This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
There has been no little controversy about the propriety of using measures to prevent pain in surgery; but the mass of the profession, influenced in some degree, no doubt, by the powerful instincts of our nature, have come to the conclusion that such measures are not only admissible, but very often advisable. The advocates for their use maintain, and, as appears to me, very reasonably, that not only is the suffering of the patient mitigated if not entirely prevented, but that, in severe operations, the measure proves positively salutary, and conduces to a favourable result by obviating the shock on the nervous system, which is sometimes fatal even during the operation. The objection on the score that nature intended that there should be pain in surgical operations, if it need an answer, is fully met by the simple counter statement, that nature has also presented us with a remedy for the pain. The notion that ether might act injuriously by depraving the blood, and retarding the healing process, has proved as groundless on trial, as it really was in theory. The opium which almost every surgeon formerly gave, left a much more powerful impression on the system than the brief action of ether could do; and yet no one supposed that it prevented the healing of wounds. Another objection to the use of ether has been the doubt, whether it really exercised the anaesthetic influence ascribed to it, as patients, by their agitation during the operation, seem to evince some degree of suffering. But when, as has often happened, they have retained sufficient consciousness of what was going on to give an authoritative statement in the case, they have almost uniformly declared that they felt no pain or very little; and the agitation was really ascrib-able to some dreamy delusion at the time, or merely to reflex action. The only real question, as it seems to me, is whether ether can be given safely; for I doubt whether we have the moral right to relieve pain, at any appreciable risk of life. Reasoning from our knowledge of the effects of ether, I should say that a full dose of it, sufficient to bring on the state of anaesthesia, is less dangerous than a full soporific dose of opium, supposing in both cases the system to be in health. Etherization is certainly less dangerous than intoxication from alcoholic liquor, as the circulation is disturbed less, and the influence is much shorter in duration. Nor has experience contradicted the suggestions of reason. The instances are extremely rare, if in fact there are any on record, in which etherization, employed to prevent pain in operations, has proved fatal when the measure was judiciously applied, and the case properly selected. The measure itself is certainly not accountable for the ignorance or care-lessness of the person who employs it, and should not be rejected on this score, any more than opium or mercury, or even quinia, should be rejected for the mischief they have often done in reckless and unskilful hands. Indeed, considering the number of instances in which ether has been used, even by the most notoriously ignorant persons, it is somewhat surprising that we have heard so little of its mischievous effects. This assuredly cannot be said of chloroform, which our professional brethren in Europe cling to with so much pertinacity, notwithstanding that almost every journal comes to us burdened with some fatal case, and it is presumable that many happen which never find their way into the public records.
Ether has also been much employed to mitigate or annul the pains of childbirth. Upon the propriety of this application of it, there has been even greater difference of opinion, or rather there has been greater opposition to the measure, than in reference to its use in surgery. Having no practical experience of my own in this branch of our profession, I feel altogether incompetent to give an opinion upon the subject, and allude to it here as a point in the history of etherization which cannot be wholly overlooked.
Ether should not be recklessly used. In cases of seriously diseased heart, active congestion or acute inflammation of the lungs, brain, or stomach, organic cerebral disease, apoplectic or active hemorrhagic tendencies, or a generally plethoric condition, it should either be avoided altogether, or used only after a careful preparation of the system. It should be carried no further than is sufficient for bringing about the state of anaesthesia, and should be at once withdrawn, if a failing pulse indicate any danger of asphyxia. The utmost care should be taken that sufficient atmospheric air is inhaled. The want of this is probably the greatest danger of the process under unskilful management. The patient, by the very state of insensibility into which he is thrown, becomes incapable of giving warning through his feelings of suffocation; and hence the greater necessity for care on the part of the operator. The rule simply is that, while the vapour of ether is admitted into the lungs, it should be accompanied with free access of the atmospheric air.
Various instruments have been invented to meet the requisitions of convenience and safety in inhalation; but probably nothing is better, on the whole, than a large piece of sponge, hollowed out on one side so as to admit the nose. This should be applied saturated with the ether, so that the vapour may enter with the air drawn by inspiration into the lungs. In this way a due supply of atmospheric air is ensured; and the only disadvantage is, that more of the ether is lost by evaporation than when it is confined within an instrument. The patient should breathe preferably through the nostrils. Bags containing ether should never be used.*
When an instrument is used confining the ether, from one to two fluidounces maybe employed; when a sponge, the quantity should be doubled. The operator should keep his fingers on the pulse, and, if he find it failing, should withdraw the ether. Should convulsions supervene, he must also suspend the process.