an article of the materia medica, used by medical men for various purposes, but principally to produce a state of anesthesia or painlessness in surgical and obstetric operations, and in different forms of disease.
The fluid to which the name of chloroform is given was nearly simultaneously discovered in 1831-32 by Guthrie in America, Soubeiran in France, and Liebig in Germany. Its true chemical composition, however, was not ascertained till Dumas and Peligot directed their attention to the subject in 1834-35. It consists ultimately of 2 atoms of carbon, 1 of hydrogen, and 3 of chlorine. But in accordance with the generally received opinion of chemists, it may be more correctly described as composed of 3 atoms of chlorine, and 1 atom of formyl; and hence the names given to it of chloroform, chloroformyle, formychloride, or perchloride of formyl. In other words, it is regarded as a compound of chlorine with formyl, while the latter is the hypothetic base of formic acid, or of that fluid capable of reducing the oxides of the noble metals, which Samuel Fischer long ago distilled from the body of the red ant, or formica rufa (hence the name formic and formyl), and which Marggraf, Arvidson, Richter, Gchlen, and others have subsequently more elaborately examined.
When Guthrie, Soubeiran, and Liebig first discovered chloroform in the course of their chemical experiments and inquiries, and when Dumas and Peligot subsequently worked out its true chemical composition, their sole and only object was the investigation of a subject in philosophical chemistry. They laboured for the pure love of the extension of knowledge; they had no idea that the substance to which they called the attention of their chemical brethren would or could be turned to any practical purpose, or that it possessed any physiological or therapeutic effects on the animal economy. Those who use the cui bono argument against philosophical investigations, on the ground that at first they may appear to yield no practical benefit, will find that argument fully refuted in this as in many other instances; for here we have a chemical compound which for many years after its discovery was merely interesting as a matter of scientific curiosity and research, becoming latterly an article of great importance and extensive manufacture, as a medicinal agent by which human suffering and agony may be annulled under some of the most trying circumstances in which human nature is ever placed.
Chloroform may be obtained by various processes; as, 1, by passing a stream of chlorine gas into an alkaline solution of caustic potash; 2, by decomposing chloral with the agency of aqueous fixed alkalies; 3, by heating acetate of potass or acetate of soda with chloride of lime; 4, by boiling chloroacetic acid with aqueous ammonia; 5, by decomposing chloride of methyl by chlorine in a vessel exposed to the sun's rays; 6, by distilling alcohol, pyroxilic or wood spirit, or acetone with chloride of lime, &c. &c. Some vegetable oils, as those of turpentine, lemons, bergamot, peppermint, &c., when heated with chloride of lime and water, yield chloroform. When manufactured on a large scale, chloroform is prepared by distilling a mixture consisting of six parts of chloride of lime, or common bleaching powder, in thirty parts of water, and one part of alcohol. The fluid which passes over separates into two layers, the lower of which is chloroform; and the upper layer consists principally of a solution of weak spirit. The chloroform, before it can be safely used, requires, however, to be much purified. For, 1st, in order to remove the water and alcohol mixed with it, it is shaken up with about half its volume of strong sulphuric acid, slowly added; and, 2dly, to remove the acid, the chloroform is redistilled from milk of lime. Sometimes it is redistilled a third or even a fourth time, after being allowed to stand over quicklime, in order to render it completely pure, and of the requisite specific gravity. For other methods, and full details as to the manufacture of chloroform on the large scale, we need only refer to the pharmacopoeias and dispensatories, and the various text-books on chemistry.
It is a clear, colourless, limpid liquid; heavy, and of a specific gravity varying from 1·480 to 1·500; not inflammable; very volatile; it boils at 140° Fahr., and remains liquid and transparent at 4° Fahr. The density of its vapour is 4·13, or it is about four times heavier than atmospheric air. It has a fragrant, ethereal, fruit-like odour, and a slightly acrid, but at the same time intensely sweet, saccharine taste. It dissolves very sparingly in water, to which it imparts its sweet odour and taste; but it mixes in all proportions with alcohol. It is a powerful solvent, speedily dissolving camphor, gutta-percha, wax, resins, &c.
Impurities. Chloroform is often found in the market very impure, and containing empyreumatic oils, aldehyde, chlorine, free muriatic acid, &c. When so contaminated, its medicinal use, by inhalation, is liable to be attended by headache, cough, nausea, &c. It deserves to be particularly known that the purest chloroform will sometimes spontaneously decompose if left exposed for a length of time to the combined influence of heat and light. Hence, when the liquid is kept for medical purposes, and particularly in warm climates, it is a matter of importance to keep it in a dark and cool place.
