of shock which depends on the spinal marrow and the ganglionic system.There is added, in some cases, the increased tendency to puerperal convulsions, and the collapse described in the cases of Messrs. Nunn and Robbs as the effects of the ether itself, and which has also occurred in many unrecorded cases. The dangers incurred by the use of ether in midwifery would be that of convulsion, and of the meeting of the physical shock of parturition with the shock or collapse produced by the ether itself. Whenever this complication occurred, there would be considerable danger. The moral considerations which relate to our decision I have already alluded to. Briefly, I may repeat, there is, on the one hand, the absence of pain and of painful emotions, with their attendant evils; on the other, there is the physical shock unaverted, the tendency to convulsion, and the possibility of dangerous collapse-a possibility which, in some surgical cases, has passed into fatal certainty.

I know it is ungracious to take the part of an alarmist on such a question; but many fatal cases have now occurred after operations in which etherization has been practised. The patient who underwent the Cæsarian operation died; another patient, on whom extirpation of the eyeball was performed sank; a clergyman, whose leg was amputated, never rallied after the operation; two of the women delivered while under the influence of ether, by the Baron Dubois, subsequently died; and fatal collapse occurred in the case of a woman from whose thigh a tumour was removed. Probably other fatal cases have occurred, of which we have no information. It would be difficult to say in how many of these instances the ether contributed to the fatal results: in some, death would no doubt have taken place under any circumstances: but in others, it may be considered well nigh certain that its use was the chief, if not the sole, cause of death.

The morbid phenomena fairly attributable to ether, observed in cases which have recovered, have been-nausea, sickness, stertorous breathing, pulmonary and cerebral congestion, convulsions, and protracted failure of the heart's action. Now, the bare possibility of producing symptoms such as these by a remedial agent, however valuable, renders it imperative that we should be able to distinguish the cases in which the more serious of them are likely to occur, otherwise the agent itself must inevitably fall into disrepute. As is well known, digitalis may produce failure of the heart; opium, congestion of the brain; and hydrocyanic acid, convulsions: and consequently, caution is always observed in the administration of these still valuable remedies; but after etherization, we may have effects which resemble either undue narcotization, an over-dose of hydrocyanic acid, or the cumulative results of digitalis; so that it behooves us to be triply careful respecting its indications and its exhibtion. In two fatal cases, a fluid state of the blood has been found after death.

As yet, very little has been said towards indicating the proper cases for resorting to ether, and those in which it should be avoided. There has been a general rush towards the operating room, such as the world has never before witnessed. Great numbers of cases were successful on its first introduction; and this gave an eclat to the subject, and induced a confident state of mind in patients, which has doubtless been an element in the successful results; but now that fatal cases have occurred, all that was mere prestige must fall to the ground; and unless the proper cases for etherization can be distinguished with somewhat approaching to certainty, patients upon whom it may be used will go under the knife influenced by previous dread rather than confidence; and so an item of evil, not properly belonging to etherization itself, will come into play. Such is the constitution of the human mind, that a few fatal cases, even by the side of a great number of successful ones, will be sufficient to transmute hope into fear, confidence into timidity and mistrust. Probably the fatal cases which have become known have already produced this effect, and it is believed that many of our most eminent surgeons are declining the use of ether as much as possible. For the sake of etherization, itself, then, something like a pause is required,

otherwise it is to be feared that the old empire of pain will return, and if so, it will seem for the future doubly difficult of endurance, because of the hopeful promise that, in surgical operations at least, it was conquered for ever.

It may be said, that in the dangerous and fatal cases the ether was unduly or improperly inhaled-and from an examination, it does appear that the ether was inhaled for a longer time than usual by some of the patients who died, but in none does it appear to have been inhaled longer than was necessary to produce insensibility; and in Mr. Robbs' case, if we may believe that reflux movements were mistaken for movements of volition, complete insensibility was not present at any time during the operation. It would appear as though the ether occasionally followed an erratic course, not, as is usual, affecting the brain at all, but still going on to poison the spinal marrow and the ganglionic system, and to alter the condition of the circulating fluid. Indeed, so various have been the symptoms observed by different operators, that ether seems almost as volatile in its effects, as in its physical consitution.

