serve.

Uric acid is also found combined with ammonia. Thus the essential character of febrile urine is due to the presence of the acid urate of ammonia; this salt gives to it a peculiar aspect, which we will refer to when treating of semciology. However, in proportion as fever becomes more chronic and the patient more debilitated, the lithate of ammonia diminishes in quantity. In cirrhosis, the urate of ammonia can be detected in abundance in the urine; and Chélius asserts that the exhibition of colchicum causes a return of lithic acid in

the urine of gouty subjects. Lithic acid diminishes in cases of neuroses, and during the rigor of intermittent fever; but in diabetes we have not found any appreciable decrease. C. Of the lactic acid of urine we know nothing. D. The colouring matter and the mucus contained in the renal secretion may also increase or diminish in disease. E. The state of science is not fixed on the changes of proportion produced by disease in the saline elements of urine. They are usually dissolved; but chemical actions may proceed in the bladder and cause their deposition. Thus when urine is alkaline, its phosphates must be precipitated; when it is acid, uric acid and urates are thrown off. Healthy urine should contain 900 parts of water in 1,000. The influence of drink upon this water is all-powerful; and the increase or diminution of the water causes such variations in the aspect of urine, its solid components remaining the same, that we are induced to advise you never to judge of the composition of urine by its aspect.

D. M'CARTHY, D.M.P.

literature: one, by the late Dr. John Clarke, in the
third volume of the "Transactions" of a Society
for the Improvement of Medical and Surgical
Knowledge; another, by Mr. Coley, late of Bridg-
north, in vol. iii. of "The Provincial Medical and
Surgical Transactions"; and the third, reported by
Dr. Gooch, "Diseases of Women," his fourteenth
case: the same case was also given by Dr. F. Rams-
botham's father, in his "Practical Observations in
Midwifery."

The disease consists in ulceration of the whole or
chief part of the lining membrane of the uterus,
under which the parietes of the organ become soft-
ened in structure, much as they do in pregnancy,
and generally irregularly thinned in substance,
while the cavity is considerably dilated, and con-
tains coagula, unbealthy, foetid pus, and portions of
shreddy fibrin, which adhere with greater or less
tenacity to the internal surface. In the specimen
exhibited, the cavity would hold a large orange; in
his father's case it would have contained a foetal
head at birth. In the instance before the society,
although the principal part of the lining membrane
of the uterus is destroyed by the ulcerative process,
very little of the fibrous substance is eaten away,
and the parietes have consequently not lost much
of their original thickness; in his father's case, at
some points near the cervix, little was left besides
the peritoneal covering; and in Mr. Coley's case
the fibrous portion was so completely disorganized
that it was not thicker than an ox's bladder; in
some places it was altogether destroyed by ulcera-
tion, and at one spot it was so thin that the peri-
toneal coat gave way on the application of slight
pressure, when a quantity, to the amount of three

REPORTS OF THE PATHOLOGIAL SOCIETY pints, of a dark-coloured, offensive fluid escaped

OF LONDON.

RUPTURED UTERUS.

Dr. Lever presented the uterus of a woman, aged twenty-eight, who had given birth to four children at three confinements, the first being a twin-labour, both the children males, in both of which there was an arrest of development of the sexual organs. Although in the daily expectation of her confinement, she had busied herself about her domestic concerns, and at eleven A.M. on the Friday she expressed herself as feeling very tight, and thought she should be confined towards evening. Soon after three o'clock she felt a violent foetal movement, followed by pain and a sensation of faintness. She was seen at half-past three, and found sitting in a chair, supported by an attendant, gasping for breath, her face pallid, somewhat livid, nostrils dilated, eyes staring, a cold, clammy perspiration bedewing the body, and her pulse scarcely perceptible. A vaginal examination found the os uteri closed. She rallied under the administration of stimulants, and at eight P.M. a second vaginal examination detected the os uteri as large as a crown piece there were no labour pains, but she complained of a little constant stomach-ache. At ten the pulse was small, and scarcely perceptible; the presence of fluid in the peritoneal cavity was plainly detected. The quantity of liquor amnii was very great, and the uterus felt exceedingly tense. She was delivered by artificial assistance, and died at half-past eight A.M. The child was a male: its sexual organs presented the same deformity as those of the twins. On examination, thirty-two hours after death, the surface of the body was very pale. On an abdominal section, a large quantity of fluid and coagulated blood, estimated at between five and six pints, was found in the peritoneal cavity. All the viscera of the thorax and abdomen were pale, but healthy. The uterus was large, soft, and pulpy. On the fundus there was found a laceration of the peritoneal coat, passing trausversely, exposing the proper tissue, but not implicating it. On the posterior part, and to the right side, of the body of the viscus, there was another laceration, of zigzag form, implicating the superficial uterine fibres, and exposing a large vein, from which, doubtless, the greater portion of the blood found in the peritoneal cavity had proceeded.