When inhaled in small quantities only, and slowly, the influence of chloroform upon the system is exhilarating and intoxicating, like the influence of alcohol or any diffusible stimulant.
When inhaled in larger and continuous doses, with the view of suspending pain in surgical, obstetrical, or medical practice, its effects are generally as follows:—After a few inhalations there supervenes a feeling of warmth and exhilaration, radiating from the heart towards the extremities, but generally perceived first in the extremities themselves. In most persons this feeling is speedily followed by a sensation of vibratory thrilling and benumbing throughout the body, and by affections of the organs of sense, as by loud whirring noises in the ears, or brilliant lights before the eyes. After one or two additional inhalations there is a rapid loss of sensation and voluntary motion, and at last a total suspension of consciousness. The state induced is a condition of deep artificial sleep. During this anesthetic sleep, the relation between the mental condition of the patient and his unsusceptibility to the feeling of pain differs much in different individuals, and is greatly regulated by the amount of dose that is used. When the dose is at last full and complete, and such as is now usually given before most great surgical operations, no mental action appears to go on, or, at least, none whatever is remembered. In other persons, however, and especially when the dose is not so great and complete, though all consciousness of pain is suspended, the mind is still active as in dreams; and occasionally, though rarely, this peculiarity is observable—that the same type of dream recurs to the same individual every time he is subjected to the anesthetic vapour. Sometimes when the dose of chloroform is not sufficiently great, a patient will wince or cry out under the use of the surgeon's knife or cautery, and afterwards on awaking declare that he has felt nothing. In such cases a certain amount of sensibility and consciousness appear to remain, but the memory of the patient subsequently retains no recollection whatever of any circumstances that have happened during his temporary anesthetic sleep. Persons occasionally will talk ramblingly when subjected to an incomplete dose; but this rarely happens, except some of those around are conversing and exciting the patient; and it can be readily arrested by an additional dose of the anesthetic, and by enforcing quietude. In other persons again, sometimes, when the dose is small, sensation is found to be suspended, and freedom from pain obtained, whilst still a greater or less amount of mental consciousness and intellectual activity and clearness remains. Their sensibility to suffering is more or less completely deadened, while their intelligence is preserved. The muscles of voluntary motion usually become more and more relaxed as the intensity of the anesthetic effect increases, and at last their action can always be thoroughly suspended—a matter of great surgical moment in relation to the reduction of dislocations. But occasionally, before this total relaxation is produced, a state of spasm supervenes, particularly if the patient is held and restrained, or excited by talking and noises during the inhalation of the chloroform. Generally the pulse is increased in frequency during the first inhalations, but when the system is fully brought under the influence of the anesthetic it decreases to its natural standard, or even becomes slower than natural; and few persons are able to bear with total impunity the wounds of a severe surgical operation until the anesthetic vapour is given to such an extent as to have reduced the pulse to this degree. The respiration, though unaffected at first, becomes slower and deeper as the influence of the anesthetic increases; and usually it is rendered soporose before any great surgical operation is begun. The temperature of the body decreases when the action of the chloroform is long continued.
The rapidity with which the effects of chloroform upon the mind and body disappear is perhaps not less wonderful than the rapidity with which they supervene. Generally the awakening from the anesthetic sleep is in the course of a few minutes after the inhalation is arrested. When the patient is left undisturbed, he usually awakes to a state of perfect consciousness; but sometimes, particularly if roused artificially or too early, a few minutes will elapse before he is perfectly master of his own state and situation. When the drug used is pure no headache follows. In some cases there is left a tendency to sleep.
The inhalation of chloroform is now extensively employed by professional men to fulfill various purposes in the practices of surgery, midwifery, medicine, and medical jurisprudence.
