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which is then introduced into the fundament this remedy. Gobius, a distinguished Dutch of the patient. By this means the smoke is surgeon in his book “Adversaria Varii injected until the abdomen becomes dis- Argumenti”), employed tobacco smoke in tended. They then hang the patient by the this way for constipation, colic, and strangufeet to the branch of a tree and the smoke lated hernia. It is stated that he practiced is thus enabled by its pressure to force the in a country where the insufflation treatwater, which the patient has swallowed, ment had been used many hundred times. out of his mouth.

De Haen had used it two hundred times and In France Réaumur (1683–1757), who, for more than one hour at a time, the smoke by the way, is not generally recognized as being introduced with much force and in having been a member of the medical large quantities, both in experiments on profession, was the first to introduce the animals and a variety of human ailments. use of tobacco smoke in this way. He Laurence Heister in his “Institutiones Chisuggested that this could be accomplished rurgicae,” Amsterdam, 1750, in a chapter by breaking off the stem of a pipe and on Clysters, refers to the use of fumigation blowing the smoke through it. It is duly for incarcerated hernia, and gives a diagram recorded that one of his colleagues in the of the apparatus by which tobacco smoke Academy testified to the proper and satis- can be blown by the mouth of a surgeon factory effect of this remedy. His article was into the intestine, the smoke, according to published in 1740. Incidentally it may be the author, acting as a stimulus in the mentioned that he recommended rolling the intestine and causing the strangulated loop patient to and fro in an open barrel, a device not only to shrink in size, but to retract which owed its usefulness to the effect it itself into the abdominal cavity. (Fig 2.) had in producing artificial contraction and Dr. Ludwig Knapp (1908) in a modern expansion of the thoracic cavity, although rendering of Cangiamila's work on Theology the restoration of this function was not and Midwifery, 1754, mentions among the evidently recognized as an important feature remedies this ancient author laid down at that time.

for the resuscitation of new-born infants In Holland the literature on this subject apparently dead, the use of clysters of seemed to have been more abundant than tobacco smoke "to establish the peristaltic in other countries, as might naturally be action of the intestines and thus arouse supposed from its geographical character. through cooperation of the diaphragm the The reports of the Society of Amsterdam action of the heart and lungs.” If these are are filled with many accounts of the use of the words of the author, and not the described by Lobelius in 1576. Speaking of its use

translator's, we have here the first indication by the inhabitants of the West Indies he says, of the recognition of a physiological purpose .. “For you see many sailors who have returned

in the use of this remedy. from that country who carry little funnels made of a coiled palm leaf, or of reeds, into one end of which

Christopher Keil, in his handbook on are placed curled, broken up and dried leaves of this

Surgery, 1747, Leipsic, describes the use of (nicotiana) plant. They set light to it, and drawing clysters and recommends long flexible tubit into their mouths as much as they can, they suck ing for the purpose. In a frontispiece in this in the smoke by inhalation. They are thereby work an illustration is given of such an enabled to endure hunger and thirst to maintain the

apparatus, by which an individual is able strength and to exhilarate their spirits. They declare

to administer to himself rectal insuffiation. that it soothes the brain with a pleasant form of intoxication and it certainly gives rise to an incredible

(Fig. 3.) quantity of spittle.The Quarterly Review, July 1913,

In the latter half of the eighteenth P. 139, London.

century (1772) we find an organization was

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izations for the same purpose. The methods generally employed by these various organizations towards the end of the eighteenth century recommended officially (just as artificial respiration is to-day) by the Maurepas (1701–1781) Min

authorities for this purpose. Incidentally it may be mentioned that one of the rules laid down by this report was to forbid the rolling of a body in a cask or to hold the body up by the feet.

The Royal American Magazine, February

were

2 Detail des succes de l'establissment que la ville de Paris a fait en faveur des personnes noyées, 1775.

3“A fumigation machine is kept at every station house. The method of using it is as follows:-Half an ounce of smoking tobacco is placed in the box of

the machine and is slightly moistened. The bellows are then attached and force the smoke through a long pipe; three quarters of an hour should be employed in administering the half ounce of tobacco. The bellows should be blown gently."

1774, gives Dr. Tissot's method of restora- The following case is stated to show that tion of the apparently drowned. Here it is rectal insufflation can be employed, even stated that in addition to blowing the warm when the necessary machinery is not at breath into the patient's lungs, tobacco hand. smoke may be introduced not only into the A rescued woman's husband, who thought fundament, but into the lungs as well. After his wife dead, was told by a passing soldier tobacco has been lighted in the bowl of a smoking his pipe to dry his tears, that his pipe, the bowl should be wrapped in a wife would soon be revived. Then giving paper in which several holes are pricked the pipe to the husband, he instructed him and through these holes force the breath how to introduce the stem into the anus, strongly. It is also recommended by this then placing his mouth, covered with author that if a surgeon is present the perforated paper, to the bowl of the pipe, to jugular vein should be opened and about blow with all of his force. At the fifth twelve ounces of blood taken.

insufflation of smoke a loud rumbling was It may be well to give here examples of heard and the patient expelled water from the methods employed at this period in the mouth and a moment later regained two cases.

consciousness. René H., 25 years old, while bathing, was But this method, even at this time, was rescued from the water three-quarters of an not without its critics, for M. Portal, hour after being submerged. He was un

