ANESTHETIC 



80 



ANESTHETIC 



for its administration, as follows : Allis's is probably 

 the best form of open inhaler. It consists of a metal 

 frame, so arranged that a flannel bandage can be 

 stretched across and the whole surrounded with a 

 leather case, which acts as a face-piece. Clover' s port- 

 able ether inhaler consists of a dome-shaped receptacle 

 pierced by a central shaft connecting with a rubber 

 bag into which the patient breathes. Moving with the 

 face-piece is a metal indicator to register the amount 

 of ether admitted. A water chamber surrounds the 

 ether vessel to regulate the temperature. The Cone is 

 much used in America. A towel is folded into the 

 shape of a cone, a sponge is placed at the apex, and 

 the ether poured upon this. Hewitt's apparatus may 

 be used for giving gas and ether. In his inhaler the 

 inspiratory and expiratory valves are placed in a little 

 chamber near the face-piece ; a free draught of air is 

 permitted. Ormsby's inhaler consists of a leather 

 face-piece, crowned with a cone-shaped wire cage 

 covered with leather and joined to a soft leather bag, 

 covered by a loose net to prevent excessive expansion. 

 The wire cage contains a sponge on which the ether 

 is poured. Rendle adds to a cone containing a flan- 

 nel cap a mask for the face. Rectal etherization may 

 be resorted to in operations about the face and throat. 

 The ether vapor is introduced into the bowel, the pro- 

 cess taking longer for complete anesthetization than 

 by the usual method. Ethidene Chlorid is similar 

 in its action to chloroform. Patients take a longer 

 time to recover consciousness than when chloroform 

 is used, but they experience fewer after-effects, and re- 

 cover rapidly. Anesthetization occurs in three to five 

 minutes. Hydrobromic Ether (bromid of ethyl) 

 produces unconsciousness and anesthesia in one 

 minute, and complete muscular relaxation in two or 

 three minutes. The heart's action is somewhat 

 weakened. Return to consciousness after withdrawal 

 of the ether is very prompt. Its use may be followed 

 by vomiting. According to some observers, death re- 

 sults from cardiac failure, while others believe it kills 

 by direct action upon the respiratory center. It is best 

 administered by an Allis inhaler, and is of most service 

 in minor surgery for short operations. Nitrous Oxid, 

 by inhalation, is much used by dentists for extraction 

 of teeth. The symptoms resemble those of asphyxia, 

 hence it is more important to watch the respiration 

 than the pulse. It may be employed in minor surgical 

 operations. There are but few after-effects, those 

 most often observed being headache and malaise. 

 Bert' s 7nethod of administering nitrous oxid consists 

 in giving it in conjunction with oxygen under pres- 

 sure ; by this method the administration may be pro- 

 longed indefinitely. Clover's Gas and Ether Inhaler 

 is intended for the administration of a mixture of 

 these anesthetics ; it is so arranged that gas can be 

 given alone, or in combination with the ether. 

 Buxton's apparatus is used for the administration of 

 gas only, and possesses a special contrivance to filter 

 the air. Fontaine' s chamber is an apparatus devised 

 to keep the patient under an atmospheric pressure 

 equal to 26 inches mercury, so that the vapor inhaled 

 would be 50 per cent, gas and 50 per cent, air, and 

 asphyxia thus be prevented. The employment of 

 supplemental bags has been advocated by Braine. The 

 patient breathes into these bags, the gas supply being ' 

 turned off and the expiratory valve closed. It is 

 claimed that this method produces a more prolonged 

 period of unconsciousness. Various accessory instru- 

 ments are needed in the use of gas, such as gags, 

 mouth openers, and mouth props, spoons, etc. A., 

 Local, an anesthetic that, locally applied, produces 

 absence of sensation in the organ or tissue so treated. 



