Transactions of the American Medical Association.
Vol. II. pp. 956.
If the merits of a volume were to be judged of by its size, we
should at once pronounce these “ Transactions ” a highly valuable
production ; but inasmuch as quality, not quantity, of matter must
be the test, and as it often happens that the most voluminous
works contain less actual information than those of meaner preten-
sions, it becomes us to look beyond the cover, into the contents,
and see how far this massive volume, may sustain the reputation
of the numerous and important body from which it emanates.
We hold that every American physician is more or less in-
terested in the decision of this question.
The “ Transactions ” represent, in one sense, our medical charac-
ter. The work is a national one : emanating from a representa-
tive body, supposed to combine within itself, the best talent of the
profession in this hemisphere ; which although young in years,
has proved itself vigorous and energetic in action.
The best medical minds in America are enrolled amongst its
members, and have taken an active part in its proceedings ; and if
the Association has failed to make a favorable impression, both at
home and abroad, as to the present state of medicine amongst us,
it has rather injured the cause of science than promoted it.
It is therefore with some anxiety that we have opened the volume
before us ; but as we have proceeded in its examination, doubts
and fears have given place to a feeling of satisfaction, that the
labors of this great national association have been w’orthily per-
formed, and that this volume of Transactions, will confer lasting
credit upon the medical literature of the United States.
The chief portion of the work consists of the reports of the
various committees appointed to investigate the different
branches of medicine, and although some of these might,
perhaps, with propriety, have been curtailed, or have been
confined more strictly to matters connected with the progress of
medical science in this country ; yet they all manifest a degree of
research and an amount of learning highly creditable to those
concerned in their preparation.
In connection with these reports, it has been suggested, that the
time required in their reading, and the space which they occupy
in the printed Transactions, are a sufficient reason for discon-
tinuing them, and a proposition has actually been made to abolish
the standing committees altogether. As this matter will come up
at the next meeting, to be held at Cincinnati, it deserves the seri-
ous consideration of the members. For our own part, we are not
prepared for such a sweeping change in the original plan of the
Association. Were it adopted, it is to be feared that the time now
devoted to the reading of valuable and solid papers, would be con-
sumed in fruitless discussions upon medical politics, and that
matters of science, and the true and permament interests of the
profession would be overlooked. At the same time wre believe that
the duties of the standing committees on medical topics should be
circumscribed within the limit of the constitution, and their atten-
tion directed mainly to new ideas and modes of practice, originat-
ing in America.
This would give to their labors a freshness and originality which
they do not now possess ; while it would impart to the volume of
Transactions a more distinctive and national character, and curtail
its present unwieldly dimensions.
The first report of the series, on medical sciences, from the pen
of Dr. L. P. Yandell, of Louisville, Ky., is a full and elaborate
retrospect of the improvements and discoveries in Anatomy,
Physiology, Hygiene, General Pathology and Therapeutics, Medi-
cal Jurisprudence, Materia Medica, &c., made within the year, so
far as these have come to the knowledge of the committee through
the medium of medical periodicals, books, &c.; this occupies 82
pages, and is not confined to the progress of medicine in this coun-
try alone. Indeed the committee say that they have not “ re-
stricted themselves in their retrospect to medicine at home,” con-
ceiving that this course would render their report unsatisfactory
and incomplete. Whether this extension of the field of enquiry
beyond the limits marked out by the rule of the Association, will
be generally approved, is perhaps questionable; while at the same
time it must be acknowledged, that a very large amount of valuable
matter would be excluded, by conforming to the requirements of
the law. As it relates to foreign improvements, however, this
omission would be less regarded, from the fact that a summary of
a like character is to be found in the Retrospects of Braithwaite and
Ranking, which are issued in this country at a cheap rate, and ex-
tensively circulated ; and hence we cannot fully accord with the
views of the committee on this point. It would carry us far beyond
the limits assigned to this notice, to examine this interesting re-
port in its various details. As an able and lucid summary of new
facts, theories and suggessions, on the several branches embraced
in the enquiries of the committee, it will be profitably consulted
by the profession, both here and abroad; while the amount of re-
search, industry and taste, displayed in its preparation, will fully
sustain the reputation of its accomplished author.
The report of the Committee on Practical Medicine, Dr. D.
Francis Condie, chairman, is a clear and concise notice of such
epidemic diseases as have occurred in the United States within the
year, so far as they have come to the knowledge of the committee.
The materials at their disposal did not admit of a full and accurate
delineation of many of these diseases, but where they possessed
the required information this has been done. Typhus and typhoid
fevers, erysipelas in its various grades and types, the febrile ex-
anthemata, dysentery, cerebro-spinal meningitis, yellow fever,
and cholera, as they prevailed in different sections of the United
States within the year, form the chief topics of this valuable paper.
Such annual exhibits of the rise, progress and peculiar character-
istics of epidemic diseases, are peculiarly interesting, both for
present instruction and for future reference ; and we cannot con-
ceive of a more appropriate object for a great national medical
association, than to bring this knowledge together in a concise
form, and spread it before the world from year to year.
