HYDROBROMIC ETHER OR 
BROMIDE OF ETHYL AS 
AN AN,ESTHETIC. 
I.AURKNCL TURNBULL, M. T)., PH. G., 
OK ITIII.ADK.I.ITIIA. 
Kefrintni from the Journal of the American Me/lit a I 
Association, Movemher 2r. rtttf f. 
CM (CABO: 
IVINTHI) AT THIS Ol'l K K OK TIIU ASSOCIATION 
1885. HYDROBROMIC ETHER OR 
BROMIDE OF ETHYL AS 
AN ANAESTHETIC. 
LAURENCE TURNBULL, M.D., PH. G. 
OF PHILADELPHIA. 
Reprinted from the Journal of the American Medical 
Association, Novevtber 21, iSSj. 
CHICAGO; 
Printed at the Office of the Association. 
1885. HYDROBROMIC ETHER OR BROMIDE OF ETHYL 
AS AN ANESTHETIC. 
The hydrobromic ether or bromide of ethyl was 
discovered by Serullas in 1827, but received no spec- 
ial attention until Dr. Thomas Nunnelly, of Leeds, 
made some experiments with it on animals in 1849. 
Dr. Nunnelly brought the subject again before the 
profession, by a paper read at the meeting of the 
British Medical Association in 1865, in which, in con- 
junction with another anaesthetic, he says he had 
employed the one or the other in all the principal op- 
erations at the Deed’s General Eye and Ear Infirmary. 
This was at the time when chloroform held such com- 
plete sway in England, that no importance was at- 
tached to Nunnelly’s experience or experiments, and 
he had no one to follow him in using it, and we hear 
no more of it until 1876, when some experiments 
were made with it in France, by Rabuteau, on the 
lower animals, but evidently without a knowledge of 
the fact that this had been done previously in Eng- 
land by Nunnelly. 
I then took the agent up without the knowledge of 
the experiments of Dr. Nunnelly, of England, and 
had it made in Philadelphia by Professor Remington, 
and with two friends began experimenting in Septem- 
ber, 1877, using it first on myself, and then upon my 
patients. After satisfying myself as to its efficiency 
and safety as an anaesthetic, I laid the subject before 
the Pennsylvania State Medical Society in 1878, and 
a record of ten cases, with my conclusions, which 
were published in the volume of their Transactions 
for that year. In August, 1879, I brought it before 
the British Medical Association at Cork, and in Sep- 
tember of the same year, I presented a report of one 
hundred cases before the International Medical Con- 
gress at Amsterdam (to which I was a delegate from 4 
the American Medical Association), up to March, 
1879, when the second edition of my work on anaes- 
thetics went to press I had published a report of 
125 successful cases in quite a variety of surgical 
operations, and had not only employed it at my 
daily ear clinic, but also in the Jefferson Medical 
College Hospital, and administered it in April, 1879, 
to a patient of Ur. Samuel W. Gross, at the public 
clinic, when he (Dr. Gross) removed a hyoid cyst in 
front of the neck of a child. Dr. R. J. Levis, who 
was at this clinic, for the first time saw it employed, 
and became much interested in its use. 
I thus compelled chemists to make it, by produc- 
ing a demand for it, and gave them, through Dr. 
Green, a good formula free from phosphorous; I in- 
terested surgeons all over the country to try it, and 
especially the surgeons of this city, by bringing it in 
every way before their attention. Subsequently the 
whole number of cases in which it has been employed 
by myself and friends up to June, 1880, numbered 
some eight or nine hundred. 
I can but feel disappointed that two deaths, not 
produced by it, should have been associated with it,1 
as such accidents will be employed by those having 
a prejudice against the ether, to condemm it on theo- 
retical grounds.2 It is my firm conviction that al- 
VThe bromide of ethyl as an anaesthetic, by Marion Sims, M.D,, 
LL.D., New York Medical Record, April 3, 1880. 