In surgery it is employed with different indications, as, in Surgery, 1. And principally, to annul and abolish the pain and agony attendant upon the various chirurgical operations, whether these operations are performed with the knife, caustic, ligature, or otherwise. But the surgeon finds great value in its use in other matters of practice, as, 2. In enabling him to make a fairer examination and more accurate diagnosis in some difficult cases of injury and disease, such as fractures, dislocations, stone, &c. 3. By the total relaxation which a full dose produces, the reduction of dislocations, hernia, &c., is much simplified and facilitated. 4. The removal of patients who have suffered severe injuries or wounds, to their homes or to hospitals (a matter often attended with much and exhausting suffering), has now, by the previous use of chloroform, been often accomplished without pain and without danger. 5. The agony attendant upon the daily dressing of large wounds, as those made by burns, amputations, &c., has been abolished by its employment. 6. Under the use of chloroform amputations and other operations, required after severe injuries and wounds, are sometimes capable of being performed when, without it, the state of shock and depression would otherwise totally forbid operative interference. And lastly, the mortality accompanying surgical operations has been in a marked degree diminished and lessened since the general introduction of anaesthetics.
Various important objects are gained by the accoucheur through the employment of chloroform in midwifery. 1. By its use he is enabled to save the mother from the suffering attendant upon the process of common parturition in the human female, and that without placing his patient in a degree of anesthesia by any means so deep, and hence so dangerous, as is required in surgery. 2. In morbid or difficult cases of labour, requiring manual or instrumental interference, the state of anaesthesia enables him to apply that interference without pain to his patient, and generally with much greater facility to himself. 3. By its aid the process of obstetric diagnosis is, in many circumstances of doubt and difficulty, very greatly improved and facilitated. 4. By its relaxing effects it renders the dilatation of the maternal canals more easy, especially where these canals have any tendency to spasmodic rigidity and contraction. 5. In cases where arrestment of uterine action is a matter of great importance, as in the operation of version, &c., a very complete and very deep dose of chloroform enables us to attain this object far better and more speedily than by opium or other means. 6. Chloroform seems generally capable of redueing and keeping in abeyance one of the most common and most fatal complications in difficult labour, namely, puerperal convulsion. And, lastly, by saving the constitution of the patient from the pain attendant on the process of human parturition, it saves her strength and constitution, expedites her convalescence, and renders her proportionally less liable to the various affections which occur in the puerperal state.
The inhalation of chloroform has been employed in medicine for various purposes:—1. As an anodyne or anaesthetic in severe and exhausting pains, whether inflammatory or neuralgic; as in earache, toothache, pleurodynie, tic, &c. 2. As a narcotic in cases of delirium tremens, of puerperal and other forms of mania, and in other diseases where there is wakefulness and excitement. 3. As an antispasmodic in colic, dysmenorrhoea, laryngismus, asthma, hooping cough, the pains attendant on the passage of biliary and renal calculi, in chorea, tetanus, hysteria, and in infantile and other forms of convulsion. 4. In small doses as a diffusible stimulant to arrest the first commencement of the rigor in ague, in ephemeral fever, &c., and to support the excitement of the system where the stomach will not bear wine or other stimulants. Lastly, it has been used, particularly by some German and French physicians, in inflammatory affections alike of the head, chest, and abdomen. In the hospital of Frankfort and elsewhere small and frequently repeated inhalations of chloroform have been extensively employed in inflammation of the lungs, with the effect, it is alleged, of more marked relief to the cough pain, and fever, and a more speedy resolution of the disease than under any other treatment with which it was contrasted. It will probably ere long be applied to other uses in medicine.
Chloroform, administered by the stomach and not by the lungs, is also used by physicians. The usual dose of the drug when swallowed is from five to twenty drops, dissolved in a mucilaginous or oily liquid. In this form it exerts in a less marked but in a more prolonged degree the same therapeutical effects as the inhalation of the drug by the lungs.
In the detection of feigned diseases, as in pretended paralysis and contractions of limbs, in simulated deafness, &c., chloroform has been successfully used by army surgeons and others.
Various chemical gases and vapours beside chloroform have been found when inhaled to possess the effect of producing, some in a more, others in a less marked degree, a state of anaesthetic insensibility and sleep. Among these we may enumerate protoxide of nitrogen (the "laughing gas" of Sir Humphry Davy), olefiant gas, light carburetted hydrogen, bisulphuret of carbon, chloride of hydrocarbon, or Dutch liquid, aldehyde, acetone, coal and rock naphtha, benzoine, and various ethers, as the nitric, acetic, hydrochloric, formic and other ethers, but particularly sulphuric ether.
It has also been supposed that the odour and vapours of some vegetable substances can exert an anaesthetic effect. We shall afterwards see that the ancients believed that the odour of mandragora, and that vapours arising from the concentrated juices of henbane, hemlock, &c., were capable of producing insensibility to surgical operations. Knowing the soporific effects of the common puff-ball (Lycoperdon bovis) upon the working bee, we some years ago made repeated trials of the effects of it, but without ever producing any very marked degree of anesthesia in man. Since that time it has been tried by Mr Richardson and others, but, we believe, without any greater success.
