"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
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.,
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
With a Description of a New An/esthetizer.
By a. M. ADSIT, M.D.,
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-
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
[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
2d. A reservoir large enough to hold a sufficient quan-
tity of the anesthetic to maintain anaesthesia from one to
3d. An apparatus regulating or controlling the flow of
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
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-