ing and shrieks of the patient only interrupted by the grinding noise of crushing the stone or the admonitions of the surgeon to the victim: imagine, if you can, the sight of the instruments, and the patient slowly witnessing the amputation of a limb, only to suffer the application of red-hot irons in order to stop the bleeding; add to this the shock, often fatal, which followed such operations, and you have a faint idea of what surgery was before anesthesia.

We have not the time to consider the evolution of anesthesia, and must pass over the hints given Morton by Sir Humphrey Davy and Horace Wells, who both worked with nitrous oxide. Dr. Morton left Baltimore, after graduating in dentistry, and began the study of medicine at Harvard University in November, 1844. It is said that his preceptor, Dr. Charles T. Jackson, suggested to him the use of sulphuric ether, but be this as it may, William Morton performed all of the experiments and made the final convincing test. He first rendered dogs unconscious with ether, and soon after this he attempted a bold experiment. He shut himself in his room, saturated his handkerchief with ether, and soon became unconscious. When he first regained consciousness he was unable to move, and thought that he was dying, and he feared that his discovery would be lost to the world. But he soon regained his muscular control, and after that anxiously awaited the chance to administer this drug in practice. This opportunity came the same night. Eben Frost, a patient, called with a very sore tooth, and when Morton told him that he could extract the tooth without pain Frost consented to the use of ether. Morton's experiment was entirely successful, and the painless extraction of the tooth followed.

The final step in the introduction of this great discovery to the world consisted in its use in the surgical amphitheater of the Massachusetts General Hospital on October 16, 1846, when Dr. John Collins Warren, one of the most prominent of American surgeons, allowed Morton to render unconscious one of his patients. The amphitheater was crowded with students, and Warren was surrounded by the most prominent surgeons of Boston. After some delay Dr. Warren was about to start the operation, when Morton entered. The surgeon turned abruptly and remarked, "Well, sir, your patient is ready." Morton made no reply, but placed his glass flask over the patient's face, and in a few minutes he remarked, "Dr. Warren, your patient is ready." The surgeon then removed a vascular tumor from the neck of Gilbert Abbott without pain or return of consciousness until after the operation was completed. Dr. Warren turned to the class and said, "Gentlemen, this is no humbug," and Bigelow remarked, "I have seen something today that will go around the world."

This discovery did go round the world bearing the tidings of

freedom from pain and suffering to millions of people. Its beneficent results are before each one of you every day, but we should all bear in mind that the relief of pain is not its only advantage. In rendering patients unconscious, and therefore quiet, it enables surgeons to attempt very delicate operations around arteries and nerves. They can also prolong operations and attempt hundreds of surgical feats which were hardly dreamed of before the days of Morton. Shock is also avoided and the exacting details of aseptic surgery can be thoroughly carried out. Thus pain has been conquered and life lengthened by Morton's immortal discovery.

It would be most satisfactory, in closing the consideration of this subject, to speak of the honor, praise, and gratitude which were paid to William Morton, but history has written otherwise. His life was henceforth clouded by disputes and controversies with Wells, Jackson, and others concerning priority of discovery. Attempts were made to interest Congress in his behalf, and several bills were proposed to reward the discoverer of anesthesia. The President, however, refused to sign the final bill, and thereby placed upon our national record a blot which I hope a spirit of mercy has long since wiped out. The trustees of the Massachusetts General Hospital presented him with a silver box containing $1000, and I take especial pride in stating that in 1852 his Alma Mater, now known as the College of Physicians and Surgeons of Baltimore, presented him with an honorary diploma in medicine. On it you will find the names of Monkur, McCook, Roberts, Bond, Lee, Morris, Jenkins, and Mackenzie. Many of these names are still prominent in a younger generation of medicine in Baltimore. I hope to be pardoned for adding that my grandfather's name, William Hughes Stokes, is also on this diploma, but I rejoice in the fact that he was able to aid in granting ever so small an honor to a man who was certainly not justly honored in his day.

Morton died poor and disheartened in 1868 at the age of 48, but his name will live forever. And as long as men and women suffer they will always bear a sense of deepest gratitude to him who "made of pain a dream.”

And if before closing we can briefly review these four great medical discoveries, we may, I think, take just pride in the fact that two of them were made by Americans and two by Englishmen. Maryland may also feel proud of having taken a part in the education of Reed and Morton, and Virginia and Massachusetts must share with us this honor. But, aside from local pride, the study of great men and great deeds of medical history should have a profound effect upon the character of any medical man or student who reads such history aright. Then diligently search these honorable records, young men, in the hope that it may be said of you as was said of Edward Jenner--"and he stood between the living and the dead, and the plague was stayed."

