393ETHER-VAPOUR AND SURGERY.-APPEAL TO THE MEDICAL PROFESSION.

influence on the practice of surgery in this country. MrBROOKES, one of the Surgeons of the Cheltenham General

Hospital, has, with laudable zeal, published an account of anumber of cases which had appeared in the medical pe.riodicals. But the value of the report made by Mr. BROOKEEis much lessened by the omission of a statement of thosedetails, which alone could enable the profession to form anaccurate, and therefore a satisfactory, judgment on the wholequestion. The most full and ample particulars are requiredfor such a purpose. This is no case for ignorant prejudice, wildspeculation, or baseless hypothesis. It is a subject in whichexperience will correctly guide the judgment to a true and faith-ful decision. The bearings of the question must be settled byfacts,and not by idle doubts and surmises. If the ETHER- VAPOURcan be safely used for the prevention of pain when the knifeof the surgeon is necessarily at work in the human body,such a great scientific fact cannot be too quickly establishedon evidence which shall defy both doubt and disputation.On the other hand, if the newly employed agent be one of a

dangerous character, or if the results of the use of it be un-satisfactory, why should the truth be concealed It is dueto the feelings of the unhappy persons who have to submit tothe hard doom of becoming the subjects of surgical operationsthat no information regarding the effects of such a medicineas ETHER-VAPOUR should be any longer withheld. The time

has indeed arrived when " the whole truth, and nothing butthe truth," must be known. With a view to the accomplish-ment of such an important object, Mr. WAKLEY.jun., one ofthe surgeons of the Royal Free Hospital, has addressed thefollowing note and blank form to the surgeons of all the

metropolitan and country hospitals. That gentleman has alsoexpressed a hope to us that every surgeon, whether he beengaged in public or private practice, who has operated onpatients under the influence of ether-vapour, or who has evenbeen present at such operations, and is acquainted with theresults of the cases, will consider that the blank form is

addressed to him. Mr. WAKLEY, jun., states that it is his

earnest desire to obtain the fullest and most accurate infor-

mation on the subject, and to submit it without delay to thejudgment of his professional brethren. It is quite right thatthis labour should be undertaken by a junior member ofthe profession, who has time and energy at his command.

(Circular Note.)SIR,-As I am very desirous of obtaining strictly accurate

evidence respecting the employment of ETHER-VApoup in thepractice of SURGERY, I venture to trespass on your attention,with the request that you will supply, in the accompanyingform, such information as you may possess on the subject, andreturn your report to me at your earliest convenience. If youøhould be disinclined to have your name published, be kindenough to notify the objection on the face of your report.Trusting that you will pardon the liberty I have thus taken,I have the honour to be, Sir, your very obedient servant, ’

THOMAS WAKLEY, Jun.One of the Surgeons of the Royal Free

Hospital, London.Bedford-street, Strand, London, April Soth, 1847.P.S.-I shall, with great pleasure, forward the blank

form to all medical practitioners who may so far approve ofmy object as to apply for it.

REPORTS OF OPERATIONS IN SURGERY PERFORMED UNDER THBINFLUENCE OF ETHER-VAPOUR.

By ............... Surgeon, residing at ............... one ofthe Surgeons of the..................

1. Name and description of patient.2. Sex.3. Age and occupation.

4. Nature of case.5. Duration of operation.6. Apparatus employed.*7. Kind of ether, and its specific gravity.8. Temperature of body and room.9. How soon effects were manifested.

10. First effects noticed.t11. Order of succession of effects.12. State of pulse.13. Colour of complexion, and loss of blood.14. State of pupils.15. Return of consciousness or other suspended powers.16. Remarks of patient during and after operation.17. After symptoms and progress.18. Result.19. Remarks.* Be kind enough to note, under the above heads,-the dia-

meter of the air-passages of the instrument, particularly of thevalves. By what means the nostrils were closed. Was airadmitted after the vapour had passed the reservoir 1t Loss of sensibility to pain; of voluntary motion; of mental

consciousness.N.B.-When notes of cases have not been kept, it is hoped

that surgeons will state the number of times they have ope-rated, and the results; and also any other particulars they mayremember.

AN APPEALTO THE

MEDICAL PROFESSION ON BEHALF OF THE"GENERAL MEDICAL ANNUITY FUND."

