View source for A.C.E. mixture

'''A.C.E. mixture''' (or '''ACE mixture''') is an old [[Anesthetic|anaesthetic]] agent for [[general anaesthesia]], which was first suggested by Dr. George Harley<ref name='old-anaesthetics-book'>{{cite book | last = Wilmot Buxton | first = Dudley | authorlink = | coauthors = | title = Anaesthetics - Their Uses and Administration (Reprint of the first edition - 1888) | publisher = Read Books | date = 2009-12-09 | location = | pages = 332–340 | url = http://books.google.com/books?id=Sv7Oj1PtHOEC&lpg=PA335&ots=xriomCub4_&dq=ace%20mixture%20inhalers&pg=PA332#v=onepage&q&f=false | doi = | id = | isbn = 978-1-44469-013-2 }}</ref> and first used in England around 1860, and in 1864 it was recommended for use by the [[Medical and Chirurgical Society of London|Royal Medical and Surgical Society’s]] [[Chloroform Committee]]. However it was used rarely after the 19th century, although used for slightly longer in Germany.<ref name='anesthesia-history'>{{cite journal|title=History of Anesthesia in Germany|journal=Journal of Clinical Anesthesia|year=1991|first=Juergen|last=Wawersik|coauthors=|volume=3|issue=3|pages=235–244|id=PMID 1878238 {{doi|10.1016/0952-8180(91)90167-L}}|url=|format=|accessdate=2010-04-28 }}</ref>

It was a mixture of [[Ethanol|alcohol]], [[Chloroform#As an anesthetic|chloroform]] and [[Diethyl ether#Anesthetic use|ether]] (diethyl ether)<ref name='old-anaesthetics-book' /><ref name='family-doctor-1935'>{{cite book | last = No Given Author or Editor.
| title = Everybody's Family Doctor | publisher = Odhams Press LTD | year = 1935
| location = London, UK | pages = 11 }}</ref> which gives the mixture its name (see also the definition of {{linktext|initialism}} in [[wiktionary:Wiktionary:Main_Page|Wiktionary]]). 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.<ref name='old-anaesthetics-book' />  Its [[boiling point]] was given as {{Degree|48}}C<ref>{{cite journal|title=On the administration of a certain mixture of chloroform and ether in gynecological operations by means of a Clover's inhaler without the bag|journal=The Lancet|date=1898-12-17|first=WJ|last=Mccardie|coauthors=|volume=152|issue=3929|pages=1621–1624|id= {{doi|10.1016/S0140-6736(01)84517-7}}|url=|format=|accessdate=2010-04-28 }}</ref> and it was measured in [[Dram (unit)|Drachm]]<ref name="death-reference-1">{{cite journal|title=Deaths Under Chloroform And A.C.E. Mixture|journal=The British Medical Journal|date=1892-11-12|first=|last=|coauthors=|volume=2|issue=1663|pages=1072–1073|id= |url=http://www.jstor.org/stable/20222445|format=|accessdate=2010-04-28 }}</ref><ref name='death-reference-2'>{{cite journal|title=Death Under Chloroform|journal=The British Medical Journal|date=1893-07-15|first=|last=|coauthors=|volume=2|issue=1698|pages=143|id= |url=http://www.jstor.org/stable/20225168|format=|accessdate=2010-04-28 }}</ref>.

==Usage==

A.C.E. mixture was most commonly made up in the ratio: 1 part alcohol, 2 parts chloroform, and 3 parts ether<ref name='anesthesia-history' /> although other ratios existed.  See 'other preparations' below.

Chloroform (which was first used in 1847) used on its own produces myocardial depression, however the [[Stimulant|excitatory]] properties of the alcohol and ether contained with the choloroform in the A.C.E. mixture was believed to reduce this<ref name='anesthesia-history' />. However, some did question this experimentally at the time<ref name='contested-use-of-alcohol'>{{cite journal|title=Alcohol In Anæsthetic Mixtures|journal=The British Medical Journal|date=1890-08-30|first=J. Christian|last=Simpson|coauthors=|volume=2|issue=1548|pages=529|id= |url=http://www.jstor.org/stable/20240176|format=|accessdate=2010-04-28 }}</ref>.