livered by craniotomy; and in her last pregnancy, six years ago, premature labour was induced at five months, and the foetus, though so small, passed with difficulty. At the time of her death, the pelvis had become so highly contracted that from the promontory of the sacrum to the symphysis pubis it measured only one inch and three-eighths; on the right side, in the same direction, one inch; on the left side, three-quarters of an inch. The right oblique measurement was three inches; left, three and a quarter; transverse diameter, three; depth from brim to tuber ischii, on right side, three inches and five-eighths; left, three inches; space between spinous processes of ilia, nine inches; between tubera ischiorum, three inches. The lower part of the spinal column was so much thrust downwards and forwards that the upper part of the fourth lumbar vertebra was opposite the symphysis pubis, and the sacrum was exceedingly bent. Thus the pelvis, during the last eleven years and a half of her life, had become diminished from at least three inches or more, in the conjugate diameter at the brim, affording a space sufficient to allow the passage of a live child at full time, to the small size just noted. The vertebræ, bones of the pelvis, and head of the femur were so soft as to be easily cut with a cartilage knife, of a dark colour, and spongy appearance, with a thin layer of osseous matter externally; a quantity of thick oily matter oozed from their sections when scraped. The thickness of the pelvic bones was much diminished.

The following account is furnished by Dr. John Hall Davis :-"Two years ago she had sustained a severe loss of blood, both fluid and clotted, from the uterus, and was then considered in danger, but nothing like a fœtus came away, as far as could be into the abdomen. At other parts, as well as at the learned. Up to October, in last year, she menspot where the laceration took place, the fibrous struated with perfect regularity; the function then structure was quite destroyed, and, on being divided, ceased until April of this year, when she menthe parietes of the uterus collapsed like moist wash-struated once, since which there has been no cataleather, its average thickness being reduced to the menial appearance. She, therefore, thought herself eighth of an inch. In another preparation of the pregnant, especially as she further had enlargement same disease, exhibited by Dr. Ramsbotham to the of the breasts, with a secretion of milk in them, society, which had been in spirits many years, and morning sickness, enlargement of the abdomen, and a drawing of which is given in his published lec- a sensation as though she had quickened. I visited ture, already referred to the ulceration affected the her first," writes Dr. Davis, "on October the 24th; whole mucous lining, and had even extended I could distinguish no well-circumscribed solid enthrough the peritoneal covering during life; for largement of the uterus, which one might expect there is a jagged, sloughy, or ulcerated aperture at the fundus uteri, through which the tips of three fingers could be passed with ease, no part of the parietes being thicker than the eighth of an inch; and the same kind of aperture was found by Dr. J. Clarke in the case which he has detailed.

This disease (Dr. Ramsbotham observed) is interesting in three points of view: first, on account of its rarity; secondly, because in three out of the four cases it was mistaken for pregnancy; and, thirdly, from its fatal tendency. It is unlike the more ordinary cases (although they are also very rare) that have been reported under the term hydrometra, such as that given by Dr. A. T. Thomson, in the thirteenth volume of the "Medico-Chirurgical Transactions," as well as others noticed by Boivin and Dugès; because in them the internal surface of the uterus had undergone no perceptible morbid change, and because the os uteri was obliterated by adhesion; in Dr. Thomson's so perfectly, that, although its situation could be traced from the vagina, yet, internally, it was no more perceptible than if it had never existed. In the cases under consideration, on the contrary, the os uteri was pervious, though in Mr. Coley's, indeed, it was plugged by a tough mucus, resembling that secreted in

pregnancy.