GENTLEMEN, Ň The project for establishing a " GENERAL

MEDICAL ANNUITY FUND," for disabled members of the pro-fession, and for widows and orphans, has now been nearly twoyears before the public. It is true, that in the first instanceit was designed to form an integral part of the affairs of the" Provincial Medical and Surgical Association," but themeeting at Norwich having decided that it should standalone, a separate and distinct institution from that body, itnow becomes necessary to reorganize it, and give its inde-pendent existence that permanence and stability which itsvalue and importance demands.The unexpected decision of the Norwich meeting somewhat

staggered me, for I had previously felt I was acting under theauspices of the Provincial Association, and that many mem-bers of that important body had not only lent their powerfulnames to the institution, but had aided its advancement bydonations and subscriptions. Still, though I was staggered, Iwas not paralyzed in my energies, nor disheartened as to thefinal accomplishment of the project, even though it stoodalone; for that which possesses in itself an intrinsic virtue,seldom requires foreign aid to sustain it. The human heart,although corrupted by selfishness, and deadened by apathy,has many soft and gentle impulses, which need but the rightstimulus to excite into activity, and when excited, a freshnessand beauty is given to character, superior to renovated bodilyvigour, after the wastings of disease; for " true philanthropyis health of soul :’Although the motives which have impelled me in all I have

done in this matter are open to God, and, I trust, unimpeachedby man, I have, nevertheless, felt a delicacy in obtrudingmyself,-an unwillingness to seem too prominent,-a desirethat that which was of general interest to the professionshould find amongst its ranks others who would step forward,and bear with me the heat and the toil. I thought, if theproject was worthy of support, the acknowledged talent of anenlightened profession like ours would be employed in itsbehalf, and expected, ere this, to have found many advocates;nor have I been altogether disappointed. Mr. Kelson, ofSevenoaks, Kent, has furnished to the Provincial Journal aletter, which evinces an enthusiasm worthy his benevolentspirit, and an activity, in a pecuniary point of view, which isan unequivocal earnest of his sincerity. If every county inthe kingdom would produce a spirit like his, the prosperity ofthe institution could not be problematical. My thanks arelikewise due to those gentlemen who honoured me with ananswer to a circular, published a few weeks back. They havewith much kindness encouraged my efforts,-expressed a con-fidence which is cheering, and, moreover, have promisedactive cooperation, so soon as they shall be put into a positionto become active. This latter promise is more congenial andsatisfactory to my mind than all the compliments they havebeen good enough to pay me, for I feel that counsel and help

394

are essential. It is a gigantic establishment which is con-

templated,-a vast Institution, comprehending in its grasp a

huge tract of territory, and having for its object a diffusivespirit of benevolence. I therefore trust that many of thesegentlemen will give to us their personal presence, at theforthcoming meeting at Northampton; it is worth while, insuch a cause, to make some sacrifice. I am informed, both bythe public press and by private letters, that the GENERALMEDICAL ANNurl’Y FuND" has many well-wishers, who are atpresent unknown as its supporters. These gentlemen are inabeyance, waiting the further development of the scheme,and its final establishment, ere they give to it their coun-tenance and support. To such I would remark, " If you thinkwell of the scheme, why hesitate to support it? Your help ismost needed now, in the early stages of its establishment,when your opinions and your counsel might lead to valuableresults. The growth of a tree depends upon the planting: ifthe labourers fail to loosen the earth, to arrange the fibres, toseek congenial soil and proper locality,-if they neglect towatch and water it, to shelter it from the rude blast, andsustain its delicate and yielding form from the rough windswhich blow upon it, the chances are that it perishes; but if,on the contrary, they combine their powers and unite theirskill, in all that may be necessary for its sustenance, thenshall it take deep root in the earth, rear its majestic form,thicken its bole, and spread around its branches, while itsimpervious foliage shall shelter from heat and storm, andbeneath which they may repose in calm security.To advance the interests of medical science is a duty we all

owe both to the public and ourselves. To watch over thepolitical movements which bear upon our profession, moreparticularly at a time like the present, so rife with such move-ments, is equally important. But let not the claims of phi-lanthropy and benevolence be lost in the struggle. Let theirstill small voice be heard; they speak to the heart, and itshould feel it. In this age of general improvement, when thespirit of amelioration is abroad, and societies are establishedto meet the contingencies of disease and death, and the cala-mities which accompany such visitations—when the artisan,the mechanic, nay, the agricultural labourer, have combinedto furnish help to their distressed brother, and to the bereavedfamilies of their departed fellow-workmen,-can it be enduredthat we, who claim for ourselves the advantages of education,the privilege of expanded minds, the influence of moral andreligious feelings, and in some measure the pride of clanship-can it be endured, that in pure benevolence and nobleness ofspirit we should be outdone by these? Does the cause of thewidow and orphan require either eloquence or talent to pleadwith enlightened men? Is not the certainty of their fallencondition, when shrouded with poverty and neglect-often-times their utter helplessness, their agony, their privations-eloquence itself? Cannot imagination picture how forlornand miserable must be that object who, having once enjoyedease, comfort, and competency, is, from no fault of her own,but from the dispensations of Heaven, thrust from her homeand her pleasures to toil for bread, to sink into dependence, orto have her weekly dole from the hands of a parish func-tionary ? It is rank hypocrisy to put a prayer to AlmightyGod in the venerable ritual of our church, asking Him 11 todefend the fatherless children and widows," while we refuse asmall mite from our resources to make the prayer effectual, asfar as human means can make it.The difficulties under which many worthy and intelligent

