CHLOROFORM AND ETHER. BY CHRISTIAN V. SPIEGEL, M. D., of Utica, N. Y. The employment of anæsthetic agents has now become so general, and their great value so fully attested by eminent physicians and surgeons in all parts of the world, that I shall here give but a brief account of their uses and mode of application. Indeed, the discovery of a means, whereby to give complete relief from pain or consciousness during the tedious surgical and dental operations, as well as to mitigate the spontaneous suffering attendant on many diseases, must be considered one of the most important in the annals of medicine. That pain is useful in indicating the seat and progress of disease cannot be denied; yet, on the other hand, its severity may exhaust and destroy life, and to entirely allay and quiet the pain is sometimes the most difficult and, at the same time, necessary part the physician is called upon to perform. The inhalation of ethereal substances now allows the practitioner to obtain a more perfect and complete control over these "ills that flesh is heir to," enabling him to alleviate some and wholly prevent others. Notwithstanding the benefit to be derived from its judicious use, the mode of inhalation is also capable of producing a great deal of mischief and evil in the hands of the unskilled and ignorant, and it should therefore only be employed by those who are fully and thoroughly acquainted with its numerous and diversified effects and operations. Ether and chloroform produce essentially the same effects, but the latter is by far the most powerful and rapid in its action. The progressive stages of etherization seem to be about as stated by Gibson, viz.: 1. Cerebral excitement. 2. Cerebral derangement, staggering intoxication. 3. Cerebral sleep (sopor), pupils contracted, dreams, reflex functions of the brain and spinal marrow still active. 4. Cerebral death (coma), reflex functions of the medulla and spinal marrow still active. 5. Death of spinal marrow; cessation of respiration (heart's action still present generally). 6. Cessation of heart's action. He also says: "It is very important to be able to tell EASILY when the stage of safety has been passed," that is when the limit of safetysopor, is about to merge into the state of danger-coma." The action of the pupils is the key to this all-important knowledge. Inhalation should not be continued one instant after the pupils previously contracted have begun to dilate, for then danger is at hand. If unconsciousness can be secured by sopor the inhalation should not be carried on to produce coma. If complete muscular relaxation be sought for, as in hernia, to secure taxis, in dislocation to facilitate reduction, and make it easy, and in tetanus, then the patient must be urged from sopor into coma generally, but as soon as the muscular relaxation is secured, the inhalation should at once cease. When chloroform or ether is employed in chorea, delirium tremens, or other affections, it should never be urged beyond sopor. In neuralgia it is usually needless to produce complete unconsciousness. Whenever the pain disappears the inhalation ought to cease. According to Dr. Snow, a necessary precaution for watching the effects of ether and chloroform is that they possess accumulative properties, their influence increasing sometimes for twenty seconds after the inhalation is discontinued. It is seldom necessary to carry the process farther than sopor; in this dreamy state insensibility to pain is perfect, and in some persons much earlier. Many patients seem to be perfectly awake to all mental impressions, and even take an interest in the progress of the operations, without the slightest pain, and indeed in some cases, experiencing agreeable sensations. Chloroform alone, or ether are not the only soporific agents that produce insensibility to pain, with mental knowledge still active, for we have found that the Essende of Mint is comparable, very favorably to Ether and Chloroform in producing insensibility to pain by acting on the sensory nerves. Chloroform has been found to be, also, a local anesthetic, for Mr. T. Hunnely, of Leeds, has discovered that local anesthesia may be caused by Chloroform and Ether, and that the brain and other parts of the body not subjected to its influence, remain unaffected. After an extensive series of experiments on different animals, he finds that by immersion in a small quantity of the fluid, or by applying the vapor locally for a few moments, a limb may be rendered perfectly senseless and motionless, and what may be an advantage, in any fixed position. The benefits likely to be derived from this new and valuable discovery promise to be very great. The influence of these agents being transmitted by the blood, pervades the whole system simultaneously and particularly excites the capillary circulation, as evinced by the injected conjunctiva, increased lachrymal and salivary secretions, and turgidity of face and neck, the redness of which, however, soon gives place to pallor. As regards the mode of applying these vapors, the principal point to be observed is, that they be freely diluted with atmospheric air. Many instruments have been invented for inhalation, but most of them have given place to a simple handkerchief or sponge. In the use of chloroform a towel or handkerchief is the best, which is about the simplest thing yet proposed for the service it renders. The degree of etherization is not so much in the amount inhaled, but should