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because ether is far more difficult to administer than chloroform. If ether is to be given
with satisfaction it requires an inhaler, and special instruction in the use of it. But ether
always gives warning of danger, whereas under chloroform there may be sudden death.
One point I would strongly urge is always to have a sufficient variety of anæsthetics on
a table at hand, viz., chloroform, ether, A.C.E. cocaine. Latterly I have added Messrs
.' Bartts' improved Clover's gas and ether inhaler. No one can predict with certainty
which anæsthetic the patient will take best. I have had cases (generally alcoholic patients),
where ether caused struggling and great excitement, but after Clover's inhaler had been
changed for Ormsby's, with A.C.E., the patient quietly and quickly went under; in
s u c h c a s e s c h l o r o f o r m s h o u l d n e v e r b e g i v e n . I ti
s a p i t y t h a t A . C . E . i s n o t m o r e g e n e r a l l y u s e d ;
for when ether fails to stimulate it is most valuable, as in ovariotomies and such like
protracted cases.
In reference to* inhalers. I am sure none can compare with Clover's for ether; with
it the exact percentage required can be given. Ormsby's is the best for A.C.E., mixture,
Messrs. Bartts have lately made a hinged cap for me, whereby the mixture can be poured
on to the sponge without removing the cap, for small quantities constantly put in are
preferable to a large amount. Caution is needed in using the inhaler, for the alcohol and
ether volatilise more rapidly than the denser vapour of chloroform. For chloroform
a d m i n - i s t r a t i o n n o t h i n g i s b e t t e r t h a n a d o u b l e p i e c e o f l i n t , w h e r e b y p l e n t y o f a t m o s p h e r i c a i r
can be given. I have noticed live deaths where metal inhalers have been used. I have
witnessed several deaths from chloroform, though I am thankful to say that none have occur-
-red in my own practice, and I am convinced that they were due to an overdose and not due to
shock from too little being given; and I would here draw attention to Dr. Hewett's admirable
letter in your issue of March 1st, wherein he mentions a case of syncope arising from deep
chloroform narcosis, where he went on with ether for the remainder of the operation. Surgeons
now-a-days expect too much from anæsthetics. Profound anæsthesia cannot be maintained for
1 1 / 2 o r 2 h o u r s w i t h o u t g r e a t d a n g e r o c c a s i o n a l l y , a n d t h e r e a r e m a n y c a s e s w h e r e i t s u f f i c e s t o
keep the patient on the verge of returning consciousness, e.g., sequestrotomies and similar
tedious but not delicate operations.
I would conclude by saying that ether should be always given between the ages of
sixteen and sixty, except there is some good reason to the contrary, such as pulmonary. renal
or arterial disease. Never, uponc o n s i d e r a t i o n w h a t e v e r ,
s h o u l d c h l o r o f o r m b e g i v e n f o r
d e n t a l c a s e s . I t i s a l w a y s d a n g e r o u s i n t h e s i t t i n g p o s t u r e f o r a n y t h i n g . I m u s t a p o l o g i s e
for taking up so much of your valuable space, but my excuse must be the immense importance
of the subject and the alarming mortality of chloroform.
H. CHESTER NANCE,
Norwich and Norfolk Hospital,
House Surgeon.
Norwich, June 9th, 1890.
* Vide The Lancet, vol. ii. p. 1220. 1888. Dr, Squire's communication on his giving ether for Liston in 1846,
and his first inhaler.