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VoL. CXXXV, No. 16.] BOSTON MEDICAL AND SURGICAL JO URNAL.

SEMI-CENTENNIAL OF ANESTHESIA.

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REMINISCENCES OF 1846.1

BY ROBERT T. DAVIS, M.D., FALL RIVER, MASS.

Mr. President and Gentlemen: Fifty years agoto-day occurred the first authentic, unquestionable,public exhibition of anesthesia during a surgical oper-ation. As one of the few surviving witnesses of thatmemorable event, the most important in surgical, andone of the most important in human history, I havebeen invited to state my recollection of the incidentsattending it, and very gladly comply with the re-quest.

The operation in which the anesthetic was adminis-tered was performed in the surgical ampitheatre of theMassachusetts General Hospital, by Dr. John C. War-ren, in the presence of a number of distinguished sur-geons and physicians, including Dr. Hayward, theelder Dr. Bigelow, one of the wisest and greatest menwho have adorned our profession with their multifari-ous gifts and accomplishments, and his celebrated son,not then arrived at the zenith of his fame. The Har-vard medical class was also present. After some de-lay Dr. William Morton appeared with his apparatus,when Dr. Warren addressed the medical class, whichhad not been previously notified of the proposed ex-periment, stating in substance that there was a gentle-man present who claimed that he had discovered thatthe inhalation of a certain agent would produce insen-sibility to pain during surgical operations with safetyto the patient, and he added that the class was awarethat he had always regarded that condition as an im-portant desideratum in operative surgery and he haddecided to permit him to try the experiment.

The patient, who was a young man, was sufferingfrom a vascular tumor of the neck on the left side, oc-cupying the space from the edge of the jaw downwardto the larynx and from the angle of the jaw to themedian line. Dr. Morton proceeded to apply to thelips of the patient a tube connected with a glass globe.After the inhalation had continued four or five min-utes he appeared to be asleep, and the operation wascommenced and completed without further inhalationof the ether. It consisted of an incision about threeinches in length over the centre of the tumor, andthrough the skin and subcutaneous cellular tissue, andthe removal of a layer of fascia, which covered the en-larged blood-vessels. A curved needle armed with aligature was then passed under and around the tumor,and considerable compression was employed.

During most of the time occupied by the operationthe patient gave no sign of sensibility, and appearedto be sleeping quietly. A short time before its com-

upon recovering consciousness he declared that he hadsuffered no pain but simply a sensation like scraping

The exhibition of the anesthetic was admitted bythose present to be a complete success. The operatingsurgeon expressed his satisfaction in these emphatic

1 An Address delivered October 16, 1896, at the Commemoration ofthe Fiftieth Anniversary of the First Public Demonstration of Surgi-cal Anesthesia.

words: "Gentlemen, this is no humbug." From thattime forward it became the practice to employ it at thehospital in all operations of importance.

Dr. Morton continued to administer it until it wasproved that it could be easily and safely administeredby others. The apparatus which he had used in thefirst and a few subsequent instances was soon aban-doned as unnecessary and attended with possible risk,and a concave sponge was substituted. Sulphuricether as an anesthetic very promptly passed into gen-eral use in Boston and throughout the State, and soonafterward in public and private practice in the largecities of other States, followed by its employment allover the country wherever scientific surgery was prac-tised. Its fame crossed the ocean, and it rapidly be-came a necessary adjunct to surgery in Europe as wellas here, and beyond, even to the utmost limits ofcivilization - it did not stop there, but among savagetribes and barbarous races in distant continents andislands it followed the footsteps of the explorer, thetrader and the missionary on its divine errand ofmercy to mankind.

It is impossible to estimate or comprehend the im-portance of this beneficent discovery. It safely andabsolutely secures insensibility to pain, unconsciousnessand immobility for long periods of time, conditionswhich are essential to the successful performance ofprolonged and delicate surgical operations. We knowthe pain and terror which accompanied ordinary sur-gical operations before the advent of anesthesia. Icannot forget the impression produced by the case ofa naval officer, upon whom a painful operation wasperformed at this hospital. The suffering was so greatthat he repeatedly screamed, and was quite unable tosuppress the exhibition of his agony. He afterwardapologized to the gentlemen present, and stated thathe could not control the expression of unendurablepain he had experienced, and to which his haggardfeatures and shaking frame bore undoubted testi-mony.

It was fitting that the discovery of anesthesia shouldbe ushered to the world from this historic institution,dedicated to the service of humanity in the broadestspirit of charity, by the gifts of noble men and women.It was fitting, also, that the most eminent surgeon ofhis day in New England permitted the experiment andperformed the operation. His name will be alwayshonored and gratefully remembered by the professionand the public, for his courage and wisdom in assum-ing the responsibility of sanctioning what might haveproved a hazardous experiment, whose failure wouldhave compromised his great reputation. Such consid-erations had no terrors for him; he thought only ofthe lasting and limitless blessings which would followsuccess. These qualities he inherited from an illustri-ous ancestry. He was the son of a Revolutionarypatriot and military surgeon, who was for forty years

New England, and a nephew of the heroic Warren,

life, to offer up his own in defence of American libertyin the first pitched battle of the Revolution, and

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 CollinsWarren, who aided so signally the renowned discov-erer of anesthesia, to whom all. generations will be

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BOSTON MEDICAL AND SURGICAL JOURNAL. [OCTOBER 15, 1896.

debtors, in conferring that unequalled boon upon hisfellow-men.

Let me add that discoveries of such permanent anduniversal interest and importance are not accidental.Such an assumption would be an impeachment of theorder of the universe, and the designs of Providence.They are the natural and indeed inevitable result ofthe progress of scientific thought and investigation.The eager quest of previously unknown facts whichdistinguishes our age reaches the very threshold ofdiscovery, when some fortunate explorer takes a stepin advance, ascertains the new truth and proclaims itto the world. The history of surgical anesthesia fur-nishes no exemption from this general law. In thenoon of this grandest of the centuries the spirit ofhumane science whispered these glad tidings; the at-tentive ear of Morton heard the message and trans-mitted it to mankind. Thenceforth this matchlessdiscovery was destined to bestow its blessings, so longas the race shall endure -wherever in all time humansuffering cries aloud for succor or languishes in silentdespair, and the Divine attribute of mercy, aided bythe wisdom of science, flies to its relief.

SURGERY BEFORE THE DAYS OF ANES-THESIA.1

BY JOHN ASHHURST, JR., M.D., LL.D., PHILADELPHIA.