Alcohol, locally, removes sensation to pain, while 

 tactile sense persists. Cool the alcohol to about io° 

 below the freezing point, by placing it in ice and salt, 

 and place the part to be numbed in it. Bisulphid 

 OF Carbon, by spray or irrigation, has a disgusting 

 odor, and is a powerful poison. Carbolic Acid, 

 painted over the skin — its action, however, is caustic. 

 Chlorethyl, in vapor form, is useful in minor and 

 dental surgery. Chlorid of Methyl, CH 3 C1, al- 

 lowing the liquid chlorid to drop on the skin or mucous 

 membrane. Unless kept carefully under control the 

 vitality of the tissues may be affected. Cocain is 

 used in subcutaneous injections, by painting over mu- 

 cous surfaces, or by instillation into the eye. As a 

 paint a 20 per cent solution is used, weaker prepara- 

 tions being of little value over cutaneous surfaces ; 

 several coats are necessary. A 10 per cent, solution 

 should be used on mucous surfaces ; for the eye a 4 

 per cent, solution will answer, and this solution is 

 strong enough when cocain is employed as a spray. 

 Hypodermatically, mjj-v of a 10 to 20 per cent, 

 solution are usually injected, and this may be repeated 

 two or three times during the operation. Drumin is 

 oxalate of lime prepared from a euphorbiaceous plant. 

 It was formerly suggested as a local anesthetic, but has 

 been found not to possess anesthetic properties. 

 Ether, in spray, is recommended by Dr. B. W. 

 Richardson. The anesthesia thus produced is con- 

 fined to the skin, and is very transient. It may pro- 

 duce a slough from excessive freezing. Faradic 

 Currents were formerly used by dentists, but are of 

 no value. Rhigolene, in spray, its use being similar 

 to that of ether. A. Mixtures contain combinations 

 of substances for producing anesthesia. The follow- 

 ing are the most important : A. C. E. Mixture : — 

 alcohol, sp. gr. .838, 1 part; chloroform, sp. gr. 1.497, 

 2 parts; ether, sp. gr. .735, 3 parts. Billroth's: 

 — chloroform 3 parts, alcohol and ether each I 

 part. It is best administered by the open method. 

 LlNH art's: — alcohol I, chloroform 4. It is admin- 

 istered similarly to chloroform. Martindale's : — 

 a volumetric mixture, the ingredients of which evap- 

 orate almost uniformly ; it consists of absolute alcohol, 

 sp. gr. .795, one volume ; chloroform, sp. gr. 1.498, 

 two volumes ; pure ether, sp. gr. .720, three volumes. 

 Medico-Chirurgical Society of London : — ether 

 3, chloroform 2, alcohol 1. Methylene, or Bi- 

 chlorid of Methylene, a mixture of methylic 

 alcohol 30 per cent. , and chloroform 70 per cent. The 

 so-called " Liquid of Rcgnauld" consisted of 80 per 

 cent, chloroform, 20 per cent, methylic alcohol. 

 Methylene is not much used, several deaths from car- 

 diac paralysis having occurred from its employment. 

 Nussbaum's, ether 3, chloroform 1, alcohol 1. 

 Richardson's : — alcohol 2, chloroform 2, ether 3. 

 Sanford's : — the so-called " Chloramyl " is a mix- 

 ture of chloroform and amyl nitrate in the proportion of 

 two drachms of the nitrate to the pound of chloro- 

 form. It is a dangerous mixture, both drugs depress- 

 ing the heart. Vienna General Hospital : — ether 

 9, chloroform 30, alcohol 9. Vienna Mixture: — 

 ether 3, chloroform 1. Von Merino's: — chloroform 

 one volume, dimethylacetal two volumes. It is said 

 to produce no failure of respiration or heart, and no 

 lowering of the blood pressure. Wachsmuth's : — 

 one-fifth part of oil of turpentine is added to the 

 chloroform. It is Said to prevent any danger of heart- 

 failure. 



Various methods have been suggested by means of 

 which the influence of the anesthetic may be prolonged 

 or its dangers and sequels: largely averted. The follow- 

 ing are the most important : — Dastre-Morat's; con- 



