[COMPLIMENTS OF THE AUTHOR.] 
THE BROMIDE OF ETHYL AS AN 
KY 
J. MARION SIMi M.D., LL.D. 
(Read before tie New Yorl Acaiemy of Medicine, Marcl 18, 1880,) 
WITH DISCUSSION ON THE SAME HY 
Drs. Levis (Philadelphia), Squibb, Dalton, 
Post, Piffard, Little, Wylie, and 
Roberts (Philadelphia). THE BROMIDE OF ETHYL AS /N ANESTHETIC* 
By J. Marion Sims, M.D., LL.D., New York. 
The bromide of ethyl is now making considerable reputa- 
tion as an anaesthetic. According to Dr. Turnbull it was 
discovered by Serullas in 1827, but attracted no special 
attention till Dr. Thomas Nunnelly, of Leeds, made some 
experiments with it on animals in 1849. In 1865, Dr. Nun- 
nelly brought the subject again before the profession by a 
paper read at the British Medical Association in which he 
says he had employed it as an anaesthetic “in all the prin- 
cipal operations at the Leeds General Eye and Ear In- 
firmary.” This was at the time when chloroform held 
such complete sway in England that no importance was at- 
tached to Nunnelly’s experience, and he had no followers. 
In 1876 some experiments were made with it in France 
by Rabuteau on the lower animals, but without a knowl- 
edge of the fact that this had been done previously in Eng- 
land by Nunnelly. 
To Dr. Lawrence Turnbull and Dr. R. J. Levis, of Phila- 
delphia, we are indebted for what we know of the anaesthet- 
ic properties of the bromide of ethyl. 
Dr. Turnbull began to experiment with it in September, 
1877, using it first on himself, and then on his patients. 
After satisfying himself as to its efficiency and safety as an 
anaesthetic, he laid the subject before the Pennsylvania 
State Medical Society in 1878. In August, 1879, he brought 
it before the British Medical Association at Cork, and in 
September of the same year before the International Med- 
ical Congress at Amsterdam. In April, 1879, Dr. Turnbull 
had the good fortune to interest Dr. Levis in the subject. 
Dr. Turnbull’s operations under the ethyl were mostly in 
* Read before the New York Academy of Medicine, March 19th, 1880. 2 
ophthalmic and aural surgery, and were generally of short 
duration. But Dr. Levis being surgeon to two large general 
hospitals (the Pennsylvania and the Jefferson Medical Col- 
lege Hospital), had ample opportunities of testing its quali- 
ties and proving its excellence as an anaesthetic in general 
surgery and in prolonged operations ; and through his in- 
fluence and teachings at these hospitals it seems to be 
coming rapidly into common use. 
The bromide of ethyl has been pronounced by Maisch and 
Still6, and by Dr. Greene, of Philadelphia, to be hydrobro- 
mic ether. 
There are two or three processes for making the hydro- 
bromic ether. Our friend Dr. Squibb will explain them to 
you. The most economical is the phosphorus, alcohol and 
bromine one. The disagreeable odor belonging to the hy- 
drobromic ether made by this process is supposed to be due 
to the phosphorus. Another process is by distilling absolute 
alcohol with about three times its weight of bromine. 
Another process consists in the combination of potash and 
bromine. Its formula is : 
C2, H5Br.; boiling-point, 105° F.; density, 1,419 at 59° F. 
Dr. Turnbull defines hydrobromic ether to be “a pure, 
colorless, very volatile liquid which evaporates with great 
rapidity on bibulous paper, leaving no residue, and having 
a strong ethereal odor which remains upon the patient’s 
breath long after its use. It has a sweetish and hot taste. 
Its boiling-point is intermediate between that of chloroform 
and ordinary ether. It is sparingly soluble in water, but 
mixes with it, and in all proportions with alcohol and ether.” 
I here show* you samples of it made by four different 
manufacturers in Philadelphia. That marked No. 1 was 
made by Wyeth & Bro., and is mostly used by surgeons 
in Philadelphia. You see how readily its vapor extinguishes 
a flame. No. 2 contains ether and ignites. These two have 
a peculiar but not disagreeable odor. Nos. 3 and 4 have a 
very strong, unpleasant odor, which is repulsive. This is 
the kind that was used by Turnbull and Levis before Wyeth 
made a better article. 
It is claimed for hydrobromic ether that it produces 3 
anaesthesia more rapidly than chloroform, and is eliminated 
from the system more rapidly by the lungs and kidneys than 
any other anaesthetic, and that it is less apt to produce 
vomiting than ether or chloroform. 
It usually produces anaesthesia in two or three minutes— 
sometimes four ; and consciousness returns in two or three 
minutes after its administration ceases. It is given (accord- 
ing to Turnbull and Levis) “ on a handkerchief or small 
napkin folded up to a space of about four inches square, and 
then laid on a larger napkin folded so as to be large enough 
to cover the entire face of the patient.” 
About two drachms are poured on the napkin to begin with, 
and a drachm is added afterwards at intervals as required. 
Hydrobromic ether has been administered in Philadelphia 
as an anaesthetic about two hundred times, and it is greatly 
lauded by all who have used it. Of course, this is a small 
experience upon which to base its absolute safety. Chloro- 
form was administered to thousands of cases before we 
heard of a death from its use, and now we know that it has 
slain its hundreds. 
