SURGICAL ANESTHESIA 
 
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THE 
 
 SEMI-CENTENNIAL OF 
 
 ANAESTHESIA 
 
 OCTOBER 1 6, 1846 
 OCTOBER 16, 1896 
 
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 BOSTON 
 MASSACHUSETTS GENERAL HOSPITAL 
 
 1897 
 
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 CAMBRIDGE, MASS., U. S. A. 
 
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WITHDRAWN. 
 
 PROGRAMME 
 
 I. ADDRESS OF WELCOME. 
 
 By CHARLES H. DALTON, Esq., President 
 
 of the Massachusetts General Hospital. 
 
 II. REMINISCENCES OF 1846. 
 
 By ROBERT T. DAVIS, M. D., of Fall River. 
 
 III. SURGERY BEFORE THE DAYS OF ANAES- 
 
 THESIA. 
 
 By JOHN ASHHURST, JR., M. D., LL. D., of 
 Philadelphia. 
 
 IV. WHAT HAS ANESTHESIA DONE FOR SUR- 
 
 GERY. 
 
 By DAVID W. CHEEVER, M. D., LL. D., of 
 
 Boston. 
 
 V. RELATION OF ANAESTHESIA AND OBSTET- 
 RICS. 
 
 By JOHN P. REYNOLDS, M.D., of Boston. 
 
 VI. THE INFLUENCE OF ANESTHESIA UPON 
 MEDICAL SCIENCE. 
 
 By W. H. WELCH, M. D., LL. D., of Baltimore. 
 
 VII. .THE SURGERY OF THE FUTURE. 
 
 By CHARLES McBURNEY, M. D., of New 
 
 York. 
 
 VIII. THE BIRTH AND DEATH OF PAIN. 
 
 A Poem, by S. WEIR MITCHELL, M. D., 
 LL. D., of Philadelphia. 
 
HONORARY COMMITTEE 
 
 JOHN SHAW BILLINGS, M. D., LL. D., New York, Chairman. 
 
 CHARLES W. ELIOT, LL. D., President of Harvard University. 
 
 HENRY P. WALCOTT, M. D., President Mass. Medical Society. 
 
 MORRILL WYMAN, M. D., LL. D., Cambridge. 
 
 CLAUDIUS HENRY MASTIN, M. D., LL. D., Mobile. 
 
 ROBERT F. WEIR, M. D., New York. 
 
 HUNTER McGUIRE, M. D., LL. D., Richmond. 
 
 PHINEAS SANBORN CONNER, M. D., LL. D., Cincinnati. 
 
 WILLIAM WILLIAMS KEEN, A. M., M. D., LL. D., Philadelphia. 
 
 HORATIO C. WOOD, M. D., LL. D., Philadelphia. 
 
 WILLIAM PEPPER, M. D., LL. D., Philadelphia. 
 
 HENRY H. MUDD., M. D., St. Louis. 
 
 LOUIS McLANE TIFFANY, A. M., M. D., Baltimore. 
 
 NICHOLAS SENN, M. D., Ph. D., LL. D., Chicago. 
 
 CHARLES McBURNEY, M. D., New York. 
 
 NATHANIEL PENDLETON DANDRIDGE, M. D., Cincinnati. 
 
 FRANCIS JOHN SHEPHERD, M. D., Montreal. 
 
 J. WILLIAM WHITE, M. D., Ph. D., Philadelphia. 
 
 WILLIAM OSLER, M. D., Baltimore. 
 
 WILLIAM J. MORTON, M. D., New York. 
 
 FREDERIC SHEPARD DENNIS, M. D., New York. 
 
 WILLIAM S. HALSTED, M. D., Baltimore. 
 
 ROSWELL PARK, A. M., M. D., Buffalo. 
 
 LEVI C. LANE, M. D., LL. D., San Francisco. 
 
<*<••* 
 
COMMITTEE OF ARRANGEMENTS 
 
 J. COLLINS WARREN, M. D., LL. D. 
 
 CHAIRMAN 
 
 JAMES C. WHITE, M. D. 
 WILLIAM L. RICHARDSON, M. D. 
 
 HENRY H. A. BEACH, M. D. 
 
 FREDERICK C. SHATTUCK, M. D. 
 
 WILLIAM STURGIS BIGELOW, M. D. 
 
ADDRESS OF WELCOME 
 
 BY CHARLES H. DALTON, Esq. 
 
 PRESIDENT OF THE 
 
 MASSACHUSETTS GENERAL 
 
 HOSPITAL 
 
ADDRESS OF WELCOME 
 
 ENTLEMEN AND LADIES: It is my 
 
 privilege, on behalf of the Corporation of 
 I the Massachusetts General Hospital, to 
 welcome you here to-day as guests of this 
 venerable institution. Though somewhat 
 less than a century old, the hospital is one of the ear- 
 liest in the country. It has long passed its infancy and 
 youth, and has reached a period in its life already rich 
 in history and traditions. 
 
 In 1810 two distinguished members of the profession, 
 being impressed with the importance of founding a gen- 
 eral hospital in this growing city and neighborhood for 
 the better care of the sick and wounded, for the larger 
 opportunities for the study of the art of healing and sci- 
 entific investigation of the causes of disease, addressed a 
 letter to their fellow-citizens asking their cooperation for 
 this purpose. 
 
 In the following year the Commonwealth gave a char- 
 ter and a generous grant, known as the Province House 
 Estate, and the merchants and other citizens responded 
 with equal liberality to the appeal of Drs. James Jackson 
 and John Collins Warren, which resulted in the building 
 of the central part of the hospital, — a structure which, 
 both in respect to its architectural dignity and its honest 
 workmanship, as well as its fitness for its purposes, is a 
 fair monument to the characters of its first projectors. 
 
 13 
 
address of Since then, for three generations, the institution has 
 
 never failed to have at its service the highest professional 
 skill in all its constantly growing departments and scien- 
 tific development, and the sympathy and confidence of 
 the public. 
 
 During these eighty-four years there has been an 
 annually increasing procession of patients seeking its 
 protecting shelter, who have been tenderly cared for, 
 whether on free beds or otherwise, and in this most 
 important function the hospital has amply realized the 
 purposes of its enlightened and humane founders. 
 
 I do not refer to this record as being in any degree 
 peculiar to this hospital. It is simply the story of the 
 performance of its duty to the public, and for which it 
 was chartered by the Commonwealth. It is, in general, 
 the common history of all similar institutions, illustrat- 
 ing perhaps, in the most sincere form, man's humanity 
 to man. But it is, nevertheless, a record which has 
 amply justified its foundation, and should insure its pres- 
 ervation in the years to come. 
 
 If, however, we could imagine all this record erased ; 
 if all the intelligence of the physician, the skill of the 
 surgeon, the watchfulness of the nurse, the benefactions 
 of the public, and, more than all, the saving of life and 
 relief of suffering, were as naught, — there would still re- 
 main one page in its history which of itself alone would be 
 more than a recompense for the loss of all the rest, inas- 
 much as of what was inscribed thereon the whole world 
 has been the beneficiary, and incidentally has raised the 
 name of The Massachusetts General Hospital to an hon- 
 orable distinction at home and abroad. 
 
 Fifty years ago to-day in the operating theatre, then 
 under yonder dome, Sulphuric Ether was first used for 
 the prevention of pain to a patient undergoing a serious 
 
 14 
 
operation. This application was made by Mr. W. T. G. address of y 
 
 m * ^i • , WELCOME 
 
 Morton. The experiment was a success. 
 
 Of the infinite blessings which followed this the great- 
 est gift of the century to mankind, of its contributions to 
 the relief and safety of suffering humanity, to the surer 
 confidence and success of the physician and surgeon in 
 his efforts for the saving of human life, and in scientific 
 investigation, it is not my function to speak. These 
 themes are for the scholar and scientist. 
 
 I have simply to express to you the cordial welcome of 
 the Corporation to this celebration of the fiftieth anni- 
 versary of the first surgical operation under which the 
 patient suffered no pain, no discomfort, no anxiety. 
 
 The occasion is unique. 
 
 *5 
 
REMINISCENCES OF 1846 
 
 BY ROBERT T. DAVIS, M. D. 
 OF FALL RIVER 
 
 9 
 
REMINISCENCES OF 1846 
 
 R. PRESIDENT AND GENTLEMEN: 
 
 Fifty years ago to-day occurred the first 
 authentic, unquestionable, public exhibition 
 of anaesthesia during a surgical operation. 
 As one of the few surviving witnesses of 
 that memorable event, the most important in surgical, 
 and one of the most important in human history, I have 
 been invited to state my recollection of the incidents 
 attending it, and very gladly comply with the request. 
 
 The operation in which the anaesthetic was adminis- 
 tered was performed in the surgical amphitheatre of the 
 Massachusetts General Hospital by Dr. John C. Warren, 
 in the presence of a number of distinguished surgeons 
 and physicians, including Dr. Hayward, the elder Dr. 
 Bigelow, one of the wisest and greatest men who have 
 adorned our profession with their multifarious gifts and 
 accomplishments, and his celebrated son, not then arrived 
 at the zenith of his fame. The Harvard medical class was 
 also present. After some delay Dr. William Morton ap- 
 peared with his apparatus, when Dr. Warren addressed 
 the medical class, which had not been previously notified 
 of the proposed experiment, stating in substance that 
 there was a gentleman present who claimed that he had 
 discovered that the inhalation of a certain agent would 
 produce insensibility to pain during surgical operations 
 with safety to the patient, and he added that the class 
 
 J 9 
 
reminiscences was aware that he had always regarded that condition as 
 OF l846 an important desideratum in operative surgery, and he 
 
 had decided to permit him to try the experiment. 
 
 The patient, who was a young man, was suffering from 
 a vascular tumor of the neck on the left side, occupying 
 the space from the edge of the jaw downward to the lar- 
 ynx and from the angle of the jaw to the median line. 
 Dr. Morton proceeded to apply to the lips of the patient 
 a tube connected with a glass globe. After the inhalation 
 had continued four or five minutes he appeared to be 
 asleep, and the operation was commenced and completed 
 without further inhalation of the ether. It consisted of 
 an incision about three inches in length over the centre 
 of the tumor, and through the skin and subcutaneous 
 cellular tissue, and the removal of a layer of fascia, which 
 covered the enlarged blood-vessels. A curved needle 
 armed with a ligature was then passed under and around 
 the tumor, and considerable compression was employed. 
 
 During most of the time occupied by the operation 
 the patient gave no sign of sensibility, and appeared to 
 be sleeping quietly, A short time before its completion 
 he moved his head, body, and limbs, and muttered words 
 which I could not hear distinctly, but upon recovering 
 consciousness he declared that he had suffered no pain, 
 but simply a sensation like scraping the parts with a 
 blunt instrument. 
 
 The exhibition of the anaesthetic was admitted by 
 those present to be a complete success. The operating 
 surgeon expressed his satisfaction in these emphatic 
 words : " Gentlemen, this is no humbug." From that 
 time forward it became the practice to employ it at the 
 hospital in all operations of importance. 
 
 Dr. Morton continued to administer it until it was 
 proved that it could be easily and safely administered by 
 others. The apparatus which he had used in the first 
 
 20 
 
and a few subsequent instances was soon abandoned as reminiscences 
 unnecessary and attended with possible risk, and a con- OF l846 
 cave sponge was substituted. Sulphuric ether as an anaes- 
 thetic very promptly passed into general use in Boston 
 and throughout the State, and soon afterward in public 
 and private practice in the large cities of other States, 
 followed by its employment all over the country wherever 
 scientific surgery was practised. Its fame crossed the 
 ocean, and it rapidly became a necessary adjunct to sur- 
 gery in Europe as well as here, and beyond, even to the 
 utmost limits of civilization ; it did not stop there, but 
 among savage tribes and barbarous races in distant conti- 
 nents and islands it followed the footsteps of the explorer, 
 the trader, and the missionary on its divine errand of 
 mercy to mankind. 
 
 It is impossible to estimate or comprehend the impor- 
 tance of this beneficent discovery. It safely and abso- 
 lutely secures insensibility to pain, unconsciousness and 
 immobility for long periods of time, conditions which are 
 essential to the successful performance of prolonged and 
 delicate surgical operations. We know the pain and 
 terror which accompanied ordinary surgical operations 
 before the advent of anaesthesia. I cannot forget the 
 impression produced by the case of a naval officer, upon 
 whom a painful operation was performed at this hospital. 
 The suffering was so great that he repeatedly screamed, 
 and was quite unable to suppress the exhibition of his 
 agony. He afterward apologized to the gentlemen pres- 
 ent, and stated that he could not control the expression 
 of unendurable pain he had experienced, and to which 
 his haggard features and shaking frame bore undoubted 
 testimony. 
 
 It was fitting that the discovery of anaesthesia should 
 be ushered to the world from this historic institution, 
 dedicated to the service of humanity, in the broadest 
 
 21 
 
reminiscences spirit of charity, by the gifts of noble men and women. 
 
 OF l846 It was fitting, also, that the most eminent surgeon of 
 
 his day in New England permitted the experiment and 
 performed the operation. His name will be always hon- 
 ored and gratefully remembered, by the profession and 
 the public, for his courage and wisdom in assuming the 
 responsibility of sanctioning what might have proved a 
 hazardous experiment, whose failure would have compro- 
 mised his great reputation. Such considerations had no 
 terrors for him ; he thought only of the lasting and lim- 
 itless blessings which would follow success. These qual- 
 ities he inherited from an illustrious ancestry. He was 
 the son of a Revolutionary patriot and military surgeon, 
 who was for forty years the most distinguished member 
 of our profession in New England, and a nephew of the 
 heroic Warren, who left a profession, whose duty it is to 
 save human life, to offer up his own in defence of Amer- 
 ican liberty in the first pitched battle of the Revolution, 
 and whose name is on the lips of every schoolboy who 
 has read the immortal story of our nation's birth. Blessed 
 forever be the memory of Joseph Warren, who fell at 
 Bunker Hill, and that of John Collins Warren, who aided 
 so signally the renowned discovery of anaesthesia, to 
 whom all generations will be debtors, in conferring that 
 unequalled boon upon his fellow-men. 
 
