cases; quite as frequently, in fact, as chloroform. Vomiting also
follows the use of ether quite as often as that of chloroform. The
insensibility from ether lasts longer than that from chloroform without
repeating the inhalation when the narcotism is carried to the same
degree. When the narcotism from ether is carried to the fourth degree
there is generally a complete absence of pain for three minutes, and a
state of unconsciousness for five minutes longer, a period during which
any pain there might be would not be remembered afterwards. On account
of this longer duration of the effects of ether, it is better adapted
than chloroform for certain operations on the face, as removal of
tumours of the jaws, the operation for hare-lip, and making a new nose.
The relaxation of the muscular system from the effects of ether seems
greater in general than from chloroform, and ether therefore seems to be
the better agent to employ in the reduction of old dislocations, and
strangulated hernia.
_Great safety of Ether._ I believe that ether is altogether incapable of
causing the sudden death by paralysis of the heart, which has caused the
accidents which have happened during the administration of chloroform. I
have not been able to kill an animal in that manner with ether, even
when I have made it boil, and administered the vapour almost pure. The
heart has continued to beat after the natural breathing has ceased, even
when the vapour has been exhibited without air; and in all cases in
which animals have been made to breathe air saturated with ether vapour,
at the ordinary temperatures of this country, they have always recovered
if they were withdrawn from the vapour before the breathing ceased. Even
in cases where the natural breathing had ceased, if the animal made a
gasping inspiration after its removal from the ether it recovered.
I hold it, therefore, to be almost impossible that a death from this
agent can occur in the hands of a medical man who is applying it with
ordinary intelligence and attention.
I am only aware of two deaths which have been recorded as occurring
during the administration of ether, and it is not probable that the
death in either case was due to the ether. The first of these cases
occurred in France, at the Hotel Dieu d’Auxerre, on July 10th,
1847.[165] The patient was a man fifty-five years of age, who had a
cancerous tumour of the left breast of seven months duration. He was
robust, and had no general lesion resulting from the cancerous disease.
The ether was exhibited with the apparatus of Charrière. The patient had
hardly inhaled two or three minutes when he became strongly excited. The
trunk and limbs were agitated with violent starts and shocks. The
breathing became frequent, and the face injected. He endeavoured to push
away the inhaler, and babbled as if drunk. This state lasted for five
minutes, and the prick of a pin showed that sensibility still remained.
The apparatus was still applied, but in opening to the ether vapour an
issue as large as the instrument permitted; for the tap which gave
passage to it had hitherto been but half turned, and that progressively.
At the end of ten minutes from the beginning of inhalation, the
relaxation and immobility of the limbs was complete, the insensibility
was not doubtful, the respiration was deep, gentle, but free from râle.
The muscles of the face had ceased to be agitated, and it was of a
violet red colour, as was also the skin in front of the chest; the
pupils were turned upwards, dilated and immovable.
The apparatus was taken away, and the operation was commenced; but the
incision had only given issue to a small quantity of black blood, when
it was perceived that the features were altered and become entirely
violet, and that the respiration was extremely feeble. The pulse,
touched on this moment for the first time, was soft, full, and very
slow. All at once it ceased to beat.
Twenty-four hours after death, all parts of the body yielded a strong
odour of ether. The blood was deep black, fluid, and rather viscous. The
blood which gorged the back part of the lungs had a consistence and
colour somewhat like treacle. The mucous membrane of the bronchi,
trachea, and larynx was very much congested. The spleen was so softened
in its interior as to resemble the lees of wine.
This patient appears to have died rather from the want of admission of
sufficient air to the lungs than from the effects of ether. The
apparatus was applied without intermission, long after the face became
injected, and was kept applied till it became of a violet colour. The
pulse was not felt till the patient was dying. Artificial respiration
was not attempted, although it would most likely have restored the
patient.