Bichloride of methylene has been given by Spencer Wells 
most extensively, perhaps a thousand times without acci- 
dent, and yet a voice comes up from the profession saying 
that it is quite as dangerous as chloroform ; and outside of 
the personal influence of Spencer Wells it is rarely used in 
England, and has not been generally adopted elsewhere. 
The profession have been for a long time in search of a 
new anaesthetic. We have been waiting for one as pleasant 
to take as chloroform and as safe as ether. When we are 
convinced that we have one answering this description, it 
will be heartily welcomed by the profession all over the world. 
Does the Turnbull-Levis anaesthetic come up to our ex- 
pectations ? Time alone will show. It is the duty of every 
man who has had any experience with it to lay it before his 
brethren. With this obligation pressing heavily upon me, 
I came here to-night to lay my contribution on this im- 
portant subject before you. 
For my knowledge of the use of hydrobromic ether I am 
indebted to Dr. Levis. I made him a visit on the 28th of 4 
January last, when he told me of his experience, gave me 
his paper on the subject, and gave me a bottle of the ether 
for experiment. I came home saturated with Dr. Levis’s 
views. From his experience I felt quite convinced that we 
had at last found the long looked-for anaesthetic. 
Three days after my visit to Dr. Levis I gave the hydro- 
bromic ether to a young lady at St. Elizabeth’s Hospital ; 
but, not understanding the proper method of administering 
it, I failed utterly to produce its anaesthetic effect. In 
eight minutes we had wasted eight drachms of the hydro- 
bromic ether, and it produced only a stage of excitement in 
which the patient was wholly uncontrollable. I then laid 
it aside and resorted to ether. On the next day I gave it 
to a young lady, twenty years old, who was completely 
anaemic from menorrhagia which had continued many 
months. She was so exhausted from loss of blood that she 
occasionally had syncope, even in the recumbent posture. 
By the inhalation of two drachms of the hydrobromic ether 
given by Dr. Wylie she was completely anaesthetized in two 
minutes. The operation was performed in about five minutes, 
and she was placed in bed and recovered consciousness in 
two or three minutes more. I was so well pleased with the 
anaesthetic in this instance that I felt encouraged to give it 
further trial. The effect produced in this case differed 
widely from that in the first, and depended entirely upon 
the different methods of administration in the two cases. 
In the first, the bromide of ethyl was poured on a folded 
handkerchief, and held close to the mouth and nostrils, but 
not in absolute contact with them. In the second case, it 
was poured on a folded handkerchief and laid in contact 
with the mouth and nose, and held firmly there by a towel 
folded into a square of eight or ten inches. By this method 
no air could be breathed that was not loaded with the ethylic 
vapor. With this experience as a guide I determined to 
administer it in a case of Battey’s operation. 
Miss B , twenty-five years old, in perfectly good 
health, had been subject to epileptic attacks for the last 
five years. They came regularly on the fourth or fifth day 
after the cessation of the menses. Menstruation was scan- 5 
ty, lasting but two days. She had retroversion, and the 
right ovary was enlarged and painful on pressure. 
Bromides had been largely used without any permanent 
improvement. The uterus had been replaced, but with no 
improvement ; afterwards the cervical canal was enlarged 
by incision ; then menstruation became normal in quantity 
and painless, and yet the post-menstrual epileptic seizures 
were not modified in the least. Her physicians, Dr. Betton 
and Dr. Bond, had advised Battey’s operation, and from my 
failure to give her any relief by the tentative efforts just 
alluded to, I advised her to submit to Battey’s operation, 
and it was performed on Monday, February 9, 1880. 
Everything being ready, a drachm of bromide of ethyl was 
poured on a folded napkin and held closely over the mouth 
and nose. In a minute more another drachm was poured 
on the napkin, and at the end of two minutes she became 
insensible and relaxed ; but the conjunctiva was sensitive 
to the touch, and her eyes rolled about, and her breathing 
was very rapid. At the end of five minutes (the hydro- 
bromic ether added as required) she was perfectly insensible 
and breathing sixty times a minute. This very rapid breath- 
ing would moderate whenever the ether-napkin was removed 
so as to allow the admission of pure air, and would always 
increase by pouring fresh ether on the napkin. At the end 
of ten minutes she could be kept quiet, breathing softly and 
regularly, but always above the normal standard. The 
pulse was now 86, full and strong. During the first twenty 
minutes we had used about two ounces of the hydrobromic 
ether. At that time she vomited freely. At the end of 
forty minutes she vomited again, with severe straining. 
On three occasions during the operation there was con- 
siderable opisthotonos, with twitching and rigidity of the 
muscles of the extremities, and constant rolling of the eyes 
in every direction. 
Dr. Nash thought these were similar to her epileptic 
attacks, in one of which he had seen her. 
The operation lasted an hour and a half. Her condition 
was good during the whole time, and her pulse was strong 
and full. The rapid, short breathing was a peculiar feature; 6 
the sensitiveness of the conjunctiva existed from the be- 
ginning to the end of the operation, and her eyeballs were 
in almost constant motion. There was.no unusual dilatation 
of the pupils. In all, about four and a half or five ounces of 
ethyl were used. 
She recovered quickly from the anaesthetic after being 
put to bed, but she had the most distressing retching and 
vomiting imaginable. The straining was so violent that 
Dr. Nash more than once placed his hands over the abdomen 
to prevent the wound from bursting asunder. From the 
moment of returning consciousness she complained of violent 
pain in the head, and to relieve this pain she got a fourth of 
a grain of morphine hypodermically. In an hour this was 
repeated. Two hours after the operation (6.30) the pulse 
was 60, full and strong. 