2ln the discussion following the report of the fatal case by Dr. Sims to 
the New York Medical Society, Dr. Squibb, undertook to account for the 
poisonous effects of bromide of ethyl by assuming it to be a loosely molecu- 
lar article, easilysdecomposed, that thus its administration is prone to be 
followed by an impregnation of the system with bromine, and that if it 
remained as bromide of ethyl in the system it might not be harmful. This 
theory has been shown to be based on insufficient grounds. In the first 
place, Prof. Jungk has shown, bromide is not “a loosely molecular article,” 
that in fact it is a very stable salt (for a salt it really is), and very difficult 
of decomposition, much more difficult than chloroform. In the second 
place, the assumption that anaesthesia is due to a breaking up of the 
anaesthetic into its elements is nothing more than a hypothesis, and one 
too, which has little or nothing to support it. The fact that it is one of 
the characteristics of bromide of ethyl, that it is perfectly unirritating to 
the bronchi, goes to show that it is not decomposed- if it were, the bro- 
mine in its composition, one of the most irritant of substances, would 
certainly manifest itself in its effects on the air passages. 5 
though in several instances recently the use of this 
anaesthetic has been attended with persistent vomit- 
ing, in the thousands of cases in which it has been 
employed, chiefly in Philadelphia, in not one single 
instance has it caused cerebral trouble, or any of the 
symptoms produced by the action of free bromine, 
which are as follows. When dogs are confined in an 
atmosphere of bromine vapor, they suffer a profuse 
secretion from the eyes, nostrils, and fauces, with 
cough, hoarseness, dyspnoea. I have experimented 
upon frogs, cats, dogs, rabbits and various other ani- 
mals by subjecting them to an atmosphere highly 
charged with the vapor of hydrobromic ether, and in 
no instance was there the slightest effects as described 
above. 
In the case of death under the employment of this 
agent in the hands of Dr. Levis, in subjecting the new 
anaesthetic to this most severe test, we do not think 
Dr. Levis was doing justice to it; knowing the ex- 
treme debility of the patient, and that the most sim- 
ple nervous shock would render him liable to death. 
Hundreds of patients have thus died. Again, when 
ordinary ether, chloroform, or other anesthetics cause 
fainting, which was no doubt tie result in this case, 
respiration has to be resorted to; now we are reliably 
informed that when this useful means was resorted to 
by alternating and relaxing the chest walls, the pus 
which was in this man's lungs was forced into his 
bronchial tubes and suffocated him. Again we are 
very sorry that the valuable agent, nitrite of amyl, 
which has been found useful in such cases, was not 
employed. 
Philadelphia, June 2, 1880. 
“Deputy Coroner Beam made an investigation of 
the circumstances, as reported in The Times, of the 
death of Wm. Linderman, 18 years old, of Schuylkill 
county, while upon the operating table at the Jefferson 
College Hospital under the influence of the new anaes- 
thetic, bromide of ethyl, and about to be treated for 6 
stone in in the bladder. He had been about sixteen 
weeks under the care of Dr. R. J. Levis, one of the 
strongest advocates of the new anaesthetic, and was 
taken to the hospital by his direction. Linderman’s 
health was very poor at the time. Dr. Ames, who 
applied the bromide, said no incision had yet been 
made, but Dr. John B. Roberts said it had. The pa- 
tient was in such a condition that something had to 
be done, because he could not tide over the hot 
weather; 96° 98° in the shade. 
“Dr. J. G. Lee, the Coroner’s physician, testified 
that he found the brain congested, the lungs far ad- 
vanced in consumption, and the kidneys and liver en- 
larged and two large encysted stones in the bladder. 
His opinion was that they could not have been safely 
taken out. Linderman could not have lived over a 
week or two at any rate. Dr. Lee said further, that 
he had experimented with the bromide on animals 
without bad results. In his opinion death resulted 
from exhaustion and prostration, the result of phthisis. 
The jury took the same view in their verdict.” 
In some recent experiments on animals, I crowded 
four ounces (the quantity stated to have been used 
by Dr. Sims) upon a dog for several minutes, by 
means of a tin inhaler, until he became apparently 
dead, with no perceptible action of the heart or lungs, 
but the expression of his eye was clear, and the pupil 
was dilated, while there was no secretion from the 
eyes or nostrils. The apparatus was removed in the 
space of four minutes, and he was exposed to the 
air when at once he began to breath, and by the end 
of the six minutes, he had almost entirely recovered 
consciousness. The dog did not seem much inclined 
to move for ten or twelve minutes afterwards. While 
this dog was only partly under the influence of this 
anaesthetic, having at first caught the inhaling appa- 
ratus with his under teeth; there was a good deal of 
rigidity, and slight tetanic movements of the extrem- 
ities, but this was overcome by the free use of the ether. 7 
Now, had we been using chloroform, just before 
we would have been ready to perform any experi- 
ments upon the animal, he would have been dead, 
and no removal of the anaesthetic nor the introduction 
of atmospheric air, would have been of any avail. 
