156 



POPULAR SCIENCE NEWS. 



[October, 1889- 



n^etliciue aijd Pljarniacy. 



[Original in The Popular Science News.] 

 SOME FACTS CONCERNING ANAESTHETICS 



BY JOHN CROWELL, M. D. 



The earliest attempts to deaden pain, under the 

 ordeal of surgical operations, date back to the 

 Roman Empire. In the year i8oo, Sir Humphrey 

 Davy advocated the use of nitrous oxide gas as an 

 aniESthetic, as follows: "As nitrous oxide, in its 

 extensive operation, seems capable of destroying 

 physical pain, it may probably be used with great 

 advantage during surgical operations in which no 

 great loss of blood takes place." It was not until 

 1844 that the use of this agent showed any practical 

 results, when Thomas Wells, a dentist of Hartford, 

 Conn., had a tooth extracted while under its influ- 

 ence. Since that time, this compound has been 

 extensively used in dentistry, but its effects are too 

 transient for operations in capital surgery. 



The introduction of ether as an anesthetic into 

 the practice of surgery formed a most interesting 

 epoch in the history of medical science, completely 

 revolutionizing the methods once in use, and intro- 

 ducing to operative surgery a range of delicate 

 manipulation that is the marvel of our generation. 

 The writer recalls the prejudice existing in the 

 minis of some of the most noted surgeons, in his 

 student days, against the use of ether, even after its 

 safety had been demonstrated by repeated experi- 

 ments in the hands of Drs. Morton, Warren, and 

 Jackson, of Boston. It was not until 1S50 that the 

 conservatism of the Pennsylvania Hospital yielded to 

 the inevitable, in the use of ether; and while Pan- 

 coast and Mutter were operating successfully in 

 the Jefferson College under its influence, Gilson and 

 Fox were holding on to the old method of stupefy- 

 ing by opiates. 



The safety of the popular an;esthetics, ether and 

 cliloroform, is so well established as to need no 

 advocacy of their claims, and when in competent 

 hands, under proper conditions, their use may be 

 pronounced as generally harmless. 



Ether was first administered for a surgical opera- 

 tion in Boston, October 17, 1846, by Dr. T. G. 

 Morton, the operation being performed by Dr. 

 Warren. On September 30th of the same year, 

 Dr. Morton had used the agent^ successfully in 

 extracting a tooth. For a long time a controversy 

 wals sharply waged between Dr. Morton and Dr. 

 Charles J. Jackson, as to the title to the honor of the 

 discovery of the wonderful ansesthetic; but the gen- 

 eral verdict is, that to Dr. Morton belongs the 

 honor of having first used ether in a surgical opera- 

 tion. On January 19, 1S47, Dr. Simpson, of Edin- 

 burgh, first used ether to mitigate the pangs of 

 labor. On November loth of the same year a new 

 ansesthetic was introduced by Simpson. At the 

 suggestion of Mr. Waldo, a chemist in Liverpool, 

 he tried chloroform, and soon after published a 

 treatise giving his success with this powerful agent. 



The medical profession was thus armed with 

 these two potent ana;sthetics, and the blessed effects 

 of painless operations were soon apparent. Chloro- 

 form, being much more powerful in its action, soon 

 almost displaced ether, and, except in the city of 

 Boston and in Lyons and Naples, was the only 

 ana:sthetic used for several years. The frequent 

 fatal results following the free use of the agent re- 

 sulted in awakening a fear, and very soon modifica- 

 tions were devised by various medical authorities. 

 In London, a mixture was recommended by the 

 Medico-Chirurgical Society, called A. C. E., con- 

 sisting of one part of alcohol, two parts of chloro- 

 form, and three parts of ether. The Vienna mix- 

 ture consists of six parts of ether to one of 



chloroform. It is stated that in eight thousand 

 administrations of this mixture, but one fatal result 

 is recorded. 



Inquiry among medical men in different sections 

 of the country reveals the relative use of the two 

 ana;sthetics. Throughout New England, ether is 

 generally used. In the great cities of New York, 

 Brooklyn, and Philadelphia, containing three mil- 

 lions of people, but half a dozen surgeons use 

 chloroform only, a few more use the mixture, and 

 the rest the ether. In the West, the use of ether 

 prevails, while in the South, chloroform is more 

 generally used. A change has recently occurred in 

 the hospitals of Great Britain, where chloroform 

 was used extensively ten or fifteen years ago. 

 About one-third of the surgeons now use a mixture, 

 and one-third the pure ether, the other third hold- 

 ing on to the chloroform. In France, except Lyons, 

 chloroform is the sole agent used, and the same is 

 the case in Germany, except at Vienna, where mix- 

 tures are used. 



It is difficult, by figures, to state accurately the 

 relative safety in the u.se of these two ana'sthetics. 

 Of the 500 deaths from chloroform, the number of 

 administrations is not given, and all attempts to fix 

 a ratio are futile. In one hospital one death 

 occurred with 525 administrations, while in 28,000 

 examples of its use in the Confederate army, and in 

 40,000 administrations seen by Nussbaum, not one 

 fatal result followed. These examples present the 

 extremes. The chief danger attending the use of 

 chloroform is in its action upon the heart. Under 

 its use, the blood pressure and the great and sudden 

 irregularities of the heart's action are known to 

 occur, and the term "capricious" has been applied to 

 the action of that organ under the influence of 

 chloroform. There are several inducements for the 

 use of this agent which have rendered it popular in 

 the hands of some operators. Among these are its 

 pleasant taste, its concentrated form, and the quick- 

 ness of its action. In contrast with ether, the 

 chloroform has also marked advantages. The vapor 

 of ether is inflammable, sometimes igniting at a 

 distance of fifteen feet, thus rendering its use dan- 

 gerous by artificial light. But the relative danger 

 of the two agents, as indicated above, must be con- 

 sidered, and exercise the controlling influence in 

 choosing between them. 