6.15.—Distressing retching and vomiting continued almost 
uninterruptedly ever since the operation was finished. Head- 
ache very severe. Quarter-grain of morphine hypodermi- 
cally for pain in head. One ounce of urine drawn by catheter. 
7.30.—Nausea and retching, but no vomiting ; still has 
severe pain in head. Thin, yellowish brown movement 
from the bowels, watery, but a few ounces ; odor very 
offensive, having the smell of bromide of ethyl. 
8 P.M.—Another movement from the bowels, the same 
character as the first. 
9 P.M.—Another movement of the same brownish water ; 
each attended with some tenesmus. 
9.30 P.M.—Milk and brandy, to be repeated at intervals. 
10.15 P.M.—Two ounces of urine drawn ; bowels moved 
twice in the last hour. This makes five movements of 
bowels in three hours. The odor of the bromide of ethyl 
in the passages was so strong that it attracted the notice 
of the inmates of the house. 
11 P.M.—Pulse, 117 ; temperature in axilla, ; respi- 
ration, 25. Still complains of pain in the head ; small, 
brownish, watery discharge from the bowels, attended with 
tenesmus and mucus. 
12.35 A-M-> Tuesday, Feb. 10th.—Very restless ; com- 
plains of pain and desire to go to stool. Gave one-fifth 
grain of morphine hypodermically. 7 
3.15 A.M.—Has slept since the administration of the mor- 
phine (2 h. 40 m.). Drew off two ounces of urine. Hic- 
cough occasionally since 10 o’clock. Tenesmus and effort 
at movement of the bowels. Pulse, 125 ; temperature, 
10110. Sleeping. 
5 A.M.—Pulse very feeble. Stimulants. 
5.30 A.M.—Pulse scarcely perceptible. 
6 A.M.—Small, brownish, watery movement from the 
bowels, with tenesmus. 
6.40 A.M.—Recurrence of hiccough ; quietly sleeping ; 
perfectly conscious when spoken to. 
7 A.M.—I saw the patient and made the following note : 
pulse imperceptible ; no pain except in head ; somewhat 
restless. I fear internal hemorrhage, because the diarrhoea 
does not seem to have been sufficient to prostrate her to 
this extent. Her breath is highly charged with the ethyl 
odor. The movements from the bowels are brownish dirty 
water with some tenesmus and mucus. Passed a catheter 
into the sigmoid flexure and injected thirty grains of tannin 
and twenty drops of laudanum, which passed offimmediately. 
7.45 A.M.—Very restless ; wishes to sit up ; growing 
weaker ; mind wandering. 
8.40 A.M.—Catheter introduced, no urine in the bladder; 
pulse imperceptible. Respiration, 36 ; temperature, 102^.° 
10.30 A.M.—Catheter introduced, teaspoonful of high-col- 
ored urine drawn. 
11 A.M.—Severe convulsion, with frantic ravings. Con- 
vulsions ceased at 11.40 A.M., with heart-rending screams, 
and she died at 12.15 P.M., about twenty-one hours after 
operation. 
Wednesday, Feb. 11, 1880, 8.45 A.M.—Post-mortem made 
(twenty hours after death) by Dr. S. Waterman, Dr. Water- 
man, Jr., and Dr. Nash. External wound three and a half 
inches long. Sutures (8) removed ; edges of wound adher- 
ent throughout. Abdomen laid open by free incisions, lon- 
gitudinal and transverse. Two and a half ounces of bloody 
serum in the peritoneal cavity, three drachms of it being in 
the Douglas pouch below the retroverted uterus. There 
was no exudation of lymph, and no signs of peritonitis. 8 
The left broad ligament united to sigmoid flexure by old 
and strong adhesions were broken up, and then the uterus 
and broad ligaments were removed, together with the 
utero-sacral ligaments, a portion of bladder, and the upper 
part of vagina. The lower part of the ileum for about 
eighteen inches looked dark and congested, and about 
twelve inches of it were removed, severing it at the caput 
coli. The colon was also of the same dark brown color, 
and five or six inches of the descending colon were removed, 
and also both kidneys. The kidneys seemed to be healthy. 
Now, the question arises : What was the cause of death 
in this case ? Before the post-mortem was made I supposed 
that the uncontrollable straining efforts to vomit had re- 
sulted in displacing some of the pedicle ligatures, and that 
my patient had died of slow internal haemorrhage. But the 
post-mortem proved otherwise. 
In a letter received from Dr. Levis (Feb. 19th) he says : 
“ It seems to me that the only unpleasant symptoms 
which could possibly be referred to the anaesthetic were 
those of the head, and it is evident that the death of the 
patient is not to be attributed to cerebral causes. As to 
the diarrhoea or cholerine, which, probably with shock, 
seemed to cause death, that could not be attributed to the 
anaesthetic. Ethyl has been used in this city about two 
hundred times, uniformly with the most happy results. In 
my experience there has been no headache or other evi- 
dence of cerebral disturbance following the administration. 
No bowel affections have been observed, and none would be 
thought of. Do not be too hasty in the association of the 
anaesthetic with the cause of death. Many thousands of 
patients have died within twenty-two hours after the ad- 
ministration of ether and chloroform.” 
Some persons think that death was produced by cholerine. 
Let us sum up the evidence bearing on this point. 
