ETHYLIZATION: 
The Anaesthetic Use of the Bromide of Ethyl. 
HY 
R. J. LEVIS, M.D., 
SURGEON TO THE PENNSYLVANIA HOSPITAL AND TO 
THE JEFFERSON COLLEGE HOSPITAL. 
From “ The Medical Record.” 
SHERMAN A Co. PRS. PHIIA. ETHYLIZATION: 
The Anaesthetic Use of the Bromide of Ethyl. 
My observations of the anaesthetic action of the bromide 
of ethyl, which commenced in April, 1879, have been 
directed to its physiological action in the human subject, 
to its practical application in the relief of human suffering, 
and to its value as compared with other anaesthetics. 
Every administration has been carefully watched and 
studied, and records of its phenomena have been made as 
they were observed. From such basis of experience, I 
present some facts which may at least help toward a 
proper estimate and appreciation of its therapeutic value. 
Since the publication of my recent articles on the sub- 
ject in the Philadelphia Medical Times, my continued 
observations have been generally confirmatory of the 
statements then made. I now summarize the deductions 
from my entire experience in the anaesthetic use of the 
bromide of ethyl, and present my convictions in regard to 
its comparative value. 
The terms bromide of ethyl and hydrobromic ether are 
arbitrarily applied by chemists, in accordance with differ- 
ing chemical nomenclature; but, for distinctiveness, and 
without reference to chemical accuracy, I prefer the former 
expression. I prefer to give to the substance the generic 
name of ethyl, and speak of ethylizing and ethylization 
on the same grounds, as, by common consent, the words 
ether and etherization are applied to sulphuric ether. 
The decided characteristics of the administration are its 
rapidity of action and the quickness of recovery from its 
impression. I have produced complete anaesthesia in cases 
of young children in less than one minute. The longest 
period required to produce the anaesthetic state in adults 
has not exceeded five minutes. 2 
The ethylized patient recovers much more rapidly than 
is the case with chloroform or ether. Intellection and 
muscular co-ordination are regained very soon after the 
inhalation has- ceased. In some instances these functions 
return as quickly as after the administration of the nitrous 
oxide gas, and frequently the patient, on awakening, is 
able to at once stand erect and to walk. 
If the anaesthetic impression be slowly effected, a brief 
period of intellectual excitement, associated with muscular 
action or rigidity, may occasionally be manifested; but 
violent emotion and struggling, if they should occur, are 
more moderate, brief, and transient than in the early stage 
of the anaesthesia of ether or chloroform. The stage of 
excitement can generally be avoided by making a rapid 
impression of the anaesthetic. I have observed that 
persons accustomed to the habitual use of alchoholic 
stimulants are less readily impressible by anaesthetics 
generally, and with them a stage of excitement is apt to 
precede anaesthesia. In this class of subjects narcotics act 
as stimulants, and the same holds true with regard to 
anaesthetics. 
As anaesthesia is developed the circulation generally 
shows evidences of moderate excitement, as indicated hv 
some increase in the rapidity of action of the heart, and 
the pulse evinces greater general arterial tension. The 
face of the patient usually becomes brightly flushed, and, 
when anaesthesia is profound, the forehead and the general 
surface are apt to be moist with sweat. In these respects 
the anaesthesia of the bromide of ethyl differs from the 
ordinary pallor of countenance and the usual check of 
skin-transudation of chloroforming. 
The physiological action of the bromide of ethyl does 
not incline to the dangers of cerebral anaemia and cardiac 
syncope, which sometimes occur in chloroforming, and, in 
my experience, no tendencies in such directions have 
seemed to threaten. The respiration is slightly increased in frequency until 
anaesthesia becomes complete, when it assumes the charac- 
teristics of normal sleep. The decided indication of the 
attainment of very profound anaesthesia is the slowing of 
the patient’s breathing, as in ordinary sleep, which becomes 
easy, long, and free. The irritation of the respiratory 
passages, which often inconveniences the inhalation of 
ether, does not occur in any degree with the bromide of 
ethyl. If brought into contact with the skin of the face, 
it is less irritating than chloroform. 
I do not recognize any ordinary after-effects on awaken- 
ing from the anaesthesia of bromide of ethyl, the patient 
speedily returning to his normal sensations and usual 
condition with but a drowsy sense continuing for a brief 
time. In my own person, the whole impression is more 
agreeable than is that of ether or chloroform; and others 
who have thus tried comparatively the different anaesthetics 
have expressed to me the same appreciation. 
The liability to nausea and vomiting is less than after 
ether and chloroform, but it is not entirely avoided. 
