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the Allen surgical pump, have been provided for this purpose, and
give very satisfactory results.
There was formerly employed for the purpose of wet cupping a
small spring instrument, containing several sharp knives, by which a
series of incisions were made in order that blood might be drawn.
This instrument cannot be kept clean and is not used at present.
When wet cupping is desired the part should be scarified with a
sharp knife and the cup applied as above.
Leeching.—Leeches figure largely in literature of the past, but are
not often used, although they may be made effective,
especially when applied behind the ears in cases of cerebral
congestion. The American leech can be relied on only to abstract
about a teaspoonful of blood, while the Swedish will draw three or
four times that amount. The region to which they are applied must be
washed, and, if necessary, shaved. The part should then be
smeared with milk, blood, or sugar-water. The leeches should be put
in a basin of fresh water, after which they are placed upon a dry
towel for two or three minutes. Each one is then taken up in a small
glass or test-tube and inverted over the spot chosen. As soon as the
animal fastens itself upon the skin the glass may be removed.
Leeches are often capricious and will sometimes wait considerable
time before attaching themselves. When full of blood they usually
relax and drop. If it be desired to remove them a little salt will make
them relax. Leeches should never be applied over loose cellular
tissue nor over superficial vessels or nerves. If used in the interior of
a cavity they should be prevented from passing too far.

COUNTERIRRITATION.
Counterirritation is a valuable means of accomplishing that which
is sometimes induced by leeches—namely, attracting blood to the
surface for the relief of deep congestion. In fact it comprises more
than this, since there is some deep influence exerted through the
medium of the nervous system; it not only equalizes the circulation,
but tranquillizes a disturbed innervation. The milder and more
domestic means include the use of the so-called rubefacients—hot
water, mustard, and turpentine. These are of little use in surgical
conditions which call for counterirritation; their use should be
controlled with caution lest mere counterirritation be converted into
actual burning.
By the use of vesicants a blister is produced, i. e., an effusion of
serum and lymph beneath the superficial and outside of the deeper
layer of the skin. Mustard and cantharis are the principal vesicants in
common use. The former may be used in full strength, in which case
it is active, or it may be reduced with wheat flour or linseed meal. To
bring out the full strength of mustard, hot water should not be used in
its preparation, as it renders it almost valueless. A mustard paste or
plaster should be watched at intervals, and it should be removed
when the desired effect has been obtained—at all events, when the
surface to which it has been applied is covered with vesicles.
Cantharis, or Spanish fly, is used either in the form of the
cantharidal cerate or mixed with collodion, the latter being the
neatest and most pleasant preparation. Several layers are painted
on the surface where its effect is desired. This is then protected, and
vesication will be found to have been produced within an hour or
two, except where the skin is most resistant. The stronger chemicals,
like ammonia, chloroform, strong iodine, and nitrate of silver
solutions, will be found to be active blistering agents, but should be
used with caution.
Two other methods of irritation were at one time in favor—namely,
the seton and the issue. The former consisted of a bundle of threads
or a wick, drawn into a large needle with a lancet-shaped point; the
skin was picked up into a fold, the needle made to traverse it, and
the wick was thus drawn through and cut off, so as to be left in place.
The issue was made by drawing a blister with a powerful agent, and
then preventing it from healing by the use of an irritating foreign
body. These procedures have been abandoned by the medical
profession, but are still in vogue among veterinary surgeons.
The Actual Cautery.—In some one of its improved forms the
Paquelin cautery has replaced all the old
cruder methods of cauterization. When properly employed its
counterirritant effect can be made most serviceable for the relief of
pain, or for any desired form or degree of counterirritation. Applied
over the upper abdomen, with the lightest possible touch, in such a
way as to deserve the term “flying cautery,” it will sometimes afford
great relief in nausea and vomiting, especially when these symptoms
are purely reflex.
Used over the course of the larger nerves it does much to relieve
the pain of neuritis; while over swollen joints and swollen testicles it
affords great relief from the pain of chronic arthritis and chronic or
acute epididymitis. In deep-seated congestions and inflammations
ignipuncture may be made with a small cautery point, by plunging it
through the skin into the underlying tissues, and into bone. The relief
of tension as well as the counterirritation will give great relief. When
practised in this manner local or general anesthesia may be used.
Except when thus used it will rarely be necessary to do more with it
than to disturb the exterior of the skin. When skilfully used this can
be done with the production of very little pain.

