthetic lies 
in the fact that it is the most generally applicable of all, and 
that it is practically safe in common use. Few doubt the suf- 
ficiency of its power to produce complete anaesthesia with 
practical safety to life in its primary influence, the chief ob- 
jection to it being the supposed difficulty of application. 10 
ANAESTHETICS. 
And in this difficulty with ether, rather than in any better 
effect from chloroform, may be found the reason why it does 
not more rapidly take the place of the more dangerous agent 
in general practice. 
This difficulty in successful application is not real in any 
sense that should be accepted by an intelligent profession 
whose skill involves human life, simply because it is surmount- 
able by ordinary average intelligence and skill. The common 
objections to the use of ether are, that it is slow in its opera- 
tion ; causes a long troublesome stage of excitement; and that 
after these disadvantages have been submitted to, it often fails 
to produce a sufficient anaesthesia from any reasonable quan- 
tity that may be given. It is not uncommon to see, even in 
what should be the expert practice of large hospitals, four, 
six, and even eight fluidounces of ether used in the effort to get 
patients through the stages of intoxication, and a pound or 
more is not unfrequently consumed in a single operation. 
The patient and by-standers, and indeed the whole apartment, 
become charged with ether-vapor, to such an extent that the 
air must be nearly explosive, and it is rather remarkable that 
some accident from fire has not occurred. These efforts often 
require ten to twelve minutes, and then have to be supple- 
mented by the use of one or more strong men to control the 
patient’s struggles, and enable the operator to get unsatisfac- 
torily through his work within a reasonable time. In not a 
few cases, the desirable third stage of narcosis is not reached 
at all. 
flow, with all due deference to the well-deserved reputation 
of many surgeons under whose supervision and control this 
occurs, it is all due to mismanagement, and is easily avoided. 
Dr. John Snow, of London, in his valuable book “ On 
Chloroform and other Anaesthetics,” published in 1858, covers 
the whole ground upon this subject, with an accuracy which 
time has but served to confirm. He states that the quantity of 
ether necessary to produce the third stage of narcosis is be- 
tween four and five fluidrachms in an average of cases; but 
that, inasmuch as fully one half is thrown back from the lungs, 
about one fluidounce is usually inhaled by an adult in becom- 
ing insensible. He usually placed two fluidounces in his in- 11 
ANAESTHETICS. 
haler, in order to have an excess in store, and this was com- 
monly sufficient if the operation was not unusually protracted. 
He usually rendered adults insensible in four to five minutes, 
and children in two to three minutes; and never failed to 
produce complete insensibility in any one instance, in one hun- 
dred and sixty-four applications, which embraced all the great 
operations of surgery several times. These results were ob- 
tained from the use of what is known as “ Snow’s Inhaler,” 
but which Dr. Snow ascribes to Dr. Francis Sibson, and Mr. 
Julius Jeffries; and from ether which was at least ten per 
cent, more dilute than that now in common use in this coun- 
try for anaesthetic purposes, the specific gravity being 0.735 
at 60° Fahr., instead of 0.728 as it should be. 
More recent observations, and notably those of Dr. Fred- 
erick D. Lente, formerly of Cold Spring, now of Hew York 
City, exhibit similar results without a special inhaler. This 
accurate and skilful observer, and earnest advocate for the 
general use of ether in anaesthesia, gives some of his experience 
in the American Medical Times for 1862, vol. iv., p. 356, 
and for 1863, vol. vii., p. 95. The results obtained in this 
published record were by the use of the cone, extemporaneously 
formed of coarse towels for each application, and with ether 
containing not over six or seven per cent, of alcohol and water, 
s. g. 0.725 to 0.728 at 60° Fahr. The time required to produce 
anaesthesia, or the third stage of narcosis, the quantity of 
ether consumed, and the operations for which the anaesthesia 
was induced, are as follows : 2|- minutes, 1-J- (f.) ounce, trephin- 
ing; 5, 4, 3, and 2£ minutes, 16, 12, 12 and 10 (f.) drachms, 
four amputations of the thigh; 2 minutes, 7 (f.) drachms, ex- 
traction of a ball from the tibia; 4 minutes, 12 (f.) drachms, 
searching for a ball in the knee-joint; 3 minutes, 16 (f.) 
drachms, amputation at the knee; 30 seconds, 6 (f.) drachms, 
incision of an infiltrated scrotum ; 70 seconds, 10 (f.) drachms, 
exsection of the shoulder-joint; 62 seconds, 6 (f.) drachms,, ex- 
section of the humerus; 3 minutes, 12 (f.) drachms, counter 
opening of the knee for the extraction of a ball; 3 minutes, 
16 (f.) drachms, searching for a ball in the thigh. Average 
time for 13 administrations less than 3 minutes, average quan- 
tity less than 12 (f.) drachms. The second list published by 12 
ANESTHETICS, 
Ether Inhaler of Dr. F. D. Lente, of Hew York City. 
Fig. 1. Skeleton of wire with brass nipple at the top, and bound round at 
the bottom so as to form a cushioned rim for close application to the 
face, and notched out for the nose. 
