greater than during that of chloroform, owing both to the greater
quantity of vapour it yields on account of its lower boiling point, and
to the lower specific gravity of the vapour. The evaporation of ether
from the bulb of a thermometer usually lowers the temperature nearly to
zero of Fahrenheit. When the inhalation of ether was first commenced,
the inhalers employed consisted generally of glass vases containing
sponge, to afford a surface for the evaporation of the ether. Both glass
and sponge being very indifferent conductors of caloric, the interior of
the inhalers became much reduced in temperature, the evaporation of
ether was very much checked, and the patient breathed air much colder
than the freezing point of water, and containing very little of the
vapour of ether. On this account, and through other defects in the
inhalers, the patient was often very long in becoming insensible, and,
in not a few cases, he did not become affected beyond a degree of
excitement and inebriety.
To ensure the ether taking effect in a short time in every case, I made
use of the conducting power of the metals, and the great capacity of
water for caloric. The inhaler which I employed was made of plated
copper, and was placed in two or three pints of water, of the ordinary
temperature. The form of the inhaler was that of one which had been
contrived by Mr. Julius Jeffries for the inhalation of aqueous
vapour.[159] No sponge or bibulous paper, or other material, was used;
and the air, before being inhaled, was made to pass over a considerable
surface of ether by means of a spiral volute, soldered to the top of the
inhaler, and reaching nearly to the bottom. The accompanying engraving
shows the interior of the inhaler, on a scale of half the dimensions,
the bottom being removed.
[Illustration]
_The Physiological Effects of Ether_ are essentially the same as those
of chloroform. The various degrees of narcotism which I described in the
earlier part of this work, when treating of chloroform, were first
described by me when treating of ether in 1847, before chloroform was in
use.[160] All the remarks which I made with respect to the manner in
which age, strength or debility, and other circumstances, influence the
action of chloroform, apply also in an equal degree to ether.
I performed some experiments in 1848,[161] for ascertaining the
proportions of vapour of ether present in the blood in the different
degrees of narcotism. They were conducted on the same principles as
those previously related, which were performed for the purpose of
determining the same point in regard to chloroform.
_Experiment 31._ Two grains of ether were put into a jar holding 200
cubic inches, and the vapour diffused equally, when a tame mouse was
introduced, and allowed to remain a quarter of an hour, but it was not
appreciably affected.
_Experiment 32._ Another mouse was placed in the same jar, with three
grains of ether, being a grain and a half to each 100 cubic inches. In a
minute and a half, it was unable to stand, but continued to move its
limbs occasionally. It remained eight minutes without becoming further
affected. When taken out, it was sensible to pinching, but fell over on
its side in attempting to walk. In a minute and a half, the effect of
the ether appeared to have gone off entirely.
_Experiment 33._ A white mouse in the same jar, with four grains of
ether, was unable to stand at the end of a minute, and at the end of
another minute ceased to move, but continued to breathe naturally, and
was taken out at the end of five minutes. It moved on being pinched,
began to attempt to walk at the end of a minute, and in two minutes more
seemed quite recovered.
_Experiment 34._ Five grains of ether, being two and a half grains to
each 100 cubic inches, were diffused throughout the same jar, and a
mouse put in. It became rather more quickly insensible than the one in
the last experiment. It was allowed to remain eight minutes. It moved
its foot a very little when pinched, and recovered in the course of four
minutes.
_Experiment 35._ A white mouse was placed in the same jar with six
grains of ether. In a minute and a half, it was lying insensible. At the
end of three minutes, the breathing became laborious, and accompanied by
a kind of stertor. It continued in this state till taken out, at the end
of seven minutes, when it was found to be totally insensible to
pinching. The breathing improved at the end of a minute; it began to
move at the end of three minutes; and five minutes after its removal, it
had recovered.
_Experiment 36._ The same mouse was put into this jar on the following
day, with seven grains of ether, being 3·5 grains to the 100 cubic
inches. Stertorous breathing came on sooner than before; it seemed at
the point of death when four minutes had elapsed; and being then taken
out, was longer in recovering than after the last experiment.
