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.

625/664 page 605

$In cases where nasal intubation was for any reason impractic- able Mills advised anaesthetists to use a mouth-tube—' what is called a flexible metallic catheter, No. 12, with both ends cut off, and hold it in the mouth about on a level with the wisdom teeth \1 Hewitt's account of anaesthetic procedure in ' operations within or about the mouth, nose, pharynx, and larynx (exclud- ing the extraction of teeth ....)' which he gave in the second edition of his book Anaesthetics and their administration (London. 1901) may, perhaps, be taken as representing the opinion of the majority of British specialist anaesthetists at the end of the nineteenth century : ' Twenty years ago ', he wrote, ' delicate and prolonged operations within the oral cavity were not unfrequently aban- doned owing to want of knowledge as to the principles upon which anaesthesia should be maintained. #But with our present methods it is possible to safely and satisfactorily anaesthetise all patients requiring these operations, provided attention be paid to certain important details which may now be conveniently considered under the following heads : £ (1) The selection of the anaesthetic and the adjustment of the depth of anaesthesia. ' (2) The posture of the patient and the avoidance of asphyxia! complications from the entry of blood into the larynx and trachea.' Under (1) Hewitt expressed the opinion that where pro- tracted unconsciousness was essential anaesthesia should be maintained first with ether and finally with chloroform, but should be induced with nitrous oxide or the A.C.E. mixture, ' in order to prevent the initial unpleasantness of the ether '. Anaesthesia having been established ' the patient can be safely charged-up, so to speak, by considerable quantities of . . . [ether] vapour,' Hewitt explained, ' so that when the inhaler is withdrawn there is not that tendency to inconvenient recovery during the necessary initial manipulations of the surgeon which is so common when other anaesthetics have been used '. Once the patient had been placed deeply under the influence of ether Hewitt advised suspending the administration and allowing * a slight tendency towards recovery, i.e. the reappear- ance of slight conjunctival reflex, cough, or swallowing '. The 1 Tarcet, 1878, ii, 839 ; Brit. med. J., 1883, i, 917, 969.$