»» ><•- k--' $ *»»• mm i MWIMillMI«iWI MMMMMIIIiMMWMCKMMMMI nrni iiimnii |inlr» ii iBiWii. ii ni. i MMIWiMWWMIIMpi j... ,..,;. ....J .J..Jl-^^^«^J.;J^^^iJ»^M«^ II 1 1 J jYo./.f Vol.- 1882. I f MEDICAL LIBRARY OF I I A, E, Calkins, M, D, I^ ^ J3rMy owner never lends mCtsSJ r]in|<n'ji|g[itTii]|jit -mjir-JHiic ihijp -J SF"-i'lilF 'WWW^'V Ifilf YALE MEDICAL LIBRARY HISTORICAL LIBRARY The Harvey Cushing Fund ARTIFICIAL ANESTHESIA ANAESTHETICS HEDICTI, BY HENPtY M. LYMAN, A.M., M.D., Professor of Physioloffy and oi Diseases of thft Nervous System, in Rush Medical College, Chicago, III., and Professor of Theory and Practice of Medicine, in The Woman's Medical College, Chicago, III. / NEW YORK WILLIAM WOOD & COMPANY 27 Geeat Jones Street 1881 COPTRIOHT WILLIAM WOOD &, COMPANY ISbl Trow's Printing and Bookbinding Company 2oi-2i]i East iith Street New York PREFACE. Into the following pages I have endeavored to distil all the excel- lences of the wi-iters who have investigated the subject of Artificial Anaesthesia. The practised expert will, therefore, everywhere recog- nize the quality of Perrin, of Snow, of Simpson, of Sansom, of An- stie, of Turnhull, of Kappeler, and of Kottenstein. To this fine ether- eal essence I would fain have added something of substantial value, but the unyielding limits of the time within which my endeavors were necessarily restricted would permit no such gratification. For the consequent inequality and insufficiency of a work performed without access to any library of importance, I must ask the forbearance of a generous profession. To my eminent colleague, Moses Gunn, Professor of Surgery in Eush Medical College, to the members of tlie surgical staff of the Cook County Hospital, and to my laboratory assistant, Mr. Edward P. Davis, my thanks are due for much practical assistance in the pro- secution of these studies. HENHY M. LYINIAN. Chicago, III., May 10, 1881. CONTENTS, PAGE History op Anesthesia 1 Phenomena of Anesthesia 8 Physiology op Anesthesia 14 Administration op Anesthetics 39 Method op Producing Anesthesia 34 Ether-Inhalers 39 Nitrous Oxide Inhalers 43 Accidents op Anesthesia 44 Treatment op the Accidents op Anesthesia 51 Anesthetic Mixtures Gl Artificial Anesthesia in Obstetrical Practice 68 Anesthesia in Dentistry 73 Local Anesthesia 74 Mortality op Artificial Anesthesia 78 Medico-Legal Relations op Anesthesia 80 Anesthetic Substances 98 Methylic Chloride 100 Methylene Bichloride 101 Methylene Ether 104 Chloroform 105 Cases of Sudden Death during the Inhalation of Chloroform 136 Carbonic Tetrachloride 301 Bromoporm 203 Methylic Iodide 303 VI CONTENTS. Anesthetic Substances— ^^'^'^ Iodoform ^"^ Ethtlic Chloride ^^'^ Anjesthetic Ether, or Aran's Ether 204 Ethylenic Chlokide 205 Ethidene Dichloride ~05 Death from Inhalation of Ethidene Dichloride 207 Monochlorethylenchloride 208 METHTLCnLOROPORM 209 Ethtlic Bromide 210 Ethylic Iodide 223 BuTYLio Chloride 223 isobutylic cnloride 223 Amylene 223 Deaths caused by Inhalation of Amylene 224 Amylic Hydride 225 Amylic Chloride 225 Amylic Iodide 326 Caprylic Hydride 226 Keroselenb 226 Oil op Turpentine 227 Benzene 227 Pyrrol 228 Alcohol 228 Chemistry of Alcohol 230 Phenol 255 Chloral Hydrate 259 Physiological Action of Chloral Hydrate 200 Bdtyl Chloral Hydrate 376 Methylic Ether 277 Ether 278 Cases of Death caused by the Inhalation of Ether 289 Methylal 298 Aldehyde 298 Acetone : 299 Formic Ether 299 Acetic Ether 300 CONTENTS. VU Anesthetic Substances—Continued. page NiTRODS Ether 300 Nitric Ether 301 Amylic Nitrite 301 Nitrogen 307 Nitrous Oxide 308 Death from Inhalation of Nitrous Oxide Gas 323 Carbonic Oxide 324 Carbonic Acid Gas 326 Carbonic Disulphide 327 Puff-Ball 328 Anesthesia by Rapid Respiration 329 Anesthesia by Electricity 330 Index 331 AETIFIOIAL ANESTHESIA ANAESTHETICS. HISTORY OF ANESTHESIA. From the earliest ages of antiquity man lias continually sought for the means of relief from paiu. The most ancient record of the race introduces the hero of the flood plunged in a deep and scandalous sleeij, under the influence of wine which he had prepared. At the siege of Troy the Grecian sui'geons were skilled in the art of assuaging the pains of injui-ed men by the application of alcohol and carbonic acid to their wounds. Thus the venerable Nestor came to the relief of the wounded Machaon with a medi- cated poultice composed of cheese, onions, and meal, mixed with the wine of Pramnos. Other agents, still more potent, were known to the wise men and women of Egypt, and by them were transmitted to their friends in other lands. Some preparation of opium or of Indian hemj), it may have been, with which, after the ten years' siege was ended, beautiful Helen, once more in her lawful home, coming " out of the sweet-smelling, lofty- roofed chamber," drove away sad memories from the minds of her husband and his friends, by making them drink of wine into