In all I have said I am merely setting forth my individual opinion. I have given you the data upon which it is founded, and which, I believe will stand the test of examination. I should observe, in conclusion, that Professor Simpson is far more sanguine than myself in his views of the application of ether to midwifery. His last paper upon the subject ends in the following terms:

"I have stated that the question which I have been repeatedly asked is this: Will we ever be 'justified in using the vapour of ether to assuage the pains of natural labor? Now, if experience betimes goes fully to prove to us the safety with which ether may, under proper precautions and management, be employed in the course of parturition, then, looking to the facts of the case, and considering the actual amount of pain usually endured, (as shown in the above desscriptions of Merriman, Naegele, and others.) I believe that the question will require to be quite changed in its character. For instead of determining in relation to it whether we shall be 'justified' in using this agent under the circumstances named, it will become on the other hand necessary to determine, whether on any grounds, moral or medical, a professional man could deem himself justified' in withholding, and not using any such safe means, (as we at present pre-suppose this to be,) provided he had the power by it of assuaging the agonies of the last stage of natural labor, and thus counteracting what Velpean describes as those piercing cries, that agitation so lively, those excessive efforts, those inexpressible agonies, and those pains apparently intolerable,' which accompany the termination of natural parturition in the human mother.

Baron Dubois concluded his address to the Academy of Medicine, as reported in THE LANCET, in less glowing terms:

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My profound conviction is, (he said,) that inhalation of ether in midwifery should be restrained to a very limited number of cases, the nature of which ulterior experience will better allow us to determine."

More recent experience has certainly not been in favor of enlarging the limits of its applicability in practical midwifery. In our own department there is good reason to believe, that after a short time, unless some certain mode of binding or disciplining this Prometheus shall be discovered, it will be rarely, if ever, used in difficult parturition or obstetric operations, and certainly never in natural labor. It will be a disappointment to have to turn from this promised good, but it is better to do so than to follow an ignis fatuus, if so it prove, to the neglect of real and scientific advancement. Let us hope that this glimpse of deliverance from this heavy infliction on humanity, may act as a stimulus to Science to continue her search after some certain ând available relief from physical pain-possibly a visionary search,-but still one for which human nature will never cease to yearn.

AMERICAN MEDICAL INTELLIGENCE.

1.-Observations on the Poisonous Properties of the Sulphate of Quinine. By WM. D. BALDWIN, M. D., of Montgomery, Ala.

Under this title we find an interesting paper in the American Journal of the Medical Sciences, for April 1847. While the writer gives his testimony to the great value of this important remedy, he cautions the profession against the abuse of it, and adduces cases and experiments upon animals to show that it sometimes proves a deadly poison. He is far from being satisfied with the impression entertained by many, of its "harmlessness under all circumstances, and when given in any quantity." On the contrary he says, "we have in a few instances been advised of the baneful effects of quinine in producing deafness, amaurosis, hæmaturia, violent gastralgia, sudden prostration, delirium, epilepsy, palsy, &c., and under circumstances so obvious as to leave no doubt of its being the result of the poisonous operation of quinine."

After quoting Christisen and Orfila to prove that almost all poisons act in exactly the same way on dogs and cats as on man, he gives the following experiments which he made with quinine on dogs.

Experiments. These experiments were performed in the presence of different members of the faculty, and for valuable aid and assistance I am especially indebted to the kindness of Drs. Boling, Sims and Mc Lester, of this place. I will not impose upon the reader a minute detail of each individual experiment, but will endeavour to condense the general results as concisely as possible.

