The advantages and accidents of artificial anaesthesia: a manual of anaesthetic agents, and their employment in the treatment of disease

Front matter

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

THE

Preface To The Second Edition

The rajjid sale of a large edition of this work in the short period of one year, shows the appreciation with which it has been received by the medical and dental press and professions. Its success has induced the author to revise the subject matter and rewrite several of the articles. To make the volume more worthy of the favor of the profession, a number of new and original experiments have been made ; especially with hydrobromic ether'. The boiling points and relative time of evaporation of the several agents employed in mixed anaesthetics, and the best proportion in which ether, alcohol, and chloroform should be united, have been determined ; also a continuation of the experiments on the action of anaesthetics on the blood, the use of the spectroscope in relation to anaesthetics, more especially nitrous oxide.

In this second edition there will be found many more practical suggestions as to the employment of anaesthetics that are safe, and the rules for their adoption or reasons for the rejection of some of them in different cases, grouped, and made convenient, so that the student can memorize them, and be fully prepared for any emergency. As has been well observed in a review of this work by the distinguished editor of the Dental Cosmo*, "When trouble comes to a patient from any cause during the anaesthetic state, it is not a good time to hunt up information."

6 PREFACE TO THE SECOND EDITION.

The new table of deaths from chloroform which has been added, and in the preparation of which much time and labor has been expended, -will be found of special interest and vital importance in regard to the sex, age, character of operation, time at which the patient died, quantity of chloroform used, and form of apparatus employed, general condition of patient, prominent symptoms of chloroform-poisoning, causes of death and post-mortem appearances. A new ether inhaler has been described and illustrated, which has been, and is now, employed in the clinical service of Jefferson College Hospital.

A bibliography published in the first edition has been omitted, bu< additional old or new works which were not then introduced, or cannot be found mentioned in the body of this work, have been printed tor reference.

A historical sketch of the discovery of amesthesia at the end of the previous edition has also been omitted, as more space has been devoted to the subject in our introduction, but full references to all the authorities on the subject have been given.

There has been introduced a notice of the metric system in accordance with the recommendations of the "American Medical Association " at its last meeting, at Atlanta, in May, 1879 ; also a table of the Centigrade, and Fahrenheit thermometric scales. More space has likewise been assigned to the physiological and therapeutic action of anaesthetics in disease. In most of the instances where a remedy has been recommended, the authority has been quoted, or we have tested its therapeutic value in an extensive private practice, or in the daily clinics of two large public institutions.

It was found impossible to acknowledge, in every instance, the source from which all contained facts have been

Preface To The Second Edition. 7

obtained, but in the majority of instances we have endeavored to give credit to every original worker in the field of progress.

The author desires to acknowledge many courtesies at the hands of several eminent members of the profession, but he is especially indebted to his son, Dr. Charles 8. Turnbull and to Dr. Charles E. Sajous, resident physician of Howard Hospital.

1502 WALNUT STREET, June, 1879.

Preface To The First Edition

This little work was originally written by the Author as a report for a medical society, anil was subsequently extended to its present form to supply a want that evidently exists at the present day, for a convenient hand-book on the administration of the various anaesthetics, that the practitioner of medicine or dentistry can consult to enable him to decide which one lie can best employ. Many valuable books have, unquestionably, been written on the subject of anaesthetics, but as far as the writer's observation extends, none of a practical character have appeared within the last few years. Much useful matter in relation to sulphuric ether, nitrous oxide, and chloroform, employed as anaesthetics, has accumulated within this period, but this valuable information is contained in various monographs, journals, etc., where, associated with what is extraneous, it is unprofitable to the busy practitioner.

The object of this work may be stated to be : —

First. To give in as concise a manner as possible a description of the most available agents that may be successfully and safely employed as anaesthetics.

Second. To present the chief chemical tests of the purity of each substance considered, with its composition, physical characters, and medical properties.

Third. To exhibit the best methods of administering the various anaesthetics, to give careful directions, and to state

Preface To The First Edition. 9

the precautions to be taken to avoid risk to the life of the patient.

