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pletely answers these purposes. (See our Report of the Med. Chir. Society, March 3d.) Experience has shown that the inhalation should be so conducted as to produce its full effect as soon as possible, in order to prevent or shorten the period of excitement. With this view a large volume of vapour should be inhaled from the first, the individual should not be disturbed, or the inhalation interrupted, and the ether should be pure.
It has been proved experimentally by Mr. Young, cutler, Edinburgh, on his own person, before the Society of Arts, that so far from there being any danger of explosion during the inhalation, that flame applied to the mouth, and breathed upon, is immediately extinguished.
Physiological effects.-Numerous experiments have been performed on the lower animals by MM. Flourens, Serres, Gruby, Longet, Magendie and others. The same phenomena have for the most part been observed in them as in man. Stupification by ether constitutes a convenient mode of depriving animals of sensation, for experiments on the excito-motory system. If pushed too far, however, even this is affected, and death is occasioned. Different degrees of insensibility may be produced, aud an action upon the brain proper alone, or combined with this upon the medulla oblongata, and spinal chord, be occasioned according to the extent to which inhalation is carried. According to M. Flourens, ether acts on the nervous centres in the following order :-First, on the cerebral hemisphere; second, on the cerebellum; third, one the spinal chord; lastly on the medulla oblongata, destroying successively intelligence, regular movements, sensibility, and life. Dr. Buchanan of Glasgow, having pointed out that the blood surcharged with ether is sent directly to the heart and brain, explains the evanescence of its action by comparatively pure blood from the lower regions of the body, succeeding it as soon as the inhalation is stopped. (Paper read to the Philosophical Society of Glasgow.) The peculiar sensations experienced by individuals. vary considerably in different cases.
Applications. The removal of pain during surgical operations still constiutes the chief object of inhalation. Even this application of it, however, has caused perhaps less sensation than that of destroying the pains of child-birth, without interfering with the progress of labour. This fact, first ascertained by Professor Simpson, of Edinburgh, has been confirmed by Professor Paul Dubois of Paris, and subsequently by several others.
We are informed by Dr. Simpson that latterly he has ascertained two important points with regard to the use of ether in midwifery. First, its action may be kept up for hours. In one case he had a patient placed for four, and in another for five hours and a half, under its influence before the child was born. When the patients awoke, about thirty or forty minutes after delivery, they were quite unconscious of the birth of their infants, and could scarcely at first be persuaded of the happy result. Both labours had been previously exceedingly tedious. One of the patients had child's head arrested at
the brim, and after being above thirty-six hours in labour, was delivered by Dr. S. with the long forceps. Second; the fœtus in utero seems not to be deleteriously affected by even such prolonged etherization of the mother. In these two cases the action of the fœtal heart was carefully watched by Dr. S. with the stethoscope, and did. not vary above ten or fifteen beats during the whole time of the etherization. Both children were born alive and well.
Ethereal inhalation has also been tried in several cases of facial neuralgia, inducing insensibility to the painful paroxysms, and sleep which could not otherwise be procured.
Another application has been made by M. Baudens to determine true from feigned diseases in the army. In one case, where curvature of the back was simulated, the deformity disappeared during the insensibility caused by ether, and the individual was led to confess the imposture. In another case. a suspected ankylosis of the hip joint was in the same way proved to be a reality.
Inconvenient effects have frequently resulted from the inhalation. Many of these will be found related by Professor Syme and Dr. Roberts, in our report of the meetings of the Medico-Chirurgical Society of Edinburgh. Great excitement, cough with expectoration of pus, hemoptysis, and convulsions, during the inhalation, have been witnessed by ourselves. In some cases, erotic feelings, and even nymphomania, have been occasioned in females, in others hysterical symptoms, or those of depression or intense headache, which have continued several days. In our last number we noticed the occasional occurrence of alarming sinking, which required vigorous measures to restore the individual. In some cases, the individuals have been thrown into such a state of agitation as to render the performance of the operation impossible.
