his work, as Lizars did for McDowell's. In 1800 Sir Humphry Davy (1788-1829), of Penzance, England, experimented upon himself with nitrous oxide, and stated that "it may probably be used with advantage in surgical operations in which no great effusion of blood takes place." In 1844 Horace Wells (1815^8), a dentist of Hartford, Connecticut, began to use nitrous oxide in dentistry, communicating his results to his friend and former partner, William Thomas Green Morton (1819-68), of Charlton. Massachusetts; but a fatal case caused Wells to withdraw from practice, and he eventually put an end to his life. Morton had, in the meantime, been studying medicine, having for his preceptor Dr. Charles T. Jackson, a chemist of ability, who pointed out to him the anesthetic effects of chloric ether, which he proceeded to apply in filling a tooth in July, 1844. Becoming interested, Morton pushed his inquiries further and subsequently learned from Jackson that sulphuric ether is also an anesthetic, whereupon he applied it at once in extracting a deeply rooted bicuspid tooth from one of his patients. Morton then visited Dr. John ('ollins Warren, of the Massachusetts General Hospital, and persuaded him to give the new anesthetic a trial in surgical procedure, without, however, disclosing the name of the drug. The operation took place at the hospital on October 10, 1846, the case being a "congenital but superficial, vascular tumor, just below the jaw, on the left side of the neck." The tumor was dissected out by Warren in five minutes, and, as the patient came back to consciousness, he exclaimed, "Gentlemen, this is no humbug." The next day a large fatty tumor of the shoulder was removed by Hayward, with Morton as anesthetist, and again with success. On November 18, 1846, the discovery was announced to the world in a paper by Henry J. Bigelow, published in the Boston Medical and Surgical Journal.1 It was largely due to the high character and repute of such men as Warren and Bigelow that ether anesthesia was taken up all over the world and became a permanent part of operative surgery, for Morton tried to patent the drug as "letheon" (1846),- squabbling with Jackson about their respective legal rights, and not announcing it as sulphuric ether until 1847.3 In the meanwhile. Robert Liston had amputated a thigh under ether in December, 1846; Syme took it up in Edinburgh (1847), and Pirogoff wrote a little manual on etherization (1847), based upon his Crimean experiences. The terms "anesthesia" and "anesthetic" were pro

1 Boston Med. and Surg. Jour., 1846-47, xxxv, 309; 379. »T. W. Morton: Circular, Morton's letheon, Boston, 1846. * Morton: Remarks on the proper mode of administering sulphuric ether, etc., Boston, 1847.

posed by Oliver Wendell Holmes. On January 19, 1847, Sir James Young Simpson (1811-70), professor of obstetrics at Edinburgh, used ether in midwifery practice for the first time in Great Britain, but on November 4, 1847, he was led to substitute chloroform, the discovery of Liebig, Guthrie, and Soubeiran, and was so much impressed with its advantages over ether in obstetric work that he published his results a week later.1 The effect of these discoveries upon medicine and surgery was remarkable in many ways. First of all, the surgeon, who, in pre-anesthctic days, had to rush through an operation at lightning speed and under great disadvantages occasioned by the struggles and distress of the patient, could now take his time and therefore perform many new operations impossible under the old conditions.2 The days of sleight-of-hand feats were over, and the prestidigitations of a Cheselden, a Langenbeck, a Fergusson, or a Pirogoff gave place to careful, deliberate procedure. Again, a few whiffs of chloroform enabled the lying-in woman to confront the fierce pangs of labor with greater ease and security, and the obstetrician was able to work under the same advantages as the surgeon. Both surgeon and obstetrician specialized at need, as operative gynecologists, while laboratory workers in physiology and other branches of experimental medicine could have no further misgivings about the sufferings of vivisected animals. In these fields anesthesia was, in the memorable phrase of Weir Mitchell, the "Death of Pain."

Operative gynecology, which had no special existence before the beginning of the nineteenth century, was largely the creation of a number of surgeons from the Southern States, and, as has been suggested, had its origin in the attempt to repair the errors and omissions of backwoods obstetrics. In the eighteenth century, we find William Baynham (1749-1814), of Virginia, operating twice with success for extra-uterine pregnancy (1790-99),* and, in the early part of the nineteenth, John King (1819-93), of Edisto Island, South Carolina, performed a remarkable operation for abdominal pregnancy in 1816,4 saving both mother and child by cutting through the walls of the vagina and applying the forceps, with abdominal pressure exerted upon the fetus from above. He afterward expanded his observations in a thin volume of 176 pages, published at Norwich, England, in 1818, entitled "An Analysis of the Subject of Extra-uterine Fnetation, and of the Retroversion of the Gravid Uterus," the first book on the subject. The founders of operative gynecology were McDowell and Sims.