Appended to this report, are several interesting papers on the
epidemic diseases of particular localities, written by practitioners
who were addressed by the committee. Two of these letters are
from New Jersey, one from Dr. J. F. Garrison, of Swedesboro’,
and the other from Dr. J. Fithian of Bridgeton ; the other refers to
an epidemic dysentery, as it prevailed in Cambridge, Mass., and
is from the pen of Dr. Merrill Wyman, of that place.
Next in order is the report on Surgery. Dr. Nathan R. Smith,
of Baltimore, chairman.
Dr. Smith has also confined himself mainly to a retrospect of the
progress of surgery in America, within the past year, though he
states that “ the small amount of the required information, fur-
nished from these sources, (viz., replies to a private circular and the
journals,) and the brief period which has elapsed since the last
report, will, it is to be hoped, justify the chairman of your com-
mittee, in presenting such results as may have fallen within the
sphere of his own personal observation ; and also authorize retro-
spection, in relation to such alleged improvements, as may never
yet have been presented to the profession, though of date anterior
to the past year.
The employment of ansesthetic agents in surgery, and the com-
parative merits of ether and chloroform, occupy a prominent place
in the report. The dangers to be apprehended from the use of
both these agents are fairly stated ; and the following just conclu-
sion is arrived at: “ It is a rational inference,” says Dr. Smith,
“ that any agent, sufficiently powerful to render the living system
insensible to the pain of a severe surgical operation, (lithotomy,
for instance,) must exert a tremendous influence upon the vital
powers. It is by virtue of this counter-impression that its remark-
able effect is accomplished. Is it not rational, also, to suppose
that such powerful impressions will sometimes be injuriously ex-
erted, and that that which is so powerful for good, should occa-
sionally be equally so for evil 1 This must be true, if these
agents be at all analogous to other articles of the Materia Medica.”
As chloroform is the most powerful anaesthetic agent, it is fair
to presume that it will prove the most dangerous, when in-
cautiously administered ; and that immediately fatal results from
its use will be more numerous. The fifteen fatal cases collected by
Dr. Warren, are admitted ; but these are considered a small num-
ber in comparison to the millions of subjects to whom it has been
administered, and should not be considered, according to the com-
mittee, as a valid argument against its use under proper circum-
stances. “ The individual,” says Dr. S., “ who subjects himself to
its influence, ought to feel no more apprehension than he who
takes his seat in a rail road car, and much less than one who essays
a voyage across the Atlantic.”
The superiority of chloroform over ether, is sustained by the
testimony of a number of eminent American surgeons, of large ex-
perience, whose views were solicited, and altogether from a strong
array in favor of this powerful agent. Drs. Warren and Knight,
with some other very respectable names, are, however, found
against the use of chloroform, and in favor of ether; the former
gentleman preferring the chloric ether to either article.
In view of all the facts developed within the year, Dr. Smith
fully sustains the views of the former committee, for 1848, in re-
gard to the use of anaesthetic agents, and considers that great
progress has been made “ in establishing professional and public
confidence in these extraordinary agents, and on the vast benefit
which is likely to result to mankind, from this achievement of
science and humanity.”
The remainder of this interesting report is occupied with the
history of improvement in the treatment of fractures and disloca-
tions, and with the replies to the circular of the committee upon
other practical questions.
They conclude with the sentiment, that “ in this department of
medicine, the spirit of improvement is abroad in our country, and
that the inventive genius which we claim as a national characteris-
tic, is being exercised with signal success, in whatever relates to
the science and art of surgery.”
We have only to regret that the topics discussed in this valua-
ble paper are confined so exclusively to the mechanical and opera-
tive parts of surgery ; with so little attention to the higher theme
of the medical treatment of surgical diseases. The latter is cer-
tainly one of great interest, and we would fain hope that the spirit
of progress would be found equally marked in this department of
the science.
The report on Obstetrics, from the lively pen of Dr. Gilman, of
New York, is divided into two parts, viz., Diseases of Females, and
Obstetrics proper.
Under the former head is included, congestions of the os and
cervix uteri, and the importance of the speculum in diagnosticat-
ing these affections; uterine displacements, with an account of
recently invented instruments to correct them, occlusion of the
vagina, ovariotomy, &c. And under the latter, the practice of
separating the placenta from the uterine wall in cases of placenta
previa, and the use of anaesthetics to control the sufferings and
facilitate the progress of labor.
Our space will not permit even a passing notice of these several
topics, except the last, the importance of which, at this juncture,
seems to demand some remark.
There is certainly no question in the whole range of obstetrical
practice of equal interest with this.
Under what circumstances should aneesthetic agents be adminis-
tered to women in the throes of labor ? Should they be given in
natural labors or only in protracted or instrumental cases ? What
are the dangers attending them ? Have there been fatal results,
and if so, how many, and under what circumstances ? Which
agent is preferable, ether or chloroform, or a combination of the
two? These questions are continually presenting themselves, and
the great mass of the profession are still in doubt and anxiety in
regard to their solution.