_Experiment 37._ Two or three days afterwards, the same mouse was placed
in the jar, with eight grains of ether, being four grains for each 100
cubic inches. It became insensible in half a minute. In two minutes and
a half, the breathing became difficult; and at a little more than three
minutes, it appeared that the breathing was about to cease, and the
mouse was taken out. In a minute or two, the breathing improved; and in
the course of five minutes from its removal, it had recovered.
The temperature of the mice employed in the above experiments was about
100°. That of the birds in the following experiments was higher, as is
stated; and they differ widely from the mice in the strength of vapour
required to produce a given effect, although I found but little
difference between the mice and birds, in this respect, in the former
experiments on chloroform. And one of the linnets was employed in both
sets of experiments. Having seen MM. Dumeril and Demarquay’s statement
of the diminution of animal temperature from inhalation of ether and
chloroform, before the following experiments were performed, the
thermometer was applied at the beginning and conclusion of some of them.
I have selected every fourth experiment from a larger series on birds.
_Experiment 38._ 18·4 grains of ether were diffused through a jar
holding 920 cubic inches, being two grains to each 100 cubic inches, and
a green linnet was introduced. After two or three minutes it staggered
somewhat, and in a few minutes more appeared so drowsy, that it had a
difficulty in holding up its head. It was taken out at the end of a
quarter of an hour, quite sensible, and in a minute or two, was able to
get on its perch. The temperature under the wing was 110° before the
experiment began, and the same at the conclusion.
_Experiment 39._ Another linnet was placed in the same jar, with four
grains of ether to each 100 cubic inches of air. In two minutes it was
unable to stand, and in a minute more, voluntary motion had ceased. It
lay breathing quietly till taken out, at the end of a quarter of an
hour. It moved its foot slightly when it was pinched. In three minutes
it began to recover voluntary motion, and was soon well. The temperature
was 110° under the wing, when put into the jar, and 105° when taken out.
_Experiment 40._ A green linnet was put into the same jar with 55·2
grains of ether, being six grains to 100 cubic inches. It was insensible
in a minute and a half, and lay motionless, breathing naturally, till
taken out at the end of a quarter of an hour. It moved its toes very
slightly when they were pinched with the forceps, and it began to
recover voluntary motion in two or three minutes. Temperature 110°
before the experiment, and 102° at the end.
_Experiment 41._ A linnet was placed in the same jar, containing eight
grains of ether to each 100 cubic inches. Voluntary motion ceased at the
end of a minute. The breathing was natural for some time, but afterwards
became feeble, and at the end of four minutes appeared to have ceased;
and the bird was taken out, when it was found to be breathing very
gently. It was totally insensible to pinching. The breathing improved,
and it recovered in four minutes.
_Experiment 42._ 9·2 grains of ether, being one grain to each 100 cubic
inches of air, were diffused through the jar, holding 920 cubic inches
of air, and a frog was introduced. At the end of a quarter of an hour,
it had ceased to move spontaneously, but could be made to move its
limbs, by inclining the jar so as to turn it over. At the end of half an
hour, voluntary motion could no longer be excited, and the breathing was
slow. It was removed, at the end of three-quarters of an hour, quite
insensible, and the respiratory movements being performed only at long
intervals, but the heart beating naturally; and it recovered in the
course of half an hour. The temperature of the room was 55° at the time
of this experiment.
We find from the 32nd experiment, that a grain and a half of ether for
each 100 cubic inches of air, is sufficient to induce the second degree
of narcotism in the mouse; and a grain and a half of ether make 1·9
cubic inch of vapour, of specific gravity 2·586. Now the ether I
employed boiled at 96°. At this temperature, consequently, its vapour
would exclude the air entirely; and ether vapour, in contact with the
liquid giving it off, could only be raised to 100° by such a pressure as
would cause the boiling point of the ether to rise to that temperature.