Again if Squibb’s rectified and absolute ether had 
been employed; we must have super-saturated the 
animal,and been annoyed by the expectoration of large 
quantities of mucus, and in one recent experiment by 
me was followed by death. Then we frequently have 
seen tetanic convulsions, requiring several assistants 
to hold the patient, with great reduction of temper- 
ature, from the use of ordinary ether. The rapidity 
of the anaesthetic action of hydrobromic ether and 
its rapid elimination from the system by the lungs, 
are two of its chief merits for all operations that are 
not prolonged. If an operation is to be very tedious, 
and requires from one to two hours, we would advise 
the additional use of purified sulphuric ether to the 
anaesthetic. We would therefore recommend pure 
hydrobromic ether in operations not lasting over forty 
minutes. There is one great advantage in the use of 
this agent, that the administrator must attend to the 
anaesthetic all the time, he cannot watch the op- 
eration and forget the patient for a few seconds, his 
whole attention must be given to keep up its action. 
We have often felt sure that the wet napkin, from the 
water, in the ordinary ether pressed over the patients 
mouth by the weight of the body of the persons giv- 
ing the ether, and watching the operation, were the 
indirect causes of the death of the patient. As an 
anaesthetic in labor, it has peculiar advantages in that 
it is so rapid in its effects, and the patient is comforted 
between the pains, but never passes into such a state 
of profound anaesthesia, that she is not aroused by the 
expulsive effort, and has all her consciousness about 
her; and there are none of the depressing effects of 
ether or chloroform. It is also most valuable in these 
cases in changing the position of the child, also in 8 
bringing forward the neck of the uterus into its proper 
position.1 In none of my cases was there disturbance 
of the bowels, pain in the back or head. To the 
country practitioner, who has to extract teeth or per- 
form all the minor operations in surgery, it is a great 
boon, as it acts like nitrous oxide gas; it is well where 
a number of teeth are to be extracted, that a prop of 
hard wood attached to a string should be used so as 
to prevent such an accident as once occurred in Phila- 
delphia under the use of nitrous oxide gas—the swal- 
lowing of a prop of cork. In many cases in which 
we do not want a very profound narcotism with hy- 
drobromic ether, the muscles of the patient become 
rigidly contracted. This condition occurred in a re- 
cent case, when we administered of this amesthetic 
and the operators finger was caught and pinched, as 
also his forceps; and yet before operating we could 
touch the cornea with impunity. Although the im- 
pression passed away very rapidly, twelve teeth were 
extracted with entire success, the patient promptly re- 
covering consciousness, and not feeling the pain. In 
the following case the patient went under it very 
kindly: This patient was a man of very nervous 
temperament. With three drachms of the hydrobromic 
ether anaesthesia was produced without any struggling, 
and in four minutes from the time he had commenced 
to inhale it, the dentist had extracted ten teeth, and 
he had fully recovered consciousness, although he 
had just eaten a breakfast of solid food. There was 
no nausea in either of these cases. 
In a recent case of cataract extraction, the patient 
went beautifully under the influence of the anaesthetic, 
extraction was accomplished, and the patient recov- 
ered so as to be able to count fingers, yet owing to 
some strong coffee which she drank, from dyspeptic 
symptoms, or the swallowing of water soon after the 
operation, she became very sick at her stomach, and 
ISee pamphlet on the “Bromide of Ethyl as an Anmsthetic in Labor,” 
by E. E. Montgomery, 12 pp. New York; W. Wood & Co,, 1885. 9 
vomited for almost twenty-four hours; and yet the 
case did well. In case of operation for torticollis in 
a woman, she swallowed so much air with the ether, 
that as a consequence she complained of pain, of a 
hysterical character, in lower part of the abdomen, the 
same which is often the result of nitrous oxide gas 
inhaled, and too much air admitted. 
We received a letter from the late Dr. J. Patterson 
Cassells, of Glasgow, a distinguished aurist and a 
surgeon to the celebrated Glasgow Infirmary. He 
writes that he has used a specimen of the hydrobromic 
ether, which I gave him at Cork, as vapor, in diseases 
of the middle ear, and has also employed it as an 
anaesthetic with success. 
