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02Ether and Chloroform

Between October 1846 and November 1847 two inhalational agents entered surgical use, a name was proposed for the state they produced, and the first death was recorded. Almost every later argument in the subject is already present in those months.

October 1846

The demonstration of 16 October 1846 is the conventional starting point of the record. Ether was administered before an operation on the neck, the patient did not move or cry out, and the surgeon confirmed afterwards to the assembled observers that the method was not an imposture. What made this case decisive was not priority. Ether had been used for the same purpose in Georgia four years earlier, and that case went unpublished until 1849, by which time the credit had been settled elsewhere. The 1846 case was decisive because it was public, successful and immediately written up.

The report travelled fast. An amputation under ether was performed in London in December, two months after the Boston case, and within a year the method was in use across Europe. The speed of adoption is itself worth noting: this was a technique that required no new instrument that could not be improvised, no training that could not be described in a paragraph, and no theory at all. It spread because it visibly worked in front of people who had spent their careers unable to offer anything.

The name

The state produced had no accepted word. In November 1846 a term was proposed in a letter, built from Greek roots meaning without sensation, and it took hold quickly. Naming mattered more than it might appear. It marked out the condition as a distinct object of study rather than as a side effect of intoxication, and it made possible a literature about the state itself, separate from the literature about the operations performed under it.

November 1847

Ether had practical drawbacks. It is irritating to breathe, induction is slow and often turbulent, and it is highly flammable in rooms lit by open flame. In Edinburgh a search for a better liquid was conducted by the direct method of inhaling candidates after dinner until one produced unconsciousness in the room. The liquid that did so was chloroform, and it was reported in November 1847. It was pleasanter to breathe, acted faster, and required no bulky apparatus, and it displaced ether across much of Europe within a few years.

Its adoption was also fought over on non-medical grounds, particularly in childbirth, where objections were raised that the pain of labour was ordained and should not be removed. Those objections lost their force after the agent was used at a royal birth in 1853, which is a reminder that the acceptance of a technique is a social process and not only a scientific one.

The first death, and the first argument

In 1848 a death under chloroform was recorded in England. It was the beginning of a long comparison between the two agents which occupied the profession for the rest of the century. The essential point, established slowly and with much resistance, was that chloroform is the more dangerous of the two, that its margin between an effective and a fatal concentration is narrow, and that some of its deaths occur early and without warning. Ether is unpleasant, slow and inflammable, and it is far more forgiving.

This is the first appearance in the subject of a permanent structural problem: the agent that is most agreeable to use is not necessarily the agent that is safest, and the difference cannot be settled by impression at the bedside. It has to be settled by counting. The work that followed, in particular the systematic treatises of 1847 and 1858, approached administration as something to be measured, with attention to the concentration of vapour actually delivered rather than the amount of liquid poured onto a cloth. That shift from art to quantity is the intellectual beginning of the field.

What the twelve months established

Four things were fixed in that year and have not changed since. Insensibility can be produced reliably and reversibly by an inhaled vapour. The state so produced is a proper object of study in its own right. Different agents differ in safety in ways that matter and that are not obvious from how they feel to use. And somebody has to attend to the patient continuously while the operation proceeds. Everything in the following two centuries is an elaboration of those four points.