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.

397/664 page 377

$after operation before restoration of consciousness after chloroform'. It read as follows : ' . . . After the stump was dressed a subcutaneous injection of a solution of a third of a grain of morphia was practised, with a view of inducing freedom from pain, and some refreshing sleep after a return to consciousness. This practice, as Mr. Paget remarked, has been in use for some time at the Middlesex Hos- pital, and has afforded much comfort and ease, especially after many of the more important and painful operations. From a quarter to one third of a grain, or if necessary even half a grain of morphia may be employed according to circumstances.' 1 One of the first events which seems to have had an indirect influence in turning attention towards the subject of premedica- tion was a case occurring in the practice of the Viennese surgeon Pitha, which was reported in the medical journals in England and on the Continent. In 1861, Pitha, after experiencing the utmost difficulty in anaesthetizing with chloroform and ether (presumably the Vienna mixture, 1 part chloroform, 3 parts ether) a patient about to be operated on for incarcerated hernia, proceeded to give an enema containing ' a scruple of the extract of belladonna. [2] . . . Some time after that, the patient appeared to be in a state of deep intoxication ; and herniotomy was then performed. The sopor resembled throughout a deep and tranquil sleep . . . and it was not until twelve hours after the operation that the patient awoke. . . . Professor Pitha thought that the anaesthesia was due to the combined action of chloro- form, ether and belladonna ; and he recommended a mixture of atropine and chloroform to be administered for inducing anaesthesia in cases of chloroform refractaires '.3 In spite of the publicity given to Pitha's suggestion it appears that no one else at the time adopted it in practice. Nevertheless ment devised by C. G. Pravaz, of Lyons, about 1853, for injecting iron perchloride into an artery for the cure of an aneurysm. It consisted of a very fine gold or platinum trocar which was to be introduced obliquely through the artery wall ' with a kind of screwing movement' . The trocar was attached to a syringe, the piston of which turned on a spiral thread, so that the liquid in the syringe was expelled in a steady, controllable stream. (C.R. Acad. Sci., Paris, 1853, 36, 88.) 1 Lancet, 1863, i, 148. 2 Atropine was first prepared from the plant Atropa belladonna, Linn., by Mein, and by Grieger and Hesse, in 1833. The use of various parts of the plant itself as soporofics was traced back with certainty to 1450, by Fltickiger and Hanbury and was probably much older. (Fluckiger, F. A., and Hanbury, D. 1879. Pharmacographia. London.) 3 Med. Times Lond., 1861, ii, 121.$