The advantages which chloroform possesses over the other anaesthetic agents hitherto discovered are various. A tages of smaller, and hence a more portable quantity of chloroform chloroform than of other anaesthetics is required in order to produce form, the state of anesthesia; its action is more perfect and more certain; it exerts in ordinary doses no such depressing effects on the heart and general system as most of those chemical compounds which we have enumerated do; it acts rapidly, and consequently with a comparative short stage of excitement; its inhalation is infinitely more agreeable than the inhalation of most other anaesthetic gases or vapours; its odour is rapidly evanescent, and does not adhere to the clothes of those near it, giving it in this respect no small advantage with the busy physician over the persistent and disagreeable smell of sulphuric ether, &c.; it is cheaper than any other known anaesthetic; and, lastly, no special instrument requires to be used in its exhibition.
To produce such a complete anaesthetic effect as is required for most surgical operations a larger and more rapid mode of dose is necessary than in obstetric practice; whilst in midwifery the drug requires to be given in smaller quantities, but for a far greater stretch of time than in surgery. Numerous forms of instruments have been proposed for the exhibition of chloroform by inhalation, but they merely complicate the process; and certainly the simplest as well as the safest apparatus is a piece of sponge, or a towel or handkerchief.
Two or three fluid drachms of the liquid diffused upon the interior of a towel or pocket handkerchief, arranged in a somewhat concave form in the hand of the exhibitor, and applied over the mouth and nose of the patient, generally suffice to produce speedy and complete anaesthesia. If such an effect does not follow, an additional dose ought to be poured on the handkerchief at the end of a minute or two, for the drug rapidly evaporates. At first the moistened handkerchief ought to be held at the distance of half an inch or an inch from the face of the patient to allow free access of air to the mouth and nostrils, and afterwards it should be gradually approached nearer. At last it should touch the face except at one side where the fingers interpose between the face and it, to allow of a sufficient access of atmospheric air. In order that the patient may be brought speedily under the influence of the drug, and with as short an excited stage as possible, the vapour should be allowed to pass into the air tubes by both the mouth and nostrils, and all means of compressing either of these two cavities by the fingers or instruments must be strictly avoided. It should always be remembered that the vapour of chloroform is about four times heavier than atmospheric air, and hence the handkerchief or towel should be held in such a position over the mouth and nostrils, or so adjusted about the lower part of the face as to allow the vapour, by its mere gravitation, to fall into the air passages. Not unfrequently, at the moment when the patient is first becoming insensible, he will suddenly withdraw his face, or forcibly push aside the handkerchief with his hand; but the handkerchief should be instantly so reapplied as to allow the vapour to gravitate towards, and be drawn into the mouth and nostrils; and a few additional inhalations will now, after this point of excitement, render the patient quite insensible. The tests of the patient being fully anaesthetized that are usually most relied upon in practice, consist of induced slowness of the pulse, or some degree of noise or sopor in the respiration. Either or both of these phenomena, viz., slowness of the pulse, or some noise in the respiration, indicate that the patient is sufficiently insensible for undergoing any surgical operation, and the chloroform handkerchief must be withdrawn as soon as they supervene.
Subsequently, only smaller and intermittent doses of the vapour are in general required in order to maintain an adequate state of anaesthesia during the performance of the operation. The principal error committed in using chloroform in surgery consists in giving it at first in such small doses, or so slowly, as to keep up a state of excitement instead of inducing a true state of anaesthesia; and a still more grievous error is sometimes committed in commencing the use of the knife before the pulse or respiration is affected, and consequently while the patient is not yet sufficiently anaesthetized.
In midwifery practice there are two leading peculiarities in regard to the exhibition of chloroform, viz., first, that it is given to the patient only when the parturient actions or pains are present, and is always totally and entirely withdrawn in the intervals between these contractions or pains. The neglect of this simple but all-important rule has led, on the part of some practitioners, to much error and misconception regarding the effects and utility of chloroform in midwifery. But, secondly, the drug does not require to be given in such large and full doses in midwifery as in surgery, except where severe obstetric operations are to be performed. And, as ample experience has now shown, it may be given in common obstetric practice with perfect safety for two, four, six, or more hours, if the two simple rules alluded to above be duly followed.