Mr. President and Gentlemen of the Board of Trus-tees and Hospital Staf Ladies and Gentlemen:- Astudy of the condition of operative surgery before thedays of anesthesia reveals on the one hand a pictureof heroic boldness and masterly self-control on thepart of the surgeon, and on the other a ghastly pano-rama, sometimes of stoic fortitude and endurance,sometimes of abject terror and humiliation -butalways of agonizing wretchedness and pain - on thepart of the unhappy victim, man or woman, whosenecessities required a recourse to the surgeon's aid.And from our vantage ground of a half-century's ex-perience it is difficult for us to understand, why, withthe constant and persistent efforts made by surgeonsin past ages to lessen the pain of operations, and withthe gradual but continuous accumulation of facts, show-ing that by certain agents pain could be temporarilyabolished without danger, the eyes of all - patients aswell as practitioners - yet seemed to be holden, andwhy, science and art working with a common object,if independently, though the whole world seemed tobe trembling on the verge of the discovery, it yet wasnot until fifty years ago to-day that the crucial experi-ment was made in this hospital, and that surgical an-esthesia became a glorious reality.

It is somewhat difficult to obtain an accurate pictureof pre-anesthetic surgery from the patient's point ofview, probably for a similar reason to that indicatedby the lion in the fable, when he criticised the artistfor always representing a combat between lions andmen as terminating in a human victory - lions do notpaint; and so, as operations are habitually reportedby surgeons and not by patients, we read of the skilland intrepidity of the operator, of difficulties met andovercome, and of victories snatched as it were fromthe very jaws of impending defeat; but we hear little

1 An Address delivered October 16, 1896, at the Commemoration ofthe Fiftieth Anniversary of the First Public Demonstration of Surgi-cal Anesthesia.

of the tortures of the victim under the life-saving pro-cess, or, in an unsuccessful case, of the gradual sub-sidence of agonizing cries hushed in the silence ofdeath. And yet we sometimes catch, incidentally, aside-glimpse of an operation from the patient's stand-point, and can thus form some faint notion of theshades as well as of the high lights of capital surgeryin days gone by.

Those who are familiar with the history of Britishsurgery seventy years ago will recall the famous caseof " Cooper versus Wakley," in which the enterprisingfounder and proprietor of the Lancet was sued andmulcted, though in but nominal damages, for the reportof an operation for lithotomy performed by Sir AstleyCooper's nephew, Mr. Bransby B. Cooper. Thereport opens with a quotation from John Bell, refer-ring to " long and murderous operations, when thesurgeon labors for an hour in extracting the stone, to

the inevitable destruction of the patient," and then,having described in terms as graphic, as uncompli-mentary, the operator's prolonged efforts to removethe calculus, and the words which showed his ownanxiety 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, brokenonly by the horrible squash, squash, of the forceps inthe perineum. 'Oh! let it go-pray let it keep in!'was the constant cry of the poor man." The patientwas on the table nearly an hour, and, after a night anda day of great pain, "death" adds the reporter,"ended the poor fellow's sufferings, about twenty-ninehours after the operation." The fatal result appearedto have been due to peritonitis. It is, indeed, not an

unheard-of thing that a surgeon's presence of mindshould fail him in a difficult operation even at thepresent day; but at least the patient, unconsciousthrough the blessing of anesthesia, does not know it,and this complication is spared, to the great comfort

of all concerned.The " pitilessness" which Celsus urged as an essen-

tial trait in the operative surgeon - though Percy andLaurent declare that this pitilessness was meant to beapparent only - was, indeed, before the days of anes-thesia, a feature in the surgeon's character which im-pressed very strongly the public generally as well asthose immediately connected with the operation; andit may be feared that there are not wanting, even atthis nineteenth century's end, some who would echothe comment of the younger Pliny upon the operativesurgeons of his time: "They make experimentsthrough deaths, and no head is secure from them."

It is interesting to recall that Sir James Simpson, ofEdinburgh, shortly after beginning his professionalstudies, was so affected by "seeing the terrible agonyof a poor Highland woman under amputation of thebreast," that he resolved to abandon a medical careerand seek other occupation; happily, his intention wasreconsidered, and he returned to his studies, askinghimself, "Can anything be done to make operationsless painful ?" and, as every one knows, in less thantwenty years became himself a high priest of anesthe-sia, and the introducer into surgical and obstetricalpractice of ether's great rival, chloroform.

Not only did delicate women and tender childrendread the ordeal of the surgeon's knife, but strong andbrave men also recoiled from its use in horror: Buffonpreferred death to relief from the agonies of calculus

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by the operation of lithotomy, and case after case isnarrated by Monfalcon and other writers, in whichmen submitted themselves with the utmost calmnessand fortitude to the hands of skilful operators, in-stantly falling into collapse after the first incision, andwithout undue loss of blood, quickly succumbing to thedepressing effects of simple shock and pain.

No braver or more gallant gentleman ever livedthan Admiral Viscount Nelson, and after his rightelbow had been shattered by a French bullet in theassault at Teneriffe, he manifested the utmost courage,refusing to be taken to the nearest ship lest the sightof his injury should alarm the wife of a fellow officerwhose own fate was uncertain, and when his own shipwas reached, climbing up its side without assistance,and saying, "Tell the surgeon to make haste and gethis instruments. I know I must lose my right arm, sothe sooner it is off, the better." " He underwent theamputation," we learn from a private letter of one ofhis midshipmen, " with the same firmness and couragethat have always marked his character," and yet sopainfully was he affected by the coldness of the opera-tor's knife, that though when next going into actionat the famous battle of the Nile, he could after calmlyfinishing his meal say to his officers, "By this time to-morrow I shall have gained a peerage or WestminsterAbbey," yet he gave standing orders to his surgeonsthat hot water should always be kept in readiness dur-ing an engagement, so that if another operation shouldbe required, he might at least have the poor comfortof being cut with warm instruments.