 Let me add that discoveries of such permanent and 
 universal interest and importance are not accidental. 
 Such an assumption would be an impeachment of the 
 order of the universe and the designs of Providence. 
 They are the natural and indeed inevitable result of the 
 progress of scientific thought and investigation. The 
 eager quest of previously unknown facts which distin- 
 guishes our age reaches the very threshold of discovery, 
 when some fortunate explorer takes a step in advance, 
 ascertains the new truth and proclaims it to the world. 
 
 22 
 
c/ <f 
 
The history of surgical anaesthesia furnishes no exemp- reminiscences 
 tion from this general law. In the noon of this grandest l 4 
 of the centuries, the spirit of humane science whispered 
 these glad tidings ; the attentive ear of Morton heard the 
 message and transmitted it to mankind. Thenceforth this 
 matchless discovery was destined to bestow its blessings, 
 so long as the race shall endure, wherever in all time 
 human suffering cries aloud for succor or languishes in 
 silent despair, and the divine attribute of mercy, aided by 
 the wisdom of science, flies to its relief. 
 
 23 
 
 
SURGERY BEFORE THE DAYS 
 OF ANAESTHESIA 
 
 BY JOHN ASHHURST, JR., M. D., LL. D. 
 OF PHILADELPHIA 
 
SURGERY BEFORE THE DAYS 
 OF ANAESTHESIA 
 
 R. PRESIDENT and Gentlemen of the 
 Board of Trustees and Hospital Staff, La- 
 dies and Gentlemen : A study of the con- 
 dition of operative surgery before the days 
 of anaesthesia reveals on the one hand a 
 picture of heroic boldness and masterly self-control on 
 the part of the surgeon, and on the other a ghastly pan- 
 orama, sometimes of stoic fortitude and endurance, 
 sometimes of abject terror and humiliation, but always 
 of agonizing wretchedness and pain, on the part of the 
 unhappy victim, man or woman, whose necessities re- 
 quired a recourse to the surgeon's aid. And from our 
 vantage ground of a half century's experience it is diffi- 
 cult for us to understand why, with the constant and 
 persistent efforts made by surgeons in past ages to lessen 
 the pain of operations, and with the gradual but contin- 
 uous accumulation of facts showing that by certain 
 agents pain could be temporarily abolished without dan- 
 ger, the eyes of all — patients as well as practitioners — 
 yet seemed to be holden, and why, science and art work- 
 ing with a common object, if independently, though the 
 whole world seemed to be trembling on the verge of the 
 discovery, it yet was not until fifty years ago to-day that 
 the crucial experiment was made in this hospital, and that 
 surgical anaesthesia became a glorious reality. 
 
 27 
 
surgery It is somewhat difficult to obtain an accurate picture 
 
 the days of of pre-anaesthetic surgery from the patient's point of view, 
 anesthesia probably for a similar reason to that indicated by the 
 lion in the fable, when he criticised the artist for always 
 representing a combat between lions and men as termi- 
 nating in a human victory, — lions do not paint ; and so, 
 as operations are habitually reported by surgeons and not 
 by patients, we read of the skill and intrepidity of the 
 operator, of difficulties met and overcome, and of victo- 
 ries snatched as it were from the very jaws of impending 
 defeat ; but we hear little of the tortures of the victim 
 under the life-saving process, or, in an unsuccessful case, 
 of the gradual subsidence of agonizing cries hushed in 
 the silence of death. And yet we sometimes catch, inci- 
 dentally, a side-glimpse of an operation from the patient's 
 standpoint, and can thus form some faint notion of the 
 shades as well as of the high lights of capital surgery in 
 days gone by. 
 
 Those who are familiar with the history of British sur- 
 gery seventy years ago will recall the famous case of 
 Cooper vs. Wakley, in which the enterprising founder 
 and proprietor of the " Lancet " was sued and mulcted, 
 though in but nominal damages, for the report of an op- 
 eration for lithotomy performed by Sir Astley Cooper's 
 nephew, Mr. Bransby B. Cooper. The report opens 
 with a quotation from John Bell, referring to "long and 
 murderous operations, when the surgeon labors for an 
 hour in extracting the stone, to the inevitable destruc- 
 tion of the patient," and then, having described in terms 
 as graphic as uncomplimentary the operator's prolonged 
 efforts to remove the calculus, and the words which 
 showed his own anxiety and discomposure during the 
 process, adds : " Such were the hurried exclamations of 
 the operator. Every now and then there was a cry of 
 ' Hush ! ' which was succeeded by the stillness of death, 
 
 28 
 
broken only by the horrible squash, squash, of the for- surgery 
 ceps in the perineum. ' Oh ! let it go — pray let it keep the°days of 
 in ! ' was the constant cry of the poor man." The pa- anesthesia 
 tient was on the table nearly an hour, and after a night 
 and a day of great pain "death," adds the reporter 
 "ended the poor fellow's sufferings, about twenty-nine 
 hours after the operation." The fatal result appeared 
 to have been due to peritonitis. It is, indeed, not an 
 unheard-of thing that a surgeon's presence of mind 
 should fail him in a difficult operation, even at the pres- 
 ent day; but at least the patient, unconscious through 
 the blessing of anaesthesia, does not know it, and this 
 complication is spared, to the great comfort of all con- 
 cerned. 
 
 The " pitilessness " which Celsus urged as an essential 
 trait in the operative surgeon — though Percy and Lau- 
 rent declare that this pitilessness was meant to be appar- 
 ent only — was, indeed, before the days of anaesthesia, 
 a feature in the surgeon's character which impressed 
 very strongly the public generally, as well as those imme- 
 diately connected with the operation ; and it may be feared 
 that there are not wanting, even at this nineteenth cen- 
 tury's end, some who would echo the comment of the 
 younger Pliny upon the operative surgeons of his time : 
 " They make experiments through deaths, and no head 
 is secure from them." 
 
 It is interesting to recall that Sir James Simpson, of 
 Edinburgh, shortly after beginning his professional stud- 
 ies, was so affected by " seeing the terrible agony of a 
 poor Highland woman under amputation of the breast," 
 that he resolved to abandon a medical career, and seek 
 other occupation ; happily, his intention was reconsid- 
 ered, and he returned to his studies, asking himself, 
 "Can anything be done to make operations less pain- 
 ful?" and, as every one knows, in less than twenty years 
 
 29 
 
SURGERY 
 
 BEFORE 
 
 THE DAYS OF 
 
 ANESTHESIA 
 
 became himself a high priest of anaesthesia, and the in- 
 troducer into surgical and obstetrical practice of ether's 
 great rival, chloroform. 
 
 Not only did delicate women and tender children 
 dread the ordeal of the surgeon's knife, but strong and 
 brave men also recoiled from its use in horror : Buffon 
 preferred death to relief from the agonies of calculus by 
 the operation of lithotomy ; and case after case is narrated 
 by Monfalcon and other writers in which men submitted 
 themselves with the utmost calmness and fortitude to the 
 hands of skilful operators, instantly falling into collapse 
 after the first incision, and, without undue loss of blood, 
 quickly succumbing to the depressing effects of simple 
 shock and pain. 
 
 No braver or more gallant gentleman ever lived than 
 Admiral Viscount Nelson, and, after his right elbow had 
 been shattered by a French bullet in the assault at Ten- 
 eriffe, he manifested the utmost courage, refusing to be 
 taken to the nearest ship lest the sight of his injury 
 should alarm the wife of a fellow-officer whose own fate 
 was uncertain, arid when his own ship was reached, 
 climbing up its side without assistance, and saying, " Tell 
 the surgeon to make haste and get his instruments. I 
 know I must lose my right arm, so the sooner it is off 
 the better." " He underwent the amputation," we learn 
 from a private letter of one of his midshipmen, " with the 
 same firmness and courage that have always marked his 
 character;" and yet so painfully was he affected by the 
 coldness of the operator's knife that though, when next 
 going into action at the famous battle of the Nile, he 
 could after calmly finishing his meal say to his officers, 
 " By this time to-morrow I shall have gained a peerage 
 or Westminster Abbey," yet he gave standing orders to 
 his surgeons that hot water should always be kept in 
 readiness during an engagement, so that if another oper- 
 
 30 
 
ation should be required, he might at least have the poor surgery 
 comfort of being cut with warm instruments. the°days of 
 
 But the most striking picture of which I am cogni- an ^sthesia 
 zant, showing the way in which an intelligent patient 
 looked upon a surgical operation, is to be found in a let- 
 ter written to Sir James Simpson by a friend, himself a 
 member of the medical profession, who had had the mis- 
 fortune to lose a limb by amputation before the introduc- 
 tion of anaesthesia : " I at once agreed," he says, " to sub- 
 mit to the operation, but asked a week to prepare for it, 
 not with the slightest expectation that the disease would 
 take a favorable turn in the interval, or that the antici- 
 pated horrors of the operation would become less appall- 
 ing by reflection upon them, but simply because it was 
 so probable that the operation would be followed by a 
 fatal issue that I wished to prepare for death, and what 
 lies beyond it, whilst my faculties were clear and my emo- 
 tions were comparatively undisturbed. . . . The week, 
 so slow and yet so swift in its passage, at length came to 
 an end, and the morning of the operation arrived. . . . 
 The operation was a more tedious one than some which 
 involve much greater mutilation. It necessitated cruel 
 cutting through inflamed and morbidly sensitive parts, 
 and could not be despatched by a few strokes of the 
 knife. ... Of the agony it occasioned I will say nothing. 
 Suffering so great as I underwent cannot be expressed in 
 words, and thus fortunately cannot be recalled. The 
 particular pangs are now forgotten ; but the blank whirl- 
 wind of emotion, the horror of great darkness, and the 
 sense of desertion by God and man, bordering close 
 upon despair, which swept through my mind and over- 
 whelmed my heart, I can never forget, however gladly I 
 would do so. Only the wish to save others some of 
 my sufferings makes me deliberately recall and confess 
 the anguish and humiliation of such a personal experi- 
 
 31 
 
SURGERY 
 
 BEFORE 
 
 THE DAYS OF 
 
 ANESTHESIA 
 
 ence; nor can I find language more sober or familiar 
 than that I have used to express feelings which, happily 
 for us all, are too rare as matters of general experience 
 to have been shaped into household words. . . . During 
 the operation, in spite of the pain it occasioned, my 
 senses were preternaturally acute, as I have been told 
 they generally are in patients under such circumstances. 
 I watched all that the surgeon did with a fascinated inten- 
 sity. I still recall with unwelcome vividness the spread- 
 ing out of the instruments, the twisting of the tourniquet, 
 the first incision, the fingering of the sawed bone, the 
 sponge pressed on the flap, the tying of the blood-vessels, 
 the stitching of the skin, and the bloody dismembered 
 limb lying on the floor. Those are not pleasant remem- 
 brances. For a long time they haunted me, and even 
 now they are easily resuscitated ; and though they cannot 
 bring back the suffering attending the events which gave 
 them a place in my memory, they can occasion a suffer- 
 ing of their own, and be the cause of a disquiet which 
 favors neither mental nor bodily health." 
 
 On the side of the surgeon, we find throughout the 
 ages a constant effort to diminish the terrors of opera- 
 tions, and a continuous reprobation of the distressful, 
 not to say cruel, modes of practice adopted by preceding 
 generations. " Who can read without a kind of hor- 
 ror," cries Monfalcon, " the account of those frightful 
 operations which were then practised ? And yet the time 
 is not very far distant from ours when they lopped off a 
 limb by striking it violently with a heavy knife ; that 
 time when they knew neither how to stop nor how to 
 prevent hemorrhage but by burning the part whence the 
 blood jetted with boiling oil or the red-hot iron; that 
 time when surgeons armed themselves at every moment 
 with pincers, with burning cauteries, and with a thousand 
 instruments the representations even of which cause ter- 
 
 32 
 
ror." Will it happen that on the occasion of some future surgery 
 anniversary our successors will speak of our operative tri- the°days of 
 umphs with the same scorn and abhorrence with which anesthesia 
 writers of the present day sometimes refer to the great 
 deeds of our surgical forefathers ? 
 
 The belief that operations might be rendered painless, 
 and the hope that some means might be discovered by 
 which this end should be accomplished, appear to have 
 been present in the minds of surgeons from the earliest 
 periods. Witness the accounts of the Memphis stone, 
 described by Dioscorides and Pliny, which Littre sur- 
 mised to have been merely marble, which by steeping in 
 vinegar was made to give forth the fumes of carbonic 
 acid; and of the mandragora, employed according to Theo- 
 doric, when mixed with other narcotics, by inhalation, 
 and causing a sleep from which the patient could only be 
 aroused by the fumes of vinegar : so profound was the 
 stupor induced by this drug that Bodin assures us that 
 under its influence a man^ubmitte^ without conscious- 
 ness to a painful operation, anHVontinued to sleep for 
 several days thereafter may ^ 1902 
 
 Vigo speaks of the wj^pl^body being " broug^^tsleep by 
 the smelling of a spongewfe^rtit^c^iiofitis,'' but warns his 
 readers that the practice is dangerous, because the use of 
 opium is sometimes followed by gangrene. In his work 
 on " Natural Magic," Baptista Porta speaks of a volatile 
 drug, kept in leaden vessels, which produced sleep when 
 applied to the nostrils; and Perrin suggests that this may 
 actually have been ether, or some other of our modern 
 anaesthetic agents. 
 