As I have before stated,1 uno ancesthetic can be used 
with absolute safety.” See “ A Presumable Ether- 
Death from Heart Failure,” by John R Roberts, 
M.D., Medical News, Sept. 27, 1884; by the same 
author, “Ether-Death,” Medical Times, June 4, 1881. 
“Case of Death following the Inhalation of Chloro- 
form,” reported by P. L. Helsman, M.D., Albany 
(Ga.) Medical News, Sept. 27, 1884. No anaesthetic 
has been yet found that is free from danger; 
all will kill. Chloroform kills in round numbers 
about one in every three thousand. Pure ether is, 
next to nitrous oxide, the safest anaesthetic, only 
seventeen cases of death, and many of these doubt- 
ful; but it requires boldness and freedom in its ad- 
ministration. If slowly or ineffectually administered 
it is apt to produce a free secretion of bronchial mu- 
cus, which occasions troublesome coughing. If 
nitrous oxide is administered alone as a prelude to 
ether, the secretion of mucus is less troublesome, 
but there is a great amount of venous congestion 
and the tissues become gorged with blood, so that 
every incision tends to bleed. Some surgeons use 
the mixture which is known as A. C. E., which con- 
!Ether fortior, liquid, 94 per cent, of oxide ethyl, 6 per cent, of alco- 
hol, and a little water. tains one part by measure of absolute alcohol, two 
of chloroform, and three of Squibb’s ether. This is 
not simply a mixture; the absolute alcohol,1 99.4 per 
cent., causes a solution of the other two and they 
evaporate together. But the mixture should be ad- 
ministered freely from a cone of felt or flannel, with 
a paper covering, and the desired effect should be 
produced as rapidly as possible. The best results are 
by the agents which produce rapid effects, and which 
are as rapidly recovered from. No other has pro- 
duced such rapid anaesthesia as the hydrobromic, and 
it is the most rapidly recovered from. 
There are certain conditions of the system that 
forbid the use of, anaesthetics. Again, there are cer- 
tain of this class of agents that should not be em- 
ployed in prolonged operations, as, for instance, the 
“bichloride of methyline,” bichloride of ethedene, 
and bromide of ethyl. One or two deaths have fol- 
lowed the improper use of each of these agents, even 
when recommended by a committee appointed by 
the British Medical Association and by Sir Spencer 
Wells.2 As the result of the observations and exper- 
iments with the bromide of ethyl, my conclusions 
have been that one hour is the longest time that a 
patient should remain under the influence of this 
anaesthetic with safety; just as is the case in the ad- 
ministration of potent remedies like morphine, atro- 
pine, hydrocyanic acid, etc.; no one will attempt to 
ignore or not use such valuable remedies because in 
certain individuals and under certain conditions of 
the system they produce death. Can we in all cases 
rely on the experiments on animals as a true and ab- 
solute guide to determine our course in the human 
being? We think not; for it is a well-known fact 
Specific gravity .0716, at 77° F. 
2Turnbull on “Artificial Anaesthesia,” second edition, 1879. 
Messrs. Regnauld and Villejean (Lancet, July 6, 1884) have con- 
firmed my statements (see page 65 of the last edition of my work) that 
the so-called “ chloride of methyline” is a mixture of chloroform and 
methylic alcohol. that many animals eat plants which are deadly poi- 
sons to man, and certain anaesthetics are fatal to 
dogs.1 Again, certain salts taken with impunity by 
man are poisonous to animals. Experiments in the 
laboratory with the prolonged use of anaesthetics of 
two hours3 duration, cannot be taken as the results 
against those obtained by numerous careful observ- 
ers on themselves and others. Clinical experience 
has now reached at least two thousand2 well authen- 
ticated cases in which the bromide of ethyl has been 
employed with safety since 1880, when the two deaths 
were reported. 
I will quote only a few of the many impressions 
and experiments with the pure bromide of ethyl. 
