of a dull character; sometimes the operation is supposed by the patient to be performed upon somebody else. Certain patients, whose teeth have been extracted, remember the application of the extracting instruments; yet none have been conscious of any real pain.

As before remarked, the phenomena of the lethargic state are not such as to lead the observer to infer this insensibility. Almost all patients under the dentist's hands scowl or frown; some raise the hand. The patient whose leg was amputated uttered a cry when the sciatic nerve was divided. Many patients open the mouth, or raise themselves in the chair, upon being directed to do so. Others manifest the activity of certain intellectual faculties. An Irishman objected to the pain that he had been promised an exemption from. A young man after sitting in the chair and inhaling a short time rejected the globe, and taking from his pocket a pencil and card wrote and added figures. Dr. Morton supposing him to be affected, asked if he would now submit to the operation, to which the young man willingly assented. A tooth was accordingly extracted, and the patient soon after recovered his senses. In none of these cases had the patients any knowledge of what had been done during their sleep.

I am as yet unable to generalize certain other symptoms to which I have directed attention. The pulse has been, as far as my observation extends, unaltered in frequency, though somewhat diminished in volume; but the excitement preceding an operation has, in almost every instance, so accelerated the pulse that it has continued rapid for a length of time. The pupils are in a majority of cases dilated; yet

1 Since the above was written, I find this irregularity of symptoms mentioned in the case of poisoning by alcohol. Dr. Ogston, according to Christison, has in vain attempted to group together and to classify the states of respiration, pulse, and pupil.

they are in certain cases unaltered, as in the above case of amputation.

The duration of the insensibility is another important element in the process. When the apparatus is withdrawn at the moment of unconsciousness, this state continues, upon the average, two or three minutes, and then the patient recovers, completely or incompletely, without subsequent ill effects. In a sudden cessation of the symptoms, this vapor in the air tubes differs in effect from narcotics or stimulants. in the stomach, and also, as far as the evidence of a few experiments of Dr. Morton goes, from ethereal solution of opium when breathed. Lassitude, headache, and other symptoms, lasted for several hours when this latter agent was employed.

But if the respiration of the vapor be prolonged much beyond the first period, the symptoms are more permanent in their character. In one of the early cases, that of a young boy, the inhalation was continued during the greater part of ten minutes, and the subsequent narcotism and drowsiness lasted over an hour. In a case already mentioned, the narcotism was complete during more than twenty minutes, the insensibility approaching to coma.

Such cases resemble those before quoted from Christison and other authors, and show that the cessation of the inhalation, after it has been prolonged for a length of time, does not produce a corresponding cessation of the symptoms, while, if the inhalation is brief, the insensibility ceases in a short time. Recovery in the latter case is not improbably due to the complete and rapid elimination of the vapor from the lungs; the more gradual return of consciousness in the former case, to the presence of a larger quantity of unexhaled particles. A fact mentioned by Christison bears upon this point. This author states that insensibility from the presence of a large quantity of alcohol in the stomach often gives place to a complete and sudden return of conscious

ness when the alcohol is removed by the stomach pump. It is probable that the vapor of the new preparation ceases early to act upon the system, from the facility with which it is exhaled.

The process is obviously adapted to operations which are brief in their duration, whatever be their severity. Of these the two most striking are, perhaps, amputation and the extraction of teeth. In protracted dissections the pain of the first incision is alone of sufficient importance to induce its use; and it may hereafter prove safe to administer it for a length of time, and to produce a narcotism of an hour's duration. It is not unlikely to be applicable in cases requiring a suspension of muscular action, such as the reduction of dislocations or of strangulated hernia; and finally it may be employed in the alleviation of functional pain, of muscular spasm, as in cramp and colic, and as a sedative or narcotic.

The application of the process to the performance of surgical operations is, it will be conceded, new. If it can be shown to have been occasionally resorted to before, it was only an ignorance of its universal application and immense practical utility that prevented such isolated facts from being generalized.

It is natural to inquire with whom this invention originated. Without entering into details, I learn that the patent bears the name of Dr. Charles T. Jackson, a distinguished chemist, and of Dr. Morton, a skilful dentist, of this city, as inventors, and has been issued to the latter gentleman as proprietor.

It has been considered desirable by the interested parties that the character of the agent employed by them should not be at this time announced; but it may be stated that it has been made known to those gentlemen who have had occasion to avail themselves of it.

I will add, in conclusion, a few remarks upon the actual position of this invention as regards the public.

No one will deny that he who benefits the world should receive from it an equivalent. The only question is, Of what nature shall the equivalent be? Shall it be voluntarily ceded by the world, or levied upon it? For various reasons, discoveries in high science have been usually rewarded indirectly by fame, honor, position, and occasionally, in other countries, by funds appropriated for the purpose. Discoveries in medical science, whose domain approaches so nearly that of philanthropy, have been generally ranked with them; and many will assent with reluctance to the propriety of restricting by letters patent the use of an agent capable of mitigating human suffering. There are various reasons, however, which apologize for the arrangement which I understand to have been made with regard to the application of the new agent.

1st. It is capable of abuse, and can readily be applied to nefarious ends.

2d. Its action is not yet thoroughly understood, and its use should be restricted to responsible persons.

3d. One of its greatest fields is the mechanical art of dentistry, many of whose processes are by convention secret, or protected by patent rights. It is especially with reference to this art that the patent has been secured. We understand already that the proprietor has ceded its use to the Massachusetts General Hospital, and that his intentions are extremely liberal with regard to the medical profession generally, and that, so soon as necessary arrangements can be made for publicity of the process, great facilities will be offered to those who are disposed to avail themselves of what now promises to be one of the important discoveries of

the age.

INSENSIBILITY DURING SURGICAL OPERATIONS PRODUCED BY INHALATION.1

TO THE EDITOR:

SIR, I observe in the last number of your Journal an article entitled "The Inhalation of an Ethereal Vapor to prevent Sensibility to Pain," etc., signed by J. F. Flagg, M.D., a considerable part of which is devoted to comments upon a paper of mine in the same Journal, of the date of November 18, 1846.

Any one who will trouble himself to examine that paper, will find there a narrative of physiological facts observed by myself, with a few concluding remarks connected with the patent right, intended chiefly to inform the medical profession, at the request of the inventors, that every practicable facility would be afforded to them in their use of the new process. It was far from my intention to take part in the differences likely to arise from an invasion of the patent, and I indulged the belief that I had avoided any issues of a controversial character.

It may be necessary, however, to notice one or two points in the communication of Dr. Flagg, but I do so with regret that they should have emanated from so respectable a quarter. I disclaim any interest of any kind whatever in the matter under discussion, except the heartfelt desire I have, in common, I believe, with almost every man in the community, that full justice should be done to the inventors of a method by which the whole human race is benefited; and

1 Boston Medical and Surgical Journal, December 9, 1846.