Anesthetic

“ The choice of the anesthetic is of great importance as to the outcome of the operation. The Basedow’s type with predominating nervous, myasthenic and psychic symptoms is best operated on under general anesthesia, the other cases under local anesthesia. 5. Operation is contraindicated in status lymphaticus; if it can not be avoided, a local anesthetic should be employed. 6. In many cases the operation only lays the foundation for successful internal treatment. 7. The most unfavorable time for operation is that of increasing intensity of the disease ”

“ I know an American physician who has an almost similar power over negroes. Ordinarily it requires more of an anesthetic to produce insensitiveness to pain in the negro than in a white person. By personal assurance, by the absolute securing of their confidence, and through their trust in him, this man is able to produce anesthesia without the use of more than a minimum quantity of the anesthetic. ”

“ As to the wisdom of giving an anesthetic when labor is progressing in a normal and satisfactory manner, there is a difference of opinion. Much depends upon the disposition of the patient and the viewpoint of the physician in charge of the case. It is a fact that a large number of confinements are easy and are admitted to be so, by the patients themselves, and in which it would be medically wrong to give an anesthetic. In a normal confinement, however, when the pains are particularly severe and the progress slow, there is no medical reason why an anesthetic could not be given to ease the pain. ”

“ In some cases where there has been great fear of the anesthetic which has been talked over beforehand by the patient, even a few whiffs of the ether or chloroform have given rise to serious symptoms from stoppage of the heart. It is evident that it is extremely important properly to predispose such patients. ”

“ The breathing becomes normal and unrestrained as soon as the surgeon desists from these vigorous manipulations.
Crowding Probably the most common of mistakes is crowding the anesthetic. The anesthetist becomes aware of faint, high pitched notes in the breathing—the beginning of obstructed 14respiration. He examines the lid and corneal reflex and these convince him that the patient is in the state of superficial anesthesia. Naturally, he gives more of the anesthetic. To his great chagrin the breathing becomes progressively more stertorous. ”

“ Anesthesia is love-blindness. Love is pictured blind because he does not see defects. The worst blindness of love is its not seeing beauties. Most husbands’ love is blind. This is the anesthesia meant. When one is given surgically an anesthetic it is to make one insensible to pain. Love anesthesia is the insensibility to the love emotions which are stirred in every man by every woman. ”

“ Like scientific progress in many other directions, the use of anesthetics has had a long history, and we must speak of various advances rather than of a single discovery. The anesthetic effects of nepenthe, mandragora and hemp were known in antiquity, and it is said that surgical operations under them were performed in the time of Pliny, in China and in the middle ages. Sir Humphry Davy in 1800 announced the discovery of the anesthetic properties of nitrous oxide, and wrote, "it may probably be used with advantage in surgical operations." ”

“ Young women who remain anesthetic during the first cohabitation not seldom merge into an anxiety neurosis which disappears after the anesthesia is displaced by the normal sensation. As most young women remain undisturbed through such a beginning anesthesia, the production of this fear requires determinants which I will mention ”

“ Assuming that no unfavorable effect is produced by the anesthetic and that there is no hemorrhage, the cells of the brain cannot be exhausted in the course of a surgical operation except by fear or by trauma, or by both. Fear may be excluded by narcotics and special management until the patient is rendered unconscious by inhalation anesthesia. ”

“ Sometimes a remarkable calm, a period of relative apnea, precedes the stage of excitement. At other times, this stage ushers the patient directly into the state of complete anesthesia. There need be no stage of excitement at all. This is especially true if morphine has been administered hypodermatically before narcosis, and if the induction of the anesthetic is cautious and gradual. ”

“ The anesthetist is absolute master of the situation. Although the patient’s face turns somewhat blue during the vomiting efforts, the anesthetist should not attempt to push the jaw forward or exert traction on the tongue. The face is merely turned to the side and kept in position by placing the hand on the cheek. The mouth and pharynx are cleansed gently with a piece of gauze and the anesthetic is continued, drop by drop. It is often surprising in such cases how rapidly the patient can be brought back into the proper plane of anesthesia. There need be no fear that the patient will fully awake. ”

“ It is to be remembered that in a majority of these cases the operation is undertaken to remedy a deformity, however caused, one that is not necessarily serious to health, and it would indeed be unwise to place such a [59] body in jeopardy or to take undue chances if they can be avoided. Ofttimes several operations, a few weeks apart, must be done and the frequent repetition of a general anesthetic might impair the health of the patient—a condition not associated with local anesthesia. ”

“ He went to the hospital, and the anesthetist began to prepare him for the anesthesia. He told them that he wanted no anesthesia, as he was going to have the operation done without taking anything. The surgeon was loath to operate without some kind of general or local anesthetic, but he told him he wanted nothing, as he thought he could control himself. The surgeon consented, but had ready chloroform and a hypodermic with cocaine. The Doctor clinched his teeth and hands with all his might, and put himself into as powerful a tension as possible for about three minutes before lying on the table. ”

“ Anesthesia is necessary where absolute immobility of the patient is essential and where entire muscular relaxation is indispensable. The anesthetic condition is also favorable for the adjustment of displaced organs. ”

“ My experiments and researches, during many months, have conducted me to this practical result, which is worthy of all attention. Whenever an acute pain exists in any part of the animal economy, whether the pain constitute the malady in itself or be only an integral and principal part of it, the physician can relieve the patient of it for a longer or shorter time, by one or various local anesthetic applications. ”