Fig. 2. A flannel bag to fit over the skeleton frame as far down as the 
cushioned border. 
Fig. 3. A brass mounting to screw on to the nipple of the skeleton frame. 
Fig. 4. The same brass mounting, shown in enlarged section, to screw on 
to the nipple of the skeleton frame by the lower part (a). The upper 
projection is bored out down to 5, and three equidistant small brass 
tubes, curved to suit the convexity of the skeleton frame, are made to 
communicate with the bore internally so as to make a continuous pass- 
age from the apex of the nipple to the end of each small tube. 
Fig. 5. An impervious cover of tin notched out for the nose, which is put 
on over the brass mounting, and held in place by a screw-collar 
(e), Fig. 4. 
Fig. 6. An ordinary phial of about four fluidounces’ capacity, marked in di- 
visions of half a fluidounce, with a horn cap and nipple cemented on 
to the mouth and neck. 
Ftg. 7. The complete inhaler ready for use ; the face-piece and bottle con- 
nected from their respective nipples by a short piece of india-rubber 
tubing. ANAESTHETICS. 
13 
Dr. Lente embraces 32 complete cases, a large proportion of 
which are for minor operations (9 for tooth extraction), in 
which the average time was but little over 3 minutes, and the 
average quantity less than fhiidrachms. Subsequent to 
this experience this same observer devised an inhaler, which 
for simplicity of construction and management, and for effec- 
tiveness and economy in results, leaves very little to be desired. 
The description and cut of this instrument, which are repro- 
duced here, are copied from the Medical Record, for May 1, 
1866, vol. i., p. 114. 
“ It consists, first, of a light wire, helmet-shaped frame- 
work, Fig. 1, so formed at the base, which is bound with a soft 
cushion, as to fit over the nose and chin, but not to cover the 
eyes. At the apex of this cone is a small screw; over this 
frame-work is a cone of double flannel, Fig. 2, a hole at its apex 
allowing it to slip over the screw. Over this is screwed an 
arrangement, shown of proportionate size by Fig. 3, and in 
enlarged section by Fig. 4, consisting of a short tube about half 
an inch in diameter, and branching into three small tubes, so 
arranged, when adjusted, as to embrace and open upon the 
flannel cone at equal distances from each other, at about one- 
third of the height of the cone. Over this tube is slipped a cone 
of tin, or of some impervious material, Fig. 5, not easily acted 
on by ether. This cover is kept in place by a nut screwing over 
the tube; over the end of the latter is drawn a rubber tube 
about half an inch in diameter, the other end of which is to be 
slipped over the neck of a suitable bottle, containing about 
four ounces of ether, as soon as the inhaler is required for use ; 
or over the end of a metal tube fitted to a cork which may be 
attached to any bottle, but the other mode of connection is the 
safer. 
“ Having explained to tlie patient tlie manner of breathing, 
viz., to inhale as rapidly and fully as possible, as long as he 
retains consciousness, and not to be alarmed at any unpleasant 
sensations which may be excited at first, the cone is fitted as 
accurately as possible to the face ; the wire and tin being bent 
a trifle if necessary; and, as a sine qua non of the successful 
use of the instrument, I insist that, having been once placed 14 
anaesthetics, 
on the face, it is to be kept closely applied, and never once 
removed ever so little, until anaesthesia is complete.” 
This description is followed by details of the application 
and advantages of the inhaler, and remarks on the use of ether, 
which may be referred to with advantage. This instrument, 
under the title of Dr. Lente’s Inhaler, may be had of the New 
York surgical-instrument makers. 
Still later, Dr. D. II. Goodwillie, of New York City, pub- 
lished in the Medical Record, for December 2, 1867, vol. ii., 
p. 453, an account of an inhaler devised by him, wherein a 
two-way stop-cock enables the manipulator to regulate, and 
alter from time to time, the proportions of any anaesthetic 
vapor and the air in the inspired mixture. This inhaler is 
patented, however, and therefore does not deserve professional 
consideration. 
The small experience of the writer, which is unenumerated, 
and therefore hardly worth mentioning, is less favorable than 
that of Dr. Snow and Dr. Lente. The average time may per- 
haps be safely estimated at 6 minutes, and the quantity of 
ether at 12 fluidrachms to produce anaesthesia, and 16 to 18 
fluidrachms as the average total quantity for operations, ex- 
cluding those which require less than two minutes. This is 
mentioned not as the result of expert skill with a good inhaler, 
but of ordinary intelligence and common-sense, with a simple 
home-made contrivance, to be referred to hereafter. 
Dr. $now states that ether is required in eight or ten times 
the quantity that chloroform is, hut that, as ether anaesthesia is 
more persistent than that by chloroform, and easier maintained, 
the disproportion in quantity is reduced in proportion to the 
duration of the anaesthesia. Dr. Snow also states that the pro- 
portion of chloroform vapor in the inspired air should be from 
four to five per cent., but with ether the proportion of vapor 
must be about thirty per cent, to secure anaesthesia within a 
convenient time. Time and experience have abundantly con- 
firmed these statements, with the very important addition that, 
while this proportion of chloroform vapor cannot be greatly 
exceeded without largely multiplying the risks, the proportion 
of ether vapor may be exceeded very far, even to approaching 
asphyxia by exclusion of air, with comparatively small risk. ANAESTHETICS. 