which she cast a drag chosen from the "cunning and excellent" stock presented to her by the Egyptian princess Polj'damna. Most potent drug this same nepenthe must have been, for we are told (Odyss., iv. 220 et seq.), that it delivered men fi'om grief and wrath, and caused oblivion of everj' ill. It is said (Gasp. Hoffmann : De Thorace, lib. ii., cap. xxix., Francof., 1627, in fol., p. 77) that among the ancient Assyrians the pain of cu-cum- cision was prevented by compression of the veins in the neck during the time of operation. This was doubtless an ancient discovery of the j^ossi- bility of producing temporary unconsciousness by pressure upon the caro- tid arteries and pneumogastric nerves, to which attention has been again directed in modern times. The Ghinese, also, in those remote ages, had learned the anaesthetic properties of an urticaceous plant which was probably related to the In- dian hemp, if it was not that plant itself. They used the drug for the 2>ur- pose of blunting the sensibility of patients who were subjected to the oper- ation of acupuncture. 2 ARTIFICIAL ANESTHESIA AND ANAESTHETICS. Throughout the East, from time immemorial, the virtues of opium aud of Indian hemp have been known. The fertile plains of India then nur- tured the soporiferous popi^y—jjerhaps less abundantly than they do under bhaiir/ everywhere the stimulus of British rule ; aud the praises of were whisi^ered among the neoj^hytes in the mystic crew of astrologers, sooth- sayers, poets, and story-tellers who fiUed so largo a place in oriental life. Among the Egyptians the stupefying effects of carbonic acid gas were probably known. Pliny and Dioscorides describe a mineral brought from Memphis, wliich, when i^ulverized and moistened with sour wine, jsossessed the power of rendering insensible of pain those wounded parts of the body to which the mixture was ajsj^lied. Could this have been a calcareous car- bonate, some kind of marble, which thus yielded carl)onic acid gas when moistened with an acid ? But, of all the drugs that were knowTi as anfesthetics by the ancients, mandragora seems to have kept the first place. Apuleius aud Dioscorides particularly mention its power to j^'oduce insensibility and a loss of con- sciousness lasting for several hours. It was used for this purpose by the sm-geons who flourished at the commencement of the Christian era, and its reputation continued until comjsaratively modern times. For antesthetic use mandragora was infused in wine, and the liquor thus isreijared was known to the Greeks b}- the name of morion. AjDuleius states that half an ounce of this preparation would render a person insensible even to the pain of an amj^utation. Dioscorides taught that the sleep thus produced might continue four liom-s or more ; hence, no doubt, various legends which were by Shakespeare woven into the network of the story of Juliet. The "wine mingled with myrrh " (Mark xv. 23) which was offered, according to the custom of the kind-hearted Jewish women of that day, to Jesus on the cross, but which he refused to drink, was unquestionably this same man- dragora wine ; for it was a common i^ractice with j)itying souls to fiu-nish this pain-defying drug to those who were were about to suffer the horrors of crucifi-xion. The earliest reference to antesthesia by inhalation is contained in the •works of Herodotus, who relates that the Scythians were accustomed to produce intoxication by inhaling the vapors of a certain kind of hemp. This was probably something closely aUied to bhang or hasheetth. The Scythian practice may have been the origin of the method of anjesthetic inhalation which was in vogue with Theodoric, a celebrated surgeon of the school of Bologna, who was at the height of his reputation when Dante was writing the Liferno. The ItaUau siu-geou taught the ancient art—trans- mitted from generation to generation, and by him learned from Huoo de Lucca— of preparing a soporific inhalant for the use of patients who%vere about to undergo operation. The method consisted in causing the patient to breathe the vapors that were given ofl' from a sponge moistened with warm water, after it had been thoroughly steeped in a decoction of opium, deadly nightshade, hyoscyamus, mandragora, hemlock, ivy, and lettuce! Sponges thus medicated were to be dried in the sunshine, 'and stored for use as occasion might require. After the conclusion of an operation the patient was aroused by inhalations of vinegar apphed with a fresh sponge to the nostrils. If this expedient failed, the juices of rue might be poured into the ears of the too somnolent victim. Traces of this last mode of medi- cation may be found in the play of Hamlet. The heroic use of these powerful narcotics graduallv diminished as the superstitions of the middle ages aud the arts of the sorcerer fell into dis- repute after the days of the lieformation of the Church in Germany.