Fatal effects have become multiplied. In our last number, one fatal case was noticed, occurring in the Edinburgh Royal Infirmary. We are informed that there are just now two other cases in which the ether was given, dying of secondary purulent deposits in the same institution. Is this result the effect of ether? An answer in the affirmative cannot be decidedly given, but, as we previously stated, all such cases require to be put on record. M. Jobert has brought forward two cases in which he considered death to be partly dependent on the ether. M. Roux has given another of tetanus, in which the patient never rallied from the stupefaction, and where death was decidedly accelerated by it. Mr. Nunn, of Colchester, has recorded a case of lithotomy, which sunk without the patient having rallied from the operation; and Dr. Maclagan has mentioned another, occurring in London after amputation of the thigh.
We observe in the Times. an account of an inquest at Grantham, in the County of Lincoln, in a case where an osteo-sarcomatous tumour was removed by Mr. Robbs, surgeon, under the influence of ether. The patient never rallied from the operation, which was in no way severe or prolonged, and the jury found "That the deceased, Ann Parkinson, died from the effects of the vapour of ether, inhaled
by her for the purpose of alleviating pain during the removal of a tumour from her left thigh, and not from the effect of the operation, or any other cause." In the correctness of this verdict the surgeon himself, Mr. Robbs, concurred.
Morbid Appearances.-The morbid appearances which have been found after death, caused by ether in animals, are similar to those observed in asphyxia, namely, fluidity of the blood, its collection in the right side of the heart and large veins, and engorgement of the internal viscera. In the fatal case of the Royal Infirmary there was found double pneumonia, bronchitis, and secondary purulent deposits in the joints. In the case of Mr. Nunn, cerebral congestion, lungs engorged posteriorly, and uniform fluidity of the blood. In the case at Grantham there was no great congestion, but the blood was fluid throughout. The observations of Amussat and Lassaign have shown that in every case the blood loses its power of coagulation, although with the exception of the presence of a minute dose of ether, its chemical principles are unchanged.
Claims to the discovery. The merit of discovering the application of etherization to removing pain in surgical operations, has been lately claimed by Dr. Wells, of America. He states that he was led to the discovery by observing that individuals, when in a state of great excitement, as during battle, or intoxication, never felt the pain of local injuries. He consequently caused the patient to inhale ether, and nitrous oxide gas in several cases, and found that they were thus insensible to the pain of surgical operations. He was led to prefer the nitrous oxide gas for this purpose, from its causing less injurious effects than ether. He communicated his discovery to Drs. Morton and Jackson, who then received it with incredulity. He shortly after left America for Europe, and was much surprised on arriving at Paris to find that those gentlemen had propagated his ideas without any allusion to him.
Since writing the above we have been informed that Professor Syme has abandoned the use of ether in his surgical clinic.-Monthly Journal of Medical Science.
Fatal Effects of Ether Vapour in a case of Lithotomy. By ROGER NUNN, Esq., Surgeon to the Colchester and Essex Hospital.At a time when the attention of both the medical profession and the public is being called to the influence of the ethereal vapour as an agent in deadening pain during surgical operations, you may probably consider the accompanying case of sufficient interest to be admitted into your columns.
On Friday, the 12th inst., I operated upon Thomas Herbert, ætat. 52, the subject of stone in the bladder, in the presence of most of the medical gentlemen of the town and neighbourhood. The ether was exhibited by my colleague, Dr. Williams, who considered the patient to be sufficiently under its influence after having inhaled it seven or eight minutes, at the end of which time I commenced the operation. There was neither di.ficulty nor loss of time in cutting into the blad
der; 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. The time occupied from the commencement of the operation to the period when the man was unbound, was ten mninutes, during which the ether was administered at intervals. The patient was placed fully under its influence, and the breathing first became heavy, and ultimately stertorous. He recovered, however, from its effects after a short time, and continued in a quiet passive state, but without decided reaction, for 24 hours. At this period he had a chill, which lasted for nearly twenty minutes. Mr. Taylor (the house-surgeon,) immediately gave him two ounces of brandy, with an equal quantity of water, after waich the patient remained in a dozing state till 8 o'clock, P. M., when the house-surgeon considered it necessary to send for me, as a state of complete prostration or collapse had ensued. I ordered small quantities of brandy and water (equal parts,) with arrow-root, at intervals, wrapped him in hot blankets, placed hot bottles in the bed, &c. This treatment was kept up till 9 o'clock the following morning, when ammonia was given alternately with the before-mentioned stimulus. The patient seemed incoherent from 8 o'clock, P. M., of Saturday till 9 A. M., of the following day. when symptoms of slight reaction appeared. At a consultation of the medical staff, which was held at the time, it was determined that the same treatment should be continued, (modified according to circumstances,) and that, in addition, a stimulating injection should be administered. (The effects of the injection were to increase slightly the frequency of the heart's pulsation, but without exciting his nervous energies.) From this time he gradually sank, and died at 5 o'clock, P. M., being sensible to the last.
