REPRINT FROM THE &EDICAL BULLETIN, JUNE, 1880. 
HYDRO BROMIC' ETHER OR BRO- 
MIDE OF ETHYL AS AN ANAES- 
THETIC. 
BY LAUREMCE TURXBULU-O. 
** -T +F*" 
Aurual -urgeon to Jefferson College Hospital, 
Philadelphia. 
The liydrobromic ether or bromide of 
ethyl was discovered by Serullas in 1827, 
but received no special attention until 
Dr. Thomas Nunnelly, of Leeds, made 
some experiments with it on animals in 
1849. Dr. Nunnelly brought the subject 
again before the profession, by a paper 
read at the meeting of the British Med- 
ical Association in 1865, in which, in 
conjunction with another anaesthetic, 
he says he had employed the one or the 
other in all the principal operations at 
the Deed's General Eye and Ear Infirm- 
ary. This was at the time when chlo- 
roform held such complete sway in 
England, that no importance was at- 
tached to Nunnelly's experience or ex- 
periments, and lie had no one to follow 
him in using it, and we hear no more 
’ of it until 1876, when some experiments 
were made with it in France, by Rabu- 
tgau, on the lower animals, but evidently 
without a knowledge of the fact that 
iffiis had been done previously in Eng- 
land by Nunnelly. 
I then took the agent up without the 
knowledge of the experiments of Dr. 
Nunnelly, of England, and had it made 
in Philadelphia by Professor Reming- 
ton. and with two friends began experi- 
menting in September, 1877, using it 
first on my3elf. and then upon my pa- 
tients. After satisfying myself as to its 
efficiency and safety as an anaesthetic, 
I laid the subject before the Pennsyl- 
vania Sta+e Medical Society in 1878, and 
a record of ten cases, with my conclu- 
sions, which were published in the vol- 
ume of their Transaction for that year. 
In August, 1879,1 brought it before the 
British Medical Association at Cork, 
and in September of the same year, I 
presented a report cf one hundred cases 
before the International Medical Con- 
gress at Amsterdam (to which I was a 
delegate from the American Medical 
Association), up to March, 1879, when 
the second addition of my work on anaes- 
thetics went to press. I had published 
a report of twenty-five successful cases 
in quite a variety of surgical operations, 
and had not only employed it at my daily 
ear clinic, but alsa in the Jefferson Medi- 
cal College Hospital, and administered 
it in April, 1879, to a patient of Dr. 
Samuel W. Gross, at the public clinic, 
when he (Dr. Gross) removed a hyoid 
cist in front of the neck of a child. 
Pr. R. J. Levis, who was at this clinic, 
for the first time saw it employed, and 
become much interested in its use. * 
I thus compelled chemists to make it, 
by prcduciug a demand for it, and gave 
them, through Dr. Green, a good for- 
mula free from phosphorous; I inter- 
ested surgeons all ever the country to 
try it, and especially the surgeons of 
this city, by bringing it in every way 
before their attention. Subsequently 
the whole number of cases in which it 
has been employed by myself and friends 
up to the present time, June, 1880, will 
number some eight or nine hundred. 
I cannot but feel disappointed that 
two deaths, not produced by it, should 
have been associated with it,* as such 
accidents will be employed by those hav- 
ing a prejudice against the ether, to 
condemn it on theoretical grounds. It 
is my firm conviction that although in 
several instances recently the use of 
this anaesthetic has been attended with 
persistent vomiting, in the hundreds 
of cases in which it has been employed, 
chiefly in Philadelphia, in not one 
single instance has it caused cerebral 
trouble, or any of the symptoms pro- 
duced by the action of free bromine, 
which are as follows. When dogs are 
cor fined in an atmosphere of bromine 
vapor, they suffer a profuse secretion 
from the eyes, nostrils, and fauces, with 
cough, hoarseness, dyspnoea. I haveex- 
* The bromide of ethyl as an anaesthetic, by 
Marion Sims, M.D., UL.D., New York Medical 
.Record, April 3. 1880. HYDRO 13ROMIC ETHER OB BROMIDE OF ETHYL. 
perimented upon frogs, cats, dogs, rab- 
bits, and various other by sub- 
jecting them to an atmosphere highly 
charged with the vapor of hydrobromic 
ether, and in no instance was there the 
slightest irritative effects as described 
above. 