15 
The difficulty with chloroform is, to secure a sufficient and uni- 
form dilution of the vapor inhaled, but with ether the difficulty 
is to secure a sufficient concentration, or, what is the same 
thing, to prevent undue dilution. Both agents will occasion- 
ally suddenly suspend the respiratory movements, but while 
the circulation continues these are restored by new vital pow- 
er. Chloroform, however, and chloroform alone, is liable to 
suspend the heart’s action, and when this occurs suddenly and 
completely the source of vital power is cut off, and the danger 
becomes extreme. The vapor of either agent may be so ad- 
ministered as to produce only excitement and intoxication; or 
may be so administered as to cause death by asphyxia, as in 
drowning. Neither vapor is irrespirable; that is, the vapors 
do not cause spasmodic closure of the glottis, and this perhaps 
chiefly because their primary effect is to anaesthetize the lining 
membrane of the air-passages beyond the power of responding 
to their irritant effect. TIence, reflex action being thus suspend- 
ed by the local anaesthesia, there is no natural or organic con* 
trol to the introduction of the vapors, as in the case of vapors 
which are irrespirable; but, so long as the mechanical act of 
respiration continues, the manipulator holds the issue of life 
and death, from this cause, in his hands. This mechanical act 
of respiration depends for its continuance upon the circulation 
of aerated blood, and the laws of diffusion of gases and vapors 
forbid the introduction of these vapors under any ordinary sup- 
posable circumstances without some admixture of air. Al- 
though possible, it is far less easy to drown patients by exclu- 
sion of air with these vapors than with nitrous oxide; and far 
more easy with ether than with chloroform, because with the 
latter agent death occurs from its asymmetrical toxic effect long 
before the effects of exclusion of air are reached in most cases. 
According to Dr. Snow, when air is saturated with ether vapor 
at 80° Fahr., one hundred cubic inches of the mixture consists 
of twenty-nine cubic inches of air and seventy-one cubic inches 
of ether vapor. With chloroform, under the same conditions, 
the one hundred cubic inches of the mixture consists of seventy- 
four cubic inches of air and twenty-six cubic inches of chloro- 
form vapor, the terms being nearly reversed. Hence, if death 
occurred only by exclusion of air, ether would be nearly three 16 
ANAESTHETICS. 
times more dangerous than chloroform, and nitrous oxide most 
dangerous of all. This, however, is only the negative side of 
the question, and when the positive side is stated the case 
stands very differently; for if death occurred only by sym- 
metrical and regularly-progressive narcosis, the agent having 
the greatest power in a given quantity of it must be the most 
dangerous to life. Add to this the fact which experience alone 
could establish, and which experience has now abundantly es- 
tablished, that the more powerful agent, chloroform, occasion- 
ally causes death by an irregularity in its action, an asymmet- 
rical narcosis, which it is impossible to foresee or prevent. 
The application of ether is, therefore, comparatively safe from 
symmetrical narcosis; and is absolutely safe from the asym- 
metrical narcosis to which chloroform is liable. Why, then, 
does it not more rapidly take the place of the more danger- 
ous agent as the general anaesthetic? The answer is, be- 
cause it appears inconvenient for prejudiced and unthink- 
ing people to procure the inhalation of its vapor in a 
sufficient state of concentration. When properly managed, if 
not quite as prompt as chloroform, it is as prompt as any an- 
aesthetic can be to be safe; and as prompt as it need be, or 
should be, in the production of so grave a pathological condi- 
tion. The whole question, then, turns on its administration in 
a state of sufficient concentration, while it is proved to be diffi- 
cult to get it too much concentrated. This essential point of 
concentration of the vapor has long been recognized by all who 
are successful in the use of ether, as indicated in the efforts to 
get close-fitting cones, sponges, and mouth-pieces, and the uni- 
form directions to press these firmly over the mouth and nose. 
The closeness of this application, and the pressure necessary to 
maintain it with any degree of effective uniformity, are serious 
obstructions to respiration at the same dime that a foreign va- 
por is substituted for a portion of the air. This is commonly 
submitted to by intelligent patients, so long as reason and self- 
control are not materially impaired. But when the stage of 
intoxication overpowers reason, and the organic animal in- 
stincts are left uncontrolled, the imperious necessity to breathe 
brings on that struggling and resistance which so interfere 
with the success of the continuous administration in many ANAESTHETICS. 
17 
cases, because tlie slightest derangement of the apparatus is so 
liable to cause an over-dilution of the vapor by the external 
air. 