That pressure would be equal to 32·4 inches of mercury, or 2·4 inches
above the usual barometrical pressure; and the vapour would be condensed
somewhat, so that the space of 100 cubic inches would contain what would
be equivalent to 108 cubic inches at the usual pressure. This is the
quantity, then, with which we have to compare 1·9 cubic inch, in order
to ascertain the degree of saturation of the space in the air-cells of
the lungs, and also of the blood; and by calculation, as when treating
of chloroform,
1·9 is to 108 as 0·0175 is to 1.
So that we find 0·0175, or 1–57th to be the amount of saturation of the
blood by ether necessary to produce the second degree of narcotism; and
as by Experiment 35, three grains in 100 cubic inches produced the
fourth degree of narcotism, we get 0·035, or 1–28th, as the amount of
saturation of the blood in this degree. Now this is within the smallest
fraction of what was found to be the extent of saturation of the blood
by chloroform, requisite to produce narcotism to the same degrees. But
the respective amount of the two medicines in the blood differs widely;
for whilst chloroform required about 288 parts of serum to dissolve it,
I find that 100 parts of serum dissolve five parts of ether at 100°;
consequently 0·05 × 0·0175 gives 0·000875, or one part in 1142, as the
proportion in the blood in the second degree of narcotism; and 0·05 ×
0·035 gives 0·00175, or one part in 572, as the proportion in the fourth
degree.
In Experiment 42 the frog was rendered completely insensible by vapour
of a strength which was not sufficient to produce any appreciable effect
on the mouse in Experiment 31. This is in accordance with what was met
with in the experiments with chloroform. Air, when saturated with ether
at 55°, contains 32 grains in each 100 cubic inches; so that the blood
of the frog might contain 1–32nd part as much as it would dissolve,
which, although not quite so great a proportion as was considered the
average for the fourth degree of narcotism in the mice, yet was more
than sufficient to render insensible the mouse in Experiment 34.
There is a remarkable difference between the birds and the mice, in
respect to the proportions of ether and air required to render them
insensible, a difference that was not observed with respect to
chloroform. In some experiments with ether on guineapigs, which are not
adduced, they were found to agree with mice in the effects of various
quantities.
The birds were found to require nearly twice as much; five grains to 100
cubic inches, the quantity used in an experiment between the
thirty-ninth and fortieth, which is not related, may be taken as the
average for the fourth degree of narcotism in these birds, with a
temperature of 110°. By the kind of calculation made before, we should
get a higher amount of saturation of the blood than for the same degree
in mice. But as serum at 110° dissolves much less ether than at 100°,
the quantity of this medicine in the blood of birds is not greater than
in that of other animals; and, considered in relation to what the blood
would dissolve at 100°, the degree of saturation is the same.
By Experiments 36, 37, and 41, we find that with ether, as with
chloroform, a quantity of vapour in the air, somewhat greater than
suffices to induce complete narcotism, has the effect of arresting the
respiratory movements.
In treating of chloroform (page 74), the average quantity of serum in
the adult human subject was estimated at 410 fluidounces. In order to
find the quantity of ether in the system, we may multiply 410 by
0·000875 for the second degree of narcotism, and by 0·00175 for the
fourth degree, when we shall obtain 0·358 and 0·71 of an ounce, _i. e._
f. ʒii. ♏︎l in the first instance, and f. ʒv. ♏︎xl in the second. In the
third degree of narcotism, in which surgical operations are usually
performed, the quantity is intermediate, or a little over four drachms.
_On the Administration of Ether._ About a fluid ounce of ether is
usually inhaled by an adult patient in becoming insensible; fully
one-half of this is, however, thrown back from the lungs, windpipe,
nostrils, and face-piece, without being absorbed. I usually put two
fluid ounces of ether into the inhaler above described, at the beginning
of the inhalation, and this quantity often lasts to the end of the
operation, if it is not a protracted one. The inhaler is connected, by
means of a wide elastic tube, with a face-piece similar to that
described and delineated in treating of chloroform. It is necessary that
the inhalation should commence, as in the case of chloroform, with the
expiratory valve of the face-piece turned on one side, for the admission
of air which is not charged with ether, and that the vapour should be
admitted to the air-passages by degrees, to avoid the irritation that
would arise from suddenly inspiring any considerable quantity of the
vapour. The vapour of ether is very much less pungent than an equal
quantity of the vapour of chloroform; but as the patient requires to
breathe about six times as much of it in the inspired air, it feels
quite as pungent as that of chloroform, and, perhaps, a little more so.