Occasionally vomiting will occur when food has been but 
recently taken, and I have in a few instances observed 
decided nausea and retching when no food was in the 
stomach, and merely some frothy mucus was ejected. The 
quick relief from the anaesthetic impression of the bromide 
of ethyl seems to render less likely the long continuance 
of the distressing nausea and vomiting which are liable to 
follow etherization and chloroforming. It should be borne 
in mind that the fully anaesthetized patient never vomits, 
and the manifestation of nausea during the continuance of 
the inhalation is the indication for making the impression 
more profound. When vomiting occurs and persists after 
anaesthesia passes off', it can best be relieved by giving to 
the patient small pieces of ice to swallow, or a full draught 
of ice-water. 
The quantity of the bromide of ethyl required to pro- 4 
duce anaesthsia varies with individual susceptibility and 
with the manner of using it. Its rapid evaporation causes 
much loss by diffusion in the atmosphere, but this waste 
may, with a view to economy, be to some extent avoided. 
I am in the habit of administering it by pouring two or 
three fluidrachms on several folds of woven lint, or on a 
small, soft linen handkerchief, over which is pinned a 
napkin, folded large enough to cover the entire face of the 
patient. Anaesthesia is, in my experience, more quickly 
obtained without the intervention of excitement, if light is 
excluded, and the temptation to look about avoided, by 
covering the eyes with a napkin. This plan seems to me 
to be the simplest and the best, and I trust that the anaes- 
thetic use of the bromide of ethyl may never become 
complicated or embarrassed by any forms of the absurd 
contrivances called inhalers. Such apparatus implies that 
all individuals are, under all circumstances, to be dosed 
with anaesthetics in the same mechanical manner. Nothing 
can be gained by any mechanical device for the purpose, 
excepting economy in the use of the anaesthetic, and some 
of the numerous devices would rather tend to wastefulness. 
A simple napkin or piece of lint, or both together, which 
absorb and gradually exhale the vapor, are perfectly 
effective and controllable as the means of administration, 
and nothing more can be required. With an extremely 
economical object, the texture upon which the anaesthetic is 
poured may be covered with an impervious material, or 
by a napkin dampened with water. 
In commencing the inhalation of the bromide of ethyl, 
I prefer always to make a rapid and decided impression, 
with the lint and napkin held closely over the nose and 
mouth of the patient. It is the object to attain anaesthesia 
without the intervention of mental and muscular excite- 
ment. In the administration of another anaesthetic—the 
nitrous oxide gas—we are familiar with the uncontrollable 
excitement liable to be produced by slowly inhaling small 5 
quantities; and we know as well what profound anaesthesia 
is induced by rapid and impressive doses of the gas. In 
the method which I prefer of administering the bromide 
of ethyl from a piece of folded lint and a napkin, it does 
not seem possible to exclude so much atmosphere as to cause 
danger from asphyxia. The air which, through the open 
texture of the material and from lateral directions, reaches 
the lungs, must really contain but a small percentage of 
the vapor, and at every expiration it is forcibly blown 
away. 
In my experience the entire quantity of ethyl consumed 
in effecting and continuing anaesthesia in any single case 
has varied from one fluidraclim, used .in a very brief 
period, to eleven drachms required in maintaining anaes- 
thesia through an operative procedure of forty minutes’ 
duration. 
After having tranquilized the patient’s mind by assur- 
ances of freedom from suffering and danger, I direct him 
to inspire and expire, for a time, as deeply as possible. 
The expirations should be so complete that the residuary 
air is expelled from the lungs. While continuing to thus 
breathe deeply, the inhalation is commenced. 
This preliminary drill I regard as important, and it will 
always facilitate the proper production of anaesthesia. 
Until complete anaesthesia is effected there should not be 
allowed a moment during which the patient does not 
inhale the vapor, and as the anaesthetic becomes exhausted 
it should be quickly replenished. 
It is proper that the administrator of any anaesthetic 
should be able to recognize and be satisfied with the sim- 
ple production of the anaesthetic state—insensibility to 
pain—without pushing the inhalation, as is often through 
ignorance or carelessness done, to a dangerously toxic 
condition. The best indication of complete anaesthesia is 
the change in the breathing of the patient to that of 
ordinary deep sleep. When ansesthesia becomes profound 6 
there may be a more or less snoring or puffing sound, due 
to relaxation of the palatine and buccal muscles. With 
such manifestations the administration should cease or be 
very moderately continued. It should be borne in mind 
that all anaesthetics become eventually, by continuance, 
depressing agents, and their administration should not be 
viewed as a matter of trifling responsibility, and entrusted 
to careless or inexperienced persons. The administrator 
should exclusively direct his attention to wliat he is 
entrusted with, regarding only the condition of the patient, 
and not observing the operative proceeding. I have wit- 
nessed an ignorant and heedless assistant resting his 
elbows on the chest of a patient, whose labored respiration 
and livid, turgid face showed threatening asphyxia, while 
the administrator gazed abstractedly at a surgical proce- 
dure taking place at the groin. 