practitioners labour, in a pecuniary point of view, renderassurance upon their lives often impossible; but admit that aprudent and careful man has paid from his yearly incomesufficient to guarantee to his widow a thousand pounds. Now,what is the interest she will receive from this amount? Un-less she adopts some speculative mode of investment, (whichis always dangerous,) or to obtain large interest, gets security,uncertain as to punctuality of payment, her income from theordinary funds of the country will scarcely afford a veryhumble maintenance for herself; but if she have a family, itis obvious she must herself labour to obtain any respectableposition, and it may be she is utterly unqualified for suchlabour. The capital must not be touched, for that capital isdesigned for ulterior purposes, to place her children in suitablesituations, and to enable them in the end to embark in businesson their own account. Now, to meet such cases is the greatobject and design of the directors of the " General MedicalAnnuity Fund." An annuity, accruing from such a coi3j)era-tive institution, would place the widow in a position of com-parative independence; but when the average calculation ofmortality amongst medical men, as proved by statisticalreturns, is compared with other professions, the lowest on the

scale, the inference is fair that many die before they can havehad time to make provision of any kind.Take the following fact as an example:-" A young phy-

sician, respected for his general demeanour, and honoured forhis talents, possessing public appointments, with every prospectof obtaining extensive practice, died, after a short illness, (afew minutes only,) at the early age of thirty-six, leaving awidow and five children totally unprovided for." 1 quote thispassage from my esteemed correspondent, to show that Ihave not drawn my pictures from imagination, but trusted thedetail of facts.The proposition for a " General Medical Annuity Fund"

has occupied the consideration of wiser heads than mine.Dr. Percival, in his " Medical Ethics," more than forty yearsago, threw out the suggestion, but no one appeared to act uponit. I have quoted the passage in former communications tomedical periodicals, but it will bear reiteration:-" In thecounty of Norfolk, and in the city of London, benevolent insti-tutions have been lately formed for providing funds to relievethe widows and children of apothecaries, and occasionally alsomembers of the profession who become indigent. Such schemesmerit the sanction and encouragement of every liberal physicianand surgeon, and were they extended,their usefulness would begreatly increased, and their permanency almost with certaintysecured. Medical subscribers from every part of Great Britainshould be admitted if they offer satisfactory testimonials oftheir qualifications. One comprehensive establishment seemsto be more eligible than many on a smaller scale, for it wouldbe conducted with superior dignity, regularity, and efficiency;with fewer obstacles from interest, prejudice, or rivalship;with considerable saving in the aggregate of time, trouble,and expense; with more accuracy in the calculations relativeto its fund; and, consequently, with the utmost practicableextension of its dividends."*Some gentlemen have thought a guinea a year subscription

would be inadequate to accomplish the object we design. Itis scarcely necessary to enter again into this question, forI have met it on many occasions. A guinea a year sub-scription will enable us to fulfil the engagements to which wepledged ourselves;t and should the institution meet with thepatronage it deserves, it will do much more, because theliberal and the kind-hearted of the profession will notconfine themselves in their philanthropy-we have alreadyhad examples of this fact; nor will the public, when it is pro-perly represented to them, withhold their assistance in fur-thering so exemplary an object. If our anticipations in theseparticulars be realized, we may fairly hold out the prospect ofbetter annuities.

