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The aether against pain : with a lithographic plate. (The (The proceeds are intended for the poor).
Contributors
Diefenbach, Johann Friedrich, 1792-1847. Harvey Cushing/John Hay Whitney Medical Library
Publication/Creation Berlin : A. Hirschwald, 1847.
Persistent URL https://wellcomecollection.org/works/dtwafcOv
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HISTORICAL LIBRARY
The Aether against the pain Johann Friedrich Dieffenbach. With a lithographic plate. (The proceeds are intended for the poor).

Berlin, 1847. In commission with A. Hirschwald. Contents.
Preface. I Introduction... 1 The Acther.... 9 Effect of the liquid ether 13 Historical overview of the application of Acthervapors by inhalation...... 16 Priority claims on the discovery of the cation of the ether vapors . Ar. 2a Apparatuses for inhalation of ether vapors 23
Application of ether vapors.......... 32 Position of the patient during inhalation of ether vapors

Manipfes................ et 36 Effect of inhalation of ether vapors. 37 Different types of actheric intoxication... 51 Effect of acther vapors in relation to
pain during surgical operations . 59 Surgical perceptions in atherisiric patients . 63 Behavior after operal ion ... 65 On the applicability of atherosclerotic vapors to the individual
individual surgical operations ...... ' 7 Overview of surgical operations with favorable use of
favorable application of acether vapors....... 96 Objections to the use of acether vapors in surgical operations
in surgical operations ...... 98
Application of ether vapors in obstetrics 120 Application of ether vapors in internal medicine .
medicine . 126 Application in forensic
forensic medicine . . 128 From the attraction of the Aeiherrausche ..... 131

Page About the probable similarity of the etherwith dying. Surgical operations, which I have performed using the
I have performed using the etheric impulse .... 134 Extraction of a knife blade from the hand Operations on the chest Operation of the nerve, bellows and field schwiilste Operation of hematoma Surgery of arterial tumor Goiter operations tonsil extirpation Operations of nasal polyps Surgery of nasal polyps Operation of a large_ burn scar on the Operations of harelip, Surgery of lip cancer Operation of a salivary fistula Operation of a sarcoma from the pharyngeal cavity, 184

Surgery of cleft palate . . 186 Surgery of driisengeschwiilsten 181 Partial resection of the jaws. ag
Operation of strabismus ...., , 193 Operation of water briiches , 194 Destruction of bladder stones, 198 Hernia operations........... 199 Surgery of congenital phimosis. 210 Operation of rectal polyp ai Surgery of rectal prolapse. 34 Surgery of panaritium. 2
Amputation of major limbs. 213 Tendon and muscle breakdown 245 Surgery of the wrong joint 223 Upper arm dislocation 224 Application of moxen, 225 Preface
B. the publication of this paper I intended two things. First of all, I wanted to present the new, much the new, devastating discovery of the relief of pain. in its true value. Secondly, to contribute to the relief of the pain of the hun- dren. of the poor. If I could achieve this, the evening hours the evening hours I spent on my work would be pleasant. I spent on my work would be pleasantly

would be pleasantly accomplished.
That I can work on the subject without prejudice for or against I have been working on the subject without prejudice for or against, can be seen by everyone who wants to browse through this who wants to leaf through this paper. If he perhaps on the one hand friend of the ether on the one hand, he will consider me an opponent on the other. on the other hand, he will consider me an opponent of the same. opponent of the same; this is because I have considered the pro and against, heard others, and seen for myself.
have seen for myself. But that I have been cautious in my judgment in the
in my judgment, in the midst of the general ether intoxication, will not be held against me. The in the deepest peace has >
so many inventions and discoveries in a short time. which, taken up with enthusiasm, partly have only a short life span. enthusiasm, some of them had only a short life life, since they did not achieve what was expected of them. expected from them. This gave rise to the fear it might be the same with the ether.
I will try once to describe a soldier, who would have become a part of the most important theilhafiig would have become, in the field. He leaves the older house with the di 'guerreotype medallion of father and mother aı the child's chest. His weapon is a per-

eussion rifle. He is dressed in a tunic of felt cloth, over it hangs a Macintosh paletot hangs over it; he wears unstitched machine boots He wears unsewn machine boots joined together with wooden pins, His body is encircled by a belt with a pouch of artificial leather. It houses crooked cotton and conical balls. In the knapsack two bottles on top of the clothes, one of which contains bottles, one filled with binellic water, the other with the other with sulfuric ether; the one for the quick to stop bleeding quickly in the case of wounds, the latter as an anesthetic when cutting out bullets, in the removal of a leg, and so on. The two-necked from which he drinks only water, for he belongs to the from which he drinks only water, because he belongs to the fatigue club, forms the respiratory apparatus. His efssack contains contains the new oil cake grist. The magazine of his helmet contains a small box of nickel silver nickel silver with tinder and matches, and instead of the no longer common whistle, a pax
tent cigar bag with cigars, among them also some chest cigars while coughing. Thus armirt and the young warrior boards the railroad car. carriage. The locomotive emits its shrill, heart-rending cry, heartrending scream, and with whizzing the steam takes him to the army, and in two day and two night journeys, he still has he has not yet eaten his oil cake bread, the two hundred miles are two hundred miles are flown, and he faces the enemy! in the face of the enemy! He is an artilleryman. His

eye sees with delight the new, blank galvano-plastically plated safe guns, but instead of bringing instead of bringing destruction to the enemy, they burst they burst at the first blow and rip the limbs of the men the limbs of the men who are dedicated to their service. 'consecrated to their service.
Of the new inventions used here on a single man one man, there are several new inventions several, which caused such a great sensation, have been quickly forgotten. The Binelli Binelli's water, which 15 to 20 years ago was almost as an unmistakable hemostatic agent almost as great a sensation as almost as great a sensation as the ether is now, did no more than cold water. The felt cloth soon ceased to be used as a clothing material because it did not because it did not hold; the Macintosh likewise, because Macintosh, too, because although it kept you dry on the outside from the inside; the conical spheres have not yet entered have not yet come into practical use; but the beautiful white crooked cotton has again given way to black powder. to the black powder, and the stalt to give death, the humble service xu
of a healing helper for ulcers. the humble service of a healing helper for ulcers.
But we wish the ether that it may hold out, may hold, although it already begins to become quieter from him. to become quieter. If he performs only half of what what is still believed of him so far, then Jackson has Jackson will have paid off a part of the debt

America is indebted to Europe, but he will have but has secured immortality for his name.
To all the physicians who have provided me with contributions and notes from foreign journals, so benevolently supported so willingly supported me in my work, I hereby express my I hereby express my sincere gratitude, they are the gentlemen Ender, Fürstenberg, v. Graefe, Henoch, La Pierre, Meyer, Reiche, Schuft, Strafsmann and Völker.
Finally, I cannot leave unmentioned the fact that that the booksellers Hirschwald and Aber have supported the the laborious distribution of this book, without any without any other interest than that of promoting a benevolent other than that of promoting a beneficial purpose, for which I for which I hereby express my public appreciation. nce to them, The beautiful dream that pain has been taken from us has become a reality. has become a reality. The pain, this highest awareness of our earthly existence, this most existence, this clearest sensation of the imperfection of our body imperfection of our body, has had to bow to the power of the to the power of the human spirit, to the power of the the power of the etheric vapor. Where will, or where can this great discovery still lead? Through it, half of the path of death has been covered, death has only Death has only half its horror. Doesn't man fear man does not fear the pain of death just as much as death itself, and does not the pain of a major surgery appear of a major surgical operation does not seem almost as terrible to our almost as terrible as death, and does not the greatest need and does not the greatest need drive us to it in order to ward it

off?
How hopeful and trustful will the sick be from now on? the sick will look forward to the bloody operation that is to take place. operation, the horrors of which will be hidden from all their from all their senses, and instead of which probably
4 2
instead of which a beautiful dream image appears before their soul, and their awakening is already an awakening to recovery.
How many unfortunates, suffering from major surgical
suffering from major surgical ills, is not the fear of the pain of the upcoming the pain of the upcoming operation does not consume the last the last vital forces, to which they finally surrender exhausted. exhausted. Now it is a cheerful looking forward to the tragic moment the tragic moment, the action of which remains remains removed from them. If the opera-goer was otherwise the first and most important person important person, now he is not actually present at all. present at all.
So, if it is not doubtful that the fear of a major surgical operation of a major surgical operation has a posthumous influence on the {can have a lasting influence on the patient, we also hope that the we also hope that pain is not an inherent attribute of its performance. attribute of its execution, and that its removal is not a mere

momentary not merely a momentary benefit, but also a means of but also a means of recovery. recovery. This, however, only the future can teach.
What we know from earlier observations about severe injuries in intoxicated persons, shows us that this condition shows us that this condition leads to an alarming increase in the danger. the danger is increased by this condition, so that the doctor the physician who would operate on an intoxicated person would be would have been considered ignorant or unconscionable. However, the deliberate use of anesthetics, as in the case of
of anesthetics, such as opium, belladonna and
ee: the Belladonna and other similar rcolica for the relief of pain during surgical operations.
Jun
Kl
I . Operations, Without suppressing it completely, they caused a dangerous tension of the whole nervous system nervous system, which disturbs the natural course of the disease. the natural course of the disease, delayed healing, if not if not a real danger to life was brought about. was brought about. Even the artificially induced magnelic sleep did not prove beneficial as a painkiller, and the not beneficial as a painkiller, and the remaining relaxation of the of the whole body did not allow this method either. method did not gain further acceptance.

However, the intoxication caused by the inhalation of the etheric vapors is a light, ethereal intoxication that usually lasts only a few minutes, usually lasting only a few minutes and soon disappearing. and essentially different from the intoxication caused by the from the intoxication caused by the consumption of spiritual drinks, the more recent, numerous observations have sufficiently proven have sufficiently proven. Only in some of its co- and and aftereffects, he does not completely deny the nature of the the nature of intoxication from spiritual drinks in general, just as it can also in special cases cause dangerous in special cases.
If we now regard the new discovery as the greatest gain for the suffering the greatest gain for the suffering human race. to lift their fears of death, to make their laments silent, their pains mute their lamentations, to quiet their pains, then it must be the doctor a completely different position towards the sick and the the sick and the bloody art. In In this respect, the matter presents itself from quite different from very different sides.
1* 4
The difficult surgical operation can be made easier for the doctor. by the calm, silence and insensibility of the patient. by the calmness, silence and insensibility of the patient. The one who is not who is not used to performing surgical operations and who is

surgical operations, and who finds himself forced to do so by urgent circumstances, will approach the work with greater selfconfidence and will and complete the work with more ease, if he is not disturbed by the restlessness and lamentations of the patient. by the restlessness and lamentations of the sick person. Even the practiced one can gain from these favorable circumstances, since he is not distracted from his actions by anything. In every respect, therefore, the circle of the exercise of the the practice of surgery seems to have been widened by this means. of the practice of surgery, if we look at the picture only from one side. one side. It appears less bright to us from the other side,
In place of the unshakable trust of the patient of the patient in the art of the doctor has been replaced by the has been replaced by trust in the anesthesia. The patient now asks less about who operated on him, whether he is good or not so good, he is as it were absent or the third person the third person. The previous point of view of the physician is thereby crazy. If he otherwise holds a patient before him, he now has two. One, which he is to operate, and a second, who seems to be so sick in nerally seems to be so ill that he has to treat him with all kinds of medicines. with all kinds of medicines to help him.
He must do violence to himself in order to convince himself that he can help him. He must use force to convince himself that he himself has brought him to this state.

