MEANS AND APPARATUS FOR ADMINISTERING CERTAIN MATTER TO THE LUNGS FOR MEDICAL OR SURGICAL PURPOSES
Year: 1846

page_text: TO ALL TO WHOM THESE PRESENTS SHALL COME, I, MOSES
POOLE, of the Patent Office, Lincoln's Inn, in the County of Middlesex,
Gentleman, send grecting.
WHEREAS Her present most Excellent Majesty Queen Victoria, by Her
Royal Letters Patent under the Great Seal of the United Kingdom of Great
Britain and Ireland, bearing date at Westminster, the Twenty-first day of
December, One thousand eight hundred and forty-six, in the tenth year of
Her reign, did, for Herself, Her heirs and successors, give and grant unto
me, the said Moses Poole, my exors, adiñors, and assigns, Her especial
licence, full power, sole privilege and authority, that I, the said Moses Poole,
my exors, admors, and assigns, or such others as I, the said Moses Poole,
my exors, adñiors, or assigns, should at any time agree with, and no others,
from time to time and at all times during the term of years therein expressed,
should and lawfully might make, use, exercise, and vend, within England,
Wales, and the Town of Berwick-upon-Tweed, and in the Islands of Guernsey,
Jersey, Alderney, Sark, and Man, and in Her Majesty's Colonies and Planta-
tions abroad, the Invention of "MEANS AND APPARATUS FOR ADMINISTERING
CERTAIN MATTER TO THE LUNGS FOR MEDICAL OR SURGICAL PURPOSES," com-
municated from abroad;" in which said Letters Patent is contained a proviso
that I, the said Moses Poole, shall cause a particular description of the nature
of the said Invention, and in what manner the same is to be performed, by
an instrument in writing under my hand and seal, to be inrolled in Her
said Majesty's High Court of Chancery within six calendar months next and

page_text: immediately after the date of the said in part recited Letters Patent, as in
and by the same, reference being thereunto had, will more fully and at large
appear.
NOW KNOW YE, that in compliance with the said proviso, I, the said
Moses Poole, do hereby declare that the nature of the said Invention, and
the manner in which the same is to be performed, are fully described and
ascertained in and by the following statement thereof, reference being had
to the Drawing hereunto annexed, and to the figures and letters marked
thereon, that is to say :-
The nature of the Invention consists in the discovery and application of safe
and certain means of inducing in a patient, whether man or animal, a state of
insensibility to physical pain, accompanied in most cases by a state of quies-
cence or relaxation of the muscles of voluntary motion, by administering the
vapour of ether, suitably mixed with atmospheric air, to the lungs of the
patient, so that medical or surgical operations usually attended with pain may
be better performed upon the body of the patient while in such state of insen-
sibility, which is called a state of etherisation.
William TG- Morton, Dentist, and Charles T- Jackson, Chemist,
both of Boston, in the United States of America, having discovered the power
of the vapour of ether administered to the lungs to induce a state of tempo-
rary insensibility to pain, Dr. Morton succeeded, after many experiments
made upon his own person, at the peril of his health and life, in finding and
combining safe and certain means of applying the discovery to the most
important medical or surgical uses, so that the heretofore most painful opera-
tions in surgery can, by aid of this Invention, be performed without pain to
patients, with the additional advantages of greater probability and greater
rapidity of their recovery from the effects of the operations. It is well
known to chemists, that when alcohol is submitted to distillation with certain
acids, peculiar compounds, termed ethers, are formed, each of which is usually
distinguished by the name of the acid employed in its preparation. Experi-
ments have shewn that for the purposes of this Invention ether commonly
called sulphuric ether is to be preferred to all other ethers, including under
this term all-products of the action of acids upon alcohol possessing properties
similar to those of the ethers, though other ethers will produce a state of
etherisation. The basis of all the ethers is an hypothetical radical called
ethule, which is represented by the formula C³ H' and symbol A E. Pure
sulphuric ether is regarded as an oxide of ethule, and is represented by the
formula C H O, its symbol is, therefore, A E O. It is prepared by decom-
posing highly rectified alcohol by means of sulphuric acid or oil of vitriol..