The patient took three drachms and fourteen grains of 
Rochelle salts at 8.30 A.M. It operated freely twice before 
11 o’clock, and no more till 7 o’clock, about two hours after 
the operation. She then had six thin, brownish, watery 
discharges from the bowels between 7 and 11 o’clock p.m. 9 
—not large, but attended with tenesmus, and the last with 
a little mucus. At 12.15, 2.40, and at 6 and 7 next morn- 
ing, there were other thin, watery, brown discharges, with 
tenesmus and a little mucus, and the patient wanted the 
bed pan under the pelvis constantly. 
Thus, we see that, between 7 P.M., and 7 the next morn- 
ing, there were not less than ten watery, not profuse, but 
exhausting evacuations, over which opiates and astringents 
did not exercise the least influence. Dr. Nash says : “ A 
few hours before death there were several (two or three) 
large involuntary movements from the bowels, such as she 
had previously had—dirty, thin water, with the disagreea- 
ble ethyl odor.” The lower portion of the ileum and the 
colon were black and congested, and altogether presented 
an appearance far from a normal, healthy one. 
This is a strong array of facts to sustain the theory of 
death by cholerine ; and in all probability this cholerine 
had an important bearing on the termination of the case. 
But from my stand-point of view this was only secondary. 
Was death, then, caused by the anaesthetic ? 
Let us here sum up the evidence bearing on this point. 
The patient was under the influence of the anaesthetic for 
an hour and a half. Its effects were different on her from 
what has been observed by Dr. Levis and others in Phila- 
delphia. She breathed often sixty times a minute. She 
had opisthotonic convulsions three times during its admin- 
istration. When she recovered from its effects she com- 
plained all the time of severe pain in the head. She had a 
congested state of the eyes and eyelids ; and she had con- 
vulsions before death; and the discharges from the bowels 
smelt so much of the ethyl that the inmates all over the 
house noticed and complained of its peculiar, disagreeable 
odor. The woman who washed and dressed the body after 
death says that the odor of ethyl from the lungs, when she 
rolled the body over, was as strong as when it was be- 
ing administered. When we came to make the post-mor- 
tem we found the ethyl odor pervading the intestinal canal, 
and other organs of the body. At 8.45 A.M., the post-mor- 
tem was made, and I wrapped up the portions of intestine removed, the uterus and its appendages, and the kidneys, 
in a sheet of newspaper, and took them home, and placed 
them (as I was hurried) on a table in the distal end of my 
mconsulting-room, where they lay till 9 P.M.—about eleven 
hours. During the afternoon and evening the ethyl odor 
emanating from these pathological specimens was particu- 
larly noticeable in the part of the room in which they were 
laid. 
At 9 P.M., they were unrolled in the presence of Dr. Nash 
and Dr. Gilliam, to be placed in spirits for preservation. 
When the specimens were examined separately we found 
the intestine, which had been split open, smelling strongly, 
not of faeces, nor of dead animal matter, but of the anaes- 
thetic ; and when the kidneys, which had been laid open, were 
brought near the nose, it was almost like smelling ethyl 
from an open bottle. From this it would seem that every 
fibre, every tissue of the body, in its minutest parts, was 
saturated with ethyl. 
We know that aaensthetics, whether ether or chloroform, 
A 
must be eliminated from the body, and that the lungs and 
kidneys are the usual emunctories selected by nature for 
this purpose. But in this case the kidneys were locked up 
as it were, and hence the bowels were called on to aid the 
lungs in getting rid of the poison. It is altogether proba- 
ble that the cholerine was due wholly to the action of the 
ethyl, and not to the salts, which, as is usual with such a 
dose, exhausted itself by n o’clock in the morning, four 
and a half hours before the anaesthetic was given, and eight 
hours before the thin, brownish, watery discharge began. 
It is hardly probable—I should say possible—for three 
drachms of Rochelle salts to produce such a condition of 
the mucous membrane of the ileum and colon as was found 
here. 
I sent the pathological specimens to Dr. Gilliam for ex- 
amination on the 12th of February, and I received a verbal 
report a fortnight afterward saying that the kidneys were 
healthy. But a few days ago I received the following : 
“The kidneys to the naked eye look normal. Under the 
microscope there was a slight increase of the interstitial 11 
connective tissue. Many of the convoluted tubules showed 
swollen and coarsely granular epithelia, and considerable 
narrowed central calibre, a characteristic feature of acute 
catarrhal nephritis. 
“ Slight cirrhosis of the kidney, with acute catarrhal ne- 
phritis, often exists without marked clinical phenomena, 
and may be overlooked by the physician.” 
Now, if this account of the kidneys (which I do not un- 
derstand) amounts to anything, let us look at the case from 
this point of view. 
Dr. Nash, in his report to me, says : 
“ From the time she was laid in bed, she was excessively 
nauseated, and had great restlessness and intense straining 
efforts to vomit ; her eyes were red, both conjunctivae and 
lids, and when asked what pained her, replied, ‘ Oh ! my 
head ! my head ! ! ’ When spoken to she would answer 
intelligently, but at no time addressed any question or con- 
versation to any one. 
“ After answering questions she would relapse into a state 
of restlessness and groaning, often throwing her hands up 
to her head. In order to quiet her, sulph. morph, was given 
hypodermically, which never completely controlled her. 