The first is a gentleman very familiar with all the 
other anaesthetics, and his experience should be wor- 
thy of confidence:3 
The following trials of this new anaesthetic were 
made to test its merits and to obtain personal expe- 
rience of its effects. For the record of occurrences 
after loss of consciousness, and for care and atten- 
tion during administration, he was indebted to his 
friends, Drs. Pilate and Conklin: 
First Experiment—March 14th. Four hours after 
eating a moderate breakfast he proceeded to inhale 
the bromide of ethyl, in the recumbent position, and 
from a bottle just opened labelled “ 1 oz. bromide 
ethyl.” About one-fourth of the contents was poured 
into an Allis ether inhaler. The first and immediate 
sensations upon inhaling it were a sharp pungent im- 
pression on the air-passages, a sense of warmth rap- 
idly extending, and exhilaration. With the second 
inspiration he felt a decided influence upon the brain, 
and began to talk, anxious to continue speaking as 
*Dr B. A. Watson, Jersey City. “An Experimental Study of Anaes- 
thetics.” Medical News, p. 313, May, 1878. Method not given. 
2Dr. Chisholm, of Baltimore. Md. Med. Jour., January, 1883. Dr. 
Prince, of Jacksonville. St. Louis Med. and Surg. Jour., October, 1883, 
and Dr. L. Turnbull, of Philadelphia. Medical Bulletin, June, 1880. 
3“Two New Anaesthetics,” by J. C. Reeve, M.D., Dayton, Ohio. 
■Cincinnati Lancet and Clinic. 12 
long as possible, and to state his sensations. A rapid 
beating in the ears is a constant symptom with him 
in taking chloroform, and immediately precedes en- 
tire loss of consciousness. He marked its presence 
now, and also its early appearance. It could not 
have been later than the third, or possibly the fourth,, 
inspiration when he noted it, and this, as with chlo- 
roform, was the last sensation. 
Upon opening his eyes after recovery from the an- 
aesthetic, he immediately collected himself and could 
remember all; could talk clearly and had no confu- 
sion of thought. He felt a slight sense of nausea 
and a feeling of languor. Eight minutes afterwards 
he got up and walked about without dizziness, and 
was confident he could have done so sooner. He 
did not attempt it sooner because he felt that sick- 
ness would ensue if he arose. The feeling of nausea 
remained until he commenced eating his next meal, 
about forty minutes later. 
Second Experiment.—Pulse at beginning, 80, just 
after ascending stairs, Two drachms administered. 
Symptoms began to be manifested after two respira- 
tions. Spoke of general warmth, pleasant sensations 
and beating in the ears. Anaesthesia produced in 
one minute and a quarter; in another quarter minute 
it was profound, as tested by a knife point. Pulse 
during the first minute ran up to nearly xoo, then 
fell during next minute to about 70, feeble and inter- 
mittent. Pupils unchanged, normal; no struggling 
or excitement, but tetanic clutching of the inhaler so 
that it could not be gotten away only with difficulty. 
The anaesthesia lasted one minute and a half, then 
awakening without mental confusion. Pulse seven 
to eight minutes later, 64. He was not satisfied 
with this experiment, particularly in regard to the 
irregularity and intermittencc of the pulse, not a very 
assuring symptom in anaesthesia, and a result not 
agreeing with other observers. He had a suspicion 
from this fact, and from the nausea, that the speci- men was not pure. The bottle bore the name of a 
house which is always a guarantee of the good qual- 
ity of medicines; but in the early period of manu- 
facture of a new article, it would not be surprising 
if perfection was not immediately attained; he there- 
fore obtained another specimen,l and one week after 
the above trial again inhaled it. 
Third Experiment.—Being in the recumbent posi- 
tion, four hours after eating, one drachm, by meas- 
ure, was poured into Allis’s inhaler. He tried to 
take it slower this time, and count the respirations 
aloud to mark when conscious action ceased. He 
immediately felt the same grateful and pervading 
glow of warmth all over the body; counted to the 
seventh respiration; beating in the ears was again 
the last recognized impression. Pulse before, 80; at 
the end of the first minute, 120; one and a half min- 
utes, at the rate of 100; at the end of two minutes, 
78; no irregularity or intermittence. Pupils unaf- 
fected. Totally unconscious in one minute. Con- 
sciousness returned in three minutes. 
It was his design to push the inhalation farther this 
time, and to test the muscular relaxation as well as 
to decide in regard to the irregularity of the pulse. 
Feeling that this had not been done, after about fif- 
teen minutes he took it again. 