Fourth. To note the personal experience of the author, his assistants and friends, with the various forms of anaesthetics and inhalers in use, with a selection of the most approved of them, not withholding, however, the objections and experiments of other reliable investigators.

Fifth. To compare the relative mortality from all the anaesthetics now employed, endeavoring to assist the reader i" forming a fair and candid opinion on this most important subject, which is now, and has for so long a period, occupied the attention of the public as well as of the medical profession.

To conclude are added practical hints on Local Anaesthesia, the use of the various anaesthetics in the practice of medicine; the Medico-Legal Nature anil Importance of Anesthetics, with a brief History of the discovery of Artificial Anaesthesia.

1502 WALNUT STREET,

March. 1K7S.

Chapter II

Ether— The ordinary methods of administering: towel, cone, sponge, or bag. Test when patient Is fully under Its Influence. Physiological action "i ether. Cautions in regard to solid food before etherization. Cases in which ether should not be employed as an anaesthetic. The three stages of etherization, .Sulphuric ether —Always gives warning. Use of air, artery forceps, artificial respiration In fainting, etc. Statistics in reference to death. Experiments by the sphygmograph. Primary and secondary effects. Tableof deaths from ether. Abstract of report of Boston l Miami tire. Inflammability. Conclusions of Author.

Chapter III

Ethers which haveanaesthel Ic properties. Acetic ether. Experiment'! by Dr. H. C, Wood on animals, etc. Formic ether. Byasson's conclusions in regard to it. Hydriodic ether. Properties and objections to its use. Methyllc ether. Dr. Richardson's experiments with it. Bichloride of methylene. Observations upon it by Dr. Jones of Cork, Dr. Taylor and Spencer Wells of London. Iodide of Methyl. Amylene. Bromide of ethyl, or hydrobromic ether. Properties. Mode of preparation, and experiments by the writer. Chloride and bichloride of ethylene. Oxygen, nitrogen and hydrogen gases as anaesthetics. Page 63-86

Chapter IV

Chloroform, chemical composition, impurities, tests— physiological action. Toxicological effects. Employment of chloroform in labor.

CONTENTS. 11

M. Plehard. .Congress at Geneva. Drs. Lusk, Wilson, and Smith. Statistics of death from chloroform. Table of one hundred and sixty deaths, with comments. Nitrite of amyl. Effects of nitrite of amyl as an antidote to chloroform, observations and cases, by Drs. Burrall, Lane, and Munde. Richardson on physiological action of nitrite of amyl. Mixed narcosis. Use of morphia before inhalation of chloroform. Therapeutical applications. Page 87-144

Chapter V

Mixtures of chloroform, ether, and alcohol. First death reported from mixture of ether and chloroform. Composition of various mixtures. Boiling points and relative time of evaporation of the several anaesthetic agents. Opinions of Dr. Washington Atlee and Prof. Maisch concerning mixtures. How chloroform is altered by mixing with alcohol, etc. Recent deaths from chloroform and ether mixed. Chloroform combined with alcohol in parturition. The comparative effects of the early state of anaesthesia with ether and chloroform. Page 145-1.58

Chapter VI

Nitrous oxide gas as an anaesthetic. Mode of preparation, chemical constitution, gasometer, inhaler, and mode of purifying nitrous oxide gas. The advantages of the gas being recently prepared. Class of cases for inhalation. Difficulties and dangers, with mode of treatment. Liquid nitrous oxide in cylinders. Physiological action of nitrous oxide. Experiments and observations by Doctors Evans, of Paris, M. Buisson, Doctors McQ,uillen, Thomas, Robert Amory, George Johnson, and the writer. Mode of action of amesthetics by Doctors C. Binz, H. Ranke, Claude Bernard, and Committee British Medical Association. Investigations upon the protoxide of nitrogen by Drs. Jolyet and T. Blanche. The spectroscope and its relations to nitrous oxide. Experiments of Doctors Waterman, J. C Richardson, Wm. M. Hodges, C. S. Turnbull, and the writer. Niti'ous oxide gas in dental and minor surgery. M. Paul Bert on the use of a mixture of nitrous oxide and oxygen gases. Deaths from the inhalation of nitrous oxide.

