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.
The inhalation of ether causes an increased flow of saliva in many 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.