The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum].
- Duncum, Barbara M.
- Date:
- 1947
Licence: In copyright
Credit: The development of inhalation anaesthesia : with special reference to the years 1846-1900... / [Barbara M. Duncum]. Source: Wellcome Collection.
437/664 page 417
![respiration, the facepiece can be more or less firmly applied. Even when the inhaler is firmly applied there is still sufficient space at certain points for atmospheric air to filter in between the rim of the facepiece and the face. But one is particularly careful to see that the lower border of the facepiece fits well, so that the ether vapour, which is heavier than air, cannot flow out there. At first the bag hangs down. In the bottom is the liquid ether in a pool, from the surface of which vapour rises and passes to the facepiece where it mixes with air and so will be inspired by the patient. As anaesthesia progresses one supplies the patient with an increasingly concentrated ether vapour by shaking the bag. Care must be taken, however, that breath holding does not occur ; should it do so it is a sign that the patient is not yet tolerating the concentrated ether vapour and this is particularly the case if reflex spasm occurs. Once tolerance is established the bag is shaken so that the patient breathes concentrated ether vapour until the corneal reflex is totally abolished, which may be regarded as a sign that anaesthesia is fully established. When surgical anaesthesia is complete the inhaler can be removed from the face, but not for very long, because the effect of ether is far more transient than that of chloroform, and the patient very quickly begins to wake. During deep anaesthesia the facepiece, in the majority of cases, is lightly applied, but the shaking is dis- continued. The small amount of vapour rising from the surface of the liquid ether is sufficient, even when the apparatus is not shaken, to maintain anaesthesia. ' The point which distinguishes this from Julliard's mask is the way in which the ether vaporizes. In the first place, in Wanscher's inhaler the surface of the ether from which evapora- tion takes place is relatively small, but in Julliard's mask the whole of the inside of the mask is covered by ether-soaked flannel, providing a huge surface for evaporation. Secondly, in Julliard's mask the vapour descends, but in [Wanscher's inhaler] the vapour must rise. This circumstance is extremely important when one considers that ether vapour is heavier than air. If one allows ether to vaporize from an open dish the vapour diffuses to the floor of the room and collects there. If one pours ether into the Wanscher inhaler and immediately applies the face to it and breathes the vapour present in the bag, one draws in a large, suffocating quantity of ether, f1] But if one waits a few moments until the walls of the bag (freely moistened by the pour- ing in of the ether and thus presenting a much greater evaporating surface) have dried, one can then breathe easily and without that almost unbearable feeling of suffocation, the trifling quantity of 1 Landau's assistant, Vogel, stated that this was, in fact, one way of producing narcosis with the inhaler—a way closely resembling Julliard's in effect. (Berl. klin. Wschr., 1894, 31, 406.) 14](https://iiif.wellcomecollection.org/image/b20457200_0441.jp2/full/800%2C/0/default.jpg)
