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"A few months after the birth of Sydney Smith's daughter, he went in the summer for a short time to Burntisland, a small sea-bathing place at no great dis- tance from Edinburgh, for the recovery of his wife's health ; and here but for his courage and firmness, he would have lost his long-wished-for daughter in a way he had not at all anticipated. When only six months old she fell sick of croup with such fearful violence that it defied all the remedies employed by the best medical men there. The danger increased with every hour. Dr. Hamilton, then one of the most eminent medical men in Edinburgh, was sent for, could not come, but said, ' Per- severe in giving two grains of calomel every hour ; I never knew it to fail.' It was given for eleven hours ; the child grew worse and worse ; the medical man in attendance then said : ' I dare give no more ; I can do no more ; the child must die : but at this age I would not venture to give more to my own child.' ' You,' said Sydney Smith, ' can do no more ; Dr. Hamilton says to us, "Persevere;" I will take the responsibility, I will give it to her myself.' " Mesterolone Online He gave it and the child was saved. To anyone caring to see the brochure of Dr. Reiter, which is little known of, and is so peculiar in its style as to entitle it to be considered an oddity in medical literature, I will say that it was published by J. B. Lip- pincott & Co., in 1878, and it is entitled "A Mono- graph on the Treatment of Diphtheria based upon a New Etiology and Pathology," by William C. Reiter, A.M., M.D. The matter of detailing cases from my case-books, which will supply several hundred cases treated by calo- mel, with the usual symptoms and repetition of treatment, I do not deem altogether necessary here, but I shall re- peat here some rules which I gave in my essay for the use of the practitioner : 1. Give calomel untriturated and unmixed with sugar, in doses of two to five grains, to a child from two to five years old, every two hours, either dry on the tongue or floated on a teaspoonful of water, until you procure the peculiar chopped spinach-colored stools, i.e., stools look- ing much like the water polyps one sees floating in an old-country roadside watering-trough. 2. When these stools are procured, then increase the interval but don't diminish the dose. Continue to se- cure two stools daily, at least. 3. Give little, if any other medicine. 4. Give light nutritious diet. The treatment is so simple and easily followed, both by practitioner, nurse, and patient, and the results are so far superior to any other I have tried, that I again recom- mend a trial of it to the profession with confidence. W. H. Dalv, M.D. ' A Memoir of Sydney Smith, edited by Mrs. Austin, voL i., p. 63. Harper Brothers, 1855. SOME REMARKS ON THE ADMINISTRATION OF ANAESTHETICS, With a Description of a New An/esthetizer. By a. M. ADSIT, M.D., HASTINGS, MINN. For years I have been convinced that the methods in vogue for the administration of anaesthetics are not only faulty but in many cases extremely dangerous. Physicians seem to forget that neither chloroform, ether, nor any other anesthetic can be substituted for air. The most frequent method of administering ether is by saturating a towel, covered with a cone of paper. This device is held tightly down over the face, almost wholly excluding the air. The patient is compelled to breathe the vapor but slightly diluted. Administered in this way it acts as an irritant to the mucous membrane, and the initial effect is the arrest of inspiration. A study of those cases in which death is reported to have been caused by the administration of ether, demon- strates that a majority die during the initial stage of an- festhesia, or at least exhibit marked signs of disturbed respiration resembling asphyxia. The symptoms usually given as arising from the ad- ministration of ether, during the first stage, are the fol- lowing : The face becomes flushed, red, or slightly livid. The veins become distended, and the arterial pulsation in the temples more pronounced. The pulse becomes full and quick. The respiration is increased in frequency, is sometimes catching and shallow, and sometimes scarcely perceptible, ceasing for considerable intervals. Coughing is excited by the local stimulating effect, and there is an increase in the quantity of mucus. These symptoms teach two things : first, that ether strikes its first blow at the respiratory centres ; second, that the vapor has not been given sufficiently diluted with air. It is generally admitted that death from ether, as a rule, is due to direct paralysis of the respiratory centres. I do not doubt that the respiratory centres are affected by the ether ; but I believe that the paralysis has a greater cause in the limited supply of air and in the hasty initial administration. I believe that the greatest danger in the inhalation of ether lies in this initial disturbance of in- spiration, preventing the proper aeration of the blood, and, as a result, we have the flushed face, the distended veins, the coughing, the jerky, catching inspiration, the increased flow of mucus, and the wild struggle for liberty. To avoid these bad effects two rules must be observed ; first, begin the administration with air lightly charged with ether ; second, always permit all the air necessary to sustain life comfortably. By this I mean as much as the patient would require were he engaged in his usual pur- suits There is no good reason why a patient