This inconvenience is so prominent in the use of ether, and 
causes such an enormous waste of the anaesthetic, that the writer 
has long looked for some simple device, which, by interfering 
less with the mechanical act of respiration, and confining the 
vapor better, might prove useful in less intelligent or inexpert 
hands. To effect the objects in view, the bag so long in suc- 
cessful use with nitrous oxide supplied the essential idea, and 
it was only necessary to render this pervious to air to a limited 
extent, and adapt it to the use of a liquid and its vapor, instead 
of a gas. 
ISTow, it must never be forgotten that the simple cone of 
towels supplies all that is needed in the hands of Dr. Lente 
and many others; and that for a still larger class of manipula- 
tors Dr. Lente’s admirable inhaler will leave nothing to be de- 
sired, for it is extremely doubtful whether failure is possible 
with any moderately-intelligent use of this instrument. And 
further, it must never be forgotten that success or failure be- 
longs far less to any special mechanical means, than to the 
knowledge and skill with which these are applied. The value 
of a billiard-cue to effect its object depends so much upon the 
experience and skill of the hand and eye that use it, that with- 
out the skill it is but a stick in the wrong place. The inventor 
of an admirable mechanical contrivance (Mr. R. Dudgeon, the 
inventor of the hydraulic jack) was beset for directions how to 
apply the machine. After spending much time and labor in 
specific replies, his experience taught him that this was, in a 
large proportion of cases, wasted. So he abbreviated this labor, 
and told his correspondents that, although he might sell them 
the very finest fiddle and bow, the sending them the very best 
instruction-book in the world would not supply the place of 
brains in learning how to play the fiddle. 
It may be safely said that apparatus never succeeds in any 
thing. All it can do is to supplement the amount of intelli- 
gence with which it is applied; while in apparatus generally 
ingenuity often conceals a want of practical utility. 
The simple apparatus for administering ether vapor, now to 18 
ANAESTHETICS. 
be alluded to, was first made and used by the writer about a 
year and a half ago, and it has been distributed to various per- 
sons for trial since that time. In a few hands it has been mod- 
erately successful, and is retained in use with supposed advan- 
tage. In others it was successful at first, as a novelty, but 
was soon discarded for the older sponge or cone of towels. In 
others it was used with partial success, but needed improve- 
ments which could only be made at the expense of simplicity 
and cheapness. In others it was entirely unsuccessful; while 
some have not reported their results, and it is fair to consider 
such as being unfavorable. In Bellevue Hospital, where, for 
many years, ether has been exclusively and largely used, 
although it was explained and applied there by the writer, it 
utterly failed in gaining any favor at all, and was soon laid 
aside in favor of the simple cone of towels, with which, and 
commercial ether, the best results seem to be obtained. In 
another hospital it had better success, and is in practical use. 
The average drift of all this testimony makes it somewhat 
doubtful whether it is worth describing, but one point induces 
the writer to give it the benefit of the doubt, and that is the 
almost unanimous testimony to its economy in the use of ether 
in proportion to the effect obtained. This, in connection with 
the admitted fact that it will accomplish the object, wTill justify 
any one who is at all dissatisfied with other modes of adminis- 
tration in giving it a fair trial. Half a dozen of them are here- 
with offered for trial to any who will accept them, and from 
these they may be home-made almost without expense. The 
surgical-instrument makers will, of course, soon furnish them 
at a trifling cost should they be demanded. 
As shown in the adjoining sketch, the apparatus consists of 
an hour-glass-sliaped muslin bag, Fig. 1, which, wdien laid flat, 
is about twenty inches long by nine inches wide at the widest 
part, one end of which is cut off so as to be funnel shaped, and 
open to receive the lower part of the face. This funnel-shaped 
mouth of the bag is of such a size as to admit the nose, mouth, 
chin, and beard of an adult male, and may be adapted to any 
smaller face by turning it back like a cuff, as in Fig. 4. The 
muslin of this end of the bag is double, to afford additional 
obstruction here to the passage of air and ether vapor. ANAESTHETICS. 
19 
Bag foe Ether Anesthesia. 
Fig. 1. Size and shape of thick muslin, two pieces of which stitched to- 
gether by “ pudding-hag seam ” all round, excepting the straight top 
or mouth of the bag, the muslin of each piece being double at the 
upper part (a). 
Fig. 2. Tin tube two inches in diameter by seven inches long, the edge of 
the tin being turned in instead of out at the ends, so as to offer an 
obstruction to the. falling out of the roll after it is slipped into place. 
Fig. 3. A piece of flannel laid on a piece of stiff blotting-paper or blotting- 
board, each about six and a half inches wide by eighteen inches long, 
and the two rolled up together so as to slip easily into the tin tube. 