It was difficult for two nurses to keep her covered, on ac- 
count of constant motion of arms and legs, and rapid turn- 
ing from side to side for two hours after operation. I fre- 
quently asked her if she had pain at the seat of operation, 
and she invariably replied, ‘ No, my head ! ’ The expres- 
sion of face was never natural after operation ; jaws much 
sunken, and eyes often rolled upward. The discharges from 
the bowels were saturated with the odor of the ethyl, and 
the lady of the house and others told me that the medicine 
we gave her to put her to sleep had gone through her bowels, 
as they smelt it when the bed-pan was emptied into the 
closet. Not until about ten hours after the operation did 
she acknowledge having pain in the abdomen, and that was 
merely the tenesmus attending the cholerine evacuations. 
“ I never considered her as having entirely recovered 
from the effects of the anaesthetic. The convulsions con- 
sisted in frantic ravings, with agonizing screams ; eyes wide 12 
open, glaring, and intensely red. Then followed a few 
minutes of quiet, and then death. 
“ A few hours before death there were several (two or 
three) large involuntary movements from the bowels, such 
as she had previously had—dirty brown, thin water, with 
the disagreeable ethyl odor.” 
In reading Dr. Nash’s report carefully, we are led to ask : 
“ Was this a case of uraemic death ?” We know very well 
that ether, as an anaesthetic, often proves fatal where there 
is organic disease of the kidneys. Dr. Emmet was, I be- 
lieve, the first to impress this on the medical mind. 
I have seen two deaths from etherization in women over 
fifty years of age, where no disease of the kidneys was sus- 
pected till fatal coma was produced by the ether, In these 
cases the secretion of urine was almost instantly arrested, 
and the little found in the bladder was loaded with albu- 
men. One of these was a patient of Dr. James R. Wood’s ; 
the other, a lady from Brooklyn. 
In cases of organic kidney disease, the hydrobromic ether 
may be just as dangerous as ordinary ether. 
In the case under consideration, between the time of op- 
eration and death, twenty-one hours after, there were 
drawn off but five ounces and one drachm of urine, viz : 
One ounce at 6.15 P.M., and two ounces at 10.15 P.M., on 
the 9th ; two ounces at 2.40 A.M., on the 10th ; bladder 
empty at 8.40 A.M. ; one drachm at 10.30 A.M. ; death at 
12.15 P.M. 
Of course the purity of the article is essential to safety. 
Was the ethyl given to my patient pure or impure ? 
You will perceive what a difference there is in odor be- 
tween the two. The Wyeth sample is not unpleasant 
to the smell ; the other is execrable. It is very im- 
portant to determine this point before we condemn this 
new anaesthetic. It has many qualities to recommend it: 
it is easy to administer ; the patient goes quickly under its 
influence, and recovers rapidly from its effects. But, if it is 
dangerous, all these qualities pass for naught. Would it be 
asking too much of the Academy to order an analysis of 
these two specimens of the hydrobromic ether to be made 13 
for the benefit of the profession at large ? If the two are 
identical in their chemical characters, then I should not ad- 
vise the use of hydrobromic ether as an anaesthetic. But if it 
be proven that one specimen contains noxious properties 
not in the other, then I would advise further experiments 
with the pure article. 
We know that ether is safe in long operations, and that 
chloroform maybe unsafe in short ones. It maybe possible 
that hydrobromic ether will prove safe in short operations, 
and unsafe in long ones. , 
In some of Dr. Lawrence Turnbull’s cases it produced 
very distressing effects, which, if prolonged, might have 
ended, as my case did, fatally. 
Dr. Turnbull gav-e the hydrobromic ether to a nervous, 
hysterical woman, aged twenty-five (Case 8), for the pur- 
pose of replacing a retroverted uterus and adjusting a pes- 
sary to hold it in position—Case 8,* . . . . “ With a little 
less than one ounce of hydrobromic ether there was pro- 
duced complete anaesthesia in four minutes, long enough 
for placing of a pessary to relieve the above symptoms. 
During the administration the pulse was but slightly accel- 
erated ; return of consciousness was accompanied by exces- 
sive gagging and vomiting of large quantities of mucous, 
great burning in stomach and throat, severe headache, cold 
perspiration, weak and rapid pulse, all of which continued 
for twenty-four hours, with more or less severity. Both 
sulphuric ether and chloroform had previously, on several 
occasions, produced similar symptoms, but not so se- 
verely.” 
Any agent which in four minutes’ time could produce 
“ excessive vomiting, burning in stomach and throat, severe 
headache, cold perspiration, and a weak and rapid pulse ” 
which continued for twenty-four hours, would, if the anaes- 
thetic had been continued (as in my case) long enough for 
the whole mass of blood to become poisoned and for 
every tissue in the body to become saturated with it— 
would, I say, certainly have ended in the death of the 
patient. 
’Artificial Anaesthesia, etc., 2d edition, p. 74. 14 
Dr. Levis has had a larger experience with this anaesthetic 
than any other surgeon, but his longest operation was only 
forty minutes, whereas my unfortunate case lasted an hour 
and a half. It may be that we did not administer the ethyl 
as skilfully as it should have been done. But I do not think 
we could have given less and maintained the anaesthesia 
sufficient for its purpose. 
If the operation had been comparatively short—if it had 
lasted only twenty or thirty minutes—if it had terminated 
before my patient’s system, solids as well as fluids, became 
thoroughly saturated with it, she would in all probability 
have recovered ; but, as it was, it seemed to kill by super- 
saturation which could not be eliminated, even with the aid 
of the whole mucous tract of the alimentary canal to aid 
the lungs. If mine had been a short operation, I might to- 
day have been lauding the new anaesthetic as a veritable 
boon to surgery. But, as it was otherwise, I must raise a 
warning voice, especially in prolonged operations. 
