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NAVAL ASSISTANT-SURGEONS: THE MEANS FOR THEIR ACCOMMODATION ON BOARD SHIPS OF WAR.
487 further stated, that, to his
knowledge, it was
not unusual for
elderly persons to live several years with the aortic semilunar ’valves in that degenerate state which is the precursor of, and soon leads to, a deposition of bone, and unaccompanied by cardiac suffering, but in these instances the disease did not affect the upper portions of the valves. Mr. Canton had found - that the sinuses of Valsalva, in such cases, were increased in their capacity, and they aided in the safety-valve function, by admitting more blood than usual, whereby the valves were secured that approximation which bony deposits, even towards their lower parts, might otherwise tend to prevent. Mr. BARLOW remarked, that all the speakers seemed to agree
space in the after-cockpit for the erection of two cabins, in addition to those which were already there. Two cabins on the main deck had been thrown down by the captain, Lord
H-.
H.M.S. Bellerophon :No spare cabins. NoteThe commanderand master occupied four cabins in the ward-room. There was space in the after-cockpit for the erection of two cabins. H.M.S. Ganges :No spare cabins. Note: Four spare cabins had been knocked down. H.M.S. Powe1ful: Four spare cabins. The captain’s steward occupied one, and the master of the band another. in one point, that valvular disease of the heart had not been The latter kindly permitted poor M—, assistant-surgeon, advanced stage of phthisis, to recline on his bed occaproved by the paper to be less dangerous than was usually suspected. He had been struck with Dr. Bird’s explanation sionally. In each of the brigs on the station there was a spare cabin. respecting the influence of regurgitative disease of the mitral In the greater number of the steamers on the station there valve acting as a safeguard. We generally thought the peril was in proportion to the extent of the disease, but the view of was a spare cabin; and there was space for the erection of Dr. Bird was conclusive to the contrary. Mr. Barlow then cabins in all. I now supply a few facts respecting the sufficiency of the went on to say, that whatever relieved an overgorged heart when diseased, tended to remove alarming symptoms, and space within the ward-room to accommodate a greater number stated that no doubt life might be prolonged to a considerable of officers than that which now constitutes the mess. The ward-room of H.M.S. Vengeance is small for the size time by quiet and care. He instanced the case of Hunter as one illustrating the effects of calmness of mind on heart disof the ship. Sixteen guests, in addition to the full complement ease, and its sudden termination fatally from a fit of passion. of the ward-room officers, have sat down to dinner without the He considered also that much of the danger would depend table having been lengthened, and without alteration of any of the upon the condition of the muscular fibre of the heart when the every-day arrangements. I cannot trust myself to comment on valves werediseased. If the structure were fatty, or in any these statements, but I will simply observe that the Admiralty other way changed, to such extent would the disease be more entirely forget that there has been an immense augmentation in the tonnage of men-of-war during the last twenty or thirty dangerous. Mr. STREETER referred to one point not alluded to in the years. Frigates now equal, and even surpass, the old line-ofpaper, or by the speakers: he meant the influence of age on battle ships in size. Does not this increase of dimensions afford space for additional accommodation to men and officers ? our diagnosis and prognosis of heart-disease, and whether that disease was the result of inflammatory deposit, or of accele- Is it not glaring injustice to the assistant-surgeons, to leave rated degeneration of structure. It was necessary to make them unprovided with cabins, when cabins have been increased this distinction, and also to ascertain how far the deposit or in size in a corresponding ratio with the augmentation of the the degeneration interfered with the function of the organ. tonnage of the ships, and new cabins erected ? Is it not a If the disease was of slow progress, it adapted itself more defiance of the Sovereign’s Order in Council of 1805 ? I beg easily to circumstances than when it came on quickly. He to subjoin the plans of the arrangement of the orlop deck in spoke of the necessity of cheering patients labouring under line-of-battle ships. It is time for the country to demand a heart-disease, and remarked, that whatever produced obstruc- re-adjustment of the disposition of the space within the ships of the royal navy. tion in the liver, kidneys, or lungs, produced obstruction ofof I am, Sir, your obedient servant, the heart, acceleration of its action, and consequent danger.I FRED. JAMES BROWN, M.D., ! Dr. SEMPLE, in reply, congratulated the meeting upon the Strood, Rochester, 1850. Late Assistant-Surgeon R.N. interesting discussion to which his paper had given rise. He did not think that his paper, however, fairly bore the construction that some of the speakers had put upon it; for he Diagram, showing the arrangement and appropriation of apartdid not deny the importance and seriousness of heart-disease; ments on the orlop deck of a ship of the first-rate, fitted on the he only contended that patients might live and enjoy tolerably old and still generally followed system. under health circumstances apparently most unfavourgood able. He admitted that his cases were exceptional ones, and 1. Marines’ Accoutrements. indeed he brought them before the Society on that account; 2. Cabin of Lieut. Marines. of he had numerous records heart-disease which for although Naval Lieut. 3. had occurred in his practice, he thought it would be most " advisable to bring forward only those which were somewhat Boatswain. 4. " 5. unusual, and therefore of a more interesting and novel chaCarpenters. " racter. 6. Gunner. "