The case which was the immediate cause of this affection of the uterus being brought before the society, offered another ground of considerable importance, because it was complicated with another rare disease, mollities ossium, of about twelve years' standing, during which time the patient had lost eleven inches in height: being, at her marriage, five feet high, when she died she only measured four feet one inch. She was married sixteen years ago, in her twentieth year, and during the first four years and a half had three living children; she then had a dead child, after a very severe labour; shortly before which pregnancy, the disease would Three similar are recorded in English medical appear to have commenced; another child was de

RARE UTERINE DISEASE.

By Dr. F. Ramsbotham.

to have found at five and a half or six months of pregnancy, and especially with an extremely contracted pelvic brim. The application of the stethoscope elicited no sign of pregnancy; there was no varicose state of the veins, which she had had in her former pregnancies; the breasts were enlarged, and contained a milky fluid, a state in which they had not been for six years, since her last pregnancy; but this could not be considered of itself of great value.

"Examination per vaginam.-The conjugate measurement of the pelvic brim, as well as could be taken with the outlet of the pelvis, also a good deal contracted, did not give more than an inch and a half, if so much, and there was perceptibly less space on either side of the sacral promontory. The mouth of the uterus was found open, admitting the tip of the index finger; the part of the uterus above, and immediately adjoining the vaginal attachment, could not be felt, owing to the narrowness of the brim; so that no idea could be formed as to the degree of uterine enlargement or development by the vaginal examination. I now passed in a staff, or bougie, to measure the length of the uterine cavity, and it proved to be five inches and a half, showing an expanded cavity to a considerable extent. Withdrawing the bougie two inches, that it might not press against the fundus, I left it in situ for five hours, secured by tapes, the bladder having been first relieved. At the end of that time (ergot of known good quality having also been given in the interval) no action had been induced, A sponge text and the instrument was removed. was then introduced within the uterine orifice, and the vagina was plugged with sponge. This was withdrawn on the following night. Some bearingdown pain had been occasioned, but that ceased; on the removal of the plug, some stiffish mucus, and a slight sanguineous discharge, blended with mucus, came away. During the following day she got up, and sat as usual in her chair, thinking that

SATURDAY, JANUARY 9, 1847.

HYDROPATHY.

"Prodire tenus, si non datur ultra."-HORACE.

66

they may cool gradually, and in the morning Mr. Smith, a surgeon of Kingussie, of abdoTHE MEDICAL TIMES. they have dry shirts and headclothes put on.” minal inflammation successfully treated by cold Dyspepsia is a favourite subject with the cold-water, within and without. They are to be water quacks, and no doubt they have done found in the Ed. Med. and Surg. Journal,” some good, and earned plenty of money, by vol. ix., pp. 287-299. One of them is so recommending their plan to men who have striking that we really must quote it. suffered the oppression due to over eating and drinking the good things of this life. But, in this said plan we owe nothing to Priessnitz or his followers. Long before any of them took to "doctoring," cold water was known to be useful in certain forms of dyspepsia, and was frequently recommended by the profession. We could quote scores of cases in proof, but we will quote only one, and challenge modern hydropathy to find its equal. It is recorded by Dr. John Bell, in "Duncan's Medical Commentaries," ," vol. xvi, pp. 386, 387 :

THIS motto will tell our readers, that, with the present article, we conclude our observations on the Cold-water System. Before drawing our inferences, however, we have a few more proofs to offer, how far from novel the present hydropathic practice is.