But the most striking picture of which I am cog-nizant, showing the way in which an intelligent patientlooked upon a surgical operation, is to be found in aletter written to Sir James Simpson by a friend, him-self a member of the medical profession, who had hadthe misfortune to lose a limb by amputation before theintroduction of anesthesia: "I at once agreed," hesays, " to submit to the operation, but asked a weekto prepare for it, not with the slightest expectationthat the disease would take a favorable turn in theinterval, or that the anticipated horrors of the opera-tion would become less appalling by reflection uponthem, but simply because it was so probable that theoperation would be followed by a fatal issue, that Iwished to prepare for death and what lies beyond it,whilst my faculties were clear and my emotions werecomparatively 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. . . Theoperation was a more tedious one than some whichinvolve much greater mutilation. It necessitated cruelcutting through inflamed and morbidly sensitive parts,and could not be despatched by a few strokes of theknife. . . . Of the agony it occasioned I will saynothing. Suffering so great as I underwent cannotbe expressed in words, and thus fortunately cannot berecalled. The particular pangs are now forgotten;but the blank whirlwind of emotion, the horror ofgreat darkness, and the sense of desertion by God andman, bordering close upon despair, which sweptthrough my mind and overwhelmed my heart, I cannever forget, however gladly I would do so. Onlythe wish to save others some of my sufferings makesme deliberately recall and confess the anguish andhumiliation of such a personal experience; nor can Ifind language more sober or familiar than that I haveused, to express feelings which, happily for us all, are

too rare as matters of general experience to have beenshaped into household words. . . . During the opera-tion, in spite of the pain it occasioned, my senses werepreternaturally acute, as I have been told they gen-erally are in patients under such circumstances. Iwatched all that the surgeon did with a fascinatedintensity. I still recall with unwelcome vividness thespreading out of the instruments, the twisting of thetourniquet, the first incision, the fingering of the sawedbone, the sponge pressed on the flap, the tying of theblood-vessels, the stitching of the skin, and the bloodydismembered limb lying on the floor. Those are notpleasant remembrances. For a long time they hauntedme, and even now they are easily resuscitated; andthough they cannot bring back the suffering attendingthe events which gave them a place in my memory,they can occasion a suffering of their own, and be thecause of a disquiet which favors neither mental norbodily health."

On the side of the surgeon, we find throughout theages a constant effort to diminish the terrors of oper-ations, and a continuous reprobation of the distressful,not to say cruel, modes of practice adopted by pre-ceding generations. " Who can read without a kindof horror," cries Monfalcon, " the account of thosefrightful operations which were then practised? Andyet the time is not very far distant from ours, whenthey lopped off a limb by striking it violently with aheavy knife; that time when they knew neither howto stop nor how to prevent hemorrhage but by burn-ing the part whence the blood jetted with boiling oilor the red-hot iron; that time when surgeons armedthemselves at every moment with pincers, with burn-ing cauteries, and with a thousand instruments therepresentations even of which cause terror." Will ithappen that on the occasion of some future anniversaryour successors will speak of our operative triumphswith the same scorn and abhorrence with whichwriters of the present day sometimes refer to thegreat deeds of our surgical forefathers ?

The belief that operations might be rendered pain-less and the hope that some means might be discoveredby which this end should be accomplished appear tohave been present in the minds of surgeons from theearliest periods. Witness the accounts of the Mem-phis stone, described by Dioscorides and Pliny, whichLittre surmised to have been merely marble which bysteeping in vinegar was made to give forth the fumesof carbonic acid; and of the mandragora, employedaccording to Theodoric, when mixed with other nar-cotics, by inhalation, and causing a sleep from whichthe patient could only be aroused by the fumes ofvinegar; so profound was the stupor induced by thisdrug that Bodin assures us that under its influence aman submitted without consciousness to a painfuloperation, and continued to sleep for several daysthereafter.

Vigo speaks of the whole body being "broughtasleep by the smelling of a sponge wherein opium is,"but warns his readers that the practice is dangerousbecause the use of opium is sometimes followed bygangrene. In his work on "Natural Magic," BaptistaPorta 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 beenether or some other of our modern anesthetic agents.

Others endeavored to prevent the pain of opera-tions by mechanical means. The Assyrians, Hoffman

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assures us, compressed the veins of the neck, appar-ently by tying a band around the part, before prac-tising circumcision, and compression of the carotidarteries was suggested as an anesthetic measure inmore modern times by Dr. Fleming; while still morerecently Dr. Augustus Waller has shown that insen-sibility may be induced by compressing the cervicalvagi. Garroters have indeed clearly shown, as re-marked by Simpson, that a person may readily bechoked into unconsciousness, but it is not surprisingthat their mode of practice has not commended itselfto surgeons for general adoption.

Compression of the limb by a fillet or tight liga-ture, before amputation, is referred to by Pard as amode of alleviating the suffering which attends thatprocedure, and Benjamin Bell tells us that "in ampu-tating limbs, patients frequently desire the tourniquetto be firmly screwed, from finding that it tends todiminish the pain of the operation." The samewriter refers approvingly to the suggestion of Mr.James Moore, that pain should be controlled by theapplication of a screw compressor to the principalnerve of the part, but surgeons generally appear tohave agreed with Monfalcon that the inconveniencesof such an apparatus fully equalled its very slightadvantages.

Mental pre-occupation was sometimes sought as ameans of preventing pain. Richard Wiseman foundthat soldiers dreaded the loss of a limb much less if itwas removed immediately, while they were "in theheat of fight," than if the operation was postponeduntil the next day ; " wherefore," he says, "cut it offquickly, 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 Neapolitandungeon, measurably alleviated his own distress by en-gaging in the composition of a Treatise on Mineralogy,while his unfortunate servant and fellow-prisoner, whohad not the same intellectual resources, was hungryenough for both.

But the presence of pain was not the only evildreaded by our predecessors in attempting importantoperations: the great risk of fatal accident from someinvoluntary movement of the patient was constantlypresent to the mind of the conscientious surgeon." How often," says Dr. Valentine Mott, "when oper-ating in some deep, dark wound, along the course ofsome great vein, with thin walls, alternately distendedand flaccid with the vital current - how often have Idreaded that some unfortunate struggle of the patientwould deviate the knife a little from its proper course,and that I, who fain would be the deliverer, shouldinvoluntarily become the executioner, seeing mypatient perish in my hands by the most appalling formof death! Had he been insensible, I should"have feltno alarm." So greatly was the responsibility of usingthe knife felt by the best-informed surgeons of pre-anesthetic days, that many, like Haller, distrusted theirown manual dexterity, and declined to perform opera-tions which, while recognizing their necessity, theyfelt should be left to other surgeons differently consti-tuted from themselves. Would that a little of thisHallerian diffidence might affect some tyros of theprofession in our own day, who, without the slightestpreliminary practical training, do not hesitate to under-take the most hazardous procedures, and seem to con-sider themselves disgraced if they cannot count oneor more abdominal sections, even if terminating fatally,

within the accomplishments of their first year'spractice!

