ANAONI 448 ANAGNI ficially by the employment of certain substances known as ana-sthetics, or by hypnotic suggestion. In diseases of the central nervous sj'stem, anaes- thesia is a common symptom. Usually it is limited in extent, involving a "definite area of the skin surface. Its limits can be traced by the distribution of certain nerves. In funct ional diseases of the nervous system, usually spoken of a.s hysterical or neurotic, there may be what is called amputation anaesthesia, that is, loss of feeling abruptly limited by a line such as would be followed in an amputation, but not ac- cording to the distribution of nerves to the part. In both functional and organic nervous diseases anesthesia may occur in conjunction with hyper- a?sthesia and pancsthesia in other parts of the body. Complete anaesthesia occurs in persons suffering from catalepsy, or, occasionally, in those who are in a trance. Artificial anaesthesia by the use of drags or the inhalation of vapours only came into general use during the last half of the nineteenth century, but there is abundant evidence to show that its practice is very ancient. Homer mentions ne- penthe, "an antidote to grief and rage inducing oblivion to all ills ". Herodotus relates that the Scythians inhaled a kind of hemp to produce in- sensibility. Dioscorides alludes to the employrnent of mandragora to produce anaesthesia when patients are cut or burnt. Pliny refers to the effect of the odour of mandragora as causing sleep if it was taken "before cuttings and puncturings lest they be felt". Lucian speaks of mandragora as used before the ap- plication of the cautery. Galen has a short allusion to its power to paralyze sense and motion. Isidorus is quoted as saying: "A wine of the bark of the root is given to those about to undergo operation that being asleep they may feel no pain." The first mention of anaesthesia, in comparatively modern times, is connected with the name of I^gone da Lucca, who was born a little after the middle of the twelfth century. He had discovered a soporific which, on being inhaled, put patients to sleep so that they were insensible to pain during the operations performed by him. The drug he employed is also knowTi to have been mandragora. There are men- tions of antesthetics in the literary works of practi- cally every century since that time. Boccaccio in the fourteenth century, in the story of Dioneus, gives an account of the effects of an anaesthetic mixture which "being drunk would throw a person asleep as long as the doctor judged it necessary ". In the fifteenth century William Bullein described a con- coction of an herb which " bringeth sleep, and casteth man into a trance, until he shall be cut out of the stone ". In the 16th century Shakespeare, as will be remembered from "Romeo and Juliet," refers four tim&s to the an;psthetic plant under the name of mandrake, and twice under the name of mandragora. In the beginning of the seventeenth century Thomas Middleton wrote of "the pities of old surgeons who cast one asleep, then cut the diseased part ". Be- fore this Du Bartas described the surgeon as "bringing his patient in a senseless slumber before he put in u.se his violent engines ". Notwithstanding this continuity of tradition, very little was generally known about the use of ana-sthetics, and it seems probable that their effects were rather uncertain. About the beginning of the nineteenth century the task of finding a reliable anxsthetic was taken seriously. In 1800 Sir Humphrev T)ay described the effects of nitrous oxide, or laughing gas, in allay- ing pain or toothache. He suggested its employ- ment in surgery. Ether began to attract attention at the end of the eighteenth century. It was used by inhalation in England, for relief of asthma, and by Dr. Warren, of Boston, in the treatment of the later stages of con.sumption. In 1818, Faraday proved that the inhalation of the vapour of ether produced anjEsthetic effects similar to those of nitrous o.xide. This fact was also demonstrated by the American physicians, Godman, in 1822; Jackson, in 1833; and Wood and Bache, in 1834. The first practical use of anaesthesia, however, was delayed until December, 1844, when Horace Wells, a dentist, of Hartford, Conn., had a tooth extracted while under the influence of nitrous oxide, or laughing gas. He resolved to make dentistry painless by this means, but was deterred from pursuing the project by an unfortunate failure in experiments in Boston. About two years later Dr. William Morton, also a dentist of Boston, made use of the vapour of ether for anesthesia in the extraction of teeth. Subse- quently he employed it in cases requiring se-ere surgical operations, with complete success. In about two months the news of his discovery reached Eng- land, and before the end of 1846 operations on anaesthetized patients were performed in London. At the beginning of the year 1847, Sir James Y. Simpson, the distinguished surgeon and obstetrician of the LIniversity of Edinburgh, employed ether to allay labour-pains. In November, 1847, Simpson announced his discovery that chloroform was as effective an anesthetic as ether, and lacked many of its inconveniences. Ives, in Connecticut, had used chloroform for difficult breathing in 1832. After Simpson's announcement it came to be used especially in England, and on the Continent, and even in America, as the favourite anesthetic, though ether continued to be employed here to a considerable degree. A series of investigations, in the last quarter of the nineteenth century, showed that chloroform had a much greater mortality than ether, and now the latter has replaced it almost entirely for an- esthetic purposes. Other substances, such as the cliloride of ethyl and bromide of ethyl, have also been employed. Recent years have seen the de- velopment of local anesthesia to replace general anesthesia for minor operations. It has been de- monstrated that even extensive operations can be performed without causing pain, by the injection of cocaine and similar substances in the neighbourhood of the site of the operation, or into the ner'es lead- ing to the part. Spinal anesthesia, which is a form of local anesthesia, consists in injecting substances into the spinal cord which paralyze all the sensory nerves from the parts below the point of injection. For a time, about the end of the nineteenth centurj', it was very popular, but it proved to have many in- conveniences and some serious results, and was not always reliable. General anesthesia always in- volves some risk. Even in the most careful hands deaths occasionally occur. Usually the fatal termi- nation comes at the very beginning of the adminis- tration of the anesthetic, and seems to be at least partly due to shock. It is impossible to foresee such fatalities, and they occur not infrequently in the young and apparently strong and vigorous. It is important, therefore, that clergymen should take due precautions by advising the administration of the sacraments before anesthesia, even though it may be but for a slight operation. Surgeons should warn patients of the risks, even though they are but slight, since the reassurance from the due perform- ance of Christian duties will usually make the patient more composed, and less subject to the in- fluence of shock. FoY. Ancesthetica, Ancient and Modern (London. 1889): Mork-Maddkn, Notes on the probable emploifment of Anrrsthet' irs in ancu-nt times in Ireland; Dublin Journal of Medieal ^cietiee (December, 1874): BlOELOw, Anfesthtsia and other Addresses (Beaton, 1894). James J. Walsh. Anagni, The Diocese of. — An Italian diocese in the province of Rome under the immediate jurisdic- tion of the Holy See. It comprises ten towns. The
