Part 32

“In conclusion, I would remark, that the convulsions were in no measure mitigated by the depletion, which was carried to the utmost; nor was there any yielding of the os uteri until the chloroform was inhaled.”

The urine was not examined in either of the above cases, and it is not stated that œdema was present.

Hysterical Paralysis and Contractions. In December 1851, I administered chloroform in Charing Cross Hospital to a young woman about twenty-five, a patient of Dr. Chowne. She kept her left knee in a semiflexed position, and would not allow it to be moved. She had been in bed in the hospital for two months. She inhaled the chloroform reluctantly, and, after becoming unconscious, she breathed and sobbed in a hysterical manner. When insensible, the limb went down flat on the bed, the knee being quite movable. A straight splint was applied, and the limb was secured to it with bandages. I was informed that in a few days she contrived to get her leg bent again. She was the domestic servant of a nobleman. It was evident that there was nothing the matter with her limb, and that it was only influenced by her volition, which was perverted by the hysteria under which she was labouring.

In November, in the same year, I administered chloroform in the same hospital to another patient of Dr. Chowne, whose case was more obscure and complicated. The patient was a woman, aged thirty-three, who represented that for several months she had been unable to open her mouth, or to speak, and that she had, for the same length of time, been paralyzed in the left arm and leg. The affection, it was said, came on suddenly, in a kind of fit, which was followed by unconsciousness for three or four weeks. It was also said, that she had one or two fits the previous year, after which she was unconscious for a long time. The patient was quite conscious before inhaling the chloroform, and replied to questions by nodding or shaking the head, or by writing on a slate. She was unmarried, and had not menstruated for some months past. The chloroform was administered with a view to ascertain whether or not she was feigning. On first becoming unconscious, the patient breathed in a sobbing and hysterical manner. The chloroform was given very gradually; and as she became more affected, there were some struggling and rigidity, when the right arm and leg were moved about a good deal. The left arm and leg were also distinctly moved, but not above a tenth part as much as the extremities of the opposite side. When the patient was quite insensible, the limbs being relaxed, the pupils turned upwards, and the conjunctiva insensible, attention was turned to the jaws, which were still firmly closed, but they were opened by using a moderate degree of force with the fingers. The effect of the chloroform having been allowed in a great measure to subside, it was again administered, when the movements of the limbs recurred, and there was the same difference between the motion of the right side and that of the left, as before. When I left the patient, more than half an hour after the chloroform was discontinued, she had not opened her eyes or answered questions; and she did not do either for six days. I saw her five days after the chloroform. The pulse was very rapid on my first going to the bedside, but its frequency subsided in a few minutes. On my raising the eyelid, she turned her eye about, as if endeavouring to hide the pupil under the lid. On the following day she answered questions by nodding and writing on a slate, and was, in other respects, the same as before inhaling the chloroform.

The great difference in the amount of motion in the limbs of this patient, under the influence of chloroform, showed that the paralysis of the left side was not a mere pretence. It is, indeed, possible that the absence of motion in the limbs of the left side, for several months, would cause them to move less than the opposite ones during the action of chloroform; but it is not to be supposed that the patient would keep these limbs in one posture during the night, and when no one was present, without ever moving them, unless she herself believed that they were paralyzed. I looked on the woman as a sick person, and not a mere impostor; for although she appeared to exaggerate her symptoms, and to have a good deal of pretence and affectation, this circumstance arose, no doubt, from her complaint.

In April 1853, I administered chloroform four times to a patient of Dr. Arthur Farre, a girl of fifteen years of age, who was affected with a contraction of the flexor muscles of the left thigh and leg, of the muscles which bend the body to the left side, and those which bend and turn the head to the same side, in consequence of which the leg was drawn up, and the body and head were curved greatly to the left side. The contraction of the muscles had lasted for several weeks, but she had been ill for a much longer period, her illness having commenced with a fever. She took an extremely small quantity of nourishment, and was very thin. Her bowels were moved with difficulty. The pulse was very feeble and small, and there was a tendency to coldness of the surface. An eminent surgeon in the provinces had expressed his opinion that the distortion of the limbs and trunk was a feigned disorder; but the action of the chloroform proved that he was altogether in error. The muscles became completely relaxed when the patient was quite insensible, and the limbs and trunk and head could be readily moved into any position; but as the effects of the chloroform subsided, the deformity returned on each occasion before the patient recovered her consciousness. Neither the chloroform nor any other measures were of any service, and Dr. Farre informed me that the patient died a few weeks after I saw her.