Coming down to the days more immediately preced-ing the date of the great discovery, we find that opiumand alcohol were the only agents which continued tobe regarded as of practical value in diminishing thepain of operations, though the attendant disadvan-tages of their employment were of course recognized." Previous to every painful operation," says Dorsey," a dose of laudanum should be administered." "I wasin the habit," says Dr. Mott, "of giving opiates freelybefore the introduction of anesthetics, both before andafter operations, . . . and opium and its preparationsare the only anodynes well adapted to surgical use.No substitutes are worthy of confidence." Demmetells of a woman, who, under the influence of opium,submitted to amputation at the hip-joint, and emittedbut a single cry; and I myself recall distinctly patients,who, in the hands of that excellent surgeon, the lateDr. George W. Norris, had limbs amputated withalmost no manifestation of pain when well chargedpreviously with opium and whiskey. Alcohol, pushedto the point of producing intoxication, was employedas an anesthetic by some surgeons, and Dorsey tells usthat Dr. Physick, following Richerand's suggestion,used it successfully for its relaxing effect in a rebelliouscase of dislocated jaw, in which on account of thepatient's "extreme debility " it was not thought pru-dent to resort to the usual remedy -"blood-lettingad deliquium animi."

Meanwhile facts were accumulating, the significanceof which we can now plainly recognize, but whichexcited no attention at the time. Sir Humphry Davyhad, in the very early days of the nineteenth century,experimented with nitrous oxide gas, afterwards em-ployed by Horace Wells, and had in so many wordssuggested its use as an anesthetic in minor operations;its power of preventing the sensation of pain was wellknown to many persons, and it was the custom atsome of our medical schools - at the University ofPennsylvania 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 earlierrecommended by Beddoes, Pearson and Thornton, asa remedy for certain diseases of the lungs, and in 1805your own Warren had employed it "to relieve the dis-tress attending the last stage of pulmonary inflamma-tion." Its intoxicating qualities, when inhaled, and itspower, when in sufficient concentration, to producestupefaction, had been recognized, in 1839, in Pereira'swell-known treatise on Materia Medica, and werequite familiar to American medical students; and it isno doubt possible - I certainly have no wish to denyit - that in isolated cases it may have been used as ameans of relieving pain by individual practitioners, asby Dr. Long, of Athens, Georgia, whom Perrin, withthat happy disregard of the geography of all countriesexcept their own, which is characteristic of Frenchwriters, calls the " Greek physician."

But yet - and yet - surgeons went on, in everycountry, cutting and burning, and patients went onwrithing and screaming, until on the sixteenth day ofOctober, in the year 1846, in the Massachusetts Gen-eral Hospital, DR. JoHn C. WARREN painlessly re-moved a tumor from a man who had previously beenetherized by DR. WILLIAM T. G. MORTON - andSURGICAL ANESTHESIA became the priceless heritageof the civilized world.

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WHAT HAS ANASTHESIA DONE FOR SUR-GERY?'

BY DAVID W. CHEEVER, M.D.

WHAT victim of surgery, who, under ether, sinksinto a calm and dreamless sleep, during which hisabdomen can be cut open, his bowels taken out,handled and replaced, his nerves cut, his veins orarteries tied, and his skin sewed up, and who is madeso absolutely oblivious as to ask on awakening, " Areyou not ready to begin?" but concedes with grati-tude, on realizing the result, that this is the greatestdiscovery ever made for the happiness of mankind ?

In proportion as anticipation is worse than reality,must be estimated the mental relief brought about byanesthesia.

To dread the knife, to shrink from an operation, tofear pain, is there a more universal instinct? It isnext to the vital instinct of self-preservation. Whatiron will, what previous agony must induce that forti-tude which can bring the sufferer to lie down and becut without stirring !

All this is annulled by anesthesia. How much men-tal shock is thus removed !

What is surgically termed the "shock of the opera-tion," or the disturbing effect on the nervous systemof violence done the flesh and nerves, is also largelydiminished. Anticipation is done away with; pain isprevented; shock is reduced.

The patient consents to operation earlier; he doesnot wait until life becomes unbearable, but calmlycontemplates surgery as the natural and easy channelof relief. Hence his chances of benefit from an oper-ation are much increased; he averts destructive pro-cesses, shortens disease, is more likely to recover.So much is done for the patient.

To the surgeon anesthesia gives the patient asleep,motionless, senseless. He need not hurry; he neednot sympathize; he need not worry; he can calmlydissect, as on a dead body; heedful only that theetherizer is competent, the breathing and pulse watched,the operation not prolonged beyond the verge of ex-haustion.

The surgeon, then, can do better work; he can bemore careful; he can pause and consider; he canchoose his steps; he can be deliberate, if not dexter-ous. He can even summon the aid of the pathologistand his microscope, who, in ten minutes, while thepatient sleeps, can decide the nature, the innocence ormalignancy, of the tumor he is removing.

It is also just to believe that the moral fibre of thesurgeon is less strained; judicial callousness is nolonger called for; he need not steel his heart, for hisvictim does not feel.

For surgery and for diagnosis, anesthesia has doneeven more. It has enlarged its domain by renderingjustifiable and even promising severe and delicateoperations.

The tyranny of misguided conscience drove theinquisitors of the Middle Ages to rack the jointsapart: so, too, the surgeon was formerly obliged touse the rack to tire the muscles and disrupt thecapsule, to reduce a dislocation. Now, anesthesiarelaxes the muscles, and manipulation rolls the boneinto the socket.

Homeric strength was needed to bear HomericI An Address delivered October 16, 1896, at the Commemoration of

the Fiftieth Anniversary of the First Public Demonstration of Surgi-cal Anesthesia.

surgery. Strong men and calm women endured des-perate mutilations and recovered. But at what acost !

Such surgery must necessarily have been largelytraumatic, or the result of emergencies threateningdeath if not relieved.

It is not too much to say that all the finer work ofplastic, conservative and abdominal surgery datesfrom the discovery of anesthesia. It could not havebeen done before. Neither surgeon could persist, norpatient endure it. Perhaps one thousand ovariotomieswere done by Sir Spencer Wells before asepsis wasmuch practised, but they were all done since anesthe-sia was known. The tedious details in a radical cureof hernia were mostly mechanical before anesthetics;and the operative measures have been adopted since.

Formerly the surgeon was estimated for dexterityand quickness. Now he is esteemed the great sur-geon, who to judgment adds dexterity, and to dex-terity patience.

Anesthesia was the necessary precursor of asepsis.Without the former the latter would not be what itnow is. Even if antiseptic agents were used in dress-ing wounds, the operations which caused the woundscould not have been done aseptically without anes-thesia.