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the sick person and for his own relief. and his own relief. He cannot grasp all this grasp all this so quickly. He stands alone in sad isolation. isolation. During the operation, the anesthetized man knows nothing of his doctor, and the doctor knows nothing of his patient. patient. The bond of mutual communication is broken. is torn, the mild encouragement that lifts him up is not heard, the question is not answered. is not heard, the question is not answered, a ghastly loneliness prevails. He fears at the sight of the unconscious man bleeding, whether he has also He also enjoyed too much of the eelher. He might ask, inby sinking his knife here and there into the flesh of a living man. into the flesh of a living man, how? where? what? to direct and turn the steel afterwards, to avoid a to avoid a nerve, not to grasp it with the pincers. but no answer but a muffled groan, a twitch a twitch, a demonic movement of the hand toward the suffering place. towards the suffering place.
It falls uncannily powerful over him, who in his life has who has surrendered to the ether in life, in apparent death, not not as before out of free choice, but out of fear of the pain. fear of the pain. Soundless and insensitive he lies voluntarily out of the circle of the living, the living, the sensing, the thinking, lies with closed eyes eyes like a gentle slumberer, and in frightening loneliness

in frightening loneliness the doctor completes his work. work. But not every sick person slumbers gently and under the sharpness of the knife. Another one goes into excitement, ardent fantasies take hold of him, and in the feeling of fantasies take hold of him, and in the feeling of unnameable bliss, brilliant of unnameable bliss, brilliant dream images appear before his soul. music of the spheres and celestial melodies gently gently reach his ears, and in an immeasurable space of azure and of azure and yellowish gold shine, the inner eye loses itself the inner eye is lost in glaring contrast to the knife in his flesh the knife in his flesh, to the saw in his legs, to the hand in his the hand in his intestines, to the hook in his eye and the eye and to the warm blood pouring out, and words of delight flow from his mouth. mouth. - Another, otherwise fine in life, gentle and mild, suddenly becomes a rage; in the state of a wild, raw in the state of a wild, raw excitement, he imagines himself to be among robbers and murderers, the most bitter curses flow from his mouth the most bitter imprecations, by word and deed he seeks to counter the supposed violence, he he smashes everything to the ground with his fists, rushes like a man possessed, on everything, and would it be bare weapons weapons, or an abrupt abyss, or the glow of a melting furnace furnace, he would throw himself into it.
A fourth becomes a perfect fool. The same person, whom we meet with a deeply devoted his serious destiny with a deeply devoted expression, becomes a in a few minutes is transformed into a buffoon, grinning and grinning, laughing, acting like a silly fool, and is

like a silly Thor, and is no less difficult to govern than the one who to rule than the one who considered us his murderers. his murderers.
All these circumstances are now little suitable, 7
facilitate the operation for the physician; rather, he encounters rather, he encounters obstacles that were previously completely unknown to him. were unknown to him. As a newcomer, he now approaches the new patient. new patient. At the moment when the new patient the fateful tube to his mouth, in order to inhale the the fogging ether vapor into his lungs. into his lungs, the fearful gaze of the gently intoxicated sufferer the gently intoxicated sufferer bids him farewell - and soon his senses his senses are clouded - and alone the doctor stands there with his with his assistants, and art quickly begins the battle with the the fight with the illness or at the same time with the agitated,
A friendlier picture shows itself to us now again. again. It is done. There is no more blood. The wound is bandaged. Where am I? the sick man opens his eyes and breathes deeply. I must have I must have been dreaming? Is the operation about to start? He does not believe when he is told that the operation has been performed. it has happened. One woman doesn't want to believe that her breast was removed. breast, another that his nose has been put on. another that a nose has been put on him, the one leads the hand

where the breast used to be and feels that it is empty; The latter brings his fingers to his face, amazed that a new nose has that he has grown a new nose overnight, and he asks his doctor his doctor, where did you come from? JamThe doctor is amazed and astonished. Not about not about his work, but about that demonic, grofsartige appearance of being and non-being. He stands like a small child without a concept, which collapses when it is when it is looked at seriously. Also he, too, needs composure, composure, he, too, awakens from an intoxication, and rubs his eyes, and only then begins to and only then begins to breathe freely again.
If he wishes himself to be calm, especially during the wild, stormy the patient's wild and tumultuous excitement during the operation. tion, he feels that he has returned to his old standpoint. he feels too overwhelmed by this new, great appearance and to overwhelmed and carried away to this great discovery. that he would like to have it a little more difficult if only the He would like to have it a little more difficult, if only the sick person suffers less, He vows to fathom her good deeds more closely.., and to investigate her more closely in all her relations, This should then also be the task and the striving of all doctors of all physicians, so that it may be freed from all inconveniences and dangers in its use. and dangers in its application, and that the perfect and dangers in its application, and become the most perfect thing that the the human mind has devised. May Jackson's patent be the recognition of the world, The Aether.

The sulfur ether was first discovered in 1544 by a doctor by a physician, Valerius Cordus, under the name of "sweet "süfses Vitriolöl", He has the process for the preparation and the method of preparation and the properties of the ether. the fame of the invention is not due to him, since in earlier the invention, since in earlier centuries wine-based mixtures of the wine mixtures of ether were used for medicinal purposes. were used for medicinal purposes. The communications of Cordus and his new oil do not seem to have enjoyed any particular enjoyed particular popularity, because already in the following the following century, the ether was again unknown until 1792, when a German chemist, Frobenius, of chemist, Frobenius, again attracted the interest of physicians and physicians and separation artists, and introduced him to the promising with the promising, poetic name "Aether". assigned to it. This beautiful name he owes partly the tendency of alchemists to choose pompous names for their arcana.
for their arcana, and partly to its physical properties, its ephemeral physical properties, its volatility, its colorlessness colorlessness, its strong light-refracting power and its easy its easy combustibility. Froben was more fortunate happier than the Medicus Cordus. The ether was was investigated many times, and by the famous physicians of the by the famous physicians of the 18th century. among them notably Friede10

rich Hoffmann through his liquor anodynus, the well known known Hoffmannstropfen, - ether mixed with 3 parts" of wine spirit spirit of wine - contributed much to the spread of the same. contributed a lot to its spreading. x
The ethers are produced by the action of stronger acids on alcohol. acids on alcohol. The sulfur ether, ether, is obtained by mixing a mixture of mixture of 9'parts of concentrated sulfuric acid and 5 parts of alcohol of 555 in a retort until boiling. boiling. Through a device on the retort the retort, as much alcohol is allowed to flow into the mixture mixture as the liquid overdistilled from it. lirt. The vapors that develop are separated in a carefully cooled by dripping water, snow, etc., to form a carefully cooled by dripping water, snow, etc., to a liquid which This liquid is the so-called crude ether, This raw ether, which still contains water, small amounts of alcohol and usually alcohol and usually also some sulfurous acid, is acid, is purified by water containing potassium, then then recycled over coal powder and burnt magnesia. reclifieirt. Pure ether must not redden litmus paper, must not must not redden, must not smell of sulfurous acid, and must have any other secondary odor. If the ether is to be anhydrous, it must be separated after reclification by an addition of purification by the addition of burnt lime after reclification. purification by the addition of burnt lime, - because of its due to its property to chemically combine with acids acids and to form salts with them, the chemists of recent times have The chemists of recent times have called the Acther the "salt". "

1
oxide of a hypothetical hydrocarbon-water radical, aethyl of a hypothetical carbon-water radical, the ethyl (4 carbons, 40 hydrogens). and thus the seed of the binary compound is also of the binary compound also to organic chemistry. thus designate the aelher, which consists of 4 atocarbon, 10 atoms of hydrogen and one atom of atom of oxygen, as ethyl oxide, Ae-+0, the alcohol alcohol, which is composed of 4 carbon atoms, 12 water atoms and 2 oxygens, and can only be distinguished by a plus by a plus of one atom of water (1 oxygen, 2 hydrogen). serst.) from the ether, as ethyl oxyhydrate, and so on,
It would be too much to explain the different theories about the formation of ethers in more detail. We content ourselves with a few brief hints. Since the sulfuric acid is formed by the procefs of the conversion of the alcohol into ether, and since the alcohol and since the spirit of wine, as already mentioned, can only be in its composition from the ether only by the water atom, so the ether only by the water atom, the assumption was very obvious that the the concentrated sulfuric acid only through their strong the change of the alcohol into ether only by its strong alcohol into ether. This theory put forward by Fourcroy and Vauquelin by Fourcroy and Vauquelin is very much shaken by further experiments and and research on this subject has been very much shaken and at present it is almost completely abandoned. 'electro-chemical theory explains the formation of ethers from

the the electric voltage, which is in the chemical affinity indifferent in the alcohol, which is indifferent with respect to the chemical affinity. . 12
strong acidity, and which forces it to transform into a base, into a base. Also the doctrine of of the contact effect has the interpretation of the process on itself.
Some of the properties of the ether have already been mentioned above, others may follow here. follow. The ether has a peculiar, highly penetrating smell and taste. pervasive odor and taste; its specifiIts specific gravity (Gay-Lussac) is at + 20° = 0.713, the specif. The specific weight of its gas = 2.586. It boils at ordinary atmospheric pressure at a temperature of 28°R. At - 24,8°R. it starts to appear in white, shiny needles. white, shiny needles, and at - 36°R, it forms a soft, solid it forms a soft, solid, crystalline mass. It burns with a bright, soap-yellow flame that gives off a call, is mixed with ethyl alcohol in all proportions, with water, with water, which dissolves ;5 of its weight of ether. miscible. Camphor, phosphorus, rubber, felte, etheric oils, chlorine oils, chlorine metals, etc. are dissolved by it. dissolved. - One of the peculiarities of acether, i.e. its the easy combustibility, must be remembered here once again. be remembered here. Because of its "volatility, the spread quickly through larger spaces, and it cannot be it is not possible to determine the distance to which a burning light a burning light from an open vessel filled with ether. filled with ether. Already several times

accidents have occurred due to the fact that in the vicinity of a light ether from one vessel into another in the vicinity of a light. the other gofs. Recently Runge has referred to this 13
Runge recently drew attention to this problem, and to the possibility of dangerous of dangerous explosions as a result of ignition of the acther of the acther gas mixed with the air. mixture forms a kind of oxyhydrogen, and its effects are similar to those of the effects are similar to those of the burning of the in atmospheric air - or sump gas. similar. Therefore, for example, if no precautionary rules are rules are not taken, the use of annealing or of annealing irons or moxes, for example, that the anesthesia achieved by the acther could spread over too too large a number of individuals,
Effect of liquid ether.
The effect of liquid ether on our organism is similar to that of alcohol. ganism is little different from that of alcohol, and consists mainly in a transient excitation, i.e. in an increase i.e. an increase in the activity of the organs, which allows a quick return to the equilibrium of the healthy of the interaction. The stimulation of the system is less than with other volatile substances. volatile substances, but the central organs of the nervous system are more organs of the nervous system are more segregated and are used in a and in a peculiar way.

The local effect of the ether on the skin increases on the skin by the fact that its rapid volatilization the skin by its rapid volatilization, 14
The vessels contract, the skin becomes pale, The thinner the epidermis, however, ı
the easier it is for the actherfluid to reach the veins underneath.
veins underneath it, and the sensation of cold the sensation of cold gives way to a feeling of heat, burning
pain. The vessels dilate, the skin becomes red and bloody. red, bloody. On the mucous membranes the leicter series of phenomena occurs almost instantaneously since their very thin, moist epidermis is more permeable to fluids. It occurs when we ingest a small amount of ether. a small amount of ether, at first a violent irritation of the olfactory irritation of the olfactory and gustatory nerves, and the mucous membrane of the throat, later a feeling of increased later a feeling of increased warmth in the stomach, which spreads the whole abdomen. From the stomach the ether reaches the bloodstream with great speed and with it the brain. and with it to the brain and spinal cord, from where it exerts its effects against the most peripheral nerve provinces, How it acts on the nerve masses and fibers of the brain and spinal cord. fibers of the brain and spinal cord, what kind of stoflumor stollen changes it brings about in them. We do not know. I confess that I am

the theory of the decomposition of the spinal cord, which has been of the decomposition of the ether and the burning of its elements in the blood. elements in the blood, however palpable it may seem. however palpable it may seem, cannot be reassured, rather the effects of the eelher seem to depend preferably on the fact that depend on the fact that a part of the absorbed elements is 15
unchanged to the brain and spinal cord, and in these and spinal cord unchanged, and causes certain material changes in them. material changes in them. Be that as it may, with the absorption of the ether into the blood, the cyelus of its general of its general effects, the promotion of the worm-like The promotion of the vermiform movement of the intestinal tract, the increased secretion of the gastric juice glands, the easier, perhaps also increased excretion of the bile. bile form an intermediate and transitional stage from the local to the from the local to the general effect phenomena. phenomena of action. But not only the secretion glands located in the intestinal tract or attached to it, but also that of the glands located in the intestinal tract or attached to it, but also that of the other secreting glands in the intestinal tract or attached to it, but also the secretion of the other secreting in the skin, the mucous membranes on almost all mucous membranes. skins. The more highly tuned brain life, insofar as it is the source of it is the source of our soul life, is reflected in the most

in the most diverse nuances of thought and word, will and movement, imagination and invention. - We note that the ether (here we always speak of liquid ether) is the liquid ether) is not as easily intoxicating as alcohol. as easily as alcohol. In larger doses it can can easily induce vomiting, larger doses result in death. death. Strangulation, vomiting, dizziness, paralysis of sensory paralysis of the sensory nerves, muscles, lungs and heart. heart indicate the poisoning that has occurred. Pure ether is rarely used in medicine. in use. Only in combination with numerous other it is used mainly as an analgesic and 16
"Hoffmann's spirit, Hoffmann's drops, Spiritus rieo - aelhereus in hypochondriacal, hy: Nervous disorders, etc., used to relieve the pathological to reduce the morbidly increased or altered activity and alter the pathological increased or altered activity, The purpose may be achieved by stimulating the by stimulating the nervous system on the whole.

a kind of derivation for the suffering "part from the rapid, almost instantaneous state of the effect. of the effect, however, it seems that the local that the local action on the gastric and dart nerves is the main thing. nerves is the main thing. u
Historical overview
of the application of the Acther vapors by inhalation Inhalation,
It was the chemist and physician Jackson, a learned man in a learned man in Boston in the North American Free Free States, to find in the sulfuric ether the ether as a great remedy for pain, a medicine long Medicines in other respects long known, n Jackson was the first to realize, more specifically than others, that the inhalation of the ether vapors in a short time. of unconsciousness and a sudden cessation of all painful sensations. and a sudden cessation of all painful sensations. 17
To investigate this interesting phenomenon in relation to painful to investigate this interesting phenomenon more closely in relation to painful operations and to examine it more closely in all its relations.
"relations, he made a series of preliminary experiments on which a series of experiments, which later supported his courtand conjectures, which later gave them complete his court and his assumptions.