Chapter VII

Hydrate of Chloral. Chemical composition. Tests of purity from taste and odor. An abstract of original and selected observations on, and experiments with, hydrate of chloral on animals and man by the writer. M. Vulpian, injections into the veins. Physiological effects on man and animals. Dr. Bouchut on hydrate of chloral as an Anaesthetic for Children. M. Couty on death of animals from Hydrate of Chloral. Corroborative experiments by the writer. Prof. Or6 of Bordeaux on intravenous injection of Chloral Hydrate. Advantages and risks by De Neffe, Van Wetter, Warlomont, Besnier v and Vulpian. Cases of recovery from large doses of hydrate of chloral, and in certain cases death following moderate quantities.

12 CONTENTS.

Delirium tremens produced by chloral hydrate. Case of Dr. Da Costa reported by Dr. Woodbury. Discussion od the subject of chloral by members of the Philadelphia County Medical society. Dr. Arbuckle's experiments with i 'hi oral and wit h narcotics. Its influence oil the retina] circulation. Chloral hydrate— poisoning l>y, and means to prevent or treat. Therapeul Ic effects of Hydrate of * 'hi oral mi traumatic tetanus, nausea of pregnancy, eclampsia and convulsions, retention of urine, migraine, chorea, diphtheria. Local anoesi in 'i ic application and counter irritation with Hydrate of* 'hi oral, li u i > Ichioi;ii-h\ drate. I se of and experiments by Liebretch.

Chapter VIII

Inhalers of Hawkslcy.Hearn, Cheatham, I. cute, A I lis, Morgan, Richardson, Any rove, and Clover for ether, inhalers or A i lis and Skinner lor chloroform. Inhaler of Thomas for nitrous oxide gas. Inhalers of J. !•'. < lover, I'. K. ( '. S., and ( 'odmaii ..t Khurllefl for nil roufl

oxide gas and ether. Morgan's inhaler for Bichloride of Metbj lene,

Chapter IX

Bon wilt's method of anaesthesia. Analgesic effects of rapid breathing.

Car hoi lie oxide gas. i a 1 1 ionic at id yas. Tei rachloridi' of carbon. Carbolic acid. Anaesthesia of the larynx. Local anaesthesia in odontalgia. Paradlc anaesthesia, Bromoform. Local anaesthetics. Richardson's method of local anaesthesia/with apparatus. Freezing mixtures. Extract eucalyptus, morphia, etc. Page 'Miu-Si'.i

Chapter X

The Legal responsibility of physicians in the administration of anaesthetics. Medico-legal relations of anasstbetlcs. Case in Philadelphia of a surgeon den list. The important question whether chloroform can he administered for criminal purposes? Cases in France, England, and the United States. Dr. X. L. Folsom, R.'M. Denlg. Chloroform as a poison. Experiments of A. Martin Ewald, Hitzig, C. Bernard and Liinz. Ethers; their action as poisons. Kther intoxication. Page 27J-2'J0

CHAPTER XL

GENERAL CONCLUSIONS.

Alcohol preparations. Treatment of poisoning by ether. Inhalation and internal administration. Precautions in its inhalation. Bichloride of methylene. Hydrobromic ether; use and new mode, of preparation; conclusions. Ethidene di chloride. Oxygen, hydrogen, and nitrogen gases. Dr. Gray's experiments with oxygen gas. On the use of anaesthetics, especially chloroform, in dental operations. Treatment of chloroform poisoning. Chloroform and chloral in poisoningby strychnia. On the choice of anaesthetics. Another death from chloroform. Bibliographical list of papers and works on anaesthetics. The .Metric system. Page 291-314

ARTIFICIAL ANESTHESIA.

INTRODUCTION.

ANAESTHETICS OF THE ANCIENTS.