“ It seems a little childish to suggest similar procedures with grown patients, but even surgeons of long experience with the older methods who have insisted on the trial being made on their patients have found much benefit from it. Familiarity with the anesthetist and even with the inhaler {757} and the breathing through it on several occasions beforehand, when no anesthetic is being administered, helps many patients not a little. ”

“ Under ether anesthesia the damage to the nerve-cells is at least four times greater than under nitrous oxid. Inhalation anesthesia is, therefore, but a veneer— a mask that "covers the deep suffering of the patient." The cause of the exhaustion of the brain is the discharge of nervous energy in a futile effort to energize the paralyzed muscles in an attempt to escape from the injury just as if no anesthetic had been given. ”

“ Not only is it desirable in the minor surgical operations and the more important ones upon patients suffering with a cardiac or nephritic derangement, where a general anesthetic is positively contraindicated, but in every instance where it is at all possible, the dangers and annoyances of general anesthesia should be avoided, and the regional or local anesthesia should be employed. ”

“ Among the advantages, aside from the number of assistants required and the discomfort immediately following the administration of a general anesthesia, are the absence of remote ill effects of the invasion throughout the entire system of a noxious chemical substance and its direct deleterious effects on many large organs such as the lungs, heart, kidneys, and liver, and the assurance, when a proper drug, dosage, and technic are employed, that death cannot be ascribed to the anesthetic. ”

“ The discoverers of anesthetics are classed among the greatest benefactors of humanity, because it is believed that ether, chloroform, cocaine and similar nerve-paralyzing agents have greatly lessened the sum of human suffering. ”

“ If nitrous oxid anesthesia and sleep are chemically identical, then we have a further clue to one of the primary mechanisms of life itself; and as a practical corollary one might be able to produce artificial sleep which would closely resemble normal sleep, but which would have this advantage, that by using an anesthetic which interferes with oxidation the brain-cells might be reconstructed after physical fatigue, after emotional strain, or after the depression of disease. ”

“ Although it has thus fallen out of use as an anesthetic in these serious cases, still it is used constantly, and more and more every day, in minor surgery. In dentistry it certainly has its place; in outpatient departments of our hospitals it is often of value, as it has no after effects. ”

“ Others clinch their teeth and hands, and double their toes up in their shoes. Why do you suppose they do this? They do these, and many other natural and apparently inevitable things, because they are instinctive and scientific, and because Nature knows her business. We have done and shall continue to do them involuntarily and automatically, because they relieve pain and nerve tension, because they produce a form of analgesia, or pain-deadening, similar to that which follows the injection of water or some anesthetic solution into a sensory nerve. ”

“ Nowhere in the domain of surgery is the influence of the mind more important than in the production of anesthesia for surgical purposes. It is well known that intense preoccupation of mind will make an individual completely anesthetic even for very severe injuries. In battle men frequently are severely wounded, yet do not know it, or at least have no idea of the extent of the wound and of the pain that ordinarily would be inflicted by it. ”

“ A number of local anesthetics have been introduced, and in some hands only comparatively small quantities of them are needed in order to produce complete absence of pain during operations. In other hands, however, considerable and even toxic quantities may have to be employed and sometimes without entire satisfaction. Infiltration anesthesia depends for its success largely on the personal influence of the administrator over the patient. It is extremely important that the patient should have complete confidence and not have that confidence disturbed in any way. ”

“ I need not tell you that this whole performance was managed with considerable eclat, and Doctor Will Mayo, probably the first surgeon of the world, was to use the knife; and in the gallery looking on were Doctor Finney, of Johns Hopkins, Doctor Billings, of Chicago, Doctor Vaughan of the Michigan University, and others. On the whole, it was what the society reporter would call a recherche affair. The local anesthetic consists of morphine and scopolamin. It is administered directly by needle to the nerves that lead to those particular parts which are to be affected by the operation. ”

“ The use of local anesthetics in the operative field prevents nerve-currents from the seat of injury from reaching the brain and there integrating the entire body for a self-defensive struggle. The result, even though a part of the brain is asleep and the muscles paralyzed, is the same as that produced by the interception of the terrifying sound of the gun, or of the sight of the dangerous reptile, since the stimulation of the motor mechanism is prevented. ”

“ Professor Richard M. Pearce, of the University of Pennsylvania, calls attention to the new era in surgery introduced by the use of anesthetics. This not only saves immeasurable suffering, but it makes possible, and comparatively safe, operations that could not be undertaken if the patient could move and struggle. Professor Pearce does not attempt to assign credit for the discovery of anesthetics, though he properly attributes its introduction to the world to the administration of ether by Dr. W. T. G. Morton, a dentist, for an operation performed by Dr. ”

“ Anesthetics, and how they had served to ameliorate pain. I could have pointed out that life itself was living on life and always had been, and that as yet no substitute for the flesh of helpless animals had been furnished man as food. ”

“ To this poor sufferer insensibility is next to heaven. For the past half century all the formidable operations of the surgeon have been performed with the aid of anæsthetics and without suffering to the patient, producing happy recoveries, and greatly contributing to the success of the result by relieving the surgeon of the distraction of the patient’s pain, and the interference of his involuntary movements. Quite a number of anæsthetics are known and used to-day. Those more generally employed are—naming them in the order of their first application—nitrous oxide gas, ether, and chloroform. ”