He took a folded piece of linen "soaked with ether. piece of linen soaked in ether, which passed freely through the air. the air, and continued inhaling until he passed out. inhalation until he fainted, and fell into a strange sleep or sleep. sank back into the chair in a strange sleep or dream-like state. sank back into the chair. At the same time he felt a certain freshness and cheerfulness, followed by a feeling of warmth. followed. Finally, complete unconsciousness set in. It was only during a later experiment that he discovered that state was associated with a complete insensitivity to pain. to pain: he was led to this remark by the fact that the was led to this observation by the fact that a violent state of irritation of the trachea, which he had contracted by inhaling inhalation of chlorine vapors, when inhaling ether vapors with the onset of unconsciousness. immediately ceased with the onset of unconsciousness, but then returned. but returned again.
If the ether is weak, it does not have, according to Jackson, it does not have the peculiar effect, the patient is only intoxicated, and later feels a dull headache. dull headache.
But always the ether as a remedy had not yet come into and Jackson was lacking in gels.
2 * 18
Jackson lacked the opportunity to try its analgesic effect in chi operations. He asked the dentist Morton to test the aether vapors when he and gave him a large bottle filled with mil densı b filled large bottle, into which a gl

flowed into it, as a temporary breathing apparatus. the first operations confirmed the come what Jackson halle expected, for d Extraction of the teeth was successful without any pain. tion.
Jackson and Morton, delighted to have made H of the pain, also wanted to make it possible for the by keeping secret this great discovery. to remain in the sole possession of them for the time being, ' take a patent on it. With us this may be a in America, however, less so, but this was the v' that all the surgeons in Boston refused to perform major surgeons in Boston refused to perform major surgical operations without without prior communication of the anesthetic secret. take. Years had passed since the first Jac son's discovery, until at last the finally became the traitor of the great anesthetic secret. and the physicians who had been present at Morton's tooth doctors who had been present at Morton's dental surgery soon followed. After they had discovered it, they advised the sick not only at the dentist's: the sick not only during tooth extraction, but also during larger but also in larger operations with the same success as Morton. as Morton.
Now that the veil of secrecy has been lifted 19
was lifted, Jackson and Morton freely came forward with their discovery. their discovery, and now sought to give it the most spread it as much as possible and to secure the well priority against the freebooters now rising up everywhere. against the buccaneers now rising everywhere. Morton, who in

the meantime had who in the meantime had made a large number of dental operalions in Boston and Massachuseis, now reported with the greatest the Jacksonian discovery to Dr. Boot in London. discovery to Dr. Boot in London. Warren in BoWarren in Boston, who in the meantime had performed several major operations on etheric patients, informed in a detailed in a detailed letter to Dr. Forbes in London, the editor. Forbes in London, the editor of the English and Foreign Medical and foreign mediz, Zeitung (Review), about his obtained results and the whole procedure of this new type of ope- ration. ralionsart, and says only in a postscript: "'the discoverers of the remedy are Doctors Jackson and Morton." Jackson, however, had already in November v. J. at the Paris Academy two sealed letters, of which the first the first of which stated that he had already the anesthetic effect of the inhaled actherd vapors on himself 5-6 years ago. the anesthetic effect of the inhaled Acther vapors. first in an accidental experiment, then in a severe catarrh, which he catarrh, which he had contracted by inhaling chlorine gas. inhalation of chlorine gas. The second letter contained information about the painless extraction of the teeth in of the teeth of etherized patients,
Thus the new discovery had reached Europe
and first to England. 98 20
The first experiments in London were made by

and Robinson during tooth extraction, they just as favorable as those of Ameril sb where operations have since been successfully performed by other surgeons. operations have been carried out with success by other surgeons After these first attempts by London dentists
to test this promising new means in their hospitals; the new means in their hospitals; the excellent, cautious and bold Liston and the bold Liston began to operate according to new new way of operating, and as newcomers, they are the bloody path they had trodden,
When the American discovery had reached the reached the icy ground, it spread with the divisibility of the ether Theilability of the ether haze or like a g
in which science is stirring, and today £ I write this, a few months after the E
masses piled up, that only a large number of represent the same in their whole extent 21
Priority claims
on the discovery of the effect of ether vapors,
It was to be expected that with such an important and important, such a sensational agent, claims for priority from several from several sides for the priority of such an important from several sides, a phenomenon that we have never seen with never happen with insignificant discoveries, but always with

important ones. important discoveries. The power of truth, however, is so great that the real discoverer can discoverer is only rarely snatched from his property. from the real discoverer. Thus, no one will rob Jackson of his honor.
Granier de Cassagnac claims to have been the discoverer of the great the discoverer of the great new agent seven to ten years ago. and that he has carried out more than 200 tests on himself. on himself. Chance led him to inhale the fumes inhaling vapors from a large bottle of ether, and after the first and after the occurrence of the first, usual phenomena on himself, he repeated the first common phenomena on himself, he repeated his longer and longer experiments until he reached the sea state with which we are familiar. state with which we are familiar. Then he experimented on his brother his brother, in whom the same phenomenon occurred, and finally he had the idea of treating a migraine.., by which he had been plagued for years. by it more often.
One does not really know whether Cassagnac, which is the most 22
who really already 17 years ago wrote this all political and literary journal of Toulo, should be should be regretted that this beautiful work has been right to be the discoverer of the secret of the eagle. been snatched away from him by Jackson, or whether ms reproach him for never having done the same thing in a more 'meaner, than with his own migraine benul

with his means vorrilten, and the Anı had asserted his discovery earlier. € sagnao seems to have stopped halfway: sein, He probably came only elwas further than when we have a severe toothache to a bottle of " with Köllnischem water or to a vial m naphta or camphor or any other spiritual substance. or any other spiritual substance to anesthetize us. The punctum saliens, the abolition of sensation in general, especially of soreness; especially of the pain of the wound, remained for him as well as to others, but remained completely hidden. Had had known it and kept it to himself, he would have been responsible for the would have been responsible for the many pains that the poor human for 17 years by means of surgical operations. nes for 17 years, he would be responsible. Ducros is also to be pitied for not being granted the right of discovery. the right of discovery that he desires for himself right of discovery, which he covets for himself and therefore claims the France for this purpose. He invokes to a book published by him in 1842: "Effets physiologica "Effets physiologiques de ether sulp que elc.", in which he informs us that the 23
ether in the case of the chickens belonging to the birds belonging to the chicken sex, a drowsy anesthetic state. anesthetic state in birds belonging to the chicken species. From this observation, he concludes that this remedy is also useful for people humans in certain diseases as well. This

does not seem to be much more than what was already known about the before him about the effect of the aclher. Finally, even in 1844, Wells wants Jackson the application of the Aciherdämpfe to have taught. Why, we ask, did he not make this important thing known and and introduced it into life? As for the local application of the ether vapors for nervous vapors for nervous deafness, they have really been Itard and Wolf really used them earlier.
Apparatuses for inhaling the ether vapors.
The first compound apparatus used for inhaling the inhalation of the ether vapors, since the original means of original means, a cloth or a sponge moistened with ether cloth or a sponge, was not always sufficient, is that of Morton. of Morton. It consists of a glass sphere with two necks; in it are sponges filled with ether. sponges filled with ether. With one neck of the sphere with a mouthpiece is connected to one of the necks of the sphere. through which the patient inhales the ether vapors. inhales the ether vapors. Through the other opening the air enters the bottle from the outside, whereby 24

the evaporation of the ether. The return The return of the exhaled air into the flask is The air is sucked into the bottle through a
The nose can be closed by squeezing either with a clamp or with the finger. can be prevented. 4
Since the time of its introduction, this apparatus has undergone many since it became known, because its simplicity was not enough for many because of its simplicity was not sufficient for many, and because they believed that greater complic greater advantages could be achieved by greater complicity.
Glass containers, of which the upper downward vı with this part in the wide neck of the lower bottle. lower bottle. The upper he of the upper bottle can be closed by a glass
can be closed as desired. In both containers there are sponge bags soaked with ether. Near the bottom of the lower bottle is attached the Schlaı which serves as a neck and mouthpiece, and and is provided with a bead for the exact circulation of the lips:

of the lips. Two valves, a hi with perpendicular movement, and a dieular one, have different dieular, have different determinations. The second opens on exhalation, releasing the exhaled air. This allows the vapors to escape from the glass bell jar.
out of the glass bell jar, but prevents their return. 3
To increase, reduce or completely eliminate the amount of ether vapors to be inhaled, it is vapors to be inhaled can be increased, decreased or completely interrupted. A tap near the mouthpiece serves to increase or decrease the amount of ether vapor inhaled.
Little different from this is an apparatus later described by Robinson, which is used by the London physicians London physicians use excellently.
The mechanism described by Charriere, a famous instrument maker in Paris. instrument maker in Paris, comes close to Morton's mechanism. Morton's, since it consists only of a from top to bottom strongly compressed flap. from top to bottom. A funnel extending through the neck to the depth the depth of the bottle, serves to refill the aether of the ether onto the pieces of sponge in the bottle. pieces of sponge in the bottle. The breathing tube rises next to the funnel tube rises from the upper tube next to the funnel. Also This apparatus is also equipped with valves. In a Charriere has cleverly designed all the places from which the from which the oil vapor can escape, by means of a fine wire wire netting, as in Davy's lamp for miners, to prevent the

miners, in order to prevent the ignition of the aether vapor when the light approaches, e.g., during the burning of burning of fuel cylinders. This apmost French wound physicians use this ap- parate physicians. Bonnet modified it by transferring the ether from a special the ether from a special container into the bell. from a special container into the bell, that the tube is considerably wider the mouth and the nose are covered at the same time, and that a special valve and that a special valve indicates when the patient is breathing inhales atmospheric air. 26
Another apparatus was given by Luer in P given. This one consists of two tin tin boxes. A larger square one, ler box rests on a small, flat, but b as on a poslament: the upper one, which contains the which contains the eelher, is separated by imperfect dividers sixfold, as in the case of the slides of an oven. theteilt. While the one partition does not the top, the other does not go all the way down to ı down. The breathing tube is located at the side edge of the large box. The lower K must be filled with warm water through a neck opening. be filled. Three openings made in the roof of the can be opened and closed with plugs, and the chamber can be and closed, and thus the chamber of the chamber of the machine can be closed off or municalion with each other. This has the purpose of to supply the patient with ether vapors in lesser or greater through the tube to the patient.
This apparatus is quite impractical; th

due to its considerable size, partly due to its Complicalion its application is made difficult. Aı is, of which the Smee's apparatus will soon be the R The more abundant development of the aether through the heif The more abundant development of the ether vapors is highly dangerous. dangerous, " 'Smee rejects all glass bottles and recommends straight pewter tubing 8 inches long and 3 inches wide. width as a clyslir syringe. The rear thirdll 27
of the cave is separated from the front roughme. Each of these caves is provided with an with a necked opening. Into the front, the ether is poured into the front, wider cave, the back with hot water, by the heat of which the transition of the ether is the transition of the ether into darkness is accelerated. The heat of the water accelerates the transition of the ether into darkness. The definition of the water tank must be The opening of the water tank must be closed with a plug when the The opening of the water tank must be closed with a plug when the The opening of the ether container also serves for the entry of the ether. the ether is poured through it, it also serves as an inlet for atmospheric air, In the ether compartment there is a tube with a valve near the mouthpiece. valve near the mouthpiece. This valve valve opens with each exhalation, so that the exhaled air can escape. air can escape. The mouthpiece is surrounded by an oval hoop of rubber elaslicum for comfortable

to be placed comfortably on the lips.
This device does not provide any special features, but the faster development of the ether vapors through the vapors through the container filled with hot water. filled with hot water, the same is not possible, because of the the same is very dangerous for the patient because of the vapor dangerous for the sick person, inflammatory irritation of the lungs of the lungs and unexpectedly rapid onset of anaesthesia. will easily occur in this case.
Reisig in Vienna described a simple apparatus. It consists of a wooden, bottle-shaped box and would be able to hold about } Maas of liquid, The lower, wider part can be unscrewed, 23
Into it are placed pieces of sponge soaked with ether or cotton, and then this part is attached to the sieve-shaped the sieve-shaped bottom of the upper can. screwed on. If now the wide mouthpiece of the appathe mouth, the vapors rise through the sieve into the upper room. through the sieve into the upper chamber, from which they are emitted. are emitted. ae = Heller's device in Vienna consists of a | bubble of gold beater's skin, with which a tube and a mouthpiece are a tube and a mouthpiece of boxwood. and a boxwood mouthpiece. The mouthpiece is 2 inches

wide and 3 inches long; the tube has a length of 4-6 inches and a width of 4- 6 lines. The simplicity of this device gives it the preference over several complieirte apparatuses, except that the tube is the tube is too narrow. Schauer found that when inhaling the ether vapors, the air the air already inhaled is always driven back into the the air that has already been inhaled is driven back into the oxygen is ultimately consumed. This problem is remedied by a device of his own. This consists of two air-tight cylinders of wood, which are screwed into each other. cylinders of wood, which are placed as close to the mouth as possible. the mouth as close as possible to the breathing tube. The inner cylinder The inner cylinder is cut diagonally in the middle and is and covered with a flap of thin leather and wood, Through it the opening is completely closed, so that the airflow from the vessel can exit, but not return. but not the return is designed, In the outer Cy29
linder there is a cutout with a flap, which allows the exhaled air to escape, but when inhaled inhalation, while the inner flap opens, and the air flap opens, and the vapors can be drawn in from the vessel. can be drawn in.
Bonnet and Ferrand gave a filled mask with a nose and mouth opening, which ends in a tube and fed into a vessel containing ether.
Mayor recommends a long hanging cap of oilcloth in the front with two glass panes for looking