The ancient Greeks, it is stated, possessed a plant called mandrake. It belonged to the same family of plants as the belladonna, or deadly nightshade. From the root of this plant was extracted, by means of wine, a narcotic which was employed by them as an anaesthetic. Lucius Apulcius, who lived about 160 A. D., and of whose works eleven editions were republished in the fourteenth and fifteenth centuries, says " that if a man has to have a limb mutilated, sawn, or burnt, he may take half an ounce of mandragora wine, and whilst he sleeps the member may be cut off without pain or sense." To prove that this was true, Dr. B.W. Richardson, of London, after a lapse of live centuries, obtained a fine specimen of mandragora root, and made mandragora wine and tested it, and found it was a narcotic having precisely the properties that were anciently ascribed to it. He found that in animals it would produce even the sleep of Juliet, not for thirty or forty hours, a term that must be accepted as a poetical license, but easily for the four hours named by Dioscorides; and, on awakening, there was an excitement which tallied witli the same phenomenon that was observed by the older physicians. Another fact was noticed by the ancients, that many volatile substances acted more promptly by inhalation than by the stomach, and this form of medication was employed in Greece, Rome, and Arabia. By their published works, the knowledge of these facts was extended to other parts of the world.

In China, in ancient times, the word ma-yo meant not only Indian hemp, but anaesthetic medicine; other substances besides hemp entered into these benumbing recipes, such as tin' datura, a solanaceoua plant, probably identical with the atropia mandragora; also aconite, hyoscyamus, etc. Some of these drugs form constituents of the, formula said to be employed by kidnappers of children, and robbers, and arc therefore naturally forbidden in China, at the present, to be sold or employed.

The Indian hemp, under the name bfiang,w&B extensively used liy the Mohammedans and others in Central Asia. The most wonderful properties are ascribed to it. " Taken in excess, the -pirits and demons may he seen ; it confers prophetic powers; it is sometimes taken I >y persons wishing to indulge in spiritualism, and it is used as an antidote to forgetfulness." (Dudgeon.)

Tbeodoric, about the year 12H.S, gives elaborate directions how to prepare a " spongia somnifera " by boiling it dry in

numerous strong narcotics, and afterwards moistening it for inhalation before operations.

Opium was also employed in later years (prior to surgical operations i, and was found one of the best of narcotics for the relief of pain and for producing insensibility, but was not free from danger.

On September 3d, 182s, M. ( lirardin read, to the Academy of Medicine of Paris, a letter addressed to His Majesty Charles X, describing surgical anaesthesia by means of " inhaled gases."

Richerand suggested drunkenness in reducing dislocations; and patients, while dead drunk, have been operated upon painlessly. Larry, after the battle of Eylau, found in the wounded, who required amputations, a remarkable insensibility, owing to the intense cold, this being the first • i — * - of cold as an anaesthetic.

A strong impulse was given to the study and application of the " different kinds of airs and gases" by the discovery of oxygen by Priest ley and Seheele, in the middle of the last century, and numerous experiments were made by physicians with it. Another still more practical result was obtained by Sir Humphrey Davy, and published in 1800. "That nitrous oxide appears capable of destroying physical pain, and may be used with advantage during surgical operations." This valuable and practical suggestion remained without fruit for a long time, and the surgeons, physicians,

INTRODUCTION. 15

and accoucheurs still employed alcohol in some form, or opium and its salts, to deaden as far as possible the sensibility to pain during their various operations. It was not until 1844 that an effort was made in the United States by Dr. Wells, of Hartford, who experimented with it in fifteen cases with varying success ; but he employed too small a quantity of the gas. In April, 1848, Dr. Bigelow, of Boston, demonstated its value in surgery by performing an excision of the breast, using sixty gallons of the gas. But the crowning result was obtained in 1846 by Dr. Morton, in the Massachusetts General Hospital, when it was demonstrated successfully that the inhalation of "ether" was so capable of deadening the sensibility of the nervous system, that any operation, no matter how painful, could be performed and the patient not suffer from its effects. It was also proven that ether was safe and like the wine that Juliet drinks, the action of which the Friar Lawrence so well describes : —

"Through all thy veins shall run A cold and drowsy humour, which shall seize Each vital spirit; for no pulse shall keep His natural progress, but surcease to beat : No warmth, no breath, shall testify thou liv'st; The roses in thy lips and cheeks shall fade To paly ashes; thy eyes' windows fall, Like death when he shuts up the day of life; Each part, deprived of supple government, Shall stiff, and stark, and cold appear like death: And in this borrow'd likeness of shrunk death Thou shalt remain full two and forty hours, And then awake as from a pleasant sleep."