Mania. I have been informed of several cases in which chloroform has been administered in acute mania, with the effect of calming the patient and procuring sleep. I have administered it in two cases with the same temporary advantage. In one of the cases, the patient was persuaded to inhale it; in the other, he had to be held by three keepers till he was unconscious. An eminent and well-known scientific man, who became insane some years ago, refused to take food. It was found that after being made unconscious by chloroform, he would take a meal just as he recovered from its effects, and the chloroform was given before every meal for a long time.

Spasmodic Pain. In August 1851, I administered chloroform to a woman who was labouring under a severe paroxysm of spasmodic pain in the abdomen. The pain was completely removed, without altogether causing unconsciousness. An opiate was given to prevent the pain from returning.

I have not had the opportunity of administering chloroform during the passage of calculi down the ureters, or of gall-stones; but there can be no doubt that it would be of the greatest service in such cases. If Dr. Griffin had been provided with chloroform when he attended the late Mr. Augustus Stafford with an attack of gall-stones, he would have been able to relieve his patient in five minutes, instead of taking two or three hours to produce relief by opium. There would have been no occasion for the venesection, which was carried to thirty ounces. And at the end of the attack, on Dr. Griffin leaving his patient for the night, if chloroform had been employed, he would have left him without any appreciable amount of the narcotic in his system. As it was, however, he left him with a quantity of opium unabsorbed from the alimentary canal. The bandage got displaced from the arm; there was an additional hæmorrhage, the opium became absorbed more quickly, and a dangerous state of narcotism was induced.

Frequent and long continued Use of Chloroform. Many patients have inhaled this agent hundreds of times, and it continued to produce insensibility as readily as at first. The dose does not require to be increased on account of its long use. I was informed of the case of a lady who was affected with a painful cancer, and was attended by the late Mr. Keate and Mr. Henry Charles Johnson. She inhaled chloroform at frequent intervals, by day and night, for a very long time, consuming three or four ounces in the twenty-four hours.

In November 1851, a surgeon in the north of England wrote to me respecting one of his patients, a lady, who had inhaled a great deal of chloroform, on account of neuralgia of the uterus. He said that, during that year, and principally within the last six months, she had inhaled at least two hundred ounces; that she often inhaled as much as three ounces in a day; and that it seemed to have produced very little effect on her general health, except that she seemed to be more susceptible of pain. He said that he had reluctantly yielded to the entreaties of his patient to administer it so often, and he wished for my opinion respecting the propriety of continuing its use, and what effect it would be likely to produce.

I advised that the chloroform should be continued as long as the severity of the pain rendered it necessary; and expressed my opinion, that it would produce as little ultimate effect as any other narcotic which might be used to relieve the pain. I saw the surgeon in September of the following year. He informed me that the chloroform was continued for some time after he had written to me; but that his patient had recovered from her complaint, and had left off the chloroform, and was in good health.

Mr. Garner, of Stoke-upon-Trent, has related the case of a lady, affected with neuralgia, who inhaled sixty-two ounces of chloroform from her handkerchief, in twelve days.

SULPHURIC ETHER, OR ETHER.

History and Composition. “This liquid is first described by Valerius Cordus, in 1540, under the name of oleum vitrioli dulce. The term ether was applied to it a hundred and ninety years afterwards by Frobenius, who, in a paper in the Philosophical Transactions, described its singular properties; at the end of this paper is a note by Godfrey Hankwitz, Mr. Boyle’s operator, mentioning the experiments that had been made upon it by Boyle and by Newton.”

The present chemical name of ether, or sulphuric ether, is oxide of ethyle. It consists of four atoms carbon, five atoms hydrogen, and one atom oxygen. Its atomic number is consequently 37.

The usual way of making ether, is to distil common alcohol (the hydrated oxide of ethyle) with sulphuric acid.

Chemical and physical Properties. Ether is a clear, colourless liquid, of the specific gravity of 0·715 at 68°. It boils at 96° Fahr.; and the specific gravity of its vapour is 2·565. It is soluble, in all proportions, in alcohol, and it is soluble in nine parts, by measure, of water. Water is also soluble in nine parts, by measure, of ether, so that after ether has been agitated with water, it retains one-tenth of its volume of that fluid. Ether is very inflammable, and, as it yields its vapour very freely, great care is required in pouring it out by artificial light. Its vapour is also very explosive when mixed, in certain proportions, with atmospheric air.

