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EMPLOYMENT OF ANESTHETICS.
HE discovery of anaesthetics was universally hailed as a great and unqualified blessing to the victims of unavoidable pain. The year of the announcement of the power of ether to render the patient insensible under the hand of the operator, was distinguished as the annus mirabilis ; it began a new era in the history of operative surgery, and the older surgeon, in the language of the elder Warren, "wished again to go through his career under the new auspices." We can well imagine with what enthusiasm he who had been accustomed to struggle through difficult operations on patients forcibly held, now pursued his dissections as on the cadaver, and saw the patient, on the completion of the operation, suddenly restored to a full possession of all his faculties, as if by magic. And when, a year or more after these first experiments with ether, chloroform was introduced to notice, so agreeable to the senses, so prompt in its action, and so harmless in its effects, the perfection of anaesthetic agencies was thought to have been attained. But every good must have its corresponding ill. It was soon announced that a lady, sitting in a
dentist's chair, had suddenly expired while inhaling chloroform preparatory to the extraction of a tooth. A second, third, and fourth case was reported, and always previously to some trivial operation. The faith of its friends, however, remained unshaken, and these unfortunate results were attributed to the attending circumstances, and not to the anaesthetic. At length fatal cases began to occur occasionally in hospitals, in the presence of eminent physicians and surgeons, and in spite of their previous precautions, and efforts to resuscitate the victim. Finally, the fact seemed established beyond a peradventure, that chloroform is not an innocuous agent, even under circumstances apparently the most favorable for its administration, by the occurrence of a fatal case (in a dentist's chair, however), in spite of the persistent and well-directed efforts of Professor Simpson himself to restore animation. It can now no longer be denied that anæsthetics are followed by unpleasant and occasionally fatal effects in a given number of instances. The latest statistics that have been published are as follows: Total fatal cases in Europe, one hundred and twenty-five. When we take into account the aggregate of cases of anesthetization during the last sixteen or seventeen years, of their almost universal use in hospitals, and in private practice, this mortality is a percentage of the whole number of cases positively infinitesimal. It is doubtful if any active remedy of the materia medica
can show a better record. The recent death by chloroform in Bellevue Hospital has, we understand, raised the question in the Medical Board as to the propriety of allowing this agent to be longer employed for purposes of anesthesia in that institution. Before this question can be properly decided, the comparative merits of ether and chloroform must be considered, for anæsthetics in some form are now indispensable to the practice of operative surgery and midwifery, and can never be discarded, even though the mortality from their use were tenfold its present percentage. And before chloroform is stricken from the list, it were well to inquire as to the real sources of danger for its use, for if it is demonstrated that under certain circumstances it is as safe as any anaesthetic, every surgeon will, under such circumstances, prefer chloroform. The comparative merits of ether and chloroform, as anæsthetics, it is not easy to decide. The statistics which we have given above show, that of the one hundred and twenty-five fatal cases from anæsthetics in Europe, twenty-five occurred during the inhalation of ether, and one hundred of chloroform, giving a mortality from the latter equal to four-fifths of all the cases. Although chloroform would seem by this exhibit to be the more fatal anesthetic, yet a moment's reflection will convince any one that it may not even approximate the truth, for we have no knowledge of the percentage of deaths to the number of cases of
administration of either agent. It might, and probably would appear, could we sift this subject thoroughly, that chloroform had been given four times as often as ether during that period. We may, however, arrive at a very satisfactory conclusion as to the safety of chloroform, by taking the gross number of cases of its administration in certain well-authenticated instances, and noting the results. For example, it was given twenty-five thousand times by the French, in the Crimean war, without a single fatal issue. It is freely used in midwifery by many eminent English and American obstetricians, and, we believe,, no fatal case has yet been reported in this department of practice. Professor Simpson is stated to have used from five to seven gallons annually for some thirteen years, without an unfavorable result. The real sources of danger in the employment of chloroform have not been sufficiently studied. Authors mention: 1st, A full stomach; for vomiting being a common symptom in chloroform inhalation, the patient is liable to be suffocated. 2d, Affections of the nervous system, as delirium tremens, epilepsy, hysteria, etc. 3d, Affections of the vascular system, as fatty degeneration of the heart, atheromatous deposits, etc., We do not propose to discuss these alleged contra-indications to the use of chloroform, as it is by no means as yet established how far these conditions are to be regarded as complicating its effects. We believe, however, that it was main
tained by the late Dr. Snow, whose opinion on all subjects relating to chloroform is entitled to our confidence, that even when lesions of the nervous and vascular system do exist, chloroform properly administered, is far less dangerous than an operation without an anesthetic. From some recent investigations as to the nature of death from chloroform, the following interesting facts appear: 1st, That the great majority of deaths (two-thirds) occur in slight operations, and those performed on sphincters, in tenotomy, strabismus, toothdrawing, etc., etc., but few during the larger operations, as amputations, resections, ovariotomy, etc. 2d, In the majority of fatal cases by chloroform, death occurred before the operation,— during the first stage of inhalation-the stage of excitement. 3d, That the deaths that have occurred after the operation, and were attributable to the anaesthetic, have generally been when ether was slowly administered, or ether and chloroform, but not pure chloroform. Without dwelling on these subjects, which are all of the deepest interest to those who are discussing the question of the relative or actual merits of the different anæsthetics, we shall allude to what we consider, if not the real, certainly a great source of danger in the use of anaesthetics in general, and chloroform in particular, in our hospitals. We refer to the gross and culpable carelessness of their administration. Rarely is the patient carefully examined by a competent person to determine if