I cannot too much impress the greater importance of 
observation and reliance on the state of the respiration, 
rather than of the circulation, as an index of the condition 
of the ethylized patient. 
The patient’s position, should, if possible, be that of 
dorsal recumbency, with the head slightly elevated and 
flexed. It is well to remember that in the sitting or erect 
positions there may be more danger to very feeble patients 
from syncope. During muscular excitement the neck 
should not be allowed to be forcibly curved backward, as 
is the tendency, producing tension on the ante-tracheal 
muscles and impeding venous return. The chest and 
abdomen should be free from the mechanical restraint of 
tight clothing, so that full and deep inspiration may not 
be impeded. If it should be necessary to have the patient 
in the prone position, the administration requires watch- 
fulness lest respiration should, by pressure become embar- 
rassed. 
When practicable, the taking of solid food should be 
avoided by a patient for four hours, and liquid food for three hours before the administration of any anaesthetic. 
If the patient’s condition should be feeble, alcoholic 
stimulants or ammonia may in advance be given. When, 
in an emergency, anaesthesia must be induced very soon 
after a meal, the act of vomiting should be carefully 
watched, and the patient’s trunk so held that ejected 
substances may not gravitate into the larynx. 
NO fatal case referrible to the action of the bromide of 
ethyl has occurred, nor even in the now large number of 
administrations, as far as I am aware, have there been any 
dangerous or threatening symptoms; yet, just as in what 
ought to be the almost invariably safe administration of 
sulphuric ether, death may occur, but it will most probably, 
be in cases in which, if proper care had been observed, the 
fatal result would have been avoided. Its action does not 
seem insidious or uncertain ; but, judging from the careless 
and bungling manner in which other anaesthetics are 
sometimes administered by incompetent persons, 1 think 
that so agreeable and unirritating an agent as the bromide 
of ethyl is liable to be ignorantly, heedlessly, and inordi- 
nately used, and its usual harmless and beneficent anaes- 
thesia pushed to toxic conditions and even death. 
In the minor operations of surgery, occupying but a 
very brief time, and of but momentary pain, it is sufficient 
evidence of the production of anaesthesia when the patient 
does not respond to a sudden call by the voice. The more 
profound state of anaesthesia is evinced by insensibility of 
the surface of the conjunctiva to the touch of the finger, 
and by change in the breathing of the patient to that of 
normal deep sleep. The occurrence during full anaesthesia 
of dilatation of the pupils and of general sweating, are 
frequent, but not invariable phenomena of ethylization. 
The bromide of ethyl, as most recently produced by our 
best chemists, differs materially in some of its sensible 
properties from that which has generally been described 
by chemical writers, and from that which I first had the 
opportunity of using. 8 
Its odor is characteristic, but is less decided than that 
of ether or chloroform, and to most persons it is more 
agreeable. The article I now use leaves less evidence on 
the breath of the patient, is soon dissipated from the 
apartment, and the odor does not remain, as does that of 
ether, on the clothing of the operator and his assistants. 
The bromide of ethyl is said to be liable to chemical 
change by prolonged exposure to light, but I have kept 
daily, for more than a month, exposed to direct sunlight, a 
specimen made by Wyeth & Bro., of this city, and can 
perceive no evidence of change in either its ordinary 
properties or its anaesthetic action. 
The bromide of ethyl may always be used without 
danger, in the closest proximity to lights and to the actual 
cautery, as its vapor is not inflammable. If a few drops 
be poured into a tumbler, or other deep vessel, a lighted 
taper or a match is at once extinguished if immersed in 
the vapor. 
I have used the bromide of ethyl in the surgery of two 
large general hospitals and in private surgical practice, 
under the most varied circumstances which could be 
required to test the merits of an anaesthetic. In my use 
of it in the most abnormal conditions of debility and shock 
of injury, in capital operations, through protracted periods 
of administration, in patients from early infancy to extreme 
old age, it has always been satisfactory and free from 
manifestations of danger. I express my conviction that it 
is practically the best anaesthetic known to the profession.