page_text: Five parts of alcohol, of ninety per cent., are mixed with nine parts of oil
of vitriol, in a vessel of copper or iron, placed in cold water so as to cool the
mixture. By elevation of the temperature and brisk ebullition the oxide of
ethule is formed, and passes over in vapour. The distilled liquid may be treated
with an alcoholic solution of potash, to neutralise the acids which it may
contain, and to render it slightly alkaline. Commercial ethers may contain
sulphurous acid gas, acetic, formic, and aldehydic acids, the three latter being
produced by absorption of oxygen from the air. It should then be re-distilled
in a water bath, and the operation is to be arrested so soon as the ether has
attained a specific gravity of 0.72 at eighty degrees of Fahrenheit. The
specific gravity may be still further reduced by allowing it to stand for some
days over dry chloride of calcium, and then redistilling it in contact with that
hygrometric substance. Its boiling point is at ninety-six degrees Fahrenheit.
It has a penetrating acromatic odour, and is highly inflammable. It should
not change the colour of blue litmus paper. The pure vapour of ether, as
thus prepared, will not support respiration, and by excluding air from the lungs,
would produce complete asphyxia. Therefore the vapour should be admi-
nistered mixed with a sufficient quantity of common air, to enable the lungs,
to perform their usual functions but slightly disturbed by the ethereal vapour.
In cases when symptoms of asphyxia may occur from accidents of improper
administration, or from impurities of the ether employed, pure oxygen gas
may be administered, which, acting upon the blood, immediately renders it
arterial. Children are more easily affected by the vapour of ether than adults,
and females more easily than males. In some cases a state of complete
insensibility to pain is produced after inhalation for a few seconds; in other
cases inhalation during several minutes is requisite. Few, if any, persons, will
fail to be rendered insensible to pain after inhalation properly conducted for a
period of five minutes. Should a longer time than this be required, there will be
reason to suspect idiosyncracy of constitution or something wrong in the
mode of administration. The physiological phenomena, and their order of
appearance, exhibited by patients during the process of etherisation, are not
the same in all individuals, being doubtless modified in each case by the quality
of ether employed, the proportion of atmospheric air mixed with it, the degree
of perfection of apparatus used, and the length of time of inhalation, as, well
as by the peculiar constitution of the patient. The state of etherisation which
is considered most favorable for the performance of surgical operations
may be recognized by insensibility of the skin to pain, quiescence or relaxation
of the muscles.of voluntary motion, the normal performance of the vital or
involuntary functions, attested by deep and regular breathing and pulsation,

page_text: at first accelerated, then restored to a natural state, apparent mental uncon-
sciousness, a turning-up of the ball of the eye, and a general expression of
the countenance as in sleep. Perfect etherisation may be described as a state
of artificial sleep. The patient upon awaking usually speaks of having
had agreeable dreams. If the character of dreams depends upon the thoughts
and feelings in the mind of a person when entering the state of sleep, the
operator may usefully avail himself of the fact by preparing the mind of
the patient for a state of pleasurable reverie. The duration of the state of
etherisation varies in different cases. It does not generally continue more than
a few minutes after the removal of the means and apparatus employed.
Should the patient begin to recover sensibility to pain before the termination
of an operation, renewed inhalation will restore insensibility, which may be
prolonged an indefinite length of time, at the discretion of the operator.
The state of etherisation or ether sleep may be induced by various modes
of administration. All that is essential is that the patient should inhale for
a certain length of time vapour of ether mixed with certain proportions of
atmospheric air. About equal proportions of vapour of ether and atmo-
spheric air are considered best, though etherisation may be produced by a
greater or less proportion of the vapour of ether. If air be in excess, there
will be either no effect or disagreeable and useless nervous excitement; if
ether be in excess, there will be danger of asphyxia. Perhaps the simplest
mode of administration is to hold near the mouth and nostrils of the patient
a piece of sponge, best of a concave form, or cloth or other porous or fibrous
material, permeable to air, saturated or wet with ether, so that the patient
shall inhale the vapour mixed with a suitable proportion of atmospheric air.
This mode, which may be advantageously adopted as an auxiliary, particularly
in some operations upon the mouth or face, and which may be resorted
to in an emergency, is objectionable on account of its wastefulness, its
requiring too much experience, care, and attention, its want of cleanliness,
its uncertainty, and the difficulty or impossibility of measuring quantities or of
observing effects. Another mode of administration is by means of a bladder
provided with a tube to be inserted into the mouth of the patient, whose
nostrils are closed, so that the patient shall breathe and rebreathe the vapour
of ether contained in the bladder, mixed with carbonic acid gas given off
by the lungs. This mode is liable to all the objections mentioned against the
ordinary use of a piece of sponge, together with another more serious one,
namely, danger of asphyxia.
It is now proposed to describe the apparatus which the Inventors consider
best suited to the purpose of etherisation, and the manner of employing it.

