191 



received. As the case is here fairly reported, and as the letter 

 contains other important information, they have deemed it proper 

 to incorporate it into this report. 



My Dear Dr. 



In compliance with your request of this morning, I enclose you the 

 result of my experience with sulphuric ether and chloroform. 



I have used the ether in a number of surgical operations, twice 

 for lithotomy, many times for the removal of scirrhus mamm?e and 

 other tumours — for strictures of the urethra — both in dilatation and 

 cutting to the bladder, besides a great variety of cases of lesser im- 

 portance, and altogether must have administered it on upwards of 

 fifty occasions. In all these instances I have never seen any bad 

 effects following its employment excepting in tivo cases — one of them 

 was a case of lithotomy, and in the other, where it was given for the 

 removal of a tumour in the femoral region, it produced the effects of 

 the nitrous oxide gas in so violent a degree, that I was compelled to 

 postpone the operation, and the patient was seriously ill for several 

 weeks. In the case of lithotomy, regarding which you have desired 

 information, the child died on the morning of the third day after 

 the operation, apparently from the effects of the sulphuric ether. 



I say apparently, as the congestion of the lungs, of which the 

 patient died, might have happened from other causes, and it has 

 been questioned by some, who saw the case with me, whether it was 

 not brought on by exposure to cold after the operation, to which 

 the child was somewhat carelessly subjected. There can be no 

 doubt that congestion of the lungs, ending in effusion, was the cause 

 of death. The patient, whilst in this state, was carefully examined 

 throughout its progress by Drs. Clymer, Keating, Mayer, and 

 others, who all concur in opinion. The calculus was of so large 

 and unusual a size, and required necessarily so long a time to extri- 

 cate it from the bladder, and the child so young (18 months), that 

 even without the use of the ether he might have sank from the shock 

 of the operation. There was, however, no evidence of such a shock 

 to be perceived; in all other respects, as before stated, everything did 

 as well as could have been desired. The urine flowed freely from 

 the incision, which looked sound and healthy. 



If the fatal result was owing to the ether, I am convinced that it 

 was from its too long continuance and too powerful administration; 

 indeed I have never witnessed a patient more completely under its 

 influence, so unconscious and lifeless. The child was under its in- 

 fluence for twenty-five minutes, and was roused with great difficulty 

 by the application of cold water to the head and breast. The ether 

 was administered by means of Dr. Roper's inhaler. Most unfor- 

 tunately the opposition of the parents and friends prevented our 

 obtaining a post-mortem examination. These, my dear Dr., are the 

 facts of the case. My own opinion, as well as that of the gentle- 

 man before mentioned, is that the congestion of the lungs was pro- 