When used in the treatment of medical diseases, chloroform is sometimes employed for a much longer time than in either midwifery or surgery. Patients suffering under tetanus, peritonitis, &c., have sometimes been kept more or less under its influence for two, three, or more continuous days. We have seen a child affected with infantile convulsions of such severity as to defy all other means, kept under the agency of chloroform with slight intermissions, to allow of food being taken, &c., for fourteen days, with the effect of arresting the fits, and ultimately saving the life of the little patient.
We have as yet found no human being capable of withstanding the anesthetic effect of chloroform, though sometimes in exceptional cases a much larger dose is required than in others; and the actual amount necessary in any case can be judged of only by the actual effects of the drug, and not by any rules as to its mere measurement or quantity.
There are perhaps few morbid states which entirely contra-indicate the use of chloroform when required as an anæsthetic agent. It is generally, however, believed that marked disease of the valves of the heart, or fatty degeneration of the walls of that organ, and diseased states of the brain, form reasons for avoiding its employment. It should not be given in large doses—as for surgical operations—shortly after meals; otherwise sickness and vomiting of the contents of the stomach are liable to follow. A little previous fasting usually prevents this complication.
In the way of caution in the employment of chloroform, Cautions, the points that demand the principal attention are the following:—1. The drug employed should be as pure as possible, and free from those various deleterious ingredients that are sometimes found mixed up with it, and which are liable to produce cough, headache, &c. 2. In its exhibition there ought always to be allowed to enter with the vapour of chloroform a free intermixture of atmospheric air, the fingers of the exhibitor being for this purpose always kept placed at one side between the face of the patient and the chloroformed towel or handkerchief; and, 3. Its action should always be suspended, and the handkerchief or instrument containing it instantly removed, whenever snoring and stertor supervenes in the respiration, or when the pulse becomes languid, and falls much below the natural standard; or when the face and lips greatly alter in their colour either to pallor or lividity.
The exhibition of chloroform, as of every other potent drug used in medicine, is liable to be attended with danger and death, provided it be given in too large or in too long continued doses. Like most other valued medicinal agents, it is powerful for evil as well as for good. But its occasional disagreement with, or deleterious influence upon one in 10,000 or 20,000 patients, is no sound argument against other patients benefiting from its employment. It has been calculated, from the returns of the registrar-general, that every year in England and Wales alone some 300 or 400 human beings are poisoned with opium; but certainly no one would argue that this is any reason why opium, the most valuable remedy in our pharmacopoeia, should not be given to other human beings in proper doses and in proper cases. Patients have often sunk under the depressing effects of calomel, antimony, digitalis, &c.; but such accidents, while they teach us very strong lessons of caution, form no reason why these most useful drugs should be banished from the pharmacopoeia. Many persons are annually drowned in bathing; but no reasonable man would argue from such unfortunate occurrences that this powerful means of maintaining and restoring health be therefore abandoned and forsaken. Deaths certainly ever and anon occur in patients subjected to the influence of chloroform, but assuredly only very rarely indeed when a pure drug and all proper precautions are used. Perhaps the exhibition of any other potent medicinal agent in the materia medica, exhibited in equally full doses to as many hundreds of thousands of patients as have now inhaled full doses of chloroform, would have been followed by more accidents and deaths than have been witnessed in the use of this anæsthetic agent. When we consider the immense extent to which chloroform has already been employed in all quarters of the world in medicine, in surgery, and in midwifery, the frequent great im- parity of the drug, and the little care which has sometimes been observed in its use, the wonder perhaps really is, that so few accidents have happened from its employment. And as a counter-balance to these accidents, we know from statistical evidence the fact, that in the absolute, it has been a great means, not only of saving human suffering, but also of saving human life, by diminishing in a marked ratio the danger and fatality attendant upon surgical operations and diseased states. Thus, let us take amputation of the thigh as an example. Out of 987 cases of this operation, collected by Mr Phillips, 435 proved fatal, or 44 in every 100 died. But out of 144 amputations of the thigh performed upon patients in an anesthetic state, only 27 proved fatal, or 25 in 100 died. According to this computation the number of persons saved from death in amputation of the thigh by the patients being anesthetized during the operation, amounts to 19 lives in every 100 operations performed, or to 190 lives out of every 1000 such operations.