1 Sir J. Y. Simpson: Account of a new anesthetic agent, Edinburgh, 1S47.

2 "When I was a boy, surgeons operating upon the quick were pitted one against the other like runners on time. He was the best surgeon, both for patient and onlooker, who broke the three-minutes record in an amputation or a lithotomy. What place could there be in record-breaking operations for the fiddle-faddle of antiseptic precautions? The obvious boon of immunity from pain, precious as it was, when we look beyond the individual, was less than the boon of time. With anesthetics ended slapdash surgery; anesthesia gave time for the theories of Pasteur and Lister to be adopted in practice." Sir Clifford Allbutt, Johns Hopkins Hosp. Bull., Bait., 1898, ix, p. 281.

3 Baynham: New York Med. and Phil. Rev., 1809, i, 160-170. > King: Med. Repository, New York, 1817, n. S., iii, 388-394.

Ephraim McDowell (1771-1830), of Virginia, was a pupil of John Bell, of Edinburgh, in 1793-94, and, through Bell's eloquent teaching, was early impressed with the sad and hopeless fate of women afflicted with ovarian disease. In 1795, he settled in the village of Danville, Kentucky, then one of the outposts of civilization, and soon became known as a skilful and successful surgeon, especially in lithotomy, which he performed 22 times in succession without losing a case. In December, 1809, he performed his first ovariotomy upon Mrs. Crawford, a woman of forty-seven. who afterward lived to be seventy-eight. McDowell reported this case with two others in April, 1817,' following these with a report of two more cases in 1819.- He performed the operation 13 times in his life, with a record of 8 recoveries. Although he may have been preceded by Weyer's swineherd of the sixteenth century, and by the partial operation (tapping of cyst) by Houstoun, of Edinburgh, in 1701, yet one swallow does not make a summer, and ovariotomy had no existence in surgical practice before McDowell produced his results and put it upon a permanent basis. He had sent a manuscript copy of his first paper to his old preceptor, John Bell, who was then ending his days in Italy and never saw it. It came, however, into the hands of Bell's pupil, John Lizars (1787-1860), of Edinburgh, who took up McDowell's work with interest, publishing his results in his "Observations on Extraction of Diseased

[graphic]

Ephraim McDowell (1771-1830).

1 McDowell: Eclect.. Repertory and Analyt. Rev., Phila., 1S17, viii, 242

244.

McDowell: Ibid., 1819, is, o46-553.

Ovaria" (1825), the next important contribution to the subject. In the meantime, Dr. Nathan Smith had performed an ovariotomy at Norwich, Vermont, in July, 1821,' in ignorance of McDowell's work, which was destined to receive its greatest impetus at the hands of the brothers, John L. and Washington L. Atlee, of Pennsylvania, the former of whom performed the operation 78 times, with 64 recoveries (1843-83), and the latter 387 times (184478). Ovariotomy was firmly established in English surgery through the admirable labors of Charles Clay (1801-93), of Manchester, and Sir Spencer Wells (1818-97), of London. Benedikt Stilling did an ovariotomy by the extraperitoneal route in 1837. The introduction of ovariotomy in France was due to Auguste Nelaton, to Jules Bean (1830-98), who performed the first successful operation in Paris (1864), and to the Alsatian surgeon Eugene Koeberle (1828-1915), who performed his first ovariotomies on June 2 and September 29, 1862.2

Before the time of Sims, much important work of a scattered character was done in Europe and America, notably Osiander's eight cases of excision of the portio for cancer (1801-8),3 C. J. M. Langenbeck's vaginal hysterectomy for cancer (1813),4 which was followed by the cases of J. X. Sauter (1822) and J.-C.-A. Recamier (1829); Ritgen's case of gastro-elytrotomy (1821),6 Roux's operation for ruptured perineum (1834);6 William Campbell's "Memoir on Extra-uterine Gestation" (1840); Rccamier's invention of the speculum plein et brisi (1842),' the simultaneous invention of special uterine sounds, in 1843, by Huguier, of Paris, Kiwisch, of Prague, and Sir James Young Simpson* (1811-70). of Edinburgh; Bennett's treatise on "Inflammation of the Uterus" (1845); C. D. Meigs' "Females and their Diseases" (1849); Tilt on "Ovarian Inflammation" (1850); Nekton's description of pelvic hematocele (1851-52) ;9 Noeggerath's operation of epicystotomy (1853),ln and Daniel Ayres's plastic operation for congenital exstrophy of the female bladder (1859)." In 1836, Michaelis, of Kiel, reported the celebrated case of Frau Adametz, upon whom four Cesarean sections had been successively performed, his own operation being as successful as the rest;12 and, in America, John Lambert Richmond performed the first Cesarean section at Newtown, Ohio, on April 22, 1827.l3 Francois Prevost (17(54-1842), of Donaldsonville, Louisiana, performed the

1 Smith: Am. Med. Recorder, Phila., 1822, v, 124-126.

2 Koeberld: Mem. Acad, de med., Paris, 1862-63, xxvi, 371-472, 6 pl. 5 Osiander: Gottingen gelehrte Ariz., 1808, 130; 1816, 16.