PARACENTESIS.
Paracentesis is the technical name given to the act of tapping, or
the withdrawal of fluid from any of the closed cavities of the body. It
includes aspiration, tapping, and incision.
Aspiration.—By aspiration is meant the removal of fluid without
the admission of air; it comprises the use of a suction
apparatus, usually known as an aspirator, which may be had in
various forms and sizes. A small so-called exploring syringe will
answer for small cavities, while for large collections of fluid, such as
may be met with in the thorax, more elaborate apparatus is used,
consisting of a suction pump connected by tubing with a bottle in
which the vacuum is produced. By another tube this bottle is
connected with a hollow needle used for the withdrawal of the fluid.
Absolute asepsis should be observed, even in this minor procedure.
The skin should be cleansed, and the needle, instrument, and hands
should be sterilized. The pain of puncture may be prevented by use
of the freezing spray, of cocaine injected locally, or by touching the
skin with a drop of pure carbolic acid. The vacuum is commonly
resorted to in the removal of fluid from the thorax, the spinal and the
cranial cavities, and from joints; also in small collections of pus in
any part of the body.
 Tapping.—Tapping means a somewhat similar procedure with a
larger instrument known as a trocar and a surrounding
cannula, without the aid of the vacuum. Precaution should be taken
in every regard that the instruments and the parts should be
sterilized.
The trocar, inserted in the cannula, should be plunged quickly into
the cavity at the site selected. Considerable resistance will be
offered by the skin. If the trocar be small it is enough to anesthetize
the skin; if large, a small incision will permit of its better use. The
instrument makers have provided cannulas of various descriptions,
to which tubing may be attached, so that the fluid may be conducted
into a suitable receptacle, and wetting the patient avoided. It is well
to draw the skin aside and not to make the instrument pass directly
into the cavity to be tapped unless it contain pus and it be desired to
keep it open. If this precaution is taken the skin will cover the deep
opening after it slips back into its position, and will act as a valve to
prevent leakage. In this way infection may be avoided.
When fluid has ceased to be serous and has become purulent, as
in empyema, it is often so thick that it will not flow through any hollow
instrument. In such an event free incision should be made. When the
thorax is involved incision is made between the ribs, and in order to
maintain drainage a good-sized drainage tube should be inserted.
This at times may be so compressed between the ribs that an inch or
more of one rib should be exsected to provide against this possibility.

TRANSFUSION AND INFUSION.

Though much has been said concerning the indications for these
procedures no explicit directions have been given. While they are
often emergency measures they are, nevertheless, frequently
practised. In well-regulated institutions the conveniences are always
at hand for instant resort when needed; but it would be well for every
general practitioner to have ready at all times the few things that are
required, for at least hypodermoclysis. In country practice, however,
a clean fountain syringe, a suitable aspirator needle (both carefully
sterilized), some boiled water, table salt (when nothing else is at
hand), and soap and water for sterilization of the operator’s hands
and the patient’s skin are all that are necessary. In every outfit there
should be a needle which may be used for this purpose. It may be
carried in a glass tube, always sterilized, and ready for use. No
