I cannot tell whether Mr. Robbs would have undertaken the operation if ether had not been about to be used, but if he had undertaken it without ether, one may presume that he would have done what every surgeon does who undertakes a great operation, that he would have informed the patient and her friends that it would be attended with some amount of danger. In his communication to the Medical Gazette, Mr. Robbs complains of the friends of his patient having thought it necessary to obtain a coroner’s inquest; but he has himself to blame for that. After he had attributed the death entirely to a new agent, which had been given with a view to prevent the pain, and had entirely failed even in that, it was very natural that they should seek for a legal investigation of the affair.
Mr. Robbs makes no admission that the pain his patient suffered could be due to any defect in the administration of the ether. He states, that he “was quite unprepared for that perfect state of prostration of the brain and nervous system which it appears in this case to have induced”. The fact of the patient crying much, and complaining, and writhing in great agony of pain, and the contraction of the muscles, and the struggles which protracted the operation, do not look like a prostration of the brain and nervous system. At the end of the operation she was, to be sure, prostrated by its long duration, and the great loss of blood which must have occurred; but her brain and nervous system were not so much affected as the vascular and muscular system. She spoke of the operation as having been very severe, and she retained her mental faculties perfectly to her death. Ever since 1818 many of the students at lectures on chemistry had inhaled the vapour of ether to quite as great an extent as Mr. Robbs’ patient.
As a proof how far the feelings will suspend both reason and common sense, it may be mentioned that some of the medical men, who were strongly opposing the use of ether in 1847, did not hesitate to allude to the inquest in this case, as showing that ether had caused the death of a patient.
Mr. Eastment, of Wincanton, Somersetshire, related a case[[169]] in which he attributed the death of the patient to ether. It was apparently the first time he had seen ether employed on the human subject; and with a larger experience of its effects, he would no doubt alter his opinion respecting the cause of death in the case he related.
A boy, aged eleven years, became entangled in the machinery of a mill, about eight A.M., on February 23rd, 1847, in consequence of which he sustained a very severe compound fracture of the left thigh, with great laceration of the soft parts, and a simple fracture of the right thigh. The surgeons in attendance waited till four P.M. for the boy to recover from the shock of the injury, and then performed amputation of the left thigh. Ether was given, but so badly, that the patient’s sufferings were so severe on the circular incision being made, that it appeared to be a complete failure. The inhalation was repeated, however, and the pain of the latter part of the operation was prevented. The patient died three hours after the operation, being in a state of great exhaustion, with occasional mental excitement, during the three hours.
This patient’s chance of life would probably have been improved if the ether had been more effectually given, so as to prevent all the pain of the operation; but I believe that his chance of recovery would have been most improved by administering the ether soon after the accident in the morning, which would most likely have removed the collapse, and enabled the surgeon to perform amputation at once, and thus have prevented the eight hours suffering and depressing effects of the great laceration of the thigh.
M. Bouisson[[170]] has mentioned a case in which death was attributed to ether by a surgeon named Roël, of Madrid. Dolorès Lopes, aged fifty, of very feeble constitution, and addicted to drunkenness, had long suffered from a cancerous tumour of the breast. It was removed after the patient had inhaled ether for half an hour, and it weighed three pounds and a quarter. The patient died seven hours after the operation. But the operation itself was sufficient to account for the death of such a patient; and she could not die from ether at the end of seven hours after inhaling it.
On account of its great safety, ether is extremely well adapted for medical cases, in which it is necessary that a narcotic vapour should be administered by the patient’s nurse.
The Combination of Chloroform and Ether. Some practitioners have recommended the inhalation of the vapour from a mixture of chloroform and ether; but the result is a combination of the undesirable qualities of both agents, without any compensating advantage. Ether is about six times as volatile as chloroform—that is to say, if equal measures of each be placed in two evaporating dishes kept side by side, at the same temperature, the ether evaporates in about one-sixth the time of the chloroform; and when the two liquids are mixed, although they then evaporate together, the ether is converted into vapour much more rapidly; and, in whatever proportions they are combined, before the whole is evaporated the last portion of the liquid is nearly all chloroform: the consequence is that at the commencement of the inhalation the vapour inspired is chiefly ether, and towards the end nearly all chloroform: the patient experiencing the stronger pungency of ether when it is most objectionable, and inhaling the more powerful vapour at the conclusion, when there is the most need to proceed cautiously.
A death which occurred during a surgical operation in America, has been attributed to the mixture of chloroform and ether which was employed;[[171]] but there is no doubt that the patient died of hæmorrhage. Dr. R Crockett, of Wytheville, Virginia, removed a fatty tumour from the back of a boy, aged five years. Four parts of washed ether by measure were mixed with one part by measure of chloroform, and a drachm of this mixture was poured on a funnel-shaped sponge which was applied near the mouth and nostrils. The tumour was very large, and required two incisions of nine inches in length for its removal. Six arteries required to be tied; and just as the last one was secured, the child began to vomit. He was found to be pulseless, and he died three or four minutes from the commencement of vomiting. Dr. Kincannon, who was present, and watching the patient, said that up to the time he began to vomit, there was nothing in the circulation or respiration to produce the least apprehension.