The other death which happened whilst the patient was under the
influence of ether took place at the Hotel Dieu de Lyons, on September
11th, 1852.[166] The patient was a woman, aged fifty-five, but looking
much older. She was affected with a tumour of the superior maxillary
bone, and was weak and in a bad state of general health. M. Barrier was
reluctant to remove the tumour, but yielded to the entreaties of the
patient. The ether was administered from a sponge placed in a bladder,
and the patient was quickly put to sleep. M. Barrier had made the
incisions in the face, and had just divided the ascending process of the
jaw, when the breathing stopped. There was no pulse at the wrist, and it
was doubtful whether there was any at the precordial region. The patient
was placed horizontally, and artificial respiration and other measures
were applied, but without success.
This patient evidently died of hæmorrhage; the mode of death which M.
Barrier must have been dreading, as we perceive from his reluctance to
perform the operation. According to the result of my experiments on
animals, ether is not capable of causing the kind of death which this
patient died.
There were three or four cases in which ether was blamed by the
operating surgeons for causing the death of patients, who recovered from
its effects, and, died some days, or at least hours, afterwards. The
nature and circumstances of the operation were sufficient to account for
the fatal result in each of these cases, whilst the extended use of
ether has confirmed the opinion that it cannot be the cause of deaths
which occur days, or even hours, after its use.
On Friday, the 12th of February, 1847, Mr. Roger Nunn performed
lithotomy, in the Colchester Hospital, on a man who, as it was found
after his death, had disease of the kidneys. The ether seemed to act
favourably. Mr. Nunn says: “There was neither difficulty nor loss of
time in cutting into the bladder; but having done so, some little delay
occurred in grasping the stone, which was small, very flat, and lying in
the posterior part of the bladder; the delay was also increased by the
extremely relaxed state of the bladder itself, which seemed to fall in
folds on the forceps, and to cover the stone.”[167] This delay in
grasping the stone is attributed by Mr. Nunn to a collapsed state of the
bladder caused by the ether, but it can only have arisen from the fact
of the urine having escaped from the bladder, before the stone was
seized. The small vessels divided in making the first incision showed
much inclination to bleed, and Mr. Nunn secured them immediately after
the patient was put to bed.
Speaking of his patient and the ether, Mr. Nunn says: “He recovered from
its effects after a short time, and continued in a quiet passive state,
but without decided reaction for twenty-four hours. At this period he
had a chill, which lasted for nearly twenty minutes.” Stimulants were
given, but without much effect. The patient seemed incoherent from eight
o’clock P.M. of Saturday till nine A.M. of the following day. From this
time he gradually sank, and died at five o’clock P.M. of that day,
Sunday, being sensible to the last.
On March 9th, 1847, Mr. Wm. Robbs, of Grantham, removed an
osteo-sarcomatous tumour from the back part of the left thigh of Ann
Parkinson, a married woman, aged twenty-one, the mother of one
child.[168] Mr. Robbs tried to make his patient insensible with ether,
but did not succeed. He says, indeed, that in about ten minutes its
usual effects were produced; but these could not have been its full and
proper effects; for he says, “she appeared quite sensible to the pain
during the whole of the operation.” It is reported that she appeared to
feel the first cut. Mr. Robbs says that during the early part of the
operation, the patient “cried out much, complained, and writhed in great
agony of pain.” The operation was begun by an incision commencing midway
between the tuberosity of the ischium and the trochanter major, and
extending about six inches down the thigh. The fascia was next divided,
and the muscles were next separated with the handle of the scalpel, so
as to expose the upper surface of the tumour. After this had been done,
the inhaler was replaced to the mouth of the patient whilst the
operation proceeded, but the ether appeared to take no effect. The
tumour was “very adherent to the long head of the biceps flexor cruris,
which nearly covered it anteriorly, while posteriorly it rested on the
sheath of the great sciatic nerve. It took its origin from the common
tendon of the flexor muscles, close to the tuber ischii, and was
inserted into the short head of the same muscle just below its origin.”
Mr. Robbs says: “The dissection was protracted longer than I expected,
from the violent contractions of the muscles, and the struggles of the
patient.” He estimated the time occupied in the operation at twenty-five
or thirty minutes; and the sister-in-law of the patient, who gave her
evidence at the inquest, expressed her opinion that the operation lasted
an hour all but five minutes. At the end of the operation, the patient
appeared very faint, and the pulse was very rapid and feeble. The
patient remained much depressed, with a pulse of 140 in the minute,
small, and without much power, having her intellect perfect; she died
forty hours after the operation.