Fig. 4. The bag in readiness for application to a child. That is, with the 
upper double part turned back like a cuff, so as to allow the chin, nose, 
and mouth, to occupy a narrower portion of the bag. The tin tube is 
slipped farther through, into the round part of the bag. 20 
ANAESTHETICS, 
The narrow part of the bag is made elongated, so as to 
receive a tin tube, Fig. 2, about seven inches long and 
two inches in diameter. And the bottom of the bag or 
round end is made of such a size that, when moderately 
distended, it holds say forty or fifty cubic inches, or more 
than is necessary for a full inspiration. When about to be 
used, this bag is thoroughly wetted in water, and squeezed so 
that it does not drip, for the purpose of rendering it only par- 
tially pervious to air and ether vapor. It is not certain that 
an impervious bag would not answer as well, but it would be 
more difficult to obtain, more expensive, less cleanly, and, per- 
haps, less safe. The sole object of the tin tube is to keep the 
narrow portion of the bag distended while in use. A piece of 
flannel about six and a half inches wide and eighteen inches 
long, and a piece of thick blotting-paper or blotting-card of 
the same size as the flannel, completes the apparatus. The 
flannel is laid upon the blotting-board, and the two are rolled 
up together, Fig. 3, into a roll or spiral which will slip into 
the tin tube, and when there spring out sufficiently to retain 
its place loosely. A two-ounce graduated measure, and a can 
or bottle of ether, are all that are now required for the anaes- 
thesia. 
The patient to be anaesthetized being fasting, takes, about 
fifteen minutes before the time set for operation, a fluidounce 
or a fluidounce and a half of brandy or whiskey, if an adult 
male, or two fluidounees of wine if a female. This, upon an 
empty stomach, will produce slight intoxication in about ten 
minutes, and the anaesthetic has only to supplement this in 
order to get quickly through the stage of excitement in many 
cases. It also renders retching less likely to occur. The 
patient is then placed quietly on the table, and is advised, in a 
slow, quiet tone, to be composed and perfectly still. lie is 
told that he will soon begin to feel intoxicated, or excited and 
restless; that this is very much under his control, and that the 
more he resists it the sooner he will be asleep. If this advice 
be given with tact and skill, it will be well received, and be of 
service in a majority of cases. The manipulator is then to 
wet the bag thoroughly, squeeze out the water till it no longer 
drips, slip the empty tin tube into its place in the narrow part ANAESTHETICS. 
21 
of the wet bag, and then prepare the charge of ether. This 
may be done in several ways; but perhaps the best way is to 
pour the measured quantity of ether into a tumbler, and, hav- 
ing allowed the roll of flannel and blotting-board to expand 
itself to nearly the size for the tin tube, dip first one end and 
then the other into the ether until the ether is all taken up, 
and then at once slip the charged roll into its place in the tin 
tube, the latter being already in its place in the wet bag. Then 
fold, first one end of the wet bag and then the other, up over 
the part which holds the tin tube so that both ends of the tin 
tube may be closed up by the wet muslin to prevent loss of 
ether, and then lay it aside ready for use at any moment. The 
loss of ether, while thus lying ready, is very small—not over 
a fluidrachm in half an hour. The quantity of ether for the 
first charge should vary with the estimated sensibility of the 
patient. For an adult man, one and a half to two fluidounces, 
and for females and sensitive males one to one and a half 
fluidounce is sufficient, if the ether be good ; for children, a 
half to one fluidounce. In the anaesthesia of children, and in 
many exceptional cases, no general rule can be laid down; 
and, indeed, the circumstances of each case must always 
modify each application; and yet the following directions may 
be found more or less applicable, and therefore useful in a 
large number of instances: 
About ten minutes before the time for operation, the bag 
being thus in readiness, the can or bottle containing the supply 
of ether is held to the patient’s nostrils, and he is asked to 
smell it strongly at each inspiration for the purpose of getting 
used to it. This taking the vapor from the can or bottle is 
continued for one minute or more, according to circumstances, 
during which time the advice in regard to self-restraint is 
firmly repeated. This step establishes tolerance or partial 
anaesthesia of the mucous membrane of the air-passages, and 
thus avoids some of the coughing and strangling that are liable 
to occur from the sudden application of concentrated vapor; 
but it often brings on hysterical symptoms or delirious rest- 
lessness pretty promptly, and whenever this occurs the bag is 
to be at once applied. If the ether be in a tin can, which is 
always the best and safest containing vessel for it, and this be 22 
ANAESTHETICS, 
only about one-third or half full, the warmth of the hand 
causes a good supply of vapor, and the early stages are rapidly 
brought on. At most, but a minute or a minute and a half is 
occupied by this step, and the manipulator has still about eight 
minutes to the time set for operation. The bag is then un- 
folded, laid on the patient’s chest, and the open end drawn 
over the mouth and nose. The redundant size is taken up in 
a plait by the side of the nose, and folded down so that the 
wret muslin is closely applied to the skin of the face, and 
pressed down into the fossse on each side of the nose. The 
part which is least likely to lie close, and which therefore re- 
quires most attention, is that under the chin. The most con- 
venient place for the manipulator is at the head of the table, 
whence he can best apply a hand to either side of the 
patient’s face, and thus support the bag in position without 
much pressure. The thumbs then naturally fall into the fossae 
on each side of the nose, while the lingers support the part un- 
der the chin, care being taken not to press upon the larynx. 