 Others endeavored to prevent the pain of operations 
 by mechanical means. The Assyrians, Hoffman assures 
 us, compressed the veins of the neck, apparently by tying 
 a band around the part, before practising circumcision, 
 and compression of the carotid arteries was suggested as 
 
 33 
 
surgery an anaesthetic measure in more modern times by Dr. 
 
 the days of Fleming ; while still more recently Dr. Augustus Waller 
 anesthesia ^as s h own that insensibility may be induced by compress- 
 ing the cervical vagi. Garroters have, indeed, clearly 
 shown, as remarked by Simpson, that a person may read- 
 ily be choked into unconsciousness, but it is not surpris- 
 ing that their mode of practice has not commended itself 
 to surgeons for general adoption. 
 
 Compression of the limb by a fillet or tight ligature, 
 before amputation, is referred to by Pare as a mode of 
 alleviating the suffering which attends that procedure ; 
 and Benjamin Bell tells us that, "in amputating limbs, 
 patients frequently desire the tourniquet to be firmly 
 screwed, from finding that it tends to diminish the pain 
 of the operation." The same writer refers approvingly 
 to the suggestion of Mr. James Moore, that pain should 
 be controlled by the application of a screw compressor 
 to the principal nerve of the part, but surgeons generally 
 appear to have agreed with Monfalcon that the inconven- 
 iences of such an apparatus fully equalled its very slight 
 advantages. 
 
 Mental preoccupation was sometimes sought as a 
 means of preventing pain. Richard Wiseman found 
 that soldiers dreaded the loss of a limb much less if it 
 was removed immediately, while they were " in the heat 
 of fight," than if the operation was postponed until the 
 next day ; "wherefore," he says, "cut it off quickly, while 
 the soldier is heated and in mettle ; " and Renauldin 
 recalls the case of the amiable Dolomieu, who, exposed 
 to the pangs of starvation in a Neapolitan dungeon, 
 measurably alleviated his own distress by engaging in 
 the composition of a Treatise on Mineralogy, while his 
 unfortunate servant and fellow-prisoner, who had not the 
 same intellectual resources, was hungry enough for both. 
 But the presence of pain was not the only evil 
 
 34 
 
dreaded by our predecessors in attempting important surgery 
 operations : the great risk of fatal accident from some the days of 
 involuntary movement of the patient was constantly pres- AN ^ STHESIA 
 ent to the mind of the conscientious surgeon. " How 
 often," says Dr. Valentine Mott, " when operating in 
 some deep, dark wound, along the course of some great 
 vein, with thin walls, alternately distended and flaccid 
 with the vital current, — how often have I dreaded that 
 some unfortunate struggle of the patient would deviate 
 the knife a little from its proper course, and that I, who 
 fain would be the deliverer, should involuntarily become 
 the executioner, seeing my patient perish in my hands 
 by the most appalling form of death ! Had he been 
 insensible, I should have felt no alarm." So greatly was 
 the responsibility of using the knife felt by the best- 
 informed surgeons of pre-anaesthetic days, that many, 
 like Haller, distrusted their own manual dexterity, and 
 declined to perform operations which, while recognizing 
 their necessity, they felt should be left to other surgeons 
 differently constituted from themselves. Would that a 
 little of this Hallerian diffidence might affect some tyros 
 of the profession in our own day, who, without the 
 slightest preliminary practical training, do not hesitate 
 to undertake the most hazardous procedures, and seem 
 to consider themselves disgraced if they cannot count 
 one or more abdominal sections, even if terminating 
 fatally, within the accomplishments of their first year's 
 practice ! 
 
 Coming down to the days more immediately preced- 
 ing the date of the great discovery, we find that opium 
 and alcohol were the only agents which continued to be 
 regarded as of practical value in diminishing the pain of 
 operations, though the attendant disadvantages of their 
 employment were of course recognized. " Previous to 
 every painful operation," says Dorsey, " a dose of lauda- 
 
 35 
 
SURGERY 
 
 BEFORE 
 
 THE DAYS OF 
 
 ANESTHESIA 
 
 num should be administered." " I was in the habit," says 
 Dr. Mott, " of giving opiates freely before the introduc- 
 tion of anaesthetics, both before and after operations, . . . 
 and opium and its preparations are the only anodynes 
 well adapted to surgical use. No substitutes are worthy 
 of confidence." Demme tells of a woman who, under 
 the influence of opium, submitted to amputation at the 
 hip-joint, and emitted but a single cry; and I myself 
 recall distinctly patients who, in the hands of that 
 excellent surgeon, the late Dr. George W. Norris, had 
 limbs amputated with almost no manifestation of pain 
 when well charged previously with opium and whiskey. 
 Alcohol, pushed to the point of producing intoxication, 
 was employed as an anaesthetic by some surgeons ; and 
 Dorsey tells us that Dr. Physick, following Richerand's 
 suggestion, used it successfully for its relaxing effect in 
 a rebellious case of dislocated jaw, in which, on account 
 of the patient's " extreme debility," it was not thought 
 prudent to resort to the usual remedy, " blood-letting ad 
 deliquium animi!' 
 
 Meanwhile facts were accumulating, the significance 
 of which we can now plainly recognize, but which excited 
 no attention at the time. Sir Humphry Davy had, in 
 the very early days of the nineteenth century, experi- 
 mented with nitrous oxide, gas, afterwards employed by 
 Horace Wells, and had in so many words suggested its 
 use as an anaesthetic in minor operations ; its power of 
 preventing the sensation of pain was well known to many 
 persons, and it was the custom at some of our medical 
 schools — at the University of Pennsylvania for one — 
 for students to breathe the " laughing gas," as it was then 
 called, for diversion. The use of ether by inhalation had 
 been still earlier recommended by Beddoes, Pearson, and 
 Thornton as a remedy for certain diseases of the lungs, 
 and in 1805 your own Warren had employed it "to 
 
 36 
 
relieve the distress attending the last stage of pulmonary surgery 
 
 inflammation." Its intoxicating qualities when inhaled, the°days of 
 
 and its power, when in sufficient concentration, to pro- anesthesia 
 
 duce stupefaction, had been recognized, in 1839, in 
 
 Pereira's well-known treatise on Materia Medica, and 
 
 were quite familiar to American medical students ; and 
 
 it is no doubt possible — I certainly have no wish to deny 
 
 it — that in isolated cases it may have been used as a 
 
 means of relieving pain by individual practitioners, as by 
 
 Dr. Long, of Athens, Georgia, whom Perrin, with that 
 
 happy disregard of the geography of all countries except 
 
 their own which is characteristic of French writers, calls 
 
 the " Greek physician." 
 
 But yet — and yet — surgeons went on, in every coun- 
 try, cutting and burning, and patients went on writhing 
 and screaming, until on the sixteenth day of October, in 
 the year 1846, in the Massachusetts General Hospital, Dr. 
 John C. Warren painlessly removed a tumor from a man 
 who had previously been etherized by Dr. William T. G. 
 Morton — and Surgical Anaesthesia became the priceless 
 heritage of the civilized world. 
 
 37 
 
WHAT HAS ANESTHESIA DONE 
 FOR SURGERY 
 
 BY DAVID W. CHEEVER, M.D., LL. D. 
 OF BOSTON 
 
 9 
 
WHAT HAS ANESTHESIA DONE FOR 
 
 SURGERY 
 
 HAT victim of surgery, who, under ether, 
 sinks into a calm and dreamless sleep, 
 during which his abdomen can be cut 
 open, his bowels taken out, handled, and 
 replaced, his nerves cut, his veins or ar- 
 teries tied, and his skin sewed up, and who is made so 
 absolutely oblivious as to ask on awakening, " Are you 
 not ready to begin ? " but concedes with gratitude, on 
 realizing the result, that this is the greatest discovery 
 ever made for the happiness of mankind ? 
 
 In proportion as anticipation is worse than reality, 
 must be estimated the mental relief brought about by 
 anaesthesia. To dread the knife, to shrink from an op- 
 eration, to fear pain, — is there a more universal instinct? 
 It is next to the vital instinct of self-preservation. What 
 iron will, what previous agony, must induce that forti- 
 tude which can bring the sufferer to lie down and be cut 
 without stirring ! 
 
 All this is annulled by anaesthesia. How much mental 
 shock is thus removed ! 
 
 What is surgically termed the " shock of the opera- 
 tion," or the disturbing effect on the nervous system of 
 violence done the flesh and nerves, is also largely dimin- 
 ished. Anticipation is done away with ; pain is pre- 
 vented ; shock is reduced. 
 
 41 
 
what has The patient consents to operation earlier ; he does not 
 
 done for wait until life becomes unbearable, but calmly contem- 
 
 plates surgery as the natural and easy channel of relief. 
 Hence his chances of benefit from an operation are 
 much increased; he averts destructive processes, short- 
 ens disease, is more likely to recover. So much is done 
 for the patient. 
 
 To the surgeon anaesthesia gives the patient asleep, 
 motionless, senseless. He need not hurry ; he need not 
 sympathize ; he need not worry ; he can calmly dissect, 
 as on a dead body; heedful only that the etherizer is 
 competent, the breathing and pulse watched, the opera- 
 tion not prolonged beyond the verge of exhaustion. 
 
 The surgeon, then, can do better work; he can be more 
 careful ; he can pause and consider ; he can choose his 
 steps ; he can be deliberate, if not dexterous. He can 
 even summon the aid of the pathologist and his micro- 
 scope, who in ten minutes, while the patient sleeps, can 
 decide the nature, the innocence or malignancy, of the 
 tumor he is removing. 
 
 It is also just to believe that the moral fibre of the sur- 
 geon is less strained; judicial callousness is no longer 
 called for; he need not steel his heart, for his victim 
 does not feel. 
 
 For surgery and for diagnosis, anaesthesia has done 
 even more. It has enlarged its domain by rendering 
 justifiable, and even promising, severe and delicate oper- 
 ations. 
 
 The tyranny of misguided conscience drove the inquis- 
 itors of the Middle Ages to rack the joints apart : so, 
 too, the surgeon was formerly obliged to use the rack to 
 tire the muscles and disrupt the capsule, to reduce a dis- 
 location. Now anaesthesia relaxes the muscles, and 
 manipulation rolls the bone into the socket. 
 
 Homeric strength was needed to bear Homeric sur- 
 
 42 
 
gery. Strong men and calm women endured desperate what has 
 
 . . ANESTHESIA 
 
 mutilations and recovered. But at what a cost ! done for 
 
 Such surgery must necessarily have been largely trau- SUR,jrERY 
 matic, or the result of emergencies threatening death if 
 not relieved. 
 
 It is not too much to say that all the finer work of 
 plastic, conservative, and abdominal surgery dates from 
 the discovery of anaesthesia. It could not have been 
 done before. Neither surgeon could persist, nor patient 
 endure it. Perhaps one thousand ovariotomies were 
 done by Sir Spencer Wells before asepsis was much 
 practised, but they were all done since anaesthesia was 
 known. The tedious details in a radical cure of hernia 
 were mostly mechanical before anaesthetics, and the oper- 
 ative measures have been adopted since. 
 
 Formerly the surgeon was estimated for dexterity and 
 quickness. Now he is esteemed the great surgeon who 
 to judgment adds dexterity, and to dexterity patience. 
 
 Anaesthesia was the necessary precursor of asepsis. 
 Without the former the latter would not be what it now 
 is. Even if antiseptic agents were used in dressing 
 wounds, the operations which caused the wounds could 
 not have been done aseptically without anaesthesia. 
 
 The essence of asepsis is detail, tedious rules and pre- 
 cautions, prolonged and accurate dressings. All this 
 requires time, immobility, unconsciousness. To stitch 
 the most delicate tissues with accuracy, to match the 
 bowel or bladder so that it will not leak, — how could 
 this be done on a conscious and quivering patient ? 
 
 First, anaesthesia ; second, asepsis. They must be in- 
 separable for success. 
 
 All visceral surgery, which deals with the great serous 
 cavities, and which constitutes the proud distinction of 
 modern surgery, depends on anaesthesia first, and on asep- 
 sis afterward. The latter is as beneficent a discovery as 
 
 43 
 
what has the former. Hand-in-hand, equal benefactors, anaesthesia 
 done T for and asepsis march calm and triumphant. Together 
 
 surgery ^y j iave altered life, enlarged what is worth living for, 
 
 postponed death. May we not claim now as fulfilled for 
 surgery that old saying which our fathers regarded as the 
 acme of success and skill in curing the patient, Tuto, 
 cito et jucunde (Without danger, without delay, without 
 pain) ? 
 
 Is there no reverse to this brilliant picture ? There is 
 if we allow it, but most dangers and mischances can be 
 averted by care. The danger of immediate death from 
 anaesthetics is no greater than the ordinary risks of life 
 in the daily pursuits of civilized communities. The use 
 of power, whether steam or electric, surrounds the life of 
 cities with hourly perils ; and the chance of succumbing 
 under the inhalation of ether is no greater than the risk 
 of a street accident or a railway journey. Of those who 
 inhale sulphuric ether, about one in fifteen thousand die. 
 I formerly believed that chloroform was ten times more 
 fatal than ether; larger statistics have modified that 
 opinion, and it may now be fairly stated to be five times 
 more dangerous, or of those who inhale chloroform about 
 one in three thousand die. 1 
 
 Since neither anaesthetic is given to the well and sound 
 person, but always to the sick or injured, we cannot 
 eliminate the chances of death from inhalation, which 
 may be increased by infirm hearts, lungs, or kidneys. 
 The patient is forced to take those chances. And yet 
 how few perish from these pain-dispelling agents ! 
 