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 "[[Substance intoxication|excited]]" state of patients on regaining consciousness after the anaesthetic, due to the alcohol in the mixture<ref name='bmj-ace-mixture'>{{cite journal|title=A. C. E. Mixture|journal=The British Medical Journal|date=1887-11-12|first=J|last=Walters|coauthors=|volume=2|issue=1402|pages=1078|id= |url=http://www.jstor.org/stable/20213635|format=|accessdate=2010-04-28 }}</ref>. Another downside of the mixture, as with all anaesthetics at the time, was its high [[flammability]].

Deaths have been known to occur from the mixture<ref name="death-reference-1" /><ref name="death-reference-3">{{cite journal|title=Deaths Under Anæsthetics. A.C.E. Mixture|journal=The British Medical Journal|date=1895-02-02|first=|last=|coauthors=|volume=1|issue=1779|pages=282|id= |url=http://www.jstor.org/stable/20231460|format=|accessdate=2010-04-28 }}</ref>. Although, at the time, deaths from A.C.E. mixture were reported less in number than the deaths from chloroform or ether <ref name='less-deaths'>{{cite journal|title=Ether Versus Chloroform|journal=The British Medical Journal|date=October 13, 1923|first=AG|last=Levy|coauthors=|volume=2|issue=3276|pages=681|id= |url=http://www.jstor.org/stable/20434527|format=|accessdate=2010-04-28 }}</ref><ref name='death-reference-2' />.

===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<ref name='old-anaesthetics-book' />. One particular doctor documents using equal parts of alcohol with choloroform for minor operations and chloroform with [[Eau de Cologne]] (which has a high content of alcohol) for dental procedures (to make a more pleasant experience)<ref name='cologne-as-an-anaesthetic'>{{cite journal|title=A Pleasant Anæsthetic Mixture|journal=The British Medical Journal|date=1888-01-07|first=William J.|last=Stephens|coauthors=|volume=1|issue=1410|pages=19|id= |url=http://www.jstor.org/stable/20214092|format=|accessdate=2010-04-28 }}</ref>.

Other mixtures were<ref name='old-anaesthetics-book' />:
* 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% [[Methanol|methylic alcohol]] 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 [[vivisection]]<ref name='vivisection'>{{cite journal|title=Royal Commission On Vivisection. Fifth Report (Continued)|journal=The British Medical Journal|date=1908-07-18|first=|last=|coauthors=|volume= 2|issue=2481|pages=159–162|id= |url=http://www.jstor.org/stable/25278404|format=|accessdate=2010-04-28 }}</ref>.

==Method of administration==

A.C.E. mixture could be given through drops (from a drop bottle<ref name="death-reference-1" />) on a piece of {{Linktext|lint}} (a [[towel]]), 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'. <ref name='old-anaesthetics-book' />

==External links==
*[http://www.thegarret.org.uk/collectionanaesthetic.htm The Garret Museum Online Collection: Anaesthetics] which has many useful pictures and further information on each of the inhalers.
*[http://www.antiquescientifica.com/web.anesthesia_antiques.htm Anesthesia Antiques: Inhalers And Droppers] which contains a picture of Allis' Ether Inhaler
*[http://www.oyston.com/history/junkers.html Historical Anaesthetic Equipment - Junker's Chloroform Inhaler]
*[http://www.general-anaesthesia.com/clover-inhaler.html Clover's portable regulating ether inhaler (1877). A notable one hundredth anniversary] A paper that shows Clover's inhaler {{Doi|10.1111/j.1365-2044.1977.tb09971.x}}
*[http://www.flickr.com/photos/39799176@N07/3683629799 Ellis obstetric inhaler] a photo of Ellis' inhaler, which was used for women in labour. From Manchester Medical School Museum's [[Flickr]] photos.
*[http://www.lifelongcompany.com/rvf.html Richard von Foregger, Ph.D (1872-1960)] an article Richard von Foregger that contains a picture of Gwathmey's appartus.
*[http://research.ncl.ac.uk/nsa/museum.html The Brian Welsh Memorial Museum of Anaesthesia] which has lots of image resources.

==References==
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[[Category:Drugs]]
[[Category:Anesthesia]]
[[Category:Anesthetics]]
[[Category:General anesthetics]]
[[Category:Initialisms]]
[[Category:2Fix]]