A coroner’s inquest was held, but neither the coroner nor any of the
jury appeared to have any knowledge or suspicion that a surgical
operation on the thigh could possibly be the cause of death. A surgeon
who gave evidence stated, that “the shock from the operation was not
simply the cause of death, as the seat of the disease was not essential
to life.” The verdict was, that the death of deceased was caused by the
inhalation of ether; and that no blame was attached to the surgeon, as
ether had been used and recommended by eminent medical men.
I cannot tell whether Mr. Robbs would have undertaken the operation if
ether had not been about to be used, but if he had undertaken it without
ether, one may presume that he would have done what every surgeon does
who undertakes a great operation, that he would have informed the
patient and her friends that it would be attended with some amount of
danger. In his communication to the _Medical Gazette_, Mr. Robbs
complains of the friends of his patient having thought it necessary to
obtain a coroner’s inquest; but he has himself to blame for that. After
he had attributed the death entirely to a new agent, which had been
given with a view to prevent the pain, and had entirely failed even in
that, it was very natural that they should seek for a legal
investigation of the affair.
Mr. Robbs makes no admission that the pain his patient suffered could be
due to any defect in the administration of the ether. He states, that he
“was quite unprepared for that perfect state of prostration of the brain
and nervous system which it appears in this case to have induced”. The
fact of the patient crying much, and complaining, and writhing in great
agony of pain, and the contraction of the muscles, and the struggles
which protracted the operation, do not look like a prostration of the
brain and nervous system. At the end of the operation she was, to be
sure, prostrated by its long duration, and the great loss of blood which
must have occurred; but her brain and nervous system were not so much
affected as the vascular and muscular system. She spoke of the operation
as having been very severe, and she retained her mental faculties
perfectly to her death. Ever since 1818 many of the students at lectures
on chemistry had inhaled the vapour of ether to quite as great an extent
as Mr. Robbs’ patient.
As a proof how far the feelings will suspend both reason and common
sense, it may be mentioned that some of the medical men, who were
strongly opposing the use of ether in 1847, did not hesitate to allude
to the inquest in this case, as showing that ether had caused the death
of a patient.
Mr. Eastment, of Wincanton, Somersetshire, related a case[169] in which
he attributed the death of the patient to ether. It was apparently the
first time he had seen ether employed on the human subject; and with a
larger experience of its effects, he would no doubt alter his opinion
respecting the cause of death in the case he related.
A boy, aged eleven years, became entangled in the machinery of a mill,
about eight A.M., on February 23rd, 1847, in consequence of which he
sustained a very severe compound fracture of the left thigh, with great
laceration of the soft parts, and a simple fracture of the right thigh.
The surgeons in attendance waited till four P.M. for the boy to recover
from the shock of the injury, and then performed amputation of the left
thigh. Ether was given, but so badly, that the patient’s sufferings were
so severe on the circular incision being made, that it appeared to be a
complete failure. The inhalation was repeated, however, and the pain of
the latter part of the operation was prevented. The patient died three
hours after the operation, being in a state of great exhaustion, with
occasional mental excitement, during the three hours.
This patient’s chance of life would probably have been improved if the
ether had been more effectually given, so as to prevent all the pain of
the operation; but I believe that his chance of recovery would have been
most improved by administering the ether soon after the accident in the
morning, which would most likely have removed the collapse, and enabled
the surgeon to perform amputation at once, and thus have prevented the
eight hours suffering and depressing effects of the great laceration of
the thigh.
M. Bouisson[170] has mentioned a case in which death was attributed to
ether by a surgeon named Roël, of Madrid. Dolorès Lopes, aged fifty, of
very feeble constitution, and addicted to drunkenness, had long suffered
from a cancerous tumour of the breast. It was removed after the patient
had inhaled ether for half an hour, and it weighed three pounds and a
quarter. The patient died seven hours after the operation. But the
operation itself was sufficient to account for the death of such a
patient; and she could not die from ether at the end of seven hours
after inhaling it.
On account of its great safety, ether is extremely well adapted for
medical cases, in which it is necessary that a narcotic vapour should be
administered by the patient’s nurse.