All the patients that die under the hand of the operator when chloroform is used do not necessarily die from the effects of the chloroform upon the constitution. In several of the recorded cases, the dose given was far too small to have had any such fatal effect. Before the time that anesthetics came to be used in surgery, deaths on the operation table ever and anon occurred. Such cases have been recorded by Brodie, Cooper, Home, Travers, &c., &c., but they excited no marked share of professional attention, as they were generally supposed to be accidents against which no caution could be of any use. Of late years, and since chloroform has been employed, they have usually been directly and at once ascribed to the deleterious action of the chloroform. The week after the anesthetic effect of chloroform was discovered in Edinburgh, a patient suddenly died upon the operating table in the infirmary of that city, immediately after the first incisions for the reduction of a hernia were made, and before the operation was finished. Fortunately, from special casual circumstances, chloroform was not used in this case, or otherwise the drug would doubtlessly have been blamed for the result. We know of two other cases in the same city in which, since the introduction of chloroform, patients have died during or immediately after surgical operations, and in both of which, from accident rather than any other cause, chloroform did not happen to be used or to be at hand for use.
When in any case too powerful and large a dose of chloroform is given, the means of recovery which ought to be pursued are chiefly the following:—1. The instant removal of the chloroform handkerchief or instrument, and of everything containing the liquid, from the neighbourhood of the patient. 2. The supine position. 3. The free access of pure air to his face. 4. If necessary, the performance and continuance of artificial respiration by alternate compression and relaxation of the walls of the chest, or other means, taking special care at the same time to pull forward the tongue in the first instance, provided it has fallen backwards on the top of the windpipe. Some authorities have recommended the use of galvanism if an apparatus be at hand, the inhalation of oxygen or ammonia, inversion of the body, &c. No liquid should be poured into the mouth of the patient till he is able to swallow.
Instead of being inhaled so as to produce a constitutional anesthetic effect, chloroform is sometimes used locally in the form of a liquid or vapour with the view of obtunding the sensibility of that individual part of the body only to which the agent is directly applied. The local application of chloroform alone, or mixed with oil, is one of the most powerful local sedatives which the materia medica possesses; and as such often relieves rheumatic, neuralgic, and other pains, when applied to the suffering part. But in the human subject, the degree of partial and superficial local anesthesia which is capable of being produced by chloroform liquid or vapour is never sufficiently great to allow of the part being cut or operated upon without pain. All late experience has gone to prove the truth of this observation in regard to man. But in some of the lower animals complete local and limited anesthesia can be readily induced by the local application of chloroform. For example—in the articulata, as in the common earthworm and the centipede, the application of chloroform to the head or tail of the animal or to individual medial rings will render the parts touched altogether anesthetized, whilst the remainder of the body retains its natural state. Latterly, in the human subject, it has been proposed by Dr James Arnott to produce local anesthesia, before some minor surgical operations, by previously freezing or frost-biting the affected part by the application of a strong frigorige mixture. In most people no inconsiderable amount of pain attends this process of sudden local freezing; the part frozen is not in a condition admitting of easy surgical interference with common instruments, and the state of anesthesia does not extend beyond the skin and subcutaneous cellular tissue.
The vapour of chloroform was first proposed by Dr Simpson as an anesthetic agent in surgery and midwifery anesthesia in 1847. For a year previously, the vapour of sulphuric ether had been used to a considerable extent both in America and Europe, for the purpose of inducing insensibility to pain in surgical operations. It was first practically adopted for this purpose in 1846 by Dr Morton, a dentist at Boston in America. Subsequently Dr Charles T. Jackson of that city claimed the merit of having suggested to Dr Morton sulphuric ether as an agent capable of producing insensibility to pain. But the power of producing, by the vapour of sulphuric ether, an insensibility exactly like that produced by the inhalation of nitrous oxide gas, had been long previously known. The fact had been already often published by several American authorities, as by Godwin (1829), Mitchell (1832), Professor Samuel Jackson (1833), Wood and Bache (1834). Richard Pearson was the first to suggest the inhalation of sulphuric ether in medicine in 1795; and he then described its employment in some cases of phthisis, asthma, whooping cough, &c. The sedative effects of its inhalation in these affections have been noticed by almost every author who has written at any length on the Materia Medica during the first half of the present century. In 1816 Nysten proposed and described a special instrument for the inhalation of sulphuric ether.
