This section is from the book "Dental Medicine. A Manual Of Dental Materia Medica And Therapeutics", by Ferdinand J. S. Gorgas. Also available from Amazon: Dental Medicine.
To administer ether or chloroform, take a folded piece of lint, of three or four thicknesses, and of a size that can be held conveniently in the hollow of the fingers and palm of the hand; and on it pour the anaesthetic agent - half an ounce of ether or a drachm of chloroform. Some prefer a large napkin or towel, folded in the form of a cone, with an opening of an inch or an inch and a half at the apex, for the admission of air. The advantage, however, of the lint over the folded napkin is, that by holding the lint in the hand but little evaporation occurs. To give sufficient air to the patient when beginning the administration of ether, Dr. D. B. Keefe recommends the use of a large towel, folding it first five times lengthwise, and placing a piece of paper the full length between the outside folds, then roll it up into a cylinder, the size to be governed by the face of the patient: it should be large enough to cover the face, but not too large. This makes a cylinder open at both ends, full size. Then saturate the lower part of the cylinder, that comes against the face, with the ether and apply it to the face, and as the other end is open the patient receives considerable air as well as the ether vapor. Before commencing the inhalation, the condition of the pulse should be ascertained by placing the middle finger of the left hand on the left temporal artery, and at the same time endeavor to reassure the patient and allay fear by cheerful words. The clothes should be loose, and artificial teeth, if any are worn, as well as pins or tobacco, if the habit of keeping them in the mouth is indulged in, should be removed before the administration of the anaesthetic is commenced, to prevent them from slipping into the larynx and causing death. The patient should be directed not to partake of any food for twelve hours preceding the administration of ether in order to avoid vomiting, except a little milk or tea one or two hours before its administration - a piece of wet muslin may be placed over the eyes - to prevent the vapor or liquid from causing irritation. The inhalation should be commenced by holding the moistened lint or towel three or four inches from the patient's face, directing him to breathe quite naturally, always remembering that a strong atmosphere in the early stages of the inhalation is dangerous, and carefully watching for coughing or acts of swallowing, when, if any such occur, the lint or towel should be moved further away, and approached again more gradually. If the patient shows ho signs of the anaesthetic vapor being too strong, the lint or towel may be gradually brought to within an inch and a half of the patient's mouth and nostrils; and to still more concentrate the atmosphere, if lint is used, the hand holding it may be covered with one fold of an ordinary large napkin, which may hang loose over the mouth and chin, but should be so arranged above that the patient's eyes and forehead may remain uncovered and visible. The inhalation should be commenced cautiously, by instructing the patient to breathe quite naturally, and to obey any direction to raise the hand or open the eves.
When the inhalation has fairly commenced, it should be continued until there is no winking when the margins of the eyelids are touched, or the hand cannot be raised, and the limbs are perfectly relaxed, when the patient is ready for the operation; what is termed the "surgical period" having arrived. An inhalation with chloroform generally takes about four minutes; often more; seldom less. With ether, the time required is longer and the quantity of the agent greater.
It should also be remembered that, in summer, chloroform and ether evaporate more readily than in the colder seasons.
The operator should devote his undivided attention to the patient, during the inhalation of anaesthetics. One finger should be kept on the pulse, and the respiration should be carefully noted; for the latter is of more importance than the former, although the pulse is by no means to be neglected. When the patient becomes excited, he should be watched very closely, and if the respiration becomes proportionately quickened, so must the vapor of the anaesthetic be proportionately weakened, by withdrawing the lint or towel slightly from the face.
When the muscles become rigid, and the patient holds his breath and becomes livid, the anaesthetic should be given very weak indeed, as such a state of semi-asphyxiation, due to the suspension of respiration, is often followed by extreme rapidity and depth of respiration, and a dangerous condition is apt to supervene, because anaesthesia is added to asphyxia. The cumulative action of these general anaesthetics should also be remembered, for a state of narcosis frequently intensifies for half a minute or more after the suspension of the administration, which is due to the vapor of the anaesthetic which was in the lungs entering the blood after the administration ceases.
Prof. J. J. Chisholm, of the University of Maryland, gives the following five simple rules for the administration of chloroform, and which will apply to ether also: -
"1. I always, without a single exception, give a strong drink of whiskey, from one to two ounces, to every adult to whom I intend to administer chloroform. This is done a few minutes before the operation.
"2. Always loose the neck and chest clothing, so as to have no impediment to respiration.
"3. Only administer chloroform in the recumbent posture, with body perfectly horizontal and head on a low pillow, this pillow to be removed as the anaesthesia progresses. 17
"4. Give chloroform on a thin towel, folded in conical form, with open apex, so that the vapor, before inhalation, will be freely diluted with atmospheric air. In holding this cone over the face of the patient, at some little distance from the nose, place the fingers under the borders of the cone, for the double purpose of allowing the air to enter freely, and also to prevent the chloroform liquid on the towel from coming in contact with the skin of the patient's face, and thereby avoid its blistering effects.