This most valuable agent required but to be inhaled for a few minutes, when the patient, being in a pleasant frame of mind, would thus remain asleep ; and after a more or less prolonged operation, " would awake and inquire if the diseased limb were still there, and could be told that the offending member was gone, without his knowledge."

No one can form, even at the present day, a. just estimate of the true value of the various anaesthetics, or express in words their wonderful and extended application to the relief of human suffering.

To the general surgeon it gives the opportunity of operating in grave cases of disease and injury, without which, the death of the patient would be inevitable. It also affords, by

16 ARTIFICIAL ANjESTHESIA.

the immediate relief from pain, the power to manipulate the broken or injured parte with facility, and thus obtain a correct diagnosis in the most obscure diseases and painful accidents.

To the obstetrician and gynaecologist it is useful in assuaging the terrific pain of labor, and makes the dreaded instruments^ blessing in disguise. In the diagnoses and treatment of abdominal diseases, it gives precision and almost marvellous results, and in the removal of large masses or tumors great freedom from the dreadful effects of shock to the nervous system. For the ophthalmic surgeon the anaesthetic reduces the sensibility of the eye so that it can be touched with impunity, and severe and dangerous operations can lie performed upon this delicate and sensitive organ without pain and witli much less risk.

Again, in the removal of foreign bodies from the eye or ear, particularly in children, by the use of the anaesthetic all spasm is relieved, and the act is accomplished without injury. The profound sleep gives a most favorable opportunity to the aural surgeon to perforate the membrana tympani, cut the minute tendon of the tensor tympani muscle, or perforate the mastoid cells.

There arc sonic thirty substances which arc of so volatile a character, that they can be employed in producing aii.'csthesia. The following is a

I. isr OK THE PRINCIPAL AGENTS THAT WILL PRODVCE ANAESTHETIC SLEEP OR LOCAL ANAESTHESIA.

Nitrous oxide gas. < blonde ofmethyl gas.

Carbonic oxide tr:is.t Bichloride "I methylene.

Carbonic acid gas. 1 Terchloride offormyl, or chloro-

Bisutphide of carbon.* form.

Light iaiimretf.il hydrogen.* Tetrachloride of carbon.* (Hydride oi methyl, or marsh Bromotorm.

gas.) Heavy carburetted hydrogen

Methylic alcohol. L r as.

Methylic ether as. (defiant gas or ethylene.)

Those agents having the stars affixed are not safe lor inhalation, and are more fitted for producing local anaesthesia.

f Carbonic oxide has been used as a local amesthetie to cancerous or raw surfaces ; but, when inhaled, it is a powerful narcotic poison. Owing to its superior affinity, it displaces the oxygen in the red blood-corpuscles, and unfits them for the functions of respiration.

INTRODUCTION.

i;

Ethylic, or absolute ether.

(Sulphuric ether.) Chloride of ethyl.

Bichloride of ethylene.

(Dutch liquid.) Bromide of ethylene.

Bromide of ethyl, or hydrohromic

ether.

Hydride of amyl.* Amylene.* Benzole.*

Turpentine spirit.* Gasoline.*

And all of the liquid chlorides, bromides, and iodides of alcoholic radicals.

Those anaesthetics which are employed at the present day, in the practice of medicine, may be reduced in number to four; namely, alcohols, ethers, chloroform, and nitrous oxide. These can be employed alone, or mixed in various proportions. They can be reduced to a still smaller number, viz., nitrous oxide gas, and alcohol of various grades of power, as each of the eleven alcohols will, by the chemical action of an acid, produce its ether or chloroform.