in the
_
______________
7. Midshipman’s Store-room* 8. Cabin of Lieut. Marines.
Correspondence.
9. Captain’s Store-room. 10. Cabin of Naval Lieut.
"Audi alteram partem.11
NAVAL ASSISTANT-SURGEONS: THE MEANS FOR THEIR ACCOMMODATION ON BOARD SHIPS OF WAR.
Lieut. Marines.
11.
"
12.
"
Spare.
13.
"
Naval Lieut.
14. Dispensary. Ward-room Store-room. ditto. 16. Admiral’s 17. Paymaster’s Cabin.
To the Editor of THE LANCET. SiR,—I shall feel obliged to you for the publication of the following facts, for the information of the profession and of the public generally. If these are facts, then the assertions of certain admirals cannot be trustworthy: this is evident. I
15.
20.
Chronometer-room.
I also send you for publication in THE LANCET the plans of ships, fitted according to the old arrangement, and of those which have an entire orlop deck, and, consequently, a great increase in the number of cabins. Facts.-In May, 1850, the following was the condition (as respects space) of the ships and vessels in the Mediterranean fleet. There are several of which I have no notes: those I omit, lest I should state that which I cannot prove. H.M.S. Caledonia:Six spare cabins,,filled with brooms, holystones, sacks, paint-pots, d:c.
21.
Magazine-passage. Purser’s Slop-room.
ditto. Surgeon’s 19. Purser’s Steward’s Cabin.
18.
challenge inquiry.
H.M.S. FeMectHce;Two spare cabins. :Note: There
was
22.
Average Size of Cabins. Fore, loft. by 7ft.; Aft, 12ft. by 7ft. In the last commission of this ship, 7 & 9 formed "the for mates, assistant-surgeons, &c. In a former commission, 15 & 16 were on the platform this deck, which is, by far, the more fitting situation for
below
study"
488 mess
store-rooms, for two reasons-first, there is
now
great
loss of space from the necessity of having the ship’s side ON A METHOD OF DISSOLVING STRYCHNIA, AND REMARKS ON THE EMPLOYMENT OF ANÆSunencumbered ; secondly, the obviating of wounds from THESIA IN PARTURITION. shattering of bottles in time of action. To the Editor of THE LANCET. -Diagram, showing the arrangement &c. on the orlop deck of a in THE LANCET of the 31st August a case read SIR,—Having ship of the second-rate, fitted on the improved plan, of which we have already one illustration in commission. of poisoning by strychnia, in which case the strychnia was given in cinnamon-water, I cannot refrain from expressing an 1. Tar and Paint Rooms. opinion that the method of exhibiting so dangerous a medicine Prisoners’ 2. Police of the Ship-viz.,
6. 7.
Cells and Cabin of Master-atArms. Seamen’s Library. Store for Musical Instruments. " Marmes’ Knapsacks, &c. Cabins of Warrant Officers. Cabin of Lieut. of Marines.
8.
Midshipman’s Library.
3. 4. 5.
9.
"
Berth.
