Reprinted from Southern Medical Record. 
'BROMIDE OF ETHYL 
AS AN ANESTHETIC. 
BY E. H. KUYKENDALL, M. D., CHATTANOOGA, TENN. 
" The term anaesthetic, proposed by Dr. Oliver Wendell 
Holmes, means an agent capable of producing anaesthesia, or 
insensibility to pain." ' 
It is true, anaesthesia is a term which, according to its ety- 
mological signification, should be applied to loss of sensation 
of touch, chiefly; and analgesia should be used to signify loss 
of sense of pain; however, the word anaesthesia, as expressive 
of the state of profound unconsciousness induced by anaes- 
thetics, is now so firmly established by usage that it were 
better to retain it. 
Insensibility to pain (analgesia) may be produced without 
simultaneous loss of common sensation, touch, as in the use 
of cocaine and carbolic acid. 
Having administered Ethyl Bromide something over two- 
hundred and fifty times, and found it so extremely serviceable 
in the class of operations for which I make use of it, I bring 
this subject to the attention of this Association with the hope 
of doing something towards giving this valuable anaesthetic 
* Read before Tri-State Medical Association of Alabama, Georgia, and 
Tennessee, October, 1891, 2 
the place it should hold in our daily practice, alongside the 
other indispensable ones, chloroform and ether. 
Ethyl Bromide, or Hydrobromic Ether, is a colorless liquid, 
volatile, having a fragrant ogot ahd'aKhot, somewhat sweetish 
taste, afterward rather bitter. It if not inflammable. Its 
specific gravity is 1.420, aud it boils at 104 Fahrenheit; readily 
decomposes on exposure to light and air, bromine being sep- 
arated. It is freely soluble in alcohol and ether, but very 
sparingly in water. 
As an anaesthetic, it was first known to Mr. Nunnely, of 
Leeds, and he first employed it in surgical practice in 1865. 
Dr. Turnbull gave an account of its properties, based on ex- 
perimental and clinical evidence, in 1877. But the most ex- 
tended trials of its anaesthetic powers were made by Dr. 
Levis, of Philadelphia, in 1879-80. In the latter year two un- 
successful cases occurred, one in the hands of Dr. Levis, its 
chief promoter, and the other in the practice of Dr. Marion 
Sims, of New York. 
These fatal cases, and some crude physiological experiments 
undertaken to prove that ethyl bromide is a heart paralyzer, 
started a reaction against this anaesthetic, then beginning a 
promising career, and in a short time it fell very much out of 
use. 
I have found it, however, to have valuable properties, which 
should preserve it from neglect, and bring it into more con- 
stant use. 
In the fatal cases recorded, there are strong doubts in re- 
gard to the share of ethyl bromide in the results. In Dr. 
Levis' case, the patient was far advanced in pulmonary dis- 
ease, and was unfit for the administration of any anaesthetic. 
In Dr. Sims' case, the death of the patient occurred a num- 
ber of hours after the operation, which was a long and tedious 
one, requiring very protracted use of the anaesthetic. To 
induce complete insensibility about zj must be administered 
rapidly. The odor is not unpleasant, and but little irritation 
of the air passages is produced. 
If administered in full quantity, there is a very brief stage 
of excitement, hardly perceptible, and the stage of rigidity is 3 
very short and not pronounced. There is, practically, no irri- 
tation of the fauces. 
The face is flushed, the ears are red, the eyes injected and 
watery from the increased lachrymation; the pupils more or 
less dilated. The action of the heart is accelerated and the 
pulse increases in force. The respiration is somewhat quick- 
ened. When the vapor of ether or chloroform is inhaled 
sense of faucial irritation and the need of air is experienced, 
also, more or less cough is produced. 
The irritation of the fauces excites the flow of mucous, and 
the reflex act of swallowing. The first effect is a general ex- 
hileration ; the pulse increases in frequency, the respiration 
becomes more rapid, and sometimes assumes a sobbing or 
convulsive character ; the face flushes, talking, laughing, cry- 
ing, singing, and sometimes praying indicate the cerebral in- 
toxication. 
This state of excitement varies in different individuals, and 
is more pronounced in character, and more persistent in the 
robust and rough natured male and the hysterical. At this 
period, although the patient can be easily aroused, sensibility 
to pain is decidedly diminished, although the sense of touch 
may be preserved, taste and smell are abolished and the 
sight is either abnormally acute, or is perverted by illusions. 
If the inhalations be continued, the patient passes into the 
condition of complete insensibility. In women and children, 
and males reduced by illness, the production of insensibility 
is quietly attained, if the anaesthetics be not inhaled too rap- 
idly. The stage of insensibility is preceded by a tetanic, con- 
vulsive stage, in which the voluntary muscular system and 
the respiratory muscles become rigid ; the breathing sterto- 
rous, the face cyanosed. 
This condition of rigidity is similar to, if not identical with, 
the tetanic stage of epileptic paroxysm. 
If the inhalation be pushed still further, the tetanic rigidity 
subsides, the cynanosis disappears, the breathing proceeds 
quietly, and the state of complete muscular relaxation and 
loss of reflex movement is established. 
