It was a mixture of alcohol, chloroform and ether[1][3] which gives the mixture its name. Its effects were said to be between that of chloroform and ether and it was used when ether alone was contraindicated.[1] Its boiling point was given as 48°C.[4] Its actual safety margin over its components alone was marginal.[5][6]
ACE mixture was most commonly made up in the ratio: 1 part alcohol, 2 parts chloroform, and 3 parts ether[2] 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 properties of the alcohol and ether contained with the chloroform in the ACE mixture was believed to reduce this.[2] However, some did question this experimentally at the time.[7]
Many anaesthetists favoured ACE mixture and one author in 1887 in the British Medical Journal considers the ACE mixture, at the time, the best anesthesia 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.[8] Another downside of the mixture, as with most anaesthetics at the time, was its high flammability.[citation needed]
Deaths have been known to occur from the mixture.[5][9] However, fewer deaths from ACE mixture were reported than deaths from chloroform or ether.[6][10]
After widespread use of ACE mixture, anaesthetists would try different mixtures for different patients and different procedures. CE mixture omitted the alcohol and AC mixture omitted the ether.[1] One doctor described using equal parts alcohol and chloroform in minor operations, but chloroform with Eau de Cologne (which has a high alcohol content) in dental procedures for a more pleasant experience.[11]
Despite the similar names, the anaesthetic mixture named "bichloride of methylene" did not contain the actual compound that would be called bichloride of methylene (Dichloromethane CH2Cl2). Instead, it was later discovered as a mixture of chloroform and alcohol marketed as the bichloride of methylene and even given the formula CH2Cl2.[12]
ACE mixture could be given through drops (from a drop bottle[5]) on a piece of lint (atowel), 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 Gwathmey modified his idea and created a practical apparatus. Tyrrell created a similar idea called the 'Tyrrell's double-bottle method'.[1]
