Volume 1

A text-book of surgery / by Hermann Tillmanns ; translated from the 3rd [and 4th] German edition by John Rogers and Benjamin T. Tilton.

  • Tillmanns, Hermann, 1844-1927. Lehrbuch der allgemeinen Chirurgie. English
Date:
1895-1898
Catalogue details

Licence: Public Domain Mark

Credit: A text-book of surgery / by Hermann Tillmanns ; translated from the 3rd [and 4th] German edition by John Rogers and Benjamin T. Tilton. Source: Wellcome Collection.

    38/840 page 26
    but especially before the complete loss of consciousness and towards the close of the narcosis. If the stomach is full, vomiting regularly takes place. Occasionally death has been caused by asphyxia, due to the in- halation of stomach contents. During the act of vomiting the patient usually recovers consciousness, thus causing the narcosis and the opei-a- tion to be prolonged. When vomiting occurs the head of the patient should be turned to one side, and if the mouth is tightly closed it must be opened by force with one of the instruments illustrated on page 22. 2. A7io?naUes of Bespiration.—lYvegxi]^Y respiratory movements are generally—in fact almost always—to be expected during the narcosis. ^ In the beginning of the latter there is not infrequently a cessation of respiration in expiration, generally accompanied by a spasmodic closure of the glottis. As has been mentioned on page 18, this tem- porary apnoea is caused reflexly by the chloroform vapour coming in contact with the end filaments of the fifth nerve in the nasal mucous membrane. But the danger is greater if respiration stops during the stage of excitement, giving the characteristic picture of asphyxia- tion : the thorax is as stiff as a board, the jaws are tightly closed, the tongue is drawn back against the posterior pharyngeal wall, pressing down the epiglottis and so closing the larynx, while the face becomes bluish red. Under these circumstances death can result; but such a picture should cause no alarm in one who is experienced, as this dis- turbance in the respiration can be easily remedied. After the stao-e of excitement has passed and the patient is fully under the influence of chloroform, respiration can be easily interrupted by the tongue falling backward of its own weight, pushing down the epiglottis'^and thus closing the entrance into the larynx. The bluish-red colouration of the face in such cases calls attention to an interruption in the respiration. Linhart saw a singular cause for the o,sphyxia in a girl who had a very pointed nose and extremely thin alee nasi. The latter were pressed tightly against the septum on both sides by atmospheric pressure during inspiration and thus closed the anterior nares, and at the same time the mouth could not be opened owing to trismus. The alje were pried apart with a penknife and air rushed into the nose, making a distinctly audible noise. Linhart believes that the alte nasi frequently have this anatomical peculiarity. 3. Disturbances in the Circulation.—These are extremely danger- ous, and sometimes occur, at the beginning of the narcosis, but more frequently after the administration of chloroform has been kept up some time; in other words, in the stage of tolerance or deep narcosis. No matter whether the respiration is normal or not, if the radial pulse becomes intermittent and the face pale there is need of the greatest
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