It would be an interesting scientific inquiry to determine 
if ethyl-poisoning by inhalation produces cholerine with a 
deeply congested condition of the mucous membrane of the 
lower portion of the alimentary canal, and also to determine 
what other pathological changes it might induce. 
This could easily be done by experiment on the lower 
animals, and it is to be hoped that some of our physiological 
savans will soon tell us by such experiments what we have 
to fear from the long continuance of the bromide of ethyl 
as an anaesthetic. 
The inference that I draw from the facts in the history of 
this case is that the anaesthetic was the cause of death, 
while the manner of death may have been by uraemic poison- 
ing. The lesson from this is, never to give bromide of ethyl 
in prolonged operations, and never to give it where there is 
organic disease of the kidneys. What, then, shall we give ? 
certainly not ether ; because we know that it has often pre- 
cipitated uraemic poisoning and sudden death. Our 
only resource then in such cases is chloroform as an 
anaesthetic, because we know that it produces anaemia of the 
brain, and is therefore less liable to develope uraemic ex- 
plosion. 15 
The President, Prof. Fordyce Barker, spoke of the 
importance of the subject, and then called on Dr. Levis of 
Philadelphia to open the discussion. 
Dr. Levis, after some general remarks said, the only ex- 
planation he could give with reference to the difference in 
results obtained by Dr. Sims and himself was, that there 
might be a difference in the method in which it was used. 
He thought that some of the errors were such as he had 
made in his first cases in which he administered it, when he 
began very cautiously. He now knew that the proper 
method of administration was to make a rapid impression, 
such as was done in giving nitrous oxide gas. He had been 
able, nearly always, to produce complete anaesthesia, by 
the use of two drachms, in two or three minutes. He had 
produced anaesthesia in forty-five seconds ; but if the pa- 
tient could be made to inspire and expire freely, the aver- 
age time was about three minutes. The only point in Dr. 
Sims’s case which impressed him especially was the dura- 
tion of the operation, and the large quantity of the anaes- 
thetic used. In his own cases the operation had not lasted 
more than forty minutes, and the entire quantity of the 
ethyl used was eleven drachms. He had not seen any after- 
effects whatever. As to the nausea and vomiting, it per- 
haps was almost as likely to occur after the use of the ethyl 
as after the use of ether, if a considerable quantity was 
given. The quality of the article he regarded as very im- 
portant, and he was sure that, since he had used Wyeth’s 
preparation, there had been less tendency to nausea. With 
reference to the persistent odor in the breath, vomited mat- 
ters, etc., he had noticed it when he had used the same 
preparation that Dr. Sims used. 
The President. It will be noticed that the symptoms 
and phenomena manifested differ entirely from the symp- 
toms and phenomena manifested after the administration of 
any other anaesthetic which has been used. I therefore 
take the privilege of calling upon Dr. Squibb, of Brooklyn, 
with the view of receiving an explanation of its failure to be 
eliminated from the system ; that is, whether there are any 
constituents, either bad or good, in the ethyl, which of it- 
self might destroy life. 16 
Dr. E. R. Squibb. I fear, Mr. President, I have but 
little to add to the elucidation of this subject, and I must 
premise my remarks by saying that all I have to say upon 
the question is entirely theoretical. I confess to having 
had a prejudice against this agent from the earliest I knew 
anything of it, and it is upon theoretical principles, and 
upon those only, that I am capable of speaking or throwing 
out hints which possibly may be useful. As a chemical 
rule, I think that the anaesthetics which are the least dan- 
gerous are those which are the most simple, and when de- 
composed yield elements which, physiologically, are known 
to be most innocuous. If we commence with the nitrous 
oxide, we find that it is decomposable only into innocuous 
elements. If we go one step further and take the oxide of 
ethyl (and here I wish to protest against the bromide of 
ethyl being called an ethyl), it can be decomposed into 
comparatively innocuous elements. In the bromide of 
ethyl the oxygen of the ordinary ether is replaced by bro- 
mine, and the compound contains 73 per cent, of bromine, 
the other 27 per cent, being the ethyl. Now, when we 
compare the effects of all the known anaesthetics, we will 
find that those are more easily borne which are simplest in 
their nature ; that is to say, the compound ethers are less 
safe than simple ethers, and both the compound and simple 
ethers seem to be proportionately safe to the simplicity and 
innocuousness of the elements of which they are composed. 
We all know that bromine is an irritant poison. We all 
know that bromide of ethyl is a loosely molecular article, is 
decomposed very easily, much more so than bromides of 
ordinary bases which act as salts and are eliminated as 
such. Now we will suppose that the bromide of ethyl, 
under certain circumstances, is decomposed, and its irritant 
property, the 73 per cent, of bromine, goes into the sys- 
tem ; it is easy to understand that grave effects might be 
produced, and perhaps we shall be able in this way to 
account for the exceptional cases in which the anesthetic 
has been used with unpleasant results, whereas, if it had 
remained as bromide of ethyl, it may not have been harmful. 
