This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol2", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
* The preferable use of ether is not without advocates in Europe, and especially in France. The imperial Society of Medicine of Lyons, after a careful examination of the subject, came unanimously to the following conclusions. 1. Ether is less dangerous than chloroform. 2. it produces as complete insensibility. 3. if ether has some inconveniences not attaching to chloroform in the same degree, they are of little importance, and do not counterbalance the greater danger of chloroform. 4. Ether, therefore, should be generally preferred. (Ann. de Thérap., 1861, p. 44; from Gaz. Med. de Lyon.) - Note to the third edition.
* Since the above was written, an account of a case has been published, in which death took place in Scotland, under the inhalation of chloroform; but on this occasion the patient was under the care of a midwife, and had, on several previous deliveries, used the same measure safely under the superintendence of her medical attendant, (Med. Times and Gaz., Nov. 1858, p. 465.) in the same journal (Dec. 1858, p. 588) reference is made to another fatal case, said to have occurred in Edinburgh; but nothing definitely appears to be known about it. (Note to the second edition.)
Dr. Robert Johns, of Dublin, in a paper published in the Dublin Quarterly Journal (May, 1863, p. 353), strongly condemns the use of chloroform, basing his opposition mainly on the returns of the Dublin Lying-in Hospital, in which the proportion of deaths in one year, when chloroform was not used, was 1 in 100 cases, and in a second year, under similar circumstances, 1 in 102; while, after chloroform was introduced, the number of fatal cases increased to 1 out of 84; and, during this period, only 1 per cent. died of those who did not take chloroform, and 1 in 11 of those who did. But this seems to me to prove too much; and a fair inference from the facts stated, is that the enormous disproportion of deaths when chloroform was used, was owing simply to the circumstance that recourse was had to this agent only or mainly in the worst cases. (Note to the third edition.)
How far the anaesthetic practice may be desirable or justifiable in childbed, and, if employed at all, under what peculiar circumstances it is most appropriate, are questions which belong to the obstetrician to solve. My object has been to show chloroform as it really is, divested of all its imaginary terrors; so that the practitioner may not be deterred from using it by any unfounded fears, if he believe it to be indicated. That the same superiority of ether over it, which may be claimed in surgical practice, does not exist in the obstetrical, follows, I think, from the facts above stated. That it is less fatal in midwifery than surgery is owing, in all probability, to the circumstance that, in the former, it is given to relieve pain, in the latter, to prevent it; pain having apparently the effect of resisting, to a considerable extent, the depressing influence of chloroform on the organic functions. One rule is now, I believe, generally acknowledged by those who advocate the use of this anaesthetic in midwifery; that it should never be purposely pushed further than is necessary for the relief of pain, nor carried so far as entirely to abolish consciousness. The greatest caution, moreover, and watchfulness should be exercised in its use, so that, upon the least sign of over-action, it should be withdrawn; and its administration should never be entrusted to unskilful hands. Another caution, if observed, would probably go far to ensure its safety; to combine it, namely, with double or quadruple the quantity of ether, so that the stimulant influence of the latter agent may counteract its sedative effect on the heart.
An extraordinary discovery is claimed to have been made by Prof. Nussbaum, of Munich, which, if confirmed, will add greatly to the efficiency of chloroform as an anaesthetic in surgery. Towards the close of 1863, it was announced by this pathologist that, by the injection of morphia in solution into the subcutaneous tissue, just before the occurrence or after the production of insensibility from the inhalation of chlo-form, this condition may be prolonged for several hours, sometimes even for twelve, without unpleasant results. This statement was made on the authority of four or more cases, in which the measure had proved successful in his hands. His experiment was repeated in three cases by Dr. Eulenberg, with apparent success in one case, but with negative or doubtful results in the others. (See Am. Journ. of Med. Sci., April, 1866, p. 435.) Subsequently the Versailles Medical Society instituted experiments on dogs, which, so far as they went, were considered as confirmatory of the statement of Prof. Nussbaum. (Med. Times and Gaz., i have myself repeatedly observed that, in cases in which large doses of an opiate have been given with the view of producing sleep, but unsuccessfully, the inhalation of a very small quantity of chloroform, sometimes not more than a few drops, will almost instantaneously cause the patient to fall into a deep sleep, continuing the ordinary length of time of that from opium. Here the chloroform probably acts by reducing the excitement or irritation of the nerve centres which prevents the proper soporific action of the narcotic. it is easy to understand how this application of chloroform may prove highly useful in practice; but I have also noticed, in many instances, that next day the patient suffers much more from nausea and general malaise than when the opiate has been given alone; and this fact, if it prove to be generally true, will go far to neutralize any benefit from the measure.
March, 1864, p. 259.) But the testimony on the subject is yet too limited to justify any positive conclusions. There is no doubt that morphia, subcutaneously administered at the same time with chloroformic inhalation, will extend a soporific influence long after that from chloroform should cease if given alone; but there is nothing new in this fact; and the question simply is, whether the prolonged action is anything more than that of morphia alone, which it equally produces if given without chloroform; in other words, whether the latter anaesthetic tends, after the ordinary period of its own influence is passed, in any degree to deepen the insensibility produced by the opiate. I am strongly inclined to believe that no effect of this kind is gained; and the fact, that in at least two of the cases of Prof. Nussbaum the quantity of the morphia injected was nearly or quite a grain, is confirmatory; for I have no doubt that the insensibility produced by this amount of morphia, thus administered, would often produce a degree of anaesthesia sufficient to prevent pain from slight surgical operations, though it could not be depended on.