altogether, and instead of it I have used sulphuric ether. I think I may say, without exaggeration, that I am thoroughly convinced that there is a radical difference in the danger following the administration of these two substances. I am sure that chloroform is more dangerous to animals, at least; whether it is so in man or not, I do not know.

In order to understand this subject thoroughly, it is necessary that we should endeavor to ascertain the manner in which death results in fatal cases. Death sometimes follows without any evident or traceable cause. It may occur from ether or chloroform by a very careless administration, or from an impurity of the article, provided that the patient breathes nothing but the vapor of the ether or the chloroform. Now in these cases, death is not attributable to the ether or chloroform; it is simply due to the want of atmospheric air. If you give a man a grain of opium and then stop his mouth and nostrils, he will of course die; but certainly not from the opium, but from the want of atmospheric air. The same is true of the administration of the chloroform. Therefore the first thing to be attended to, when we wish to prevent a fatal issue from the administration of these substances, is to see that they are given mixed with a sufficient quantity of atmospheric air, and then one cause of death would be excluded.

Sometimes, however, even with all our precaution, we find the respiration and the heart stopping suddenly and the patient dead. It is an interesting question to know whether or not death is produced by the stoppage of respiration or of the heart. My own belief is, that in the case of chloroform death is produced by paralysis of the heart. My reasons for this view are two-fold.

In the first place, if you moderately etherize or chloroformize an animal carrying it carefully just up to the point of insensibility, and then open the walls of the chest as quickly as possible, the lungs will of course collapse, and respiration be at an end, but the heart will continue to beat for a considerable length of time. If, on the other hand, you etherize or chloroformize an animal until respiration is stopped, and then open the chest, you will find the heart still beating, but very feebly. I have several times performed the following experiments, namely: to etherize an animal moderately, but enough to deprive it of all sensibility, then immediately the chest was opened and the animal laid aside

another animal was then etherized until death was produced, and on immediately opening the chest the heart was found still, while in the first animal it was yet beating. So far as this goes, it tends to show with a great deal of conclusiveness, that the fatal result is produced by a paralysis of the heart.

In experimenting thus with animals, I have had occasion to notice very frequently, when anesthesia is carried only to the stoppage of respiration, that the animals usually recover, and expect with confidence that respiration will begin again; but if, on noticing that the respiration is stopped, I find the heart itself still, I know that the animal is dead, although I have noticed, after the circulation is at an end, that it is sometimes rëestablished in a certain manner which is entirely characteristic, and being once seen, is very readily recognized. This is, however, entirely unavailing; the animal never recovers.

In my own experience, then, fatal results have followed both ether and chloroform. I have killed dogs and cats with ether and chloroform, but I am obliged to take a great deal of pains to produce this result with ether, whereas death often follows the use of chloroform, notwithstanding the best precautions. It has been said, that when death occurs from the administration of chloroform in the human subject, that it is attributable to giving it too rapidly or too abundantly; but while there are undoubtedly many cases in which injurious results follow from the non-admission of a sufficient amount of air, still I am of the opinion that the injurious or fatal results can not be always attributed to that cause, for the reason that these accidents have occurred in the practice of our best and most careful surgeons, who invariably exhibit this remedy with the utmost caution, and yet, when everything appears to be going on well, the patient suddenly dies. So far, we know of no precaution which will prevent the occasional occurrence of this accident.

SURGICAL.

3. Sulphuric Ether Substituted for Chloroform at Lyons. - At Lyons, the second city in France, sulphuric ether has almost universally superseded chloroform, both in hospital and private practice; and as the result of a recent discussion at the Medical Society of that town, the following resolutions were passed unani

mously: "1. Sulphuric ether, employed as an anaesthetic, is less dangerous than chloroform, no accident, indeed, having followed its exclusive and abundant employment at Lyons during eight years. 2. Anæsthesia may be as constantly and as completely induced by it as by chloroform. 3. If ether gives rise to inconveniences which are not produced to the same extent by chloroform, these are of little consequence as compared with the dangers inherent to the use of the latter. 4. Ether should, therefore, be preferred to chloroform." It was proposed that the fact of using chloroform should be stigmatized as imprudent; but the Society declined taking this step, contenting itself with declaring that ether fulfils the same indications as chloroform, without giving rise to the same dangers. — Med. Times and Gazette, Nov. 26, 1859.

OBSTETRICAL.

