Early French accounts of self-inhalation of ether and conscious analgesia.

Abstract

Ray J. Defalque, M.D., Professor.A. J. Wright, M.L.S., Librarian, Department of Anesthesiology, University of Alabama at Birmingham, 619 South 19th Street, Birmingham, Alabama 35233.To the Editor:--The first French administration of ether for surgical pain relief took place in Paris on December 22, 1846. Ether anesthesia then spread rapidly throughout the country, and by early February 1847, use of the agent by the majority of French surgeons was routine. Although many American and European pioneers are known to have inhaled ether to study its effects on themselves, French accounts of self-inhalation have been lacking in the secondary historical literature. .We recently found the accounts of self-inhalation of ether by two French physicians. Both men remained conscious during their prolonged exposure to the agent and thus were able to study its effects on their senses, intellects, and moods and give detailed and vivid descriptions of the effects. These accounts differ from other early descriptions that simply mentioned a profound euphoria before loss of consciousness. The two physicians also made specific mention of a state of conscious analgesia similar to that described by Artusio more than a century later. .Joseph V. Gerdy (1809–1873), a Paris surgeon, inhaled ether for several minutes on January 21, 1847. He immediately felt a "warm and pleasant torpor spreading to his whole body," similar to that he had previously experienced with alcohol, morphine, and opium. He also "felt his whole body vibrate, as if touching a huge ringing bell." At that time, Gerdy noticed a general numbness to "tactile and surgical painful stimuli"; he did not explain how he tested this analgesic state. His hearing was impaired by "a severe ringing in his ears," but taste, smell, and vision remained intact; he could "clearly read the word ‘philosophie’ under a dim light." His attention, thinking, and will remained intact, and he "was able to force himself to remain conscious despite a strong urge to sleep." He believed that he was in full control of his voluntary movements despite slurred speech and unsteady gait.Jean-Joseph Sauvet (1817–1904), a Marseille physician, inhaled ether in early 1847. Although he occasionally administered ether for surgery, Sauvet was an alienist with a special interest in delirium and hallucinations. He wanted to compare the effects of ether with those of hashish, about which he had read extensively 2 yr earlier but "had unfortunately been unable to take himself." Sitting in his parlor with two assistants and a servant, Sauvet inhaled ether for 4 min from a Charriere inhaler. He immediately "felt a thrilling, warm and sweet languor spreading to his whole body" along with an "irrepressible urge to dance to the sounds of a beautiful valse" and grabbed a chair as a dancing partner. After restraining him, his assistants vigorously pinched his hands and pricked them with pins. Although he felt their touch, he experienced no pain and did not withdraw his hands. The area of pinching appeared to him "as a golden circle upon which converged bright rays of light."Continued inhalation produced visual hallucinations. Sauvet imagined two small people, including "a 20 centimeter-tall woman dancing a fancy polka on top of his piano, and inviting him to join her." Ether also brought back to him "some unpleasant but true memories," yet he managed to refrain from "making bitter and improper comments about them to his assistants." Although he thought he had lost "his judgment and rational thought process," Sauvet remained fully conscious of what he said and did and in full control of his speech. This "delightful dream" lasted about 20 min, and he felt "a strong urge to prolong it" but was restrained by his assistants.Neither Gerdy nor Sauvet reported the concentrations of ether they inspired during their experiments.In reviewing the vast literature on the pharmacokinetics of ether, we could find only one report of the inspired and blood concentrations of ether measured during ether analgesia: after 20 min of stable analgesia (response to spoken voice but not to painful stimuli), 15 patients had an average inspired concentration of ether of 1.2% v/v in air (range 0.6–1.7) and an average arterial blood concentration of 32 mg%(range 17–62).To our knowledge, these two accounts are among the earliest to describe conscious analgesia. Jackson claimed to have inhaled ether in the winter of 1841–42 and experienced a "warm euphoria" and the disappearance of a sore throat during his inhalation. Yet several of Jackson's claims are suspect. His report did not appear until 1861 and strangely resembles that of Gerdy, with which he was familiar. Interestingly, he believed he had to support his claim with the testimonials of six assistants and acquaintances. .Ray J. Defalque, M.D., Professor.A. J. Wright, M.L.S., Librarian, Department of Anesthesiology, University of Alabama at Birmingham, 619 South 19th Street, Birmingham, Alabama 35233.