A.C.E. mixture
Encyclopedia
A.C.E. mixture is an old anaesthetic agent for general anaesthesia
, which was first suggested by Dr. George Harley and first used in England around 1860, and in 1864 it was recommended for use by the Royal Medical and Surgical Society’s
Chloroform Committee
. However it was used rarely after the 19th century, although used for slightly longer in Germany.
It was a mixture of alcohol
, chloroform and ether (diethyl ether) which gives the mixture its name. Its actions were said to be between that of chloroform and ether and it was used as a good substitute when ether alone was contraindicated. Its boiling point
was given as C and it was measured in Drachm
.
Chloroform (which was first used in 1847) used on its own produces myocardial depression, however the excitatory
properties of the alcohol and ether contained with the choloroform in the A.C.E. mixture was believed to reduce this. However, some did question this experimentally at the time.
Many anaesthetists favoured A.C.E. mixture and one author in 1887 in the British Medical Journal
considers the A.C.E. mixture, at the time, the best anaesthetic for general use and use in childbirth
. He states one downside; the "excited" state of patients on regaining consciousness after the anaesthetic, due to the alcohol in the mixture. Another downside of the mixture, as with most anaesthetics at the time, was its high flammability
.
Deaths have been known to occur from the mixture. However, at the time, deaths from A.C.E. mixture were reported less in number than the deaths from chloroform or ether.
(which has a high content of alcohol) for dental procedures (to make a more pleasant experience).
Other mixtures were:
.
), in a Rendle's mask, a cone, or through an inhaler.
Inhalers included: Allis' inhaler, Junker's inhaler (with a funnel mask) for children, Clover's inhaler with bag removed (this inhaler has to be constantly lifted from the face to allow 'free air' to be admitted). Ellis proposed an inhaler to blend vapours in exact proportions, however it was impractical, but Dr. Gwathmey modified his idea and created a practical apparatus. Tyrrell created a similar idea called the 'Tyrrell's double-bottle method'.
General anaesthesia
General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...
, which was first suggested by Dr. George Harley and first used in England around 1860, and in 1864 it was recommended for use by the Royal Medical and Surgical Society’s
Medical and Chirurgical Society of London
The Medical and Chirurgical Society of London was a learned society of physicians and surgeons which was founded in 1805 by 26 personalities in these fields who had left the Medical Society of London because of disagreement with the autocratic style of its president, James Sims...
Chloroform Committee
Chloroform Committee
The Chloroform Committee was commissioned by the Royal Medical and Chirurgical Society in 1864 to investigate the use of chloroform. The committee recommended the use of chloroform in the same year...
. However it was used rarely after the 19th century, although used for slightly longer in Germany.
It was a mixture of alcohol
Ethanol
Ethanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug and one of the oldest recreational drugs. Best known as the type of alcohol found in alcoholic beverages, it is also used in thermometers, as a...
, chloroform and ether (diethyl ether) which gives the mixture its name. Its actions were said to be between that of chloroform and ether and it was used as a good substitute when ether alone was contraindicated. Its boiling point
Boiling point
The boiling point of an element or a substance is the temperature at which the vapor pressure of the liquid equals the environmental pressure surrounding the liquid....
was given as C and it was measured in Drachm
Dram (unit)
The dram was historically both a coin and a weight. Currently it is both a small mass in the Apothecaries' system of weights and a small unit of volume...
.
Usage
A.C.E. mixture was most commonly made up in the ratio: 1 part alcohol, 2 parts chloroform, and 3 parts ether although other ratios existed. See 'other preparations' below.Chloroform (which was first used in 1847) used on its own produces myocardial depression, however the excitatory
Stimulant
Stimulants are psychoactive drugs which induce temporary improvements in either mental or physical function or both. Examples of these kinds of effects may include enhanced alertness, wakefulness, and locomotion, among others...
properties of the alcohol and ether contained with the choloroform in the A.C.E. mixture was believed to reduce this. However, some did question this experimentally at the time.
Many anaesthetists favoured A.C.E. mixture and one author in 1887 in the British Medical Journal
British Medical Journal
BMJ is a partially open-access peer-reviewed medical journal. Originally called the British Medical Journal, the title was officially shortened to BMJ in 1988. The journal is published by the BMJ Group, a wholly owned subsidiary of the British Medical Association...
considers the A.C.E. mixture, at the time, the best anaesthetic for general use and use in childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
. He states one downside; the "excited" state of patients on regaining consciousness after the anaesthetic, due to the alcohol in the mixture. Another downside of the mixture, as with most anaesthetics at the time, was its high flammability
Flammability
Flammability is defined as how easily something will burn or ignite, causing fire or combustion. The degree of difficulty required to cause the combustion of a substance is quantified through fire testing. Internationally, a variety of test protocols exist to quantify flammability...