The essence of asepsis is detail, tedious rules andprecautions, prolonged and accurate dressings. Allthis requires time, immobility, unconsciousness. Tostitch the most delicate tissues with accuracy, to matchthe bowel or bladder so that it will not leak, howcould this be done on a conscious and quiveringpatient?

First, anesthesia; second, asepsis. They must beinseparable for success.

All visceral surgery, which deals with the greatserous cavities, and which constitutes the proud dis-tinction of modern surgery, depends on anesthesiafirst, and on asepsis afterward. The latter is asbeneficent a discovery as the former. Hand-in-hand,equal benefactors, anesthesia and asepsis, march calmand triumphant. Together they have altered life, en-larged what is worth living for, postponed death.May we not claim now as fulfilled for surgery thatold saying which our fathers regarded as the acme ofsuccess and skill in curing the patient: Tuto, cito, etjucunde (Without delay, without danger, withoutpain)?

Is there no reverse to this brilliant picture ? Thereis if we allow it; but most dangers and mischancescan be averted by care. The danger of immediatedeath from anesthetics is no greater than the ordinaryrisks of life in the daily pursuits of civilized com-munities. The use of power, whether steam or electric,surrounds the life of cities with hourly perils; and thechance of succumbing under the inhalation of ether isno greater than the risk of a street accident or a rail-way journey. Of those who inhale sulphuric ether,about one in fifteen thousand die. I formerly be-lieved that chloroform was ten times more fatal thanether; larger statistics have modified that opinion, andit may now be fairly stated to be five times more dan-gerous, or of those who inhale chloroform about onein three thousand die.2

Since neither anesthetic is given to the well andsound person, but always to the sick or injured, wecannot eliminate the chances of death from inhalation,

2 Appendix, I.

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which may be increased by infirm hearts, lungs orkidneys. The patient is forced to take those chances.And yet, how few perish from these pain-dispellingagents!

An elementary alcohol, sulphuric ether acts likealcohol in its effects when inhaled. A quickenedpulse, a stimulated heart, a vivid capillary blush, con-gestion of the brain, mental exhilaration, confusion,intoxication, a lethargy which is not lethal.

Ether is fatal unless breathed with the oxygen ofatmospheric air; nay more, provision to have thecarbonic acid exhaled must also be provided for. Anuncovered sponge for an infant, and a sponge coveredwith a porous towel for the adult, are still among thebest-and surely the safest - inhalers: rigidity, livid-ity, stertor, only emphasize the need of more air.

Chloroform affects the heart more suddenly andsurely than the respiration. It is a heavier gas,pleasant to take, less bulky, quicker in producing un-consciousness, less irritating to the lungs, less followedby vomiting; but when fatal, suddenly fatal, withoutpremonition. Its primary effect is depressing; theskin is cool and pale; the pulse not stimulated; sleepfollows speedily.

The distinction of danger from safety in the inhala-tion of both anesthetics may be described in the wordsof 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 mornWhen throned on ocean's wave,It blushes o'er the world."

A secondary danger is from prolonged anesthesia.Sulphuric ether inhaled the first half-hour is stimulant;the second half-hour, tolerable; the third half-hour,depressant. The pulse creeps up from the eighties tothe one hundred and twenties; the skin cools; colorfades; sweat rains from the surface; respiration be-comes shallow or sighing; all signs of exhaustion,collapse and death. Intent on a delicate, and as hethinks, necessary and final step in his operation, thesurgeon may persist too long, and the patient sink toolow for recovery. This danger is emphasized by thedelays of aseptic precautions, of minute embroideryof serous membranes with sutures, of too long anexposure of the vital cavities.

A common, but not constant, effect of the inhalationof ether, and of chloroform to a less degree, is nauseaand vomiting, both while asleep and after wakening.If only of brief duration, its only danger is in disturb-ing the wound, as the humors of the eye or the liga-tures on the pedicle of an ovarian cyst. This dangeris, however, to be counted. If of long duration itmarks a condition of secondary shock, which is oftenfatal.

No agent has been found to be a specific to preventvomiting. An empty stomach is an essential in inhal-ing anesthetics. As remedies, the bromides, the sub-cutaneous injection of morphia and atropia, the inhala-tion of oxygen have each given a certain success.Much vomiting may be prevented by giving ether onlyto the verge of insensibility; not filling the blood toofull of the vapor; taking the ether off permanently asearly as possible; for unconsciousness persists forfifteen to twenty minutes after apparent rousing, andthe patient's motions and moans are automatic, andnot remembered after waking.

Sulphuric ether irritates the mucous membrane ofthe bronchi and minute air-passages. We know howit congests the eyes if it runs into them. It provokesa large and sometimes dangerous, secretion of sero-mucus fluid from the bronchi; this gets churned upwith air, and fills the throat with a bubbling fluid likesoap-suds. It is both annoying and dangerous. Chloro-form causes much less of this condition.

Acute bronchitis, pulmonary edema, broncho-pneu-monia (but not true lobar-pneumonia), may follow,and turn the scale against the patient. It is claimedthat a previous injection of atropia will often dry thethroat and bronchi, and avert this excessive secretion.Light inhalations, plenty of air, watchfulness to swabthe throat, care to remove the ether early, are the bestremedies.

Both sulphuric ether and chloroform congest thekidneys, and produce albuminuria in more than one-halfthe cases. 4 This albuminuria is usually of short dura-tion; but one can readily see that a diseased kidneymight be overwhelmed by it, just as a feeble heartwould succumb to chloroform, or diseased lungs to anincreased bronchial secretion. Bright's disease, diabetes,any inflammation of the air-passages, pleuritic effusion,acute bronchitis, valvular disease of the heart, croup,- all are unfavorable conditions for an anesthetic.

The thermo-cautery about the face demands chloro-form.

If in spite of these unfavorable conditions only oneperson in fifteen thousand succumbs to the inhalationof ether, we may conclude that we shall not find asafer agent to produce unconsciousness, though wemay a more agreeable.

APPENDIX.

I. - MORTALITY.

Combined statistics of Gurit, of Berlin, and Juillard, of Geneva:Chlorobrm. -691,319 cases, 224 deaths. One death in 3,082 cases.

Ether. - 341,058 cases, 23 deaths. One death in 14,828 cases.II. -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 authoritiesbelieve 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. BostonMedical and Surgical Journal, vol. cxxxii, p. 560.

ItI. -- LuwGs.