_The Combination of Chloroform and Ether._ Some practitioners have
recommended the inhalation of the vapour from a mixture of chloroform
and ether; but the result is a combination of the undesirable qualities
of both agents, without any compensating advantage. Ether is about six
times as volatile as chloroform—that is to say, if equal measures of
each be placed in two evaporating dishes kept side by side, at the same
temperature, the ether evaporates in about one-sixth the time of the
chloroform; and when the two liquids are mixed, although they then
evaporate together, the ether is converted into vapour much more
rapidly; and, in whatever proportions they are combined, before the
whole is evaporated the last portion of the liquid is nearly all
chloroform: the consequence is that at the commencement of the
inhalation the vapour inspired is chiefly ether, and towards the end
nearly all chloroform: the patient experiencing the stronger pungency of
ether when it is most objectionable, and inhaling the more powerful
vapour at the conclusion, when there is the most need to proceed
cautiously.
A death which occurred during a surgical operation in America, has been
attributed to the mixture of chloroform and ether which was
employed;[171] but there is no doubt that the patient died of
hæmorrhage. Dr. R Crockett, of Wytheville, Virginia, removed a fatty
tumour from the back of a boy, aged five years. Four parts of washed
ether by measure were mixed with one part by measure of chloroform, and
a drachm of this mixture was poured on a funnel-shaped sponge which was
applied near the mouth and nostrils. The tumour was very large, and
required two incisions of nine inches in length for its removal. Six
arteries required to be tied; and just as the last one was secured, the
child began to vomit. He was found to be pulseless, and he died three or
four minutes from the commencement of vomiting. Dr. Kincannon, who was
present, and watching the patient, said that up to the time he began to
vomit, there was nothing in the circulation or respiration to produce
the least apprehension.
The operator said that the patient probably lost four ounces of blood,
certainly not six. It must be observed that as the blood during an
operation is carried away by the sponges, it is impossible to estimate
the amount. It could be ascertained only by an analysis of the water in
which the sponges are washed. But even admitting that in the present
case the loss of blood did not exceed six ounces, it is probable that
this amount, flowing suddenly from a child of five years of age, might
cause death. Vomiting does not take place when a patient is deeply under
the influence of ether or chloroform, and the fact of no signs of over
narcotism having appeared, confirms the view that death was occasioned
by the loss of blood.
AMYLENE.
This substance was discovered and described in 1844 by M. Balard,
Professor of Chemistry to the Faculty of Sciences of Paris.[172] M.
Auguste Cahours had given this name five years previously to a product
which is isomeric with amylene, and is produced at the same time, but is
now termed paramylene.
Amylene is made by distilling amylic alcohol with chloride of zinc. The
amylic alcohol is obtained from crude fusel oil, otherwise called oil of
grain, or oil of potatoe spirit. The fusel oil must be submitted to a
careful distillation, with a thermometer in the retort. It begins to
boil at a comparatively low temperature, but that portion only is to be
retained which comes over from 266° to 284° Fah. Caustic potash is
added, to decompose the œnanthic ether which the distilled liquid
contains, and it is then redistilled, and that portion which boils
steadily at 270° Fah. is collected as pure amylic alcohol. Amylene can
be obtained from amylic alcohol in the same manner that olefiant gas, or
ethylene, can be made from common alcohol, namely, by heating it with
dishydrating agents, as sulphuric, phosphoric, fluoboric and fluosilic
acids, and chloride of zinc; but most conveniently with the last
substance, which is the one that M. Balard employed. The product which
is obtained when amylic alcohol and chloride of zinc are distilled
together, contains at least three distinct hydrocarbons, amylene,
paramylene, and metamylene; and the amylene which is the most volatile
is separated from the others by successive distillations.
Amylene is a colourless and very mobile liquid, of extremely low
specific gravity; being one of the lightest liquids known. The amylene
made for me by Mr. Bullock[173] had a specific gravity of 0·659 at 56°.
It is very volatile, boiling at 102° Fah. according to M. Balard, and at
95° according to Frankland, and the specific gravity of its vapour is
2·45. It is composed of ten atoms carbon and ten atoms hydrogen, and
bears the same relation to amylic alcohol that olefiant gas, or
ethylene, bears to common alcohol.