 An elementary alcohol, sulphuric ether acts like alco- 
 hol in its effects when inhaled. A quickened pulse, a 
 stimulated heart, a vivid capillary blush, congestion of the 
 brain, mental exhilaration, confusion, intoxication, a leth- 
 argy which is not lethal. 
 
 1 Appendix I. 
 44 
 
Ether is fatal unless breathed with the oxygen of at- what has 
 mospheric air ; nay, more, provision to have the carbonic done T for IA 
 acid exhaled must also be provided for. An uncovered SURGERY 
 sponge for an infant, and a sponge covered with a porous 
 towel for the adult, are still among the best — and surely 
 the safest — inhalers: rigidity, lividity, stertor, only em- 
 phasize the need of more air. 
 
 Chloroform affects the heart more suddenly and surely 
 than the respiration. It is a heavier gas, pleasant to 
 take, less bulky, quicker in producing unconsciousness, 
 less irritating to the lungs, less followed by vomiting; 
 but, when fatal, suddenly fatal, without premonition. Its 
 primary effect is depressing ; the skin is cool and pale ; 
 the pulse not stimulated ; sleep follows speedily. 
 
 The distinction of danger from safety in the inhala- 
 tion of both anaesthetics may be described in the words 
 of Shelley : — 
 
 " How wonderful is Death, 
 Death and his brother Sleep ! 
 One pale as yonder waning moon, 
 With lips of lurid blue ; 
 The other rosy as the morn 
 When, throned on ocean's wave, 
 It blushes o'er the world." 
 
 A secondary danger is from prolonged anaesthesia. 
 Sulphuric ether inhaled the first half hour is stimulant ; 
 the second half hour, tolerable ; the third half hour, de- 
 pressant. The pulse creeps up from the eighties to the 
 one hundred and twenties ; the skin cools ; color fades ; 
 sweat rains from the surface ; respiration becomes shal- 
 low or sighing, — all signs of exhaustion, collapse, and 
 death. Intent on a delicate, and as he thinks necessary 
 and final, step in his operation, the surgeon may persist 
 too long, and the patient sink too low for recovery. This 
 danger is emphasized by the delays of aseptic precau- 
 
 45 
 
what has tions, of minute embroidery of serous membranes with 
 done for sutures, of too long an exposure of the vital cavities. 
 
 surgery j± common, but not constant, effect of the inhalation 
 
 of ether, and of chloroform to a less degree, is nausea and 
 vomiting, both while asleep and after wakening. If only 
 of brief duration, its only danger is in disturbing the 
 wound, as the humors of the eye or the ligatures on the 
 pedicle of an ovarian cyst. This danger is, however, to 
 be counted. If of long duration, it marks a condition of 
 secondary shock, which is often fatal. 
 
 No agent has been found to be a specific to prevent 
 vomiting. An empty stomach is an essential in inhaling 
 anaesthetics. As remedies, the bromides, the subcutane- 
 ous injection of morphia and atropia, the inhalation of 
 oxygen, have each given a certain success. Much vomit- 
 ing may be prevented by giving ether only to the verge 
 of insensibility; not filling the blood too full of the 
 vapor ; taking the ether off permanently as early as pos- 
 sible ; for unconsciousness persists for fifteen to twenty 
 minutes after apparent rousing, and the patient's motions 
 and moans are automatic, and not remembered after 
 waking. 
 
 Sulphuric ether irritates the mucous membrane of the 
 bronchi and minute air-passages. We know how it con- 
 gests the eyes if it runs into them. It provokes a large 
 and sometimes dangerous secretion of sero-mucous fluid 
 from the bronchi ; this gets churned up with air, and fills 
 the throat with a bubbling-fluid like soapsuds. It is both 
 annoying and dangerous. Chloroform causes much less 
 of this condition. 
 
 Acute bronchitis, pulmonary edema, broncho-pneumo- 
 nia (but not true lobar-pneumonia) * may follow, and turn 
 the scale against the patient. It is claimed that a previ- 
 ous injection of atropia will often dry the throat and 
 
 1 Appendix II., Dr. Prescott. 
 
 4 6 
 
bronchi, and avert this excessive secretion. Light inha- what has 
 lations, plenty of air, watchfulness to swab the throat, done T f<xr IA 
 care to remove the ether early, are the best remedies. surgery 
 
 Both sulphuric ether and chloroform congest the kid- 
 neys, and produce albuminuria in more than one half the 
 cases. 1 This albuminuria is usually of short duration ; 
 but one can readily see that a diseased kidney might be 
 overwhelmed by it, just as a feeble heart would suc- 
 cumb to chloroform, or diseased lungs to an increased 
 bronchial secretion. Bright's disease, diabetes, any in- 
 flammation of the air-passages, pleuritic effusion, acute 
 bronchitis, valvular disease of the heart, croup, — all are 
 unfavorable conditions for an anaesthetic. 
 
 The thermo-cautery about the face demands chloro- 
 form. 
 
 If in spite of these unfavorable conditions only one 
 person in fifteen thousand succumbs to the inhalation of 
 ether, we may conclude that we shall not find a safer 
 agent to produce unconsciousness, though we may a 
 more agreeable. 
 
 1 Appendix III., Dr. Blake. 
 47 
 
** 
 
 WHAT HAS 
 ANESTHESIA 
 DONE FOR 
 SURGERY 
 
 APPENDIX 
 
 I. Mortality 
 
 Combined statistics of Gurlt, of Berlin, and Juillard, of Geneva : — 
 Chloroform. — 691,319 cases, 224 deaths. One death in 3,082 
 cases. 
 
 Ether. — 341,058 cases, 23 deaths. One death in 14,828 cases. 
 
 II. Lungs 
 
 Prescott believes that ether cannot produce true lobar pneumonia. 
 He gives only two cases in about 40,000 ether inhalations. 
 
 Boston Medical and Surgical Journal, March 28, 1895, vol. cxxxii. 
 No. 13, p. 304, W. H. Prescott, M. D. 
 
 III. Kidneys 
 
 Examination of 50 cases, before and after ether. Urine filtered, 
 and nitric-acid test used. In 36 cases out of 50, ether produced albu- 
 min, or increased that already existing. But the German authorities 
 believe that chloroform irritates the kidneys more than ether. Albu- 
 min after ether was slight in amount and of short duration. 
 
 Second Lyman Prize for 1894, John Bapst Blake, M. D. Boston 
 Medical and Surgical Journal, vol. cxxxii. p. 560. 
 
 48 
 
- 
 
 RELATION OF ANyESTHESIA 
 AND OBSTETRICS 
 
 BY JOHN P. REYNOLDS, M.D. 
 OF BOSTON 
 
RELATION OF ANESTHESIA AND 
 OBSTETRICS 
 
 N the welcome that greeted anaesthesia in 
 this city fifty years since, its promise to 
 women in labor was not overlooked. Oli- 
 ver Wendell Holmes, recounting its bless- 
 ings, rejoiced that it lifted " the primal 
 curse ; " Walter Channing, our honored first professor of 
 midwifery, devoted an important volume, his " Etheriza- 
 tion in Childbirth," to its early triumphs. To-day, after 
 the half century, it is my glad office to lay before you 
 the priceless worth of anaesthesia in obstetrics. 
 
 In operative obstetrics, in the high and difficult use of 
 instruments, in the introduction of the hand for version 
 and extraction, anaesthesia resembles at all points that of 
 the graver procedures of general surgery. It brings the 
 same admirable results: a patient in blissful unconscious- 
 ness ; an operator delivered from all concern for another's 
 suffering, with ample time for exact and thorough diag- 
 nosis, and free to work with all desired accuracy, deli- 
 cacy, and caution. In obstetrics there is often a further 
 gain of great moment: loosing the formidable grip of the 
 uterine muscle. Mention must also be made of the 
 induction of premature labor, in which the power of 
 safely maintaining for many continuous hours profound 
 etherization is rapidly securing for the method of passive 
 
 51 
 
relation of manual dilatation a deserved preeminence. It may be 
 and obstet- added that five minutes only of deep anaesthesia, rapidly 
 
 RICS 
 
 induced, prove at times no mean resource in softening 
 the thin, wiry edge of a tardily dilating uterine mouth. 
 After profound anaesthesia during delivery, increased 
 watchfulness against hemorrhage is always wisely en- 
 joined ; but where the precautions which are in all labor 
 indispensable are duly enforced, any added risk is per- 
 haps rather inferred than proven. 
 
 The service of ether in puerperal convulsions is still 
 more striking. Used in the manner now to be described, 
 it prevents any new seizure. An eclamptic patient is 
 brought with all possible rapidity to complete uncon- 
 sciousness. During many consecutive hours this is 
 firmly kept up, always under strictly professional care ; 
 there can be no delegation of the physician's authority to 
 any hands less qualified than his own, not even to those 
 of the best trained nurse. An utterly passive condition 
 is secured ; and then, on the least restlessness, agitation, 
 indication of pain or uneasiness in any region, — above all, 
 at any slightest tremor of an eyelid, or other known pre- 
 monition of afresh attack, — the remedy must be instantly 
 pushed to full, snoring anaesthesia. No evil effects will 
 ensue from continuing this state for many successive 
 hours, and these can seldom be fewer than eight or 
 ten. Under anaesthesia food is, of course, withheld. It 
 must be distinctly understood that such an employment 
 of ether has no power of cure. In exhibiting it we abso- 
 lutely prevent fresh paroxysms, each of which strikes a 
 new blow at the brain and nervous centres, and we gain 
 at the same time the all-precious opportunity for treat- 
 ment. This latter must be meanwhile actively pressed : 
 first and foremost, unless already accomplished, the emp- 
 tying of the uterus ; to temporize with that does no good 
 whatever, and may bring incalculable harm. Improve- 
 
 52 
 
ment in the renal condition is the best proof of amend- relation of 
 ment. When to withdraw the ether is always a most and S obst S et- 
 anxious problem, steady continuance of it being in all RICS 
 doubtful cases the far safer alternative. 
 
 In making these strong assertions in regard to ether- 
 ization in eclampsia I weigh well my words. Carelessly 
 or ignorantly followed, they may work mischief. But the 
 subject is of extreme importance. In my results there 
 has not been the slightest variation, and I am confident 
 that I do not stand alone. The time has come to pre- 
 sent these views to the medical profession, and to press 
 their general acceptance. 
 
 For the prolonged use in eclampsia just described, and 
 even for that already suggested in the induction of pre- 
 mature labor, I dare not approve chloroform. 
 
 Would that any words of mine could bring home, as 
 I feel it, the inestimable blessing of ether in all labor, 
 silence groundless excuses for its neglect, and so rouse 
 professional interest that no one should lightly forbid it 
 to any woman in childbed ! " Bless God for ether!" has 
 burst from the lips of thousands on thousands of suffer, 
 ing women. It might well be made the cry of countless 
 thousands more. 
 
 In normal labor due anaesthesia is free from every 
 shadow of danger. The alleged after-evils do not exist ; 
 on the contrary, the gain in safety outweighs the expres- 
 sible comfort and relief. It is indispensable that the 
 anaesthetic be administered only within the limits now to 
 be laid down ; on this is conditioned the truth of all that 
 follows. 
 
 Ether, when properly given in normal obstetrics, never 
 contents the patient. She incessantly cries for more, 
 and, if in first labor, indignantly claims to be forthwith 
 put asleep, and to know nothing till after the birth. The 
 anaesthetic is allowed only during the uterine contrac- 
 
 53 
 
RELATION OF 
 ANESTHESIA 
 AND OBSTET- 
 RICS 
 
 tion,— the time of positive pain. In the interval it is 
 withdrawn. Consciousness should then return, and there 
 is often intelligent speech. Ether may be given at any 
 period, and might be continued from the beginning of 
 labor to its close. There should be here no question of 
 the so-called " stages " of labor. Only one rule governs 
 its use. Whenever the attendant sees that the woman's 
 endurance of pain begins to tell upon her patience and 
 courage, the moment for ether has come. It is to be 
 kept up so long as this need lasts ; no longer. In an 
 appreciable minority of cases, a mother who in her early 
 suffering has been clamorous for relief will herself, when 
 the so-called "real" pains appear and conscious pro- 
 gress is made, put it away : " I can do without it now." 
 On its first employment, a lull often comes in the uterine 
 action, the patient sinking into a much-needed repose, 
 to which soon succeeds a yet more vigorous advance. 
 The extremely rare case in which no such renewal occurs 
 must plainly forego anaesthesia. It should be noted that, 
 in the earliest pains, some careful observers hold that 
 chloral in suitable doses gives still greater relief. 
 
 With even these limitations, the value of ether can 
 hardly be overestimated. It is something that in the 
 distress a good and decorous deportment is no longer 
 enjoined ; it is everything that tender hands can now, as 
 in other nursing, solace each access of suffering with 
 positive help ; but far, far beyond this, that we thus up- 
 hold in the patient that vital resistance which mental and 
 nervous tension and the long endurance of pain, more 
 than all other causes combined, destroy, — that which 
 soothes becoming likewise a chief guarantee of safety, a 
 help against hemorrhage. 
 
 Unhappily, a frequent resort to ether may not be asked 
 from lying-in hospitals and the great public charities. 
 These establishments, burdened with enormous and ever- 
 
 54 
 
enlarging: cost for the first needs of the destitute, — shel- relation of 
 
 r j *.!. ' 4- J J *.u i. • ANESTHESIA 
 
 ter, food, warmth, nursing, — cannot add the great in- and obstet- 
 crease of responsible attendants which general anaesthesia RICS 
 would require. But, even for private practice, anaesthetics 
 are not, in simple labor, extensively used. The medical 
 profession does not accept what has just been said of 
 ether. Its benefits are sturdily denied. Men declare 
 that it promotes flooding; that it wastes important time; 
 that it presents them, in place of a woman bearing her 
 pain with dignity and fortitude, a creature regardless of 
 appearances and only clamoring every moment for ease. 
 