to look in and out of; under this head tent the patient should inhale the ether vapor from an open vessel! inhale!
On top of the alhm-apparatus mentioned here, there are many other are still a lot of other, more or less deviating from the original Jacksonian one. have been given. Everyone may choose the one which which seems to be the most excellent, but the simplest one is the best.
The apparatus I use differs from some others by its differs from some others by its greater simplicity. It consists of a spherical body with a very wide and a narrower neck. with a very wide and a narrower neck. bottle of white glass. With the wide neck the elastic tube, the length of which is } cubit and the width of which is one and a half inches. connected. This is done by means of a tube of 1 inch wide tube of horn, which is inserted into the pierced the pierced cork plug of the wide neck of the sphere. neck of the sphere. At the other end of the 'ches is a shell-shaped, run outg t mouthpiece of gum elasticum, or even better Horn. Half of the bottle is filled with large and small, highly porous sponges. The bottle is half filled with larger and more slippery, highly porous sponge pieces. is poured into the bottle through the ei neck into the bottle, and the two openings are closed by plugs. the two openings are closed with stoppers, the sponges are the sponges, the stopper is removed from the large neck and the and the tube is put into it. Only then does m the mouthpiece to the mouth, The narrow throat di

to communicate with the outside air, as well as to deepen the the throat, if it should be necessary; it can be can be closed by the stopper at will. Glass apparatuses with movable tube". Because of their transparency and cleanliness, the glass metal, wooden or bubbles because of their transparency and cleanliness. All complieirte have the disadvantage that they complicate the use. complicate the application. That which at the e what seems to be useful at first sight, or what really is or really is, promises some advantages, but does not grant them advantages, but not only does it not provide them, but is an obstacle to breathing. To this belongs the in the pussy lip part, which actually forms the end of the tube, belongs to this. of the tube, which the mouthpiece of the like a cigar tip between the teeth takeı. shall. Partly this is highly inconvenient, partly allows the The narrowness of the tip allows only a thin column of aethei vapors the passage. The whole tube up to 3a
mouthpiece must be the same width everywhere. All valves or air flaps are impractical. With double one opens when inhaling the ether vapors, and closes on exhalation; then the other one opens and then the other opens and lets out the expired air. The valves increase the effort of breathing and make a clattering make a rattling, unpleasant noise, untilthey are in disorder, since they become cumbersome through frequent use. they become cumbersome. A disturbance then occurs in the avoidable disturbance in the operation. The The connection of the tube to the bottle by means of a screw

screw also leads to some interruptions during application and removal. interruptions when attaching and detaching, which is why the connection is preferable. The nose clips or squeezing the nose is to be discarded, as it causes the greatest the greatest discomfort; the patient should enter through the mouth. in through the mouth and out through the nose. through the nose.
Most apparatuses are designed, as can be seen from the base, are intended to be placed next to the patient. patient, but because of the possible restlessness of the patient, it is of the patient, it is much preferable to have the patient by a helper holding the patient by the neck during the shaking a spherical bottle at the bottom shakes the sponges to the shakes the sponges for a stronger development of the vapors. development of the vapors than is the case with a flat bellshaped bottle. than with a bottle of flat, bell-shaped form.
happens. Under circumstances where a fast application of the of the ether vapors is necessary, and there is no Pre at is not available, one can revert to Jackson's simple and artless and artless method of Jackson, and use a cloth or a a cloth or sponge dipped in ether, after it has been sponge, after it has been properly squeezed, loosely over the mouth and mouth. and the patient is often just as anesthetized by this as by means of the most elaborate preparations. I have already experienced this in several cases. Bühring uses the sponge with benefit, But the sponge must be coarse and hollow and be applied with

the I side. It must not be pressed because the patient will then suffer from severe alhmet, in the case of irritable skin, the moistening can easily skin, the moistening of the skin can easily cause its irritation. At the sponge is always preferable.
Application of ether vapors.
en
The volatile excitatory properties have been known for a long time, Aelher for a long time, and also wufste n, short inhalation produces a slight intoxication. But before Jackson, they did not know that it would pain would be relieved, and pleasant dreams would be pleasant dreams. Far from, says Jackson, the to recommend, all medical authors have 33
warned against and declared the same to be highly 'dangerous. erdeclared. But this is true only of the ordinary, unpure ether, which on top of the sulfurous-acidic acidic gases, as well as acetic, formic and aldehyde acids. The considerable alcohol content of this ordinary ether of alcohol is, according to Jackson's experience the intoxication produced by it is to blame for a severe headache and a headache and nervous tension.
The pure ether vapor is, according to Jackson, irrespiral. If it displaces (the atmospheric air) completely from the

the lungs, it must cause complete asphyxia by anesthesia. phyxia by anesthesia, from which it follows, that the acther vapors must be mixed with a sufficient quantity of air so that the function of the lungs is not disturbed. function of the lungs is not disturbed. At the onset of phenomena of of the danger of suffocation, partly as a result of a bad bad application, an impure phlegm, gross irritability, or irritability, or a particular tendency to congestion of the lungs. to congestion of the lungs or head, Jackson advises Jackson, immediately gives oxygen gas, which gives the blood its red blood its red, arterial nature, to be inhaled immediately. blood its red, arterial nature. One should therefore always have the gas should be kept ready at all times, stored in a gasometer and gasometer and fill it for immediate use into a large rubber-elasticum bladder for immediate use. Ducros recommends Galvanism, others the ammonia,
The inhalation of the ether vapors is done with the help of inhalation of the ether vapors is done either through the mouth or through the nose. The former way, in which the nose
3 34
neither with the fingers nor with a clamp. is the most comfortable for the patient, and the the patient, and the vapor is carried along the widest and shortest and shortest way through the trachea into the lungs. 'gen. Jackson as well as most of the English Aerzie preferably apply this Melhode. The inhalation through the nose, which is especially recommended

by the French. the French, is not recommended because of the narrowness of the nostrils and the and the greater sensitivity of the mucous membrane of the nose. mucous membrane of the nose is sometimes associated with great irritation, and can with relief for the patient only if one of the nasal only if one of the nostrils is connected to the opening of a bottle. bottle containing the ether, and the other nostril is closed. the other is squeezed shut. However, breathing tubes can be inserted deeper into the into the interior of the nose would cause a violent would cause a violent irritation of the parts. In persons with very narrow nostrils, and especially with narrow nasal passages nasal passages, who already breathe with difficulty through the nose difficult to breathe through the nose in the usual way, inhalation is in this way should not be used at all. Bergson believes that for difficult operations it is better to breathe through the mouth. through the mouth, for smaller ones through the nose; furthermore that and also that in this procedure, the aelher-. Aelherand more complete, but that anxiety and fear are greater. and anxiety are greater, and all disturbing side effects are due to this method. all disturbing side effects are due to this method. On the other hand, the inhalation through the nose produces a more nose only the first and lowest degree of aetherrau- sion, namely and lowest degree of aetherrau- sion, namely the loss of feeling and empathy. 35

feeling for pain and almost never those side effects mentioned above. mentioned side effects. Here, however not be overlooked that the greater intensity of the remedy is not of the remedy does not depend on the oral or nasal route. or nasal route, but whether the sick person is able to experience the inhale the ether vapor in greater or lesser quantity. If he breathes in the broad way through the mouth only for a short time through the mouth for only a short time, then only the only the coincidences of the first degree would occur. It leads to the perfection of the methods in general, if they are methods, if they are tested in many ways, and all the experiences are experiences are made known according to one or the other method. one or the other method. Bergson recommends for breathing through a flat bottle with a wide neck, in which aether can be drunk. in which there are pieces of sponge soaked with ether. are found. It is closed by a cork stopper; through which runs a wooden tube, the upper end of which is shaped end of which is shaped like the opening of the nose.
As for the third application of Actherthrough the nose and mouth at the same time, it is no less inconvenient than the no less uncomfortable than breathing through the mouth with the mouth with the nose closed. The very fact of keeping the nose, which can be avoided for a few moments at the most by moments by squeezing the nose, the breathing the nose, it is easier to catch one's breath, and it cannot be and 'it cannot be considered as a reproach of this procedure that the

that the effect of the acrid is delayed by this, but that the delayed by this,
3° 36
Position of the patient in the B ether vapors. _ Ro now
Most surgical operations are performed in a sitting or lying position, some in lying position, some are performed in a half-lying position, and the turned depending on the surgical orle. M The task now is to make the inhalation comfortable inhalation in harmony. In the case of operations can be performed in a sitting position. Sick person, since he also most easily in this $ The patient should be made comfortable in a reclining chair, then a helper with the breathing: step to the left side of the patient, place the on the mouth of the sick person, and about Care for the uniform connection to the mouth of the patient. a second assistant, who stands behind the patient patient and to support the head If the operation is to be performed only in the lying position, the patient must not lie down while inhaling the air. patient must not lie down, least of all on the abdomen, because because of the discomfort caused by the inhalation, but on the lower is placed on the lower edge of a bed supported by a and pillow as a resting place. table, the back is supported by a helper, and the the back is supported by a helper, and the feet by a chair. supported. Now he begins to inhale

When the necessary state of anesthesia is reached, the patient is 37
the apparatus is quickly removed from the mouth, the patient is the patient gently and begin the operation. The Most patients prefer to be anesthetized while sitting on the chair on the chair and then carried to the operating bed without but part of the smoke evaporates during the time-consuming and during the time-consuming, laborious transport of the of the unconscious person, and consciousness returns, but the without the operation having begun, so that post-breathing of the vapors becomes necessary. This must always take place when the operation is of the kind that tion is of such a nature that it cannot be completed in a few moments. If under the same operation the full consciousness and the If full consciousness and sensation return during the operation, the patient has to do some new exercises, and if he is operated on lying and if the patient is operated on lying down, he can also be again in the lying position, until the ether has until the ether shows its renewed effect, which usually only takes usually only a few moments.
Effects of inhaling the ether vapors.
The effect of the inhaled vapors consists in a series of in a number of the most wonderful phenomena, which have already been have already been thought of in general. Here I will specify them in more detail. Immediately after the first breaths, many people experience a 38
and especially when the sick person, 'who was already excited

who was already agitated before, begins the breathing with haste. a short cough, which causes the patient to patients are induced to grasp the apparatus away from the mouth, This cough is the result of the direct action of the actherd vapors on the air, of the vapors in the air and is immediately eliminated by by allowing some atmospheric air to be breathed in again. atmospheric air again. But if the willpower is strong enough strong enough, the coughing will stop by itself when the the cough will stop by itself.
The effect of the inhaled ether vapors occurs in different different individuals, depending on their youth or age. or age, great irritability or insensitivity, either after the first either already after the first breaths or after a certain time. or after a certain period of time, and most late in the case of the later in the case of drunkards. Already after } a minute I saw individual, while in another, accustomed to spiritual another, accustomed to spiritual beverages after 4 hours. not the slightest changes occurred.
The phenomena, which we now observe are of a very heterogeneous nature, and in most cases the following in most cases the following. The expression of of fatigue, and soon after that of a stupefaction-like The expression of fatigue, and soon after that of a stupefying state, spreads over the face. The patient breathes slowly and hardly noticeably, the mouth the mouth slips from the apparatus or falls asleep against the Aelher. The eyelids cover the eye, which rolls upwards. which rolls upwards. All the outer muscles slacken, the head lowers to the side. Side, the 39

arms fall down, the legs slide forward, the back the chest sinks in, the movement of the of the abdominal wall, the breathing is deep, the breathing is deep and calm, the heartbeat is often hardly The heartbeat is often barely perceptible, sometimes the breath is snoring. If we direct our attention to the senses, we notice the attention to the senses, we notice that with the increase of the As the anesthesia increases, one sense after the other disappears, First of all, there is a feeling. The sick person does not perceive that he is pinched or pricked with a needle. with a needle. All the other senses are still active. Then the taste taste is extinguished, the patient feels and no longer no longer distinguishes between the taste sensations; then the face face, and then the smell, while the brain is still active. is still active. Finally, also this sense, which often has been which until then had remained in the greatest subtlety, ceases to exist, and full This state is the common and general one. wobn and general.
With the waning of the ether effect after the lapse of several minutes or in an unyer course of several minutes or in an unyerhiltnifsmafsig long time, the senses return in reverse order, one after the other. one after the other, first the deaf person begins to again to hear, then to smell, then to see, then to taste and then to see, then to taste and finally to feel, and when the individual senses return, the consequences are the consequences are even more precise, more regular, clearer and more sharper from each other.
Even before the beginning of the inhalation of the ae~

