18 



ANAESTHETICS. 



body. The remedies to be employed in case 

 of threatened death, are those in a general 

 way suitable to cases of suspended animation. 

 Among the measures that may be resorted to are 

 those of placing the body, if it be not already so, 

 in a horizontal position ; dashing cold water in 

 the face ; opening windows, and admitting air 

 freely if not too cold to the person; em- 

 ploying frictions of the surface or extremities ; 

 stimulating respiration by applying ammonia, 

 etc., to the nostrils ; turning the patient on the 

 side, to favor exhalation of the anaesthetic; 

 and performing artificial respiration, or else 

 " insufflation " i. e., blowing air into the lungs, 

 either from the mouth of another person placed 

 directly upon that of the patient, or through a 

 tube opening in the pharynx or passed within 

 the trachea, and blown into by the mouth or 

 with bellows. To favor or allow of respiration, 

 it is sometimes necessary to draw the tongue 

 forward, and to clear the fauces of obstructing 

 liquids, as may be done with the finger; and 

 where the means are at hand, the action of the 

 so-called "Faradization" current, to excite a 

 sort of natural respiration, is advised the 

 current to be applied, preferably, over the 

 phrenic nerve and diaphragm, and not, as 

 formerly, to the heart. Dr. J. Smith urges 

 that, in dental operations under chloroform, it 

 is not as a rule advisable to keep the tongue 

 forward with forceps or tenaculum during the 

 operation, since thus the spontaneous efforts at 

 clearing the throat by swallowing may be pre- 

 vented, and fluids in consequence pass into the 

 glottis. Dr. Mott remarks that in operations 

 in which the mouth becomes filled with blood, 

 he formerly feared the occurrence of stran- 

 gling, but his later observation has shown that 

 deglutition, taking place like the uterine con- 

 tractions by means of reflex nervous action, 

 can occur notwithstanding the anaesthetic in- 

 fluence. 



Dr. Maddin, of Nashville, quoted by Prof. 

 Gross, and Dr. Chas. Kidd, find by their re- 

 searches that a very large proportion of the 

 fatal cases, under the use of anesthetics, have 

 occurred in minor operations, especially in 

 dentistry, and generally in private practice or 

 in small institutions. Prof. Gross suggests in 

 explanation, both that the severe operations 

 appear to establish a sort of " chloroform toler- 

 ance," and that the administration of anaesthet- 

 ics has, in private hands, been frequently less 

 judicious, and in some way in fault. At Guy's 

 Hospital, London, chloroform was given in up- 

 wards of 12,000 cases, before any serious acci- 

 dent occurred from its use ; and M. Plourens 

 declares that in the Crimean war.it was ad- 

 ministered 25,000 times without a single death 

 traceable to its use. 



Dr. Arnott and others have argued that 

 chloroform has increased, and Dr. Simpson 

 that it has diminished, the rate of mortality, 

 in the great surgical operations. The average 

 of about 1,600 cases of amputation of the 

 thigh, before the introduction of anaesthetics, 



collected from several European hospitals, shows 

 45 deaths in every 100, 36 in 100 being the 

 lowest rate in any of them; while in 145 

 such amputations, under anesthetics, the fatal 

 cases were only 25 to 100. The statistics of a 

 large number of amputations performed in the 

 cities of Boston, New York, and Philadelphia, 

 show a greater rate of mortality in the cases 

 under anaesthetics than in those in which they 

 were not used ; though it has been suggested 

 that the number of cases was still not large 

 enough to warrant a final conclusion. The 

 question of the actual influence of anaesthetic 

 practice on the mortality of operations is, in 

 fact, yet undecided ; though even an apparent 

 increase of mortality may consist with no such 

 increase in reality, in view of the extension of 

 the practice of operating, as before intimated, 

 to a large number of cases, and mainly serious 

 and doubtful ones, in which, but for his re- 

 liance on anaesthetic aid, the surgeon would 

 not operate at all. Prom their analysis of the 

 V7 cases already referred to, Perrin and Lalle- 

 mand conclude that the mortality from chloro- 

 form diminished greatly (the year 1859 ex- 

 cepted) from 1847-'8 to within a few years 

 past most especially since 1854 ; and that for 

 a few years now the mortality appears nearly 

 stationary, although the use of the agent is 

 continually on the increase. Dr. Kidd col- 

 lected the accounts of deaths apparently from 

 anaesthetics, in Europe, up to May, 1860 ; of 

 these, 125 were from chloroform, 25 from 

 ether, and several (it is stated) from amylene ; 

 and he remarks that the mortality had been 

 more than twice as great among males as 

 among females. 



In regard to the employment of anaesthetics 

 in obstetrical practice, our space will permit 

 of no more than referring the reader to the 

 works, journals, etc., in which the subject is 

 treated of; and among which may be es- 

 pecially named Prof. G. S. Bedford's " Prin- 

 ciples and Practice of Obstetrics," New York, 

 1861 ; the work of Perrin and Lallemand ; 

 and the papers by Profs. Barker and Elliot, 

 with the discussion following, in the " Bul- 

 letin of the New York Academy of Medicine," 

 vol. I. 



The committee some time since appointed 

 by the Boston Society for Medical Improve- 

 ment, to inquire into the alleged danger of 

 ether inhalation, state in their report their 

 conclusion that all anaesthetics, as shown both 

 by their symptoms and by the results of ex- 

 periments, "are depressing agents." In re- 

 lation to the point specially considered by 

 them, they say: "There is no recorded case 

 of death known to the committee, attributed 

 to sulphuric ether, which cannot be explained 

 on some other ground equally plausible, or in 

 which, if it were possible to repeat the experi- 

 ment, insensibility could not have been pro- 

 duced and death avoided." A "Chloroform 

 Committee," appointed by the Koyal Medico- 

 Chirurgical Society, London, after more thaii 