page_text: Figure 1. A represents a glass or other vessel holding about a pint, having
a large mouth. o, a stopper for the vessel A, of brass or other material.
b, a tube for the entrance of atmospheric air passing through the stopper o..
c, a brass stop cock or tap in the tube b. d, the continuation of tube b into
vessel A, made of pewter perforated with small holes at its lower extremity,
to prevent the passage of air being obstructed by a piece of sponge. e, a tube
with a tap f, and continuation 9, all of brass, passing through the stopper o,
intended to allow the exit of vapour of ether mixed with air from vessel A.
8, 8, 8, s, ten or twelve pieces of sponge, about a cubic inch each in size, con-
nected together by a wire, for the purpose of keeping them separated, and to
hold some of them elevated in the vessel A, thereby facilitating evaporation of
ether, with which they are saturated or wet. y, y, a little free liquid ether at the
bottom of vessel A. h, h, a flexible tube, which is made of a spiral of wire
covered with india rubber, about two feet in length, connecting the tube
with the apparatus. B, B, a brass double valve apparatus, it may be made of
metal or other material, about an inch and a half in diameter. i, the entrance
to apparatus B, through which the vapour of ether, mixed with air, enters
from the flexible tube h, h, coming from the vessel A. j, the inhalation valve,
opening towards the mouthpiece n, but not towards the vessel A, so that
vapour may be inhaled but not exhaled through the valvej. A, the exhalation
valve, opening towards the orifice l, which communicates with the atmosphere,
but not towards the mouthpiece, so that vapour may be exhaled through the
valve k, but air cannot be inhaled. The valves j and k are simply flaps of
cloth or leather, strengthened by thin metal, the cloth or leather serving the
purpose of hinges at z, z. l, an orifice communicating with the atmosphere.
m, an orifice between valve j and valve k, in the side of apparatus B,
communicating with the mouthpiece n, and allowing respiration to be carried
on through the apparatus B. n, a mouthpiece, shaped like the mouthpiece of a
speaking trumpet, constructed of flexible materials, for instance, a frame of
pewter wire covered with india rubber, so as to be adaptable to the form of
any face, the dimensions being such as conveniently to include and cover the
lips of the patient. It is considered a most important and essential requisite
of the apparatus that the orifices, tubes, valves, and passages should be of
ample size, diameter, or bore, from the atmosphere to the respiratory organs
of the patient throughout, to allow of perfectly free and easy respiration
through the apparatus by a person in a state of unconsciousness. No inhaling