If the patient has a beard, it should be wetted to render it less 
pervious to air, and the bag drawn tightly around it. If the 
muslin be well wetted, it sticks pretty closely to the skin, where 
it gets contact, and the beard offers the chief difficulty. It 
not unfrequently happens that, after a few inspirations of the 
concentrated vapor, respiration is suspended. AVhen this 
occurs the bag is removed till it is resumed, the mouth of the 
bag being simply turned back on to the bag to save waste of 
ether. As soon as respiration is reestablished the mouth of the 
bag is replaced around the nose and mouth. When restless 
excitement occurs, the mouth of the' bag is supported in place 
by the two hands of the manipulator, but without much force, 
and with as little resistance to the motions of the patient as 
possible, and with no obstruction over the mouth or nose, and 
the bag, under no circumstances, is to be allowed to become 
loose or drop off during the excited movements. The next 
accident likely to occur is retching, a certain degree of which 
may occur without the necessity of disturbing the bag; but, 
when actual vomiting is imminent, the bag must be momen- 
tarily removed. The patient then usually lies quiet, and soon 
passes into the third or required stage of narcosis, and this ANAESTHETICS, 
often with a shudder, or slight general convulsion. The pulse, 
respiration, and color of the surface, being watched throughout, 
the eye or the roots of the nails are from time to time tried, to 
ascertain the condition as to insensibility, and as soon as this is 
fairly established the operation is begun. In a large propor- 
tion of cases not more than four of the eight minutes will have 
been consumed; and where neither arrest of respiration nor 
retching occurs not more than two or three minutes’ application 
of the bag will be required. When the operation is fairly 
under way and no sensibility shown, the bag is removed to 
avoid the fourth, or snoring stage of narcosis, and is only re- 
placed when some very slight sign of sensibility is seen. In a 
considerable proportion of operations the first charge of ether, 
if liberal and well managed, is sufficient, for anaesthesia by 
ether is quite persistent, and easily kept up, or reenforced; If 
the operation be long, advantage may be taken of one or more 
of the intervals when the bag is withdrawn, to examine the 
roll in the tin tube, and judge by the odor whether the supply 
of ether be nearly exhausted. If the odor of ether be rather 
feeble, two or three fluidrachms more is poured on to the roll 
from the measure, without removing the roll from the tube or 
the tube from the bag, and the mouth of the bag is turned 
over to prevent waste until it is needed again. A patient may 
even wince under the knife before it is reapplied, and yet, if 
there be a fresh supply of ether ready in the bag, a few inspi- 
rations will restore him to the desired third stage again. One 
or two minutes before the operation is complete, the bag may 
generally be removed entirely and finally. These precautions 
do much to prevent that supersaturation with ether which 
tends to the more certain occurrence of prolonged nausea and 
vomiting which so often introduce septicaemia, and thus cause 
death. The reaction always bears an important relation to the 
primary action, and, if this latter be moderate and well man- 
aged, the reaction is likely also to be moderate. The longest 
time during which the wwiter has kept up anaesthesia by this 
bag was about sixty-five minutes for a difficult ovariotomy, 
and in this the total consumption of ether was less than five 
fluidounces, and the recovery both from the anaesthesia and 
the operation was good. 24 
ANAESTHETICS 
If there be a prominent advantage in this apparatus, as the 
writer believes there is, it is in the entire freedom of the respi- 
ratory process. The lower end of the bag rises and falls with 
the respiration without offering any practical obstruction to the 
mechanical process. And those who wTill persevere with it 
until educated to its use will probably discover other advan- 
tages hardly less important. 
In concluding the consideration of ether, it may be safely 
said that those who resort to it after a long use of chloroform, 
and acquire the little skill necessary to use it well, will have 
a sense of safety and satisfaction which they never knew be- 
fore. 
Chloroform is the most rapid, the most certain, and the 
most effective anaesthetic which lias been practically applied 
on a large scale up to the present time. When to these prom- 
inent advantages are added the facility and simplicity of its 
administration, the small quantity required, the facility of get- 
ting it of good quality, its non-inflammability, its cheapness, 
its agreeable odor, and the prejudice in its favor to which all 
these circumstances will always tend, the key to its popular 
use is found. 
The more prominent of these advantages, however, belong 
to its excess of power, and this excess of power involves the 
power to do harm. Therefore, there is another side to the ac- 
count of chloroform which a long and extensive experience 
has accumulated against it. 
In common use, though perhaps never in expert or skilful 
use, it occasionally causes death by progressive symmetrical 
narcosis. But, as this result may be admitted to be within 
the control of skill and knowledge to prevent it, it is not the 
most serious disadvantage of chloroform, and the risks it in- 
volves might be fairly accepted as being overbalanced by its 
advantages. But, unfortunately, chloroform occasionally causes 
death by an asymmetrical narcosis which is beyond human skill 
and knowledge to foresee or prevent. The sudden and over- 
whelming narcosis or paralysis of the heart, commonly called 
cardiac syncope, whether occurring from direct or reflex ac- 
tion of the anaesthetic, is fatal in a large proportion of the ANAESTHETICS, 
25 
cases in which it occurs, and it occurs with chloroform alone. 