 These charges come mainly, I believe, from those 
 who, under varying motives, content themselves with a 
 tardy, perfunctory, or even deceitful resort to ether ; 
 " refusing it," as women sometimes say, " when we most 
 need it, and allowing it when we could most easily do 
 without it." Later, one may readily ascribe to the anaes- 
 thetic, which has in no true sense been tried, those com- 
 mon disasters of childbed which its proper use would 
 largely ward off ; and these assertions, once made, sup- 
 ply a ready excuse for that numerous, and it is to be 
 feared increasing class who do not so much oppose ether 
 as willingly evade and neglect it. 
 
 We have seldom possessed an accoucheur of wider 
 experience, or a teacher of greater gifts of tongue and 
 pen, than the late famous Fordyce Barker, of New York. 
 Several years ago, I listened with eager interest as he, 
 in this city, before the American Gynecological Society, 
 deeply condemned the growing disuse of ether in obstet- 
 ric practice. " Through a long series of years," he said, 
 " I have rarely attended labors without ether. I have 
 never seen from it any evil effects. Especially has it 
 not caused a tendency to hemorrhage. Indeed, I should 
 say that instances of flooding that I have seen have 
 rather occurred in cases where ether had not been em- 
 
 55 
 
relation of ployed." Years have but deepened my conviction of 
 
 ANAESTHESIA 
 
 and obstet- the exact truth of the words that I then so heartily wel- 
 RICS corned. 
 
 The time of an obstetric attendant is no longer his 
 own ; he may not condemn the extra half hour that ether- 
 ization will now and then compel His approval or his 
 dislike of his patient's attitude in her distress is of trivial 
 importance. Objections like these have no weight unless 
 urged by the sufferer. She was never known to advance 
 them. 
 
 The charge that anaesthesia increases flooding cannot 
 be thus lightly set aside. As matter of opinion it has 
 been to-day claimed that the due use of ether saves the 
 mother's courage and strength; that, it preserves, not 
 breaks down, uterine contractile power ; that it thus les- 
 sens the risk of hemorrhage. It will be found that clini- 
 cal facts do not belie this theory. They wait for other 
 observers as they did for Barker. Those in search of 
 them are prayed to make trial of ether in all confine- 
 ments, not, indeed, forgetting the due limitations, but 
 ungrudgingly, thankfully, gladly. 
 
 One remembers tender hearts that doubted their right 
 to evade, under ether, Heaven-sent pain. How marvel- 
 lously the words graven beneath our cherished Ether 
 Memorial send down, in reply, their adoring praise ! — 
 
 " This also cometh forth from the Lord of Hosts, who 
 is wonderful in counsel and excellent in working." 
 
 56 
 
THE INFLUENCE OF ANAESTHESIA 
 UPON MEDICAL SCIENCE 
 
 BY W. H. WELCH, M. D., LL. D. 
 OF BALTIMORE 
 
THE INFLUENCE OF ANESTHESIA 
 UPON MEDICAL SCIENCE 
 
 R. PRESIDENT, Gentlemen of the Board 
 of Trustees and of the Medical Staff of the 
 Massachusetts General Hospital, Ladies 
 and Gentlemen : Five months ago was cel- 
 ebrated the centennial anniversary of that 
 grand discovery by Jenner which brought under subjec- 
 tion the most prevalent and horrible scourge of former 
 centuries. To-day we have assembled in this famous 
 hospital on the very spot, made memorable for all time, 
 where fifty years ago William Morton first demonstrated 
 to the world the art of surgical anaesthesia, the happiest 
 gift ever conferred upon mankind by medical science or/ 
 art. We may add to vaccination and anaesthesia the more 
 recent introduction of antisepsis by Lister ; and we can 
 truthfully say that all the previous centuries can show no 
 achievement of the art of the physician or surgeon com- 
 parable in beneficence to any one of these triumphs of 
 the last hundred years. 
 
 It is in consequence of their enduring utility and ben- 
 efit to humanity that these discoveries, which have led to 
 the mastery over a pestilence, the annulment of pain, and 
 the safe healing of wounds, merit the everlasting grati- 
 tude of the world. But it is fitting on such a commem- 
 orative occasion as this that, while these practical aspects 
 receive their due consideration, we forget not the debt 
 
 59 
 
 s 
 
the influ- which these great discoveries owe to science, nor the 
 anesthesia debt which science owes to them. It is, therefore, most 
 science EDICAL appropriate that those who arranged the programme to 
 commemorate this fiftieth anniversary of the first public 
 demonstration of surgical anaesthesia should have chosen, 
 as one of the themes to be here presented, " The Influ- 
 ence of Anaesthesia upon Medical Science." Their wis- 
 dom I am sure was less conspicuously manifested in their 
 selection of the medium for the presentation of this sub- 
 ject, highly as I esteem the honor of being invited to 
 speak upon this occasion. 
 
 In the limited time allotted to an individual speaker, I 
 cannot hope to do more than to present in outline some 
 of the salient aspects of my theme. 
 
 I shall not attempt to trace the history of the dis- 
 covery of surgical anaesthesia, a history which affords a 
 lamentable illustration of how the awards of generous 
 gratitude may be sacrificed to fruitless efforts to mete 
 out equal and exact justice. I wish in this connection 
 to call attention only to the fact that this discovery was 
 made in the only way in which it possibly could have 
 been made, and that is by the method of experimenta- 
 tion. The opponents of animal experimentation have 
 endeavored to utilize for their purposes the alleged ab- 
 sence of experiments upon animals as the basis of this 
 discovery. As a matter of fact, even leaving out of 
 account the pioneer experiments upon animals by Hum- 
 phry Davy with nitrous oxide, the first successful trial 
 of ether as a- general anaesthetic for human beings by 
 Morton was preceded by his demonstration of the power 
 of this agent to produce in dogs unconsciousness and 
 insensibility to pain. It would be strange, indeed, if 
 these striking results of experiments upon animals had 
 no influence in inducing him to test their applicability to 
 human beings. 
 
 60 
 
It must, however, be admitted that the production of the influ- 
 anaesthesia in man by inhalation of ether was not pre- anesthesia 
 ceded by such numerous and properly conducted experi- science DICAL 
 ments on animals as were required to afford any adequate 
 conception of its effects or its possibilities of danger. 
 We now know that such experiments would have yielded 
 knowledge of this character. We know also that the 
 anaesthetic sleep induced by ether in man as well as 
 in animals is not attended with more than a minimal 
 amount of danger ; but suitable experiments upon ani- 
 mals would have afforded more knowledge than Morton 
 could have possessed as to whether there was to be sure 
 awakening from that sleep so like unto death. Hence 
 it is that, when that patient fifty years ago to-day in this 
 hospital was placed under the profound influence of 
 ether, he was made the subject of a scientific experiment 
 of immense practical import and of unsurpassed bold : 
 ness. This was the decisive experiment from which" 
 dates "the continuous and consequent history" of anaes- 
 thesia. 
 
 The discovery of surgical anaesthesia is, I repeat, a tri- 
 umph of the experimental method, albeit man himself 
 was made the subject of experiment and thereby exposed 
 to unknown possibilities of danger. 
 
 If my theme embraced the consideration of all of the 
 relations of artificial anaesthesia to medical science, and 
 did time permit, it would be proper for me to direct 
 attention to the part played by animal experimentation 
 in the discovery and introduction of new anaesthetics, 
 and to the numerous physiological and pharmacological 
 experiments, mainly upon animals, which have shed so 
 much light upon the mode of action of aaensthetics, par- 
 ticularly of ether and chloroform, and the sources of 
 danger in their employment. Although not all of the 
 questions involved have yet been solved, these experi- 
 
 61 
 
the influ- ments have furnished a large amount of knowledge of 
 anesthesia great scientific value and of much practical interest 
 science EDICAL concerning the properties of anaesthetics, — knowledge 
 which it is certainly desirable to possess, and much of 
 which could not have been gained otherwise than by ex- 
 periments upon animals. 
 
 I might speak also of the broad biological interest 
 which attaches to the universal susceptibility of living 
 matter to the sleep-producing influence of ether and chlo- 
 roform, a susceptibility extending even to vegetable cells 
 and the simplest unicellular organisms; also of how the 
 gentle killing of certain bacteria by chloroform enables 
 us to detect in their bodies toxic substances which are 
 destroyed by more violent modes of death ; and further of 
 interesting properties of nerve and of muscle which have 
 been revealed by studying under various conditions the 
 action upon them of anaesthetic agents. But I do not 
 interpret the subject assigned to me as including the con- 
 sideration of such matters as these, interesting as they 
 are, and it is certain that time would not permit even 
 their sketchy presentation upon this occasion. 
 
 What I especially desire to emphasize in these brief 
 remarks is, that the utility of the discovery of anaesthetics 
 is not limited to their practical application to the surgi- 
 cal and medical and obstetrical arts, but that this discov- 
 ery has been of great service also to medical science, upon 
 which these arts in large part rest. 
 
 Anaesthetics appeared upon the scene at a time when 
 the experimental medical sciences were entering upon 
 an epoch of activity and success far surpassing anything 
 previously known in the history of medicine. The 
 shackles of philosophical speculation and dogma which 
 bound medicine at the opening of this century had been 
 broken by the work of such men as Bichat, Magen- 
 die, Johannes Mliller, Rokitansky, Laennec, and Louis. 
 
 62 
 
Their work was based upon exact observation and exper- the influ- 
 iment, and there had come to be a general realization of anesthesia 
 the fact that these are the only trustworthy sources of science EDICAL 
 knowledge. Animal experimentation, which, as a fruit- 
 ful method of investigation, began with Harvey's discov- 
 ery of the circulation of the blood, had in the hands of 
 Charles Bell, Magendie, Muller, and others yielded abun- 
 dant proofs of its value. It was during the fourth decade 
 of this century that those great experimenters, Claude 
 Bernard, from the school of Magendie, and Du Bois- 
 Reymond, Helmholtz, Briicke, and Ludwig, from the 
 school of Muller, started their epochal investigations in 
 physiology. It was at the same period that Virchow 
 and Traube began those researches which established 
 animal experimentation, already successfully employed 
 by John Hunter, as a most important aid in the devel- 
 opment of pathological physiology. It was then also 
 that experimental pharmacology, which had been inau- 
 gurated by Magendie, was first cultivated as a distinct 
 branch of medical science by Buchheim. The need of 
 suitably equipped laboratories where experimental inves- 
 tigations could be conducted was now felt more keenly 
 than ever before. By being the first to supply these es- 
 sential instruments of fruitful scientific activity, Germany 
 took the lead in scientific discovery, a position w,hich 
 her enlightened policy in the establishment and support 
 of laboratories has enabled her ever since to retain. 
 
 The introduction of artificial anaesthesia came at this 
 auspicious period of awakened activity, which gave such 
 promise of the rapid development of scientific medicine 
 through the aid of exact observation and experiment. 
 And how brilliantly has this early promise been fulfilled 
 by the discoveries of the last fifty years, which have wit- 
 nessed the creation of cellular pathology, the rapid devel- 
 opment of physiology to a biological science of the first 
 
the influ- rank, conferring great benefits upon medicine, but extend- 
 an^sthesia ing far beyond the boundaries of medicine the establish- 
 science EDICAL ment of pharmacology upon a broad scientific basis; and 
 the birth of the science of bacteriology, which has un- 
 locked the gates to new fields whose brief exploration has 
 already proven of such immense importance to preventive 
 and curative medicine and practical surgery ! It is true 
 that, when we consider all that we may reasonably hope 
 to learn concerning the structure and functions of living 
 beings in health and in disease, and how they may be 
 influenced for good or for ill, only a corner of the curtain 
 has been lifted ; but when we compare the advance of 
 medicine during the last fifty years with what was previ- 
 ously known, we can truthfully say that this advance has 
 been greater during these years than during all the pre- 
 vious centuries. 
 
 A large and important part of this progress is attribu- 
 table to the results obtained by means of experiments 
 upon animals. One has only to imagine blotted out 
 from the records of physiology, pathology, pharmacol- 
 ogy, hygiene, bacteriology, and other medical writings 
 all of the facts which have been derived from animal 
 experimentation to realize how immense would be the 
 loss to both scientific and practical medicine had inves- 
 tigators been deprived of this indispensable method of 
 research. To point out in detail how broad and deep 
 would be this gap cannot be even attempted in the short 
 time here allotted, and would be surely unnecessary be- 
 fore this audience. 
 
 The use of anaesthetics has been such an important 
 
 aid in the performance of these experiments upon ani- 
 
 ; mals during the past fifty years that it is eminently fitting 
 
 I on this jubilee that medical science should also pay its 
 
 tribute to the beneficence of the great discovery here 
 
 celebrated. 
 
 6 4 
 
 
The ways in which anaesthetics have been serviceable the influ- 
 
 . J . .,,... . ENCE OF ! 
 
 to animal experimentation are essentially similar to those an^esthe&ia 
 
 ,.,,ii i r, i UPON MEDICAL 
 
 in which they have benefited surgery. science 
 
 The great majority of painful vivisectional experiments 
 upon the higher animals are of such a nature that the 
 object of the experiment is not defeated by the employ- 
 ment of anaesthetics. In experiments of this class, all 
 trained experimenters should and do use anaesthetics, and 
 there is no evidence that there exists to-day any abuse 
 of vivisection on this score in any properly conducted 
 laboratory. The dictates of humanity demand that we 
 shall gain, for the benefit of man, knowledge which can 
 be acquired only from experiments upon animals ; and 
 they demand also that this knowledge shall be gained 
 without the infliction of needless suffering. Humane 
 instincts are not less active among those who devote 
 themselves to acquiring knowledge in this way than 
 among other classes of men, but these instincts in the 
 former are controlled, not by false sentiment but by 
 reason and duty. It is a source of immense gratification 
 to experimenters, as it should be to all with humane im- 
 pulses, that, in consequence of the discovery of artificial 
 anaesthesia, so large a part of the useful knowledge which 
 can be derived only from experiments upon animals can 
 now be acquired without the infliction of pain. To 
 cite the animal experiments of pre-anaesthetic days, as 
 for example those of Magendie, as illustrations of pres- 
 ent methods of experimentation, is as unwarrantable as 
 would be a similar procedure in describing surgical oper- 
 ations. 
 