One of the most popular and humane uses of 

 an;esthetics is found in their application to the 

 diseases peculiar to women. Under their influence, 

 the most wonderful operations in laparotomy have 

 been made possible, and the results in the relief 

 from suffering, and in the radical cure of disease, 

 are among the triumphs of modern surgery. It has 

 already been stated that the use of ether to mitigate 

 the pangs of labor was introduced to the medical 

 profession by Simpson, of Edinburgh, on January 

 19, 1847, when he published a paper giving the 

 results of his experience in natural labor. This 

 treatment met with stout opposition from the con- 

 servative element of the profession, and for a long 

 it found little favor among some of the leading 

 obstetricians, among whom were Meigs of Philadel- 

 phia, Barnes, Montgomery, and Ramsbotham in 

 England, and Seebold and Scanzini in Germany. 

 But in 1853, the great influence of Queen Victoria 

 was given in its favor by the submitting of her 

 majesty to its use in the birth of Prince Leopold, 

 and again in 1857 at the birth of Princess Beatrice. 

 The result of this notable example did much to 

 make the use of anajsthetics popular in parturition. 



The power and rapidity in the operation of chloro- 

 form have made it an agent for criminal purposes, 

 and its use in this respect has formed an important 

 chapter in legal medicine. The reported use of this 

 agent in cases of assault upon women, or of an 



excuse for robber^', must be received with a great 

 deal of caution, and a physician in giving testimony 

 should be careful to consider the conditions neces- 

 sary for its successful administration. The medical 

 expert, understanding as he does the physiological 

 action of the drug, will be able to instruct a jury as 

 to the possibilities in the given case, and thereby 

 further the ends of justice. 



The question as to whether chloroform can be 

 successfully administered during sleep, without 

 awakening the person, has long been discussed. 

 It is an important question, and it is possible that, 

 with great caution, and under the most favorable 

 circumstances, the act can be accomplished. But 

 such cases must be of rare occurrence, and, except 

 with children who sleep very soundly, very improba- 

 ble, if not impossible. Impregnating the air of a 

 sleeping-room with the vapor of chloroform, for the 

 purpose of robbery, is sometimes reported in the 

 public press as a successful operation ; but such an 

 occurrence is highly improbable, inasmuch as the 

 quantity of the fluid required to produce complete 

 aniEsthesia, in a room of ordinary size, would be 

 two and a half pints, and success could then only be 

 doubtful except in a room perfectly air-tight. 



Local ana;sthesia for the performance of minor 

 operations is frequently adopted, both by the freez- 

 ing process of Dr. Arnott, and by the use of hydro- 

 chlorate of cocaine. The uses of this drug were 

 discovered by noticing the benumbing effects of the 

 coca leaves when chewed by the natives upon the 

 table lands of South America. The discovery of 

 this agent was hailed with delight by the medical 

 profession, and in delicate operations upon the eye 

 its use is highly important. The inducing of local 

 aniesthesia upon the skin by the use of the cocaine 

 has not been very satisfactory. In the form of 

 hypodermic injections, it has been found useful in 

 removing small growths, and in more difficult 

 operations the injection of the drug has proved 

 eflectual. No doubt further experiment will develop 

 still further uses of this potent agent in the wide 

 range of minor operative surgery. 



•♦> 



[Specially Compiled for The Popular Science A'ews.J 



MONTHLY SUMMARY OF MEDICAL 

 PROGRESS. 



BY W. S. WELL.S, M. D. 



Dr. Neub-eli> publishes in a Polish medical jour- 

 nal cases of subcutaneous lymphorrhagia. In con- 

 sequence of some injury, extravasation of lymph 

 from a lymphatic ves.sel occurred. One case was 

 that of a man, brought into the hospital, who had 

 been struck on the thigh with a large piece of coal. 

 There was no discoloration of the skin, but there 

 was marked fluctuation over a large portion of the 

 anterior and lateral aspects of the thigh. In another 

 case, the patient had received a blow on the back; 

 here, also, there was extensive fluctuation, involving 

 the whole of the dorsal region. 



In the first case, as the tumor showed no signs of 

 diminishing after a couple of months, Dr. Neufeld 

 made an incision into it, emptying the sac, after 

 which the wound healed rapidly without fever. In 

 the second case, the fluid disappeared spontaneously 

 after the patient had been lying on his back for six 

 weeks. A third case is mentioned, in which no 

 change took place for six weeks. Drs. Neufeld and 

 Gussenbauer agree as to the nature of these acci- 

 dents, and that the best treatment consists in laying 

 the sac well open during the first few days. 



Henry G. Beyer, M. D., publishes (Phila. Med. 

 News) the process of preparing "Absorbable Drain- 

 age Tubes from the Arteries of Animals." The 

 absorbable drainage tubes of Neuber, Treudelen- 

 burg, and Macewen, though very much superior to 