WThile some accoucheurs of high authority have boldly de-
nounced the use of anaesthetics in midwifery altogether, solely on
theoretical grounds, and without any personal experience; others
of equal credit have, from the first, taken strong ground in their
favor, and have given to the profession the results of their exten-
sive experience.
The committee, in entering upon the subject, appear anxious to
treat it impartially, and have, we think, presented the profession
with a fair and valuable transcript of the present state of the ques-
tion.
To Dr. Walter Channing, of Boston, they award the credit of
having given to the profession the largest number of cases of
etherization in midwifery, which have yet been published together,
derived not only from his own large experience, but from forty or
fifty physicians residing in and around Boston, amounting in all to
five hundred and fifteen cases of natural labor, and fifty-two cases
of instrumental or complicated labor. The results of this large
number of cases are carefully analysed, and are declared to be
highly favorable to the use of aneesthetics in natural labor, while
in the instrumental and complicated cases, the success has been
beyond what is usual, and “ most unexpectedly favorable.” Dr.
Channing’s experience on this point, is compared with that of Dr.
Collins, of Dublin, whose work “ presents the largest mass of
statistical information on obstetrics ever collected in the English
language,” and a difference in favor of Dr. Channing is clearly
shown.
Reports from Dr. G. N. Burwell, of Buffalo, Dr. H. Lindsly, of
Washington, D. C., and Dr. Joseph Parrish, of Burlington, N. J.,
are also referred to by the committee, as confirmatory of the
favorable estimate of etherization, derived from the experience of Dr.
Channing and his Boston contemporaries, while the foreign reports
on this subject, from some of the leading accoucheurs of Great
Britain, France and Germany, induce the committee to believe
“ that aneesthetics are gradually gaining favor with the profession
everywhere.”
The various advantages of etherization beyond the relief of pain,
are also freely discussed ; amongst which are mentioned the more
perfect contraction of the uterus after delivery, and the consequent
diminished liability to haemorrhage. Upon this point there has
been, during the year, considerable testimony, but not in the opin-
ion of the committee of such character as to determine its powers.
While the agency in relaxing the soft parts, and its harmlessness
upon the foetus, are considered settled.
Some encouraging experience in favor of the remedial powers
of anaesthetics in puerperal convulsions, is also given, and the
success reported is believed by the committee to establish their
character in this dangerous and frightful disease.
In summing up the results of the enquiry, the committee con-
clude that the cases in which ether or chloroform have been given
to parturient women must now be enumerated by thousands, and
“ in no one case has a fatal result followed.”
“This result, (say they,) if it stood alone, would abundantly
establish the safety, as well as the power, of anaesthetics, and
would enable us to confer upon woman the greatest benefit she
has ever received from medical science.” In surgery, however,
death has in several cases occurred, as the direct effect of the
inhalation, and this has had a most decided influence upon anaes-
thesia in obstetrics. The extent to which these unfortunate results
in surgery should operate, is a question which obstetricians must
decide for themselves, and upon which the committee decline the
expression of a positive opinion. In this connection an ingenious
explanation of the different results in surgery and obstetrics, fur-
nished by Dr. Channing, is given.
In surgery, says Dr. C., the agent is used as a preparative to
the operation. Pain is not at the time present, and has not yet
exerted its influence on the nervous system—that system is in its
integrity, and has of course its greatest capacity for impression,
the greatest amount of sensibility, with the least power of resist-
ance. The mind, too, consents to the same thing, and no moral
resistance is made; whereas, in labor the pain is present, and has
been for a long time; the nervous system has been greatly taxed,
its power has, so to speak, been used up. Impressions upon it are
weaker than they would be under other circumstances—the system
comes readily under the anaesthetic influence—very little ether or
chloroform is necessary, and when it is used it is never pushed by
the judicious accoucheur to the entire destruction of consciousness.
Whether this explanation be or be not satisfactory, it is certainly
true that all the deaths reported from the use of chloroform have
occurred in surgical practice, and in most of them it has been
given preparatory to trivial operations.
The committee compare the relative advantages of ether and
chloroform, and evidently incline to the latter, believing that it
possesses every advantage except safety. They acknowledge,
however, that the administration of this article requires a great
amount of skill and tact, which can ordinarily be gained only by
experience; and hence they recommend that all persons not prac-
tically familiar with anaethesia, should make their first trials with
ether. Where thorough knowledge and abundant skill exists, then
few if any fatal cases will occur. In regard to the limits within
which anaesthesia should be practiced in midwifery, the committee
remark, that those who resort to it indiscriminately, or in ordinary
cases of labor, are in a very small minority ; while a very large
majority of the profession would favor it in operative midwifery,
and perhaps a majority would give either ether or chloroform in
difficult cases of complex or of regular labor. In operative mid-
wifery the committee speak with great confidence of the advan-
tages of anaesthesia, believing that the patient’s chance of re-
covery is greatly augmented by the suffering and exhaustion which
she is saved.
Several other points are briefly noticed in the report, which we
shall pass over, and reserve a notice of the other contents of the
volume for our next number.