A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart.

  • Caird, Francis Mitchell, 1853-1926
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: A surgical handbook : for the use of students, practitioners, house-surgeons, and dressers / by Francis M. Caird and Charles W. Cathcart. 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.

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    ri<;lil liearl becomes distended and i;eneral con<,'esti()n occurs. We liave already alluded lo iliis, as seen in the case of drunkarrls. It is enough to remove the towel and encourage resiiiration. In anxious cases, the external jugular vein may he opened ; or, if the heart have stopped, the right ventricle might, as a last resort, he punctured with the hypodermic needle, blood withdrawn, and the endocardium at the same time stimulated. Extreme pallor and irregular and feelile pulse i)resage cardiac syncope, for which ether may he given, either hypodermically or on the towel. .Sudden heart-failure is net ijrone to occur when the i)atient is well under. It will be noted liow much can he learnt by watching the asjiect of the patient's face. The pallor of .syncope and sickness, the congestion of res])iratory eniharrassmenl must be well watched, in ■contrast with the normal colour of the lips and ears. To sum u|i : we expect that no o|jerative ])rocedurc whatsoever should lake place till the patient is (;iirly under; that as soon as he /.v under — as evidence<l hy the muscular relaxation, cutaneous insensibility, and loss of conjunctival reflex—the anx'stheiic should be at once removed ; and that in the event of any respiratory trouble arising which is not at once relieved by ])ulling forward the cliin, or by lorcible traction on the tongue with artery-forceps, the alarm should be given, and artificial respiration ])romptly begun. It is difficult to form an accurate judgment as to the beneficial results gained by the preliminary hypodermic injection o[ atropia and morphia. There does not seem to be sufficient evidence as yet, tliat danger or sickness is lessened by it. Where, however, extensive ojierations have to be iierformecl in the region of tlie mouth and jaws, the jiatient's suH'erings are mitigated, and less chloroform is recjuired by this mixed narcosis. Moreover, the operator may be greatly assisted by the patient clearing his mouth while still remaining insensible to ])ain. (2) Ether is held in favour as the safest anxsthelic by many surgeons, notably so in ICngland and America. It would a]5])ear, however, that in this respect its virtues have been exaggerated, and fatalities during its use are not e'xtremely rare, as is shown by .some recent American writings. It may be used with advantage where cliloroform is contra- indicated. It should not be emjiloyed for children, who always bear chloroform well and safely. It is contra-indicated in cranial surgery, since it congests the lirain; and it is open to similar objections in pulmonary and renal weakness, where it is more or less obnoxious from chilling the lung or irritating the kidneys. There are two methods of giving iHher, known respectively as the Open and the Closed methods. {a.) The Open'''' Afetliod.—This resembles the ordinary mode of giving chloroform. The ether is either poured on the hollow apex of a towel rolled into a cone, or on a sponge placed within the towel, and the cone is then lield over the patient's nose and mouth. The ether is renewed as required, and care similar to that exerci.scd in the administration of chloroform is carried out. As a rule, the