therdimpfe is difficult to breathe, as a result of the geis~ mental excitement. If the inhalation begins, so usually as a result of the application of the quite irregular. Some sick people beı very clumsy and unteachable, they inhale too quickly too quickly, soon too deeply and increase irritation already caused by the ether, so that coughing occurs. coughing occurs. Only at the beginning of the sensation: and even more with the disappearance of the remaining the breath becomes deep and slow, sometimes it is sharp.
The eye presses even before the onset d atlımungen a somewhat anxious excitement aı. Look is more lively, the eye shining. In a few breaths one notices a stronger]. filling of the superficial vessels and the In the case of the more active, full-blooded persons, there is often a slight The pupils usually constrict somewhat. inhalation, then dilate for a few minutes before then dilate for a few minutes, and then contract anew 2. with the onset of a deep anesthesia. often very dilated. Since the patients usually eyes are asleep, the changes in the pupil are pupil without lifting the upper eyelid is seldom" observed. observed. March
The pulse suffers a noticeable change. With the onset of inhalation, it begins to increase to become so that he probably has 20 to 30 $ı minute more. If the ether has some some part in this, then this is mostly by the initial b 4
brought about. Gradually, with the onset of rest, it decreases in

speed and drops to the normal number. the pulse rate decreases and falls to the normal number of beats. to the normal number of pulse beats, and only seldom and in the event of great anesthesia it becomes even slower than in the natural state. natural state. Thus increased frequency of the pulse in the the beginning of the anesthesia and later slowing down is the usual,
In other cases we observe the following the pulse increases little or not at all in frequency, or it is it is sometimes fast, sometimes slow, sometimes small, sometimes large, and even intermittent at times. In the same way it changes in terms of hardness and softness, fullness and emptiness. and emptiness. But these are all differences, which which show themselves only in single individuals, and as an expression of the expression of the peculiarity of their constitution and the and the irritability or insensitivity of their nervous and and vascular system.
With the dissipation of intoxication, the return of the slumbering senses the return of the slumbering senses and full consciousness. the full consciousness, the pulse increases in fullness and frequency, so that it still so that it has 5 to 10 beats more than before the inhalation of the than before the inhalation of the ether vapors.
The heart is usually calm, and its beats are rarely stronger than in natural beats are rarely stronger than in the natural state. Often it trembles only softly and the individual beats are hardly beats are hardly distinguishable from each other. Only rarely real knocking occurred, either at the beginning of inhalation or

during inhalation or at the return of consciousness, when it was consciousness, where it then suddenly lifted. To determine the effects of the inhaled vapors in relation to the application in the Heilkı and to appreciate them more precisely, a large number of a large number of experiments have been carried out on persons and also on themselves. The first to be mentioned are the experiments carried out by the Society of Physicians in Paris, as well as the hieı Berlin talented young von Gräfe, the son of the famous Gräfe, the son of the famous, blessed v. Gräfe. The beopacl made on those intoxicated with acether as well as the self-observations found during the low degrees of ether influence stable,
The following results were obtained Physicians of the German Society in no experimented on themselves. I
With respect to the frequency of the pulsos all showed a marked increase in the first minutes, followed by a decrease in frequency, which was still stronger than in the normal state. Towards the end of the experiment, towards the | Towards the end of the experiment, toward the 8th minute, a noticeable reaclio heart, whose contraclions had increased in intensity, becoming
intensity, in that it became stronger and more "snappy" again.
continued attempts. On average the mean number of pulse beats to 406.

The respiration was mostly more accelerated than | mal condition, although it should be noted that even before the trial the pulse and re: 43
were usually already faster than in the normal state, which was due to the mental tension and excitement of those who and excitement of those who were subjected to the experiment. explained. The respiration behaved in terms of frequency and frequency and extension as the pulse.
The effect of inhalation on the nervous system was in system was in most cases a complete abolition of the feeling of the feeling of pain, from which one could be by pricking the ears, nose and hands with needles, by cutting with needles, by cutting into the arm, by burning fire sponge. burning fire sponge and dripping with hot sealing wax. Here it is to be noted that 'often only after prolonged inhalation'. 'often only after prolonged inhalation of this insensitivity against the pain, while shorter experiments with the same individuals shorter time lasting tests with the same individuals were without 'result.
The duration and intensity of the effect depended depended to a large extent on the duration and accuracy of the inhalation. inhalation. The insensitivity lasted 1 minute 3 seconds for one, 1 minute 30 seconds for another, and in another, in a third { minute 14 seconds, in a fourth over {0 minutes. Several had dream appearances. One had slight light appearances in the eyes, and eyes, and there were some symptoms of dizziness. 'dizziness. Two woke up with laughter from their hot dreams. dreams. The sense of touch was completely undisturbed,

as long as the individuals were conscious, and they detected the smallest and they discovered without the help of the eyes the smallest of a body without the help of the eyes. The effect of the ether 44
seems to have passed through three stages in the experiments. stages. In the beginning, the sensation of the body such as 'the pulse and respiration, increased, d diminished the perception of the sn of the movement of the circulation, and injury is only weakly felt. In the third stadiu all feeling ceased, and the individual was as lich as a cadaver. The effect of the soon disappeared, and there remained afterwards only a of weakness and heaviness of the head, which after a after a quarter of an hour at the most. All agreed with one another that the All agreed that the ether's degradation gave them a pleasant sensation similar to that of a slight intoxication. similar to that of a slight intoxication. Professor Gerdy in Paris describes fo] the effect of the ether vapors on himself I made use of Charriere's apparatus, and soon the soon turned the stimulus to cough, which the Aetberdän produced in the trachea, the tickle and the H ten then seemed to subside due to the soothing. of the ether subsided. From this I already felt a numbness in the head. Feelings of heat connected, as with begin intoxication. This anesthesia spread over the whole body and gave a dull but very but very pleasant impression, similar to the after the consumption of beer or young white wine. The effect of the ether also resembles that of d phium, but differs, at least

45
from the opium intoxication by 'the. Lack 'of the little pleasant effect of the latter. * The sense of sight was not noticeably dulled by the anesthesia. by the anesthesia, for I read in dim light when I was already dizzy. light, when I was already dazed, The hearing was more more changed, With the increase of the anesthesia decreased the strength of the sound diminished, and only with the dwindling the intoxication, the sounds became clearer again.
The senses of smell, taste, and feeling were senses were not paralyzed by the general anesthesia; but my eyelids were heavy and I felt the need to sleep. the need to sleep, to abandon myself to my feelings. to my feelings. I fought off the fatigue and continued my observations. continued my observations, noticing that, with the exception of the feelings that, with the exception of the feeling of swaying and numbness numbness, which dulled the general feeling, and the hum the buzzing in front of my ears, which prevented me from hearing clearly. prevented me from hearing clearly, my conception as well as my mind and my mind were completely free. I tried to I also tried to walk, which was done with staggering steps, as in the case of the insane. Speaking was difficult for me and difficult and 'was slow, otherwise all the other other functions of the body seemed easy. My brother observed my pulse during this time, and found neither the number nor the strength of the beats changed. changed."

The same experiments were repeated by Gerdy on ten people, both men and women, and gave similar similar results, Some lost their self-confidence46
Some lost their self-confidence, others became very cheerful, "in others" the face darkened. Others had a darkening of the face,
To Mr. Gerdy's experiment on himself... I add the experiments made by v. Graefe on himself and numerous others. himself and numerous others, as well as his own as well as his own report, which is at the same time the critique of which at the same time contains the critique of Gerdy's experiment,
As far as first the anesthesia is concerned, of which Gerdy as the first sign of the ether effect, then it is at Gerdy as the first sign of the ether effect, then it is to be admitted to him at best. It has with the real anesthesia at the onset of intoxication. intoxication; for while the latter is visibly based on the while the latter is visibly based on the emphasis of the suhjecti vity, we find here nothing else than a suddenly reduced and a suddenly lowered and cessated tension of the nervous activity of the nervous activity, and that in both spheres of the same spheres of the same, in the sensitive and in the motor sphere. The aelhoric effect can be appropriately compared with the state accompanying the with the state that accompanies falling asleep. One could that falling asleep is accompanied by the feeling of sinking the feeling of unconscious sinking, which is found here; but also the which is found here; however, this feeling is also not constant in

the feeling is not constant, but rather it is based on a certain rather, it is based on a certain anxiety, which disappears with repeated of the experiment. Thus I consider, says von Graefe, in the latter experiments performed on myself, instead of the instead of the intoxication-like stupefaction mentioned by Gerdy. the feeling of a high physical and mental inertia at the beginning. of a high level of physical and mental inertia, which is why 47
voluntary movements and logical deductions, as they are otherwise logical deductions, as they are otherwise performed mechanically, require the the whole willpower to carry them out, and soon after the sensation of a confinement brought about by ab ning induced by relaxation.
The feeling of heat in the head and of coldness of the of the extremities is not uncommon, the arterial throbbing is so arteries are so frequent that I have been able to find Gerdy's my' experiments at an extremely early stage. the alteration of the sense of hearing observed very early by Gerdy,"
I have seen this alteration, however, in people who have who are somehow inclined to subjective auditory phenomena by the feeling of a peculiar, sounding, but still rhythmic, sound. sound, which is still rhythmic, and which is nifesliren, which at the first attempt of grofse fears them fear at the first attempt, while the perception of the sound was

the perception of the sound.
The sensation of nausea can be felt in the first The feeling of nausea can hardly arise in the first space of the ether effect, if it is not the result of swallowing the ether. It must be considered as a sympathetic phenomenon of cerebral affection. cerebral affection, which appears only much later. later. What Mr. Gerdy says about the disappearing the disappearance of the senses, it is certain that he has not his experiment not long enough 'or with too little impregnation of the impregnation of the air with acther gas'. continued.'"
If, because of the inertia mentioned above, a deficient reaction to 'sensory impressions takes place, Ku 48
a deficient action of the senses themselves, and of all senses indeed of all senses is unmistakable. With injustice Gerdy believes Gerdy is wrong to exclude the senses of smell, taste and senses, which are just as clearly and in general even more affected and in general even more affected than the sense of hearing. senses become dull, gradually lose their peculiar character, dissolve into a character, dissolve into a general, mechanical perception and disappear. mechanical perceptions and finally disappear completely. the willpower succeeds at all in delaying the effect of the act the action, this happens especially in the time period where the time when the sensory perception begins to blur; a tense,

mechanical percep blurred; a tense, intense activity of the sensory functions sensory functions holds their decay significantly. their decay. Thus, pungent smelling, tasting subtasting substances, spraying with cold water are the best and fastest and quickest antidotes for the ether effect in this degree. this degree. What von Graefe observed about the disappearance of the senses observed about the disappearance of the senses. The order, in which the senses disappear, varies thus according to the activity arbitrarily given to them. Closing of the eyes causes an early disappearance of sight. of sight, fixation of single objects with the eyes preserves it, exact with the eyes preserves it, exact attention to everything that is spoken preserves it. everything that is spoken preserves hearing, carelessness soon dulls it. carelessness soon dulls it.
Apart from this arbitrary preservation of the individual senses, one usually senses, one usually observes this corollary. The feeling becomes dull, almost. simultaneously with the taste, then the face, then the 'geEgg 49
smell and finally the hearing. The complete cessation of sensory activity usually takes place in the same suceession. Very often, however, the observation of a clear consequence is lost, namely when in a deep breathing when, in a deep breathing process, the transition from muted from subdued stimulus sensitivity to complete lack of stimulus and

and insensibility is imparted. In such cases In such cases, one usually observes the return of the senses of the senses in the reverse sequence described above. Unmentioned in Gerdy's report is the third period of third period, which refers to the suspended perception with physiological physiological necessity, namely the complete unconsciousness. complete unconsciousness, where mind and conception no longer no longer remain free. Every conscious communication with reality is cut off, the will to carry out something is no longer present, since the mind the spirit is deprived of all clues to maintain or regain consciousness. or regaining of self-consciousness are withdrawn from the mind. This is the period which, however, can be combined with intoxication. can be compared to intoxication, since here the previously since here the brain affection, which before was merely apparent, is as in sleep through anesthesia of the senses, only in another way really develops in a different way, of which the symptosymptoms give us an account of. If before there was a clouding of consciousness, now a real cessation of consciousness takes place. of the same takes place, { "The dreams of the aetherisirten, as von Graefe are of a very different kind, usually only the dreamlike usually only the dreamlike imaginings from the 4 second period, since in the third also here' recollection has taken all bases The only thing that remained for me," he says, "as for most other this stage only the feeling of an infinitely laı lived through time. In vain i

thoughts after the past dream world, d like many others, seemed to encompass a rich of life. Just as wen the nature of dreams is expressed through the @ expression. Thus I heard someone at the moan terribly and even in formal white. 0 he awoke with the feeling of
(ohlbehagens, Another one I saw with different expression of a heavenly rapture. on awakening he thought he was in the middle of a pile of in the midst of a bunch of ragamuffins who were spolting spolting etc. gi
Incidentally, what is true for all dreams is true for these dreams.
that they generally choose the most important levers of their lives. of life. Dreams of the deceased usually refer to deceased relatives and friends, who are very who are of great concern to the soul; in the case of shi Visions of religious persons, etc. are very common, Awakening from the period of perfect consciousness The transition to the normal state takes place during the the second period with successive sense Instead. If the etheric effect has actually progressed into the second period, If the ether effect has actually progressed to the third period and has some za very often vomiting occurs, as i 51
I have noticed twice myself. As for the pulse, the experience of Mr. Gerdy is not generally valid. generally valid.