Prescott believes that ether cannot produce true lobar pneumonia.He gives only two case- 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.

ANESTHESIA IN OBSTETRICS.1

BY J. P. REYNOLDS, M.D.

IN the welcome that greeted anesthesia in this city,fifty years since, its promise to women in labor wasnot overlooked. Oliver Wendell Holmes, recountingits blessings, rejoiced that it lifted " the primalcurse"; Walter Channing, our honored first profes-sor of midwifery, devoted an important volume, his"Etherization in Childbirth," to its early triumphs.To-day, after the half-century, it is my glad office tolay before you the priceless worth of anesthesia inobstetrics.

In operative obstetrics, in the high and difficult use

the Fiftieth Anniversary of the First Public Demonstration of Surgi-cal Anesthesia.

8 Appendix, III, Dr. Prescott.* Appendix, I, Dr. Blake.

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of instruments, in the introduction of the hand for ver-sion and extraction, anesthesia resembles at all pointsthat of the graver procedures of general surgery.It brings the same admirable results: a patient inblissful unconsciousness; an operator delivered fromall concern for another's suffering, with ample timefor exact and thorough diagnosis, and free to workwith all desired accuracy, delicacy and caution. Inobstetrics there is often a farther gain of great mo-ment: loosing the formidable grip of the uterine muscle.Mention must also be made of the induction of prema-ture labor; in which the power of safely maintainingfor many continuous hours profound etherization israpidly securing for the method of passive manualdilatation a deserved preiminence. It may be added,that five minutes only of deep anesthesia, rapidly in-duced, prove at times no mean resource in softening thethin, wiry edge of a tardily dilating uterine mouth.After profound anesthesia during delivery, increasedwatchfulness against hemorrhage is always wisely en-joined; but where the precautions which are in alllabor indispensable, are duly enforced, any added riskis perhaps rather inferred than proven.

The service of ether in puerperal convulsions is stillmore striking. Used in the manner now to be de-scribed, it prevents any new seizure. An eclampticpatient is brought with all possible rapidity to com-plete unconsciousness. During many consecutive hoursthis is firmly kept up, always under strictly profes-sional care: there can be no delegation of the physi-cian's authority to any hands less qualified than hisown, not even to those of the best trained nurse. Anutterly passive condition is secured; and then, on theleast restlessness, agitation, indication of pain or un-easiness in any region; above all, at any slightesttremor of an eyelid, or other known premonition of afresh attack; the remedy must be instantly pushed tofull, snoring anesthesia. No evil effects will ensue fromcontinuing this state for many successive hours: andthese can seldom be fewer than eight or ten. Underanesthesia food is, of course, withheld. It must be dis-tinctly understood, that such an employment of etherhas no power of cure. In exhibiting it we absolutelyprevent fresh paroxysms, each of which strikes a newblow at the brain and nervous centres, and we gainat the same time the all precious opportunity for treat-ment. This latter must be meanwhile activelypressed: first and foremost, unless already accom-plished, the emptying of the uterus; to temporize withthat does no good whatever, and may bring incalcu-lable harm. Improvement in the renal condition isthe best proof of amendment. When to withdrawthe ether is always a most anxious problem; steadycontinuance of it being in all doubtful cases the farsafer alternative.

In making these strong assertions in regard to ether-ization in eclampsia I weigh well my words. Care-lessly or ignorantly followed, they may work mischief.But the subject is of extreme importance. In my re-sults there has not been the slightest variation; and Iam confident that I do not stand alone. The time hascome to present these views to the medical profes-sion, and to press their general acceptance.

For the prolonged use in eclampsia just described,and even for that already suggested in the inductionof premature 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, andso rouse professional interest that no one shouldlightly forbid it to any woman in childbed! "BlessGod for ether," has burst from the lips of thousandson thousands of suffering women. It might well bemade the cry of countless thousands more.

In normal labor due anesthesia is free from everyshadow of danger. The alleged after-evils do notexist; on the contrary, the gain in safety even out-weighs the expressible comfort and relief. It is in-dispensable that the anesthetic be administered onlywithin the limits now to be laid down; on this is con-ditioned the truth of all that follows.

Ether, when properly given in normal obstetrics,never contents the patient. She incessantly cries formore, and if in first labor, indignantly claims to beforthwith put asleep, and to know nothing till after thebirth. The anesthetic is allowed only during theuterine contraction; the time of positive pain. In theinterval it is withdrawn. Consciousness should thenreturn, and there is often intelligent speech. Ethermay be given at any period, and might be continuedfrom the beginning of labor to its close. There shouldbe here no question of the so-called "stages "of labor.One only rule governs its use. Whenever the attend-ant sees that the woman's endurance of pain begins totell upon her patience and courage, the moment forether has come. It is to be kept up so long as thisneed lasts; no longer. In an appreciable minority ofcases, a mother who in her early suffering has beenclamorous for relief, will herself, when the so-called" real " pains appear, and conscious progress is made,put it away : " I can do without it now." On its firstemployment, a lull often comes in the uterine action,the patient sinking into a much-needed repose; to whichsoon succeeds a yet more vigorous advance. The ex-tremely rare case in which no such renewal occursmust plainly forego anesthesia. It should be noted,that in the earliest pains some careful observers holdthat chloral in suitable doses gives still greater relief.

With even these limitations the value of ether canhardly be overestimated. It is something, that in thedistress a good and decorous deportment is no longerenjoined; it is everything, that tender hands can now,as in other nursing, solace each access of sufferingwith positive help; but far, far beyond this, that wethus uphold in the patient that vital resistance whichmental and nervous tension and the long endurance ofpain, more than all other causes combined, destroy;that which soothes becoming likewise a chief guaranteeof safety; a help against hemorrhage.

Unhappily, a frequent resort to ether may not beasked from lying-in hospitals and the great publiccharities. fThese establishments burdened with enor-mous and ever-enlarging cost for the first needs ofthe destitute - shelter, food, warmth, nursing - can-not add the great increase of responsible attendantswhich general anesthesia would require. But evenfor private practice, anesthetics are not in simple laborextensively used. The medical profession does notaccept what has just been said of ether. Its benefitsare sturdily denied. Men declare that it promotesflooding, that it wastes important time, that it presentsthem, in place of a woman bearing her pain withdignity and fortitude, a creature regardless of appear-ances and only clamoring every moment for ease.