Fourth Experiment.—Two measured drachms were 
poured on the inhaler, and he placed it over his 
mouth and nose. The impression was much stronger 
on the nose and air-passages, and the first inspiration 
made him cough. He then counted to the third in- 
spiration, and was gone. Pupils the same as before, 
unaffected; pulse before taking, 78; at the end of 
the first minute, 124; one and a half minutes, 100; 
and of two minutes, 78; no irregularity or intermit- 
tence. Anaesthesia in one minute. At the end of 
three minutes from the time of beginning he got up 
and walked across the room, and could have remained 
IFrom the house of John Wyeth & Bro., Philadelphia. 14 
up. As an effort at prolonged anaesthesia this was 
not, therefore, a success. In eighteen minutes he 
was on his way driving to see a patient. He had 
not the slightest nausea after these two inhalations; 
felt, if anything, better than before. 
Fifth Experiment.—His next trial of the agent and 
first attempt at administration, was not satisfactory. 
The patient was a man aged about 50, a wiry, mus- 
cular fellow, of the type and build likely to give 
troublesome symptoms with any anaesthetic. He 
was placed on the table for an operation for haemor- 
rhoids, by Ur. Conklin. He had brought with him 
for the administration a large conical sponge, with 
which he constantly gave the A. C. E. mixture. Up- 
on this he poured two drachms of hydrobromic ether 
and placed it over his mouth and nose. After one 
long deep inspiration his face became deeply flushed, 
and he soon began to talk and then to shout. More 
of the liquid was poured on the sponge; but his 
movements interfered with the inhalation of it with 
promptness; muscular rigidity then came on, and 
was marked; respiration was very nearly if not quite 
stopped for a time by tetanic spasm of the chest. 
These symptoms were almost as bad as he had ever 
seen from ether, chloroform, or the mixed vapors. 
He had seen worse muscular action and rigidity, but 
this was as bad as generally met with. During this 
time the ether was rapidly added until the supply 
was exhausted (13 drachms), and sufficient relaxa- 
tion was not produced to make the operation feasi- 
ble. No observations could be made, of course, of 
the patient’s pulse. He recovered consciousness 
quite rapidly, as compared with other anaesthetics, 
and suffered no unpleasant after-effects. 
This was not, of course, a fair trial of the remedy. 
The mode of administration was decidedly faulty. It 
is an ether, and must be given as an ether; and that 
this is imperative is the lesson to be learned by this 
failure. “The personal experience with hydrobromic ether 
fully sustains the observations of others as to its ex- 
ceeding promptness of action, and the rapidity with 
which recovery from its effects takes place. It is 
also more pleasant to inhale than chloroform, which 
is not very unpleasant, and infinitely pleasanter than 
ether.” 
In my own experiments on animals I found that 
frogs, placed in a watery solution of ethylic bromide, 
become as completely anaesthetized as if they were 
immersed in an aqueous solution of chloroform.1 
Berger states to the Societe de Chirurgie (Le Progres 
Medical) that he had been impressed by the rapidity 
with which these animals succumbed to its vapor. 
Terrillon administered the vapor of ethylic bromide 
to eighteen dogs without accident to any one of 
them 
Dr. Ott, of Easton, Pa., who has made thorough 
and scientific researches with the bromide of ethyl, 
experimenting upon frogs and rabbits, believes that 
the increased frequency of the pulse is due to stimu- 
lation of the accelerative nerves, or of the cardio- 
motor ganglia, and the dangers in administering the 
drug are less than those of nitrous oxide. 
W. H. Kingston, Montreal, Canada, has used no 
other anaesthetic since commencing the use of bro- 
mide of ethyl. There is less resistance and strug- 
gling on the part of the patient. Vomiting is less 
frequent. Eliminated from body more rapidly than 
any anaesthetic except laughing gas. 
“ That bromide of ethyl is one of the, and in some 
respects the, most valuable anaesthetic hitherto used.” 
