The principles of surgery and surgical pathology : general rules governing operations and the application of dressings / by Hermann Tillmanns ; trans. from the 3rd German ed. by John Rogers, and Benjamin Tilton ; ed. by Lewis A. Stimson.

  • Hermann Tillmanns
Date:
1895
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Licence: Public Domain Mark

Credit: The principles of surgery and surgical pathology : general rules governing operations and the application of dressings / by Hermann Tillmanns ; trans. from the 3rd German ed. by John Rogers, and Benjamin Tilton ; ed. by Lewis A. Stimson. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    51/816 page 39
    # §15.] LAUGEING-GAS NARCOSIS. 39 In deep ether narcosis there is abduction of the vocal cords; and when the nai-cosis is slight there is adduction, no matter whether the recurrent laryn- geal nerve is divided or not. Narcosis per Rectum.—Molliere and Iversen have successfully produced ether narcosis by introducing the vapour into the rectum by means of a rubber tube connected with Richardson's ether vapouriser. Molliere also passed into the rectum a rubber tube which was connected with an ether flask standing in water at 50° C. (112° F.), thus causing the ether to boil. Molliere mentions as advantages of rectal anaesthesia the lack of a stage of excitement, the possibility of exactly regulating the amount of ether given, and the convenience of the method in operations on the face. Rectal etherisation was first used by PirogofP forty years ago. Recently, Starcke has also investigated the method and has urged its further trial. It was stated on page 38 that fatal cases are of much less frequent occur- rence during ether than during chloroform narcosis. E. Hankel has, with the use of Kappeler's statistics, collected forty-five cases of death from ether and analysed the causes carefully; they include asphyxia, syncope, general paralysis, shock, entrance of pus and ether into the air-passages, etc. Leav- ing out the cases of actual malpractice, however, death from ether is usually caused by disturbances of respiration. The other compounds of ethyl have not become established as anaesthetics; amongst them are ethylchloride, ethylbromide, ethylnitrate, ethylidenchlo- ride, ethylaldehyde or aldehyde, Aran's ether, acetic ether, etc. § 15. Laughing-Gas Narcosis.—Amongst the inorganic componnds, nitrogen monoxide or laughing gas (Davy) is the best anesthetic. Nitrous oxide, N,0, is a colourless gas with a slightly sweetish taste and smell. It is made by cautiously lieating ammonium nitrate, which breaks np at a temperature of 170° C. into water and nitrous oxide. The anaes- tlietic action of laughing gas is not unpleasant, and there are almost no disagreeable af ter-eiiects ; nausea and vomiting scarcely ever occur. But it is not entirely free from danger, though it is much less dangerous than chloroform or ether. Statistics show that out of four to five million cases where it has been used, only fourteen deaths have been recorded (E, H. Hankel). In a few instances it has caused epileptic fits, great excitement, deep cyanosis, and similar phenomena, but in general the drug is relatively free from danger. After making investigations with the spectroscope, Ulbrich came to the conclusion that nitrous oxide formed a chemical combination with the hjemaglobin, and so could b*e- come dangerous; but Preyer, Buxton, MacMunn, and Eothmann were unable to confirm these statements of Ulbrich's, as the duration of the narcosis is too short, therefore these authors consider that nitrous oxide is not a dangerous anassthetic. Still, a narcosis of long duration is not to be recommended. The drug is suitable for short operations, partic- ularly the extraction of teeth, and hence laughing gas is to-day the best anaesthetic for the dentist, and in England and America it is used with
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