BROMIDE OF ETHYL BY Professor of Clinical Gynaecology to the Jefferson Medical College; Obstet- rician to the Philadelphia Hospital; Gynaecologist to the E. E. MONTGOMERY; M.D, St. Joseph's Hospital. REPRINTED FROM THE THERAPEUTIC GAZETTE, JUNE 15, 1892. DETROIT, MICH GEORGE S. DAVIS, PUBLISHE 1892. BROMIDE OF ETHYL. NO one practises surgery or obstetrics without appreciating the need of an anaesthetic for short operations, the examina- tion of patients, and relief of the distressing symptoms attendant upon labor. Neither ether nor chloroform satisfactorily fill the re- quirements of such conditions ; both anaes- thetics require some time for their adminis- tration, are looked upon with anxiety by the patient, and have exceedingly unpleasant sequelae. Their use consequently cannot be practised in the office of the physician with any hope of getting rid of the patient in a reasonable length of time. Nitrous oxide requires too expensive and complicated an outfit to make it a satisfac- tory agent for such purposes. In the bro- mide of ethyl we have an agent which seems, in the experience of the writer, to meet all requirements in this special field. It has an exceedingly pleasant odor, in comparison with that of the other anaesthetics ; the pa- tients rapidly succumb to its influence : but small doses are required ; it produces none of the unpleasant sensations of difficulty of breathing and feeling of suffocation. There is an absence of the stage of excitement or struggling, and anaesthesia is produced suffi- cient for ordinary slight operations and for many examinations before the patient is ren- dered unconscious. Thus the patient can obey the directions of the physician, change The 2 position of the limbs or parts of the body, and yet not experience any pain, even when an abscess is incised or a wound probed. The effects of the drug are exceedingly evanescent, the patient recovering conscious- ness even when thoroughly under its influ- ence in less than a minute, and awakes from it as from a sleep, usually without any un- pleasant effect. It is exceedingly rare for a patient to suffer from vomiting, which is a frequent sequel from the administration of ether. Its value in cases of labor is in that it can be administered with the onset of the pain, the patient, taking two or three deep inspirations, loses the sensation of pain, and yet is able to co-operate with the attendant in whatever may be desired. In cases of confinement, my method of ad- ministration is to begin with the second stage of labor, using a Hawley inhaler, in the bar- rel of which the drug is placed. The patient holds it herself, and as soon as she has re- ceived a sufficient amount to render her un- conscious, the inhaler drops from her hand. In this way the necessity of an assistant is dis- pensed with, and the patient is enabled to use the anaesthetic with the advent of each pain. In several cases in which this anaesthetic has been given, the patient has held her limbs in position as directed during the appli- cation of forceps, co-operated by making ex- pulsive efforts, and yet after the labor has been completed, she expressed herself as un- aware of the birth of the child, and as having experienced no pain during its progress. It does not interfere with the muscular contrac- tion of the uterus, is not so likely to be fol- 3 lowed by inertia and post-partum hemorrhage as would be the administration of chloroform. I began the administration of this drug during the time it was in active use by Dr. Levis in this city, and have continued its ad- ministration in all obstetrical cases and for short operations and the examination of cases since that time. As I have used it in my hospital, as well as private, practice, I can safely claim to have administered it in nearly five hundred cases, and I have seen none in whom there seemed to be any dangerous symptoms attending its use ; while nausea and vomiting are rare results of its adminis- tration, yet there are occasional cases in whom the use of the drug is attended with marked retching and vomiting. Two cases to whom it had been adminis- tered for purposes of examination were un- able to leave my office for several hours sub- sequently on account of this distressing symp- tom, but this occurred in not more than five out of as many hundred. Another unpleasant result of its use is the exceedingly unpleasant garlic-like odor upon the breath of the patient, which continues, where it has been administered in a consider- able quantity, for a couple of days after its use, thus demonstrating that the drug is eliminated largely through the lungs. It seems singular that a drug of so much value should have been so quickly condemned by the profession upon the unfortunate result in two cases, one of which-that of Dr. Levis -was in such an enfeebled condition that the administration of any anaesthetic would have been attended with great danger. In his case, 4 the practice.of artificial respiration, which was done as soon as indication of arrested breathing occurred, resulted in the extrusion into the bronchial tubes of pus from the lungs, which at once rendered impossible further inspira- tion and oxidation. A recent article in the Therapeutische Mon- atshefte for 1888 makes an extensive analysis of the reports of the use of this drug, and gives a mortality of but two cases, while Chisholm and Prince have administered it in several thousand patients, the former using it as a regular anaesthetic in all eye operations, and the latter preceding anaesthesia for major operations by the use of this drug, and thus recommends it for its value in obviating the unpleasant stage of excitement and struggling incident upon the use of the other and more permanent anaesthetics. It has been recommended also in the den- tal profession as an anaesthetic far preferable to either ether or chloroform in the extrac- tion of teeth. Dr. Diehl, in Pittsburg Medi- cal Review, 1889, vol. iii., page 88, recom- mends it for dental purposes in preference to nitrous oxide in cases of heart- or lung-dis- ease. While its effects are rapid, they are sufficiently durable to permit the extraction of teeth, and these may be removed even be- fore the patient has lost consciousness. As reports have recently appeared in the columns of the Gazette from men who have ob- served its use, by others who have condemned it without any-or but little-experience, I have felt that, in justice to so valuable an agent, it is due to the profession to make this statement.