are

of our Profession even, would compel a Dentist to confine himself exclusively to the practice of operations on the teeth. Now, in this respect Dentists differ from all other specialists. The most eminent oculists of the day have been and General Hospital Surgeons, engaged in the practice of Surgery in all its branches; they will cut for stone, and operate for hernia as skilfully as they can extract a cataract. The same is the case with Orthopedic practitioners. The most eminent in London, the founder of Orthopædic Surgery in England, is a Physician to one of the largest Hospitals, and is extensively engaged in general Medical practice. But the Dentist, as I have already said, is a pure specialist; he does not, and cannot, consistently with his own duties, depart from the Surgery of the Teeth. Now, this being the case, why should a pupil be compelled to go through a course of study that has no bearing upon his practice in after life? What use can there be in teaching a young man the minute anatomy of the surgical regions and the mode of performing surgical operations, which he can never be called upon to practise- neglecting his own department of study the teeth-in the cure of the diseases of which his after-life will be spent? I believe it is not only useless, but positively injurious, to compel young men to a course of study which they know will lead to no practical result; to force them to acquire knowledge for the sole purpose of acquiring a professional title-to learn what they can never be called upon to practise. I have had several students attending my lectures at various times who were placed in this position, and those to whom I have spoken on the subject have always complained of the hardship and drudgery and loss of time attendant on such a course of study. It was only this day that I was speaking to one of the most intelligent young men with whom I am acquainted, who is qualifying for a Dentist, but is studying to pass the College of Surgeons, and he told me that he felt that all his studies would be useless to him in after-life, and that the time so spent was in a great measure lost. As, then, neither the education of a Surgeon fits a man for the practice of dentistry, nor the examinations for a Surgeon test his competency so to practise, I cannot look upon a connexion with the College of Surgeons as in any way necessary to the Dentist, and I do not think that he ought to be compelled to pass through the portals of that institution before he is allowed to practise his own art. But though I do not consider a connexion with the College of Surgeons as necessary, there can, of course, be no objection to a Dentist qualifying himself as a Surgeon, if he thinks it expedient to do I look upon it as in the highest degree creditable to his industry and perseverance that he should do so, but let him become a member of the College of Surgeons just as he would become a Master of Arts or a Doctor of Philosophy. There are many men among you who, having been educated for the Medical Pro

so,

fession, and having taken their Medical Degrees, have found it more agreeable or more advantageous to practise as Dentists than as Surgeons or Physicians. Such men are an honour to both Professions, and to them my remarks necessarily do not apply. But though I do not think it at all necessary that every Dentist should be compelled to be a member of the College of Surgeons before he can be allowed to practise his art, I look upon it as equally, if not more injurious that he should be allowed to practise that art without any special education to fit him for it, or any examination specially to test his competency in it. I look upon it as a very great evil that this should be allowed; and I would be glad to see it rendered compulsory in every young man who intends to enter the Dental Profession that he has followed out a certain course of education to fit him specially for it, and that he has passed through one examination that will test his qualifications to engage in its practice. I think it is of importance that he should be specially conversant with the anatomy, physiology, pathology, and surgery of all the parts connected with the teeth and mouth. Now, such a course of study is offered in an institution such as this, and it is my earnest advice that those who intend to become Dentists should take advantage of it. So far as my lectures are concerned, they will consist of a short course of six, on the Malformations, Injuries, and Surgical Diseases of the Mouth and Jaws.' To-night we shall commence with the subject of hare-lip and cleft-palate; and I may say, that, addressing a body of gentlemen who should be made specially conversant with these subjects, I shall enter more minutely and fully into them than I should think it necessary to do if I were addressing an audience of Medical students or Medical men.'

'

Mr Erichsen then explained in a very clear manner the mode of normal development of the jaws, and showed how arrest of development at various stages produced the different varieties of hare-lip. After some general remarks on the principles of the treatment of the malformation, he concluded a very interesting lecture amid general marks of approbation.

LECTURE XI.

[Delivered on March 2nd, 1859.]

ON CHLOROFORM AND THE NARCOTIC REMEDIAL SERIES, THEIR ACTION AND APPLICATION.

MR PRESIDENT AND GENTLEMEN,

THE use of medicinal substances of the narcotic class, in such way as to produce complete insensibility, is of ancient date. Various facts connected with this subject have been collected with considerable learning and interest by Dr Simpson, the late Dr Snow, and other writers. From the writings of these, especially the last one named, I may introduce a few introductory observations, which will not only be of interest to you, but useful, as indicating by what steps the method of producing anesthesia locally and generally has progressed until the present day. Dioscorides, one of the old Greek physicians, describes that a decoction of mandragora was given to patients by the mouth to prepare them for operation. He also states that a substance called "morion was used for a similar purpose. A drachm of it eaten in a cake or in other food, took away the use of reason, and the patient would sleep in the attitude in which he was left eating for the space of three or four hours. Medical men, he adds, use it when they have recourse to cutting or burning.