It is not a question of submitting to these rare accidents or 
dispensing with anaesthesia altogether; nor as to whether they 
occur from chloroform or from its impurities, or from want of 
care in its administration, nor is it a question as to whether 
they occur once in five hundred and twenty-five administra- 
tions or once in forty thousand administrations. But the 
simple fact that they occur at all with this anaesthetic, while 
they do not occur in the use of other anaesthetics which are 
in practical successful use, and always easily attainable, ought 
to be sufficient to limit the use of chloroform to the compara- 
tively few cases to which other agents are not applicable. 
The fatal accidents from chloroform appear to increase in 
proportion to the number of administrations very rapidly as it 
becomes more generally used. 
In the Westminster Review, for January, 1859, when chlo- 
roform had been in use more than ten years, Dr. John Chap- 
man makes a rough though reasonable and useful computation 
of the proportion of deaths to administrations, and his results 
are one death in every sixteen thousand administrations. Dr. 
Sansom states that in the obstetric practice of London it was 
estimated to have been used forty thousand times without an 
accident. Dr. Sansom, in 1866, also states that in the French 
Eastern campaign it wa3 administered thirty thousand times 
or more without an accident; and in the English Eastern 
campaign there were but two deaths in an unknown but very 
large number of administrations. In 1865 Dr. Anstee, of 
London, had administered chloroform more than three thou- 
sand times without an accident. And about this time Dr. 
Richardson makes a resume from the records of eight large 
British hospitals, and reports one death in seventeen thousand 
administrations. Now, however, this same well-informed au- 
thor, in a paper “ On General Anaesthesia and Anaesthetics,” 
presented to the British Medical Association, in August, 
1870, states the general proportion of deaths to administra- 
tions as being one in twenty-five hundred, or nearly five times 
greater within six years. And the chairman of the associa- 
tion, Dr. J. Hughes Bennett, in his remarks upon the paper, 
thinks the proportion of deaths is greater than this. The 26 
ANAESTHETICS. 
causes of this rapid increase can only be surmised. As some 
recent reports of London hospitals—notably that of Mr. C. 
Bader, of Guy’s Hospital, three thousand two hundred and 
twenty-four administrations and no death—do not show a 
very muucli increased mortality, it is fair to infer that the 
largest share of the increase must fall with the greater force 
upon the widely-extended general popular use, where want of 
care and skill, and bad chloroform, may both be involved as 
important elements. As bearing upon this point, the writer 
may cite from a private letter from Dr. J. S. Wellford, of 
liichmond, Virginia, that, in twenty-two thousand administra- 
tions of good English chloroform during the late war, no acci- 
dent occurred. But, subsequently, the same surgeons were 
supplied with chloroform from methylated spirit, and during 
its use had some deaths, although the same care and skil} were 
used. 
In this country no general statistics worthy of the name 
have been or can be obtained; but the deaths which occur are 
generally reported when in the hands of the regular profession, 
and generally get into the newspapers or journals through 
coroners’ investigations, or through the keenness of reporters, 
when they occur in other hands. From this single element 
each writer has to make his own estimates. Under these cir- 
cumstances this writer judges that it may be useful to present 
his estimates and their data, particularly as they are made up 
from sources not accessible to others. It must, however, be 
remembered that they are but rough estimates, and each reader 
must apply his own valuation to the data from which they are 
made up. 
No chloroform has been imported into this country, or ex- 
ported from it, within several years past, and there are but 
about four original sources of supply, of which the establish- 
ment of the writer is the smallest. Upon consultation with 
the three other sources of supply, it is found that the total 
quantity of chloroform sold for consumption in the United 
States, during 1870, cannot be less than eighty thousand 
pounds, though it may be somewhat more. This, and the 
total number of reported deaths, is all that can be had with 
any degree of practically useful accuracy. What follows, then, ANAESTHETICS, 
is simple speculation or rough estimate, though probably safe 
in the interest of human life. 
It may be estimated that not over one-third of this eighty 
thousand pounds, or say twenty-six thousand pounds, is used for 
anaesthetic purposes by inhalation. Next, it may be estimated 
that two avoirdupois ounces, or one and a half fluidounce 
is used and wrasted for each administration, and this would 
give- 
26,000x8=208,000, or say 200,000 
administrations, as a very extravagantly safe estimate for the 
whole country during 1870. 
By a pretty thorough search through the principal medical 
journals for 1870, only fifteen deaths can be found reported as 
having occurred in this country, two of which are equivocal, 
and one, though probably reported twice, is counted twice. 
Add to these one death which occurred late in the year, and 
but just now reported; and one death reported to the writer on 
hearsay, and which may or may not be among the published 
cases. This w'ould make a total of seventeen deaths, or one 
death in eleven thousand seven hundred and sixty-four admin- 
istrations. But there are undoubtedly a number of deaths from 
chloroform which escape even the keenness of newspaper re- 
porters, and the number of such is variously estimated. Some 
estimate that not more than three-fourths of the deaths are pub- 
lished, while others estimate that not more than one-half are 
ever publicly known. The writer believes the first estimate to 
be nearest the truth, but adopts the last for safety. This gives 
thirty-four deaths, or one death in five thousand eight hundred 
and eighty-two administrations. If any reader judges this esti- 
mate to be still not sufficiently liberal, he may double the 
number of deaths once more, and he will then have one death 
in twenty-nine hundred administrations, and thus get the 
mortality up to somewhere near that of Dr. Bicliardson, for 
Great Britain. But the writer cannot admit the probability of 
any such mortality for this country, though he knows of no 
good reason why it should be so much lower here. 