does not require as much air while taking an anaesthetic as at any other time. If you think that they secure the needed supply of air, place a cone over your own face and permit some one to hold it down tightly for five minutes. I think you will experience difficulty in inspiration, have a sensation of suffocation, and the Buy Mesterolone people about you will observe that your face is flushed, the veins distended, and that your complexion is a shade darker than usual. I think that it is generally taught that in order to pro- duce ancEsthesia with ether you must exclude the air, or at least only admit sufficient to produce evaporation. This doctrine is founded upon a false principle. All sub- stances, chemicals, or mixtures that will not produce an- esthesia when diluted with air are not anaesthetics proper, but rather asphyxiating agents. Chloroform and ether are the most perfect anaesthetics we possess, both being capable of producing anesthesia quickly when inhaled with an abundance of air. After anesthesia is obtained, then the all-important point is 574 MEDICAL RECORD. [October 28, 1893 simply to maintain the anaesthetic condition. This can be accomplished by adding only a sufficient quantity of the stupefying vapor to accurately balance or replace the amount being constantly eUminated. Elimination takes place quite slowly ; hence but a small quantity should be given each minute and at regular intervals. At this stage the greatest danger lies in the over- saturation of the tissues. How often at this period we see the physician add one, or even two, drachms of ether, or twenty to sixty drops of chloroform to an inhaling or evaporating apparatus, and as often observe the inspirations nearly cease, requir- ing the instant removal of the anx-sthetic for the purpose of giving the patient a few inspirations of pure air. It is this careless method of administration which causes Mesterolone Tablets the tissues to become over-saturated and paralyzes the nerve centres, when, in reality, at this stage all danger should have been past. In the administration of ether not more than fifteen drops should be used the first minute, or the equivalent of one drop to each inspiration. Of chloroform, not more than four drops should be given the first minute, and the quantity given at any one time ought not to ex- ceed fifteen drops. We need not fear prolonging the stage of excitement. This stage is more frequently caused from the sensation and belief, on the part of the patient, that suffocation is imminent, than from the di- rect effect of the anresthetic. After the first fifteen drops of ether have been inhaled the patient will have become accustomed to the vapor, and all fear of impending danger removed from his mind. Now, we can gradually increase the quantity to from thirty to sixty drops per minute, or, if we are using chlo- roform, from five to fifteen drops. As soon as anajsthe- sia is obtained, the quantity should be reduced to about fifteen drops of ether, or four of chloroform, which will quite accurately represent the elimination. In order to properly observe the above instructions a specially constructed apparatus is imperative. The essen- tials of such an inhaler are : ist. An opening admitting sufficient air to enable the patient to breathe comfortably, and the air should pass down through the vapor so as to be thoroughly mixed with it. 2d. A reservoir large enough to hold a sufficient quan- tity of the anesthetic to maintain anaesthesia from one to three hours. 3d. An apparatus regulating or controlling the flow of the anaesthetic. 4th. It should be constructed so as to prevent evapo- ration into the room, for in the inhalation of ether the vapor is not only a source of annoyance to the surgeon and his associates, but, in some cases, even dangerous from its inflammability. 5th. It should have a large evaporatirig surface, so as to evaporate the anaesthetic (luickly and thoroughly as it falls from the reservoir, for it is only in this way that the quantity used can approximately represent the amount inhaled Generic Mesterolone by the patient each minute. 6th. To obviate the necessity of the patient exhaling through the instrument, and thereby forcing the vapor into the room, the inhaler should have an opening ad- mitting the vaporized air, and another to carry off the expired air. These openings should be closed by valves, and the slightest breath should be sufficient to move them. Fig. I represents a section of my instrument, with shield attached. The different parts of the instrument are rep- resented by letters, and are thus explained : A represents a screw valve passing down through the reservoir C into the funnel D. By this device the flow of the anaesthetic is controlled. B indicates the opening through which the reservoir is filled. E represents a space for carrying the shield A' when not in use. F represents openings through which a full supply of air, charged with the anesthetic, passes down for inhalation by the patient. G and /represent valves. These valves are held in place by steel springs. The springs are so constructed and arranged as to evenly balance or neu- tralize the weight of the valves. By this device the valves are moved by the slightest breath, for the resistance of gravity and friction are entirely overcome. H and / represent openings through which the patient e.xhales. Fig. 2 represents one of the perforated plates and thin blotting- pads, by which we secure a large evaporating sur- face.

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