Mothers and nurses have lately been as

The patient was "taken out of bed, naked from his waist downwards, and supported by two at'tendants, with his feet upon the floor (which was a damp earthen one) while several pailfuls of cold water were dashed upon his legs, thighs, loins, and abdomen. The first obvious effect of this treatment was upon the strength of the patient. At his first getting out of bed he was totally unable to stand without support;

but, after the water was applied three

tounded at the suggestion of dipping newborn infants in cold water, and of regularly performing the said immersion every morning of their lives. That the custom is as dangerous and ridiculous as it well can be, every man in his right senses will doubtless allow; but, for attacked with a violent headache, for which he to his feelings at this time, he said that the

all this, it is nothing new. If there were ever such a being as Achilles, or such a mundane river as the Styx, it is exceedingly probable that the first instance of the folly we speak of was manifested by the maternal parent of the said Achilles plumping him into the cold stream to tighten and toughen his skin. However this may be, we know that there is a country called Russia, and that its inhabitants make a common practice of dipping their newborn children into cold water, to given them strength and vigour. We know, also, that about one-fourth of the poor little wretches so

exposed perish in consequence. Vigne, in his "Travels in Kashmir," quoted in "Graves' Clinical Medicine," p. 745, note, says " No

one visits Simla without descending to Annadale, to pay a rupi for seeing a mother put her

child to sleep, by laying it so that a small stream of water is allowed to pour for two or three hours upon the back of its head. The natives say, that it is a healthy practice; that that their fathers did so before them; and they still continue to do so, although they admit that many of their children die under such treatment."

66

ears,

At p. 129 et seq. of Sir John Floyer's work, we have the following account of how our forefathers, in this country, used to treat children of a year old to cure rickets. "Extreme cold springs," he says, were sought, into which some dip them twice or thrice, over head and with their shifts and nightcaps on, giving them a little time to breathe between each immersion. Others dip them no farther than the neck, because the water is apt to stop their breath, and dip their nightcaps thoroughly, and put them wet upon their heads. Others, out of tenderness to the child, or in regard to the child's weakness, content themselves with dipping only the shirt and nightcap in water, and put them wet upon him. As soon as the children are dipt, they, with their wet clothes on, are wrapt up in warm blankets, over their head and whole body, and immediately put to bed, which instantly puts them into a violent sweat. In this condition they lie all night, till towards morning the clothes are taken off by degrees, so that

"Some years ago, a Lieutenant-Colonel in
the service of the Duke of Wirtemburg was

could assign no cause. As the severity of the
him from discharging his duty, he consulted
complaint deprived him of rest and prevented
many eminent medical men from whose prescrip-
tions he derived little or no advantage. The
operation of the trepan was even recommended
and submitted to. Some violent febrile symptoms
succeeded, but the wound at length healed

favourably, though the pain still continued
as before. Despairing of relief from
medicines, he totally laid them aside, when
took to relieve his complaint. The remedy recom-
he accidentally met with a person who under-
mended was of a very simple nature; but its
efficacy was pronounced to be infallible, pro-
vided the patient would persevere for a certain
time in the use of it. Willing to do anything
that promised even an alleviation of so distress-

ing a disorder, he undertook to drink six quarts
of spring water daily for three months. He
had, at first, no great faith in the remedy, but,

as custom soon reconciled him to it, he per-
severed. He was the more induced to do this,
on finding his complaint mitigated at the end of
a few weeks. Within the time specified it was
entirely removed, and, after having been up-
wards of eighteen months in a state which de-
prived him of all enjoyment of life, he has now
been nearly three years free from any attack of

his disorder."

There can be little doubt that the ailment had its origin in the digestive apparatus; and, as we before said, we should like to see the hydropathic quacks furnish a case and a cure equal to it!

They tell us they treat inflammations successfully by cold water. That many of them can distinguish between inflammatiom and irritation, or spasm, we are prepared to doubt, and to disprove if necessary. But, granting them all the vantage-ground they want, there is still nothing new in treating inflammation with cold water. Abdominal inflammation, as we know, is one of the severest and most rapidly fatal ailments of the acute kind we are liable to. A common practice, and an excellent one too, with us in such a case, is to leech the abdomen, and follow this by hot fomentations. But, amongst other like cases on record, four are narrated by

or four times, he could walk about the apartment alone, and at last, when he saw a pailful of water aimed at him, he sprung aside with great agility to avoid it. Being questioned as pain and sense of heat within him were gone, felt cold since he left his bed." By drinking and, except in his legs and thighs, he had not copiously of cold water, and having wet cloths continually applied to his abdomen, the man completely recovered.