fountain syringe should be used which has not been freshly boiled,
except in an emergency. Tablets containing common salt in definite
amount, so that a solution of given strength can be made by adding
them to a definite amount of water, can be procured. With such a
needle, a few tablets, and a fountain syringe the surgeon is prepared
for any emergency.
For intravenous infusion for which no pressure is required, an
ordinary funnel, with rubber tubing attached, will be sufficient without
the use of a rubber bag.
The use of salt solution has supplanted the transfusion of blood.
This requires a source of blood which is not always at hand and an
amount of attention which can rarely be given in emergencies;
moreover, it has been shown that the injection even of defibrinated
blood is a dangerous procedure, because of liberation of hemoglobin
and destruction of white corpuscles, with the liability to coagulation of
the blood from increase of fibrin ferment, and the possible death of
the patient. Direct transfusion from another person into the veins of
the patient is also difficult, and has rarely been of service.
As already stated in the chapter on Shock, the best solution for
infusion is composed of calcium chloride 2 parts, potassium chloride
3 parts, sodium chloride 9 parts, sterile water, 1000 parts. The
addition of one part of sodium bicarbonate will sometimes prove of
advantage, while in diabetic cases this may be increased to three
parts to a thousand. It has also been suggested to add a small
proportion of sugar, even up to thirty parts, to this solution, in order to
increase osmotic action and better preserve the red corpuscles from
injury. It is supposed also to give a certain nutritive value.
When the fluid is injected into the venous system all that is desired
is that it barely enter; consequently the receptacle containing the
fluid should be held but a few inches above the level of the opening.
When hypodermoclysis is practised more pressure will be needed
and a greater difference of level should be maintained. In the veins
the amount injected should not exceed 100 Cc. each minute. From
500 to 1500 Cc. may be used altogether. There need be no
hesitation in introducing it at a temperature considerably above the
body normal, and in cases of shock it may be introduced even at
115° F. The character of the pulse will afford the indication as to the
amount of fluid to be used as well as the wisdom of repeating the
measure after an interval.
For intravenous infusion a vein in the arm is usually exposed and
the needle point carefully inserted. It is an advantage to have for this
purpose a special needle, made with a blunted extremity, enlarged a
little, so that by the use of a temporary ligature the vein may be held
tightly around the cannula, for such it really is, and the escape of
fluid be prevented. After withdrawal of the needle a double ligature
should be placed for purposes of security. The limb should also be
kept at rest for a few days.
For hypodermoclysis from 500 to 1000 Cc. may be employed; the
anterior abdominal wall, the flank, the thigh, and the retromammary
tissues are the best regions in which to inject the solution.
Absorption will be assisted by gentle massage. Local anesthesia by
the freezing spray, or by cocaine, will rob the procedure of its
discomfort. Adrenalin may be added to the solution, whose formula is
given above, in emergency cases where it seems to be especially
needed. In instances where infusion is practised for the purpose of
washing out the blood, i. e., in the acute toxemia of uremia,
alcoholism, etc., nothing of the kind will be required; but in conditions
of lowered blood pressure, i. e., shock, it will prove of great value, as
already indicated.

