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The Dubois's Anesthetizing Machine: The First Modern Approach for Delivery of Chloroform
Jean-Bernard Cazalaa, M.D.; Jacques Hotton, M.D.; Nguyen H. Nguyen, M.D.; Pierre Carli.
Department of Anesthesia, Hopital Necker, Paris, France
The common method to administer chloroform was to pour little by little the necessary dose of chloroform on a compress over the patient's nose. That did not provide optimal efficacy and safety. Paul Bert who was professor of physiology at the Sorbonne, perceived the importance of a system that could deliver measured chloroform mixtures. He used the Saint-Martin's gazometer which could provide a fixed mixture of chloroform in air for studies in dogs and subsequently in 22 patients. But it was a cumbersome and very heavy laboratory device.

Under Bert's direction, Raphael Horace Dubois designed in 1884 an anesthetizing machine which was as big as a hat box. It was worked by a handle. A measured volume of air was drawn into the apparatus by a pump and passed through a warmed evaporating chamber into which, simultaneously, a measured quantity of liquid chloroform was injected from the reservoir by a stroke of a piston. The resulting mixture was blown through a long rubber tube to a valveless facepiece. The device could continuously deliver a constant volume of gas (20 L) in a known chloroform concentration in air (6, 8 or 10%).

Dubois recommended an induction chloroform concentration of 10 % for 7 to 10 min, then the concentration was set to 8 % for 5 min and 6 % during maintenance. More than 200 anesthetic cases in patients ranging from 6 months to 60 years, in various severe conditions and undergoing various surgical procedures were performed in 1884 and1885.

Although the concept of delivery of chloroform was quite modern and addressed the safety issue, french surgeons found the device complex to use comparing with the traditional compress anesthesia which allowed a more rapid induction time. Controversies arose about the level of the safe chloroform concentration which must not exceed 3.5 % according to the recommendations of the Royal Medical and Chirurgical Society of London. Moreover, according to an editorial of the British Medical Journal, the Dubois's method was not new and had already been used 25 years ago by JT Clover. Finally, fierce discussions occurred during meetings at the french Academie de Medecine in 1890 and 1891 during which surgeons were called artists by physiologists and the latter were called 'physicians of dogs' by the former!

Eventually, the use of the Dubois's machine was limited to a few hospitals where Dubois himself had some personal link with the surgical staff in Paris, Lyon and Ghent. Around 1900, the Dubois's machine was barely mentionned in french textbooks of anesthesia. However, DW Buxton from England, expressed in the British Journal of Anaesthesia in 1924 the opinion that Dubois's machine 'remains one of the best dosimetric apparatus availabe'. He added 'however, it has not received much attention in this country, probably because of its size and possibly because mechanical contrivances do not apply to busy practitioners'.

Anesthesiology 2002; 96: A1165