In Terrillon’s experiments muscular relaxation oc- 
curred in human beings in two or three minutes; at 
times there was congestion of face, neck and upper 
part of the chest. The pupils did not contract, but 
were dilated. The pulse was always quickened, and 
every fresh dose caused fresh acceleration. Respi- 
IQpt. cit. “Artificial Anaesthesia.” Turnbull. ration was always hastened, and a hyper secretion of 
the buccal and pharyngeal glands took place. Sen- 
sibility and consciousness returned with great rapid- 
ity; vomiting was not uncommon both during insen- 
sibility and sometimes for hours after. Verneuil, at 
the same meeting of the Societe de Chirurgie, stated 
that one patient, a woman, to whom he had given 
the vapor of ethylic bromide, was asleep in an in- 
stant ; and Terrillon stated that anaesthesia may be 
produced in less than a minute. In our own exper- 
iments the shortest time necessary for primary anaes- 
thesia was thirty seconds. 
Dr. VV. C. Wood found, by experiments upon ani- 
mals, that if the vapor of ethylic bromide be given 
with moderation, anaesthesia may be produced with- 
out notable reduction of blood-pressure. In the ex- 
periments of Dr. C. C. Gay,1 of Buffalo, the agent 
employed was evidently, from color and taste, im- 
pure, as was also that used by Dr. D. C. Wilkinson,2 
of Galveston, Texas. In Dr. I. C. Moore’s cases 
the ethyl was abandoned for ordinary ether, even 
when the insensibility had not passed off, owing to 
the exhibition of so-called bad symptoms, great ex- 
citement, with intense and persistent retching and 
vomiting, with venous engorgements. The article 
was stated to be pure, and was from Wyeth & Bro. 
The great demand for the article and the cost and 
care requisite, caused many imitations to be placed 
upon the market, and even the original manufacturers 
did not take sufficient time to purify it, so that for a 
time the article contained carbon bromide (C 284),84), and 
free bromine phosphorus and bromoform. These 
were found in the specimens employed by Dr. Sims, 
in the form of a brown acrid liquid, with a pungent 
and disagreeable odor. Twenty drops of this given 
to a rabbit which had previously taken two grammes 
(thirty grains) of pure ethylic bromide without the 
IMedical Record, July 17, 1880. 
Record, May 15, 1880. slightest ill effect, produced irritation of the gastro- 
intestinal tract, followed by death in eighteen hours.1 
As well observed by Dr. Henry M. Lyman : “All expe- 
rience shows that the administration of anaesthetics 
to such patients is attended with danger. Even sul- 
phuric ether may prove fatal if the kidneys are se- 
riously damaged, and pulmonary disorganization is a 
well-known source of danger during the inhalation of 
anaesthetic vapor. The administration of chloroform 
to such a patient would have been a very hazardous 
undertaking. The fatal results in these cases cannot 
be so charged against the particular anaesthetic em- 
ployed, as against the exhibition of any anaesthetic 
agent whatever.”2 
That ethylic bromide may be employed with ease 
and success, has been abundantly proved by the ex- 
perience of many observers. M. Bourneville has 
administered it to a large number of patients in the 
Salpetriere Hospital, for the arrest of paroxysmal 
hysteria and of epilepsy. He has also administered 
it daily by inhalation for fifteen or twenty minutes, 
with the fortunate result of considerably diminishing 
the frequency of the convulsive paroxysms. In sev- 
eral of these cases the temperature was depressed 
about half a degree centigrade during the act of in- 
halation. Immediately after the withdrawal of the 
anaesthetic the normal degree was recovered, and 
sometimes even surpassed. The pulse in about five 
hundred administrations was somewhat accelerated 
during the period of inhalation. In six instances 
only was retardation observed. Respiration in like 
manner was almost always accelerated. A copious 
overflow of tears was nearly always remarked. The 
urine never contained either albumen or sugar, and 
the quantity of the liquid was not affected. Rigidity 
of the limbs and tremor involving the upper extrem- 
JD. S. Wolff, Am. Journal of Pharmacy, May, 1880. The writer 
also obtained a portion of the same liquid from Dr. Wolff, and on com- 
paring it with the specimen from Or. Sims found it to be the same. 
2“Artificial Anaesthesia and Anaesthetics.” Pp. 220, 221. ities, were sometimes noted. Daily inhalations for 
a period of two months exercised no unfavorable in- 
fluence over the general process of nutrition; five 
patients found their weight increased during this 
period. 
There are certain preparatory precautions which 
are necessary to the safe inhalation of the bromide 
of ethyl: 
1. All tight-fitting garments in and about the neck 
and chest should be loosened. ' 
2. The saturated ethyl vapor must be inhaled al- 
most to the exclusion of atmospheric air. The best 
form of inhaler is a thick towel folded in the form of 
a cone, closed at the apex with a large pin; between 
the folds of the towel place a sheet of newspaper. 