It is inflammable, burning with a brilliant white flame; and in pouring
it out by candle light, the same care is required as in dealing with
sulphuric ether. A slight explosion may be obtained by applying a light
to a mixture of a small amount of its vapour with a large quantity of
air.
It is soluble in alcohol and ether in all proportions, but is very
sparingly soluble in water, being in fact a hundred times less soluble
than many substances which are ordinarily spoken of as insoluble. From a
number of careful experiments which I made, I found that water dissolves
2·35 per cent. of its volume of the vapour of amylene. It follows
therefore, from the specific gravity of amylene and of its vapour stated
above, that amylene requires 9319 parts of water for its solution. The
water which has dissolved this small quantity of amylene tastes as
distinctly of it as amylene itself.
Amylene has more odour than chloroform, but much less than sulphuric
ether, and the odour does not remain long in the patient’s breath. The
smell of amylene somewhat resembles that of wood spirit. The first
specimens which Mr. Bullock made were slightly offensive, but the odour
improved and diminished in strength, as he obtained the substance in a
state more nearly approaching to purity. Many persons, who thought the
odour disagreeable at first, began to like it after they had been
exposed to it three or four times. It is almost without taste, and it
produces no irritation, or effect of any kind on the sound skin, even
when confined, and prevented from evaporating. The vapour is almost
entirely without pungency, furnishing in this respect a remarkable
contrast to both ether and chloroform. Its presence can be perceived on
first beginning to inhale it, but after two or three inspirations, one
cannot tell whether the air one is breathing contains any of the vapour
or not. It does not cause any cough unless there is great irritability
of the air-passages, or the vapour is breathed of great strength in the
very first inspirations.
Amylene produces about as much cold during its evaporation as sulphuric
ether does. If a sponge or piece of blotting paper wetted with amylene
is exposed to the air, a portion of the moisture of the air becomes
condensed on its surface, by the cold caused during the evaporation of
the amylene; and by the further effect of the cold the condensed
moisture is frozen, and the sponge or paper is covered with hoar frost.
The boiling point of pure amylene would probably be that which I have
quoted above from Frankland, viz., 35° cent. or 95° Fah.; but the
amylene which has been obtained for inhalation contains other
hydrocarbons of an analogous composition, and its boiling point is not
steady: 95° Fah. was indeed about the average boiling point of the
greater part of the amylene furnished to me by Mr. Bullock, for it
usually commenced to boil at 86°, and as it evaporated, the boiling
point gradually rose to 109°, or higher.
No method is at present known of separating amylene from the products
which come over with it, except a number of distillations; and although
these may be carried so far as to obtain a small quantity almost pure,
the price of it would be too great to admit of its employment for
inhalation. For this purpose, one must be content with a product
approaching to purity. Dr. Debout, in an article on amylene,[174] says
that the boiling point commences at 28° (82° Fah.), and rises gradually
to 40° or 45° (104° or 113°) in the best products which have been
obtained by Mr. Bullock of London, M. Hepp of Strasbourg, and the house
of Ménier at Paris.
M. Duroy published an elaborate paper on amylene, on April 9th,
1857.[175] In this paper, he gives the result of an examination of four
specimens of amylene: the first, which he calls A, was amylene made by
Mr. Bullock; the second (B) was the amylene of M. Ménier; the third (C)
was some that he had prepared according to the process of M. Hepp; the
fourth (D) was amylene which he had obtained by a process which he
described. In this process, he employed dry chloride of zinc and amylic
alcohol. M. Balard recommended a solution of chloride of zinc of a
certain strength to be used. I may state, however, that Mr. Bullock had
from the first used dry chloride of zinc.
The following table shows the temperature at which the different
specimens began to boil, and the temperature to which they rose before
being boiled entirely away.
A 30° cent. = 86° Fah. to 46° cent. = 115° Fah.
B 29 „ = 84 „ to 75 „ = 167 „
C 30 „ = 86 „ to 62 „ = 143 „
D 31 „ = 88 „ to 57 „ = 134 „
Mr. Bullock’s amylene went through the smallest range of temperature
whilst boiling away.