16 



ANAESTHETICS. 



stupor), only that they are passed through 

 much more rapidly. They may be convenient- 

 ly considered as four in number: the first, 

 that of action on the cerebral hemispheres, 

 marked first by mental excitement, and then 

 by loss of intelligence and of power of will ; 

 the second, that in which the anesthetic acts 

 on the cerebellum, destroying the power if the 

 common theory of the use of this organ be cor- 

 rect of combining the muscular actions, when 

 the body becomes fully relaxed and helpless; 

 the third, that in which the effect extends to 

 the ganglia of the base of the brain and proba- 

 bly to the exterior parts of the medulla oblon- 

 gata, as well as in some degree to the spinal 

 cord ; so that the senses are obliterated, the ca- 

 pacity of feeling pain lost, and the reflex actions 

 to some extent arrested; the fourth, that in 

 which it attacks the "vital centre" within the 

 medulla oblongata, from which arise the nerves 

 that maintain the function of respiration, and 

 so, indirectly, that of the circulation. When 

 this last degree of action is fully established, 

 the breathing and the heart's action cease, and 

 death is already taking place. 



It is, accordingly, the third stage of anesthe- 

 sia, as here divided, that the surgical or dental 

 operator seeks to produce, and to maintain. 

 The quantity of chloroform used to such end 

 may vary from one to four drachms, or an ounce. 

 A sponge or napkin wet with the liquid is 

 brought near to the mouth and nostrils, so that 

 the patient inhales the vapor mingled with air. 

 The time required for the full effect is thirty 

 or sixty seconds, or even more. Of the many 

 forms of apparatus that have been devised for 

 inhalation of anesthetics, none have been re- 

 ceived with general favor. The greater power, 

 and consequently (unless under judicious man- 

 agement) danger, of chloroform over sulphuric 

 ether, is shown in that the quantity of the lat- 

 ter required is much greater, as from two to 

 four ounces, and in some instances even a quart 

 or more ; and the time required to produce in- 

 sensibility is usually from three to five minutes. 

 Generally, it is preferred that the patient shall 

 be in the recumbent position. When the anes- 

 thesia is complete, as indicated by sonorous or 

 stertorous breathing, and other signs, the in- 

 halation is discontinued, to be renewed from 

 time to time if the patient show signs of pass- 

 ing back into the preceding or semi-conscious 

 stages. 



The fact that several cases of death under 

 chloroform, and one or more under ether, have 

 been directly traceable to the circumstances 

 that the stomach was at the time loaded with 

 food, is one that, where practicable, should 

 never be lost sight of in fixing the period for 

 operating. The most suitable time is some three 

 or four hours after a meal, when, although the 

 system is not yet weakened for want of food, 

 the organs of digestion are in the main relieved 

 and in a quiescent state. It is always desirable, 

 if possible, to guard against vomiting under the 

 influence of an anesthetic, and almost always 



unfortunate in some way where it occurs. Ac- 

 cording to Dr. Mott's observations, if vomiting 

 occurs, one result that is quite certain is that 

 the anesthetic effect will immediately pass off. 



Of seventy-seven immediately fatal cases un- 

 der chloroform, collected by Perrin and Lalle- 

 mand, and of which they present a very full 

 analysis in tabular form, in sixty-seven the 

 posture of the patient is noted ; and of the lat- 

 ter, in forty-eight cases t posture was re 

 cumbent, in nineteen t v of sitting. Tho r 

 authors, however, agree wiih the usage of prac- 

 titioners generally, in favoring the horizontal 

 posture, unless the nature of the operation re- 

 quires some other; and it is certain that an 

 upright position of the body increases the like- 

 lihood of fainting. The horizontal posture fa- 

 vors the entrance of the vapor of chloroform 

 especially its density being about four times 

 that of air into the lungs. This extreme den- 

 sity of the vapor of so powerful an agent is, 

 however, in itself, and in several ways, a source 

 of danger. The too sudden and rapid intro- 

 duction of the vapor into the lungs may at once 

 occasion asphyxia (suffocation), or it may caus.. 

 a sudden arrest of the heart's action, besic * 

 that it is apt to induce coughing, and perh. 3 

 may tend in some cases to cause vomiting. 

 Dr. Mott regards it as a further recommenda- 

 tion of the recumbent posture, in case of chloro- 

 form, that if for any reason it should become 

 desirable to free the lungs suddenly of the va- 

 por they may at the moment contain, the re- 

 sult is readily aided by turning the body upor 

 the side (or, we may suppose, inclining the face 

 partly downward), while the proper measures 

 for recuscitation are employed. An- his con- 

 sideration is the more important, s : ace, as im- 

 plied by another authority, who a alarming 

 symptoms do arise, the deadly | jwer of the 

 vapor already in the lungs may suffice to com- 

 plete the fatal effect of the druj. Both w'.th 

 ether and chloroform, while th administration 

 of the vapor should not be so slow in the outset 

 as to prolong inconveniently the prelimina;y 

 stages of the effect, it is yet, on the other hand, 

 very important that it be not commenced too 

 abruptly and too strongly in the outset, lest 

 the dangers already indicated be incurred. Dr. 

 Mott adduces the 'reckless and heedless manner 

 in which he has seen ether and chloroform ad- 

 ministered, and without evil results, in Paris 

 and New York, as a proof of the comparative 

 safety of the practice ; but he insists none the 

 less upon the necessity of such cautions as have 

 here been indicated. It is always important, 

 especially so with chloroform, that the sponge 

 or handkerchief wet with the liquid should be 

 approached cautiously toward the mouth at the 

 first ; and that it shall at no time be brought so 

 near but that the percentage of air inhaled shall 

 largely exceed that of the vapor at the same 

 time entering the lungs. 



Dr. Mott states that, although preferring 

 chloroform for use alone, he is in the habit of 

 employing often the two usual anesthetics in 