10. Cabin of Naval Instructor.
11. Lieut. Marines. " 12. ditto. " 13 & 14. Spare. 15. Cabin of Naval Lieut. ditto. 16. " ditto. 17. " 18. " Spare. Naval Lieut. ig. " 20. " Surgeon. 21. " Chaplain. 22. Dispensary. 23. Ward-room Store-room. 24. Captain’s ditto. 25. Midshipman’s ditto. 26. Pilot’s Cabin.
27. Paymaster’s Cabin 28. Clerk’s Office. 2g. Chronometer-room. 30. Purser’s Slop-room. 31. Purser’s Steward’s-room.
.
Average Size of Cabins. gft. by 7ft. N.B.-The greater dimension of all these cabins is the transverse, and this is variable, while the fore and aft extent is equal in all. In this symmetrical arrangement there are three spare cabins, in addition to the appointed positions for numerous objects not contemplated in the old arrangement. Note.—The compartments most deeply shaded by the engraver are those appropriated for the general service of the ship; those least shaded are the store-rooms of the officers’ messes; and those shaded in an intermediate degree are cabins, (see the small diagram in the previous page; and for examples Nos. 1, 7, 2, &c., among the compartments on the ship’s deck in the first diagram.)
THE NEW GALACTAGOGUE. To the Editor of THE LANCET. SIR,—By the following extract from the narrative of a voyage to the coasts of Chili and Peru, performed during the years 1712, 1713, and 1714, by M. Frezier, engineer in ordinary to the French king, it would appear that the Spaniards of Peru were acquainted with the lactagogue qualities of the leaves of the castor-oil plant, so far back as the early part of
the eighteenth century. M. Frezier’s ship, the San Josef, on the outward voyage, stopped for some days at San Vincente, in the Cape de Verde. In his description of that island, M. Frezier states, that among other plants, he saw there the ° Palma Christi, or Ricinus Americanus, by the Spaniards in Peru called Pillerilla; and they affirm that the leaf of it applied to the breasts of nurses brings milk into them, and applied to their loins, draws it The seed of it is exactly like the Indian pine-apple away. kernel. In Paraguay, they make oil of it." Dr. Tyler Smith, in his excellent paper on the lactagogue, and other qualities of the castor-oil leaves, published in this month’s number of the London Journal of Medicine, has fully demonstrated the efficacy of the plant in causing a secretion of milk in the breasts of females in this country; and I trust hat the property of drawing the milk away, assigned to it by At. Frezier, will also be specially tested by the same accomplished and painstaking observer. I would fain be allowed here to express my thanks to Mr. Henry, surgeon, of the Commercial-road, for his kindness in drawing my attention to the passage in question, and procuring me the loan of M. Frezier’s work. I have the honour to be, Sir, Your obedient servant, J. O. McWILLIAM, M.D. Trinity-sq., Tower hill, Oct. 16, 1850.
was
very incautious.
We know that
strychnia is insoluble in
water, and yet three grains of this deadly poison
were
put
into ten drachms of cinnamon-water, with directions for twenty drops to be taken three times a day in a wineglass of water. Now, supposing no mistake had been made as to the quantity of the dose, it is more than probable that the patient would have been poisoned before the whole of the medicine was taken, because the powder, being insoluble, would sink to the bottom of the bottle, and shaking the bottle would not altogether prevent it, and the last few doses would contain nearly the whole of the strychnia. I should not be so anxious to point this out if there were no remedy; but fortunately there is, and as, perhaps, it may not be generally known, I will state it. Strychnia is soluble in spirits of nitrous ether in the proportion of one grain to one drachm, and I always keep it dissolved for use, and never think of sending more than enough for two days’ use, which quantity, if accidentally taken at one dose, could not prove injurious. I also always send it in a six-ounce phial, further to obviate any mistake.
