The Vicissitudes of Ether

As Snow increasingly focused his practice on administration of anesthesia, it became evident that the benefits of ether were growing more complex, as well. It not only prevented pain and shock, it kept patients still. With ether dislocations could be relaxed and treated in minutes, whereas in the past gradual applications of warm baths and emetics were typical and marginally effective treatments. Snow's comments to the military physicians on the use of ether to detect some cases of malingering, revealing as it is of Snow's willingness to apply ether to all sorts of practical situations, is equally suggestive of the heady power with which ether seemed to render the body open for medical inspection and medical operation. For good or for ill, ether could inspire "a devotion to technological evidence," could become a means of bypassing the patient's words, an agent by which the sick person was silenced and converted into an object, a disease entity.82

Ether also seemed to offer new access to the recesses of the mind. In his first formal publications on ether in March, Snow offered some observations about the effects of anaesthesia on the mental processes that were involved in the perception of pain. "Metaphysicians [like Descartes, Locke, and Hume] have distinguished between sensibility and perception—between mere sensation and the consciousness or knowledge of that sensation, though these two functions have, as they supposed, always been combined." However, he had observed something different. "Ether seems to decompose mental phenomena as galvanism decomposes chemical compounds, allowing us to analyse them. . . . During the recovery of the patient, consciousness, which first departed, generally returns first, and the curious phenomenon is witnessed of a patient talking, often quite rationally, about the most indifferent matters, whilst his body is being cut or stitched by the surgeon."83

Snow observed that many patients dreamed of early periods of life or "that they are travelling" (E, 11). By the end of his life he would elaborate on this phenomenon, attributing this feeling to a particular set of symptoms. When anesthetics take effect, he explained, patients would frequently experience singing in the ears, dizziness, tingling limbs, darkening vision, and a loud noise; "it not unfrequently happens that a person feels as if he were entering a railway tunnel, just when he is becoming unconscious."84 For Bernard and Flourens the power of ether to close down the body's systems in a particular sequence helped to reveal physiological principles. Similarly, for Snow the shutting down of consciousness gave a glimpse into the mechanisms of consciousness.

He observed that dreaming took place only in the lighter phases of anesthesia, despite the testimony of patients who recalled having lengthy dreams. He argued that "impression of the length of dreams can of course be no argument as to how long the person was dreaming, and that the impression is often of a longer time than the whole period of insensibility" (E, 11). In one case Snow recorded an example of "the smallest amount of etherization with which an operation can be satisfactorily performed" (E, 49). A knighted gentleman underwent an operation for "two sinuses by the side of the rectum" (E, 50). Toward the end of the operation, which lasted a total of three or four minutes, as the surgeon was thrusting lint into the wound, "the patient flinched and uttered an angry expression; and directly afterwards tried to raise himself up from the sofa, but was easily prevented. In less than a minute, he said he had been in Lancashire disputing with some people" (E, 50). Only eight and a half drams of ether were used. Upon learning that the operation was over he was surprised and satisfied. Snow concluded that the "dream about the conversation probably occurred at the moment when he first spoke" (E, 51). Because he was deeply interested in determining whether a given patient experienced pain, he used his degrees of anesthesia to pinpoint the instant of the dream within the hypnagogic flow of ether. He recognized that dream states were dependent on basic mental functions. "I think that there is every reason to presume, that there can be no dreams or ideas of any kind in [deep anesthesia], and that for a short time there is not only, as in a sound sleep, the absence of mental functions, but also the impossibility of their performance" (E, 11). Snow was beginning to explore the possibility that a chemical agent, which temporarily suspended certain molecular processes in human tissues, could affect in a basic way the stuff that dreams and ideas are made on.

On the Inhalation of Ether was Snow's attempt to present the gist of his research in a way that was readily useful for the surgeon and anesthetist alike. It promoted his inhaler and the beneficent and effective use of ether. The reviewer for the Lancet thought Snow had accomplished his purpose and recommended it,85 but the reviewer for LMG resisted the entire spirit of Snow's work and challenged most of his central assertions.86 While Snow's apparatus was ingenious, the sponge appeared to have superceded "more elaborate contrivances."87 Snow was insistent that ether could provide pain-free surgery in a safe manner to virtually anyone, but the reviewer was not so sure. Snow considered children to be favorable candidates for ether, yet the reviewer worried whether children with "latent tubercular disease of the brain," acute hydrocephalus, or meningeal lesion might prove exceptions.88 Where Snow found ether to increase heart rate, the reviewer feared that it might stop the heart. Where Snow defined the five stages of etherization and advocated a reliable method of distinguishing among them, the reviewer emphasized their arbitrariness and the fluidity with which patients slipped in and out of them. Where Snow claimed that patients feel no pain, the reviewer asked "who shall say through what vicissitudes of varied, and perhaps, fearfully exalted, though afterwards unremembered suffering, the apparently passive wretch is exposed while his stupefied faculties are gradually becoming roused from the state of absolute insensibility?"89

But the LMG reviewer misread and misrepresented Snow's book. Where Snow wrote, "It is not possible always to avoid having the breathing somewhat stertorous" (E, 39), the reviewer misquoted him as stating, "It is not possible to avoid. . . ."90 Both reviewers failed to mention the bench chemistry that formed the basis for Snow's assertions, and the error in the LMG review tellingly reveals the kinds of skepticism that Snow's certainty and precision about ether engendered. Snow saw a consistent pattern where others saw vicissitudes. He thought surgical procedures performed with ether tended to induce favorable terminations from hospital care, whereas others thought this questionable. He viewed the impact of ether as discrete whereas others were concerned about predisposing conditions.

In November 1847, not quite a year after Snow first learned of ether as an inhalation agent, news of chloroform as an anesthetic reached London. The emergence of this new agent confirmed Snow's intuition that ether and, before that, nitrous oxide (whose anesthetic properties had been discovered in 1802) were part of a family of inhalants. He would continue the research project he had begun, extending it beyond ether to a more general class of "narcotic" agents. He would soon come to believe "that other agents would be met with more eligible for causing anesthesia by inhalation."91

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