.
Deaths have been known to occur from the mixture. However, at the time, deaths from A.C.E. mixture were reported less in number than the deaths from chloroform or ether.
Other preparations
After widespread use of A.C.E. mixture, anaesthetists would try different mixtures for different patients and different procedures. C.E. Mixture omitted the alcohol and A.C. mixture omitted the ether. One particular doctor documents using equal parts of alcohol with choloroform for minor operations and chloroform with Eau de CologneEau de Cologne
Eau de Cologne or simply Cologne is a toiletry, a perfume in a style that originated from Cologne, Germany. It is nowadays a generic term for scented formulations in typical concentration of 2-5% essential oils. However as of today cologne is a blend of extracts, alcohol, and water...
(which has a high content of alcohol) for dental procedures (to make a more pleasant experience).
Other mixtures were:
- Richardson's mixture: 2 parts alcohol, 2 chloroform and 3 ether
- Vienna mixture: 1 part chloroform, 3 ether
- Billroth's mixture: 1 alcohol 1 ether and 3 chloroform
- Linhart's Mixture: chloroform with 20% alcohol
- Methylene ("Bichloride of methylene"): 30% methylic alcoholMethanolMethanol, also known as methyl alcohol, wood alcohol, wood naphtha or wood spirits, is a chemical with the formula CH3OH . It is the simplest alcohol, and is a light, volatile, colorless, flammable liquid with a distinctive odor very similar to, but slightly sweeter than, ethanol...
and 70% chloroform - Schleich's solutions for general anaesthesia (number one for light anaesthesia and number three for deep anaesthesia):
- No 1: 45 parts chloroform, 180 parts sulphuric ether, 15 parts petroleum ether.
- No 2: 45 parts chloroform, 150 parts sulphuric ether, 15 parts petroleum ether.
- No 3: 30 parts chloroform, 80 parts sulphuric ether, 15 parts petroleum ether.
- Wertheim's solution: 1 part chloroform, 1 part petroleum ether and 2 parts sulphuric ether
Usage in animal testing
A.C.E. Mixture was also used to anaesthetise animals, including in preparation for vivisectionVivisection
Vivisection is defined as surgery conducted for experimental purposes on a living organism, typically animals with a central nervous system, to view living internal structure...
.
Method of administration
A.C.E. mixture could be given through drops (from a drop bottle) on a piece of (a towelTowel
A towel is a piece of absorbent fabric or paper used for drying or wiping. It draws moisture through direct contact, often using a blotting or a rubbing motion. Common household textile towels are made from cotton, rayon, bamboo, nonwoven fibers or a few other materials.-Types of towels:* A bath...
), in a Rendle's mask, a cone, or through an inhaler.
Inhalers included: Allis' inhaler, Junker's inhaler (with a funnel mask) for children, Clover's inhaler with bag removed (this inhaler has to be constantly lifted from the face to allow 'free air' to be admitted). Ellis proposed an inhaler to blend vapours in exact proportions, however it was impractical, but Dr. Gwathmey modified his idea and created a practical apparatus. Tyrrell created a similar idea called the 'Tyrrell's double-bottle method'.
External links
- The Garret Museum Online Collection: Anaesthetics which has many useful pictures and further information on each of the inhalers.
- Anesthesia Antiques: Inhalers And Droppers which contains a picture of Allis' Ether Inhaler
- Historical Anaesthetic Equipment - Junker's Chloroform Inhaler
- Clover's portable regulating ether inhaler (1877). A notable one hundredth anniversary A paper that shows Clover's inhaler
- Ellis obstetric inhaler a photo of Ellis' inhaler, which was used for women in labour. From Manchester Medical School Museum's FlickrFlickrFlickr is an image hosting and video hosting website, web services suite, and online community that was created by Ludicorp in 2004 and acquired by Yahoo! in 2005. In addition to being a popular website for users to share and embed personal photographs, the service is widely used by bloggers to...
photos. - Richard von Foregger, Ph.D (1872-1960) an article Richard von Foregger that contains a picture of Gwathmey's appartus.
- The Brian Welsh Memorial Museum of Anaesthesia which has lots of image resources.