CATHETERIZATION.
Catheters, as such, are intended for the withdrawal of urine from
the urinary bladder, or for the introduction and withdrawal of
cleansing fluids. They are made of metal, glass, gum, and silk, or
other similar material, in various sizes, while some are specially
formed or bent in order to pass more easily over the obstruction
offered by a median prostatic enlargement. Various forms are sold in
the surgical depots, from which the purchaser may make a choice.
Next to the simple tubular forms the elbowed or Coudé catheters are
of the greatest value.
 Catheters should be sterilized before use. Those used
occasionally should be cleaned after use and dried, while those in
daily use may be kept in an antiseptic solution after cleansing. The
cleansing of a catheter should include not only attention to the
exterior, but also removal from its bore of all clots, debris, etc. Some
pressure behind the fluid used for this purpose is advisable. A clean
metal or glass catheter may be sterilized in a flame just before use.
All flexible catheters should be boiled just prior to their insertion, or
they should be taken out of an air-tight receptacle in which they have
been kept in contact with some antiseptic, or in an antiseptic vapor.
For the latter purpose paraform offers an excellent material, as there
is given off from it formaldehyde vapor, which is a powerful
bactericide. It comes in crystals and in tablets. Rubber catheters
should be boiled in a 5 to 10 per cent. solution of ammonium
sulphate.
The urethra should also be cleansed, especially the meatus, in
either sex. Cases of cystitis may be directly traced to infection
introduced by a catheter, the result being the same whether the
germs be not removed from the instrument or are carried in by it
from the anterior urethra. This is particularly true in paralytics who
have no power of expelling the urine, and in prostatics who need
regular catheterization.
The technique of using the metal catheter in the male is the same
as that of introducing a sound. A lubricant is necessary for the easy
introduction of the instrument, and a sterilized ointment or oil will
serve the purpose. Olive oil, mixed with iodoform, as often used, is
not sterile. The hands of the operator should also be clean, and no
part of a clean instrument should be allowed to come into contact
with any portion of the patient’s surface. On this account the parts
exposed should be covered with sterile towels.
The catheter being intended to afford relief with the least amount
of discomfort, a smaller instrument may be used than would be
inserted were it meant for the dilatation of a stricture. Occasionally,
and in a sensitive patient or hyperesthetic urethra, a little cocaine
solution may be used to advantage, especially if force or pressure
need be made in order to overcome spasm of the cut-off muscle.
The metal instrument is too rigid in some cases, while the gum
catheter is too flexible. Under these circumstances, the silk
instrument may be used.
If the tip of the instrument be kept close to the floor of the urethra it
will rarely catch in any fossa or lacuna, particularly if the size has
been correctly chosen. When apparent obstruction occurs at the
triangular ligament the instrument should be withdrawn a little, tilted
differently, or lifted a little so that it is made to hug the roof of the
urethra rather than to press upon its floor. By a little manipulation of
the end of the instrument any obstruction at the neck of the bladder
may also be overcome. A sudden depression of the outer end as the
catheter reaches this part, or a little pressure by the finger of the
disengaged hand in the perineum, will give much help. It is well,
occasionally, to introduce one finger into the rectum in order that by it
the instrument may be better guided along its course. Only in cases
where there has been previous disease or where unsuccessful
attempts have already been made to pass an instrument will much
real difficulty be found; that is, only in those already suffering from
stricture, or from enlarged prostate with the difficulties which it
affords, will one have to resort to manipulation requiring more than
ordinary dexterity. In some of these cases even the expert is likely to
meet with difficulty, rarely with absolute disappointment. Should it be
impossible to empty a distended bladder with a catheter suprapubic
puncture with the aspirator needle should be made.
When difficulty is experienced it is enhanced by spasm of the deep
muscles, as a reflex from the soreness produced by repeated efforts
and by hemorrhage.
Hemorrhage from this source is rarely of serious character and
quickly ceases. In certain instances where it is aggravated much can
be accomplished by leaving the catheter in situ for a few hours, or
even for two or three days.
False passages will occur sometimes in spite of at least ordinary
care, and are always serious in their nature. Extravasation of urine
may result, with more or less disastrous consequences, or speedy
septic infection may quickly terminate the life of the individual. They
are to be avoided, as far as possible, by the use of instruments of
large rather than of small size, with blunt tips, and by delicacy of
manipulation. For this purpose it is well to avoid the use of catheters
which require a wire stylet for the maintenance of their proper curve,
lest during manipulation the point of the wire may work injury. The
various accidents due to or connected with catheterization will be
dealt with in their proper places in connection with the surgery of the
urethra and bladder.
There are certain constitutional complications, however, which
deserve mention. One of these is known as urethral fever, which
comes on usually with a chill, followed by more or less rise in
temperature, and with general disturbance of the system. It is to be
regarded as a manifestation of septic intoxication, the hope being
that the disturbance may not go beyond this degree. In cases that
have once suffered from this intoxication precautions should be
doubled. The deep urethra should be irrigated before and after the
withdrawal of the urine, the patient should be kept in bed, and
urotropin and quinine may be administered before and after the
discharge of urine. Much may be done in the prevention of this as of
other unpleasant occurrences, such as pain, excitement,
suppression of urine, syncope, etc., by the previous use of cocaine
and by due regard for gentleness. Should a septic process be set up
in the deep urethra it may lead to sapremia of urethral origin, and to
septicemia and pyemia. Septic complications accompanied by any
local indications, such as swelling, should make the surgeon
watchful for the time when an incision must be made for relief of
tension or escape of pus.
Postoperative suppression of urine, which may occur even after
catheterization, may be treated by giving 0.08 to 0.15 Cg. of sulphate
of sparteine every three or four hours (McGuire).