4 Langenbeck: N. Biblioth. f. d. Chir., Hannover, 1817, i, st. 3, 557.

5 Ritgen: Heidelberg, klin. Ann., 1825, i, 263-277.
»Roux: Gaz. med. de Paris, 1834, 2. a., ii, 17-22.

7 Recamier: Bull. Acad, de med., Paris, 1842-43, viii, 661-668.
"Simpson: London and Edinb. Monthly Jour. Med Sc, 1843, iii, 547;

701; 1009: 1844, iv, 208.

8 Nelaton: Gaz. d. hop., Paris, 1851, 3. s., iii, 573; 581: 1852, iv, 54; 66.

10 Noeggerath: New York Med. Jour., 1853, 3. B., iv, 9-24.

11 Ayres: Am. Med. Gaz., New York, 1859, x, 81-89, 2 pi.

12 Michaelis: Mitth. a. d. Geb. d. Med. (etc.), Altona, 1836, iv, 7.-8. Hft., p. 60.

» Richmond: West. Jour. Med. & Phys. Sc, Cincin., 1830, iii, 485-489.

operation four times prior to 1832,' with three successful cases; and William Gibson, of Baltimore, performed the Cesarean operation twice with success upon the same patient (1835-38),2 who lived for fifty years after her first experience. Myomectomy for fibroid tumors of the uterus was performed twice with success by Washington L. Atlee in 1844,3 and by Walter Bumham, of Lowell, Massachusetts, in 1853,' and, in the same year (1853),' Oilman Kimball (1804-92), of Lowell, Massachusetts, first performed this operation with deliberate intention. Eugene Koeberl6, the pioneer of hysterectomy and morcetlement of tumors, excised the uterus for uterine fibroma on March 14 and April 20, 1863, excised the uterus and adnexa for tumor in 1869, and performed his first myomectomy in 1878. He had many disputes with Jules Pean as to priority in the invention and use of the hemostatic forceps. Before the time of Sims and Koeberle, operations upon the uterus had been attempted here and there, but the various procedures had fallen into disrepute through failure (exitus lelhalis).

Prior to the year 1852, the stumbling-block of gynecology was the relief of vesicovaginal fistula. Many surgeons, from the time of Pare onward, had attempted to operate for this condition, with no better result than to entail an additional amount of suffering and inconvenience upon their unfortunate patients. Roonhuyze (1672) and Fatio (1752) left admirable accounts of their operative methods, but no reports of successful cases. Dieffenbach left a classical account of the wretched plight of the women upon whom all his wonderful resources were tried in vain (1845). Jobert de Lamballe had written a whole treatise upon female fistula; (1852).6 but his autoplastic operation par glissement had only resulted in repeated failures and the death of many of his patients. Six successful operations for the condition had been reported in America by John Peter Mettauer (1787-1875), of Virginia7 (1838-17); others by George Hayward (1791-1863), of Boston, in 1839;8 by Joseph Pancoast, of Philadelphia, in 1847;'J and, in France, by Maisonneuve (1848).10 The whole matter was changed, as Kelly says, "almost with a magic wand" by James Marion Sims (181383), of South Carolina. A graduate of Jefferson Medical College,

1 Prevost: Am. Jour. Med. ''K., Phila., 1835, vi, 347. (See Harris: New Orleans Med. & Surg. Jour., 1878-79, n. s., vi, 935-937.)

'Gibson: Am. Jour. Med. Sc., Phila., 1835, xvi, 351; xvii, 264: 1838, xxii, 13: 1885, n. s., xc, 422.

'Atlee: The Surgical Treatment of Certain Fibrous Tumors of the Uterus, New York, 1853.

J Bumham: Nelson's Am. Lancet, Plattsburgh, X. Y., 1853, vii, 147.
Kimball: Boston Med. and Surg. Jour., 1855, lii, 249-255.

6 A.-J. Jobert de Lamballe: Traite des fistules trans vesicoutdro-vaginales (etc.), Paris, 1852.

1 Mettauer: Boston Med. and Surg. Jour., 1840, xxii, 154. Also, Am. Jour. Med. Sc.. Phila., 1847, n. s., xiv, 117-121.

8 Hayward: Am. Jour. Med. Sc., Phila., 1839, xxiv, 2S3-288.

'Pancoast: Med. Examiner, Phila., 1847, n. s., iii, 272-274; 1851, vii, 650-656.

10 Maisonneuve: Clinique ehirurgicale, Paris, 1848, vii, 660 et seq.

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