In most cases, a significant acceleration takes place during the first during the first stages, which, of course, is largely due to the psychic to be attributed in large part to the mental excitement, but even in but even in the last attempts I made on myself, where I was very on myself, where I was very calm, the pulse reached a frequency of a frequency of 470 to almost 180 beats. Several several times, I had to interrupt the tests because of the A phenomenon that was never absent was the change in quality. was the change in quality. The pulse always becomes pulse is always soft, which is due to the reduced contractility of the arterial of the arterial membranes. In most cases I also saw a smaller blood wave.
The respiration is always accelerated in the beginning, even in even with appropriate apparatus, which is partly due to the mental mental excitement, and partly to the discomfort caused by the changed the altered air mixture; however, gradually the breathing However, longer intervals between the breaths gradually appear. between the breaths, so that the frequency soon falls below the normal. soon falls below normal and, when the anesthesia is completed often drops to 8-10 beats,
The many experiments with electric shocks experiments with electric shocks have proven to me that the for the same with the complete extinction of the periphe- ric sensation. Later on, very strong shocks were also given by the very strong shocks of very sensitive individuals.

4* were no longer periphoric, they twitched, but felt nothing at all. but felt nothing at all.
With all indi the same usually with the Actherisaliot which is why the first stages of ether sleep are bi leptic and also many hysterics ı than in full-safied patients, who only experience the real to avoid the real congestion stage. On 2 individuals, I saw during the anaesthesia pronounced catalepsy, arms and legs verh: the position given to them,
Difficulty in speech, which lasted for several days I saw in one experiment immediately after the 'Aetherization,
In the third stage I usually found a tive retardalion and an increasing magnitude and of the pulse, phenomena that can be traced back to the congestion of the blood in the central nervous system. central region. The behavior of the pupil vaı the time periods, but I am, although I in dı 100 attempts I have paid close attention to it, I am still not able to I am still not able to establish a valid rule for this. In the third stage, however, I saw in ! cases a dilation. ai
It is very difficult when observing a scho so difficult a condition as the Aeth is, by a more exact analysis of the gradual at least to get a proper clarity of the development. For expressions like: "the geruchsian is nic

53
paralyzed," etc., because of their vagueness, give rise to great to great errors because of their vagueness. Now such an analysis is of course not the product of a few experiments, but can only be but can only be achieved by a thousandfold repetition. can only be achieved by a thousandfold repetition. The striving for such an anaat least: the experiments that are so often carried out today. the experiments that are carried out so often today. a scientific method and a well-founded goal. and a well-founded goal."
Different types of ether noise.
The aether vapors produce a peculiar state, which is most similar to the state produced by the with the state induced by the consumption of spirituous beverages, which we call intoxication, it differs from the latter from the latter especially in that it is of a more subtle and more and more spiritual nature. However, it repeats all the usual phenomena in the state of drunkenness are repeated in an in the state of drunkenness are repeated. Just as a person can be intoxicated by even a small amount of a intoxicated by even a small amount of a spiritual drink, a few a few breaths of the ether vapor are often enough to cause drunkenness. intoxication, and just as another person does not experience the the effect of large quantities of spiritual beverages, so of large quantities of spirituous beverages, the same is also true after long inhalation of the ether vapors. One has inspired several people for over an hour 54

for more than an hour without the slightest change in them. occurred in them. The duration of the intoxication especially according to the duration of inhalation. A person who is anesthetized instantly comes to in an instant and he who is stunned for a long time, about half a day, comes to.
and difficult to wake up from his stupor. awaken. The lesser or greater receptivity to the aether for the ether depends, as in the case of spiritual the age, the sex, the degree of Rı
If we call this peculiar state intoxication, then it If we call the mental state intoxication, then it again shows a multiple which shows us a renewed similarity with the intoxication. with the intoxication. We clearly perceive four different types of intoxication. 1.
A silly intoxication, 4, a raving intoxication. As in drinking in vino veritas, so here | breathing in aethere veritas, RR
In the swooning intoxication the dividuum appears as a limp, insentient, warm body warm body, with a completely slumbering body. The eye is completely or half closed, di pale, the features more expressionless than in ordinary than in the usual state or in unconsciousness. The withered The withered facial muscles lack all facial expression. ö 55
sigh or a snore; the rule is muteness, If this intoxication becomes loud, it manifests itself in a gloomy mood and dullness,

melancholy mood and dull lamentation, without ever being ever become cheerful or dallying or angry. The awakening is usually preceded by some deep inhalations and sometimes sighs. inhalations and sometimes sighing.
The cheerful intoxication, which we often find in young juvenile persons, especially in the female gender. often expresses itself after only a few breaths, when the few breaths, when the first reluctance against the against the compulsion of the apparatus and the new air. and the new air has disappeared, it is expressed by a mild, friendly of the facial features. An indescribable contentment and and cheerfulness spreads over the face, the cheeks sometimes flush, the eye becomes shining and and then gently falls asleep, turning away from the outside world. world. The ground shakes under the feet the spirit strips off what is body, the senses and desires become senses and desires are discarded with the body. with the body. The realm of dreams gets the upper and incoherent, individual words proclaim the unnamed words proclaim the unnameable bliss. The lower senses, the feeling, the taste and the smell are dormant and show no pleasant delusion of any kind. of any kind. The inner eye now beholds the the most brilliant colors and during the sleep of the ear the sense of hearing revels in the most enchanting sounds. the most enchanting sounds. No confused image disturbs the happy ones, in the feeling of being completely disembodied, "

56 * of a state never known before, feh all time maafs. To them, this completely earthly genufs soon appears to them as a single blissful eye soon as a heavenly eternity. In the same way it is it is clear whether these phantasy pictures are and transformed recitalions of what has been experienced, od created delights. To tender children the loving parents appear as transfigured figures, and loving mothers see the garments of their children in a in a blinding beauty that is indescribable. Whoever lives lived to music, becomes in blissful self-feeling to

Meyerbeer, the girl without a voice to Jenny I the driest prose writer to Dante, the fearful one to the hero who has won the battle and is marching in the and in the glittering march of the army, with the sound of umph into the beautifully decorated father city heimkel Servant to the great lord. Under the position, which No one dreams of descending below the position that everyone has in life. climb up on eagle's wings into a azure blueness or to a yellow, shimmering sea of gold. sea of gold. No one treads the hard earth, The feet and the heaviness of the body are laid aside, float weightless and in a wide space, are they low If there are lower, earthly images of memories, which come to the soul, theater and concerts take first place. ts take the first place. Siegmund observes! a young man dreaming through his entire oriental journey . Kronser thinks that bad p could be lifted by aelher vapors and ; 57
be lifted. If this were possible, it would be a happiness, and perhaps the prose could be ennobled by it. ennobled by it.
To the cheerful intoxication would also the sensual dreams, which are sometimes said to be observed, and from which one and from which one has taken a precarious argument against the Aether, would belong. We have not observed thethe same in neither the male nor the female sex. neither in the male nor in the female sex. Thereseveral times involuntary urination occurred in actherisirs. involuntary leakage of urine.

Fortunately, the silly intoxication is rare. Already at the first onset of the effect of the ether, the face The first time the effect of the ether takes effect, the face takes on a different expression, and the person becomes quite dissimilar to himself. The visual muscles begin a vibrating game, the eyes are opened eyes are opened wide and closed again convulsively. closed again. Restlessness spreads over the whole body body and alternating voluntary and involuntary movements of the involuntary movements of the limbs. The respiratory apparatus is removed, the person begins to speak to speak without clear coherence, soon to improvise alimprovise, joke with the bystanders and probably laugh at them. jokes with the bystanders and probably to force them to laugh. Everything is accompanied by eerie gestures and gesticulations. accompanied. In addition, there are eonvulsive movements and the whole and the whole scene ends with a daze from which he then emerges. from which he then awakens. The patients do not know how to give a clear picture of their condition. of their condition, they only affirm that they were very confused and are concerned that their behavior may have caused that their behavior may have given rise to the problem. ask a thousand times for forgiveness. The raging intoxication shows us a far more beautiful picture than the strongest. licher picture than the strongest of the drunkenness deriveı. Fortunately, it is not much more violent than the silly intoxication. than the silly intoxication. With the inhalation nit the face immediately takes on a deep seriousness and di Expression of a relentless severity. The are opened wide and roll and flash nig. Now they are asleep, now the cr

motionless there and raises his voice to most terrible threats. An indistinct feeling of inflames him even more, he is unclearly aware of an external of an external act of violence, he is in his executioners. You cursed! exclaimed one, I Executioners, you murderers! And so he was greeted by a flood of invectives, against which the papi pen resisted. Finally, fatigue sets in, and n and after a few deep, snoring breaths, consciousness returns. Consciousness returns, usually without memory ( what was going on in the soul, or what the mun spoken. - In others, the ni intoxication only through violent muscular actions; without without talking, the man thrashes around, stabs the the fists and develops a force that is to be tamed. Finally the force is exhausted, the body covers itself walt, the body covers itself with Schweils, 59
the body is covered with swells, 59 and the state of rest and general slackening and the general slackening occurs. Either he has he has no memory of this state at all, or he only tells or he only says that he had a very confused dream, about which he could about which he cannot give any details,
These four different types of etheric dreams are usually different from each other. are usually different from each other, but but sometimes one notices transitions from one form to the other. from one form to the other. The cheerful intoxication into the silly one and the silly one into the raging one. raging. If transitions took place, then they followed the same order

order as they have been indicated here; I never saw a retrograde transformation. With women I have seen only the swooning and cheerful intoxication, the and serene intoxication, and the silly and delirious intoxication only a few times in men,
Effect of the aether vapors in relation to the Pain in surgical operations.
Earlier I described the mental and physical the mental and physical states of the aetherized, as we have observed them both in the healthy and the sick. Here now follows the details, what the observation in relation to the the feeling of pain during surgical operations. This is actually the main thing in the whole matter of the ether. of the ether. In this respect we take etherized persons on whom surgical operations are performed. on whom surgical operations are performed, the following f, the sick person is completely without feeling, he does not feel he feels neither the pain nor the operation, 2. operation, 2, he feels the pain and opera:
indistinct, but quite different from the natural state, 3. 3, he does not feel the pain, but the opera 4, he feels both, but differently than usual, 5 feels greater pain than in the non-etheric state. state. The pain is increased by the ether increased by the ether, but changed.
Although these different states often merge into one into one another, they can nevertheless be integrated into the same state.
aggenn 'one has a larger number of one's own observations

before one of our own observations in front of us.
1. the aetherized person is completely anesthetized and has the greatest and the most embarrassing operation is no pain at all. He does not twitch, he does not complain and he does not even betray b even during the necessary cutting of nerves. the slightest sensation. The entire operation is performed under The whole operation is performed with complete anesthesia and insensitivity. and when he wakes up he knows nothing of what has happened to him. what has happened to him, or the patient is not anesthetized. or the patient is not anesthetized, he only has the appearance of being tired with glassy eyes. One believes that he sees knows everything. A small or painful operation is performed on him or painful operation is performed on him, after which he He is as little as the other because he has been operated on. rirt, even though we thought that his vision was only diminished. dung was only diminished. It is striking striking that he is not like some of the other, lesser! 6
circumstances, what this or that person did or said. said.
2 The feeling is wrong. The patient feels instead of the pain of the wound something completely different, sometimes at the place at the place where he is being operated on, or at a distant place. distant place. He feels as if he were scratched or pressed, if he was

or pressed, if he was burned or cut. He may also experience a slight discomfort of a different kind of another kind, an unpleasant position, the uncomfortable position of a limb the uncomfortable position of a limb, or the pressure of an assistant's hand more than the operation itself,
3. he does not feel pain, but he feels the opeThis is in the series of phenomena the most wonderful! most wonderful! The patient is stunned or awake. In the In the latter case, he can know, see and hear everything quite accurately. he is operated on and has not the slightest feeling of pain. the slightest feeling of pain. In suspended animation or in suspended he follows exactly the movements of the knife into the depth of his body. of the knife into the depth of his body, he distinguishes all his and accompanies it on all of its movements without and accompanies it on all of its movements to and from the heart without any combination, It is not the recognition by the ordinary, all-embracing general feeling, but as it were a heightening of the local perception, a potentiation of physical self-examination. of physical self-examination. And in all of this there is no of pain, discomfort, fear or reflection, no kind of sensory interference! Soul and body seem to be detached from each other, and the latter only only from a distance from above without judgment. E4

62
or conjecture. It reminds us state vividly of the wonders of the "Magn which we did not believe, and which we can can grasp with our hands,
4. pain and operation are felt. In fact, however, almost only pain is felt.

