ANAESTHETICS 



17 



the same case, beginning with ether, and re- 

 sorting to chloroform if insensibility is not 

 thus ivadily indnced. Ho mentions Dr. Simp- 

 son's recent method of administering these 

 agents, with a view to securing the due ad- 

 mixture of air that of spreading a handker- 

 chief single-fold over the face of the patient, 

 and allowing the liquid to drop at intervals 

 upon this, near to the mouth and nose. He 

 ars, however, th ' 'this method might give 

 :> irritation of t -skin, a result he usually 

 guards against in bib own practice, by previ- 

 ously applying a little olive oil about the mouth 

 and nostrils. 



Prof. Samuel D. Gross, in the recent edition 

 of his "System of Surgery" (Phila., 1864), 

 treats at some length of the choice and appli- 

 cation of anaesthetics. He prefers chloroform 

 to ether, as having a less objectionable odor, 

 and as being less liable to occasion vomiting 

 and other unpleasant symptoms. Instead of 

 the mixture of ether and chloroform, 3 parts 

 of the former to 1 of the latter, employed by 

 some practitioners, he favors if any mixture 

 be used that proposed by Dr. Snow, of equal 

 parts of chloroform and alcohol. He has ad- 

 ministered chloroform in several thousands of 

 cases: no death from its use has occurred in 

 his hands, and only two threatening cases that 

 could be traced to an injudicious mode of use. 

 He regards age as being no bar to the employ- 

 ment of anaesthetics ; as he has given chloro- 

 form with success to children even to infants 

 'uder two months, and also to very old per- 

 sons in one case, to a lady of 92. As to 

 danger from disease of the heart or brain, he 

 says : " For my own part, I have never allowed 

 any aifection whatever to stand in my way ; ' 

 and considering the tranquillizing effects of the 

 anaesthetics, he finds no physiological reason 

 for doing so. Some difference of practice ap- 

 pears to exist among surgeons in respect to 

 operations about the mouth, jaws, and nose. 

 Dr. Mott recommends in these, that, gener- 

 ally, anesthetics should not be used, but 

 reliance placed on narcotics. Prof. Gross ad- 

 vises that in such cases usually the patient 

 should be under anaesthetic influence only at 

 the beginning of the operation ; but he states 

 that he has repeatedly performed excision of 

 the tonsils, exsection of the jaw, etc., while 

 the patient was perfectly unconscious and in- 

 capable of resisting. 



It has been seen that in anaesthesia the use 

 of the special senses is commonly lost, along 

 with or before the disappearance (in most parts 

 of the system) of the general sensibility and 

 susceptibility to pain. A remarkable excep- 

 tion to this rule is named by Dr. H. B. Mont- 

 gomery : a boy undergoing amputation of the 

 leg under the influence of chloroform, in the 

 Stevens Hospital, Dublin, opened his eyes as if 

 from sleep, when a finger was placed upon the 

 neck over the carotid artery, remarked that 

 there was nothing the matter with his neck, 

 but that the surgeons were setting his leg, and 

 VOL. iv. 2 A 



remained thereafter with his eyes open, and 

 noticing such objects as came before them 

 throughout the operation ; but after recover- 

 ing from the anaesthetic, he declared that he 

 had felt no pain, and did not know that ampu- 

 tation was being performed. In this case, 

 consciousness was retained, and sight, and to 

 some extent touch, were active, though the 

 common sensibility at least in the lower 

 limbs must have been in abeyance. 



M. Simonin ("Revue des Societes Satantcs," 1 

 June 26, 1863) states that the two most im- 

 portant points for the surgeon to observe, in 

 the deeper stages of anaesthesia, in order to be 

 forewarned in time of the near approach of 

 collapse of the respiration and circulation, are, 

 the condition (as to its sensibih'ty, or the oppo- 

 site) of the region of the temples, and the 

 continued contraction of the muscles holding 

 up the lower jaw, or their narcotism, allowing 

 it to fall. The disappearance of sensibih'ty of 

 the temples marks a definite and deep degree 

 of anaesthesia, but, alone, does not show im- 

 mediate danger. The sensory nervous fila- 

 ments to the temples, and the motor filaments 

 to the masseter muscles, are alike furnished by 

 the fifth pair, some roots of Avhich arise from 

 portions of the medulla oblongata not far from 

 the " vital centre." The masseters, the con- 

 traction of which holds out last in the entire 

 voluntary muscular system, may even relax, 

 and life still not be immediately threatened ; 

 but the symptom is usually one of danger, 

 showing as it does that the torpor induced by 

 the anaesthetic has spread well-nigh to the 

 nervous centre of respiration, on the action of 

 which life itself depends. Dr. B. "W. Richard- 

 son ("Brit. & Tor. Med.-Chirurg. Review," 

 April, 1864), confirming the importance of 

 Simonin's observations, explains by the prin- 

 ciple he has brought forward the fact, remarked 

 by himself, of more dangerous symptoms arising 

 during the profound anaesthesia induced for 

 operations within, the mouth, than under any 

 other circumstances. Dr. TVm. Marcet is led 

 to believe that chloroform absorbed into the 

 blood sometimes produces death, not by its 

 anaesthetic or directly depressing action, but 

 by exciting a spasmodic closure of the glottis 

 this, at the time, being likely to pass un- 

 observed ; and in case of complete suspension 

 of the respiration under chloroform, as the 

 chances of recovery are then small, he advises 

 immediate tracheotomy, and artificial respi- 

 ration. Dr. G. "W. Balfour has called attention 

 to the danger of the filling of the trachea with 

 vomited matters at least one death having 

 been known by him to occur from that cause, 

 and even tHough the patient appeared to re- 

 cover properly from the anaesthetic. 



Prof. Gross states the phenomena which 

 indicate danger, in anaesthesia, as being sterto- 

 rous respiration (very marked, of course), small 

 and feeble pulse, lividity of the features, dila- 

 tation of the pupils, relaxation of the sphincters 

 and rapid diminution of the temperature of the 