Symptoms which followed the ingestion of large doses of quinine into the stomach of dogs:—restlessness generally preceded all other symptoms, as was indicated by the animal changing its position often, and constantly moving from place to place. Vomiting, or, in those cases where the esophagus was tied, efforts to vomit succeeded. Purging was noticed occasionally, but in no instance except where the medicine was taken by the stomach. Then came on muscular agitation, or tremulous movements of the body and extremities, with a constant motion of the head, resembling somewhat parolysis agitans. In attempting to walk, the dog would totter from side to side and fall, or if he maintained his feet would walk in a direction different from the one which he seemed to desire. When under the full operation of the poison, the power of locomotion, or even the power of standing in the erect position was lost altogether, the extremities apparently completely paralyzed. This state was accompanied with more or less excitement of the vascular system; the pulse increasing in frequency and rising from 110 to 160, and in one instance even as high as 240 per minute. Great oppression of the breathing was present and sometimes frothing at the mouth. The dyspnea in all instances was excessive, sometimes panting, at others slow and laboured, resembling in a most striking manner an acute attack. of asthma; countenance expressive of great distress and anxiety. The pupils of the eyes were invariably dilated, and generally to an enormous extent, leaving but a small ring of the iris perceptible, and vision, as well as could be judged, was entirely lost. Convulsions were observed in every case (except one,) which was watched to its termination, where the dose given was sufficient to produce death, and in one or two instances where the medicine failed to produce this result. Furious delirium was present in one case, as was manifested by the dog barking and biting at everything about him. Sometimes a profound coma would ensue, accompanied with slight muscular agitation, slow and heavy breathing, terminating in death in a very few minutes after the poison had been taken, and in a few instances the subject seemed as if stunned by some sudden

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From all that I can gather I am disposed to think from fifty to eighty grains of a pure article of quinine, given in solution at one dose, will produce death nine times out of ten, in healthy adults, and occasionally even sinaller quantities. How far its operation may be modified by morbid action is a matter for consideration at the bed side."

Such are some of Dr. Baldwin's views of quinine. We give them for what they are worth; our Southern readers are capable of judging of them.

2.-A Case of Inhalation of Ether in Instrumental Labor.-By W. CHANNING, M. D.

To the Editor of the Boston Medical and Surgical Journal.

DEAR SIR,-I beg leave to offer you the following case for publication. It is indeed but a single instance of the use of ether in midwifery practice; still, such is the importance of that discovery which has abolished pain in so many, and in such a variety of cases-and such the state of opinion, and such the popular and professional interest, in everything bearing usefully on the subject, that I venture to present it in an amount of detail which otherwise might seem unnecessary. To my mind, in the present position of this great discovery, this is the most proper method of communicating such facts.

I look back on the occurrences of this trial of ether with entire satisfaction, and with the deepest pleasure. The ether did just what was looked for from its use. It did it at once, and with no circumstances of embarrassment or difficulty. When its influence was no longer needed, its effects passed quietly away, and left a repose-a continued sense of relief, which, in an equal degree, and like kind, I do not remember to have witnessed before. I shall with pleasure communicate through your Journal the results of such farther trials of ether as circumstances may seem to authorize me to make. And no one should venture upon such trials until he is perfectly satisfied that such circumstances exist. A case came under my observation this day, which impressed upon my mind very strongly the importance of this rule of practice. It was one of unusual severity, and the time of suffering was long. Still there were circumstances in the previeus history of my patient, and in her actual condition, which detered me from taking ether with ine. Such, however, at length, was the urgency, I may say violence of demand for relief, on any terms, and for the use of ether especially that I sent for it. I felt that the moral conviction, always so powerful in labor, that relief would be obtained from this agent, might revive hope, and give encouragement, where a most depressing despair existed, and that thus the labor might be naturally terminated. Whether my reasoning were correct or not, I can say, that almost immediately after the messenger was despatched, efficient uterine contractions came on, which speedily, and safely, accomplished delivery. I remain very truly yours,

Boston, May 11, 1847.

