156 ON ANAESTHETICS 
administering it has undergone a remarkable change. Instead of a free admix- 
ture of atmospheric air, such as is essential to safety in giving chloroform, partial 
asphyxia is systematically combined with the toxic influence of the anaesthetic, 
by making the patient breathe over and over again the same air contained in 
a balloon of caoutchouc, a reservoir of ether being interposed between the 
balloon and a closely fitting mask over the mouth and nares. This may for 
convenience be termed the close method of administering ether, as distinguished 
from all varieties of what we may call the ofen method, in which fresh air is 
admitted with each inspiration. It was introduced by Dr. Ormsby of Dublin, 
and was brought to great perfection by the late Mr. Clover. Various advantages 
are claimed for it. It certainly greatly economizes the ether, and brings the 
patient very rapidly under its influence. It is also said that by utilizing the 
warmth of the expired air, and thus diminishing the great coldness of the in- 
spired air occasioned in the open method by the rapid evaporation of the ether, 
it prevents a chilling of the lungs which sometimes led to serious and even fatal 
after-effects in the form of acute bronchitis or pulmonary oedema or congestion. 
There can be no doubt that this constituted a real danger of the open method. 
A striking example of death taking place unusually rapidly from this cause is 
given in the Lancet of April 1 of the present year (1882) from a report furnished 
by Dr. Parsons, of New York, in whose practice the case occurred. A healthy 
woman, fifty-four years old, had ether given for the reduction of a dislocation of 
the shoulder of five weeks’ standing, the operation lasting twenty-five minutes.’ 
She took the ether well, about 6 fl. ounces being administered. Five minutes after 
reduction was effected she took some water, and about an hour and a half later 
Dr. Parsons left her apparently well. After the lapse of another half-hour, 
however, the house surgeon found her cyanosed ; and in spite of active stimu- 
lating treatment she died in the course of another hour. On post mortem 
examination the organs generally were found healthy, but the lungs were deeply 
congested. No mention is made of the mode of administration, but from 
the quantity of ether used we may infer that it was some form of the open 
method. Such occurrences are not generally published, but they would appear 
to be by no means very uncommon. A case of death from acute bronchitis 
after an operation on the eye for which ether was given by the open method 
was mentioned to me lately by a surgeon in whose practice it occurred, and 
who had no hesitation in attributing the fatal result to the ether. Mr. Hodges, 
of Leicester, writing in the Lancet of July 15, 1882, says: ‘ As regards deaths 
from ether, I make no doubt many occur which are never reported, for the 
simple reason that the death, instead of being instantaneous (as in the case of 
* See Teale, British Medical Journal, March 11, 1882. 