It has been stated, too, publicly, that there is an objectionin sending money to Northampton, and that making applica-tion for annuities there would be inconvenient; but what isthe consequence of locality to a " General Medical AnnuityT’und," provided the parties who controlled it are men of in-tegrity and honour, and provided the representative systemwas fully carried out? It will be our great aim to neutralizeall objections of this nature. When the project was firstmooted, it was done at the annual meeting of the ProvincialAssociation, held at Sheffield; it was received there withouta dissenting voice, and a committee for carrying out thescheme was appointed upon the spot. The retiring presidentof that Association, Dr. Robertson, of Northampton, kindlyaccepted the office of treasurer, while the directors were allgentlemen chosen for their high standing in the profession,and their known integrity. For my own part, I took the officeof honorary managing director, only as an earnest of my zeal,devoting to the cause my time and the small measure of abilityI might possess-being, in short, willing to "spend and bespent" in the noble undertaking. But the institution is now acitizen of the empire, and is ready to take up its abode whereit has the best chance of support. I am willing at any mo-ment to yield the feeble protection I have given it to anymore efficient guardianship; nor do I believe an objectionwould be raised by my colleagues to placing it in a positionof greater advantage than we may possess. Our object is thefinal establishment of the " Fund," and we care not who arethe parties who shall develop its energies, and spread abroadits usefulness.

i The medical profession throughout the kingdom are espe-cially invited to the consideration of this subject. Honorary

, local secretaries are required in the different counties anddistricts for furthering the scheme, and we shall esteem it an

- especial favour if gentlemen will accept the office voluntarily,F-that is, will offer their services, rather than wait for an ap-l * Medical Ethics, p. 359. Edition 1827.j t See A ss, &c., published by Churchill, p. 9.

395

plication. Oh! let them remember the greatness of the cause,and the glory of its achievement, and methinks they will notlack in their zeal.In the early part of the spring, a meeting of the subscribers

will be held at Northampton, of which due notice will be givenby advertisement in this journal. In these times of rapidtravelling, when railway communications puts distance at de-fiance, we earnestly hope that many gentlemen will sacrificeto us their time and services on this interesting occasion. Anoble superstructure is about to be raised, the foundations ofwhich are love, in its best and purest acceptation, while itshallowed cement is cooperative philanthropy, upon which theblessing of God shall rest, for God will not withhold his bless-ing when men " hear the cry of the orphan, and wipe tearsfrom the widow’s eyes :’ IGentlemen who are desirous to be present at this meeting i

will confer a favour if they will apprize either Dr. Robertsonor myself of their intention.-I have the honour to be, Gentle- ’,,men, your obedient servant,

EDWARD DANIELL, Managing Director. ’

Newport Pagnell, Bucks, March, 1847.

Correspondence.REMARKS ON THE LATE CASE OF CÆSARIANOPERATION, PERFORMED AT ST. BARTHOLO-MEW’S HOSPITAL.

To the Editor of THE LANCET.SiR,—There are no cases of difficult parturition the treat-

ment of which has been more clearly defined by the systematicwriters of this country, than those in which the pelvis is dis-torted. In cases of pregnancy with extreme distention, whereit is impossible for a child of seven months to pass throughthe pelvis, or be dragged, with safety to the mother, with thecrotchet, after the perforator has been employed, it is nowalmost universally admitted by English accoucheurs that it isjustifiable to induce abortion, or premature labour, in the fifthmonth, or even at an earlier period of a first pregnancy.Where the pelvis is distorted in a slighter degree, and thereis the smallest hope of a living child passing at the seventhmonth, it is i:ow the general rule of practice established inthis country, to induce premature labour at the end of theseventh month, or a little later, and not to allow the gestation toproceed to the full period, when the child’s life would certainlybe forfeited, and the structures of the mother exposed to therisk of contusion by the operation of craniotomy.

In the last number of your journal, I pointed out the great im-propriety of the practice adopted by Dr. Simpson at Edinburgh,in a case of extreme distortion of the pelvis, the long forcepshaving been employed in the woman’s first labour; and in thesecond, the operation of turning, after she had been stupifiedand rendered insensible by the inhalation of ether-vapour. Adeparture from the established rnles of practice, in cases oflabour with great distortion of the pelvis, was also exhibitedin the late fatal Csesarian operation performed by Mr. Skey,which, it appears to me, requires, equally with the case atEdinburgh, to be pointed out to the profession,and condemned.The case is thus related in THE LANCET of Feb. 6th, 1847:-

"The patient, Sarah B-, first consulted Mr. Jolin, sur-

geon, of Coppice-row, Clerkenwell, on the 3rd of October.She was much deformed, being four feet one inch in heightonly, and in her thirtv-eighth year. Mr. Jolin promptly de-tected pregnancy, and became alive to the whole extent of hercalamitous situation. It was plain that no child could bepropelled through the pelvis, the antero-posterior diameterbeing only one inch and one-third, and evident that no re-source remained but the Caesarian section. Mr. Jolin lost notime in holding a consultation with Mr. Skey, and the patientwas admitted into St. Bartholomew’s Hospital, under the careof the latter gentleman. Here, Dr. Rigby, Dr. ProtheroeSmith, and Dr. Ferguson, saw the patient, and confirmed theviews of Mr. Jolin in every particular."

