"Snow's first published comments on inhalation of ether "

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(16 January 1847)Presentation before the Westminster Medical Society on 16 January 1847. Snow's comments on inhalation of ether appearing were recorded and published in the London Medical Gazette 39 (22 January 1847): 156-57.

The first weekly meeting in the New Year of the WMS, the first item on the agenda was a paper on "Sloughing of the uterus." Thereafter, the members turned to "inhalation of ether," the burning topic of the month:

"Dr. Chowne detailed some particulars of a patient who had been operated upon in Charing Cross Hospital whilst under the influence of ether.

Mr. Hancock related the case of a student of the hospital, from whose hand he had removed a large wart whilst he was under the influence of ether. He inhaled for three or four minutes, the ether apparently producing some congestion of the brain, though unaccompanied by stertor. The pulse fell from 90 to 60, and became very small; the pupils contracted. He was conscious of everything going on around him, but felt only the first cut of the knife. The sensations imparted by the ehter were pelasant ones: he felt as though he had had a 'heavenly dream.'

Dr. Snow said that the great effect of temperature over the relations of atmospheric air with the vapour of ether, had apparently been overlooked in the construction and application of the instruments hitherto used. This circumstance would explain in some measure the variety of the results, and account for some of the failures. The operators did not at present know the quantity of vapour they were exhibiting with the air; it would vary immensely according to the temperature of the apartment, as would be seen by some calculations he had made, and suspended in the room. One hundred cubic inches of air, saturated with the vapour of ether, at a temperature of

44°	would contain	27	cubic inches of vapour.
54°	" "	34.3	" "
64°	" "	43.3	" "
74°	" "	53.6	" "
84°	" "	66.6	" "

being doubled by a rise of only thirty degrees.

He (Dr. Snow) was getting an instrument made which would enable the surgeon, merely by placing it in a bason [sic] of water, warmed or cooled to a given temperature, to administer an atmosphere of any strength he wished, and by this means to gain correct experience to guide him in future. The instrument which Mr. Ferguson , of Smithfield, was making for him, was on the plan of the inhaler of Mr. Jeffreys, with some alterations and additions. The air would meet with no obstruction from having to pass through sponge or ether, and the instrument, which would be of metal, as a good conductor of caloric, would be cheap and portable.

Dr. W. Merriman had seen, at St. George's Hospital, three cases in which operations had been performed after the patients had inhaled ether. In the first case the inhalation succeeded whilst the patient was in the ward; but on coming into the theatre, the bandage fell from his eyes; he seemed frightened; no effect followed the inhalation, and he was sent away. In the second case a man had to have a finger removed. The first efforts at inhaling the ether were followed by some spasm and struggling; but at the end of ten minutes he appeared to be insensible, and the operation was commenced; the instant, however, the knife touched him, he bawled out, and snatched his hand away. In short, the ether had failed. In the third operation a leg had to be removed. The man inhaled for four minutes; he sank back as if insensible. Mr. H. J. Johnson got on with the operation (the crucial one), without evidence of pain, until he reached the bone; the man then woke up, said the saw was being used, but expressed himself free from pain. He winced, however, under the application of cold water to the stump."

Mr. Brooke believed that in both these cases the pulse rose in frequency.

Mr. Hale Thomson believed that the failures in almost every case arose, either from an injudicious use of the instrument employed, from the imperfect nature of the instrument, or the inhalation of free atmospheric air. He commented severely on the mania which seemed to prevail of making experiments with improper or imperfect instruments, instead of pursuing our investigations rationally and philosophically with an instrument known to be generally successful. He alluded to the instrument as modified from the one recommended by Dr. Boott and Mr. Robinson. Experiments made with instruments not at all calculated to develope the proper effects of ether were injurious to the character of the agent, and retarded the progress of our inquiries. He illustrated the baneful effects of this kind of proceeding by reference to the miserable and painful exhibitions which had taken place in the dental operations at the Westminster Hospital, where not only delirium, but convulsions, and almost asphyxia, had been the unfortunate results. He alluded to his own cases, recorded in this journal last week, as completely successful, and regarded their success as the result of a proper application of a good instrument. He threw out the hope that the ether would be a valuable agent in cases of hydrophobia, tetanus, and other spasmodic diseases.

Some discussion took place in respect to the value of the ether vapour in operations on the eye.

Dr. Ayres said that the eye, under the influence of the ether, was fixed as in sleep.

Mr. Thomson thought it would be less applicable in diseases of that organ than in others. Operations on the eye were not of a very painful character. He thought, with respect to its use, that it could not be safely employed in children, as the debilitating effects of ether were often of a very formidable character.

Mr. Hancock had operated on a boy of 11 years of age for strabismus, under the influence of ether; no bad effects resulted.

Dr. Snow had seen Mr. Lawrence remove a diseased eye from the orbit with complete success.

Dr. Bowman thought that the fact of spasm and convulsion occurring in some cases would prevent the ether from being useful in cases at tetanus, [etc.]"

"Westminster Medical Society," LMG 39 (1847): 156-57.