SKIN GRAFTING.
The whole method of skin grafting is based on the fact that if
epithelium be removed from any portion of the body and planted on
favorable soil elsewhere it will take root and grow, reproducing only
itself and no other kind of tissue. It is closely analogous to sewing
seed upon a favorable soil, or even to sodding. Furthermore it is not
necessary that epithelium be furnished from the individual upon
whom it is to be implanted; it may come from another of the same
species or even from a different species. Thus the skin of the frog
has been used for grafting upon human beings, and even the lining
membrane of the egg. Nor is it necessary that the epithelial cells
should be apparently alive when thus employed. Very thin shavings
of human skin which have been dried, or have been kept from
decomposing by some antiseptic, have been successfully used;
nevertheless the ideal method consists in taking what is needed from
the individual who needs it.
The term skin grafting is now applied to the employment of very
thin layers of the epidermis, i. e., as thin as can be shaved off with a
sharp razor, and it does not apply to the autoplastic methods of skin
transplantation.
Hamilton, of Buffalo, and Reverdin, of Geneva, a number of years
ago independently discovered that minute particles of healthy skin
might be implanted upon healthy granulations and that from such
minute grafts epithelium would be produced and a fresh epidermal
covering be afforded. This method was in use for years and was a
great advance on what had previously been done. Then Hamilton, of
Edinburgh, suggested the use of thin slices of clean sponge, in order
that thereby a trellis might be offered for the growing and climbing
granulation tissue; this served a good purpose in many cavities. But
the greatest advance came when Thiersch demonstrated that large
areas might be covered with skin shavings, and that thus in a few
days there would be accomplished that which took weeks or months
by older methods. His original plan comprehended only the use of
these grafts upon granulation tissue; later it was found that they
might be applied to fresh raw tissue, even to denuded bone. Thus
originated the so-called Thiersch method of skin grafting.
The surface to which these grafts are applied must be thoroughly
cleansed as well as the surface from which they are removed. If an
ulcerated surface is to be prepared for grafting it should be scraped
thoroughly with a sharp spoon; all sloughing or suspicious tissue
should be carefully removed, and all oozing allowed to subside. Not
until the surface is prepared is it advisable to remove the grafts.
These are best removed by putting upon the stretch the skin of the
selected area, so as to render it taut and as nearly flat as possible.
The razor used for the purpose should be sterilized and sharp. Salt
solution may be allowed to drip upon the razor while the surgeon is
using it. It is rarely practicable to remove a strip over 5 Cm. wide or
25 Cm. long. The endeavor should be to remove only the superficial
layer of the skin, and when properly done this removal should be
followed by but a trifling oozing of blood. If bleeding be profuse the
layer removed has been too thick. Grafts of sufficient number and
size are removed to nearly cover the desired area. The more
completely it is covered the more acceptable will be the final
appearance of the surface. If the grafts adhere, we may confidently
rely upon their furnishing enough fresh epithelium to fill in the
irregular defects between the edges. The grafts when cut should be
raised with a razor and a spatula and gently spread out upon the
prepared surface, and so pressed and treated that no air bubbles are
retained beneath them. If the surface be dry enough they will adhere
to the very thin coagulum of blood which glazes it, and after a few
moments it will take friction to disturb them.
Should the margin of the surface to be grafted be old and
indurated it is best to trim off any depression that exists, so that the
new skin may not be let in below the surface of the surrounding skin.
The dressing should consist of a layer of sterilized oiled silk, gutta-
percha tissue, or green protective, laid on in strips, in order that
excessive fluid may escape between them. A little antiseptic powder
may be dusted upon the grafts, if such be the choice of the surgeon,
but if the operation has been properly managed this will hardly be
necessary. Careful regulated pressure should be made outside of
the protective, by cotton and a suitable dressing, and then the part, if
a limb, may be bound upon a splint in order to ensure physiological
rest. Silver, tin, or aluminum foil also make a good protective, and,
on theoretical principles, are even better than the textile materials.
Some surgeons leave these dressings for several days. I have
found it an advantage to remove them within thirty-six hours, as
sometimes the grafts appear to be macerated in the fluids and to
lose their first cohesion to the prepared surface. The main thing
about the dressing is that it should be non-adhesive and restful. After
three or four days, when the grafts have completely adhered, any
ointment dressing may be used. It may happen that only a portion of
the entire number of grafts serve their purpose, and that others fail to
do their work. Even when the failure has been apparently
considerable it will often be seen that individual epithelial cells have
adhered and later will grow. The unhealed portions of such a surface
now fall within the definition given earlier of an ulcer, and should be
subjected to the same treatment.
Grafting may be repeated as often as seems to be necessary. The
best surfaces from which to take the grafts are usually the outer
aspects of the arms and thighs. The places from which they are
removed need only the simplest antiseptic dressings. If the grafts
have been of sufficient thinness the scars left by their removal are
scarcely permanent and rarely disfiguring.
Wight, of Brooklyn, has suggested that advantage be taken of the
properties of high-frequency discharges from a suitable apparatus to
secure their hemostatic and coagulant effect. He has shown that
such electrical discharge will clot blood and coagulate albumin, this
effect being partly due to the formation of nitric acid from the air. In
this way it is theoretically possible to so seal the surfaces as to fix
grafts firmly in place. The apparatus calls for a pointed electrode,
passed at a distance of about 1 Cm. above the entire surface, until
the clot is firm and reasonably dry, all serum that is expressed in the
process being removed with sponges. Where the apparatus can be
employed this affords an effective way of fixing the grafts and
preventing their displacement.
Surface epithelium from an animal source may be used when
necessary—as from a young pig after it has left the packing-house, a
young calf, or some smaller animal. All that is required is epithelium.
That from a negro will reproduce only pigmented cells like the
original. At the time when amputating a limb about which there is still
left healthy unbroken skin, shavings may be removed from it and
preserved for a week or two between dry sterilized towels or in a
weak antiseptic solution; these may then be utilized for skin grafting
during the ensuing few days.
 Fig. 30