addressing you, I will take the opportunity of short observation on the use of chloroform or any other anaesthetic agent in parturition. It is recorded in your journal, that out of twenty-seven cases in which chloroform was used, four had laceration of the perinseum. This is a frightful result; surely the gentleman who employed it must be satisfied of its mischief; it is quite fearful. I do not sup pose its equal was ever heard of in the history of obstetric practice. I havebeen in practice more than thirty years, and have attended at least 3000 cases, but such an accident has only happened once in the whole number. And I am not singular; hundreds of practitioners will tell you the same. And that case was caused by the use of the long forceps: there was slight difficulty at the brim of the pelvis, the woman was weakly, and it was her first child; Nature, finding the difficulty, refused to act; the pains left. With the forceps, I brought the head into the pelvis, intending then to remove the forceps, but the resistance being overcome, Nature set up her action again, but so forcibly and rapidly, that I had not time to withdraw the forceps before the head, with one long, continued pain, was pushed through the os externum, and the back part was torn with the forceps. What is the reason of so many as one-seventh of the cases treated by chloroform having lacerated perinseums ?-the absence of pain. We know, that when a pain comes on, it goes on urging the head forward, stretching the os externum, until the violence of the pain is so great that Nature obeys the warning, the pain ceases, the head recedes, and the perinæum is saved; and so on with a succession of pains, until, by degrees, the parts become relaxed, and the head passes without any laceration. Do away with the pain, Nature’s safeguard, the forcing power of the uterus is unchecked; on goes the head, and the almost inevitable consequence ensues-laceration of the perinaeum. Although I always gently press my hand on the perinseum, I very much doubt the practical use of the process; I doubt whether any amount of support short of that endangering the rupture of the uterus by its resistance, can be of any avail in retarding the descent of the head. In the use of anaesthetic agents, it should never be forgotten that they are all deadly poisons, and that a very little more than is just sufficient to prevent the feeling of pain is just sufficient to kill the patient. And who is to know the exact dose ? That which one patient can bear with impunity will destroy the life of another. And suppose such a lamentable event to occur, even but once in a thousand times, who is the man with hardihood enough to take such a fearful responsibility upon himself. I maintain, that for the single purpose of doing away with pain in parturition, a natural and healthy action, no man is justified in saturating the system with a deadly poison. I know by experiment, that ether and chloroform permeate every tissue of the body, that for days the flesh both tastes and smells of it; and can such an agent be diffused through the blood, the very principle of life, over the whole system, without the fear of after evils, even should no immediate ones ensue ? Have 1 not numerous cases of puerperal fever and mania been caused As I
making
am a
knowledge, it was
not unusual for
elderly persons to live several years with the aortic semilunar ’valves in that degenerate state which is the precursor of, and soon leads to, a deposition of bone, and unaccompanied by cardiac suffering, but in these instances the disease did not affect the upper portions of the valves. Mr. Canton had found - that the sinuses of Valsalva, in such cases, were increased in their capacity, and they aided in the safety-valve function, by admitting more blood than usual, whereby the valves were secured that approximation which bony deposits, even towards their lower parts, might otherwise tend to prevent. Mr. BARLOW remarked, that all the speakers seemed to agree
space in the after-cockpit for the erection of two cabins, in addition to those which were already there. Two cabins on the main deck had been thrown down by the captain, Lord
H-.
H.M.S. Bellerophon :No spare cabins. NoteThe commanderand master occupied four cabins in the ward-room. There was space in the after-cockpit for the erection of two cabins. H.M.S. Ganges :No spare cabins. Note: Four spare cabins had been knocked down. H.M.S. Powe1ful: Four spare cabins. The captain’s steward occupied one, and the master of the band another. in one point, that valvular disease of the heart had not been The latter kindly permitted poor M—, assistant-surgeon, advanced stage of phthisis, to recline on his bed occaproved by the paper to be less dangerous than was usually suspected. He had been struck with Dr. Bird’s explanation sionally. In each of the brigs on the station there was a spare cabin. respecting the influence of regurgitative disease of the mitral In the greater number of the steamers on the station there valve acting as a safeguard. We generally thought the peril was in proportion to the extent of the disease, but the view of was a spare cabin; and there was space for the erection of Dr. Bird