Whilst the patient never requires to take in more than four or five per
cent. of vapour of chloroform in the inspired air, he requires to inhale
about thirty per cent. of vapour of ether, in order to be rendered
insensible in a convenient time. The air-passages, however, soon get
accustomed to the presence of the vapour of ether, and in a minute and a
half or two minutes after the patient begins to inhale, he can usually
bear the valve to be closed so far as to charge the air with as much
vapour as is necessary speedily to cause insensibility. The inhaler
yields quite sufficient vapour when the water-bath is at 50° Fahr.; and
at the seasons of the year when the temperature of the water is higher,
the expiratory valve of the face-piece can be left more or less open to
admit a portion of air which has not passed through the inhaler.
I prefer the flavour of ether vapour to that of chloroform; and the
sensations I experience from the inhalation of ether are more
pleasurable than those from chloroform. Many persons agree with me on
both those points; but some prefer chloroform. The quantity of ether
expended in causing insensibility is eight or ten times as great as that
of chloroform, but the quantity used in a protracted operation is not so
disproportionate; for, owing to the great solubility of ether and the
large quantity of it which is absorbed, it is much longer in exhaling by
the breath, and when the patient is once fairly insensible, it does not
require to be repeated so frequently as chloroform.
In administering ether, I usually rendered adult patients insensible in
four or five minutes, and children in two or three minutes. A somewhat
longer time was occasionally occupied in cases in which the air-passages
were irritable, or where there was much rigidity and struggling. I never
failed to make the patient insensible in any one instance in which I
administered ether. I have notes of 152 cases in which I administered
ether, before chloroform was introduced, and twelve cases in which I
have exhibited it since.
Nearly all the great operations of surgery were included several times
amongst the cases in which I administered ether. Amputation of the thigh
was performed in nineteen cases; fifteen of the patients recovered, and
four died. Amputation of the leg was performed eleven times; eight of
the patients recovered, and three died. The arm was amputated three
times; one of the patients died, and two recovered. There were thus
thirty-three of the larger amputations with eight deaths, being a
mortality of twenty-four per cent. There were two amputations of the
forearm, and both patients recovered. There were nine operations of
lithotomy; seven of the patients recovered, and two died. Five of the
patients were children, who all recovered; the two deaths occurring
amongst the four adult patients. Eighteen female patients had the breast
removed for tumour, and they all recovered except one.
On July 1st, 1847, Mr. Cutler amputated the leg of a man, aged
forty-four, in St. George’s Hospital, who had suffered from disease of
the tibia and ankle, which had existed thirty years, and was caused by
an accident. This patient died on the seventh day, of sloughing
phagedena, which was present in the hospital. It was then found that he
had disease of the heart. Its structure was soft and easily lacerable;
much fat was mixed up with the muscular structure. The aortic valves
were much thickened, and almost cartilaginous in structure. Two of them
were so much contracted that they were together about the size of a
healthy one. The left ventricle was dilated, and the right ventricle
still more so; its walls being extremely thin. The ether had acted quite
favourably on this man.
I administered ether repeatedly in infants and old people. Some of the
infants were operated on by Mr. George Pollock, in 1847, for congenital
cataract by drilling; and two of them were operated on, in 1857, for
hare-lip, by Mr. Fergusson and Mr. Bowman. A gentleman, one of whose
toes the late Mr. Liston amputated in 1847, was said to be subject to
apoplectic attacks. The ether acted very favourably. Amongst the
operations which Mr. Liston performed on patients to whom I administered
ether, was the tying of the external iliac artery in a man, aged forty,
for an aneurism of the groin, situated partly above Poupart’s ligament.