Let us take an analogy found in chloroform, which con- 17 
tains 89 per cent, of chlorine. Chlorine is one of the 
organic bodies which does not possess the irritant properties 
that bromine does, and two atoms of chlorine are not so 
active in producing toxic effects as one atom of bromine 
found in the bromide of ethyl. The point can be illus- 
trated still further by supposing the existence of an arsenite 
of ethyl, the activity of which in producing dangerous 
effects as compared with the bromide of ethyl would be 
represented by the difference between the activity of bro- 
mine and the activity of arsenic as irritant poisons. If it is 
admitted that such theoretical argument has any value, I 
think we could understand some of the dangerous effects 
produced when compound ethers are used as anaesthetics ; 
and I think Richardson’s observations point us toward the 
conclusion that compound ethers are less safe than simple 
ethers, and that simple ethers are less safe still than the 
oxides. This brings us down to the oxides and nitroge- 
nous oxides of ethyl, which are the safest of all known 
anaesthetics. 
There is another point ; and that is, any agent that can 
be powerful and active for good, can be powerful and active 
for evil. We see that in chloroform, and we see it in the 
bromide of ethyl. I think we can logically argue something 
from the chemical composition of agents as to which will be 
useful to us, and especially in the application of agents which 
carry us so near the dividing-line between life and death. 
Dr. J. C. Dalton. I should be very happy, Mr. Presi- 
dent, to give to the Academy, in response to your invitation, 
any information, did I have it, with regard to this subject. 
But unfortunately I am worse off than Dr. Squibb, for I had 
never seen any hydrobromic ether before this evening. 
There were some points in Dr. Sims’s paper, however, which 
struck me forcibly, and one is the different kinds of danger 
which may be developed by different kinds of anaesthetics. 
I suppose that the profession are tolerably well convinced 
now that ether, when it is dangerous as an anaesthetic, is 
mainly so in consequence of the presence of some morbid 
change in some vital organ ; that when the entire body is 
perfectly healthy, ether comes as near to being a perfectly 18 
safe anaesthetic as we can have. I do not know of any 
modification with regard to that statement. 
In this case, reported by Dr. Sims, if the death was due 
to the hydrobromic ether, it was a death which took place 
long after the substance was administered. It was a death 
apparently due to the persistent obstinate possession which 
the bromide of ethyl had taken of the entire system. The 
system could not get rid of the substance with which it was 
saturated, and which in some unexplained way produced 
those symptoms which have been so faithfully detailed. I 
do not wish to proffer any opinion regarding the cause of 
death in the case, but it seems that there was a repetition 
of peculiar symptoms, in the midst of which the patient 
finally died, and that after death the entire system did re- 
tain, during a long period, the bromide of ethyl in sufficient 
quantity to indicate its active properties. HoW entirely 
different deaths from chloroform take place. They occur 
without any convulsions, without any marked symptoms, 
and odoriferous bodies of persons who have died under its 
influence have not been specially observed. I do not sup- 
pose, however, we have yet exhausted all the methods by 
which various anaesthetics are dangerous or may prove fatal. 
But the difference between the manner in which death is 
produced by chloroform and by ether when given to animals 
has, in my experience, been very striking ; so much so that 
I long ago abandoned the habitual use of chloroform while 
experimenting, because it was so annoying to lose an animal 
just before the experiment was required and could not be 
postponed. Not long since, in order to avoid the disturb- 
ance produced by ether, I chloroformed a cat for the purpose 
of making an opthalmoscopic examination. With all the 
recollection of frequent previous disappointment fresh in 
mind, I was extraordinarily careful in giving the anaesthetic, 
both with reference to quantity and time occupied in its 
administration and all the circumstances that could effect 
the result, and yet, just as I wished to use the instrument, 
the animal was dead. Here, however, we seem to have 
another mode of death, and one which, if real, is perhaps as 
difficult to avoid as sudden death in the use of chloroform. 19 
I am unable to see how any greater care could have been 
used than was exercised by Dr. Sims, although it is possible 
that Dr. Levis, who has a much greater experience in the 
use of the agent, might point out some improvement in the 
method adopted. • 
Dr. A. C. Post remarked, with reference to the prolonged 
action of anaesthetic agents, that he had been in the habit, 
for several years, in cases in which he anticipated a long 
operation, to use Prof. Nussbaum’s method, premising the 
use of the anaesthetic by the hypodermic injection of seven 
or eight minims of Magendie’s solution of morphia. He had 
found by so doing that the anaesthetic effect could be kept 
up for a long time with more quietude and less quantity of 
the anaesthetic than where the morphia had not been thus 
administered, and he was inclined to think it added to the 
safety of the patient as well as to the comfort of the surgeon. 
Dr. Piffard said he had no experience with the bromide 
of ethyl ; had never seen it till yesterday ; from what he 
had heard to-night he did not think he would be justified in 
using it as an anaesthetic ; and that he would now sell it 
very cheaply. 
Dr. Jas. L. Little referred to two cases, as follows : 
CASE I.—Last Tuesday, having received a specimen of the 
bromide of ethyl from Wyeth of Philadelphia, he determined 
to test its anaesthetic properties, and accordingly gave it to 
a boy three or four years old, upon whom he pro- 
posed to perform Heaton’s operation for the radical cure of 
hernia. The ethyl was administered in the manner pro- 
posed by Dr. Levis ; probably less than two drachms were 
used, and the patient went under its influence in less than 
two minutes. The pupils were contracted. Within five 
minutes after the cloth was removed from his face the child 
was able to respond intelligently. There was no vomiting. 