he 66

At p. 446 of his article, Dr. Forbes advertises the case of a lady, lame from rheumatism, who was treated at a "hydropathic institution" (Proh pudor!), and "could walk a few steps, immediately after leaving the in italics, and then tells us cold bath." He puts the marvellous part of it can guarantee its faith." Is Dr. Forbes at enmity with his literature? One of these must be, or he would own profession, or is he only half-read in its never have quoted a case like the above, in praise of a "hydropathic institution," forgetful that the legitimate practitioner has put many and better such cases upon the pages of our periodical literature! In proof, we refer him

to the one ourselves have recorded, and it is

only one, amongst many, that are accessible to

him.

To treat eruptive diseases by cold water, the hydropathic quacks affirm to be quite a novelty amongst them. Why, the practice is as old as the days of Mercurialis, who is said to have cured himself of some kidney affection by sitting with his back to the stream of the river Arnus, at Pisa; and who further recommends this sort of bathing in the coldest rivers, "when the blood is hot, when the skin is dry, or deformed by scurf, itch, or pustules. But to quote with more orthodoxy, and come nearer our own times, we can furnish proofs, legitimate and professional, how successfully the most formidable eruptive diseases have been treated by cold water. Sir John Floyer says (Op. cit., p. 69), " in that low degree of leprosy in our northern climate, which we call lepra Græcorum, I have known the cold bath at Willowbridge to have done much good. And for the scurvy, swimming in rivers is oft prescribed; and our country has found by experience that the cold water in Sutton-park cures all scabious affections.

It needs no great amount of pathological or practical knowledge to testify how dangerous,

"The maroon negroes in Jamaica, and some other nations on the coast of Guinea, have a custom of plastering the bodies of such of themselves as are taken ill of the smallpox, and especially during the eruptive fever, with wet clay, and with such good effects as induced me to try the cold bath.

common sense, in comparison with nonsense such as this! Why did not cold water, as a remedy only in certain in cases, retain its character with the profession? Because it was found to be often uncertain and unsafe! Why did it not continue to be used systematically in certain cases? For the very same reason! Does Dr. Forbes suppose the profession would have resigned the use of cold water, if it had proved the remedy the quacks say it is? And does he suppose this said profession is not as competent to judge of such a subject as the Priessnitzian tribe? We are too glad of good remedies, when they are obtainable, to part with them readily: but when they prove unworthy of our entire confidence, it would be ignorance and wickedness to give it them! Those who are best acquainted with pathology and practice, best know that there is not, and cannot be, any exactitude in physic. There are plenty of rules for us to know, but there are quite as many exceptions; and he is amongst the wisest of us who is most familiar with these. There never was a universal remedy, and there never will be, whilst constitutions and ages and diseases differ! He who would gainsay this, must be a dolt, or a dupe, oradeceiver! Cold water, like any other remedy, is good in its way, and the profession needs not to be told so; but to talk of its large or its unlimited application, is to tell a tale of folly that has had its answer a thousand times.