was conclusive to the contrary. Mr. Barlow then cabins in all. I now supply a few facts respecting the sufficiency of the went on to say, that whatever relieved an overgorged heart when diseased, tended to remove alarming symptoms, and space within the ward-room to accommodate a greater number stated that no doubt life might be prolonged to a considerable of officers than that which now constitutes the mess. The ward-room of H.M.S. Vengeance is small for the size time by quiet and care. He instanced the case of Hunter as one illustrating the effects of calmness of mind on heart disof the ship. Sixteen guests, in addition to the full complement ease, and its sudden termination fatally from a fit of passion. of the ward-room officers, have sat down to dinner without the He considered also that much of the danger would depend table having been lengthened, and without alteration of any of the upon the condition of the muscular fibre of the heart when the every-day arrangements. I cannot trust myself to comment on valves werediseased. If the structure were fatty, or in any these statements, but I will simply observe that the Admiralty other way changed, to such extent would the disease be more entirely forget that there has been an immense augmentation in the tonnage of men-of-war during the last twenty or thirty dangerous. Mr. STREETER referred to one point not alluded to in the years. Frigates now equal, and even surpass, the old line-ofpaper, or by the speakers: he meant the influence of age on battle ships in size. Does not this increase of dimensions afford space for additional accommodation to men and officers ? our diagnosis and prognosis of heart-disease, and whether that disease was the result of inflammatory deposit, or of accele- Is it not glaring injustice to the assistant-surgeons, to leave rated degeneration of structure. It was necessary to make them unprovided with cabins, when cabins have been increased this distinction, and also to ascertain how far the deposit or in size in a corresponding ratio with the augmentation of the the degeneration interfered with the function of the organ. tonnage of the ships, and new cabins erected ? Is it not a If the disease was of slow progress, it adapted itself more defiance of the Sovereign’s Order in Council of 1805 ? I beg easily to circumstances than when it came on quickly. He to subjoin the plans of the arrangement of the orlop deck in spoke of the necessity of cheering patients labouring under line-of-battle ships. It is time for the country to demand a heart-disease, and remarked, that whatever produced obstruc- re-adjustment of the disposition of the space within the ships of the royal navy. tion in the liver, kidneys, or lungs, produced obstruction ofof I am, Sir, your obedient servant, the heart, acceleration of its action, and consequent danger.I FRED. JAMES BROWN, M.D., ! Dr. SEMPLE, in reply, congratulated the meeting upon the Strood, Rochester, 1850. Late Assistant-Surgeon R.N. interesting discussion to which his paper had given rise. He did not think that his paper, however, fairly bore the construction that some of the speakers had put upon it; for he Diagram, showing the arrangement and appropriation of apartdid not deny the importance and seriousness of heart-disease; ments on the orlop deck of a ship of the first-rate, fitted on the he only contended that patients might live and enjoy tolerably old and still generally followed system. under health circumstances apparently most unfavourgood able. He admitted that his cases were exceptional ones, and 1. Marines’ Accoutrements. indeed he brought them before the Society on that account; 2. Cabin of Lieut. Marines. of he had numerous records heart-disease which for although Naval Lieut. 3. had occurred in his practice, he thought it would be most " advisable to bring forward only those which were somewhat Boatswain. 4. " 5. unusual, and therefore of a more interesting and novel chaCarpenters. " racter. 6. Gunner. "
in the
_
______________
7. Midshipman’s Store-room* 8. Cabin of Lieut. Marines.
Correspondence.
9. Captain’s Store-room. 10. Cabin of Naval Lieut.
"Audi alteram partem.11
NAVAL ASSISTANT-SURGEONS: THE MEANS FOR THEIR ACCOMMODATION ON BOARD SHIPS OF WAR.
Lieut. Marines.
11.
"
12.
"
Spare.
13.
"
Naval Lieut.
14. Dispensary. Ward-room Store-room. ditto. 16. Admiral’s 17. Paymaster’s Cabin.
To the Editor of THE LANCET. SiR,—I shall feel obliged to you for the publication of the following facts, for the information of the profession and of the public generally. If these are facts, then the assertions of certain admirals cannot be trustworthy: this is evident. I
15.
20.
Chronometer-room.
I also send you for publication in THE LANCET the plans of ships, fitted according to the old arrangement, and of those which have an entire orlop deck, and, consequently, a great increase in the number of cabins. Facts.-In May, 1850, the following was the condition (as respects space) of the ships and vessels in the Mediterranean fleet. There are several of which I have no notes: those I omit, lest I should state that which I cannot prove. H.M.S. Caledonia:Six spare cabins,,filled with brooms, holystones, sacks, paint-pots, d:c.