* Those agents having the stars affixed are not safe for inhalation, and are more fitted for producing local anesthesia.

18 ARTIFICIAL A-X.F.STHF.SIA.

Chapter I

i .. ii, ncl Aii;isth> tirs— Al.olml and Ethyl Alcohol. Methylic Alcohol for inhalation ; mode of action ; its resemblance to Chloroform.

It has limy been recognized as a fact that, when persons are under the controlling influence of alcohol, cither in the form of wine, gin, whiskey, or brandy, they may he cut, bruised, or even have their bones broken, without expressing, or experiencing much, if any pain. Alcohol was very early employed by surgeons to produce immunity from the pain of the knife, long before any true anaesthetic was discovered. Dr. John Lynk states that he lias long employed alcohol as an anaesthetic, and that he lias gradually learned to appreciate it more and more, using it now almost entirely in his surgical operations. He has not as yet tried it in a capital operation, but has employed it, in the proportion of about one pint for a strong adult, in tablespoonful doses every twenty minutes in an amputation of the finger, extraction of teeth, in a case of severance of the posterior tihial nerve; with the use of chloroform, also, ligation of radial and ulnar artery, in which he only used two drachms of chloroform and one pint of whiskey. This latter operation he thinks served to demonstrate the value of the whiskey as an anaesthetic, leaving the other functions, especially the heart, in a more normal condition than hy the chloroform alone, which he states, was proven hy the strong pulsations of the heart after the chloroform had been withdrawn.

We have tried the inhalation of whiskey, hut owing to its mixture with water and fusel oil and other carbonaceous products, it will not produce anaesthesia rapidly. If rye whiskey be pure and strong, and free from water and other products, it will produce anaesthesia if applied with the atomizer or bv inhalation.

' Cincinnati Lancet and Observer, May, 1876.

METHYLIC ALCOHOL. 19

ETHYL ALCOHOL (C 2 H 5 OH).

This compound is manufactured on a large scale, and is the most important body of the whole group, being the starting point for the preparation of all the other ethyl compounds. Ethyl alcohol, or spirits of wine, is obtained by the vineous fermentation of the sugar in the various grains, a decomposition taking place in the dilute solution of sugar in the presence of yeast, by which the greatest portion of the sugar is resolved into carbon-dioxide and ethyl alcohol.

In England the " proof spirit " of the excise contains 50.8 per cent, by weight of alcohol, and has, at 15.5° (60° F.), the specific gravity of 0.920. Owing to the high duty on pure spirit, the government allows the sale of a mixture of ninety parts of strong spirit and ten parts of crude wood spirit, called "methylated spirit," for manufacturing and scientific purposes ; this being, therefore, a mixed carbonaceous compound not fitted to produce a pure ether. Ethyl unites with dry chlorine acid gas, and forms ethyl chloride, C 2 H rj CL; also with bromine, sodium, and iodine, forming ethers.

In the United States, alcohol is usually obtained by the distillation of rye, barley, corn, or wheat whiskey. Thus obtained, it is a clear liquid, containing more or less water, which by redistillation, in conjunction with lime, becomes what is known as absolute alcohol. It is difficult to inhale pure alcohol (ethylic), as it causes great irritation of the throat and spasm of the glottis ; but if diluted with water and thus inhaled, anaesthesia will be produced as before stated.

There are two other alcohols which are found in commerce, one called methylic, and the second amylic alcohol. The methylic alcohol is obtained by the dry distillation of wood, and the amylic by the distillation of potatoes. They are both used for adulteration and for commercial purposes.