After remaining two months in the hospital, the operationwas performed, and she died thirty-six hours after. Thehistory of the patient before entering the hospital is thusnarrated:—" IT, will be interesting to give some particularsrespecting the patient before she was admitted into the hos-pital, and also respecting the state of her mind subsequent tothe operation. When she first consulted Mr. Jolin, on the3rd Oct. 184C, she complained of pains and swelling in theabdomen, and told him she had been for five months a patientof the Finsbury Dispensary, but had received no benefit from

treatment. Upon being questioned respecting the catamenia,she said she had ceased for near six months. Mr. Jolin pro-posed seing her in bed, at her house, before he would under-take to treat her. On the 7th, Mr. Jolin saw her in bed, inthe presence of her landlady. Mr. Jolin listened with thestethoscope, and distinctly heard the fcetal circulation, provingthat it was neither a tumour nor dropsy, as she had affectedto fear. As she was nervous, a nervine tonic was sent, andshe was to call on Mr. Jolin on the 10th, to let him know howshe was going on. She reported herself much better, and hadslept well, which she had not done for some length of time.She wished to continue her medicine, but was taxed withbeing pregnant, which at first she denied. Mr. Jolin im-pressed upon her mind tha necessity of his examining her oncemore, and that the examination should be per vaginam, inorder to ascertain if she could give birth to a child, knowingfrom her external appearance that she was very much de-formed. She was some days before she would consent; buton,the 23rd, she was examined, and at once told that anoperation would be absolutely necessary. Mr. Jolin proposed,if she submitted to the operation, that she should go intoSt. Bartholomew’s Hospital, and advised her to place herselfunder Mr. Skey to perform the operation. She readily con-sented, and wished to be admitted as soon as possible."From the preceding history, it appears that this unfortunate

woman was positively ascertained to be pregnant on the 7thof October, 1846, when the catamenia " had ceased for nearsix months"-when she was, in fact, only about six monthspregnant. On the 23rd of October," she was examined, and atonce told that an operation would be necessary"-the Csesarianoperation. On the 5th of November, she was admitted, andremained during the rest of the month of November, thewhole of December, and till the 26th of January, when theoperation was performed, with the usual fatal result. In thewhole history of the case, there is no allusion made to thepropriety of inducing premature labour; and it may be in-ferred, from the total silence on the subject, that the questionwas never discussed by those under whose care she was placed.Why it was never mooted, does not appear, though a morefavourable case apparently never presented itself for bringingon labour at the end of the sixth month of pregnancy, andthus avoiding all the dangers of craniotomy at the full periodof the Caesarian section. It is true, the distance between thebase of the sacrum and symphisis pubis did not exceed oneinch and one-third, but the whole brim of the pelvis was not sogreatly distorted, and there was abundance of room in thesides of the pelvic brim, if not for the head to pass aftercraniotomy at the full period, to allow of the head of a foetusof six months, after being perforated, to be extracted withease and with safety.-I am, Sir, your obedient servant,

April, 1847. ________________

SPECTATOR.

ETHER-VAPOUR AND OXYGEN.?0 the Editor of THE LANCET.

SiR,—As my second paper on ether-vapour will not beready for the ensuing week, may I beg the favour of you tostate that the use of oxygen to remove the effects of ether-vapour was known to, practised and recommended by, theAmerican discoverers. Mr. Robinson has published a bookon the subject-why did he omit this fact ? or why not stateit in his note published in THE LANCET of last week ?-Yourobedient servant, JOHN GARDNER.Mortimer-street, April, 1847.

POSTSCRIPT TO DR. MARSHALL HALL’S NOTE.*

* This PS. arrived too late to be added, as it was intended, to Dr. M.Hall’s note in our number of last week.—ED. L.

I WILL conclude this note with a remark on the action ofstrychnine, as ascertained in a recent series of experiments,and on the morbid actions in tetanus and hydrophobia. Thetetanic spasms in the frog affected with strychnine are ALLexcited, reflex actions! Avoid excitement absolutely, and thefrog remains without spasm, and duly recovers. Repeat theexcitement continually, (the spinal marrow being divided, inthis case, near the occiput,) and the frog, which, left alone,would survive eight and forty hours, dies in three minutes !We learn, from these results, what modes of proceeding

afford the greatest hope of treating with success tetanus andeven hydrophobia; and what course will as infallibly destroyour patient.So much for the inestimable value of experament !I will add one or two interesting facts, to show the

. direction of my present inquiries. An aqueous solution of