The idea, however, of saving by some artificial means the human body from the pains and tortures inflicted by the knife of the surgeon, is by no means a thought either first broached or first acted upon in recent times. For the production of anesthesia a variety of measures had been suggested, and some used long before sulphuric ether and chloroform were applied to this purpose. In 1828 Dr Hickman appears to have proposed the inhalation of diluted carbonic acid gas as an agent capable of inducing insensibility in surgical operations; and the anesthetic properties of carbonic acid have been long known and often witnessed in the experiments constantly performed before travellers on the dogs which are so often made to breathe this gas in the Grotto del Cane near Naples. In 1800 Sir Humphry Davy threw out a hint as to the possibility of applying nitrous oxide as an anesthetic. In 1784 Dr Moore attempted to produce local anesthesia in limbs requiring amputation or other operations, by previously compressing and obtunding the nerves of the implicated extremity—an idea, however, which was suggested long before Moore's time by Ambrose Paré. In the sixteenth and seventeenth centuries various authorities, as Valverdi, Hoffman, &c., suggested the possibility of producing temporary anesthesia during surgical operations, by a plan sometimes successfully adopted by modern robbers, viz., by such an amount of "garotting" or compression of the vessels of the neck as would produce the requisite amount of stupor and coma. Some surgeons also proposed to induce before operating a state of fainting, and consequently of insensibility, by a previous profuse blood-letting, &c. The administration of a large opiate has been also repeatedly suggested and tried by various authorities; but the amount of dose required to produce true anaesthesia and insensibility to the pain of a surgical operation was found to be far too large to be free from imminent danger to the life of the patient.
But at a still earlier date different medicinal agents seem to have been suggested, and practically employed too, for the purpose of producing a state of anaesthesia during surgical operations. These agents were sometimes used in the form of odours or vapours, or by inhalation; and sometimes they were administered by the stomach. Two different drugs appear to have been more particularly used at different epochs with the view of inducing insensibility to the agony and torture otherwise following the surgeon's knife, viz., preparations, 1. of Indian hemp (Cannabis sativa var. Indica); and 2. of mandragora (Atropa Mandragora).
The anodyne, ecstatic, and anaesthetic effects of Indian hemp, and of the various preparations made from it, as bang, hashish, &c., have been long known in Africa and Asia. "The bang (as Sir Joseph Banks observed half a century ago) is prepared and, I believe, used in all parts of the East from Morocco to China. In Barbary (he adds) it is always taken, if it can be procured, by criminals condemned to suffer amputation; and it is said to enable those miseries to bear the rough operations of an unfeeling executioner, more than we Europeans can the keen knife of our most skilful surgeons." M. Julien lately pointed out to the French Academy an old Chinese work proving that 1500 years ago a preparation of hemp or ma-yo was employed medicinally in China to annul the pain attendant upon cauterization and surgical operations. The wonderful power of endurance of the Hindu Suttee appears to have been sometimes procured by the influence of this powerful drug. Some high biblical commentaries maintain that the gall and vinegar or myrrhied wine offered to our Saviour immediately before his crucifixion was a preparation, in all probability, of hemp, which was in these, as well as in later times, occasionally given to criminals before punishment or execution—while 700 years previously it is possibly spoken of, according to the same authorities, by the prophet Amos as the "wine of the condemned."
The symptoms described by Homer as produced on Ulysses and his companions by their drinking of the Egyptian nepenthes are far more like the effects of hemp than of any other known agent. Herodotus twice mentions the ecstatic influence which the inhalation of the vapour of burning hemp produces upon the Scythians and Massagetaans, who, according to his account, breathed it for the purposes of excitement and inebriation.
