In modern medicine, we take for granted the ability of doctors to use anesthesia, shielding us from the pain of surgery. It has not always been this way; a great number of experimental anesthesias were tried over the years, some with horrific results, even death. What follows is an account detailing some of the recent developments in the field, circa 1910.
The history of anesthesia is only of value in as much as it documents the development of this branch of science. 1842 gives us the first record of an operation under anesthesia by Dr. Crawford W. Long of Athens, Ga. Dr. Horace Wells, a dentist of Hartford, Conn., first brought the subject into prominence in 1844 by inhaling gas to have his tooth painlessly extracted.
Chloroform: Chloroform is less inflammable than ether, has a sweetish taste and less unpleasant odor. Chemically it is CHC12. In using chloroform Vaseline should be smeared over the face as it is liable to burn, a danger that is very remote with pure ether. The stages of anesthesia are the same as with ether, but the stage of secondary excitement is more apt to be absent or to be shorter. The time of induction is shorter but must be even more carefully brought about as most of the trouble with chloroform comes in the early stages. In administering chloroform the most important thing to watch is the pulse, second, the color; third respiration, and fourth, judge again the depth of narcosis by the eye reflexes. The corneal reflex is lost much later than with ether and anesthesia should never go beyond this state, for beginning dilatation of the pupils is much more alarming here than with ether.
Whereas with ether the pulse tends to become rapid as the anesthesia deepens, with chloroform it certainly becomes slower and is oftentimes an index to the depth. Nitrous Oxide: Nitrous oxide gas (N2O) is N and 0 in chemical union. It is supplied in steel cylinders, being liquid under high pressure.These are heavy and portable with difficulty. Gas requires elaborate apparatus for its administration. To use, fill the gas bag, set all valves so that the patient for the first few breaths takes only pure air and then rapidly switch to gas and with one or two breaths the patient is unconscious, and there is no choking. There is now strenuous breathing and muscular twitching, the conjunctiva becomes insensitive to touch and the eyeball frequently oscillates. The respiration then becomes slower and shallower and cyanosis is present. The pulse must now be watched. The narcosis can be maintained indefinitely. I have myself used this method for 45 minutes, for a difficult amputation, without ill effect. But if a gradual change to ether is simply made, the patient will remain anaesthetized. By means of the “Tetter”, a general steel (http://www.youtube.com/watch?v=wdikZ Th5Hw) apparatus, oxygen can be combined with N, 0 and an occasional whiff of ether gives relaxation sufficient in most cases for laparoscopy.
The apparatus is complicated and cumbersome; requiring at least two suitcases and the weight is extreme. Of course, N, 0 has its chief value as a preliminary to ether. Ethyl bromide is only mentioned to be condemned. Somnoform, being a secret preparation, I refuse to try it. From what others tell me it is treacherous.
Ethyl Chloride: Ethyl chloride can be used on an open mask or with a special apparatus or sprayed into the gas bag. Its value is in short operations and as a preliminary to ether. It is a cardiac depressant and during its administration the pulse must be the main guide. I gave this once for 55 minutes for a suprapubic prostatectomy with abdominal phlegmon, patient 79 years of age. It is not quite as safe, pleasant or free from the after effects such as headache and nausea as is nitrous oxide, but it is when carefully used sufficiently safe and its portability is inviting. A. C. E. and molecular solution have long been discredited. Anaesthol, first made by Dr. Weidig and introduced to the profession in 1903 was supposed to be a chemical union of 17 ethyl chloride, 36 chloroform and 47 ether. It must be administered just as is chloroform. Its dangers are the same but less in degree, for in action it is chloroform with a little ether added.
The pulse is again the most important guide in an anaesthol anesthesia. Remember when using this drug you are giving chloroform with a little cardiac stimulant added, namely, ether. Anesthesia by electricity as well as resuscitation by this means, as so interestingly demonstrated last winter by Dr. Rabinovitch is as yet in the experimental stage, and as such worthy only of passing mention.
Today anesthesia is considered very safe and very effective, but it has not always been that way.
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