in general, is the sudden suppression of active | vagancies, its varied applications, its good eruptions that have a defined course to run. effects, and its bad ones, it has been anticipated We do not know whether the cold-water-men by the legitimate profession in all ages! are rash enough to treat smallpox on their ex- There is nothing of oddity, absurdity, killing, clusive plan, but, even if so, we can prove that or curing, in it, that has not got a predecessor in this, also, there is no novelty. In 1779, Dr. in the pages of our own literature! We emphaFothergill read before the Medical Society of tically deny, then, that the hydropathic quacks London a communication from Dr. Wright, on have any genuine originality to boast of. As for the the External Use of Cold Water in Smallpox. rustic Priessnitz having no access to the literature Its author observeswhich speaks of these things, this access was by no means necessary to his acquaintance with them. Though originating with the profession, they soon became popular, for there was no Latinity to clothe, and no bottles or pill-boxes to hide, them. People saw what cold water did, and they told their neighbours of it, and these told others, and then popular tracts were written in its praise, and at last, as Dr. Forbes ought to have known, all the world knew of it! The very fact of Priessnitz's system having been anticipated in every part of it, is proof enough that it is a compound of imitations. And, indeed, if it were not, what is that to us, the profession! The fellow can tell us nothing that we have not known aforetime of cold water, can do nothing with it that our own brethren have not aforetime done; and what need we care whether he stole or borrowed it of us, or had it miraculously revealed to him in a dream! We care nothing about such idle trash, and can only express our surprise and sorrow that it should be panegyrized by a pen that might have done the profession better service. If Dr. Forbes wishes to show Priessnitz as a curiosity PAINLESS OPERATIONS. and a cure-all, we beg him to do so without WE anticipate, and with reason, that the year offending the profession by eulogizing the quack 1846 will be characterized by one of the most as its contrast! If he wish to advertise and important discoveries that we have ever had to advocate hydropathic hotels and cold water, to record. The performance of severe operations the exclusion of the legitimate practitioner and without the consciousness of the patient, or, in his honourable calling, we cannot help thinking other words, without pain, has ever been a desithat it would be better, first, to cease to be deratum with the humane and benevolent proidentified with either! We feel assured, how-fession to which we have the honour to belong. ever, that he can in reality intend no such nonsense, and we hope hereafter to see him worthily engaged writing down what too many give him credit for having attempted to write up!

"So soon as a person was seized with the variolous fever, whether from inoculations or otherwise, I caused an assistant to throw cold water on their naked bodies every four or six hours. The consequence was, a truce from the fever, from the headache, and pain in the back; a glow succeeded, with a kindly perspiration. The eruption, after this, was for the most part favourable. In the cases where the smallpox had made its appearance, and by its quantity, and the continuance of the fever, a confluent pock was apprehended, the cold bath not only abated the fever, but diminished the number of pustules, and the patients went through the disease easier. I do not recollect more than one person out of 500 treated in this manner, but what agreed perfectly well with the cold affusion."

As for the treatment of fevers, simple and complicated, by the cold bath, and drinking cold water, it originated with Hippocrates, and has never been out of fashion to this day with the profession. Galen, Oribasius, and nearly all the old writers, commend it without scruple. Vesputius tells us that the savage tribes of America used to cure their fevers by immersing themselves, when the complaint was at its height, in cold water, and afterwards running about until they became hot and sleepy. In our own country, and nearly in our own times, the treatment of fever by cold water found an able investigator and advocate in the accomplished Currie, who may fairly be said to have treated the subject in a manner that left little room for improvement.

We should have thought that the many instances in which cold water has not only proved useless but injurious in the hands of those competent to employ it scientifically would have convinced Dr. Forbes that it never can be made a therapeutic system! To render it such has been adventured over and over again, in our own ranks, by "good men and true "; men honest, intellectual, and in all respects equal to the task, and yet the consequence has invariably been-failure. If such men were unsuccessful in their efforts, are better and more substantial ones likely to be made by a rude peasant? We marvel that any rational mind could entertain such an idea! In no single form of disease, in no set of diseases, has cold water been found a remedy constantly to be trusted, even when tried by the scrutiny and untiring investigation of zealous, conscientious, and intelligent advocates of it! Is it, then, We think we have fulfilled one of the in- likely to prove a universal remedy, and in the tentions of these articles, viz., to prove that hands of men whose illiteracy is only surpassed modern hydropathy has nothing whatever of by their presumption? Why, the notion of a novelty in it ; that in its excellencies, its extra-philosopher's stone might be set down as good

Cold-water dressing for burns, scalds, and ulcers, the hydropathic quacks would fain make us believe is a suggestion of theirs. It has been known to, and practised by, the profession for half a century! Our space will not permit us to quote further; we must, therefore, be content to refer those of our readers who may be interested on the subject of cold-water dressing to a striking case published by Dr. Kinglake in the "Med. and Phys. Journal," vol. xvi., p. 17; to others, by Dr. Evans, of Ketly, in the same journal, vol. xvi., p. 527, 529; to another, most singular one, at p. 465 of the same work; and to others, by Mr. Ferguson, vol. vi., p. 19, 21.