is felt. For in the case of a sensitive surgical In a sensitive surgical procedure, one actually feels only the pain, The feeling of being operated on is completely absorbed. The surgeon groans and moans under the opera ion as it happens, with the same moaning and verhalteı although he is in a state of apparent anesthesia. is. Also after the operation describes pain suffered, similar to the usual
5. there is an increase in pain.
the loudest lamentations, words, voice, and express an indescribable woe, its Is probably the wildest despair. It is ni furibund aether rapture, such as I have experienced even without op ralion with aelherisirten, alone, son the same is heightened by the latter. 'Without preceding furious deliria, e The "third, sleep-like or serene intoxication may be caused by a feeling of pain. The feeling of pain can be turned into a furious state. However, this state shows great diversity, 1] After the operation is over, we recognize from the from the patient's lungs that she is really gi f while in other cases the whole schme he
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The whole event lives only darkly in their memory. The cause of these phenomena is, as I believe, one of the I believe that the cause of these phenomena is, in particular, an unusual fear the operation, an uncommonly rigid adherence to the gruesome

of the gruesome image of the same and a consequently into the unfree etheric intoxication, Those phenomena, where the patient during the operation the pain during the operation, without the pain being pain during the operation, without the patient being conscious after the can be explained by assuming that he has only lost the memory of it. the memory of the same.
Surgical Perceptions in Aetherized Patients.
The bleeding is not noticeable during surgical operations, which are performed with the use of ether. is always stronger than usual. This stronger of the blood, the wound may be large or small, is the wound may be large or small, is particularly the result of the greater by the ether. Modifications occur by the greater anesthesia of the patient and the excitation of the and excitation of the vascular system. Amussat saw that the darker coloration of the blood always preceded the anesthesia. I found the blood to be dark as well, even if anesthesia did not occur, even though there was no anesthesia. The liquefaction of the blood of the blood seems to occur very soon after inhalation. inhalation, as the ether haze of its great nz
64
the solid, original parts of the body very quickly. the solid parts of the body. E Appearance, which is immediately perceived,

a larger number of arteries inject al and small ones, which are otherwise not noticed, The sharp jet of blood that flows through the arteries, the thinks that this increased bleeding from small arterial branches as a consequence of the aelherisalion is a new v for surgery, in that the same can be removed and and to prevent secondary hemorrhages by but this is just a disadvantage. It by the irritation, the vessels may be torquiren the vessels, and more easily give rise to serious consequences. and easier to cause serious consequences. I believe that one of the most frequent causes of death is the uni of many small vessels. " The blood, however, is not only more fluid and darker, but it has a real ether smell, It is hard to imagine a smell of ether in ı the operation, where everything in the room smells of ether. the blood flowing out, but when it is collected and it is collected and stored in another place it does not deny the smell of ether. The same results as the ether give the inhalation of coal gas, nitrogen gas, fuel gas, etc, nitrogen gas, etc., namely the previous emplin during the breath and a gradual return of the sensation when the The sensation returns with a new inhalation. d spherical air. From this it follows that the sensation 65
the result of the action of the blood on the central points of the the central points of the nerves, which is not transformed in the lungs. which has not been transformed in the lungs.
A third phenomenon is that the blood generally looks darker.

looks darker. This is less noticeable in venous blood than arterial blood, which often has a completely venous appearance. venous appearance, but is never quite as red as usual. as usual. I was not the only one to see this, but but almost all other physicians.
According to Amussat, the arterial blood becomes dark during inhalation. arterial blood becomes dark. This coloration precedes the onset of the onset of insensitivity. If atmospheric air is atmospheric air is inhaled again, the blood becomes darker before before the return of sensitivity, the blood becomes rolh,
Behavior after the operation.
The condition of patients after major chi rurgical operations shows some peculiarities, which alone or which only or mostly belong to the ether. In some cases, immediately after the operation, there is a strong immediately after the operation there is a strong upsurge and vomiting as as after an ordinary intoxication, in others a short cough and sneezing, both of which soon disappear. disappears. On the other hand, other physicians sometimes have chest pains and even spitting blood, probably after the exaggerated blood spitting, probably after the exaggerated aetherization. observed. In several patients soon after the
5 vomiting soon after inhaling the vapors, in others later after later after the operation. A

number complained only of nausea, many of them afterwards of a afterwards of a dull headache and fatigue of the fatigue of the whole body. Some were afflicted with great melancholy, and it was precisely those most of all those who were floating in a sea of \ and now, when they wake up, they feel no no bliss but that of having survived a surgical operation. surgery. A gentle sleep usually lifted inc usually lifted all these unpleasant after of the acther, and the next morning the phenomena usually the next morning, the symptoms usually disappeared again. Unmistakable, however, is the tendency of the surgical wounds to become the tendency of the surgical wounds to bleed. bleeding. It is adequately illustrated by the greater liquefaction liquefaction of the blood by the ether absorbed by the circulation. by the ether absorbed by the circulation. Stärl Compression, tamponade, cold compresses in vei combination with a cooling regimen soon the postoperative bleeding. ioke Against unusually long anesthesia, the most The most effective means are fresh air and cold water, compresses placed on the forehead. In the case of two not two people who were not strongly etherized by me: gestions to the head, which were immediately relieved by . But they were lifted immediately. The drained which smelled of ether, was more liquid, the blood] smaller, the blood water reddish. Other suffer 67
from nervous headaches for a long time. With Gerdy himself this lasted for 10 days.
The smelling of ammonia alcohol, which was recommended as

an recommended as an antidote against anesthesia with ether, would recommended only in the case of apparent death. death. Jackson advises, as has already been mentioned, in the case of deep anesthesia, to let the patient breathe in oxygen. and with every operation to be performed under the influence of the ether. to be performed under the influence of the ether. serve, but this precaution becomes superfluous, if the patient is not overly etherized.
It seems to be dangerous to give the patient strong drinks after the strong drinks to the patient after the operation is over. (Fairbrother gave the same to the patient during an amputation and etherized the patient in turn). For it can dangerous increase of intoxication can be caused. instructive in this regard is the example of Siegmund, who example of Siegmund, who treated a man on whom the ether did not man on whom the ether did not seem to have any effect. a glass of wine caused a strong after-intoxication.
Several physicians have observed strong swelling after the operation as a bad consequence of the etherization. I have seen these late tails only twice. they were in no way rejuvenating for the patient. but rather seemed to have a quite beneficial influence on the patient. rather, they seemed to exert a quite beneficial influence.
As a result of the great divisibility of etheric vapors vapors, we continue to perceive a pervasive aetheric

a penetrating ether smell for a long time.
5* Not only the exhaled air, but also the tail and the the tails and the surface of the body smells after several hours, even several after ether. In one case I still took the day after the operation. The exhaled air of etheric K Despretz says that it contains only half as much oxygen as ordinary air. of ordinary air, because at a temperature of degrees, the elastic force of the ether is only half of the average pressure of the atmosphere. half of the mean pressure of the atmosphere g Those who operate under the ether seem to have after the operation, apart from the feeling of less happy about it, apart from the feeling of fatigue, not perceived as those who have been operated with pain has been operated on, that the dreaded eye sight has passed. The dreaded eye is over, and they have a real fear of the fear of the bandage, which is far more sensitive than the They are much more sensitive to the discomfort of the bandage than the non-activated patients, the discomfort of the bandage is of very little importance. compared to the pain of the operation. Later detrimental influences of gross on the general condition of the patient. I have not noticed any adverse effects on the opera those wounds, which were treated with sticking plaster or led to immediate adhesion, were often tions were often closed in a few days, as usually, come closed. In wounds with loss of substance observa
no stronger inflammation than usual, |

a lesser). The suppuration and granulation procefs was soon natural, soon the plasticity diminishthe healing took place in the usual time, and also probably a little later.
Also the solid parts seem to have some changes due to the by the ether. The skin is withered and shows a lower degree of elasticity when cut. elasticity when cut, which is why it retracts less. retracts less. The cellular tissue is darker and the voluntary muscles are flabbier and unmistakably of a slightly brownish color. and unmistakably of a light brown coloration. brown coloration. The involuntary muscles, such as those of the intestinal of the intestinal tract, slacken; hence sometimes greater lightness, incarceration. Therefore, it is sometimes easier to bring back incarcerated fractures. The same applies to the bladder, whose voluntary sphincter muscle muscle sometimes opens and allows the urine to flow out. urine. In the case of a woman (see below), whom I operated on a I operated on an incarcerated hernia, there was a large mobile hernia on the other side, covered only by paper-thick covered by paper-thick sheaths. The clearly perceptible clearly perceptible distended loop of intestine was in great was in great excitement, and the peristaltic movement was visible. visible. After exposure to the actinic vapors, this movement was this movement was gradually paralyzed, and the intestinal loop slowly slowly crawled back into the abdominal cavity.
The state of insensibility even during the the greatest surgical operation, shows just the opposite of what

the opposite of what we see in a patient suffering from asphyxial cholera. asphyclic cholera. While in 70
the surgical wound bleeds more profusely, the Sensitivity is completely eliminated. In b cholera patients, the wound does not give a drop of blood it is almost dry, and even the largest arte the limbs are empty, and nevertheless the degree of sensitivity is present in all parts of the wound. of the wound is present. A gruesome shock Thus, the expression of life in the deathly and of the appearances in the living,
The applicability of the ether vapors in the individual surgical individual surgical operations.
The surgeons and surgical writers I have in recent times often placed ether above surgery. surgery. They speak of happy and and happy attempts, of happy and unhappy operations, and by this they mean only happy and unhappy operations.] and unhappy operations, and by this they mean only ether, not the actual surgical operation. Apart from the fact that the term "attempt is not quite appropriate in a serious matter. one experiments only at most on animals, at the most on a on a 6 months pregnant woman, as H Cardan did with the ether! (see below) Lucky li p tions are now called those, the sick person has breathed the ether well and has become one: to

intoxication; unfavorable ones, on the other hand, where he has been unruly in the alhmen, has shown a wild wild intoxication, screaming and raving, and found the and found the operation painful. The surgical part of the operation is thus completely overshadowed by the ether. ether, so that for many people it looks as if the operation would be many people it looks as if the operation and its artistic and its artistic execution are completely secondary, as if it were as if it were a minor matter whether the patient was well or badly or bad, became dangerously ill, or even died. or even died, if only he did not die immediately after the on it and the ether anesthesia.
This one-sidedness in the conception of one of the of one of the greatest discoveries can only harm it. can only harm it, lead to errors and give dangerous weapons to the opponents. dangerous weapons into the hands of the opponents. Much can and and may be operated with ethers, some things must not be not be operated with ether, and for still other things the ether is ether is a luxury, i.e. the etherization is not in proportion to the is not in proportion to the operation, it is too small, and the means too it is too small, and the means too great; it is as if one wanted to with a cannon at a sparrow, or to kill a fly with a a fly with a flap with a wooden axe. with a wooden axe, - they might take offense at that and say and say that I am an opponent of ether.
Aetherization is to be avoided under all circumstances in all operations. operations, if the person suffers from respiratory diseases

diseases of the respiratory tract, congestion of the chest and head chest and head, tendencies to blood flow, and 72
and great irritability of the nervous system. B The patient's life can then be put at risk by put life at risk, and the opening of an ulcer or the or getting rid of a sick patient can be far too expensive. can be purchased at far too high a price. on the other hand, the significant size of a: ration the sole provision for the use of ether, since it may be prohibited by some important may be forbidden. The discerning physician will know how to take ı Know everything to take into account. Nam Of the many hundreds of surgical opewhich are performed on the body of a sick person in order to restore to make him healthy again and to preserve his life. life, I would like to mention a few of them. with regard to the applicability of the ether. I beg your pardon if I do not mention the names of all the men names of all the men who have performed this or that operation with success. operation with success under the application of the with the use of the ether, since the material is b is too massively accumulated. # The burning. The fire is fuei the knife. The horror of the glowing egg the burning cylinder give the ether anesthesia one of its first places. The application of the glowing has been very limited in recent times for joint diseases. the use of the glow iron has been very limited in recent times, but we must the patient in the frequently used anesthesia. as a marvelous means of relieving their unbearable pain,

pain. Most of the 73
physicians have already made use of the ether with happy success and have saved many patients from pain, since they have pain for many patients, since they had no memory of it after the they had no memory of it at all. - During the operation, one cannot be too careful with regard to fire and light. and light cannot be too careful. As the patient is anesthetized, the apparatus and the light must be removed from the room. removed from the room, and if the room is small, a window must be window must be opened, so that there is no dangerous ignition. Charriere has therefore, as already noted above, also removed his Charriere has therefore, as noted above, also equipped his apparatus, like Davy's safety lamp of the miners, with a fine wire net. wire net.
Dislocation of the limbs. In the case of dislocation In the case of dislocation of the limbs, ether anesthesia is a wonderful is a marvelous means of setting them back in place. Through that which has been sought in vain for centuries, and of which centuries in vain, and of which only the smallest part was found. of which only the smallest part was found. In the case of fresh dislocations the difficulty of reconstruction is not great, but difficulty, but it requires some skill and practice. practice. In the case of dislocation of a large limb, especially when some time has passed since the dislocation time has elapsed, it often depends on more than just skill and not only on dexterity and the right direction of the helping

of the helping forces, but mainly on the relaxation of the spasmodic of the spasmodically contracted muscles. This This condition of general relaxation was sought in difficult in difficult cases by drawing blood to the point of fainting, 74
anesthetic medicines, purging, cures of disgust, starvation, cures, starvation, lukewarm baths, oily baths, etc. oily baths, etc.; Dupuytren made use of such a Dupuytren made use of such horror by suddenly attacking the patient with a the patient with a serum, as if he wanted to kill him, where he where he then quickly cut the limb of the patient who was the limb of the patient who had collapsed in fear. The power of the contracted muscles, as in the of the contracted muscles, as in the dislocation of the upper is sometimes so great in strong men that even pulleys cannot overcome the resistance. that even pulleys are not able to overcome the resistance. resistance, and the muscles tear more easily. give way. Only the cutting of the most muscles sometimes helped to overcome the difficulties of the device. of the device. The desirable The desirable state of complete slackening deı the anesthesia of the ether in a way that it can anesthesia in such a way that this difficult surgery becomes surgery thereby in safety and brilliant has gained forever. Should the ether all bloody surgeries should fall into disrepair again it will always be preserved in case of luxations. As a must be considered here, however, that the first degree of i ration, the abolition of sensation, is not sufficient, s but the state of full anesthesia". the slackening of all the muscles.

