Part 2. Comparison of agents available in 1847

Ether	safe but slow	irritant, flammable	resp.stimulant in light GA
Chloroform	easy but dangerous	non-irritant	VF early GA; liver/heart poison
Nitrous Oxide	fast but weak	used without O2

 Ether

colourless flammable volatile liquid with a pungent smell and an irritant vapour; C₂H₅-O-C₂H₅

1540	Valerius Cordus 'sweet oil of vitriol'
1561	Paracelsus chickens take it gladly ‘… prolonged sleep, awake unharmed’
1730	Frobenius coined name ‘ether’
early - mid 1800s	ether frolics
1818	Faraday noted similarity to N2O
1842 Jan.	W. Clarke tooth extraction. Miss Hobbie/Elijah Pope
1842 Mar.	C. Long excision of cyst. James Venables
1846 Sept 9th	W. Morton tooth extraction; Eben Frost by light of candle!
1846 Oct. 16th	W. Morton tumour of jaw. Gilbert Abbott/Warren
1846 Dec. 19th	operation in Dumfries
1846 Dec. 19th	tooth extraction in London
1846 Dec 21st	amputation of leg at UCH, London
1847	John Snow regulating inhaler; On the Inhalation of Ether
1848 onwards	ether variably eclipsed by chloroform

1862 Skinner	wire mask covered with cloth	Schimmelbusch mask 1894
1872	revival of ether in England
1877 Clover	ether inhaler with water jacket

1899 spinals	alternatives to ether become available
1931 cyclopropane
1940 Trilene
1956 halothane	ether use declines further
1988	ether only available on a named case basis

EMO ether inhaler and Oxford inflating bellows	apparatus for open ether	using Schimmelbusch mask c. 1940 (note the use of ethyl chloride prior to ether)
Ethers used by JP 1959-97:	diethyl, divinyl. ethyl vinyl, methyl propyl, fluoroxene, methoxyflurane, enflurane, isoflurane

Chloroform

colourless volatile non-flammable liquid, characteristic smell and sweetish taste - CHCl₃

1831	Guthrie, von Leibig & Soubeiran	discovered it independently
1830/1	Cynthia Guthrie	aged 8, accidentally anaesthetised herself
1847	James Young Simpson	obstetric anaesthesia
1847	John Snow	regulating inhaler
John Snow used a folded handkerchief, sometimes in the shape of a cone, for pain relief in labour, though for surgical anaesthesia he preferred to use his regulating inhaler		Lister (1882) suggested threading the corner of a handkerchief through a safety pin
1847/48		chloroform variably eclipses ether
1848	Hannah Greener	first anaesthetic death
1853	John Snow	gives chloroform to Queen Victoria
Extract from John Snow's diary Thursday 7th April (1853): Administered chloroform to the Queen in her confinement. At twenty minutes past twelve by a clock in the Queen's apartment I commenced to give a little chloroform with each pain, by pouring about 15 minims by measure in a folded handkerchief.		The first stage of labour was nearly over when the chloroform was commenced. Her Majesty expressed relief from the application, the pain being very trifling during the contractions, whilst between the periods of contraction there was complete ease.
1858	John Snow	On Chloroform and OtherAnaesthetics
1862	Joseph Clover	describes his chloroform apparatus

Clover chloroform apparatus	Clover with patient

1864 Report of the Chloroform Commission
Gradual decline in use after World War I
1981 Payne defends its use	(Brit. J. Anaesth. 53:118)

Nitrous Oxide

 colourless gas with a faint smell and a slightly sweetish taste.

manufacture of N2O c.1863

Boyle's machine c.1940

 

1772	Priestley discovered it; found it supported combustion
1799	Davy discovered analgesic effect on toothache
1800	Davy published thesis :
	… As nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.
early – mid 1800s	laughing gas frolics and ‘lectures’
1834	Colt anaesthetised 6 Red Indians by mistake
1844 Dec10th	Wells attended lecture by Quincy Colton
1844 Dec 11th	Wells had his own tooth pulled.
1845 Jan	Wells ‘failed’ demonstration at MGH – cries of “Humbug”
1863	Colton re-introduced N2O
1865	cylinders available in London
1881	Klikovich pain relief in labour
1887	Hewitt first gas and oxygen machine; GOE now possible
1911	self administration in labour
1934	Minnitt gas-air in labour
1945	pre-mixed with oxygen (80:20)
1946	bone marrow aplasia with prolonged N2O
1950 onwards	gradual decline in asphyxial administration
1964	Entonox
1970	piped gases in main theatres at Southmead
1971	scavenging of exhaled gases
2000	on the way out ?

Acknowledgement of source of pictures: apparatus for open ether from Anaesthetics by AB Vaughan. OUP 1969; asphyxial administration, Boyle's machine , handkerchief and pin, Schimmelbusch mask and ethyl chloride from Essentials of General Anaesthesia by Macintosh and Pratt. Blackwell, Oxford 1940; Clover and patient from Physics for the Anaesthetist by Macintosh and Mushin. Blackwell,Oxford 1946.

Part 3 of this lecture handout is on the stages of anaesthesia / Part 1 (history of anaesthesia up to 1846) / Home (to visit other articles/book on the history of anaesthesia)

email: john@johnpowell.net