The success of these agents, especially ether and chloroform, in preventing pain, is undoubted; nor do they appear to have any other effect, nor to prevent any necessary effort or process of nature, except in a few cases which will be mentioned further on. Many hundred operations of the most severe kind, such as cutting off limbs, removing tumors, stones, and so forth, have been performed while the patients were under the influence of these agents, and without causing them the slightest pain; in fact, many remain, during the whole process, in a pleasant dream, and cannot be persuaded, when they wake, that the dreaded operation is over. The same thing has also been observed in hundreds of cases of midwifery, both in natural labor and when instruments have been used. In numerous instances the female has been put to sleep, and safely delivered, without knowing or feeling anything whatever, during the whole time; the first intimation that she had become a mother, being the cheering cry of her newborn babe. In some instances, the state of insensibility has been continued for a long time, and during its continuance, the most hazardous operations have been safely performed.
So far as can be safely judged, from the limited time during which such means have been used, it appears that there is no danger whatever, from their employment, except when improperly administered, and in certain peculiar conditions of the system; which causes of danger will, of course, be removed by competent experience and knowledge. It is highly encouraging however, to note, though ether and chloroform have both been used so extensively and indiscriminately, both by those who understood their nature and those who did not, that the cases in which they are proved to have done injury, are not more than two or three; and in all those that I have heard of, some obvious impropriety had been committed in their use. It should be borne in mind, however, that even if the danger from them was considerable, we might still be justified in their use. It is well known that, in numerous cases, the fear of suffering, beforehand, and its severity while being endured, produce the most serious, and even fatal results. Many a patient has passed safely through the ordinary effects of a painful operation, and yet sunk from the mere effects of fear and physical suffering. Instances have even been known in which a fear of this kind has caused death, and frequently it has given a shock from which the patient never fully recovered. There is also, frequently, great danger from the violent efforts and struggles of a person in pain, and many necessary operations are even prevented altogether by them; this is often observed in difficult labors. When insensibility is produced, however, all these causes of difficulty and danger are removed; the patient's fears are quieted, suffering is entirely prevented, and there is no struggling to prevent the necessary assistance. Supposing, therefore, that the ill effects of these agents were more certain and greater in amount than has yet appeared, it would still be a question whether the evil they really prevent is not greater than that which they possibly may cause.
In regard to the two agents now chiefly used, ether and chloroform, there is no difference in their mode of action, but the chloroform appears to be more speedy, certain, and efficacious, and is, therefore, the most valuable, but proportionably more dangerous when improperly administered. There are numerous instruments or inhalers, for administering these vapors, most of which are both costly and complicated, and all of which may be easily dispensed with. A very good plan is to take a large sponge and dip it in hot water, then squeeze out the water and pour on the ether or chloroform, and hold it over the mouth and nose. In two or three minutes consciousness and feeling will both be gone, and the patient will sink into a calm sleep which will last sometimes ten or fifteen minutes, and may be kept up as long as desired, by putting the sponge to the mouth for a few minutes whenever there are signs of waking. When it is left off the patient gradually comes round as if waking from ordinary sleep, and frequently speaks of having been in a dream, sometimes of a very pleasant character, but never knows what has taken place. No ill effects follow, but sometimes there is a little drowsiness or stiffness of the limbs, which soon passes off. A pocket handkerchief soaked in the fluid, and held over the mouth and nose will answer equally well; but whatever is used, it must not be pressed close, because a portion of air ought to enter with the vapor to prevent suffocation; and it should also be removed immediately the effect is produced. When it is borne in mind how much these requisites have been neglected, and how impure the ether or chloroform has often been, it is wonderful that more accidents have not occurred; and the fact that so few have happened under such a state of things, and with our little experience, goes far to prove that there is little or no danger at all in competent hands, with pure materials. The accounts circulated in the papers of "death from ether," and "fatal effects of chloroform," have mostly been gross exaggerations, and frequently false altogether. In most of the cases where death has followed from the use of these agents, it has been proved to arise from other causes, and would have happened if they had not been used. In one or two cases, however, of surgical operations, the ether itself appears to have caused death by producing suffocation, or congestion of the lungs; but, even in these, it has been shown that it was used in an improper manner. Thus a young woman in Newcastle in England, inhaled ether to have a diseased toe-nail cut off, and died. It appears, however, that there was an evident disposition in her to congestion or rushes of blood, and therefore she was not a fit subject, and besides, the ether was poured on a thick table cloth, which, of course, prevented the entrance of air along with the vapor, and thus suffocated. I believe there is not a single case on record of injury resulting when due precautions have been used, and I have not heard of one at all in midwifery practice.
Ether having been the first article used, I shall first give an account of its effects, and then proceed to chloroform, explaining the mode of administration, and other incidental matters, as I proceed. The best article on ether which I have met with, is a review in the British and Foreign Medical Review for April, 1847, of some pamphlets on the subject, from which I shall make an extract.
In the state of perfect etherization we believe all sensation is abolished; in a less perfect state an obscure perception of external objects remains, while the sense of pain is extinct. The psychical state is various. Generally speaking, the sense of external impressions becomes at first confused, then dull, then false, with optical spectra or auditory illusions, general mental confusion, and then a state of dreaming or utter oblivion. In the majority of cases the mind is busy in dreaming, the dreams being generally of an active kind, often agreeable, sometimes the reverse, occasionally most singular; and, frequently, a great deal is transacted in the few short moments of this singular trance. Many of the patients who have undergone the most dreadful operations, such as amputation of one or both thighs or arms, extraction of the stone, excision of bones, extirpation of the mamma, have readily detailed to us, and most with wondering thankfulness, the dreams with which, and with which alone, they were occupied during the operations. The character of the dreams seemed to be influenced, as in ordinary cases, by various causes, immediate or remote, present or past, relating to events or flowing from temperament.
A good many seemed to fancy themselves on the railway amid its whirl and noise and smoke; some young men were hunting, others riding on coaches; the boys were happy at their sports in the open fields, or the filthy lane; the worn Londoner was in his old haunts carousing with his fellows; and our merry friend, Paddy, of the London Hospital, was again at his fair, wielding his shelala in defence of his friends. Others, of milder mood, and especially some of the women patients from the country, felt themselves suddenly transported from the great city and the crowded hospital-ward to their old quiet home in the distant village, happy once more with their mothers and brothers and sisters. As with the dying gladiator of the poet, the thoughts of these poor people—
"Were with the heart, and that was far away."
Some seemed transported to a less definite but still happy region, which they vaguely indicated by saying they were in heaven; while others had still odder and warmer visions, which need not be particularized.
For the purpose of obtaining information on all the points of this most interesting subject, we personally questioned all the patients in the London hospitals, who, at the period of our visits, still remained in the wards after the ether-operations. They were in all fifty-four, and the great majority had been the subjects of capital operations. They were unanimous in their expressions of delight and gratitude at having been relieved from their diseases without suffering. In listening to their reports, it was not always easy to remain unmoved under the influence of the conceptions thereby communicated, of the astonishing contrast between the actual physical condition of the mangled body in its apparent tortures on the operating table of a crowded theatre, and the really happy mental state of the patient at the time.
This perfect freedom from pain is proved by every case wherein the vapor has been efficiently administered, although there are frequently the same cries uttered, and the same motions practised as when pain is experienced which proves that nothing is prevented but the mere feeling, which it can be of no use whatever for any one to suffer from.