Although surgeons have the character of hard-
heartedness among the vulgar, yet we can
deny the assertion most emphatically, and assert
that it is ever their most ardent desire to abridge
human suffering. They are educated for that
sole purpose, and as a general rule, subject it is
true, to some unfortunate exceptions, they
fulfil their vocation of alleviating misery in
many of its most woeful shapes., That they are
thus anxious to alleviate pain, or, when it is
inevitable, to abridge its duration, is shown by
the extensive employment of the vapour of
ether as a means of rendering the patient in-
sensible to pain while undergoing the most
severe and agonizing operations. We may even
envy our American brethren the discovery of a
That the
plan so beneficial to humanity.
vapour of ether possesses the property of pro-
ducing perfect insensibility to pain, when in-
haled for a sufficient length of time, is now
sufficiently proved. We have, ourselves, seen
several operations, of greater or less severity,
performed on patients during this state of in-
sensibility, who have positively declared, on re-
covering their senses, that they had not felt the
least pain.

The cases recorded in our last number show that ether may be inhaled to a sufficient extent to produce complete insensibility without

danger, either at the time or afterwards. It is, however, a new practice, and will require enlarged experience to fully test its effects. But, although the inhalation of ether will usually produce insensibility, yet we may expect that it will sometimes fail to act in its usual manner. Idiosyncrasy will step in and render it powerless, as we sometimes see in the case of nitrous oxide gas, which, while it produces most powerful and laughable effects in most persons, entirely fails to affect others. This, we anticipate, will be the case with the vapour of ether.

Much will depend on the apparatus employed for the inhalation of the ethereal vapour. Four requisites are necessary to complete success :1. That the air which has been taken into the lungs should not be again returned to the apparatus, and respired a second time. 2. That the vessel in which the vapour is generated should be of sufficient capacity to allow the air to become saturated with the vapour. 3. That, in order to effect this, a large evaporating surface should be supplied. 4. That the tubes should be of large diameter, and the valves of the most delicate construction, so as to afford no impedi ment to free respiration.

This subject continues to excite the liveliest | thenumber of failures will decrease; although interest both in and out of the profession. Me- at present we expect to hear of many such dical men are flocking in large numbers to arising from the causes we have enumerated. our hospitals to witness the results, whenever an operation is likely to be performed by this

means.

At University College Hospital, on Friday, Mr. Liston attempted the operation of amputating the forearm by this method, with the assistance of Mr. Squires' apparatus; but, after endeavouring to produce insensibility for ten minutes without success, the arm was amputated with the usual amount of pain.

On Saturday, Mr. Tatham also attempted amputation of the finger, using the same apparatus, with the same want of success.

Several dental operations were successfully performed by Mr. Robinson, at his own house, in the presence of Messrs. Liston, Quain, Stocks, and other medical gentlemen. In one of these the vapour had not been inhaled for a sufficient length of time, and the patient complained of some pain, but not nearly so great as that he had suffered before in the extraction of teeth.

On Monday, at University College Hospital, a most extraordinary scene occurred. Α The first of these objects is fulfilled by the employment of two valves, one of which is per- the breast removed by Mr. Liston. After inwoman, it appears, was to have a tumour of pendicular and allows the air charged with haling the vapour of ether for upwards of vapour to pass from the apparatus to the lungs of the patient, but prevents the return of the twenty minutes without any sensible effect, the expired air to the apparatus; while the other is operation was performed with the usual accompaniment of severe pain. After this, a woman horizontal, with a perpendicular movement was operated on for partial closure of the which allows the expired air to escape into the mouth. Mr. Robinson superintended the inatmosphere, but closes when inhalation is attempted. The structure of the valves will be halation of the vapour, using his own appa. better understood by a reference to a more ratus; the patient became perfectly insensible in two minutes, and the operation was comdetailed description published in the pre-pleted before the patient was aware that it had sent number. The second condition is ful- commenced. When asked by Mr. Liston whefilled by employing a large glass vessel. ther she felt any pain, she replied-" No, Sir, I A large evaporating surface is obtained by have been asleep." placing a number of small pieces of sponge in the glass vessel, which are kept soaked with ether. We need scarcely remind our readers of another circumstance of great importance that the ether should be perfectly pure and highly rectified. Small quantities of sulphurous acid and of alcohol are contained in the common

crude ether. Sulphurous acid gas is of a very irritating nature, and induces troublesome cough; while the inhalation of vapour of alcohol might induce a prolonged state of insensibility, and a degree of reaction which

would prove very inconvenient, if not dangerous, to the patient. We say might, because we are not acquainted with any decided experiments on the inhalation of alcoholic vapour.

