Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    69/1272 (page 37)
    heart, and consequeufcly if it is given during shock it is wiser not to push it too far, but merely to benumb sensation without causing complete muscular relaxation. The Treatment of the Effects arising from an Overdose of any Anaesthetic is based on two principles :—1, the establishment of respiration, either natural or artificial, so as to empty the lungs of the vapour contained in the air-cells, and to aid the oxygenation of the blood ; and 2, the stimulation of the heart's action, and the maintenance of the circulation. The treatment to be adopted on the occurrence of dangerous symptoms, or of apparent death from chloroform, is as follows :— 1. The administration of the vapour nuist be at once discontinued. 2. The tongue should be seized with the fingers, or with forceps, and drawn out of the mouth ; and the larynx pushed up so that the glottis may be opened. The tongue must be pulled forcibly forwards, not merely pulled out of the mouth, for the reasons before stated. The finger should be immediately passed down the throat and the glottis examined for the possible presence of vomited food. The pharynx should be freed from mucus with a sponge on a holder. 3. Fresh air should be admitted to the patient by opening doors and windows, and by pre\-enting bystanders or spectators from crowding round. 4. All constrictions should be removed from the patient's throat and chest, and these parts should be freely exposed, 5. Artificial respiration must at once be set up, whilst these other measures are being carried out. This should be done by the Sylvester method, which is fully described in the chapter on Asphyxia. Artificial respiration should be commenced by a forced expiratory movement, so as to empty the lung as far as possible of the anesthetic vapour. Milne Murray has shown that rabbits can be revived from a nearly ftital dose of chloroform with much greater certainty if, as the first step, before commencing artificial respiration, the lungs are exhausted as far as possible by aspiration. To attempt to adopt this plan in man would cause serious loss of time before commencing artificial respiration. 6. Electricity, in the form of faradisation of the phrenic nerve, has been of great use in some cases as an adjunct to artificial respiration. It must be applied methodically as described under the treatment of asphyxia. In nsino- electricity care must be taken not to stimulate the vagus, the etlect of which might be finally to inhibit the feeble heart. 7 Nitrite of amyl, when inhaled in health, causes, according to Brunton flushing of the face, throbbing of the carotids, and a quicker and fuller pulse' with quickened respiration. It causes diminished blood pressure by a general dilatation of the arterioles, and thus relieves the heart. It seems therefore from Its stimulating influence on the cardiac and respiratory centres, to be mdicated as an antidote in chloroform poisoning, whether of the syncopal or asphyxial form ; the nis])i.-ation of the vapour of ten to fifteen drops of the nitrite unloading the vessels and restoring the heart's action. The adminis- trator should always have at hand, in case of accident, some glass capsules of nitrite of amyl. One of these should be broken into a handkerchief and held over the face whde artificial respiration is continued as above described. The Head should be placed at the same time as low as possible.