be regulated to the peculiar constitution of the patient. The physician should, therefore, be able to judge when a sufficient amount has been inhaled, for he has to take into consideration the accumulative property of the vapor and how it will affect the patient. A drachm or even a half a drachm of Chloroform poured upon a handkerchief and gradually brought to the nose, will in about two minutes, more or less, produce the desired effect. Of Ether, half an ounce may be poured upon a sponge and more added from time to time, if required. The full effect of Ether is not generally obtained under four or five minutes. As regards their comparative merits, it may be said of Chloroform, that it is less pungent and requiring a less amount, is more easily inhaled; but it is also said to have a greater tendency to produce involuntary muscular action, and exerts a more powerful action on the heart than Ether. As far as present experience goes, I have found Ether to be the milder of the two, and in case of children, from their greater suscep"tibility, should always be given in preference to Chloroform, etherization in them occurring in about two minutes. According to Snow, again, the immunity from pain does not correspond exactly with the degree of narcotism, but is greater as the patient is recovering from the effects of the vapor, than in the corresponding degree as he is coming under its influence. This is particularly the case with Ether, which he considers as possessing superior anesthetic properties to Chloroform in proportion to the narcotism produced. When Ether is inhaled the patient sometimes completely recovers his mental faculties, although insensibility to the operation still continues. The use of Ether or Chloroform is contra-indicated by the existence of any disease of the heart, tendency to engorgement of the lungs or aneurisms of any of the great vessels, nor should it ever be used during the existence of a shock resulting from a severe injury. The existence of extreme debility, is not always a contra-indication for acting as a stimulant; the inhaled vapor seems to have a great sustaining power, and has been successfully used in a state of great collapse, as well as for its sedative powers in low cases of typhus fevers. Perhaps one of the most important uses of Chloroform and Ether is for the relief of stricture, and to render easy the introduction of the catheter; here, in old and sensitive cases, as well as in retention of urine and passage of calculi, they are invaluable. The physician, in administering these vapors, should bear in mind that he is using an agent of great power, of which he must carefully observe the effect, for the life is in his hands. In some constitutions five or six inspirations have produced complete insensibility, and we must be on our guard lest alarming symptoms suddenly intervene. These are marked by suspended respiration, livid skin, widely-dilated pupils, the eyes fixed and the iris immovable. The patient should immediately be laid upon the floor, cold water dashed in the face, and the vapor of Ammonia applied to the nostrils, and, in extreme cases, artificial respiration resorted to, and, it inay be, a few ounces of blood drawn from the arm, will generally relieve the action of the heart by removing distension. We should be very careful, also, not to make the patient swallow any thing in this state of insensibility, as cough might induce suffocation, and hasten death. Besides Sulphuric Ether and Chloroform, various other preparations have been found to possess anææsthetic properties, viz.: Aldehyde, Benzoin, Acetic Ether, Bisulphuret of Carbon and Essence of Mint, but sufficient experiments have not yet been made to ascertain their relative value. As the action of Chloroform depends a great deal upon its chemical purity, this may be tested by dropping it into the following mixture: Sulphuric Acid at sixty-six degrees, and distilled water equal parts. When cool, this mixture will have a density of forty degrees (areometer) Sp. gr. 1.38. Pure Chloroform dropped into this will fall to the bottom. TRANSACTIONS OF THE SULLIVAN COUNTY SOCIETY. MIDLAND HOUSE, LIBERTY, N. Y., February 9, 1876. The semi-annual meeting of this society was held in this village to-day. In the absence of the President and Vice-President, Dr. Leon de Venoge was called to the chair. The following physicians were present from their respective localities: Dr. William Bevier, Dewittville, N. Y.; Dr. George Schonger, North Branch, N. Y.; Dr. William Darmon, Philadelphia, Pa.; Dr. L. de Venoge, Eldred, N. Y.; Dr. T. S. Quick, Youngsville, N. Y.; Dr. William W. Murphy, Liberty, N. Y.; Dr. P. Low, Liberty, N. Y. Dr. Grant, of Robertsonville, was present, and invited to participate in the proceedings of the society. The minutes of the last meeting were read and approved. Resolved, That the papers be accepted and placed upon the minutes. Adopted. Motion made that our meetings be held semi-annually in the future; to be held the second Tuesday in July and January; also that it be incorporated in the By-laws. Dues from members then called for, and the following paid: Dr. Grant presented to the society a specimen of mineral water obtained from the farm of Major George Robertson, which is at present attracting considerable attention among health seekers. It has been analyzed, and one gallon has been found to contain Bromide Calcium, grs. Carb. Magnesia, grs. Analyzed by G. C. Polk, M. D., Philadelphia, Pa. |