21.
Magazine-passage. Purser’s Slop-room.
ditto. Surgeon’s 19. Purser’s Steward’s Cabin.
18.
challenge inquiry.
H.M.S. FeMectHce;Two spare cabins. :Note: There
was
22.
Average Size of Cabins. Fore, loft. by 7ft.; Aft, 12ft. by 7ft. In the last commission of this ship, 7 & 9 formed "the for mates, assistant-surgeons, &c. In a former commission, 15 & 16 were on the platform this deck, which is, by far, the more fitting situation for
below
study"
488 mess
store-rooms, for two reasons-first, there is
now
great
loss of space from the necessity of having the ship’s side ON A METHOD OF DISSOLVING STRYCHNIA, AND REMARKS ON THE EMPLOYMENT OF ANÆSunencumbered ; secondly, the obviating of wounds from THESIA IN PARTURITION. shattering of bottles in time of action. To the Editor of THE LANCET. -Diagram, showing the arrangement &c. on the orlop deck of a in THE LANCET of the 31st August a case read SIR,—Having ship of the second-rate, fitted on the improved plan, of which we have already one illustration in commission. of poisoning by strychnia, in which case the strychnia was given in cinnamon-water, I cannot refrain from expressing an 1. Tar and Paint Rooms. opinion that the method of exhibiting so dangerous a medicine Prisoners’ 2. Police of the Ship-viz.,
6. 7.
Cells and Cabin of Master-atArms. Seamen’s Library. Store for Musical Instruments. " Marmes’ Knapsacks, &c. Cabins of Warrant Officers. Cabin of Lieut. of Marines.
8.
Midshipman’s Library.
3. 4. 5.
9.
"
Berth.
10. Cabin of Naval Instructor.
11. Lieut. Marines. " 12. ditto. " 13 & 14. Spare. 15. Cabin of Naval Lieut. ditto. 16. " ditto. 17. " 18. " Spare. Naval Lieut. ig. " 20. " Surgeon. 21. " Chaplain. 22. Dispensary. 23. Ward-room Store-room. 24. Captain’s ditto. 25. Midshipman’s ditto. 26. Pilot’s Cabin.
27. Paymaster’s Cabin 28. Clerk’s Office. 2g. Chronometer-room. 30. Purser’s Slop-room. 31. Purser’s Steward’s-room.
.
Average Size of Cabins. gft. by 7ft. N.B.-The greater dimension of all these cabins is the transverse, and this is variable, while the fore and aft extent is equal in all. In this symmetrical arrangement there are three spare cabins, in addition to the appointed positions for numerous objects not contemplated in the old arrangement. Note.—The compartments most deeply shaded by the engraver are those appropriated for the general service of the ship; those least shaded are the store-rooms of the officers’ messes; and those shaded in an intermediate degree are cabins, (see the small diagram in the previous page; and for examples Nos. 1, 7, 2, &c., among the compartments on the ship’s deck in the first diagram.)
THE NEW GALACTAGOGUE. To the Editor of THE LANCET. SIR,—By the following extract from the narrative of a voyage to the coasts of Chili and Peru, performed during the years 1712, 1713, and 1714, by M. Frezier, engineer in ordinary to the French king, it would appear that the Spaniards of Peru were acquainted with the lactagogue qualities of the leaves of the castor-oil plant, so far back as the early part of
the eighteenth century. M. Frezier’s ship, the San Josef, on the outward voyage, stopped for some days at San Vincente, in the Cape de Verde. In his description of that island, M. Frezier states, that among other plants, he saw there the ° Palma Christi, or Ricinus Americanus, by the Spaniards in Peru called Pillerilla; and they affirm that the leaf of it applied to the breasts of nurses brings milk into them, and applied to their loins, draws it The seed of it is exactly like the Indian pine-apple away. kernel. In Paraguay, they make oil of it." Dr. Tyler Smith, in his excellent paper on the lactagogue, and other qualities of the castor-oil leaves, published in this month’s number of the London Journal of Medicine, has fully demonstrated the efficacy of the plant in causing a secretion of milk in the breasts of females in this country; and I trust hat the property of drawing the milk away, assigned to it by At. Frezier, will also be specially tested by the same accomplished and painstaking observer. I would fain be allowed here to express my thanks to Mr. Henry, surgeon, of the Commercial-road, for his kindness in drawing my attention to the passage in question, and procuring me the loan of M. Frezier’s work. I have the honour to be, Sir, Your obedient servant, J. O. McWILLIAM, M.D. Trinity-sq., Tower hill, Oct. 16, 1850.