W. C.

Mrs. H., aged 23, was taken in labor, for the first time, May 5th, at 12 o'clock at night. I saw her between 9 and 10, of the morning of the 7th, in consultation with her medical attendant, Dr. W. E. Townsend. His pupil, Mr. Jerome Dwelley, was present, and who also from the beginning had faithfully attended to the case. The pains had been frequent and very severe.Some diminution of suffering had followed the exhibition of an opiate. which had been given before I saw the patient. Patient was well purged with castor oil the day before labor. I found, on examination, the head fairly in the pelvis, where, I was told, it had been many hours. There was no show. The vagina was swollen, rough, hot, especially about the urethra, or anterior part of the pelvis. The os uteri was somewhat dilated, but less in its anterior portion than elsewhere, though in no part of its circumference had it cleared the head.

It

was swollen, smooth, hard, undilatable. It gave just that feel which so strongly intimates that the labor will be protracted, and accompanied by much suffering. The scalp was much swollen, and protruded as a tumor of a conical shape through the firm ring formed by the undilated and undilatable os uteri.

Mrs. H. was comparatively easy, from the opiate apparently. Her pulse was natural. Her strength was not much exhausted. Her stomach bore food well. There was no cerebral trouble, and the bladder had been duly emptied by the catheter. Under these circumstances I suggested delay; and it was agreed to wait to observe the changes which might occur in the present rest, and on the recurrence of pains. I saw her again at noon. Belladonna oint

ment was recommended, as no important change had occurred in the state of the os uteri. I was called to see her at about 6 P. M., about forty-two hours since labor began. I learned, on reaching the address, that the ointment had been used, and a solution of tartarized antimony exhibited, and that some change had occurred in the os uteri, namely, that it was more dilatable. Her pulse was now 120 in the minute. It was less strong than at noon. She could speak only in a whisper, and with great difficulty even so. plained of great distress and most earnestly entreated to be relieved of her terrible suffering. On examination I found the os uteri somewhat more dilatable, and it was agreed that the forceps should be used.

She com

Dr. Townsend called on me to make the visit just related. I said to him, in my study, that this seemed a very fair case for the use of ether. He agreed with me in this opinion, and added that he had a quantity of pure ether at home, and a sponge of suitable size for its inhalation, and that he would meet me at his patient's house. We soon met there, and I proceeded to apply the forceps. I selected Davis's solid forceps, because they are narrow, thin and very easily introduced, and seemed less likely to injure the os uteri than a broader and a thicker instrument. The application was perfectly easy, and I made an extracting effort, which was attended with very severe pain. Mrs. H. soon became quiet, and I desired Dr. T. to apply the sponge, saturated with ether, to the mouth and nose. This he did, and in about a minute she was under the full influence of the ether. The first inspiration produced a slight cough, as if the larynx had been irritated. It was like the sound by which an effort to remove some irritating matter from the air-passages is commonly accompanied. The next noticeable effect, and which was quite an early one, was a sudden movement of the body, such as is made sometimes when one is falling asleep, and has consciousness enough to know this, and to rouse the will into sufficient action to prevent it. It was involuntary, still it did not convey the idea of being spasmodic, in any morbid understanding of the term. She was directed, to open her eyes, to answer questions, &c., but gave not the least evidence of consciousness of anything said. I now proceeded to extract. The os uteri at once came down again, and much embarrassed the operation, so that I desired Mr. Dwelley to pass his fingers between the shoulders of the forceps and the symphysis pubis, and gently press the protruding os uteri upwards. He did so, and thus removed that part from the chance of injury. The extraction was continued at intervals. Not the smallest complaint was made. The womb was roused to action, and strong expulsatory efforts were made. The head advanced, and everything promised well. But at length the head became again firmly fixed, and this to a degree which prevented its being removed by any such force as I believed it safe to employ. I removed the forceps. The effects of the ether passed off, but as soon as consciousness returned, most earnest demands were made for more. "Put it to my mouth-I shall faintyou must"; in short, all forms of entreaty were made use of to obtain the entire relief that the ether had produced. She had at first refused to employ it. The ether had now been used up, and a short delay took place while a further supply was sent for. I perforated the cranium, fixed the hook, and made some extracting effort. Again was complaint made of the suffering which was immediately produced by the traction. The repose had been entire since con