The other plant mentioned—the mandragora—is now banished from the materia medica, but its therapeutic virtues certainly seem to call for some renewed investigation. Most of the old Greek and Roman physicians and writers, such as Galen, Aretaeus, Celsus, &c., ascribe to it strong soporific powers; and several of them, but especially Dioscorides, Pliny, and Apuleius, describe its decoction or tincture as endowed with such anaesthetic powers that those drinking a proper dose of it are insensible to the pains of the surgeon's knife and cautery. It is given (writes Dioscorides eighteen centuries ago) "to cause insensibility (μηνείαν ἀναπνοιαῖς) in those who are to be cut or cauterized; for being thrown into a deep sleep they do not perceive pain." The observations of Pliny, Apuleius, &c., are to the same effect. In the twelfth and thirteenth centuries Hugo of Lucca used, and his pupil Theodoric (who died in 1298) has described a somniferous ball or sponge, "Spongia somnifera," the vapours raised from which were capable, when inhaled, of setting patients into an anaesthetic sleep during surgical operations. This somniferous ball was, in the first instance, made by filling and imbibing a sponge with dried extracts of mandragora, opium, and other sedatives; and when required for use the sponge was dipped for a time in hot water, and the patient made to breathe the vapour thus raised from it till an anaesthetic sleep was produced. A modern French surgeon, M. Daurial, states that he has successfully induced a state of anaesthesia in various surgical patients by the means described 600 years ago by Theodoric. Why the mandragora fell into disuse as an anaesthetic agent in surgery does not appear in any professional records. Aretaeus, after speaking of the deep and long-continued sopor produced by drinking an infusion of mandragora, adds, that occasionally danger results from using it, and the patient may die convulsed. The frequency and the fear of such results may probably have been the cause of its anaesthetic employment in surgery falling into abeyance. Chamappe, a French surgeon who wrote in 1538, tells us that at that time "some surgeons give, like Theodoric, soporiferous medicines to their patients that they may not feel the incisions of the scalpel;" and he describes the "somniferous sponge" of Hugo as adapted for this purpose. But already towards the end of the same century, Ambrose Parè, the celebrated Parisian surgeon, alludes to the exhibition of mandragora, "to avert the pain attendant upon the amputation of a limb" as a practice only used "formerly" by operators, and apparently as not followed in his own day. An early English author, Bulley (1579) describes the possibility of setting patients into an anaesthetic state during lithotomy, &c., by the use of mandragora; but at the same time he speaks of the sleep thus artificially produced as "a trance or a deep terrible dream."
The older authors do not always give explicit accounts of the substances and preparations which they recommend for use as anaesthetic agents. Occasionally, they affect an air of secrecy and mystery with regard to their composition and character. Thus, in the 8th book of his Natural Magic (1608), Baptista Porta gives various receipts for medicines which produce sleep, insanity, &c. Amongst others, he describes a "sleeping apple" ("Pomum somniferum"), made with mandragora, opium, &c., and the smelling of which binds, he avers, the eyes with a deep sleep. Subsequently, he states, that there can be extracted from soporific plants "a quintessence which must be kept in leaden vessels, very closely stopped, that it may not have the least vent, lest it fly out. When (he continues) you would use it, uncover it, and hold it to a sleeping man's nostrils, whose breath will suck up this subtle essence, which will so besiege the castle of his senses that he will be overwhelmed with a most profound sleep, not to be shook off without much labour. After sleep, no heaviness will remain in his head, nor any suspicion of art. These things (Porta adds) are manifest to a wise physician; to a wicked one, obscure." Meissner relates, at considerable detail, that towards the close of the seventeenth century, a secret remedy was exhibited by Weiss to Augustus II. of Poland, while his majesty was asleep, and during the state of anaesthesia thus induced the king's diseased foot was amputated. The operation was done without the royal patient's consent, and its performance was not discovered by him till the following morning.
The former general belief in the idea that a degree of anaesthetic and prolonged sleep could be induced artificially by certain medicated potions and preparations, is shown by the frequency with which the circumstance is alluded to by our own older poets and story-tellers, and made part of the machinery in the popular romance and drama. In the history of Taliesin (one of the antique Welsh tales, contained in the Mabinogion), Rhun is described as having set the maid of the wife of Elphin into a deep sleep with a powder put into her drink, and as having then cut off one of her Chlorosis fingers when she was in this state of artificial anesthesia.
Shakespeare, besides alluding more than once to the soporific property of mandragora, describes with graphic power in Romeo and Juliet, and in Cymbeline, the imagined effects of subtle distilled potions, supposed capable of inducing, without danger, a prolonged state of death-like sleep or lethargy. And Middleton, in his tragedy of "Women, beware Women," published in 1657, pointedly and directly alludes, in the following lines, to the practice of anesthesia in ancient surgery:
"I'll imitate the pities of old surgeons To this lost limb—who, are they show their art, Cast one asleep, then cut the diseased part."
Indeed, the whole past history of anesthetics is interesting as a remarkable illustration of the acknowledged fact that science has sometimes for a long season altogether lost sight of great practical thoughts, from being unprovided with proper means and instruments for carrying out these thoughts into practical execution; and hence, it ever and anon occurs that a supposed modern discovery is only the rediscovery of a principle already sufficiently known to other ages or other remote nations of men.