These charges come mainly, I believe, from thosewho, under varying motives, content themselves with

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a tardy, perfunctory, or even deceitful, resort to ether;" refusing it," as women sometimes say, "when we mostneed it, and allowing it when we could most easily dowithout it." Later, one may readily ascribe to theanesthetic, which has in no true sense, been tried, thosecommon disasters of childbed, which its proper usewould largely ward off; and these assertions, oncemade, supply a ready excuse for that numerous, and itis to be feared, increasing class who do not so muchoppose ether as willingly evade and neglect it.

We have seldom possessed an accoucheur of widerexperience, or a teacher of greater gifts of tongue andpen, than the late famous Fordyce Barker of NewYork. Several years ago, I listened with eager inter-est as he, in this city, before the American Gyneco-logical Society, deeply condemned the growing disuseof ether in obstetric practice. "Through a long seriesof years," he said, "I have rarely attended laborswithout ether. I have never seen from it any evileffects. Especially has it not caused a tendency tohemorrhage. Indeed, I should say, that instances offlooding that I have seen have rather occurred in caseswhere ether had not been employed." Years havebut deepened my conviction of the exact truth of thewords that I then so heartily welcomed.

The time of an obstetric attendant is no longer hisown; he may not condemn the extra half-hour thatetherization will now and then compel. His approvalor his dislike of his patient's attitude in her distress isof trivial importance. Objections like these have noweight unless urged by the sufferer. She was neverknown to advance them.

The charge that anesthesia increases flooding cannotbe thus lightly set aside. As matter of opinion it hasbeen to-day claimed: that the due use of ether savesthe mother's courage and strength; that it preserves,not breaks down, uterine contractile power; that itthus lessens the risk of hemorrhage. It will befound that clinical 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 ofether in all confinements, not, indeed, forgetting thedue limitations, but ungrudgingly, thankfully, gladly.

One remembers tender hearts that doubted theirright to evade, under ether, heaven-sent pain. Howmarvellously the words graven beneath our cherishedEther Memorial send down, in reply, their tdoringpraise:

"This also cometh forth from the Lord of Hosts,who is wonderful in counsel and excellent in working."

THE SURGERY OF THE FUTURE.1

BY CHARLES MOBURNEY, M.D.l, NEW YORK.

WE worship to-day at the shrine of the GoddessAnesthesia, whose gentle sway over the surgical worldof all civilized countries has so beneficently displacedthe reign of terror which existed only two genera-tions ago. What anesthesia has done for surgery hasbeen already most eloquently told, and we all realizethat without it the best of modern work would beimpossible.

It seems but yesterday, and yet it is already a matterof history, that the wonderful discovery of the aseptic

'An Address delivered October 16, 1896, at the Commemoration ofthe Fiftieth Anniversary of the First Public Demonstration of Surgi-cal Anesthesia.

treatment of wounds was given to us, through whoseagency countless thousands of human lives have beenpreserved.

Through these two discoveries surgery has becomea gentle art: for the agonies of operations, and thefatal diseases of wounds, have given way to a painlesssleep, and an awakening to a safe recovery. Andbacteriology, which in its infancy gave birth to asep-tic surgery, has penetrated with its brilliant light adarkness which our predecessors believed would lastforever.

So generous, indeed, has the recent past been tosurgery with gifts which make our science rich almostbeyond belief, that the future may well be modest intelling us what it will do. It would almost seem as ifthe toilsome ascent had been accomplished, and as if thefuture could hold for us no obstacles that could tax ourpowers. That such a comfortable view is not sharedby the ever-active surgical worker and his numerouscollaborators is fortunate, and we are thus assuredthat difficulties, perhaps not so large as those alreadyconquered, but both grave and numerous, will, byincreasing effort, be swept away and relegated to thepast.

It seems to me that in the immediate future thegreatest surgical victories are to be won by the aid ofbacteriology, which has already unlocked so manymysteries. Through it diphtheria and tetanus havebeen brought within the list of frequently curable dis-eases. Why should we not soon be able to say evenmore of general sepsis, tubercle and cancer? Wehave already reached a high degree of perfection inpreventing the entrance of sepsis through the surgicalor the accidental wound; but, given a case wheresepsis has already deeply invaded the body, throughwhatever point of entrance, and we are well-nighhelpless. We may empty an abdomen of pus, andeven remove the cause of the disease, but we knownothing in regard to overcoming the sepsis alreadywidespread throughout the body. Is it not in storefor us that the discovery will soon be made by whichwe shall be able to destroy the sepsis-producing or-ganism, no matter what its source, no matter howwidespread ? I believe it is, and that we will, in thenot distant future, be able to render the body immuneto the existence of sepsis even of internal origin.

All of the general surgeons, and many of thespecial ones, are devoting a large amount of theirtime to the treatment of tubercle. Operative surgeryhas attacked it very successfully, but we need thehelp of the bacteriologist and of the physician toenable us to prevent its recurrence and to treat it inmany localities. Surely the day is close at hand whenthe surgeon's knife, which so readily removes theproducts of tubercle, will be aided by the remedywhich destroys the bacillus itself.

Cancer in all its forms is still our worst enemy.Operative surgery has done much, very much, to over-come it, aided by greatly improved diagnosis, and bymeans 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 itsexistence to a living organism, and therefore one cap-able of death, or not, are still in the hands of thefuture, and most eagerly awaited by all of us. Thebest energies of the bacteriological and the surgicalworld cannot be devoted to a worthier object. Butthe future of bacteriology is, and ever will be, in the

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hands of the most brilliant men, and surgery is destinedto achieve many of its greatest triumphs through theaid of this ever-growing army of invaluable co-workers.With their help will the aseptic making and treatingof wounds be brought to a far higher state of perfec-tion than even the elevated one of the present day,and the exact reasons for disturbances in wound-heal-ing, some of which are still but partially understood,will become part of the knowledge of every truesurgeon.

The possibilities for discoveries of enormous valueto both the theory and the practice of surgery, throughmore perfect study of the blood, are certainly verylarge, and are already foreshadowed by what has beenso recently learned in regard to the blood-corpusclesand the organisms of disease which invade and developin the blood current. We may confidently expectthrough this means a very exact, and, what is of theutmost importance, a very early diagnosis, in manysurgical disorders, which we now first appreciate at astage too late for efficient treatment.

When one considers the very great value of therecent addition to our resources, the infusion into theblood-vessels of hot saline solution, which has so beau-tifully supplanted the difficult and dangerous processof blood transfusion, one grows impatient for the daywhen, at the same moment disease shall be drainedfrom the body through one opened vessel, and life andhealth poured in through another. Some of us willsee the day when death as a result of hemorrhage willbe always avoidable.