page_text: apparatus in use before this Invention, possessing the other essential requisites,
could be safely employed, from deficiency in this particular.
The Inventors consider it objectionable to employ any apparatus for the
purpose of etherisation in which the air passages are not throughout of a bore
or size equal to a circle of at least half an inch in diameter. A bore of five
sixteenths of an inch in diameter would suffice for very young children.
Though etherisation can be induced by means of air passages of smaller bore,
the patient is likely to suffer inconvenience, or incur danger from asphyxia,
The operator should take especial care that air or vapour shall pass with
the greatest possible freedom through the valves, and throughout the whole
course of the flexible tube, which should be as short as convenience of mani-
pulation will allow. This apparatus may be modified in a great variety of
ways without altering its essential character. Thus the vessel A, Figure 1,
may be constructed of any rigid or flexible matèrial impermeable to liquids
not easily acted upon by ether. It may be made larger or smaller, and of any
convenient shape. The mouth of the vessel and the stopper may be
dispensed with, while the tubes or openings band e may be placed at any
parts of the top or sides of the vessel. The stopcocks or taps c and ƒ may be
dispensed with, and one or both be replaced by valves. The sponges 8, 8, 8, s,
may be dispensed with, and a single sponge used, or cloth or other porous
material permeable to air may be used; or sufficient evaporation of ether may
be produced by means of artificial heat, for instance, warm water applied
externally or internally to the vessel A, and the interior of the vessel A may be
divided by vertical, horizontal, spiral, rectilinear, or other divisions, so as to
convert the interior space into a long pipe, and thus facilitate the mixture of
atmospheric air with the vapour of ether in the interior of the vessel A. The
free ether y, y, may be dispensed with, and fresh ether for evaporation be
supplied in jets or otherwise as it may be wanted. The.flexible tube h, h, may
be dispensed with. The apparatus B may be dispensed with, and the inhala-
tion and exhalation valves j and k be placed anywhere between the tube e,
leading from the vessel A, and the mouthpiece n; for instance, the inhalation
valvej may be placed in the tube e or in, the flexible tube h, h, in a position
perpendicular to the current of air or vapour, and the exhalation valve k may
be placed on the top or side of the tube between the valve j and the mouth-
piece n, as in Figure 2. h, h, represents the flexible tube. j represents the
inhalation valve opening towards the mouthpiece n, and the exhalation valve
opening towards the atmosphere on the top or side of the tube h, h. The
valves j and may be flat or spherical or of other shapes, and various con-
trivances may be used to effect the same purpose, the principle being so to

page_text: arrange the valves or contrivances as to allow the passage of vapour and air
from the vessel A. to the lungs preventing the entrance of free atmospheric
air into the lungs, and to prevent the return of exhaled vapour and air into the
vessel A, allowing its passage into the atmosphere. The inhalation valve j
may be in the tube or opening b, by which the vessel A communicates with
the atmosphere; and, as in Figure 8, the exhalation valve k may be in or upon
a separate short pipe or tube p, proceeding from the mouthpiece n, or the
valve k may be upon the mouthpiece n. The mouthpiece n may be enlarged
so as to include the nostrils of the patient, or it may consist of a large tube of
glass or other material, flattened so as to suit the shape of the mouth of the
patient, and provided with a flange 9, as in Figure 4, or with a pad or
cushion r, as in Figure 5, to press against the lips of the patient, and
thereby prevent the entrance of air directly from the atmosphero to the
lungs. By means of a simple contrivance analogous to the mouthpiece,
the patient may, if desirable, be made to respire through the apparatus
by way of the nostrils exclusively. A communication may be made with
the atmosphere by means of an orifice, which may be closed by a
slide, valve, tap, or otherwise, in any part of the apparatus between the
vessel A and the mouthpiece n, so that the operator may, at his discretion,
admit free atmospheric air directly to the lungs of the patient through the
mouthpiece without removing the apparatus from the mouth of the patient.
The vessel A, Figure 1, may be provided with a smaller vessel serving as a
reservoir containing a quantity of ether, which reservoir placed over the
vessel A, and communicating with it by a tube, may, by means of a valve, tap,
pneumatic pressure, or other contrivance, supply fresh ether for evaporation, in
jets or otherwise, as it may be wanted. The operator should carefully notice
the temperature of the apartment in which the apparatus is used; and the
temperature of the apparatus for the evaporation of liquid ether increases very
rapidly with the increase of temperature. It is recommended that the tempe-
rature of the apartment and of the apparatus should be about sixty-five or,
seventy degrees Fahrenheit, at which temperature the air inhaled through the
apparatus above described is found to be mixed with about an equal quantity.
of ether vapour. The operator having opened the stopcocks or taps of the
apparatus, and having applied the mouthpiece to the opened lips of the patient,
so that the patient can breathe easily through the apparatus, should take care
that no unmixed atmospheric air enters the lungs of the patient while inhaling
either by the sides of the mouthpiece or through the nostrils. The nostrils
should be closed by the fingers of a discreet person, and during the admini-
stration of the ether vapour the countenance of the patient should be watched.

