A medicine called chloric ether has been in use since 1831. It consists of a solution of chloroform in spirits of wine. It is somewhat variable in strength, but usually contains about twelve per cent. of its volume of chloroform. Dr. Henry Jacob Bigelow of Boston tried this by inhalation, as well as other substances, when Dr. Morton first used sulphuric ether, but he did not succeed with it in causing insensibility to pain. Mr. Jacob Bell of London tried the chloric ether in the beginning of 1847, and succeeded in causing insensibility with it in some cases.[[34]] After this time the chloric ether was exhibited occasionally in St. Bartholomew’s and the Middlesex hospitals, and in the private practice of Mr. Lawrence, but it did not come into general use, owing to its expense, and its frequently failing to cause insensibility.
The relation of chloroform to chloric ether is exactly the same as that of opium to laudanum, and no one acquainted with this circumstance could doubt for a moment that chloroform inhaled alone would produce the effects which it did when inhaled from its solution in spirit; the only uncertainty about the matter that could possibly exist would be whether it might not be too strong for use in its undiluted state.
The true nature of the so-called chloric ether was, however, known to very few persons. It did not enter into the pharmacopœias, and it was mentioned in very few of the works on materia medica. I examined a specimen of it, and found that its properties when inhaled were due to a volatile body containing chlorine, which evaporated first, leaving a great quantity of spirits of wine behind. I concluded that the volatile body was hydrochloric ether, and as this article is so volatile that it exists in the form of gas except in comparatively cold weather, and consequently could not be conveniently used for inhalation, I did not consider the matter any further. M. Flourens had indeed experimented on animals with undiluted chloroform, but was so struck with its great and dangerous power, that he was far from recommending its use in surgical practice.
It was left for Dr. Simpson of Edinburgh, who had already the merit of having discovered the use of inhalation in midwifery, to be the first to administer chloroform in an undiluted state, and to recommend it successfully for general use. Mr. Waldie, of the Apothecaries’ Hall of Liverpool, first mentioned chloroform to Dr. Simpson, as the latter states in a foot-note to his first pamphlet on the subject. Mr. Waldie has given the following account of the circumstance in a pamphlet on chloroform.[[35]]
“When in Scotland, in October last, Dr. Simpson introduced the subject to me, inquiring if I knew anything likely to answer. Chloric ether was mentioned during the conversation; and, being well acquainted with its composition, and with the volatility, agreeable flavour, and medicinal properties of the chloroform, I recommended him to try it, promising to prepare some after my return to Liverpool, and to send it to him. Other engagements and various impediments prevented me from doing this so soon as I should have wished; and in the meantime Dr. Simpson, having procured some in Edinburgh, obtained the results which he communicated to the Medico-Chirurgical Society of Edinburgh on the 10th of November, and which he published in a pamphlet entitled—‘Notice of a New Anæsthetic Agent as a Substitute for Sulphuric Ether in Surgery and Midwifery.’”
Dr. Simpson’s first experiments with chloroform were made in the early part of November 1847, and his pamphlet on the subject, which was published on the 15th of that month, had a wide circulation, and created great interest. Chloroform was immediately used everywhere to a greater extent than ether had been. An impression became very prevalent that chloroform was safer than ether. This impression arose rather from the general tenour of Dr. Simpson’s essay than from any direct statement, for he had not treated on this point.
The great strength of chloroform as compared with ether, and the extreme care required in its use, were indeed soon pointed out;[[36]] these precautions, however, attracted but little attention till the first death from chloroform occurred near Newcastle on the 28th January, 1848. Ether was exhibited by inhalation during eleven months in Europe, and about sixteen months in America, before chloroform was introduced. During all this time no death was occasioned by its use, if we except one at Auxerre in France, which appeared to be occasioned by want of air, owing to an imperfect inhaler, and not to the effect of ether. Chloroform had only been employed between two and three months when the above mentioned death occurred, and this was soon followed by others in nearly all parts of the world. These accidents have prevented many persons from inhaling chloroform, and they have prevented a still greater number from enjoying that freedom from anxiety and apprehension before an operation, which ought to be one of the greatest advantages of any plan for preventing pain. As chloroform possesses advantages over ether, in being more convenient and less disagreeable, it continues to be used, to the exclusion of the latter agent, in most parts of the world. In the Massachusetts General Hospital, however, where sulphuric ether was first employed, it was resumed three or four years ago, and the use of chloroform was prohibited by the governors, on account of two accidents from it. Ether is also employed out of the hospital, both in surgical and obstetric practice, in Boston and the neighbourhood; and I have been informed that this is also the case in Philadelphia, whilst in the state of New York both chloroform and ether are employed. I learned last year that ether was the agent employed for causing insensibility at Naples and at Lyons.
Several volatile substances have been tried in a few cases with the effect of causing insensibility, since the introduction of chloroform, but none of them came into use except amylene, which was first employed by me in King’s College Hospital in November 1856, after I had made several experiments on animals with it, and inhaled small quantities of it myself. I have administered it in a great number of operations already, and find it to possess certain advantages over chloroform in the greater number of cases. Although it has not yet been generally employed in this country, it has been used extensively in Paris, Strasbourg, Lyons, and other places on the continent, with very favourable results.
It is not improbable that, amongst the multitudes of new bodies which chemistry makes known every year, some agent may be found superior to those hitherto used; and besides the great practical advantages which are directly derived from the discovery of inhalation for the prevention of pain, the method of breathing medicinal substances in the gaseous state offers great facilities for the investigation of their effects, and cannot fail to hasten the time when the mode of action of medicines will be a branch of exact knowledge.