 The advantages of anaesthesia are not limited by 
 the mere abolition of pain. In animal experimentation, 
 as well as in surgery, the insensibility to pain and the 
 cessation of voluntary movements induced by anaes- 
 thetics have rendered many operations easy which would 
 
 65 
 
the influ- otherwise have been difficult, many practicable which 
 anesthesia would otherwise have been impossible. The success 
 science EDICAL °f tne experiment is made much more certain when the 
 operator can work at ease and without undue haste, 
 undisturbed by the thought that he is inflicting pain. 
 There are physiological experiments which, so far as I 
 am able to judge, make greater demands upon the pa- 
 tience and operative skill and delicacy of manipulation of 
 the operator than any in surgery, and these never could 
 be performed upon a sensitive and struggling animal. 
 Sensations of pain are in themselves a disturbing factor 
 which would defeat the purpose of not a few delicate 
 physiological experiments. The experiments to deter- 
 mine the functions of the brain, which have yielded 
 results of great importance to practical medicine and 
 surgery as well as to science, may be mentioned as one 
 out of many illustrations of this fact. The antiseptic 
 management of wounds, which is essential to the success 
 of some experiments and which alleviates subsequent 
 suffering when it is necessary that the animal should 
 survive the experiment, is greatly facilitated by the use 
 of anaesthetics. 
 
 I trust that I may be pardoned if I pause here for a 
 moment to correct a misconception which does not exist 
 among well-informed medical men, least of all among 
 practitioners of medicine, but which plays a considerable 
 role in anti-vivisection literature. I refer to the distinc- 
 tion there made between the use of anaesthetics and that 
 of narcotics for the purpose of rendering animals insen- 
 sible to pain. So far as the point in question is involved, 
 this distinction is ridiculous, and seems to be based upon 
 a misunderstanding of some old physiological experi- 
 ments. For prolonged experiments it is often advan- 
 tageous to place the animal in the sleep induced by 
 morphine or chloral, instead of that of ether or chloro- 
 
 66 
 
form. These drugs are administered in much larger the influ- 
 doses, and often in different ways, than is customary in anesthesia 
 human beings. That under these circumstances the ani- sci^nc^ EDICAL 
 mal is rendered insensible to pain is a fact the knowledge 
 of which might have been gained from ordinary medical 
 experience. 
 
 Curara is a drug which has important uses in a cer- 
 tain class of experiments upon animals. It has never 
 been claimed by any scientific man that it is an anaes- 
 thetic, although it has been found capable of affording 
 great relief from pain in some spasmodic affections of 
 human beings. Its use has led to important physiologi- 
 cal discoveries which could not well have been made 
 without it, and in a limited class of cases its employment, 
 either with or without the coincident administration of 
 anaesthetics, is indispensable. 
 
 There are, of course, experiments upon animals in 
 which there is no occasion to employ anaesthetics. Ani- 
 mal experimentation and vivisection are not coextensive 
 terms. There is a large group of experiments, mostly 
 of a painless character, in which there is no cutting, or 
 other operative interference whatever with the animal. 
 Here belong many of the experiments upon metabol- 
 ism, upon diet, upon the fate of drugs, etc. There are 
 others in which the operative act is so slight or tran- 
 sitory that the animal would suffer far more discomfort 
 from the administration of an anaesthetic than from the 
 operation itself. There are, finally, painful vivisection 
 experiments, relatively few in number, however, whose 
 purpose would be defeated by the use of anaesthetics. A 
 striking example of such an experiment is that of Charles 
 Bell in determining the motor and sensory functions of 
 the nerve roots of the spinal cord, an experiment which, 
 with those of Galvani, laid the foundations of modern 
 nerve physiology. 
 
 67 
 
the influ- Experiments upon animals have been and must con- 
 
 an^sthesia tinue to be an indispensable aid to the progress of scien- 
 science EDICAL tifi c an< ^ Poetical medicine. In the performance of a 
 large number of these experiments the use of anaesthetics 
 is of priceless service. I trust that without presump- 
 tion I may here express, in behalf of the great body of 
 scientific workers in medicine throughout the civilized 
 world, their feelings of gratitude for the great boon con- 
 ferred upon medical science by the discovery of artificial 
 anaesthesia, which, in the form of a safe, useful, and ef- 
 fective method, was first promulgated from this hospital 
 fifty years ago to-day. 
 
 68 
 
THE SURGERY OF THE FUTURE 
 
 BY CHARLES McBURNEY, M. D. 
 OF NEW YORK 
 
THE SURGERY OF THE FUTURE 
 
 E worship to-day at the shrine of the God- 
 dess of Anaesthesia, whose gentle sway 
 over the surgical world of all civilized 
 countries has so beneficently displaced the 
 reign of terror which existed only two gen- 
 erations ago. What anaesthesia has done for surgery 
 has been already most eloquently told, and we all realize 
 that without it the best of modern work would be impos- 
 sible. 
 
 It seems but yesterday, and yet it is already a matter 
 of history, that the wonderful discovery of the aseptic 
 treatment of wounds was given to us, through whose 
 agency countless thousands of human lives have been 
 preserved. 
 
 Through these two discoveries surgery has become a 
 gentle art : for the agonies of operations and the fatal 
 diseases of wounds have given way to a painless sleep, 
 and an awakening to a safe recovery. And bacteriology, 
 which in its infancy gave birth to aseptic surgery, has 
 penetrated with its brilliant light a darkness which our 
 predecessors believed would last forever. 
 
 So generous, indeed, has the recent past been to sur- 
 gery with gifts which make our science rich almost be- 
 yond belief, that the future may well be modest in telling 
 us what it will do. It would almost seem as if the toil- 
 some ascent had been accomplished, and as if the future 
 
 71 
 
the surgery could hold for us no obstacles that could tax our powers. 
 
 future That such a comfortable view is not shared by the ever- 
 
 active surgical worker and his numerous collaborators is 
 fortunate, and we are thus assured that difficulties, per- 
 haps not so large as those already conquered, but both 
 grave and numerous, will, by increasing effort, be swept 
 away and relegated to the past. 
 
 It seems to me that in the immediate future the great- 
 est surgical victories are to be won by the aid of bacteri- 
 ology, which has already unlocked so many mysteries. 
 Through it diphtheria and tetanus have been brought 
 within the list of frequently curable diseases. Why 
 should we not soon be able to say even more of general 
 sepsis, tubercle, and cancer ? We have already reached 
 a high degree of perfection in preventing the entrance 
 of sepsis through the surgical or the accidental wound ; 
 but, given a case where sepsis has already deeply invaded 
 the body, through whatever point of entrance, and we 
 are well-nigh helpless. We may empty an abdomen of 
 pus, and even remove the cause of the disease, but we 
 know nothing in regard to overcoming the sepsis already 
 widespread throughout the body. Is it not in store for 
 us that the discovery will soon be made by which we 
 shall be able to destroy the sepsis-producing organism, 
 no matter what its source, no matter how widespread ? I 
 believe it is, and that we will, in the not distant future, 
 be able to render the body immune to the existence of 
 sepsis even of internal origin. 
 
 All of the general surgeons, and many of the special 
 ones, are devoting a large amount of their time to the 
 treatment of tubercle. Operative surgery has attacked 
 it very successfully, but we need the help of the bac- 
 teriologist and of the physician to enable us to prevent 
 its recurrence and to treat it in many localities. Surely 
 the day is close at hand when the surgeon's knife, which 
 
 72 
 
so readily removes the products of tubercle, will be aided the surgery 
 by the remedy which destroys the bacillus itself. future 
 
 Cancer in all its forms is still our worst enemy. Oper- 
 ative surgery has done much, very much, to overcome it, 
 aided by greatly improved diagnosis, and by means of 
 more scientific and more radical operations. But the 
 discovery of the true nature of the disease, the solution 
 of the question as to whether it owes its existence to a 
 living organism, and therefore one capable of death or 
 not, are still in the hands of the future, and most eagerly 
 awaited by all of us. The best energies of the bacteri- 
 ological and the surgical world cannot be devoted to a 
 worthier object. But the future of bacteriology is, and 
 ever will be, in the hands of the most brilliant men, and 
 surgery is destined to achieve many of its greatest tri- 
 umphs through the aid of this ever-growing army of 
 invaluable co-workers. With their help will the aseptic 
 making and treating of wounds be brought to a far 
 higher state of perfection than even the elevated one of 
 the present day, and the exact reasons for disturbances 
 in wound-healing, some of which are still but partially 
 understood, will become part of the knowledge of every 
 true surgeon. 
 
 The possibilities for discoveries of enormous value to 
 both the theory and the practice of surgery, through 
 more perfect study of the blood, are certainly very large, 
 and are already foreshadowed by what has been so re- 
 cently learned in regard to the blood-corpuscles and the 
 organisms of disease which invade and develop in the 
 blood current. We may confidently expect through this 
 means a very exact, and, what is of the utmost impor- 
 tance, a very early diagnosis, in many surgical disorders 
 which we now at first appreciate at a stage too late for 
 efficient treatment. 
 
 When one considers the very great value of the recent 
 
 73 
 
the surgery addition to our resources, the infusion into the blood-ves- 
 future se ^ s °f n °t saline solution, which has so beautifully sup- 
 
 planted the difficult and dangerous process of blood- 
 transfusion, one grows impatient for the day when at 
 the same moment disease shall be drained from the body 
 through one opened vessel, and life and health poured 
 in through another. Some of us will see the day when 
 death as a result of hemorrhage will be always avoid- 
 able. 
 
 In spite of the large contributions that have been 
 made by scientific workers during the last few years, it 
 may fairly be said that we have been living in an age of 
 operative surgery, the growth of which has excited the 
 interest and admiration of all classes of men. 
 
 The public at large, and all branches of our profession, 
 have become deeply infected with the idea that there 
 are almost no limits to what can be done in the cure of 
 disease by a skilful surgeon ; and the belief is much 
 too widespread that almost any professional man, with a 
 little knowledge of antisepsis, may properly practise 
 surgery. This exaggerated feeling of confidence is the 
 natural sequel to the discovery of asepsis, which, with its 
 incalculable benefits, has scattered some harm. Every 
 region and organ of the human body has been investi- 
 gated by the operating surgeon, and far be it from me to 
 say that this has not been wise and necessary. Conclu- 
 sions cannot precede experience; and it has required 
 courage, hope, and even blind faith, to explore and learn 
 what we may accept and what we must discard. 
 
 The operating surgeon of the future will have a most 
 important and delightful task. Proud of his ability to 
 do any operation, and to secure a perfect wound-healing 
 with unfailing regularity, he will know when to withhold 
 his hand. He will sacrifice his ambition to multiply the 
 number of cases he has operated upon, and will devote 
 
 74 
 
his energies to increasing only the number of those he the surgery 
 has actually cured of disease. He will know better than future 
 we do who are the actually moribund, and he will leave 
 them untouched in the hands of the priest 
 
 He will not be tempted by the plea that the patient 
 must die as he is, and that therefore he should rightly 
 be operated upon. He will not attempt to cure with the 
 knife the poor little microcephalic child, or the advanced 
 case of carcinoma of the stomach, uterus, or larynx. 
 Our knowledge, acquired by much labor and sacrifice, 
 will be his at the outset ; and the errors which we have 
 made through over-enthusiasm will excite, not his con- 
 tempt, but his gratitude. 
 
 He will have at his disposal the large experience of 
 the surgeons of to-day, and, unhampered by the views 
 held in the pre-antiseptic era, he will draw conclusions 
 and deduce principles sounder and clearer than our own. 
 
 We may confidently look forward to vastly improved 
 diagnosis of surgical disease, more especially such as 
 will enable the surgeon to attack pathological processes 
 in their incipiency. Especially in cases of malignant dis- 
 ease is there much to be desired in this direction. Great 
 advance has been already made in the wide removal of 
 infected areas, and of the channels through which malig- 
 nant disease is carried to other parts of the body. How 
 much more efficient must such measures be when ap- 
 plied at the very beginning of a cancer ! Perhaps we 
 are justified in looking forward to such a development 
 of the Rontgen light that the surgeon will be able to 
 appreciate the location and character of all neoplasms 
 while they are still young enough to be radically curable 
 by operation. 
 
 The future surgeon will enjoy a much closer and 
 more intimate relation with his brother the physician 
 than has ever existed between them before, for what be- 
 
 75 
 
the surgery longs to medicine, and can be cured by surgery only, will 
 future be far better appreciated by both surgeon and physician 
 
 than it is to-day. 
 
 Few operations will then be done as a last resort, for 
 the only remedy that can cure in a given case will be 
 eagerly demanded by the one and willingly applied by 
 the other at the beginning of disease. 
 
