The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum].

Duncum, Barbara M.

Date:: 1947

Credit: The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum]. Source: Wellcome Collection.

351/664 page 331

$by nitrous oxide gas is used in by far the greater number of cases. Chloroform is used for very young children, and in operations about the mouth and nose which are likely to last some time. Nitrous oxide gas is employed for short operations, such as extrac- tion of a tooth or opening an abscess. Nitrous oxide gas and ether are administered by means of Mr. Clover's apparatus, which is admirably adapted for the purpose. Chloroform is given on lint, from a drop-bottle. Until January 1875, chloroform was used for nearly all cases. . . . Chloroform is used in long operations about the mouth and nose, because : 1. The narcosis of chloroform lasts longer than that of ether ; 2. In many operations, as for cleft palate ... it is necessary to keep a gag in the mouth, which comes very much in the way of a facepiece, such as is necessary for the administration of ether ; while chloro- form can very conveniently be given on a piece of lint ; 3. In operations for cleft palate, too, there is another objection to the use of ether, in the fact that it excites a flow of viscid saliva, and is apt to induce coughing. ... In cases of fracture which require an anaesthetic whilst the parts are being placed in apposition during the time the muscles are relaxed, chloroform is preferable, because patients recover from its effects quietly, the inhalation of ether being generally followed by a state of noisy delirium and struggling which would be likely to displace the fractured ends and necessitate their readjustment.' The Surgical Registrar of Guy's Hospital replied : ' I. In the surgical wards and surgery of Guy's Hospital, chloroform is the anaesthetic which is almost invariably admin- istered ; occasionally only, the mixture of alcohol, ether, and chloroform, as recommended by the Committee of the Royal Medical Chirurgical Society [see pp. 356-7], and, more rarely still, ether alone. In some cases, anaesthesia first produced by chloroform, is continued by the mixture or by ether alone ; this especially in cases in which chloroform does not appear to be well borne. 2. Chloroform is given from a piece of lint, fitted into a metal nose-piece for convenience sake alone, a few drops being poured from a stoppered bottle as often as required. The mixture is generally given on flannel, adapted as the loose lining of a cylindrical paste-board or leather inhaler ; and ether on a sponge at the bottom of a deep cylindrical leather inhaler fitting closely round the mouth. 3. During the last four or five years, all the anaesthetics, old and new, ether, chloroform, nitrous oxide, bichloride of methylene, the mixture of alcohol, chloroform, and ether, etc., have been used to a very considerable extent at Guy's ; but, chloroform being found much the most convenient in administration, and, as a rule, well borne in surgical operations, and much less frequently followed by the disagreeable$