The ordinary ether of the shops contains a portion of alcohol which has distilled over with it; the alcohol should be removed by agitating the ether with twice its volume of water, before it is used for inhalation. The ether which has been treated in this way is called washed ether. The water which it takes up during the washing can be removed by distilling it from lime, or dry carbonate of potassa; but this is unnecessary, as the water does not interfere with the action of the ether when inhaled; and part of the water evaporates and is inhaled with the ether, when the atmospheric air is not already saturated with moisture.

Ether has a peculiar and very strong odour; in this respect it differs extremely from chloroform. The odour of a single drop of ether can be distinctly perceived all over a large operating theatre, whilst a pint of chloroform may be spilt without its odour being much noticed. The strong odour of ether is, indeed, one of the greatest objections to its use, since another agent has been discovered which is free from this objection. As was previously stated, the odour of chloroform cannot be perceived in the breath, after the lungs are emptied by one or two expirations of the vapour just taken in; whilst the smell of ether can be perceived in the breath for twenty-four, and sometimes for forty-eight, hours after the patient has inhaled it. The surgeon, and others who have been about the patient, also smell of the ether to a less degree. When a rabbit has been killed by the inhalation of ether, a starving cat will not eat its flesh even after it has been boiled; whereas the odour of chloroform cannot be perceived in the bodies of animals that have been killed by it.

If ether is exposed to atmospheric air by being kept a long time in a bottle but partly filled, it is apt to be decomposed into acetic acid and water.

The following Table shows the result of experiments which I made to ascertain the quantity of vapour of ether that 100 cubic inches of air will take up, when saturated with it, at various temperatures, the barometric pressure being 30 inches of mercury. The ether I employed in the experiments was washed, but not dried. It was, therefore, saturated with water, of which it contained one-tenth of its volume. It had a specific gravity of 0·735 at 60° Fahr., and it boiled at 98°.

Temp. Fah. Cubic inches of vapour. Minims of ether. 50° 52 64 51 54 66 52 56 69 53 59 72 54 62 76 55 65 80 56 68 84 57 72 88 58 76 93 59 80 98 60 84 102 61 88 107 62 92 112 63 97 117 64 102 122 65 107 128 66 112 134 67 117 140 68 123 147 69 130 156 70 138 165

In the above Table the air is a constant quantity of 100 cubic inches, which becomes expanded to 152, and so on; but the following Table shows the quantity of vapour in 100 cubic inches of the saturated mixture of vapour and air at different temperatures:—

Temp. Fah. Air. Vapour. 40° 73 27 42 72 28 44 70 30 46 69 31 48 67 33 50 66 34 52 64 36 54 62 38 56 60 40 58 57 43 60 54 46 62 52 48 64 49 51 66 47 53 68 45 55 70 42 58 72 40 60 74 37 63 76 34 66 78 32 68 80 29 71

The absorption of caloric during the evaporation of ether is much greater than during that of chloroform, owing both to the greater quantity of vapour it yields on account of its lower boiling point, and to the lower specific gravity of the vapour. The evaporation of ether from the bulb of a thermometer usually lowers the temperature nearly to zero of Fahrenheit. When the inhalation of ether was first commenced, the inhalers employed consisted generally of glass vases containing sponge, to afford a surface for the evaporation of the ether. Both glass and sponge being very indifferent conductors of caloric, the interior of the inhalers became much reduced in temperature, the evaporation of ether was very much checked, and the patient breathed air much colder than the freezing point of water, and containing very little of the vapour of ether. On this account, and through other defects in the inhalers, the patient was often very long in becoming insensible, and, in not a few cases, he did not become affected beyond a degree of excitement and inebriety.

To ensure the ether taking effect in a short time in every case, I made use of the conducting power of the metals, and the great capacity of water for caloric. The inhaler which I employed was made of plated copper, and was placed in two or three pints of water, of the ordinary temperature. The form of the inhaler was that of one which had been contrived by Mr. Julius Jeffries for the inhalation of aqueous vapour. No sponge or bibulous paper, or other material, was used; and the air, before being inhaled, was made to pass over a considerable surface of ether by means of a spiral volute, soldered to the top of the inhaler, and reaching nearly to the bottom. The accompanying engraving shows the interior of the inhaler, on a scale of half the dimensions, the bottom being removed.

The Physiological Effects of Ether are essentially the same as those of chloroform. The various degrees of narcotism which I described in the earlier part of this work, when treating of chloroform, were first described by me when treating of ether in 1847, before chloroform was in use. All the remarks which I made with respect to the manner in which age, strength or debility, and other circumstances, influence the action of chloroform, apply also in an equal degree to ether.