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.