Here, then, is the grave and important probability that 28 
ANAESTHETICS. 
each surgeon, in offering to his patient the anaesthetic advan- 
tages of chloroform, offers him in this country one chance m 
five thousand of sudden death, when he might give him all 
the benefits of anaesthesia by other agents without the risk. 
The writer has neither read of nor heard of a single instance 
of death or grave symptoms from the use of chloroform when 
used in obstetrical practice for mitigating the pains of labor 
nor of any death from its use in controlling puerperal convul- 
sions ; but knows of one death where it was given preparatory 
to the operation of turning in a case where a midwife had mis- 
managed and protracted a shoulder-presentation. In obstetri- 
cal practice it is comparatively rarely given to anaesthesia, but 
only to intoxication, and this often in the judicious, safe way 
of smelling the vapor from a bottle held in the hand of the at- 
tendant or nurse. And in a large proportion of cases it is only 
given during the expulsive pains and after dilatation, in small 
quantities frequently repeated and largely diluted, and given 
by careful hands. Prolonged experience, however, seems to 
indicate that some unknown condition in the parturient female 
renders chloroform less dangerous in obstetrical practice than 
in general anaesthesia, while its promptness of action renders 
it peculiarly applicable to the suddenness of these pains. It is 
also the only agent that can be effectively used in puerperal 
eclampsia, and in this affection has doubtless saved many valu- 
able lives. In the comparatively small number of cases which 
are insusceptible to ether it is also applicable, since in all such 
the want of susceptibility to the less powerful agent would ra- 
tionally render the more powerful agent safe. 
In regard to these tolerant cases, it is very remarkable how 
much chloroform they may use with impunity. The greatest 
consumption the writer has ever met with was in a patient of 
Dr. Gustave Morrelli, of Hew York City. This patient was 
the widow of an Italian physician; her age was forty-eight, 
and her appearance healthy. She was subject to hereditary 
migratory gout, the sudden pain of which was so severe that 
she finally gave up all slower means of temporary alleviation 
for the prompt action of chloroform, and used it habitually for 
two years or more prior to her return to Europe. Between the ANAESTHETICS, 
29 
31st of March and the 16tli of December, 1865, a record was 
kept, and during this time, by Dr. Morrelli’s direction, she was 
supplied by the writer with fifty-three pounds of purified chlo- 
roform. And Dr. Morrelli stated to the writer that, during 
her acute attacks, she not unfrequently used two pounds each 
day, and used it as economically as she could after her long 
practice. 
The writer cannot close a paper on anaesthetics without 
again referring to his often-published statements, and his long 
use of the remarkable local and superficial anaesthetic effects 
of the phenols, or the so-called carbolic acid. The best of 
these is cresol or cresylic acid, and next phenol or the crystal- 
lized carbolic acid. But practically the cheap mixture of the 
two, called coal-tar creasote or impure carbolic acid, is as good 
as either. The prompt and complete effect of very dilute aque- 
ous solutions of this creasote upon the pain of bums, erysipe- 
las, etc., led the writer to infer peculiar anaesthetic properties 
many years ago, and the numbness or insensibility produced 
upon the hands by handling it confirmed the idea. The same 
effect in lesser degree is produced by many of the aromatic 
oils and turpentines, and it is highly probable that most of the 
liniments and embrocations which have survived the attacks 
of what is miscalled “ rational medicine,” owe their continued 
popular and empirical use to a real local anaesthetic effect pro- 
duced by this class of substances. The Chinese have long 
known and used the anaesthetic effects of the essential oils of 
the mint family of plants, and particularly oil of peppermint, 
so that it is plain that these old-fashioned local applications 
for the relief of pain rather deserve more accurate ob- 
servation and research than the contempt into which they 
are falling through the fashionable' expectantism of the day. 
The writer can now, in conclusion, only beg the attention 
of his readers to two important papers recently published on 
this subject. One by Prof. Erasmus Wilson, of London, on 
“ The Anaesthetic Properties of Carbolic Acid,” in the London 
Journal of Cutaneous Medicine, an abstract of which may be 
found in the Half-Yearly Abstract of the Medical Sciences, 
for January, 1871, at page 93. The other is a paper published 30 
ANESTHETICS. 
in the American Journal of Medical Sciences, for October, 
1870, page 573, on “The Application of Carbolic Acid as a 
Local Anaesthetic in Surgical Operations,” by J. II. Bill, 
M. D., Surgeon, U. S. Army. By this paper Dr. Bill is the 
first to propose and apply this anaesthetic to surgical opera- 
tions. 
Bkooklyn, February, 1871.