THE only authorities who have published their opinions and experience on the subject I am about to consider, are Baron Dubois and Professor Simpson; but in the accounts of these obstetricians, though valuable facts are recorded, little attempt is made to reconcile experience and the phenomena of etherization, with physiological and pathological actions, the true basis upon which its ultimate adoption or rejection must rest. The task of fixing the relations and true position of a new agency, of

more »

... uch extraordinary powers, is one of great difficulty, but it seems to me that the time is arrived when at least the attempt to do this should be made. Our opinions respecting the value of etherization in practical midwifery must chiefly depend on our knowledge of the manner in which this state of insensibility can modify the physiological actions of parturition, and also on our observation of the results in those obstetric cases in which it has been or may be employed. If the production of the etherized state merely removed pain, without inducing any other complication, the question, as it relates to midwifery, might be readily decided. The relief of the pangs of travail would indeed be an invaluable boon. But the problem to be solved is by no means so simple or so uncomplicated. The inhalation of ether takes away from the parturient woman several other elements natural to her condition besides mere physical pain, while it adds thereto other states of the system, which are not observed in strictly natural labours. The true mode of proceeding is to examine carefully what there is subtracted from, what there is added to, the processes of labour, and then to come to a decision as to whether the advantages or the disadvantages of the use of ether in midwifery are likely to preponderate. Etherization is chiefly a new condition of the nervous system, and we must examine the modes in which the different divisions of the nervous system are affected. And, first, as regards the cerebral division of the nervous system. Sensation is for a time impaired or abolished. There can be no doubt that, as one of its effects, the pains of labour may be alleviated or abolished by this new application. Volition may also be suspended; all the voluntary movements are in abeyance when the patient is fully under the influence of ether. In the partially etherized states, violent actions of the voluntary muscles takes place, but they are irregular, like the movements of ordinary intoxication. Emotion is, in the fully etherized state, withdrawn, or the ordinary emotions are replaced by the disordered emotions of dreaming or delirium. We must therefore inquire into the uses of sensation, volition, and emotion, to parturition, all of them being intimately associated together in natural labour. In the expulsory stage of labour, after the dilatation of the os uteri, the efforts of volition are of some assistance to delivery. The efforts of expiration, and especially of the abdominal muscles, are increased, and the patient aids in fixing the thorax and the pelvis, by grasping firmly with the hands, and planting the feet against some convenient place. Sensation and emotion are, in a physiological sense, even of more importance than volition to parturition. In the last pains of labour, .when the motor power is prodigious, and the patient is threatened with laceration, the sensation and emotion of pain comes in as a preservative. All the ordinary actions of labour at this period are reflex in their nature, and are, whatever their violence, uncontrollable by the will. But whenever the pain becomes too intense to be borne,-and pain is here a measure of danger, the patient, chiefly under the influence of emotion, cries out, and her cry, by opening the glottis, takes away all expiratory pressure, and leaves the uterus acting alone. So, in the last stage of labour, upon the mingled agony and exertion of which obstetricians have exhausted their descriptive powers, pain and its attendant emotion play a benign and salutary part. It is now that laceration of the perinseum is most impending, and at this point not only is the glottis opened, but the sphincter ani and the sphincter vesicae are' suddenly dilated, so as to relieve the perinæum to a very great degree. It cannot but be considered as a singular provision of Nature, that at the moment when the outlet of the vagina is threatened with the greatest danger, these two sphincters should suddenly relax before and behind it. We may even deduce from this fact a reason for the anatomical position of the vagina betwixt the rectum and the bladder. Thus, then, volition, and especially the sensation of pain, and its attendant emotion, are of considerable importance in natural parturition. Some interesting points relating to sensation have been suggested by the facts observed in etherization. It has beenagain and again noticed that patients may preserve ordinary consciousness, and the use of the special senses, with a total insensibility to pain. They have in some cases talked rationally, and have seen and heard perfectly, while they were unconscious of the performance of the most painful operations. Separate seats have been proposed for ordinary consciousness and the perception of pain. Both the seat of pain, and the exact nerves which are the communicators of pain, are as yet unascertained. It is evident that the nerves of special sense are not the conductors of pain; the optic, olfactory, and auditory, are insensible to pain; and a whitlow affecting the cushion of the finger, upon which the tactile nerves are accumulated, is not more painful than a burn on the back of the hand, or than an inflamed peritonaeum. Thus, the nerves of special sense, as such, are not ordinarily conductors of pain. Besides the fact that the intellect may remain clear while sensation is abolished, there are other reasons for believing that the cerebrum is not the seat of the sensation of pain. Longet, for instance, removed the whole of the brain of a living animal, leaving only the medulla oblongata; and on being pinched or punctured, it cried out, and gave the most lively manifestations of pain. These facts would lead to the inference that there must be a special seat of pain, and special nerves for its propagation, from the periphery to this centre of painful sensations. Lastly, it becomes a question whether ether affects the seat of pain, or the nerves which conduct to it. Afr. Adams, of the London Hospital, made the ingenious suggestion that the blood was altered in etherization, and that the altered blood paralyzed the extremities of the nerves. Others have maintained that this altered condition of the blood depends on the imperfect inhalation of the ether, and partial asphyxia. We know that a writer of eminence on the nervous system is of opinion, that the central seat of pain, with that of pleasurable sensations, and emotion, and respiration, is in that nccud vital, or nodus vitalis, the medulla oblongata, whilst its actual seat is in some part of the ganglionic system. Probably, under the full influence of ether, the whole of the nervous system concerned in the production and perception of pain is simultaneously affected. But whatever its nature and seat, sensation is removed by the influence of ether; the parturient woman may pass at once from her agony, into a state of oblivion to pain. Pain is taken away! Labour itself, like a surgical operation, produces what has been termed shock. In certain cases, the vital powers fail, the contractions of the uterus and the actions of the heart sink together, and the patient may even die from the pure influence of shock. This may take place in labours, difficult it may be, but still from which the majority of women recover in the usual way, so that we have no certain means of estimating beforehand the probable power of the shock of parturition in any given case. Professor Simpson, in his recent paper, asks, " On what division of the nervous system does the nervous shock operate-the cerebral, spinal, or ganglionic ? If on the former, it should be kept in abeyance by due etherization." Now, I conceive this important point need hardly be put as an interrogation, or if so, that it should meet with something like a definite answer. Shock is composed of several elements, and is certainly not confined to the brain; those which are really referrible to the cerebrum, and to the medulla oblongata, which partakes both of the nature of brain and spinal marrow,-for here the cerebral and spinal systems seem fused,—are, pain and emotion, and the effects of these depend on the perfect presence of consciousness and the perception of physical suffering. We must doubtless look on pain—I mean, physical sufferingas distinct from uterine contraction, which in midwiferyalmost takes the term to itself, not only as a great evil, but as a source of other evils. No human suffering, perhaps, exceeds in in. tensity the piercing agonies of child-bearing, and no benevolent mind but would consider it an inestimable blessing to