page_text: Should the patient feel an irresistible propensity to cough, which sometimes is
the case at the commencement of inhalation, the nostrils may be momentarily
released, or the apparatus removed for an instant without harm, though, inba-
lation once having been commenced, it is best to proceed to complete etheriza-
tion with as little interruption as possible. The quantity of ether requisite to
induce a state of etherisation very rarely, if ever, exceeds two ounces; generally
a much smaller quantity suffices; in some cases less than a drachm will effect
the purpose. Various aromatic or narcotic vapours may for special purposes
be administered in small proportion, in combination with the vapour of ether,
without interfering materially with the process of etherisation. As ether
vapour employed as above described is a medical agent of great power, it is
evident that no one but a member of the medical and surgical profession, or a
person properly instructed, should in ordinary cases venture to administer it.
It is impossible to define the limits within which etherisation may be advan-
tageously employed in medicine and surgery. Whenever it is desired to
induce a state of insensibility to pain, or of relaxation or quiescence of the
muscles of voluntary motion, or of mental unconsciousness, or of artificial
sleep, the physician or surgeon, being determined by the peculiar circumstances
of each case, will decide as to the suitableness of etherisation. The Inventors
have named the process of etherisation "the Lethéon," and call the apparatus
"Letheonic Apparatus."
Having thus described the nature of the Invention, and the manner of
putting it into operation, it is not claimed that any one of the parts employed
in this invention, taken singly, is new. There is novelty neither in the manu-
facture nor in the preparation of the ether employed, nor in the simple prin-
ciple of the administration of the vapour of ether to the lungs, nor in the use
of apparatus for the inhalation of vapours, nor in any one of the essential
parts of a good letheunic apparatus, taken alone. The invention is one of
novel combinations, proportions, and methods, as the novelty of the results
obtained unequivocally attests.
First, I claim the so combining the vapour of ethers as herein mentioned
with atmospheric air, together with a porous material or apparatus with a
tubular mouth or nose piece, that the vapour and air may be administered to
the lungs of a person in such manner as to obtain to the person insensibility
to physical pain, for medical or surgical purposes.
Secondly, in respect to apparatus, having in the above description explained
four important particulars among the parts or conditions of means and appa-
ratus for administering vapour with atmospheric air to the lungs, namely:-
First, sponge, cloth, or other porous material offering a large evaporating

page_text: surface, and permeable to air. Second, a mouth piece or other contrivance, so
adapted to the breathing passages of the head as that a person in a state of
unconsciousness, the nostrils being closed, or included under the contrivance,
would necessarily breathe through the apparatus. Third, a sectional dimension
or bore of air passages in their whole course from the atmosphere through the
apparatus to the mouth or nostrils of the patient equivalent in size to a circle of
not less than five sixteenths of an inch in diameter. Fourth, a system of inha-
lation and exhalation valves or contrivances so arranged as to compol the
expulsion of vapour once inhaled into the atmosphere, either without returning
into the vessel generating or containing the ether, or returning in part into
that vessel without passing through it to the atmosphere.
I claim as the second part of my Invention the making or combining of
means and instruments as follows:-
I claim the combining of apparatus generally which shall possess the four
particulars above mentioned, or any three of them together.
I also claim the combination of the first-mentioned particular with any one
of the other three particulars.
I also claim the combination of the second-mentioned particular with the
fourth-mentioned particular. And
I also claim the combination of the third-mentioned particular with the
fourth-mentioned particular.
In witness whereof, I, the said Moses Poole, have hereunto set my
hand and seal, this Eighteenth day of June, in the year of our Lord
One thousand eight hundred and forty-seven.