 Above all, Mr. President, will the surgery of the future 
 attract to its enthusiastic study and practice finer and 
 finer men, in whose hands we may safely leave the devel- 
 opment of our science. A single glance at the faces of 
 the students who collect daily in your operating-room 
 will show you what a change has occurred in the last 
 twenty-five years. For this, too, we must ever be grate- 
 ful to anaesthesia, which, in removing the torture of sur- 
 gery, has robbed it of what repelled many sensitive 
 natures. And the science of asepsis, by rendering com- 
 plete success in surgical work possible, will excite the 
 most devoted enthusiasm from many scientific men, who 
 soon would have become sick at heart over the failures 
 of former times. What more attractive opportunity 
 could possibly exist than will be offered by surgery to 
 the well-educated, refined, able, and ambitious student? 
 Through the vast experience of the recent past he will 
 find many of the coarser problems already solved, and 
 those that remain will stimulate him by their difficulty. 
 He will be an accomplished anatomist and a physiolo- 
 gist ; he will study medicine and pathology first, and then 
 general surgery. If he specializes his practice, he will 
 do so only after a large general experience ; and he will 
 borrow from every science all that can contribute to the 
 perfecting of his work. 
 
 76 
 
THE BIRTH AND DEATH OF PAIN 
 
 % $oem 
 
 BY S. WEIR MITCHELL, M. D., LL. D. 
 OF PHILADELPHIA 
 
THE BIRTH AND DEATH OF PAIN 
 
 ORGIVE a moment if a friend's regret 
 Delay the task your honoring kindness set. 
 I miss one face to all men ever dear ; 
 I miss one voice that all men loved to hear. 
 How glad were I to sit with you apart 
 Could the dead master use his higher art 
 To lift on wings of ever lightsome mirth 
 The burdened muse above the dust of earth, 
 To stamp with jests the heavy ore of thought, 
 To give a day, with proud remembrance fraught, 
 The vital pathos of that Holmes-spun art 
 Which knew so well to reach the common heart ! 
 Alas for me, for you, that fatal hour ! 
 Gone is the master! Ah ! not mine the power 
 To gild with jests, that almost win a tear, 
 The thronging memories that are with us here. 
 
 The Birth of Pain ! Let centuries roll away ; 
 Come back with me to nature's primal day. 
 What mighty forces pledged the dust to life ! 
 What awful will decreed its silent strife ! 
 Till through vast ages rose on hill and plain, 
 Life's saddest voice, the birthright wail of pain. 
 The keener sense and ever-growing mind 
 Served but to add a torment twice refined 
 As life, more tender as it grew more sweet, 
 The cruel links of sorrow found complete 
 When yearning love, to conscious pity grown, 
 Felt the mad pain-thrills that were not its own. 
 
 79 
 
the birth What will implacable, beyond our ken, 
 
 of D pain ATH Set this stern fiat for the tribeS ° f men ! 
 
 This none shall 'scape who share our human fates : 
 
 One stern democracy of anguish waits 
 
 By poor men's cots, — within the rich man's gates. 
 
 What purpose hath it ? Nay, thy quest is vain : 
 
 Earth hath no answer : if the baffled brain 
 
 Cries, 't is to warn, to punish — Ah, refrain ! 
 
 When writhes the child beneath the surgeon's hand, 
 
 What soul shall hope that pain to understand ? 
 
 Lo ! Science falters o'er the hopeless task, 
 
 And Love and Faith in vain an answer ask, 
 
 When thrilling nerves demand what good is wrought 
 
 Where torture clogs the very source of thought. 
 
 Lo ! mercy, ever broadening down the years, 
 Seeks but to count a lessening sum of tears. 
 The rack is gone, — the torture chamber lies 
 A sorry show for shuddering tourist eyes. 
 How useless pain both Church and State have learned 
 Since the last witch or patient martyr burned. 
 Yet still, forever, he who strove to gain 
 By swift dispatch a shorter lease for pain 
 Saw the grim theatre, and 'neath his knife 
 Felt the keen torture in the quivering life. 
 A word for him who, silent, grave, serene, 
 The thought-stirred master of that tragic scene, 
 Recorded pity through the hand of skill, 
 Heard not a cry, but, ever conscious, still 
 In mercy merciless, swift, bold, intent, 
 Felt the slow moments that in torture went 
 While, 'neath his touch, as none to-day has seen, 
 In anguish shook life's agonized machine. 
 The task is o'er ; the precious blood is stayed ; 
 But double price the hour of tension paid. 
 A pitying hand is on the sufferer's brow, — 
 " Thank God 't is over." Few who face me now 
 Recall this memory. Let the curtain fall, 
 Far gladder days shall know this storied hall ! 
 
 80 
 
Though Science, patient as the fruitful years, the birth 
 
 Still taught our art to close some fount of tears, A? D T ,R? T ATH 
 
 OF PAIN 
 Yet who that served this sacred home of pain 
 
 Could e'er have dreamed one scarce-imagined gain, 
 
 Or hoped a day would bring his fearful art 
 
 No need to steel the ever kindly heart ? 
 
 So fled the years ! while haply here or there 
 
 Some trust delusive left the old despair ; 
 
 Some comet thought flashed fitful through the night, 
 
 No lasting record and no constant light. 
 
 Then radiant morning broke, and ampler hope 
 
 To art and science gave illumined scope. 
 
 What Angel bore the Christ-like gift inspired ! 
 What love divine with noblest courage fired 
 One eager soul that paid in bitter tears 
 For the glad helping of unnumbered fears, 
 From the strange record of creation tore 
 The sentence sad each sorrowing mother bore, 
 Struck from the roll of pangs one awful sum, 
 Made pain a dream, and suffering gently dumb ! 
 
 Whatever triumphs still shall hold the mind, 
 Whatever gift shall yet enrich mankind, 
 Ah ! here no hour shall strike through all the years, 
 No hour as sweet, as when hope, doubt, and fears, 
 'Mid deepening stillness, watched one eager brain, 
 With God-like will, decree the Death of Pain. 
 
 How did we thank him ? Ah ! no joy-bells rang, 
 No paeans greeted, and no poet sang, 
 No cannon thundered from the guarded strand 
 This mighty victory to a grateful land ! 
 We took the gift, so humbly, simply given, 
 And coldly selfish — left our debt to Heaven. 
 How shall we thank him ? Hush ! A gladder hour 
 Has struck for him ; a wiser, juster power 
 81 
 
the birth Shall know full well how fitly to reward 
 
 and death The generous soul that found the world so hard. 
 
 O fruitful Mother ! — you whose thronging states 
 
 Shall deal not vainly with man's changing fates, 
 
 Of freeborn thought, or war's heroic deeds, — 
 
 Much have your proud hands given, but nought exceeds 
 
 This heaven-sent answer to the cry of prayer, 
 
 This priceless gift which all mankind may share. 
 
 A solemn hour for such as gravely pause 
 To note the process of creation's laws ! 
 Ah, surely He whose dark, unfathomed Mind 
 With prescient thought the scheme of life designed, 
 Who bade His highest creature slowly rise, 
 Spurred by sad needs and lured by many a prize, 
 Saw, with a God's pure joy, His ripening plan, 
 His highest mercy brought by man to man. 
 82 
 
REMARKS OF LORD PLAYFAIR 
 
 >T the close of the programme, Lord Playfair, who was 
 present, was asked to speak. 
 
 Lord Playfair expressed special interest in the celebra- 
 tion now in progress, partly due to the fact that he himself 
 in the course of his life's work had made numerous exper- 
 iments relating to means and methods of anaesthesia. 
 
 On every occasion of this sort the name of Sir James Simpson must 
 be mentioned with gratitude. The disinterested enthusiasm with 
 which Dr. Simpson worked, regardless even of actual danger to him- 
 self, was most praiseworthy. 
 
 Lord Playfair told an amusing story of an experiment which he was 
 about to conduct with Sir James Simpson in the direction of a sup- 
 posed new anaesthetic method. Sir James came to him one day and 
 told him that he was disgusted with chloroform, and would thank him 
 very much for the discovery of a satisfactory substitute. Lord Play- 
 fair a few days later announced to him that he had made the required 
 discovery. The material that he intended to use was bi-bromide of 
 ethylene. Sir James Simpson smelled the compound, and forthwith 
 said that it was the very thing wanted. He was very anxious to repair 
 immediately to Lord Playfair's private room and experiment upon 
 himself. 
 
 Lord Playfair was unwilling that the experiment should take place 
 before further trial, and finally induced Sir James to have the anaes- 
 thetic tried on some rabbits first. The rabbits were accordingly 
 treated, and were put away to await developments. 
 
 On the next day Dr. Simpson appeared at Lord Playfair's labora- 
 tory, propped himself up with two chairs, and asked Lord Playfair for 
 the solution. Lady Simpson, who was present, advised her husband 
 to see how the rabbits had fared under the treatment before he 
 applied it to himself. 
 
 " When the attendant came in," continued Lord Playfair, " we saw 
 him holding by the ears two rabbits — perfectly dead ! " 
 
 83 
 
APPENDIX 
 
APPENDIX 
 
 HOSPITAL RECORD OF THE FIRST PUBLIC ADMINIS- 
 TRATION OF ETHER 
 
 ILBERT ABBOTT, age twenty, painter, single ; tumor on 
 face. This man had had from birth a tumor under the 
 jaw, on the left side It occupies all space anterior to 
 neck, bounded on the inside by median line, on the out- 
 side is even with the edge of jaw ; below, on a level with 
 the Pomum Adami, and in front tapers gradually as far as anterior 
 edge of jaw; integuments not adherent to it; skin smooth and of 
 natural color ; it is uniformly soft, except in centre, where a small, 
 hard lump can be felt, corresponding in size and situation with sub- 
 maxillary gland ; can be made to disappear by compression, but seems 
 rather to be displaced than emptied. The edge of the lower jaw-bone 
 can be felt, through the tumor, to be irregular. On examination of 
 the inside of the mouth, find a soft, smooth tumor, a hemisphere about 
 five lines in diameter, of a livid color, on the left lobe of tongue, 
 about an inch behind tip. That portion of the organ in front and 
 underneath the tumor is of a dark purple color. This tumor is readily 
 emptied by slight pressure, but it fills again in one or two seconds, but 
 not seoner when pressure is made simultaneously upon the external 
 tumor. For distance of five lines from angle of mouth on right side 
 the lower lip is of a livid hue. This seems to be a continuation of a 
 stripe, similar in appearance, which extends from angle of jaw on 
 right side about on level of lower teeth ; it is about four lines wide 
 and slightly raised ; its color seems to depend on small spots like 
 granulations, of a livid color, set on mucous membrane of ordinary 
 appearance. 
 
 This case is remarkable in the annals of surgery. It was the first 
 surgical operation performed under the influence of ether. 
 
 Dr. Warren had been applied to by Mr. Morton, a dentist, with the 
 request that he would try the inhalation of a fluid which, he said, he 
 
 87 
 
APPENDIX had found to be effectual in preventing pain during operations upon 
 
 the teeth. Dr. Warren, having satisfied himself that the breathing of 
 the fluid would be harmless, agreed to employ it when an opportunity 
 presented. None occuring within a day or two in private practice, he 
 determined to use it on this patient. Before the operation began, 
 some time was lost waiting for Mr. Morton, and ultimately it was 
 thought he would not appear. At length he arrived, and explained 
 his detention by informing Dr. Warren that he had been occupied in 
 preparing his apparatus, which consisted of a tube connected with a 
 glass globe. This apparatus he then proceeded to apply, and after four 
 or five minutes the patient appeared to be asleep, and the operation 
 was performed as herein described. To the surprise of Dr. Warren 
 and the other gentlemen present, the patient did not shrink, nor cry 
 out, but during the insulation of the veins he began to move his limbs 
 and utter extraordinary expressions, and these movements seemed to 
 indicate the existence of pain ; but after he had recovered his faculties 
 he said that he had experienced none, but only a sensation like that 
 of scraping the part with a blunt instrument, and he ever afterward 
 continued to say that he had not felt any pain. 
 
 Note. — The results of this operation led to the repetition of the use 
 of ether in other cases, and in a few days its success was established, 
 and its use resorted to in every considerable operation in the city of 
 Boston and its vicinity. 
 
 Operation by Dr. Warren. — The patient having been placed in the 
 operating chair in the amphitheatre, an incision, two and one half 
 inches in length was made over the centre of external tumor, just 
 beneath the edge of jaw, extending through skin and subcutaneous 
 tissue. A layer of fascia was dissected off and disclosed a congeries 
 of large veins and small arteries. Hemorrhage was slight, no vessel 
 requiring ligature. A curved needle, armed with a ligature, size No. 
 6, was passed under the mass, and the tumor included, under a knot 
 with considerable compression. The wound was then filled with a 
 small compress and lint, and the patient returned to bed. 
 
 Patient continued to do well, and was discharged well, December 
 7th. Cicatrix perfect ; tumor same size as on entrance, but no vessels 
 to be detected in it. Tumor on tongue not altered, nor is appearance 
 on inside of right cheek. General health much improved. 
 
 88 
 
APPENDIX 
 ACCOUNT OF AN EYE-WITNESS 1 
 
 The day arrived ; the time appointed was noted on the dial, when 
 the patient was led into the operating-room, and Dr. Warren and a 
 board of the most eminent surgeons in the State were gathered 
 around the sufferer. "All is ready — the stillness oppressive." It 
 had been announced " that a test of some preparation was to be made 
 for which the astonishing claim had been made that it would render 
 the person operated upon free from pain." These are the words of 
 Dr. Warren that broke the stillness. 
 
 Those present were incredulous, and, as Dr. Morton had not arrived 
 at the time appointed and fifteen minutes had passed, Dr. Warren 
 said, with significant meaning, " I presume he is otherwise engaged." 
 This was followed with a " derisive laugh," and Dr. Warren grasped 
 his knife and was about to proceed with the operation. At that mo- 
 ment Dr. Morton entered a side door, when Dr. Warren turned to him 
 and in a strong voice said, " Well, sir, your patient is ready." In a 
 few minutes he was ready for the surgeon's knife, when Dr. Morton 
 said, " Your patient is ready, sir." 
 