In spite of the large contributions that have beenmade by scientific workers during the last few years,it may fairly be said that we have been living in anage of operative surgery, the growth of which hasexcited the interest and admiration of all classes ofmen.

The public at large, and all branches of our profes-sion, have become deeply infected with the idea thatthere are almost no limits to what can be done in thecure of disease by a skilful surgeon; and the belief ismuch too widespread that almost any professional man,with a little knowledge of antisepsis, may properlypractise surgery. This exaggerated feeling of confidenceis 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 beeninvestigated by the operating surgeon, and far be itfrom me to say that this has not been wise and neces-sary. Conclusions cannot precede experience; and ithas required courage, hope, and even blind faith, toexplore and learn what we may accept, and what wemust discard.

The operating surgeon of the future will have amost important and delightful task. Proud of hisability to do any operation, and to secure a perfectwound-healing with unfailing regularity, he will knowwhen to withhold his hand. He will sacrifice his am-bition to multiply the number of cases he has operatedupon, and will devote his energies to increasing onlythe number of those he has actually cured of disease.He will know better than we do who are the actuallymoribund, and he will leave them untouched in thehands of the priest.

He will not be tempted by the plea that the patientmust die as he is, and that therefore he should rightlybe operated upon. He will not attempt to cure withthe knife the poor little microcephalic child or the

advanced case of carcinoma of the stomach, uterus, orlarynx. Our knowledge, acquired by much labor andsacrifice, will be his at the outset; and the errors,which we have made through over-enthusiasm, willexcite not his contempt, but his gratitude.

He will have at his disposal the large experience ofthe surgeons of to-day, and, unhampered by the viewsheld in the pre-antiseptic era, he will draw conclu-sions and deduce principles sounder and clearer thanour own.

We may confidently look forward to vastly improveddiagnosis of surgical disease, more especially such aswill enable the surgeon to attack pathological processesin their incipiency. Especially in cases of malignantdisease is there much to be desired in this direction.Great advance has been already made in the wideremoval of infected areas, and of the channels throughwhich malignant disease is carried to other parts of thebody. How much more efficient must such measuresbe when applied at the very beginning of a cancer!Perhaps we are justified in looking forward to such adevelopment of the Rdntgen light, that the surgeonwill be able to appreciate the location and character ofall neoplasms while they are still young enough to beradically curable by operation.

The future surgeon will enjoy a much closer andmore intimate relation with his brother the physicianthan has ever existed between them before, for whatwhat belongs to medicine and can be cured by surgeryonly, will be far better appreciated by both surgeonand 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 willbe eagerly demanded by the one, and willingly appliedby the other, at the beginning of disease.

Above all, Mr. President, will the surgery of thefuture attract to its enthusiastic study and practicefiner and finer men, in whose hands we may safelyleave the development of our science. A single glanceat the faces of the students who collect daily in youroperating-room will show you what a change hasoccurred in the last twenty-five years. For this, too,we must ever be grateful to anesthesia, which, inremoving the torture of surgery has robbed it of whatrepelled many sensitive natures. And the science ofasepsis, by rendering complete success in surgicalwork possible, will excite the most devoted enthusi-asm from many scientific men, who soon would havebecome sick at heart over the failures of former times.What more attractive opportunity could possibly existthan will be offered by surgery to the well-educated,refined, able and ambitious student? Through thevast experience of the recent past he will find many ofthe coarser problems already solved, and those thatremain will stimulate him by their difficulty. He willbe an accomplished anatomist and a physiologist; hewill study medicine and pathology first, and thengeneral surgery. If he specializes his practice, hewill do so only after a large general experience; andhe will borrow from every science all that can contrib-ute to the perfecting of his work.

Dn. SAMUEL FENWICK has resigned his post asvisiting physician to the London Hospital, after anincumbency as physician and assistant physician oftwenty-eight years. He has been appointed to theconsulting staff.

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BOSTON MEDICAL AND SURG1CAL JOURNAL. [OCTOBER 15, 1896.

lpoem.

THE BIRTH AND DEATH OF PAIN.1

BY 5. WEIR MITCHELL, M.D.

FORGIVE 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 apartCould the (lead master use his higher artTo lift on wings of ever lightsome mirthThe 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 artWhich knew so well to reach the common heart.Alas! for me, for you, that fatal hour!Gone is the master ! Ah! not mine the powerTo 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 strifeTill 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 completeWhen yearning love to conscious pity grownFelt the mad pain thrills, that were not its own.

What will implacable, beyond our ken,Set this stern fiat for the tribes of menThis, none shall 'scape, who share our human fates:One stern democracy of anguish waitsBy 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 brainCries, 'tis 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 wroughtWhere torture clogs the very source of thought.

Lo! Mercy ever broadening down the yearsSeeks but to count a lessening sum of tears.The rack is gone - the torture chamber liesA 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 gainBy swift despatch a shorter lease for painSaw the grim theatre, and 'neath his knifeFelt 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

1 Read October 16, 1896, at the Commemoration of the Fiftieth An-niversary of the First Public Demonstration of Surgical Anesthesia.

In mercy merciless, swift, bold, intent,Felt the slow moments that in torture wentWhile '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 'tis over." Few who face me nowRecall this memory. Let the curtain fall,Far gladder days shall know this storied hall!

Though Science patient as the fruitful years,Still taught our art to close some fount of tears,Yet who that served this sacred home of painCould e'er have dreamed one scarce-imagined gain,Or hoped a day would bring his fearful artNo need to steel the ever kindly heart.

So fled the years! while haply here or thereSome 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 hopeTo art and science gave illumined scope.

What Angel bore the Christ-like gift inspired!What love divine with noblest courage firedOne eager soul that paid in bitter tearsFor the glad helping of unnumbered fears,From the strange record of creation toreThe 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? AhI no joy-bells rang,No pmeans greeted, and no poet sang,No cannon thundered, from the guarded strandThis 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 hourHas struck for him; a wiser, juster powerShall know full well how fitly to rewardThe generous soul, that found the world so hard.

Oh ! fruitful Mother - you, whose thronging states,Shall deal not vainly with man's changing fates,Of freitborn thought, or war's heroic deedsMuch have your proud hands given, but nought exceedsThis heaven-sent answer to the cry of prayer,This priceless gift which all mankind may share.

A solemn hour for such as gravely pauseTo note the process of creation's laws!Ah, surely, He, whose dark, unfathomed MindWith 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.

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Documents

Semi-centennial of Anesthesia : Addresses