Philadelphia, June 2,1880. 
“ Deputy Coroner Beam made an in- 
vestigation of the circums ances, as re- 
ported in The Times nearly a week ago, 
of the death of William Linderman, 
eighteen yearso!d,of Schuyikillcounty, 
while upon the operating table at ihe 
Jeffers n College Hospital on Wednesday 
last, un d or tli e infl n erree of t h e n e w an se > 
thetic. bromide of ethyl, and about to 
be treated for s' one in the bladder. He 
lu.d been about sixteen weeks under the 
care of Dr. It. J. Levis, one of the 
strongest advocates of the new ana'S- 
theLie, and was taken to the hospital by 
his direction. Lir.derman's heal h was 
very poor at the time. . Dr. Ames, who 
appl'ad the bromide, said no incision 
had yet bpen made, but Dr. John B. 
It diets su'd it had. T e patient was in 
such a condition that something had to 
be d me, because lie could not tide ever 
the hot weather: 9G° 93° in the shade. 
Dr. J. (1. Lee, the Coroner’s physician, 
testified that he found the brain fon- 
ge.-ted, the lungs far advanced in con- 
sumption, mid the kidneys and liver en- 
larged, and two large encys eel stones in 
the bladder. His opinion was that they 
cru’d not have been safely taken out. 
Linderman could not have lived over a 
week or two at any rate. Dr. Lee said 
further, that he had experimented with 
the bromide on animals without bad 
results. In his opinion death resulted 
from exhaustion and prostration, the 
result of phthisis. The jury took the 
same view in their verdict.” 
In subjecting the new anaesthetic to 
this most severe tes$ we do not think 
our friend Dr. Levis was doing justice 
to it; knowing the extreme debility of 
the patient, and that the most simple 
nervous shock would render him liable 
to death. Hundreds cf patients have 
thus died. Again, when ordinary ether, 
chloroform, or other anaesthetics cause 
fainting, which was no doubt the result 
in this case, artificial respiration has to 
be resorted to; now we were reliably in- 
formed that when this useful means was 
resorted to by alternating and relaxing 
the chest walls, the pus which was in this 
man's lungs was forced into his bronchial 
tubes and suffocated him. Again we are 
very sorry that the valuable agent, 
nitrite of amyl, which has been found 
useful in such cases was not employed. 
In some recant experiments on animals 
I crowded four ounces (the quantity sea- 
ted to have been used by Dr. Sims) upon 
a dog for several minutes, by means of 
a tin inhaler, until lie became appa- 
rently dead, with no perceptible action 
of the heart or lungs, but his expression 
of eye was clear, and the pupil was 
dilated, while there was no secretion 
from the eyes or nostrils. The appara- 
tus was removed in the space of four 
minutes, and he was exposed to the air 
when at once he began to breathe, and 
ly the end of the six minutes, lie had 
; lmost entirely recovered corscicusncss. 
The clog did not seem much inclined 
to move f iv ten or twelve minutes after- 
wards. While this dog was only partly 
under the influence of this anaesthetic, 
having at first caught the inhaling ap- 
paratus with his under teeth ; there was 
a good deal of rigidity, and slight tetanic 
movements of the extremities but this 
was overcome by the free use of the 
ether. Now, had we been using chloro- 
form, just before we would have been 
ready to perform any experiments upon 
the animal, he would have been deed, 
and no removal of the anaesthetic nor the 
introduction of atmospheric air, would 
have been of any avail. Again if Squibb’s 
rectified, and absolute ether had been 
employed ; we must have super-satura- 
ted the animal, and been annoyed by the 
expectoration of large quantities of mu- 
cus. Then we frequently have seen te- 
tanic convulsions, requiring several as- TIT DUO BUD MIC ETHER OR BROMIDE OF ETHYL- 
sistants to hold the patient, with great 
reduction of temperature, from the use 
of ordinary- ether, Tite rapidity of the 
anaesthetic action of hydrobromie ether 
and its rapid elimination from the sys- 
tem by the lungs, are two of its chief 
merits for all operations that are not 
prolonged. If an operation is to be very 
tedious, and requires from one to two 
hours, we would advise the additional 
use cf purified sulphuric ether to the 
anesthetic. We would therefore recom- 
mend pure hydrobromic ether in operations 
not lasting over forty minutes. There is 
one great advantage in the use of this 
agent, that the administrator must 
attend to the anaesthetic all the time, he 
cannot watch the operation and forget 
the patient for a few seconds, his whole 
attention must be given to keep up 
its action. We have often felt sure that 
the wet napkin, from the water, in the 
ordinary ether pressed over the patients 
mouth by the weight of the body of 
the persons giving the ether, and watch- 
ing the operation, were the indirect 
causes cf the death of the patient. 