CASE II. An adult, in good condition, had two or three 
drachms held close over his mouth and nose on a napkin, 
and at the end of three minutes no special effect had been 
produced by the anaesthetic except to excite powerful strug- 
gling on the part of the patient. The ethyl was applied 
more freely, the patient struggled very violently, the face 20 
was suffused, not however like that seen in ether inhalation ; 
the pupils dilated and contracted alternately, the eyeballs 
rolled about ; and at the end of eight minutes Dr. Little be- 
came somewhat alarmed at the condition of the man and 
discontinued the ethyl. The patient seemed, within three or 
four minutes, to come from under what influence of the anaes- 
thetic he had received. The quantity used was two ounces 
and two drachms by weight, and the time occupied eight 
minutes. There was neither nausea or vomiting. Both the 
pulse and the respiration became exceedingly rapid. The 
condition was entirely different from anything he had ever 
seen in connection with the inhalation of either chloroform or 
ether. Ether was subsequently administered, and the ope- 
ration performed. 
The President. It will be noticed that Dr. Sims re- 
ported in his case that the respiration became exceedingly 
rapid. In the administration of this anaesthetic it seems, 
from what has been said, that it is necessary to produce its 
anaesthetic effect as rapidly as possible ; that no atmos- 
pheric air is admitted, or just as little as possible. Of 
course, associated with this is another influence. We know 
that the exhalation of carbonic acid gas is limited, and, 
therefore, the question naturally arises : May not that fact 
be one which contributes to the danger ; may not a part of 
the poisoning be due to the carbonic acid gas ? I will next 
call upon Dr. Wylie, who has had experience with Dr. Sims 
in the administration of this agent. 
Dr. Wylie, remarked that he had nothing to add to the 
details of the case which Dr. Sims had reported, except that 
he endeavored to follow Dr. Levis’s directions regarding the 
mode of administration, in the most exact manner. In 
three cases in which he had administered it he had seen the 
muscles in general convulsed. He was satisfied that hy- 
dro-bromic ether could not be used as an anaesthetic with 
the same freedom as could ether. He had not had any dif- 
ficulty in administering either chloroform or ether, having 
used both many hundreds of times, yet it was just possible 
that he failed to give a sufficiently large quantity of the 
ethyl just at the beginning. He could see no other expla- 21 
nation for his failures in attempting to produce safe anaes- 
thesia with the new agent. 
Dr. Squibb made special reference to two points : i. In 
many substances employed, the anaesthesia is separate from 
other effects produced by the agent. Therefore, it is nec- 
essary to be cautious in regarding the disappearance of the 
anaesthesia as the disappearance of the entire effects of the 
agent ; that is to say, the disappearance of the anaesthesia 
suddenly after the administration of the agent has ceased 
does not indicate that the effect produced by the anaesthet- 
ic has passed away. 2. Many of the symptoms in Dr. 
Sims’s case looked very much like those belonging to bro- 
mine poisoning. If it was a case of poisoning by bromine, 
that fact was to be separated from the known character of 
the agent as an anaesthetic. A better illustration of the ef- 
fects of an irritant poison, he thought, could hardly be 
found, not only upon the alimentary canal, but also upon 
the kidneys. The idea that the organic condition of the 
kidneys, discovered only by the microscope—and that after 
they had once been thought to have been healthy—was a 
condition that had anything to do with producing the 
death of the patient, did not look probable in view of the 
presence of other well-marked irritant symptoms. He 
would say, therefore, that he should abstract the anaesthet- 
ic element altogether from the case, and study it as a simple 
case of irritant poisoning. The color of the eyes, and their 
peculiar movements, and the intense pain in the head, 
together with the other symptoms, pointed directly to the 
irritant effect of some such agent. 
Dr. Roberts, of Philadelphia, on invitation, remarked 
that he had* administered the bromide of ethyl many times 
as an anaesthetic, both for Dr. Levis and in his own prac- 
tice, yet he had nothing special to add to what had already 
been said. He had had no experience whatever in the use 
of chloroform, and therefore was unable to compare the 
bromide of ethyl with that agent. His own experience 
with ether had been that it was a safe anaesthetic, some- 
times, however, requiring large quantities to produce the 
desired effect. The most troublesome symptom he had 22 
observed with ether was the expectoration of large quan- 
tities of mucus and the existence of coarse bronchial rales, 
due to hypersecretion into the bronchial tubes. He always 
felt specially disturbed with reference to the respiration of 
a patient inhaling ether. One of the chief benefits arising 
from substituting the bromide of ethyl for ether was that 
the ethyl affected the respiration but little, except to a cer- 
tain extent, to increase its frequency. In no case had he 
seen hypersecretion of mucus, such as was so annoying in 
etherization, when bromide of ethyl was used. As a rule 
the pupils had been dilated during the period of the most 
profound anaesthesia. It was a little difficult to judge of 
the pulse. The eyes were not so suffused as in etheriza- 
tion. As a rule, patients had come from under its influence 
promptly. In two cases he had observed nausea. He was 
not at all an advocate for the agent, but simply felt inter- 
ested in assisting to place it upon record as an anaesthetic 
that had been used successfully. He thought it possible 
that in Dr. Sims’s case sufficient stress had not been laid 
upon the operation itself as a factor in producing the death 
of the patient, as some deaths had followed the abdominal 
incision for removal of the ovaries, or Battey’s operation. 
With reference to the tetanic convulsions, he thought they 
were not infrequently seen in connection with the use of 
ether. He also called to mind a case in which the patient 
had severe convulsions occurring with etherization, and it 
was subsequently found that the patient was an epileptic. 
It was possible that some such influence might have been 
at work in Dr. Sims’s case. He thought that it might be 
difficult to use the ethyl in plastic operations about the face, 
’because its effects were so evanescent. 
The Academy then adjourned.