METHYLIC ALCOHOL,

Pyroxide spirit, or wood spirit, as this has been differently called, has been known for about sixty-two years, and when analyzed by Messrs. Dumas and Peligot, it was found to

-fl> ARTIFICIAL AX.KSTHESIA.

contain 37. -J percent, of carbon, 12.5 per cent, of hydrogen, and 50 per cent, of oxygen. When pure, it remains clear in tin' atmosphere. It has an aromatic smell and taste, with slight acidity, and boils at 140° F. According to the experimentsof Pr. B. W. Richardson, of London, this alcohol, owing to its volatile nature, may be exhibited freely by inhalation, in the same manner that chloroform is administered. Il then enters the blood by being carried with the air thai is inspired into the pulmonary tract, and thus into the air vesicles; here it is absorbed into the circulation by tin- minute blood-vessels which make their way from the heart through the lungs, and which ramify upon the vesicle-. By administering the vapor of methylic alcohol in this way, its effects are rapidly developed, for it condenses quickly in the blood, is carried rapidly into the left side of the heart, ami thence is distributed by the arteries over the whole body, as quickly as can be condensed and absorbed.

This alcohol is recommended by Dr. Richardson, and he has obtained better results from its use than from the heavier or ethyile spirit. It is much more rapid in its action, and much less prolonged in its effects than common alcohol; and, what is of more importance, it demands the least possible ultimate expenditure of animal force for its elimination from the body. According to the same authority the lighter the alcohol, therefore, ctetcris paribus, the less injurious its action. When inhaled, its effects are developed iii four distinct Btages.

First stage, there is excitement, flushing of the body, and dilatation of the pupils; after a time there follows languor, and the muscular movements become irregular.

Second stage, muscular prostration, and labored breathing, attended by deep sighing movements and rolling over Of the body.

Third stage, complete insensibility to pain, with unconsciousness to all external objects, with inability to exert any voluntary muscular power. The breathing now becomes embarrassed and blowing, with bronchial rales, due to the passage of air through fluid that has accumulated in the finer bronchial passages. The heart and lungs, however, even in this stage, retain their functions, ami therefore recovery will take place if the conditions for it be favorable.

ALCOHOL AS A LOCAL ANAESTHETIC. -1

Also, if the body be touched or irritated in parts, there will be a response of motion, not from any knowledge or consciousness, but from reflex action. During all these stages there is no violent convulsive action, but, step by step, a reduction of temperature, so at last the loss of heat will become dangerous, for the cool body cannot throw off the water freely, and therefore fluid collects in the lungs and there is a risk of suffocation, as from drowning. If the administration of the methylic spirit be continued when the third degree has been reached, there is a last stage, which is that of death. The two remaining nervous centres which feed the heart and respiration cease simultaneously to act, and all motion is over. If, however, after the third stage of insensibility the administration of methylic spirit be stopped, recovery from the insensibility and prostration will invariably take place on one condition, that the body be kept warm for seven hours.*

There is but little doubt that this sudden reduction of temperature is one cause of death after the administration of ether and chloroform. The patient is apparently all right, and is transferred to the ward from the warm operating room ; no special means are employed to keep up the temperature, and gradually the patient sinks into an unconscious state, from the fluid which collects, and dies from congestion of the lungs, the result of neglect.

A memoir recently presented to the French Academy states that injurious effects are often produced by the continued inhalation of vapor of methyl alcohol ; for example, on workmen who are using it.

ALCOHOL AS A LOCAL ANESTHETIC.

In the use of snow or ice there is more or less pain in the part until it is frozen. By substituting cold alcohol the parts can be immersed in it for a long time, so as to deprive them of ordinary sensibility; and, although the faintest touch can be perceived, cutting or pricking them can be well borne.

*On Alcohol. A course of six Canton Lectures, delivered before the Society of Arts (London, 187.3, by Ben.j. W. Richardson, M. A., M. D., F. R. S.).

22 ARTIFICIAL AN-KsTHESIA.

Alexis Horvath, of Kieff,* states:—

" Knowing the painful sensation experienced by immersion of the hand in water at a temperature of 0. C, I was much astonished to not experience the same sensation with

the hand in alcohol, the temperature of which had been reduced to —5° C

"The discovery of this curious fact, which was made by in.- a- early as 1869, led me to undertake some experiments, <>f which I give briefly the results.