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