The conditions we have described are best fulfilled by an apparatus constructed by Mr. Robinson, surgeon-dentist, of Gower-street, which is carefully described and figured in our present number. We have to apologise to our readers for having failed to perform our promise of introducing a wood engraving into the last number of our journal; we can only excuse ourselves by stating that the press was delayed several hours, with the expectation that the cut would have been received, but, as it did not arrive from the engraver's in time, we were compelled, very reluctantly, to go to press without it.

At King's College Hospital, Mr. Fergusson operated on Tuesday, on a woman for laceration of the perineum. The patient, after taking two or three inspirations, declined to go on, declaring that it would render her insensible; and, preferring to retain her sensibility at the expense of pain, Mr. Fergusson remarked, that their worthy physiologist, Dr. Todd, justly observed that she illustrated the physiology of obstinacy." Mr. Robinson attempted the administration of the vapour in this instance.

Other operations have probably been per-
formed in various hospitals, which have not

come to our knowledge, with more or less com-
plete success. We print an account of one
from Bristol, extracted from the Times paper,
together with a letter from Mr. Herapath, ac-
companied by some editorial observations.

We draw the conclusion from a somewhat
extended experience, that, in by far the great
majority of cases, insensibility to pain will be
produced by the inhalation of the vapour of
ether, although some few persons will altogether
resist its influence. But by far the majority of
failures will be the result of imperfection of the
apparatus or want of tact in its application, or,
again, from ignorance of the signs of perfect in-
the action of this agent, we do not doubt that
sensibility. As we increase in knowledge of

Ether acts on the animal body in the same manner as alcohol; but the effect is known to be much more evanescent. In the case of alcohol, that substance does not appear to escape as alcohol, but undergoes decomposition in the system; while ether is exhaled at once, without undergoing any change in its composition. Adding to this, that ether is much more easily converted into vapour than alcohol, we may give a reason for the transient effect of ether on the system. We have said that the vapour of ether acts in a similar manner to alcohol, or, to use a vulgar term, makes the patient dead-drunk and insensible to pain; but this inebriety is of a very transient character, and is not followed by the excitement and disorder of the system consequent on alcoholic potations.

So far as our own personal knowledge has gone, no injurious effects have followed its exhibition, and most, if not all, the patients have escaped inflammatory fever, so frequently a consequence of operations.

Subjoined will be found a selection from a reached us on this interesting subject. vast amount of communications which have

PAINLESS SURGICAL OPERATIONS. DESCRIPTION OF ROBINSON'S INHALER.

invented and employed by Mr. Robinson, for the The above woodcut represents the apparatus, inhalation of the vapour of ether.

The mouthpiece appears to be the most im portant part, which contains two valves—a perpendicular one which permits a perfectly free inhalation, but closes when expiration begins; and opens the other, a horizontal valve, with a per

pendicular action, placed within one inch of the pad-by means of which, inspiration and expiretion are both rendered perfectly free.

The pad for covering the external contour of the mouth consists of a thick piece of leather cut is sewn two or three layers of flannel or cotton to the shape of the mouth, to the inside of which wool, which is covered with soft leather; within a quarter of an inch of the external edge of the pad is inserted a very thin piece of sheet copper, which, being of a flexible nature, is easily adapted to the variable external contour of the mouth.

sometimes employed, which effectually prevents A small clip for compressing the nostrils is the patient breathing anything but the air charged with the vapour from the vessel.

About three inches from the horizontal valve,

inserted in the tube, is a stopcock for cutting off the communication with the vessel, if necessary, or if the operation should be difficult or protracted,