3. Instruct the patient in advance to make deep 
and long inspirations. In the cone place about one 
drachm, by measure, and at once cover the nose and 
mouth with it, and do not remove the cone until an- 
aesthesia is produced, which will be in from twenty 
to thirty seconds. 
The anaesthetic sleep will not last more than from 
two to three minutes. The patient retains the usual 
healthy color of lips and skin, and the pulse first 
becomes rapid, then slower and stronger as the nar- 
cosis becomes profound. The patient, as a rule, 
awakens suddenly and completely; but if there is 
nausea or much agitation, it is best for him to re- 
main quiet and in a horizontal posture for some time. 
Perhaps no operations are more painful than those 
on the eye, eyelids, or eyeball, in a sensitive person, 
and there is no anaesthetic that I have found so ap- 
plicable as bromide of ethyl in such operations. I 
recently administered it for the removal of a deep- 
seated tumor of the eyelid, the operation being per- 
formed by Dr. Hermann Knapp, of New York. The 
patient took the towel in her hands and applied it to 
her face with about two drachms of the ether, and 
in thirty seconds she was so completely anaesthetized that she was not conscious of one particle of pain 
until the tumor was entirely removed; she had no 
nausea whatever, or any other disagreeable symptom. 
Again, in operations on the diseased mastoid cells, 
I have employed it in some twenty cases with entire 
success, and in a very recent case in which the whole 
bone was diseased and much of it had been removed, 
an opening had to be made of a most painful nature. 
I administered the bromide of ethyl to this patient, 
who was very much exhausted by profuse discharge 
from a large cancerous growth. The patient went 
under the influence of this anaesthetic with the most 
delightful effect, not suffering at all from the operation, 
and going to sleep after it without a bad symptom. 
We have, in times past, heard a great deal of the 
injurious effects of bromides, and at first we felt that 
it might be so, reasoning in a chemical way, and for 
a time we gave the hydrobromic acid and ether with 
great caution, never exceeding thirty drops three 
times a day. But not so now; experience has taught 
us that we can use it, if well diluted, up to sixty 
drops three times a day without any injurious results. 
To obtain its full physiological effects in epilepsy, 
certain cases of pulsating tinnitus aurium, and in 
preventing the disagreeable cephalic symptoms oc- 
casioned by quinine and iron in these various ner- 
vous affections, we have found it at times very sat- 
isfactory. The salts of this agent, bromine, can be 
and are used with the greatest freedom in the form 
of bromide of potassium, sodium, and lithium, in 
doses of grs. xl-Hvi, given in six days without the 
least fear of its injurious effects upon the most deli- 
cate stomach; and relieving, as by a charm, convul- 
sions, epilepsy, whooping cough, sleeplessness, head- 
ache, cerebral disturbance, tetanus, and all forms of 
mental derangement. 
As well-observed by Dr. Chisolm:1 “For office 
use I find the bromide of ethyl invaluable on account 
IMaryland Medical Journal, January, 1883. 20 
of its promptness, efficiency, evanescent nature of 
the anaesthesia, indeed, the absence of nausea, and 
the perfect comfort with which patients operated up- 
on can leave my office within a few minutes after the 
ethylization.” 
Bromide of ethyl should never have taken the place 
of chloroform or sulphuric ether where any tedious 
operations are to be performed; but there is no rea- 
son why this useful anaesthetic should not be em- 
ployed in all operations in minor surgery and in those 
on the eye, ear, throat and noie, having everything 
ready in advance so that the patimt shall be as short 
a time as possible exposed to the evil effect of an 
anaesthetic. 
I conclude this brief paper by the results which I 
obtained, and the conclusions I then arrived at 
(1879), and I still consider them my firm opinion at 
the present time, after using the article from 1878 to 
1885 in all my office operations: 
Minutes. Seconds. 
Shortest time taken to place a patient under the 
primary anaesthetic influence o 30 
Longest time 5 00 
Average time 1 30 
I did not then advise that bromide of ethyl should 
be resorted to in protracted operations, and I never 
have employed it in any case longer than forty min- 
utes, and have never used more than four ounces of 
the pure ether in one case. 
1502 Walnut St., Philadelphia, Oct. 12, 1885.