Within the last few days we have em- 
ployed it in labor for the second time, 
and it has peculiar advantages in that 
it is so rapid in its effects, and the pa- 
rent is comforted between the pains, 
buc never passes into such a state of 
profound aneesthesia, that she is aroused 
by the expulsive effort, and has all her 
ccnsoicusness about her, and none of 
the depressing efforts of ether or chlo- 
roform. It is also mest valuable in these 
esses in changing the position of the 
child, also in bringing forward the neck 
of the uteras into its proper position. 
In neither of these ins'.ances was there 
disturbance of the bowels, pain in the 
back or head. To the ccuntiy practi- 
tioner who lias to extract teeth or perform 
all the miner operations in surgeiy it is 
a great boon, as it acts like nitrous oxide 
gas; it is well where a number of teeth 
are to be extracted, that a prop of hard 
wood attached to a string should be used, 
so as to prevent such an accident as once 
occured in Philadelphia, under the use 
of nitrous oxide gas, as of the swallowing 
of a prop of cork. In many cases where 
you do not want a very profound narco- 
tism With hydrobromic ether, the mus- 
cles of the patient become rigidly con- 
\ tracted. This condition occured in a re- 
cent occasion, when we administered (§i) 
of this anaesthetic and the operators fin- 
ger was caught and pinched, as also his 
forceps, and yet before operating we 
could touch the cornea with impunity. 
Although the impression passed away 
i very rapidly, we extracted twelve 
teeth with entire success, the patient 
promptly recovering consciousness, and 
net feeling the pain. In the following 
case the patient went under it very 
kindly. This patient was a man of very 
nervous temperament. With three 
drachms of the hydrobromic ether an- 
aesthetic was produced without any 
strue gling, and in four minutes from the 
time he had commenced to inhale it, the 
dentist had extracted ten teeth, and he 
had fully recovered consciousness, al- 
though he had just eaten a heavy break- 
fast of solid foed. There was no neausea 
in either of those cases. 
In a recent case of cataract extraction 
the patient went beautifully under the 
influence of the anaesthetic, extraction 
was accomplished, and the patient recov- 
ered so as to be able to count fingers, yet 
owing to seme strong coffee which she 
drank; from dyspeptic symptoms or the 
swallowing cf water soon after the ope- 
ration, she became very sick at her stom- 
ach, and vomited for nearly twenty-four 
hours, and yet the case did well. In a 
case cf operation for torticolis in a wo- 
man. she swallowed so much air with 
the ether, that as a consequence she com- 
plaint d of pain, of a hysterical character, 
in lower part of the abdomen, the same 
which is often the result of nitrous oxide 
gas inhaled, and too much air admitted. 
A lew days ago we received a letter 
from Dr. J. Patterson Cassells, of Glas- 
gow, a distinguished Aurist and a :*ur- 
• eon to the celebrated Glasgow Infirm- 
ary, lie writes that; he has used a spe- 
cimen cf the hydrobromic el her, which 
1 gave him a: Cork; as vapor, in diseases 
of the middle ear, and nave also em- 
ployed it as an anasthetic with success. THE ADVANTAGES AND ACCIDENT j 
OF 
ARTIFICIAL ANESTHESIA. 
A Manual of Anaesthetic Agents, and their Employment 
in the Treatment of Disease. 
BY 
LAURENCE TURNBULL, M.D.,Ph.G„ 
Aural Surgeon to Jefferson Medical College Hospital. 