Figure-of-8 bandage of leg.

Fig. 31 Fig. 32

Velpeau’s bandage. Ascending spica bandage of the groin.

BANDAGING.
 Bandaging is a subject now taught so generally by actual
demonstration, and so simplified, that it scarcely seems necessary to
more than present a few illustrations showing how simple bandages
can be applied in the most effective manner.
The purposes of a bandage are either to afford means of retaining
splints and dressings, to exert pressure, or to afford physiological
rest. After every operation of importance it is necessary to apply and
retain an occlusive and aseptic dressing, under which the wound
may heal or into which wound discharges may be received; but the
ideal dressing affords more than this—it furnishes support and rest.
Fig. 33 Fig. 34

Spica bandage of shoulder.

Fig. 35 Fig. 36
 Third roller of Desault’s bandage.

There is danger in the injudicious use of any bandage, as by the

exertion of undue pressure it may interfere with wound healing, or
may even lead to gangrene. If applied loosely at the extremity and
too tightly above it will lead to venous obstruction and possibly
secondary hemorrhage. Moreover a bandage which seems properly
arranged may become so tight as to be painful and even unbearable
after swelling has occurred. There is but one safe rule, and that is to
take note of the appearance of the part as well as of the sensations
of the patient. An abdominal bandage may have been placed with a
proper degree of snugness at the conclusion of an operation, and yet
be altogether too tight when the abdomen becomes distended with a
little gas. There is then always room for discretion and good
judgment in the matter of bandaging. It may be necessary to apply a
bandage quite firmly at first in order to repress hemorrhage, with the
intention to relax it after a few hours.
A splint may be a necessary feature in a surgical dressing; after
amputating at the lower part of the leg it is advisable to bind the limb
upon a splint in order that the necessary physiological rest may be
thus afforded. The first requisite of a bandage is not its appearance
but its effectiveness; a due regard for the esthetic in surgery will,
however, dictate that it be made as presentable as possible.

Fig. 37 Fig. 38

T-bandage. Kelly’s bandage with perineal straps.

For the roller bandages of cotton cloth, universally in use twenty-

five years ago, there have been substituted bandages of thin gauze
or crinoline, which have scarcely body enough to be applied, as was
the roller, or else of flannel, made wider and necessarily thicker,
which are more flexible, comfortable, and applicable.
 Fig. 39

Barton’s head bandage as employed for suspension in applying

plaster-of-Paris bandage.
 Crinoline impregnated with starch is also in general use and
makes a serviceable bandage for head injuries. When prepared with
plaster of Paris it is capable of affording absolute support and even
rigidity.
 CHAPTER XX.
ANESTHESIA AND ANESTHETICS, GENERAL
AND LOCAL.
To Oliver Wendell Holmes we owe the term anesthesia, as
generally employed and made to mean insensibility to pain, no
matter how produced. A more strict definition would limit the term to
conditions comprising not only insensibility to pain but loss of
consciousness. For mere loss of sensation we should, strictly
speaking, use the word analgesia. This is a distinction with a
difference. Thus I have on rare occasions seen a patient under
chloroform absolutely oblivious to pain but perfectly conscious, and
chatting intelligently throughout the operation. This is a rare
phenomenon, but has been noted by various observers. So after
intraspinal cocaine injections we secure complete analgesia of the
lower portion of the body, but not complete anesthesia, the former
being what we are most anxious to produce.
The discovery of anesthesia is essentially to America’s credit.
Long, of Georgia, had produced anesthesia by ether as early as
1842; Jackson, of Boston, also claims credit for the discovery; but to
Morton, a dentist of Boston, is undoubtedly due the honor of having
introduced it for surgical purposes. The first public demonstration of
its properties was made by Morton and Warren, October 16, 1846, in
the Massachusetts General Hospital. Chloroform seems to have
been exploited independently by Guthrie, of Sackett’s Harbor, N. Y.,
and Simpson, of Edinburgh, in 1847. It is a curious historical fact that
the patient to whom Simpson meant first to administer chloroform in
his clinic did not receive it because of some failure to have it on
hand; she took ether instead and died, presumably of the anesthetic.
Had she died under the influence of chloroform it would have been a
serious setback to any general appreciation of its merits. Nitrous
oxide is also an anesthetic for which America may take the credit.
These are the three drugs in common use today, although there are
others which are coming into general favor.