Professor of Medicine at the Royal College conscious, without voluntary movements of France, claimed that the insufflation and pulseless, and supposed to be dead. impeded the circulation of the vessels of Taken to the Guard House the soldiers the viscera in the abdomen and thorax treated him by insufflation of air into the and thus acted injuriously. Pia, however, mouth, rectal fumigations with tobacco, refers in reply to this objection to the friction of the skin, and application of quotation of Heister, which we have already ammonia to the nostrils, a treatment which mentioned above, to the effect that tobacco extended over two hours, when signs of life smoke appears to irritate the intestine and began to appear, the eyelids moving and cause a diminution of its caliber. the pulse being felt, etc., and finally move- In London we find John Aiken (1775), ments of the body and cries. He was then using the rectal insuffiation of tobacco smoke carried to a house nearby where warmth and preventing the over-heating of the tube was applied. Here he was bled from the arm, by wrapping cloths wet in cold water instead of the jugular vein, owing to his around it. The use of this remedy was resistance. Tobacco fumigation produced recommended by him as a "stimulant to abundant evacuation of the bowels and an arouse the vital motions.' emetic brought up a large amount of salad Cullen, Edinburgh, 1784, in a letter to and other food. He was made to swallow Lord Cathcart, says, “with regard to the brandy, which served the purpose of an stimulants, I must conclude with observing "anti putrid cordial,” and revived him. that when a body has laid but a short time His comrades next took him to their inn in the water and that therefore its heat and and carried out further ministrations advised irritability are but little impaired, the by the surgeon who bled him. After receiving application of stimulants alone has often two purgings, he reported on the fourth been found to be effectual for recovery. day at the City Hall to express his grateful But, on the contrary, when the body has acknowledgments, stating that he had had lain a long time in the water and the heat no recollection of what had happened to him. of it is very much extinguished, the applica

" 4

tion of any other stimulants than that of sarily be productive of mischief.” In contobacco smoke to the intestines can be of cluding this statement, he speaks next of very little service and the application of the sympathy between the heart and the others ought never to interfere with the stomach as being greater than between the measures of recovering heat and the motion heart and intestines. Here evidently was a of respiration.”

pioneer in modern therapeusis! Goodwyn, (1788) refers to the application In Dr. Willich's Domestic Encyclopedia, of different substances to the skin, the London, 1802, is given the list of articles stomach, the intestines, the parts of genera- contained in a box devised by Kite and tion, the nose, the fauces, the extremities of further amplified by Mr. Redlich of the fingers by Jacob Gummer as based on a Hamburgh, among which is to be found mistaken opinion of the principal seat of the machine for injecting the smoke of tolife.

bacco. Fig. 4. Willich shows clearly in his But Kite, 1795, in experiments on animals article that inflation of the lungs is one of rendered insensible by submersion, gives as the means of restoring life. “Stimulating his opinion, under the head of other clysters consisting of warm water and comremedies, that the “principal of these are mon salt or a strong solution of tartar electricity, particular stimuli adapted to the emetic, or six ounces of brandy should be different

organs of sense and irritating speedily administered. We do not consider, medicines thrown into the stomach and he says, injection of the smoke of tobacco, intestines.” Here, for the first time, we find or even clysters of that narcotic plant in all powerful stimuli like that of electricity used instances safe and proper. for arousing vital action. But while the The final touch may have been said to surface of the body thus has the benefit of have been placed on this mode of practice the new agencies, the interior surfaces are by Daniel Legare (1805) who, in an not neglected. Our old friend "rectal in- inaugural dissertation, on graduating from sufflation” is still employed with a view to the University of Pennsylvania, presented local stimulation.

as his graduation thesis experiments upon But a definite reaction had already set animals with the rectal insufflation of in, for we find that Edward Coleman, tobacco. After the insufflation the abdomen London, in 1791, speaks in no uncertain was opened and the changes in the cirterms as follows: “As tobacco smoke thrown culation carefully observed in a series of up

the rectum in the form of smoke was one cases. He found an increase in the mesenteric of the first remedies employed in suspended arterial circulation, but a diminution of the respiration, and as we see, to our regret, that peristaltic action of the intestines. He it is still too frequently made use of, we shall concluded that this method was of no value endeavor by a few animadversions on its as a means of resuscitation. effects to proscribe its continuance.

Although it is often difficult to repress a The history of medical errors scarce affords smile at some of the medical theories of a a more blind and obstinate prejudice than bygone period, it is well to pause in this that which still induces us to adopt a instance before passing final judgment and mode of practice so obviously destructive. to ask ourselves whether there may not For smoke and fluids of all kinds, when have been after all some well founded obsergiven in large quantities, will distend the vations which served to implant a theraintestines, the result of which will be that

4 See “History of the Humane Society of the their mechanical effect in preventing the Commonwealth of Massachusetts,” by M. A. De easy descent of the diaphragm will neces- Wolfe Howe, p. 18.

peutic measure so firmly in the traditions of ailments. Moreover, the levator ani muscle, medical practice.

being composed of a powerful enveloping The ancients were wont to regard the mass of muscular fiber and bearing an rectum as the ultimum moriens. Here there intimate relationship to the lower intestinal was supposed to exist one of the principal canal, has been classed by more than one seats of life. Its outlet, an extremely sen- physiologist of the past as one of the muscles sitive region, is abundantly supplied with of respiration. It is at least one of the nerves and blood vessels and easily accessi- groups of muscle which exert an antagonistic ble to restorative measures. This faith in action to that king of respiratory muscles,

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