Page:The American Cyclopædia (1879) Volume I.djvu/486

 454 ANAESTHETICS section of nerves, or the taking up of arte- ries. 7. Patients will now apply earlier than heretofore for relief in surgical diseases, the dread of the surgeon's knife often having in- duced them to postpone it until the case be- came almost hopeless. 8. The mortality from operations has materially decreased, for it is well known that pain has a serious tendency to depress the nervous system and produce death from exhaustion. In midwifery: 1. In addition to preserving the mother from the pain always incident to parturition, we have the power of preserving her strength unimpaired when the labor is long continued or especially severe. 2. In all cases of instrumental labor or those requiring manual assistance, the aid can be afforded with greater ease to the ac- coucheur and more safety and less accompany- ing suffering to the mother. 3. Many cases in doubt in diagnosis can be more correctly solved. 4. From the relaxation of the muscular fibres, the exit of the child through the uterine neck or the vaginal passage, when they are rigid, is facilitated. 6. Anaesthetics have the power of keeping in abeyance and reducing the violence of one of the worst complications of labor, puerperal convulsions. 6. The recovery of the patient after labor is assisted, and the chances of subsequent dangers lessened. In medicine: 1. As a relief from severe or ex- hausting pain in disease, as from toothache, passage of calculi, or neuralgia. 2. As a nar- cotic in mania, delirium treraens, excitement, or wakefulness from any cause. 8. As an anti- spasmodic for cholera, hysteria, asthma, convul- sions, &c. They have also been employed in the treatment of many inflammatory diseases, fevers, &c. They are found very useful in the detection of feigned diseases, as affected paral- ysis, dumbness, or contraction of limbs. They have been sometimes employed for nefarious purposes in cases of violence, where a strug- gle or noise was feared. The first effects of all anaesthetics, or when they are taken in small quantities, is exhilarating and intoxicating as from any diffusible stimulant, evidenced by bursts of laughter, hysterical weeping, or loud unmeaning talk. "When long continued or in large doses, there ensues a general feeling of warmth, extra power, and excitement gener- ally, first felt in the extremities, soon followed by a prickling benumbed sensation, with confu- sion of ideas, noises in the ears, usually com- pared to the vibration of an engine from one side of the head to the other, and flashes of light before the eyes. This is soon followed by loss of sensation and voluntary motion, and total coma. The patient is generally observed to become a little flushed in the face, the veins of the forehead turgid, the eyes suffused and staring open, and the pupils dilated. The pulse is gen-jrally increased at the commencement of inhalation, but becomes decreased often lower than natural when the system is fully under the influence, which is the time chosen for the per- formance of all great surgical operations. The respiration, which is slightly quickened at first, becomes slower and deeper in the somnific state. The temperature of the body remains generally of the ordinary standard, but becomes slightly reduced when the influence is long continued. The effects of the anaesthetic generally disap- pear soon after the administration is discon- tinued, and the patient returns to consciousness with merely a slight tendency to sleep and dizziness, and with no recollection of anything which has happened during the inhalation. Sometimes, however, the recovery is attended with nausea or vomiting, which most often happens when the drug is taken on a full stom- ach ; for this reason it should not usually be given until several hours after a meal has been eaten. No person has yet been found to with- stand the influence, but the effect is seen much sooner and more quietly in some than in others. Anaesthetics should not generally be used in diseases of the heart or brain, or when there is excessive degeneration of the lungs. When, from an over-dose or the inattention of the giver, the patient seems likely to sink, and respiration is suspended, the vapor should be removed from the mouth at once, the pa- tient laid in a reclining position, free access of air allowed, cold water dashed upon the chest and face, and, if necessary, artificial respiration made, sinapisms placed on the feet, and galvan- ism used. Many instruments have been devised for inhalation, but, as often happens, the sim- plest means is usually the best. The most ad- visable plan for administering is to fold a coarse towel into the form of a small cone, and place in the bottom a small sponge containing the liquid. At the commencement the sponge should be held at a small distance from the mouth, and the patient be directed to inhale by deep and long-continued inspirations, notwithstanding the cough. As he gets more and more under the influence, it should be approached to the face, but it is imperatively necessary that there should be a free admission of atmospheric air. Par- ticular attention should be paid to the condi- tion of the pulse. It is now generally conceded that chloroform is much more dangerous to life than ether. Ether should therefore be em- ployed in preference, unless special circum- stances make it imperative to select chloroform as the anaesthetic agent. If chloroform be used, it should be remembered that its vapor is hea- vier than the air, and consequently sinks ; care should also be taken to guard the skin from its irritating properties by smearing slightly with oil or glycerine. If ether be used, care should be taken not to have any lighted candles or gas jets in the neighborhood of the patient, as the vapor of ether is exceedingly inflammable, and very serious consequences might result from its accidentally taking fire. The ratio of power of ether and chloroform is considered as about 8 to 1 in favor of the latter, this producing its effect in from 80 to 60 seconds, the former on an average in from 3 to 4 minutes. The dose of chloroform is from 30 drops to 1 oz. ; that