I should here mention that the small vessels which are necessarily divided in making the first incision showed much inclination to bleed, owing, I imagine, to their want of contractile power. I therefore, to prevent any unnecessary hæmorrhage, secured them immediately after the patient was put to bed, so that he did not lose much blood.
Postmortem (67 hours after death.)-Membranous congestion of the brain, but no effusion; brain firm; lungs permeable throughout, anteriorly ex-sanguineous, posteriorly engorged; heart flaccid, of a natural size, and nearly empty; the left kidney pale; the right, slightly congested. The bladder and the adjoining parts presented the usual aspect after an operation.
I would mention that the blood throughout the whole vascular system was in a perfectly fluid state.
It is not my intention or inclination to attribute the loss of my patient wholly to the influence of the ether which was administered in this case, nor hastily to decry its use under all circumstances connected with surgical operations; but still I feel called upon to bring before the notice of my medical brethren the effects which resulted from its exhibition in this instance, that the profession may judge,
from the recital of an unsuccessful case, how far it may be considered safe to employ ether generally as a means of preventing the pain otherwise inseparable from the physical lesion. The suffused eye, livid lips, and stertorous breathing, accompanied, first, by convulsive struggles, and next by a sudden cessation of all motion, are often indicative of the effects of the vapour; and these were not altogether absent in the present instance: still, I felt myself justified in employ. ing it, from the published accounts of many successful cases, and the sanction of my colleagues and numerous friends around me. In prosecuting the operation, there was nothing peculiar to attract my attention, or to lead me to consider the patient's physical condition different from that of those on whom I had before operated, until I had reached the bladder, when I can but attribute the difficulty in seizing the stone to the apparently collapsed state of that viscus which had fallen in folds over the calculus, and so prevented its being grasped by the forceps. I must not, however, omit to mention the fact that the patient expressed no signs of suffering during the operation. Thus far, therefore, it may be said the ether fulfilled its intended office; but I think another question is involved, viz. whether the artificial means thus employed may not produce very serious depressing effects on the nervous system, depriving a patient of that reactive power so necessary to the reparative process. Has not a patient, after the administration of ether, a double shock to overcome that produced by the vapour superadded to that of the operation itself? Does not the history of the postmortem examination bear out the suspicion of the depressing influence of this inhalation ?—positively, from the still fluid state of the blood (although the body was not opened for 67 hours after death,) and from the flaccid state of the heart; negatively, from the fact that the inspection detected no indications of violence done to the parts that could explain the rapid dissolution which ensued, and that there was no evidence of nature hav ing made the slightest effort towards local reparation. Pain is doubtless our great safeguard under ordinary circumstances; but for it we should be hourly falling into danger; and I am inclined to believe that pain should be considered as a healthy indication, and an essentiul concomitant with surgical operations, and that it is amply compensated by the effects it produces on the system as the natural incentive to reparative action.
I trust that the publication of this unsuccessful case may lead to the publication of many others which have occurred, so that the profession may not be led away by the erroneous supposition that the prevention of pain is so vital a desideratum in operative surgery.
**Operators have hitherto fallen into the error of looking only to one side of the question. The profession is indebted to Mr. Nunn for placing in so strong a light the danger which may occasionally arise from the use of ether vapour. We have hitherto had a run of successful cases: it is now time that our correspondents should pause in their records of successful cases, and look to the possible danger. London Med. Gaz.