Velpeau easily adjusted the thigh of the the thigh. Just as easily succeeded other Wı a 2 75
the dislocated upper arm and other limbs just as easily. and other limbs.
From complieirte bone fractures of greater especially of the lower leg, where the fracture ends are fracture ends are pushed over each other, and where everything depends on the fracture surfaces against each other again. The same applies as to dislocations. The slackening of the muscles irritated and contracted by the injury muscles irritated and contracted by the injury, which anesthetization of the patient, makes it possible to perform the with far less effort than usual, so that two people can now be than would otherwise be the case, so that two people can now easily achieve what four would otherwise only be able to do with all their effort and with the greatest pain. and with the greatest pain.
In resections of the sick, as well as in the removal of large the removal of large sequestra, the aetheric has been done several times with the greatest relief for the sick. has already been done several times. So resecirte Heyfelder resected the head of the upper arm under ether.
The operation of the arterial tumor, during the the ligature of large vascular trunks to heal aneurysms. aneurysm, the advantage of anesthesia is not great. great. The operation is rarely very painful, and the patients tend to remain calm out of fear.

A restless or even wild intoxication could be very dangerous here and dangerous and could cause injury to the artery to be exposed and artery to be exposed and stopped. Two important circumstances seem to me to be worthy of consideration here. 76
worthy of consideration. One is useful for the operation, the useful to the operation, the other is opposed to it. The liquefaction 'ether causes liquefaction of the blood mufs The liquefaction of the blood caused by the ether must the collateral circulation and prevent the death of the limbs. of the death of the limbs. At On the other hand, a new concern arises! The etherization decreases the plasticity of the limb. a proper thrombus is not always formed ı after the vessel is cut through by the tethering thread After the vessel is cut by the tether, a hemorrhage occurs. Even less, however, is the aetherisir | shows, to an accidentally wounded greater kindı because, due to the above-mentioned conditions, the bleeding of the lichenen, the bleeding by inhaling dı ihers would be increased, the To appears with Aelherisirten gewils very precarious un läfst probably even more easily to bleeding than the tying. and Orthopedic operations. In the major orthopedic orthopedic surgeries, the use of the The use of the ointment as an analgesic is a suitable suitable field, as it is particularly sensitive when a large when a large limb that has been curved for many years is limb, after the cutting of the ı tendons or muscles, even before the application of the

machine must be stretched to some extent before use. applies especially to the contractures of the hip and the joint, of infinite benefit here is " 77 .
therization, as I have seen from time to time during my operations. The same is also indicated by others. 'give. Where, however, nux the Achilles tendon, as in the case of equine fufs. or the lower degree of the lateral clubfoot, or in the case of the the contracture in the elbow joint or the crooked neck. or the oblique neck, if only one tendon is to be cut, the act to be cut, the Actherrausch is less in the place, since these place, since these operations are less painful and require only a moment. If the sick person intoxication, the operation would be made very difficult for him and himself. the operation would be very difficult for him and for himself. The situation is different with the higher degrees of clubbing, where the twisting of the where the twisting of the fist, or the change of its shape, requires the the cutting of several tendons is required, especially when especially when, because of the large contraction and and shape of the foot, cuts in the sole of the foot are necessary. in the sole of the foot would be necessary, in order to the natural position, shape and usability of the limb, shape and usability. In these operations, actheresis is urgently recommended. strongly recommended. The same also applies to the setting up of obsolete dislocations. dislocations with an. Tendon and muscle transection B. of the shoulder, arm, hand, knee and knee joint. and en The rigid resistance of the shortened by the long duration of the ailment is somewhat

by" the anesthesia and thus facilitates their ee their ee even more facilitated. A great good deed is to give the patient the sensation of the It is a great good deed to deprive the patient of the sensation during these painful procedures, " [za 78
and it is certain that the institution here will now also succeed cases where it was not always possible in the past. possible in the past.
The extirpation of tumors bethe ether if they are large and the operation is painful. ration is painful. This applies both to tumors on the of tumors on the surface of the body as well as of those in accessible caves. Of the latter is in another place will be discussed in more detail in another place. The operation of large, fixed fibrous, scirrhotic and steatoand steato-matous tumors, as well as the feit and bellows tumors, are the patient and the doctor by the ether, so that he can the doctor by the ether, so that he can do the same at greater rest, which the patients do not have during these operations which patients do not tend to have during these operations, in a much shorter time. in a much shorter time. On the other hand, anesthetization with ether is too anesthesia is too great a means to be used for cutting out every small small tumor on the head or on any other part of the body. on the head or on any other part of the body. body part. Only the individuality of the patient will make an exception here, so that even in the case of small even with small operations of this kind, very timid and sensitive sensitive patients, especially if they long for the ether.

for the ether, a slight lack of sensation before the operation can be of before the operation,
In the case of the wrong joint, which after an unhealed bone fracture. The piercing of the ends of the bones and the insertion of pins in the same and the insertion of pins into the bone ends to induce a
2 79
inflammatory swelling with new callus formation This intricate operation causes the muscles to go dormant and to of the muscles and complete immobility of the patient. highly desirable.
Amputation of the limbs. The amputation of not amputation not only of small limbs, such as fingers and toes but also of whole arms and legs is already so common so often in ether anesthesia, and with such decisive so much that the value of the remedy in this respect can be the value of the remedy in this respect as favorable. favorable in this respect. In the case of ampulalions of larger limbs, the patient's the mind of the patient has already been affected by the sad the crippled perspective of walking among the healthy. so broken, that only the painful fusion of a healthy of a healthy limb, or the pain caused by protracted bone disease. or the exhaustion caused by a protracted bone disease. in the deepest resignation in the sufferer the desire to the desire to give up his meager life for an arm or a leg. for an arm or a leg. But already a ear to the doctor, they tremble at the thought of the size and at the thought of the magnitude and the pain of the operation,

which and the pain of the operation, which can be performed by the most the same by the most skilled surgeon in just a few moments. it may be in the joint or outside it. joint or outside of it, it remains the same joint or outside of it, it touches the innermost life. A wonderful benefit here is the anesthesia of the ether. A wonderful benefit is the ether anesthesia, since experience has shown since experience has shown that even the thigh, without the sick person without the patient feeling it in the least. s
However, it is absolutely necessary to disregard such great advantages. in my opinion, ether anesthesia is not to be recommended here. not to be recommended here. The amputations are indicated in the case of fusion of the limbs, which make it impossible to preserve them, and in which the attempt to relocate the extremity limb is sometimes paid for with life, furthermore in such diseases of the joints, bones, or soft tissues or of the soft tissues, which cause death if the patient does not death, if the patient does not, as he did in the small one the painful tooth, here his sick limb, the source of our the source of unspeakable suffering, Under these circumstances, however, the Actherisalion is not to be recommended for amputations. Only the only the patient who still has a part of his body strength which has not completely deteriorated and has a certain and has been able to maintain a certain degree of physical and moral strength. of physical and moral strength, I would like to etherize without

etherize unconditionally. On the other hand, I would a patient who has suffered from a long lasting carious in or outside of the joint, by hectic by hectic fever, almost aggravated, to anesthetize. anesthetized, so that he will not feel the operation. from the operation. In such a lamentable condition one would run the risk one would run the risk of the artificial intoxication.., the perlurbirte condition of the system of gels, immediately fatal immediately cause fatal congestions of the chest and head. and head. Furthermore, the etheric liquefaction of the Liquefaction of the blood, with the already Auiderem sı
blood 'of the patient, to greater loss of juices, which is which one has to avoid with the Ampulalion here so already the ampoule, as well as to greater bleeding after the to major postoperative bleeding. At the most I may give the patient the first hints of aether sedation by a few moments a few moments in front of nose and mouth. and mouth for a few moments and then quickly perform the perform the operation. But since even the most the most hectic fever sufferer, whose life time has expired whose life time has expired except for a few days. life can still be saved by amputation of the diseased limb. countless experiences teach that life can be saved by amputation of the sick limb.
Trepanation of the skull. Of all the of all major surgical interventions, none of them prohibits the as much as the trepanalion of the skull, an operation, which in the case of head injuries in recent in recent times, because of its ingratitude, is in itself so much the best surgeons because of its ingratitude, that it is now used only in a few cases.

The treatment of persons with severe head injuries before trepanation before trepanation would perhaps still have the 'good would perhaps have the advantage of lowering its credit even more. (since death would be more frequent afterwards) and to save the lives of death would occur more frequently) and to save the lives of later patients, by doing even less than now Irepanirie.
The condition of a head injured person is often already similar to that of a severely aelherisirte, death-like sleep, complete sleep, complete unconsciousness, or wild delirium, Conyulsions, etc. give the terrible picture of the
6 82
disturbance of the intellectual functions. The trepanaTrepana- tion is sometimes performed without the patient or because, even in the most severe cases, the patient is not Even in the most severe cases, the patient is only vaguely aware of the of the bloody intervention and only expresses his unclear and expresses his unclear sensations only by a muffled groan, Therefore, whoever under such circumstances gives the patient anesthesia to the patient's natural anesthesia. to the natural anesthesia of the patient in order to make things easier for him and himself. would thereby betray his sad limitation. would betray his sad limitation. But even in the case of head injuries with with perfect consciousness, where trephination seems to be nolh-

trepanation seems to be necessary, the aetherization is dangerous, in the blood flow to the injured or irritated brain is significantly increased. the injured or irritated brain, and the course of the disease is The outcome of the disease is made much more doubtful. Fortunately, this operation has not yet been under the influence of the Acther. In the case of eye surgery, as much can be said for as against the for and against the ether. The delicacy of the organ and the delicacy of the operation require the most absolute absolute surrender and silence of the patient, if the operation is not performed by the most experienced hand. include the stoma operation, the pupil formation and the squint operation. squint surgery. If the patient can be made more more passive, this is a relief for the doctor, who is still for the doctor, who can complete his work even faster, and for can complete his work more quickly, and for the patient, because he he does not feel anything. The previous observations 83
still speak in favor of aetherization in the case of eye operal ions. However, one can object to the fact that the that the low painfulness of some ophthalmic and the speed with which they can be carried out, the with which they can be performed, makes the aetherization overfluid. makes the aetherization liquid. Of greater concern, however, is the fact that the circumstance, when the intoxication under the operation suddenly becomes an impetuous one. suddenly becomes an impetuous one, where the instrument which is

the eye at the time, can injure it or cause damage to the eye. z. or, for example, break off a stasis needle in it, so that it would be considered would be considered lucky if it could be quickly removed from the eye quickly out of the eye before the operation is completed. before the operation is completed. In the case of ophthalmic operalions, I would I would recommend that in the case of ophthalmic operalions, since everything depends on the type of intoxication, a few days before the operation I would try to etherize the patient. the patient a few days before the operalion, although this still not always a reliable determination of the nature of the of the later intoxication, but during the operation to etherize etherize as much as possible during the operation, to let the operation the operation for a while, and if he remains calm, to operate and, if he remains calm, to operate immediately; if he becomes wild until the agitated state is completely over.
Of decisive value is the aetherization in other coarser and coarser ophthalmic operalions, where accidental side effects are not to be feared even in restless patients. even in restless patients. This includes the paror total extirpalion of the eyeball belongs to it. If painless removal of the large dark staphyloma of the cornea staphyloma of the cornea, which is the cause of the imminent
6* 8
of the eye and the transition to the the eye and the transition into the eye, should be a great relief

for the patient. the eye, we owe the highest appreciation to ether anesthesia. we owe the highest tribute to the ether anesthesia, if we most gruesome and painful era the cutting out of the eye destroyed by cancer, blood or eye destroyed by cancer, blood or sponge, the severing of Optic nerves and probably even with the eyeball zı the removal of the eye seized by cancer, and the unfortunate can perform, and the unfortunate person of the tending pain in the process. Augenoperalionen stands in relation to Aetherisirung cutting out the eyeball is therefore above, and there is there is not a single reason against it.
In operations on the eyelids, especially if they are of greater extent, the artistic, plastic operation, where a. lid is to be replaced, the Actherisalion of unsuitable for all minor operations, e.g. cutting out small the excision of small growths of the bellows, and
In facial surgeries, the Aelherb is to be used with great with great advantage. The This operation, which is intended to create a new, ed is to be created, requires from the side of the the greatest tranquility and devotion, in order to or the place of the missing nose by means of Iı and extirpations to accommodate a flap to be inserted from the st 'or arm skin to be inserted flap vor re " BR EN di
" 7
An even more silent behavior of the sick person requires di Artificial excision of the forehead or arm flap,