REVIEW IN MEDICINE.

Under the Supervision of Thomas R. Brown, M.D., Baltimore.

ULCER OF THE STOMACH AND DUODENUM.

Howard (American Journal of the Medical Sciences, December, 1904) analyzes all the case of round ulcer that have occurred in the clinic of Dr. Osler at the Johns Hopkins Hospital. Eightytwo cases of round ulcer have occurred in the various services of the hospital in a period of 15 years or in 44,338 admissions. The frequency of round ulcer for the hospital, therefore, was about one-fifth per cent. This is distinctly less than the incidence of round ulcer in hospitals in other cities. In this series the relative frequency in men and women seemed to be about the same. As regards occupation, indoor work seemed to be far more likely to be productive of ulcer than outdoor work. In 47 cases there was a definite history of previous stomach trouble, while in seven cases there was a positive history of trauma. Arteriosclerosis was present in about one-half the cases and to a marked degree in about one-quarter of the cases. The three cardinal symptoms-vomiting, pain, and hematemesis-were found in 85, 83, and 76 per cent. of the cases, respectively. Of these symptoms, pain was usually the first indication of the existence of the disease and was its most constant and distinctive feature. In more than one-half the cases it was usually referred to the epigastrium. Of the cases in which vomiting of blood took place, in two-thirds the blood had a coffeeground appearance, in one-third a bright red. In most of the cases the appetite was fair or good, while constipation was present in about three-fifths of the cases. An analysis of the contents of the stomach after the Ewald test-meal showed that hyperchlorhydria was present in only 18 per cent. of the cases tested-much lower than the results met with in the majority of the series of cases of gastric ulcer. The average number of leucocytes was within normal limits, while the hemoglobin, determined in 62 cases, averaged 58 per cent.

As complications of the disease, Howard discusses pyloric obstruction, death from hemorrhage, perforation with general or with local peritonitis, parotitis, tetany, and ulcus carcinomatosum. The chronicity of the disease is well recognized, and the usuallyaccepted time limit is from three to five years.

The medical treatment employed was similar to the treatment in vogue elsewhere, that is, absolute bodily rest for from three to six weeks, rectal-feeding for from 5 to 14 days, regulation of the bowels, correction of the anemia, if present, by iron or arsenic, while if hyperacidity was present it was treated with large doses of carbonate of magnesia and occasionally by gastric lavage. The

indications for surgical treatment, according to Mayo Robson, are, first, perforation; second, perigastric adhesions; third, lack of success of prolonged medical treatment; fourth, recurring and profuse hematemesis; fifth, certain cases of acute hematemesis. The conclusions of Howard's paper are as follows:

I. Gastric ulcer is rare in the Johns Hopkins Hospital as compared with cancer, the respective incidences being 1 to 225 and I to 56 general admissions.

2. Gastric ulcer in our series was as common in the male as in the female. In the male the percentage of greater frequency was between the ages of 40 and 50-a decade later than usual.

3. Ulcer was in our cases relatively more frequent in the colored race and among Germans.

4. Vomiting occurred in 85.3 per cent., pain in 82.9 per cent., and hematemesis in 75.6 per cent.

5. Great loss of weight may be present. Thus in 36 cases there was a loss of more than 10 pounds, and in nine of 40 pounds or

more.

Our statistics would indicate that hyperchlorhydria is not so constant as is usually maintained. It was present in only 17.6 per cent. of our cases.

7. The blood picture is one of chloranemia as seen from the average count (hemoglobin 58 per cent., red-blood corpuscles 4,071,000, white-blood corpuscles 7500 per c. mm.).

8. Hemorrhage was the cause of death in 8.5 per cent. of the total number of cases and in 29.5 per cent. of the fatal cases.

9. Perforation is rare (three cases, or 3.6 per cent., of our series). General peritonitis occurred in but one instance (1.2 per cent.).

IO.

series.

Ulcus carcinomatosum is rare-at least 4.8 per cent. of our

II. Operation is indicated in all cases with perforation or perigastric adhesion, and in cases of copious or recurring hemorrhage when medical means have failed after a fair trial.

12. The mortality of the series was 29.3 per cent. In the cases, however, which received treatment there was a mortality of only 18.8 per cent.; in those receiving medical alone, 8.6 per cent.

*

SLEEPING SICKNESS.

So much work of interest has been done in regard to this most interesting of African diseases, notably by the English commission and the Portuguese commission, that perhaps it would be of interest to briefly sketch the result of these investigations as far as they have gone at present. Bruce, Nabarro, and Greig in their "Fur