 Here the most sublime scene ever witnessed in the operating-room 
 was presented, when the patient placed himself voluntarily upon the 
 table, which was to become the altar of future fame. Not that he did 
 so for the purpose of advancing the science of medicine, nor for the 
 good of his fellow-men, for the act itself was purely a personal and 
 selfish one. He was about to assist in solving a new and important 
 problem of therapeutics, whose benefits were to be given to the whole 
 civilized world, yet wholly unconscious of the sublimity of the occasion 
 or the part he was taking. 
 
 That was a supreme moment for a most wonderful discovery, and, 
 had the patient died under the operation, science would have waited 
 long to discover the hypnotic effects of some other remedy of equal 
 potency and safety, and it may be properly questioned whether chlo- 
 roform would have come into use as it has at the present time. 
 
 The heroic bravery of the man who voluntarily placed himself upon 
 the table, a subject for the surgeon's knife, should be recorded and 
 his name enrolled upon parchment, which should be hung upon the 
 walls of the surgical amphitheatre in which the operation was per- 
 formed. His name was Gilbert Abbott. 
 
 The operation was for a congenital tumor on the left side of the 
 
 1 Dr. Washington Ayer, of San Francisco. 
 
 8 9 
 
APPENDIX neck, extending along the jaw to the maxillary gland and into the 
 
 mouth, embracing margin of the tongue. The operation was success- 
 ful ; and when the patient recovered he declared he had suffered no 
 pain. Dr. Warren turned to those present and said, " Gentlemen, this 
 is no humbug." 
 
 LETTERS FROM INVITED GUESTS 
 
 London, September 14, 1896. 
 My dear Dr. Warren : I beg you to allow me thus to thank you 
 and the other members of the staff and the trustees of the Massachu- 
 setts General Hospital for the invitation with which they have hon- 
 ored me. I am deeply sorry that I cannot be present at the proposed 
 commemoration of that which was certainly one of the most notable 
 events in the history of surgery. 
 
 I am sincerely yours, James Paget. 
 
 Edinburgh, September 16, 1896. 
 
 Dear Dr. Warren : Boston does well to commemorate the fiftieth 
 anniversary of the day on which Dr. Morton first gave a public dem- 
 onstration of the practicability of surgical anaesthesia, and so put into 
 the hands of his professional brethren the means of saving the pa- 
 tient from untold suffering. 
 
 I thank you for your courteous invitation to the Massachusetts 
 General Hospital on such a great occasion, and regret that my Uni- 
 versity duties make it impossible for me to avail myself of your kind- 
 ness. Believe me, 
 
 Yours very faithfully, A. R. Simpson. 
 
 Detroit, September 18, 1896. 
 
 Dear Dr. Warren : I regret very much that I shall not be able to 
 avail myself of the privilege of attending the exercises in commemo- 
 ration of the first public demonstration of surgical anaesthesia. The 
 occasion is one which cannot fail to excite an universal interest. It 
 commemorates not only the birth of a procedure which has been an 
 unspeakable blessing to the human race, but also the first great con- 
 tribution made by American surgeons to the surgical science. 
 
 It would seem highly proper, therefore, that every American sur- 
 geon who cannot be present in person should express his warm con- 
 gratulations to the trustees and staff of the great hospital, which was 
 the scene of this great surgical exploit, in writing. 
 
 90 
 
Please accept, my dear doctor, my sincere sympathy with you in APPENDIX 
 your coming celebration. 
 
 Yours cordially, Theodore A. McGraw. 
 
 Toronto, September 30, 1896. 
 
 Dear Dr. Warren : The idea of celebrating in your hospital the 
 fiftieth anniversary of the first public demonstration of surgical anaes- 
 thesia is a happy conception, and I should be delighted to attend the 
 proposed function if it were possible for me to get away at the time. 
 
 To no city in America is surgical science a greater debtor than to 
 your own, and I would gladly take part in any procedures tending to the 
 acknowledgment of debts that we can never hope to pay. There are 
 no boundary lines limiting the spread of such beneficent discoveries 
 as have been given to the world by the members of our profession in 
 Boston. When I think of what the discoverers of anaesthesia, of 
 what Holmes and Bigelow and Bowditch, and those who have borne 
 and now bear the honored name of Warren, have done for us, our 
 obligation weighs heavily, and we can but rejoice that through Lister 
 and through the grand traditions of British surgery we are able in part 
 to make a return. 
 
 I wish you heartily a celebration worthy of the occasion and of the 
 men who will take part in it, and am 
 
 Yours sincerely, N. A. Powell. 
 
 Frankfurt A. M., 27 Sept., 1896. 
 
 Hochgeehrte Herren : Ihre sehr ehrenvolle Einladung zu der 
 Commemoration of the Fiftieth Anniversary of Surgical Anaesthesia 
 ist mir zugegangen. Sie war mir urn so erfreulicher als ich selbst eine 
 der ersten war, der im Jahre 1846 in Berlin selbstandige versuche mit 
 der ^Ether-Narkose gemacht hat. Niemand kann mehr als ich selbst 
 von der Wichtigkeit dieser entdeckung uberzeugt sein, und ich wiirde 
 mich glucklich schatzen, wenn ich Ihnen personlich meine Gliickwiin- 
 sche aussprechen konnte. Aber die zeit gestattet mir nicht so kurz 
 vor der Wieder beginnen meiner Vorlesungen Europa zu verlassen. 
 
 Nehmen sie daher meine herzliche griisse und die Versicherung 
 meiner aufrichtiger Hochschatzung der Amerikanische Heilkunst 
 entgegen. Rudolf Virchow. 
 
 Royal College of Surgeons of Edinburgh, 
 5th October, 1896. 
 
 Dr. J. Collins Warren. My dear Sir : I beg to thank you and 
 the hospital staff for the honor of the invitation to the commemoration 
 
 9 1 
 
APPENDIX of the fiftieth anniversary of that great discovery, surgical operation 
 
 without pain. Distance alone prevents my being among you on the 
 occasion. I had the pleasure of visiting Boston twelve years ago, and 
 I hardly think it would be quite prudent at my age (now three years 
 over the proverbial threescore and ten) to venture again across the 
 great Atlantic. Among the pleasures I had in visiting America, as 
 compared with the countries of Europe, was that of realizing that we 
 are the same people. I admired Boston as, among American cities, 
 reminding me most of home ; and I can recall the beautiful view of 
 the Charles River from the window of dear old Oliver Wendell 
 Holmes, one of those who have made Boston famous in literature and 
 science. 
 
 This commemoration brings up memories to me of the days of pre- 
 anesthetic surgery in our old Royal Infirmary here, — the operating 
 theatre ringing with the groans and shrieks of the patient, the dis- 
 tressed faces of the crowd of students, and the haste of the operator 
 to be done. I well remember, when the news came across the Atlan- 
 tic, the first use of ether in that great theatre by my old masters, Syme 
 and Miller. The change was wonderful j no longer pain, the patient 
 lying nearly as quiet as the sleeper, and the operator undisturbed and 
 risking nothing by haste. 
 
 It is well that this commemoration should be held, not merely that 
 such a great event deserves celebration, but in order to remind the 
 young generation that has since grown up that these benefits which 
 they (patients and surgeons alike) now enjoy were not always. I may 
 add that the celebration is more particularly required among us here. 
 Ether, or a mixture of ether and chloroform, seems to be the anaes- 
 thetic most commonly employed in England ; but here, and in Scotland 
 generally, it is so almost invariably chloroform that the word " chloro- 
 form " has come to be identified in the public mind with painless oper- 
 ation, as if chloroform had been the discovery. I do not mention this 
 as in diminution of the merit of Sir James Simpson, one of my old 
 teachers, in the subsequent discovery of the anaesthetic property of 
 chloroform ; but magna est Veritas, and it is well to keep our public in 
 mind that we owe the great discovery to our American brethren. 
 
 In return, we have sent you the no less great boon of antiseptic 
 surgery. We were but last month, at the meeting of the British Asso- 
 ciation at Liverpool, paying renewed honor to Sir Joseph Lister, my 
 former colleague on the surgical staff of the old Royal Infirmary here, 
 as the man to whom we and the world owe this great boon in surgery. 
 It is quite wonderful for me to see, when I visit our new Royal Infir- 
 mary, what can now be done under antiseptic treatment, — things we 
 
 92 
 
would not have ventured on in the old days. And now we are having APPENDIX 
 the Rontgen rays, letting us actually see the bones in the living body. 
 It has, indeed, been a half century of wonderful progress. 
 
 But I must bring this too long letter to a close. I beg to congrat- 
 ulate the Massachusetts General Hospital on having been the scene 
 of the first public demonstration of the great discovery ; and, if I am 
 right in my impression that it was by your hands, I no less congratu- 
 late you on having lived to see half a century of the fruition of your 
 example. I have the honor to be, 
 
 Yours very sincerely, John Struthers, 
 
 President of the College. 
 
 San Francisco, Cal., October 7, 1896. 
 
 Dear Dr. Warren : Great events make memorable history. The 
 eventful discovery of ether owns the most brilliant page in the history 
 of medicine, — a page full of the recorded blessings of anaesthesia ; 
 and yet at the close of the nineteenth century who can tell what other 
 great discoveries will soon follow to relieve human suffering ? While 
 being thankful for the past, let us be hopeful for the future. 
 
 California sends greeting to Boston upon the semi-centennial anni- 
 versary of the discovery of ether. While steel and iron ties bind the 
 shores of the Pacific and Atlantic together, still stronger ties unite 
 the Occident to the Orient in bonds of unity, — the ties of fraternal 
 love and good-fellowship for the members of the noble profession 
 of medicine. I well remember the simple preparation made in the 
 amphitheatre of the Massachusetts General Hospital for the most 
 important surgical operation the world ever witnessed, which gave 
 painless surgery to the world. There was no display, no ostentation, 
 but the profound silence told the importance of the occasion. Then 
 Dr. W. T. G. Morton administered the ether, and Dr. John C. Warren 
 performed the operation, and the anxious suspense was over when the 
 apparently lifeless body of the patient began to move. A new revela- 
 tion was then given to the world, and the scene that followed no pen 
 will ever be able faithfully to describe ; but, after fifty years, it is fresh 
 before me, like a living picture daguerreotyped on the memory, there 
 to remain forever. 
 
 I hoped to revisit the scenes of my youth and be present at this 
 grand jubilee, held in commemoration of the most important event in 
 the history of medicine, but sickness compels me to forego the pleas- 
 ure, while the world rejoices in the benefactions bequeathed to suffer- 
 ing humanity by the discovery of ether. 
 
 Yours sincerely, Washington Ayer. 
 
 93 
 
APPENDIX Sir Richard Quain sincerely regrets that distance renders it im- 
 
 practicable for him to attend the fiftieth anniversary of the public 
 demonstration of surgical anaesthesia at the Massachusetts General 
 Hospital on October 16, 1896. He heartily congratulates the institu- 
 tion whence has emanated one of the greatest blessings ever con- 
 ferred upon mankind. 
 
 He sends a copy of an address which he once gave the students of 
 University College, London, in which a brief statement is made as to 
 the introduction of anaesthesia into Europe : — 
 
 " Robert Liston was one of the greatest of modern surgeons. I 
 would, however, desire especially to emphasize the fact that it was 
 Mr. Liston who in our hospital performed the first operation under 
 anaesthetics in this country. The facts, of which I was a witness, will 
 be found fully recorded in the first volume of the ' Lancet ' for 1847. 
 The story briefly told is this : that Mr. Morton, a dentist in Boston 
 in the United States, used sulphuric ether to produce insensibility to 
 pain during the removal of teeth. Subsequently some capital opera- 
 tions were performed in the Massachusetts Hospital without pain. 
 This success was communicated through Dr. Boott, a retired American 
 physician who resided in Gower Street, and who was a zealous mem- 
 ber of the Council of our College, to Mr. Liston, who, influenced by 
 the statement, saw Mr. Robinson, a dentist in Gower Street, remove a 
 tooth, as Mr. Morton had done on several occasions in Boston, and 
 the result is told in the following note from Mr. Liston : — 
 
 ut Clifford Street, December 21, 1846. 
 " * My dear Sir : I have tried ether inhalation to-day in a case of 
 amputation of the thigh, and in another requiring evulsion of both 
 sides of the great toe-nail, with the most perfect and satisfactory re- 
 sults. It is a very great matter to be thus able to destroy sensibility 
 to such an extent and without any apparently bad result. It is a fine 
 thing for operating surgeons, and I thank you most sincerely for the 
 early information you were so good as to give me of it. 
 
 " ' Yours faithfully, Robert Liston/ 
 
 " Thus anaesthesia, that great boon to mankind, was introduced in 
 this country at University College Hospital by one of its surgeons. 
 The nature of the anaesthetic, of which there are now, as you know, 
 several, was really a subject of secondary importance. The * oil of 
 wine ' and also ' choric ether ' had been tried in America." 
 
 94 
 
APPENDIX 
 CONGRATULATIONS BY CABLE 
 
 The following cablegrams were read by the Chairman, Dr. J. C. 
 Warren, at the opening of the exercises celebrating the semi-centen- 
 nial of anaesthesia on October 16th : — 
 
 Christian ia, October 16, 1896. 
 Trustees and Staff Massachusetts General Hospital, Boston : 
 Best congratulations on fiftieth anniversary. 
 
 CESAR Bceck. 
 
 Moscow, October 16, 1896. 
 Boston, Massachusetts General Hospital. Collins Warren : 
 The Moscow Surgical Society, at a special meeting held in honor of 
 the fiftieth anniversary of the introduction of anaesthetics, celebrates 
 the memory of Morton and Simpson, the great benefactors of man- 
 kind. It greets the committee, and wishes it every success in its labors 
 on behalf of science, which knows no geographical boundary. 
 
 Diakon, President. 
 Warneck, Secretary. 
 
 95 
 

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