Report on the action of anaesthetics to the Scientific Grants Committee of the British Medical Association / by a committee consisting of John G. McKendrick, Joseph Coats, David Newman.

Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Report on the action of anaesthetics to the Scientific Grants Committee of the British Medical Association / by a committee consisting of John G. McKendrick, Joseph Coats, David Newman. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    that there was «(7 change in the condition of|the conjunctiva. SI. signifies slight; and N., with a figure before it, shows the length of time the vomit- ing or sickness lasted, h. bein^ a contraction for hour. N., in columns viii and IX, mean no vomiting or sickness occurred. In the columns showing the appearance of surfaces, G. signifies that the colour was goad; P., that it was />ate; W., that the skin was ; C.,cold; M,, moist ; andX).,dry; I,, that the conjunctiva was injected. In Table i, the observations, as recorded in the ethidene schedules, are inserted so as to show at a glance the history of each case, and, at the same time, in such a form as to facilitate the comparison, not only of individual cases, but also the general results of our investigations. It will be observed that, at the foot of the first four columns, figures are given showing the average time in minutes required to put the patient under the anxsthetic; time under the anesthetic; time occupied in recovery ; and the average dose in cubic centimitres. The same plan is adopted in Table il. Let us first contrast these results. It may be here stated that, before making up these tables, our general impressions as to the comparative results were somewhat different from what is sho^vn in the figures before us.. The average dose of ethidene may be stated as 40.3 c. c.; or, in other words, 1.8 c.c. for each minute during which the patient is under the ansesthetic; whereas, in the case of chloroform, the average dose is 31.8 c. c., or 1.7 c. c. for each minute.* It will be further seen, that the time required to put the patient under chloroform is greater by i.i minute (5.4—4.3) than what is neces- sary to anjesthetise with ethidene. In connection with these observa- tions, there are several points which must be taken into consideration. First, owing to the average time during which the chloroform patients were under the ancesthetic being less (18 m.) as compared with those who had ethidene (22.3), the dose per minute (1.7 c. c.) is proportion- ately increased in the case of chloroform ; for it is during the first few minutes that the greater quantity of the entire dose is administered. WTien the patient is once under the anaesthetic, a comparatively small quantity is required to keep him under. The same cause may also account for the difference in the time necessary for recovery from the effects of the agents. In chloroform, the average time required is 4.8, with ethidene 4.4, minutes. The chloroform average is considerably augmented by the figures given in Cases i, 3, 5, and 6; in all of which the time occupied was more than twice, and in one case (No. 15) more than three times, the average. Deducting these five cases, the average will be found to be 4. i in the place of 4.4 minutes. There are only three cases in which the time necessary for recovery from ethidene was more than double the average (Nos. 9, 18, and 21). In two cases in which ethidene was employed, sickness during the oper- ation is recorded. In Case No. 2, it is accounted for by the fact that the patient, shortly before the operation, had taken a glass of milk. (The usual practice in the Western Infirmaiqi is to allow the patients to have a cup of beef-tea five or six hours before the operation, but nothing after that time.) The sickness in the other case (No. 40) occurred as the patient was recovering from the anesthetic. In twenty-four cases, sickness is recorded as occurring within twenty-four hours after the operation, in fifteen of which it was associated with more or less vomit- ing. In most of the cases, the vomiting was slight; in three cases * The method we adopted for administering the aniesthetic (on a towel) prevents ns from arriving at a conclusion as to the actual amount of antesthetic vapour which entered the patient’s lungs ; the results in respect to the doses given are, therefore, only comparative.