The patient lay perfectly still in this, as in all the other important
operations in which I administered ether. He recovered.
On June 18th, 1847, I exhibited, in University College Hospital, ether
to a man, aged forty-two, with stricture of the urethra, caused by an
accident. He passed his urine only in drops, and the attempts to pass a
catheter had all failed. It was Mr. Liston’s intention to divide the
urethra in the perinæum, but when the patient was placed fully under the
influence of ether to the fourth degree of narcotism, a catheter (No. 1)
passed into the bladder, and the operation was not required. Larger
catheters were introduced in a few days, and on July 27th, the patient
was discharged, being able to pass his urine in a good stream.
Ether was administered in many cases of midwifery by Dr. Simpson, who
had first applied it in obstetric cases, and by a number of other
practitioners. I only exhibited it in one case, and then only for a
short time. Mr. Lansdown of Bristol used it in thirty cases.[162] In one
case, it was continued for eleven hours and a half, and fourteen fluid
ounces of ether were used. He said that he invariably found the perinæum
relaxed before the head came to bear on it, thereby not requiring the
pressure of the head to force it open, in cases where ether was used. He
says: “I find the uterus sending out the placenta immediately after the
expulsion of the child, and there has been scarcely any hæmorrhage
following.” Mr. Lansdown said that he had found the action of the uterus
to be induced by ether, when in a sluggish state, but he had not found
this effect from chloroform, in the cases in which he had used it.
Ether was used with great advantage in most of the kinds of medical
cases in which chloroform was afterwards applied. In the summer of 1847,
an infant, nine months old, was brought to me in a convulsive fit, which
had lasted twenty minutes. I poured twenty minims of ether on a sponge,
and applied it to its mouth and nostrils; in two or three minutes, the
quantity was repeated. The spasm subsided, and the child fell asleep. It
had no return of the fit. It was labouring under hooping-cough at the
time, which had existed a week.
The inhalation of ether was employed in the treatment of asthma,
hooping-cough, and tetanus, before it was employed in surgical
operations. It has been already stated (page 14) that Dr. Richard
Pearson administered the vapour of ether in consumption in 1795. Dr.
Robert Willis sent an article to the _Medical Gazette_ on February 2nd,
1847,[163] in which the following passages occur.
“Ether, given by the mouth, has long been familiarly employed in the
treatment of asthma. I have for many years been aware of the fact that
it is vastly more efficacious administered directly in vapour by the
breath. My plan of using it is extremely simple. I have had recourse to
no kind of apparatus for this purpose, but have been content to pour
two, three, or four drachms of the fluid upon a clean handkerchief, and
to direct this to be held closely to the mouth and nostrils: a single
short and difficult inspiration is hardly made before the effect is
experienced; and I have occasionally seen the paroxysm ended in six or
eight minutes, the respiration having in that brief interval become
almost natural.
“It is not otherwise with hooping-cough: the paroxysms of coughing are
positively cut short by having the ether and the handkerchief in
readiness, and using them when the fit is perceived to be coming on.”
I have been informed of a case of tetanus which was treated successfully
by inhalation of ether more than twenty years before this medicine was
used to prevent the pain of operations, but I am not able at present to
give a reference to the case. Mr. C. A. Hawkesworth, surgeon, of
Burton-on-Trent, wrote me an account of a case of tetanus, which had
recovered under the inhalation of ether in 1847. The patient was a
healthy-looking butcher’s boy, about twelve years old, who had received
a slight scalp wound, which was followed by general tetanus. Mr.
Hawkesworth administered the vapour of ether to him during the greater
part of one day. The spasm relaxed most completely whilst the influence
of the ether continued, but returned in great degree when the inhalation
was intermitted. He took no other medicine except calomel and jalap,
with a view to purgation; the calomel, however, acted on his mouth. He
recovered speedily and completely. Some other cases of recovery from
tetanus under the inhalation of ether have been recorded in the medical
journals.
In February, 1847, Dr. Sibson related several cases of facial neuralgia
that had been greatly benefited by the inhalation of ether;[164] and it
has been used in many cases since.