238 INORGANIC AGENTS 



even a slight surgical procedure may cause death by reflexly stimulating 

 the vagus and inhibiting the heart. Such an accident is not likely to 

 occur with ether, and minor operations are often done with safety during 

 the first stage of anesthesia (primary anesthesia) when consciousness 

 and sensation are lost and the muscles begin to relax. 



Shock from hemorrhage, or prolonged and severe surgical opera- 

 tions, may lead to fatalities during anesthesia, and it sometimes occurs 

 when an operation is begun before the patient is fully under the influence 

 of an anesthetic — particularly chloroform — as described above. 



Crile's theory postulates the existence of a "kinetic system" com- 

 posed of the brain, liver, adrenals, thyroid gland and muscles. On this 

 system excessive stimuli caused by pain, traumatism, fear, infection, 

 hemorrhage or great exertion, act to produce destructive changes or 

 shock. 



He actually finds such pathologic changes in these organs in shock. 

 In surgical operations the stimuli caused by the traumatism pass to the 

 brain just as readily under ether and chloroform as without. To inhibit 

 the stimuli one must block the nervous pathways by injecting the oper- 

 ative field with novocaine and by giving morphine under the skin be- 

 forehand, and, if necessary, during and after operation. Also the avoid- 

 ance; of all unnecessary traumatism is essential. Strychnine is the very 

 worst drug to use in shock as it sensitizes the nervous system and favors 

 fever. Surgeons generally endorse Crile's theory and find in practice 

 that shock is avoided and more favorable results follow severe opera- 

 tions conducted as he advises. By this method Crile has reduced his 

 operative losses by 75 per cent. In practice, three causes of danger 

 from the use of anesthetics, i. e., respiratory failure, circulatory depres- 

 sion and shock, are usually combined. 



The following embraces the proper treatment of all these condi- 

 tions, and should be followed in every case where danger threatens dur- 

 ing anesthesia: 



1. Remove the anesthetic and allow plenty of fresh air. 



2. See that there is no mechanical obstruction to the movements of 

 the chest, or to the free entrance of air. Pull forward the tongue and 

 lower jaw and extend the head. 



3. Invert small animals, except with chloroform, to allow blood 

 to flow to the brain. With chloroform, keep the body level, as sudden 

 cTiange in position may cause heart failure. 



4. Use forced, artificial respiration with bellows and rubber tube 

 introduced into larynx. Practice ordinary artificial respiration in small 

 animals by carrying the forelegs outward and forward till they meet in 

 front of the head, and then bring them back till they touch, and com- 

 press the sides of the chest. These movements should be repeated 

 twenty times a minute. Massage over the heart, together with artificial 

 respiration, is useful in sudden cardiac arrest in small animals. Arti- 

 ficial respiration may be done in the horse by two persons compressing 

 intermittently one side of the chest with the knees and hands. Rhyth- 

 mical traction of the tongue, at intervals of five seconds, has proved suc- 



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