At this time the surface is usually cool, and bathed with 
profuse perspiration, the countenance is placid, the eyes are 4 
closed, the pupils rather contracted than dilated, the respira- 
tion easy, but more shallow than normal; the pulse slower- 
it may be feebler, it may be stronger than in health, the func- 
tions of the cerebrum are suspended, only the centres presid- 
ing over respiration and circulation continues in action. 
The main deviations observed from these successive stages, 
when administering bromide of ethyl, are, that we have, prac- 
tically, no stage of faucial irritation beyond the choky sensa- 
tion; a scarcely noticeable stage of excitement, and the period 
of rigidity is very short and not pronounced ; no cerebral in- 
toxication, breathing in early stage decidedly quickened, the 
face never cyanosed, but constantly flushed, the ears red, 
the eyes injected, with the pupils more or less dilated. 
My mode of administration is to take a towel and form of it 
a closely fitting cone, having previously placed a layer of firm 
close paper (usually a leaf from a good quality printed pamph- 
let) between the folds. 
I prefer a towel to all patent inhalers, for I have found none 
to so well exclude the admixture of air. My attention is 
then given to instructing the patient in the part he is 
to perform, to make it most comfortable to himself, and 
speedy in action. I wish to impress this point, for it is a most 
important one. I tell the patient it is going to feel choky, 
but that it will not choke him ; and the best way to get rid of 
the choky feeling, is just to blow it out with the mouth wide 
open. Now, of course, they cannot blow out, without taking the 
inspiration, but this seldom, if ever, occuis to the mind of the 
patient. I then practice the patient at blowing into the towel 
for half a minute before putting any anaesthetic in it, leaving 
this impression, that he must blow it out, the last one upon 
his mind. I then turn dr.j. (one drachm) of the ethyl bromide 
into the apex of the cone, and place it closely over the mouth 
and nose, telling them at the same time to blow it out. 
Usually three or four whiffs serve to produce loss of conscious- 
ness, and in a half minute (a minute at the longest) complete 
anaesthesia is produced. Just so soon as this is attained, I re- 
move the towel altogether. The stage of complete anaesthesia 
lasts from a minute and a half to two minutes, in which time 
many painful operations can be completed. - 5 
The patient comes from under the influence of the anaes- 
thetic as if waking from a natural sleep, with the mind per- 
fectly clear and with complete contol of the muscular system. 
If my instructions fail to have children inhale the bromide 
as I wish, and they hold their breath instead of bieathing 
freely, I give the anaesthetic free from admixture of air for 
about half a minute and then remove the towel a little, 
to allow them to take one free inspiration of air, but as soon 
as this is done, I again place the towel over the mouth and 
nose, when the breathing always proceeds as desired, no 
further holding of the breath ever having been noted in my 
experience. 
I have often noticed complete insensibility to pain to last 
for a minute or two after the patient has returned to conscious- 
ness, and diminished sensibility to keep up much longer. 
Dr. Julian J. Chisholm, of Baltimore, with whom I have had 
my training in the use of this drug, has administered it some 
three thousand (3,000) times, and he, (in his larger experience,) 
as well as myself, has never seen the slightest indication of 
harmful results, following or accompanying this careful 
method of administration. 
It is not to be used in long operations, but is eminently 
suitable for any that can be performed successfully in two 
minutes. 
I have found it sufficiently lasting to perform squint opera- 
tions on very young children ; to open into a mastoid ab- 
scess, perform optico-ciliary neurotomy, or enucleation of the 
eye-ball (having first taken up the muscles under cocaine,) and 
many minor to these. 
If the operation is not completed when consciousness re- 
turns, after the first administration, or if seen that it will not 
be completed, do not repeat the administration of bromide, 
but keep up the anaesthesia with chloroform. When the bro- 
mide is repeated or the anaesthesia kept up with chloroform, 
nausea is certain to follow; whereas, it rarely follows 
the single administration of the ethyl bromide. 
I have never given ether in conjunction with it, but always 
used chloroform, when a single administration of the ethyl 
bromide did not produce anaesthesia of sufficiently long dura- 
tion in which to complete the operation. 6 
Some claim it must be much more dingerous than chloro- 
form or ether, from its power and rapidity of action, but they 
lose sight of the fact that nitrous oxide has also this rapid 
action, yet is universally conceded the softest of anaesthetics. 
When giving an anaesthetic, it is well for the administrator 
to keep a sharp notice of the ears, for these are always 
flushed, but quickly pale on the slightest disturbance to cir- 
culation, affording one of the earliest warnings of danger. I 
have never found it necessary in my expei ience in giving 
anaesthetics, to use instruments, with their oftimes consequent 
laceration, for the purpose of getting the tongue out of the 
way, to secure free inspiration and expiration. 
By forcible extention of the head, with the hand under the 
chin, by the action of the digastric, stylo-hyoid, mylo-hyoi3, and 
genio-hyoid muscles in this position, the hyoid bone is lifted 
up, bringing of necessity the larynx with it, and gaining 
by this means the same end as pulling on the tongue itself.