was
very incautious.
We know that
strychnia is insoluble in
water, and yet three grains of this deadly poison
were
put
into ten drachms of cinnamon-water, with directions for twenty drops to be taken three times a day in a wineglass of water. Now, supposing no mistake had been made as to the quantity of the dose, it is more than probable that the patient would have been poisoned before the whole of the medicine was taken, because the powder, being insoluble, would sink to the bottom of the bottle, and shaking the bottle would not altogether prevent it, and the last few doses would contain nearly the whole of the strychnia. I should not be so anxious to point this out if there were no remedy; but fortunately there is, and as, perhaps, it may not be generally known, I will state it. Strychnia is soluble in spirits of nitrous ether in the proportion of one grain to one drachm, and I always keep it dissolved for use, and never think of sending more than enough for two days’ use, which quantity, if accidentally taken at one dose, could not prove injurious. I also always send it in a six-ounce phial, further to obviate any mistake.
addressing you, I will take the opportunity of short observation on the use of chloroform or any other anaesthetic agent in parturition. It is recorded in your journal, that out of twenty-seven cases in which chloroform was used, four had laceration of the perinseum. This is a frightful result; surely the gentleman who employed it must be satisfied of its mischief; it is quite fearful. I do not sup pose its equal was ever heard of in the history of obstetric practice. I havebeen in practice more than thirty years, and have attended at least 3000 cases, but such an accident has only happened once in the whole number. And I am not singular; hundreds of practitioners will tell you the same. And that case was caused by the use of the long forceps: there was slight difficulty at the brim of the pelvis, the woman was weakly, and it was her first child; Nature, finding the difficulty, refused to act; the pains left. With the forceps, I brought the head into the pelvis, intending then to remove the forceps, but the resistance being overcome, Nature set up her action again, but so forcibly and rapidly, that I had not time to withdraw the forceps before the head, with one long, continued pain, was pushed through the os externum, and the back part was torn with the forceps. What is the reason of so many as one-seventh of the cases treated by chloroform having lacerated perinseums ?-the absence of pain. We know, that when a pain comes on, it goes on urging the head forward, stretching the os externum, until the violence of the pain is so great that Nature obeys the warning, the pain ceases, the head recedes, and the perinæum is saved; and so on with a succession of pains, until, by degrees, the parts become relaxed, and the head passes without any laceration. Do away with the pain, Nature’s safeguard, the forcing power of the uterus is unchecked; on goes the head, and the almost inevitable consequence ensues-laceration of the perinaeum. Although I always gently press my hand on the perinseum, I very much doubt the practical use of the process; I doubt whether any amount of support short of that endangering the rupture of the uterus by its resistance, can be of any avail in retarding the descent of the head. In the use of anaesthetic agents, it should never be forgotten that they are all deadly poisons, and that a very little more than is just sufficient to prevent the feeling of pain is just sufficient to kill the patient. And who is to know the exact dose ? That which one patient can bear with impunity will destroy the life of another. And suppose such a lamentable event to occur, even but once in a thousand times, who is the man with hardihood enough to take such a fearful responsibility upon himself. I maintain, that for the single purpose of doing away with pain in parturition, a natural and healthy action, no man is justified in saturating the system with a deadly poison. I know by experiment, that ether and chloroform permeate every tissue of the body, that for days the flesh both tastes and smells of it; and can such an agent be diffused through the blood, the very principle of life, over the whole system, without the fear of after evils, even should no immediate ones ensue ? Have 1 not numerous cases of puerperal fever and mania been caused As I
making
am a