Second Edition, 12mo., Cloth, pp, 330, with 25 illustrations. 
PRICE, $1.50. 
“The exhaustion of one edition of this work In one yei,- prove? that it was win el by the prof.; 
Finn Kncnuraged by its success, the writer h is carefully re-sturliod every part and remodelled such 
ns did not harmonize with the latest researches . .' Oerl .inly every me iie.nl s udenr. and prac- 
titioner should be familiar with this little volume. Wo doutr not that’it will speedily Had its way 
into every medical library.”—The Detroit Lancet, November, 1879. 
“ We do not know of a w irk that deserves more g moral papal irity than does tills All the various 
nnoes hotics, their properties, manner of administririon. dangers and antidotes, are treated of in the 
clearest, an i most forcible style.”—Nashville Journal, of Me Heine and Surgerg, November, 1S79. 
“ The work will prove highly useful to the surgoon who lias not the time to Seek in s •iitiercd trea- 
tise* what is admirabiv collated and condensed i i Dr. Turnbull's work, and to the dentists, which 
class it has also been written for it cannotbut prove invaluable. We greet its appearance as an im- 
portant c mtribution to original American medical literature.”—St. Louis Clinical R cord, (Jet 1879 
“ Wo no iced the first e li i >n In this j rarnal quite fully at the time of publication and 1 nvo only 
to add ihat, U is without question the m is" complete and best written work on antesthe ics published. 
Kvery d midst of wha tever s anding should be the possessor of this inestimable volume.”— The Denial 
Advertiser, Buiftli. N. Y.. October, H79. 
“ Dr. Turnbull's 'Manual his met with a reception gratifying to him and merited by the care and 
labor he his bestowal upon it.”— The Medical and Surgical Reporter, Philadelphia, August 16, 1179. 
Dr. Turnbull’s work considers very fully the idvnntages and accidents of artificial anaesthesia* 
anaesthetic agents, and their employment in dis :ase. He h is accumulated n large amountof ranterial 
upon everv branch o( this subject, an I h iscl issified it Tor '-cference. The author’s conclusions, derived 
fr m careful and logical study of tho ma crials collected from a large personal experience, mode-tly 
stated, and from experimentation upon 1 >W‘r aniin »Is. are of deei led weight. We believe, with him, 
that the recent graouate, to whom the administration of the antes hetic is usually entrusted during 
an opera i n, generally receives fir t mi little infer n ition in the course of his s.udles upon flic require 
tnet.is of this position which we regard ns one of considerable responsibility The ho d; is cer airily 
Interesting to read, and valuable for reference.”— The Medical Gazette, New York. January 31, 1SS0. 
“ In the present edition now matter Ins been added—the best proportion in which ether, alcohol 
or chloroform should be mixed having been determined, nnct new experiments made on the action of 
anmsthetics upon ‘he blood. It also contains additional practical tiints for the safe administration of 
anesthetics, so shor lv given ns to be readilv remembered in an emergency. Among other iuteres.lng 
points in the work, we notice the local use of hydr mrotnic ether spray as a remedy for noises in the 
cars, and the effect of climate on the useofchlorof mm. The preduetionof mresthasia bv rapid breath- 
ing. such as one uses when trying to blow up a fire, is mentioned, and its use in dentistry and chert 
operations. illustrated by cases. This work is a useful and acceptable contribution to the literature 
of anaesthetics."—London Practitioner, January, 1880. 
“Anaesthesia is a subject of great interest an 1 unnortance to physic! ins and dentists, and every- 
thing that will aid them in better understanding the subject is sought with great avidity. This work 
we regard as the best aid in the study of this snbject, and it presents the subject up to the presant 
hour ”—Dental Register. 
“The value of such a work as tho present is unquestionable ... the book contains a great 
amount of useful information on the nature and use of nnse-ohetics, applied externally or internally, 
In vapor, or in ordinary modes of administration.”—Medical Times and Gazette, London. Nov. 2\ 1879. 
“This little work of 210 pages should be on the table of every practitioner who expects to admin- 
ister an anaesthetic of any kink.”—St. Louis Medical and Surgical Journal. 
Published by LINDSAY 'a BLAKISTON, PMladelphia, and for sale by all Pcohseller?.