4. Trismus Nascentium.-In the course of our meetings this summer, I mentioned to you that I had been considerably interested in the observation of quite a number of cases of trismus nascentium during the decade just now closing; - that interest has been augmented, of late, by the occurrence of three other cases in quick succession. You, if I remember correctly, promised to either mention it in the College of Physicians and Surgeons, or to a few of our mutual friends, most largely engaged in the management of children, and give me the general result of their experience. Lest you may forget it, I send you this reminder, and mention one or two facts connected with the cases which seem to me not a little curious.

1st. In a practice of ten years in Henry county, during which time my obstetric cases were not less than an average of thirty annually, I did not see a case of the disease, whilst in ten years here, with an average of fifty cases per year, I have had seventeen cases of trismus.

2. And most curious, my ordinary circle of observation is about ten miles in diameter. The locality in which all the cases have occurred, constitutes an oblong of about four miles in width and six in length, situated nearly in the middle of my field. Outside of this district I have not seen a case, and have not heard of one.

For twenty years or more the negro children born within this boundary have been quite subject to the disease. Several farmers who owned large families of slaves, raised but few slave children between 1830 and 1845. They would say, "We can not raise negro children; they all die with the nine-days disease." About that time an old woman of the neighborhood was the general midwife; and her professional duties were mainly restricted to the infected, or I should say, to the afflicted district. She lost cast, indeed, in her vocation, on account of the numerous cases that followed her deliveries. One of the oldest and most respectable physicians of this part of the country sought diligently for the causes of the old midwife's misfortunes, and confidently believes he found it. He says, in each case, the old lady tied the cord so slack that its nerves (?) were merely irritated, not deadened hence actual traumatic tetanus. Whether his is the true explanation, I leave you to determine; but if it is, Madam Griffith's successors, of whom I am one, have also tied too loosely. For, following me, quite a number of cases have occurred. All the cases I have seen were not of my own delivery—indeed, the majority of them were not, for, charging double the fee of my professional neighbors, the majority of the slave labors fall into their hands; yet the proportion of cases under my sole management has been as great as under the management of either of my neighboring medical friends.

Every case has belonged to the African race. Many have been disposed to attribute the disease, therefore, to negligent, ignorant, or careless nursing. At first I was inclined to adopt that opinion, coupled with the idea that a diseased state of the umbilicus, as abrasion, inflammation, irritation, or some other unhealthy condition, was necessary to its production. But I was not long in satisfying myself that neither of these facts was constant. The children, a number of them, being nursed as tenderly, carefully, and cleanly, as a large number of the white children; and the navels, I have observed, have presented no constant indications. Some of them are well-healed up fully-others inflamed, indeed, in very varying and opposite conditions. Then I went off on the idea of persisting compression of the brain from some one of the cranial bones. In this view I was vastly strengthened by the announcement of the same idea by a gentleman of Tennessee,

I think, who gave a number of cases in which he thought it manifest, that the occiput increased the pressure, and that the compression was kept up by laying the children mostly on the back. It is singular that I have forgotten this physician's name, for I remember that I was quite grieved, upon reading his paper, that I had not published, when I first conceived the thought, and thus entitled myself to the paternity of the great idea.

But further observation has satisfied me that I did not lose much by dilatoriness. I have fully convinced myself that compression of the brain, from persistent bony depression, does not always produce the disease.

The inquiry as to what the accidents of labor may have to do with it has also been raised. I have not been able to find anything constant in this connection.

I have seen it following tedious and quick, laborious and easy, difficult and complicated labors, about in the same proportion. Nor do I find in the nervous, muscular, secreting, respiratory, or digestive systems, any premonitory signs.

Twelve out of the seventeen cases have occurred in the six months comprising the last half of spring, all the summer, and the first half of fall. Five have occurred in the other half of the year. It begins never earlier than the fourth day, or later than the eighth. Mean duration, about two days. I have had two recovery cases. I attributed their recovery to full feedingthe mothers drawing the milk from the breast, and feeding them; and they are the only instances in which I thought sufficient nourishment was received.

One other point in the treatment, to which, however, I attribute no importance, but as it was practiced in both of the recovery cases, and has not been used by me at least in but one other case, may as well be mentioned-tobacco poultice over the abdo

men.

The foregoing, I believe, sums up the essential particulars in my cases, and leaves me as completely at sea in regard to the disease as I was ten years ago, before I had ever seen a case.

Please mention the thing to some of our friends, and find out from them whether they often meet with them what is the proportion of the recoveries, etc., etc., and communicate to your obedient servant.-E. D. Foree, M.D., Waverly, Ky., in Louisville Monthly Medical News.