Pliny, in like manner to Dioscorides, speaks of mandragora, and after stating that the juice of the leaves is more potent than the preparations made from the root, says that to procure sleep for painless operations it is necessary only for some persons to smell the medicines; from which remark it may be inferred that narcotism by inhalation is a practice also of ancient date. But the most interesting and at the same time the most striking

passage is by Apuleius, who informs us that any one who may

be about to have a limb mutilated, burnt, or sawn, may drink

half an ounce of the wine of mandragora, and whilst he sleeps the member may be cut off without pain or sense.

At a period perhaps quite as early as that which we have glanced at, Indian hemp was in use for the same purpose by the Chinese. Dr Snow infers that the fumes of the hemp were inhaled for producing sleep, and his view is supported by a remark in Herodotus to the effect that the ancient Scythians were accustomed to inhale the fumes of burning hemp to produce intoxication, as well as by the fact that the Hindoos have smoked hemp with the same object for ages past. Omitting notice of certain other supposed means of causing anesthesia invented in the middle ages, I would note an anecdote, quoted first by Dr Silvester and afterwards by Dr Snow, which shows that in the seventeenth century anesthesia was practised by means of a narcotic draught.

"Augustus, King of Poland and Elector of Saxony, suffered from a wound in his foot which threatened to mortify. The Court medical men were opposed to the operation of amputation; but during sleep, induced by a certain potion surreptitiously administered, his favourite surgeon, Weiss, a pupil of Petit, of Paris, cut off the decaying parts: The royal patient was disturbed by the proceeding, and inquired what was being done, but on receiving a soothing answer he again fell asleep, and did not discover till the following morning, after his usual examination, that the operation of amputation had been really performed."

By accident and custom a variety of narcotic substances have been used to produce entire insensibility and forgetfulness of external impressions. The smoking of opium to the production of perfect anaesthesia will occur to all as a prevalent custom. In the early days of Scottish history nightshade was used as a stupifying agent in like manner, and it is said that darnel, or as it was called in Italy, imbriaca, a plant which grows amongst corn, was at one time used in the form of cake as a powerful drunken stupifier. There is some indirect proof also that these agents have been occasionally employed previous to the performance of operations. The practice, nevertheless, has never been reduced to a system till now, nor was anything definitely suggested for the production of anesthesia as a process until the early part of the present century.

The credit of proposing narcotism in surgical operations, after the manner in which it is employed at the present time, belongs to one of our own great countrymen, Sir Humphry Davy. In the researches of this distinguished philosopher he made a series of experiments on the effects of a gas called nitrous oxide. There is not in the history of physiology any set of inquiries more valuable than this. Having taken_nitrous oxide himself, and exhibited it to men and animals, Davy, in describing the effects of the agents, uses this expression, which

I will read to you from his own work: "As nitrous oxide in its extensive operation appears capable of destroying pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place." In this sentence we have the text of all that has been since performed in the study of anesthesia and anæsthetics,

It is remarkable, however, that a long time elapsed before the meaning of Sir Humphry Davy's labours were understood or put into practice. With the exception of a suggestion made by a country practitioner in England, as to the propriety of employing carbonic acid as a sleeping agent, we find no progress until the year 1844, when an American dentist, Mr Horace Wells, on seeing Mr Colston go through the well-known experiment of administering nitrous oxide as an amusement at a popular lecture, asked the said Colston to administer the gas to him while another dentist extracted a tooth. This was on December the 11th, and this was the first operation in our day performed after the removal of sensibility. Wells, elated with the appli. cation of the gas as suggested by him, tried to introduce it into general practice in operations. Thus used, it failed in his hands, probably because he was not sufficiently skilled as an experimentalist, and was not sufficiently acquainted with the properties of the agent.

Soon after this event a new phase is opened. Wells communicated the facts he had learned to Morton, another dentist, and on the 30th of September, 1846, Dr Morton administered sulphuric ether to a patient, and extracted a tooth without pain. This was the first application of ether vapour, but it had previously been ascertained and proved that this vapour had the power of causing effects very similar to those caused by the nitrous oxide. It has been a disputed point whether the suggestion of etherization as a practice is really due to Dr Morton; another claimant, Dr Jackson, having stated that it was he who pointed out to Morton the influence of sulphuric ether. The merits of this controversy have been very carefully canvassed by Dr Snow, and I shall here introduce word for word the observations of that writer, as embodying, all I would say, with much fairness and precision.

"Dr Morton was well acquainted with Mr Horace Wells, and had been in partnership with him. Before administering the ether to his patient on September 30th, Dr Morton had a conversation with Dr Charles J. Jackson, professor of chemistry, respecting the safety and propriety of the application, and the names of these gentlemen were associated in a patent which they took out for the discovery. Dr Jackson asserts that Dr Morton knew nothing of the effects of the vapour of ether till he gave him the information; whilst the latter says it was his

intention to use the ether before he went into Dr Jackson's laboratory. It seems impossible to arrive at the exact truth on